25 June 2020

A fortress deep and mighty


My third bulletin for the BSH sees our country and our health service tentatively opening up. Although far from being a celebration, the lessening of pandemic-related restrictions is welcome to many. However, as we try to move on, we cannot and must not ignore the ways in which the pandemic has cruelly compounded the systemic unfairness and inequalities that already exist in our society.

Unfairness to our colleagues and patients from Black, Asian and minority ethnic groups has high relevance to the practice of medicine in all disciplines but the particular relevance to haematology was starkly highlighted by a recent independent review of practices at the Colindale site of National Health Service Blood and Transplant. This review found evidence of “unacceptable treatment of Black Asian and Minority Ethnic colleagues; poor management practices”. I think every one of us should read that report and reflect.

We also must acknowledge - but not accept - the situation that our colleagues from Black, Asian and minority ethnic groups have been more likely to have lost their lives in the pandemic. The reasons for this are manifold, but existing health inequalities and being more likely to work in public-facing roles with more exposure to the virus are among those reasons. To quote Sir Michael Marmot, Professor of Epidemiology and Public Health at UCL from a BBC article "One way of describing that is racism". Sir Michael Marmot taught me epidemiology when I was a student at UCL. I feel I still have a lot more to learn. I am ashamed of ignoring things which have been staring me in the face my whole life.

Another group of fellow citizens who particularly concern us as haematologists and human beings are those with haematological malignancies and other long-term blood conditions such as haemoglobinopathies who have been ‘shielding’. I am certain that all of the clinicians reading this will understand the genuine anguish and complex decisions that families with shielding members are having to make, as the lockdown eases. I would like to personally thank Gemma Peters the CEO of Blood Cancer UK for all her and her organisation’s work in publicly advocating for patients with blood cancer and by extension, highlighting the plight of all those who are shielding.

The past few months has made many of us feel “I am a rock, I am an island. I've built walls. A fortress deep and mighty1.” Perturbation of the protective physical and psychological barriers that we have all built up is going to come with greater challenges than keeping a bag of masks and gloves by the door and identifying a reliable source of flour. Almost every one of us has lost something from the seemingly trivial such as personal space or ready access to our workplace, to significant losses of income and freedom. And many have also lost someone – be it a relative, a friend, a respected colleague or a dear patient.

We have all been damaged in some way from this experience. Grief and mourning take their time and course very differently for each of us. Easing the lockdown may, for some people simply be a time to stop holding fast to the effort of relentless positivity and start coming to terms with what has happened whilst for others it will be a huge and pleasurable release. Let’s be patient with each other and use the time to re-evaluate how we express and support genuine respect for diversity of thought and behaviour. “It takes all sorts” was a throw-away remark frequently made by adults during my childhood (more accurately “Ee, it teks all sorts”) to describe things that other people do that we somehow didn’t approve of. I came a long way from what my own background offered me to realise that actually, it does take all sorts. I promise to ensure that, on my watch, the BSH also remains on the same trajectory - to truly value and cherish the diversity of ethnic origin, social background, thought and action that has long characterised our haematology workforce.


“I Am A Rock” Simon, P. 1965 CBS Records