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SoWhoCaresAnyway E21 Would you like to put that wheelbarrow down? · SoWhoCaresAnyway

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Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
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My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
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What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
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I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups, and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
Hello and welcome to the next episode of So Who Cares.
Anyway, and today I am delighted to be joined by Barbara Stillwell, who I met recently when I joined a global nursing event, which I'll let Barbara talk about a little bit more in a moment.
But Barbara is a nurse.
She's also a researcher and well known in the nursing and academic world and has authored quite a number of books, and it was one of those books that Barbara was talking about when I joined the event probably about a month ago now.
I'm just gonna pass safe to you, Barbara, and ask if you would introduce yourself a bit further, please.
Yes, thanks Ruth, and thank you so much for inviting me.
It's a real thrill to be able to be here and chat to you.
So yes, I think I'm all the things you mentioned over a long career, um, I'm very old now, so I'm finding it difficult to, to recall sometimes all the things that have gone into my career, but of course I remember.
The most wonderful people, mentors, people who've helped show the way, and that's something I think we should all be grateful for.
And I think the event you were talking about was young nurses, so it's something that's very dear to my heart.
So yes, I started as a young nurse.
I became a health visitor, and I then went into, actually, I went back to work in a hospital in intensive care.
For a while, and it was looking at the, I suppose you'd call it, the tension between being a health visitor, somebody in the community, and being in an intensive care in the hospital, which is really clinically interesting.
That got me looking at the role of the nurse practitioner.
And so I looked at how we might make that work in the UK and set up a project in Birmingham in the inner city.
Where I worked as a nurse with an extended role with a GP supervising me, and it was a fascinating project because there were a lot of women there from the Indian subcontinent who had moved there, many of them very isolated, just at home with their kids, and so my waiting room was absolutely full every day.
Of people who really wanted information, so they weren't coming in because they were desperately ill, but they really wanted information.
So I ended up writing that up and having it published in a journal.
And amazingly, and this is why I was saying how important it is to be mentored, somebody called Peggy Nuttall, who was yet an editor.
A nurse, she saw the journal article and she rang me up and she said to me she had a scholarship in her gift and she would like to give it to me to go to America to study on a nurse practitioner program.
Can you imagine? I've got two small kids.
I'm standing in my living room holding the phone thinking, what? Now? What am I gonna do? So I've ended up doing that.
I went to the USA and I have to say it completely changed my career.
Because I was studying on a master's program and at that time in the UK it was really unusual to have a nurse studying on a nursing master's program.
So I studied on that program and when I eventually came back to England, I, for some bizarre reason, best known to myself, I went to the Department of General Practice in Birmingham University.
Of course, they would be the last people who might be interested in having a nurse practitioner.
But to their credit, and because again, there was a person there, Robin Hull, who was the deputy head of that department, he'd just come back from the same university that I had been in in America.
And so he'd worked with nurse practitioners and when I went and pitched this idea to them, the prof that I spoke to said, oh, I think Robin knows about that.
And he called in this guy and Robin said, we should definitely do this.
Definitely.
And so began the journey of the nurse practitioner with me in the lead.
One may say completely by chance because doors opened.
I went through them, you, and it just shows really what I'm saying to listeners is you never know.
Go through that door.
You never know what might happen.
So I did that.
Then became a researcher because we needed to research what was going on.
I got very interested in research, particularly in.
The lived experience of people coming to consult me, and we did a big study on that, which was published, and then I got a call from the Royal College of Nursing and they were very interested in the role of the nurse practitioner because it had a lot of publicity and some controversy.
So they became very interested in exploring that with me, and I think they were slightly anxious that what I was saying was we needed many doctors, wasn't what I was saying at all.
And then that became very clear.
And so they said, would I be willing to go and create a course and put that on at the RCN, which I did.
And we had 11 wonderful students on the first program.
We had 35 on the second and 70 plus on the third, and by then we'd franchise the course.
So the rest was history really.
They were these wonderful people who came on These courses have carried on that amazing.
And I do think it is an amazing role.
I mean, not talk about myself, but I think the role offers so much in primary care.
That was the whole nurse practitioner thing, for which I'm known in this country.
But then I was actually asked to go and join the World Health Organization because I'd been doing some work with them with the RCN.
And again, the door opened.
I went, I went for six weeks and I stayed for 10 years.
And then I was headhunted by an international organization in the USA, and by then I was kind of using my nursing skills.
In fragile states and conflict affected areas.
So I'd become a bit of a specialist in that, and that's what I did in my next gig, which was based a USA based organization.
But I lived in several places, including Palestine, actually.
So that is really my history.
I've written five books, I think, along the way, the latest of which is the one you heard, Ruth.
So yes, I think I'm all the things you said.
Thank you, Barbara.
That's an absolutely fascinating history and the fact that you talk about that door opening, but the first door open because you've done something and I'm always of that mantra, if you do nothing, nothing happens, but actually you've done something and that caused that first door to open, and as you said, you then chose to go through it and it's led to so much for you.
This sounds like an absolutely fascinating journey and career, but having gone through the advanced nurse practitioner program myself.
I know just how much that's changed and having been an advanced practice lead across the system.
I know how much that's changing still and how much that landscape still continues.
I think one of the things that really resonated with me there was when you were talking about mini doctors and so often people get mistaken that that's what people are doing and there is, this whole thing isn't a push towards a medical model, but actually as we start to move forward, we realize that there's so much else that we can do for people in so many different ways.
What an absolutely fascinating history.
So I wonder if you'd tell me a little bit more about what was your drive, what was your driving force behind all of this for the nurse practitioner program, my driving force was truly that I believed it had something to offer to the people who were coming in to general practice.
It was a time when there was a lot of concern because gps were very busy.
And they could only give six minutes at the most to a patient.
And in fact, there was a book written by a guy called Michael Bain called Six Minutes for the Patient.
And that really was my inspiration.
I read it and I thought there has to be another way because one of the things you realize if you work in general practice, and I'm not sure if you have Ruth, but in the community in general, I think is there are a lot of worried, well people when you see them.
They'd say, I've had this pain in my arm for for six weeks.
I'm really worried about what it is.
And when you actually go into it, you find they're dealing with loads of dreadful things or they've taken up weightlifting or there's some cause that you can put your finger on and that can really make a huge difference to that person because what they're worried about it, it's not that they actually have some terrible pathology.
And of course you have to be able.
To rule that out, but it's the worry I think that sends people often into a spiral and being able to sit with them and hear what they're worried about.
So, you know, for example, I had a guy come in to see me many years ago in general practice.
He was in his twenties and he had chest pain and he'd come in, uh, at the end of surgery because he was so worried about this chest pain.
The receptionist has said to me, oh, he's just come in no appointment, will you see him? So he came in to see me, and I mean, looking at him right away, he looked completely healthy.
He wasn't pale and sweaty or there was nothing that would make you imagine something was going on.
But I obviously looked at all his physical parameters and did an EC, G.
Everything was completely normal.
So I sat with him and I said.
Do you think there's something you know that's on your mind that may be causing you to sort of think about this pain? And he said, well, my father died six weeks ago of a heart attack, and I'm worried I'm going to get one as well, which was so interesting.
And I said, okay, so how are you dealing with that? How are you coping with that? And he said, well, I'm not really at the moment because my sister's come to stay with her baby.
Yeah.
So I said, oh, so you know, do you have a lot of room at home? No.
He said, I live in a one bedroom flat and she's got the bedroom with the baby, and I'm sleeping on the sofa and the baby's crying and I'm not really getting over my dad.
And there we had it, you know, there was the picture.
But I spent probably 40 minutes with him and I was able to say to him, look, do you think it's a chance that maybe all the stress you're feeling, plus your dad.
Could be influencing this.
And he said, you know, I think you're right.
He said, and having talked to you about it, I feel so much better.
And uh, he went and the receptionist called me up and she said, I dunno what you said to him, but it was a miracle cure.
She said, it's completely better.
And of course, it was nothing to do with me.
It was the fact that I gave him a chance to explore what was going on in his life and I could do the physical exam and to me.
That is the great benefit of having a nurse who can do the physical exam because you can actually rule out, you know, the physical, the dangerous physical stuff that needs immediate attention.
You can look at that and then having managed that, you can then move on to why that person's worried.
And that drove me in my nurse practitioner role because I realized so many people.
I used to say, it's like you go into the practice with a wheelbarrow, and in the wheelbarrow it's a big fat pulsating lump and you take it in and the doctor says, oh wow, that lump looks interesting.
Look, can I have a little poke around? And the nurse says, could you put down that wheelbarrow now have a rest.
Come and tell me what it's like pushing that wheelbarrow around.
And that's the analogy I used to use when I was teaching because.
That's what I think so many people want to want to have in general practice.
That's fascinating.
And to answer your question, Barbara, yes, I've worked in general practice as a practice nurse, and that's where I've done my advanced nurse practitioner training.
Um, and then later on I went on to help to develop the training hubs.
So they're the people that.
Develop the education for primary care really.
So thinking about who we need.
So of course all these new roles.
So we haven't just got nurses working at this level.
Now we've got paramedics, pharmacists and everything else as you Sure.
As I'm sure you know.
But I'm just saying that for people that that are listening really.
Yeah, it's fascinating, but I think there was, I think what I found frustrating in that advanced nurse practitioner role was the fact that it was just that clinical bit that people wanted.
So yes, I would spend that time, but I was still only afforded to 10 minute appointment.
So I was always running late because I was always spending time doing this type of things that you were talking about.
But there was this frustration because as I've talked about before, Kim Manley was on the podcast, who you may well know, but we talked about those, the other pillars rather than just clinical set research, leadership and education.
And so the reason why I went into the training hubs was my frustration around the fact that we weren't afforded time to do that.
I think your story really demonstrates why that matters and why that makes it makes a difference.
So I wonder if you just take us on to the more of that international work because that's fascinating me and it was one of the fascinations when I listened to you a couple of weeks ago when you had started to talk about some of that work.
So what drove you, I know the opportunity came along, but what was it about working with World Health Organization? You were invited there for six weeks and stayed for 10 years.
There must be something behind that and what, why you decided to carry that on? Yes, thanks, Ruth.
Yes.
Well, I, that part of my life was initially driven by my personal values.
I think when I worked as nurse practitioner in London, I worked with homeless, single homeless men in a practice because at that time, homeless people didn't really have access to healthcare or, or not many of them.
So I worked with single homeless men and then homeless young people subsequently in London.
And again, that was driven by my own personal values about, I suppose human rights and equality.
If I'm to give it a fancy name and social justice.
I've always felt passionate about creating situations of social justice.
The way that we as people tackle that.
Uh, it's always been another part of my life, if you like.
So in a way that kind of drove me to WHO, not initially, the initial hook was because I was working with the wonderful Jane Salvage who wrote the politics of nursing.
So you can perhaps imagine that drove the two of us together.
We looked at the politics of nursing and social justice and equity and all of those things.
I.
But Jane by then was working in Euro as the chief nurse for the European WHO region, and she asked me, we knew each other, but she also knew I was working at the RCN.
So she asked if the RCN would release me to help her with a project on learning materials on nursing for the emerging countries post-Soviet Union.
So these were Romania, Poland, Latvia, Lithuania, all of these countries that had been part of the Soviet Union and nursing had really been driven outta many of those countries by the presence of Fels, which is interesting, which we were go, uh, kind of barefoot doctors.
So in Romania, for example, they didn't even have a word for nursing at that time.
So that was completely fascinating for us.
So what we did was we gathered materials on nursing and we went and delivered these programs in many countries, a little team of us, and gave them the materials and we got publication rights to do it.
And they were then able to translate these materials into their own language and it was called the lemon project, learning materials on nursing.
Everything was lemon in it.
Everything.
Lemon files, lemon pictures.
We know all things lemon.
I was hoping we could have a lemonade as well, which would be a concert to raise money for the real estate.
But we ended up not doing that.
Anyway, that's beside the point.
So I'd got involved like that and up through that work I had met the chief nurse for WHO, and so she asked me to go to Swaziland to do some work with nurses there.
Well, it's Tini now, but at that time it was Swaziland and I did, and of course.
What I found was that it was a huge challenge.
It was because the nurses in these settings had nothing, and I realized even though we were still developing as a profession, they were so much further behind and it was so much more challenging for them to actually move on and.
The other thing, of course, was that at that time, HIV was just beginning to make itself known the mid eighties, and by the time I was invited to go to WHO in 1990, that was a really big challenge.
So it was really my own personal values.
I went to WHO for an interview in Geneva and.
The person who interviewed me took me for lunch in the cafeteria and we sat on a big table and I think there were five languages being spoken at the time.
And I just looked around and I thought, I really want to do this.
I really, really do.
And I think it's partly that in myself, I really like a challenge.
And of course the nurse practitioner program now was franchise.
It was taking off, it was, it was going to continue with without me, and I just thought, you know.
I could take some of the stuff I've learned and take it into a new setting because I was convinced of the value of nursing.
That's what the nurse practitioner program had shown me.
Not just myself, but all the nurse practitioners, you know, that I taught and talked with, and they're wonderful.
Creativity, their entrepreneurship, all of that is so much gives value.
To the nursing profession, and I really wanted to take that message with me because I knew this would be an opportunity to do it.
I didn't realize how difficult it would be, but if we realized that at the beginning we'd probably, nobody would do anything, would they? No, they probably wouldn't.
However, it sounds to me, Barbara, like you might have done because you were so.
You were obviously so enthralled when you were in that room and you decided it was something you wanted to do, so you probably didn't think about how difficult it was, and I don't suppose you were that that surprised, really.
But yeah, it's fascinating and you've given so much more talking about how you worked with the homeless and that drive and passion for social justice.
Seeing people for who they are as well, really is what you're talking about.
And then really coming into that bit about the value of nursing.
I hadn't been aware that there wasn't nursing in some countries.
I think in the UK we take it as a given, don't we? And a lot of the western world as well, that nursing exists and people don't always quite know what nurses do, but most people know that they exist to not be there at all.
It is quite a surprise.
So from there you moved on to working, you said, with another international company.
I think that led to some of the things that you were talking about in your book, the impact of global work and working in that global way on a much broader context.
So I wonder if you talk about some of that for us, please.
Yes.
Uh, thank you, Ruth.
The book is called Global Health and Nursing.
Thank you.
A new narrative for the 21st century.
I'm shamelessly promoting it on here, global Health and nursing, a new narrative for the 21st century.
It's a fabulous book and you're more than welcome to promote it.
So yes, when I was at WHOI, and as I say, that was for 10 years, so I ended up.
Being a sort of workforce specialist, and at that time there were not many of us who were workforce specialists.
I think in the whole world there were probably only 15 of us, so I was actually headhunted to go and take that role to this American organization.
It was a big project.
It was called the Capacity Project, and it was funded by USAID for five years.
I was asked to go and be a senior advisor on this project based in the USA, but working in, well, actually the first country they sent me to was South Sudan, which was such an enormous challenge.
I mean, I needed all of my resilience to stick that one out.
It was just emerging from the war.
We were living in tents.
It was really difficult and there were hardly any nurses.
There were no doctors.
It was just really tough.
But those things are good because they make you think about what it takes to move on from that situation where you have nothing.
And so there were so many things that came to me in that time.
One of which, and you know, nurses listening to this will, will think about this too.
You can't tell people what to do.
You, you just can't.
You can tell them what the evidence shows, but you can't say somebody lose weight and they go away and lose weight.
It's not gonna happen.
And you know, you go into South Sudan, they've got no roads, no buildings.
So to go in and say to 'em, look, I think we need to put in a training school for nurses in here three years with a degree, let's do it.
I mean, how on earth is that gonna happen? So.
What it made me do was to think about all the systems that surround us as nurses and how do we manage those systems to get where we want to go with people.
So that can be something like if somebody comes out of hospital with diabetes, type two.
They're living in a community where nobody's interested in that and there's lots of fast food restaurants.
Nobody's really interested in buying fresh food.
Nobody in the family knows how to treat diabetes and their best option is simply to ignore it.
What are you gonna do? You know you've got those.
The family system, the community system.
Then you've got the economic system, which says that in these stores, all the restaurants around here are Pizza Express, McDonald's, other restaurants are available, and you know, stores where they sell sort of instant food, which is all ultra high processed food.
And so what are you gonna do as a nurse if you are in that community? And I think those are the things that nurses hackle.
Don't always get the credit for, and I think that public health nursing is going to only grow in its importance.
And a lot of what I did in those international roles amounted in effect to public health nursing because in going to look at systems, you know, so I would go into a country, I'd be asked to go and advise.
It might be about workforce.
So one of the early things I had to do was go and advise about setting up systems for hiv aids prevention and treatment, and that was heartrending because you know, it decimated whole populations.
In some countries it was so difficult.
But from that work grew, things like treating nurses, having hubs where nurses could be treated for IV aids.
Because if you lose your population of nurses, you haven't got anybody to provide the treatment.
And those countries where we worked initially went on and they were brilliant.
They went on to set up great systems that would suit their environment and really get the work done.
They built on the systems they had so that when COVID hit countries in Africa were really the best at getting the pandemic management.
Strategies out there because they have the systems in place to do it, and they'd learned from what they'd done.
And in that is a great lesson and that's in the book as well, which is all about decolonizing healthcare.
So getting away from this idea that we have the answer and we just go and tell people, this is what you do.
We've got the answer.
We haven't got the answer.
We've got an answer.
One of them that works where we are or has worked in our country or in another country maybe, but we haven't got all the answers.
And I think one of the things I learned, perhaps the most important lesson I learned when I went to WHO was the importance of listening.
And that listening is a superpower.
And most nurses have that superpower and they don't realize it's a super, and it's so you don't have to go into a room and be the person with all the best ideas.
You can go into a room and listen to everybody and then summarize what you've heard.
And you know that power, the power to do that is immense for nurses.
And so critical if you are asked to go and help, it doesn't matter who it is, a family, an individual, a community, a country, the first thing is to go and listen.
What do they want? What do they think they can do? What have they got and how can they work to pull this together in a way that's going to be, that's gonna last, it's gonna be sustainable for them.
So that listening power really became.
And still is actually.
It still is interestingly, something that I think is vital and something that I try to practice practice now.
So it was the global work that threw up all these things like decolonizing nursing, the importance of the sustainable development goals, which again is in the book.
There's a whole chapter on sustainable development goals and why nurses should be concerned about them.
When you look at them, you see that health is across something like 15 of the, of the goals.
And you know, even though the goal may be related to the health of oceans, it's related to our health because as we know, if you get polluted oceans, it affects those people swimming in the oceans of the seaside.
And so those things are, they're critically important.
So.
That understanding of systems and the understanding of how they affect health has is really underplays the book.
So there's a whole chapter on the way women are treated.
Don't get me started on way women are treated in the world and in healthcare.
There's a long chapter on that.
There's a, a chapter on planetary health.
And there's one on globalization, the effect of economics on us, on the fact, on what's happening in the world.
How does it affect us and why we should be concerned about it.
So yeah, my time at World Health Organization was, was very influential in bringing me a more global view, but not losing sight of how important nursing is in that global view.
Thank you, Barbara.
You have touched on so many things there that my mind is just going 19 to the dozen at the minute, thinking about it all.
I'm just gonna start off with that bit about lo listening, being a superpower power, because it is, you know, being able to listen, summarize, and take all of that in.
But you've also touched on quite a few other things here.
I mean, you've talked about systems thinking, really thinking about that wider system, which I'd really like to come onto in a moment.
And you've talked about.
Seeing people and that decolonizing, colonizing, if I'm saying correctly, healthcare is really fits in with, and I don't know that you particularly would've listened, but I had a gentleman called Russell A.
Mack Russell on a few weeks ago who talks about asset based community development, which is really about that same thing about how where the world has become commercialized, how we've actually almost commercialized healthcare, and said that big institutions can come in and look after you.
As people, we've just accepted that rather than saying, oh, actually as a community we have assets and there's things we have, and listening and building on those things.
And then absolutely when, when something goes wrong, when you need health or social care, whatever that is, then people stepping in later.
So you've really started to talk about those things as well.
So I'm wondering with that systems thi think thinking part, you talked about how a lot of the African countries that you had perhaps worked with.
Had really got those systems in place so they coped so much better with COVID when it came along.
And so I'm wondering if you can describe that to us please.
'cause I'll be inter, I'm fascinated to be fair, as the what, obviously it's a very different environment than UK environment that, that I know.
So what was about the difference and what did that system look like? What was happening, what was going on, and what were the key things behind that that perhaps made that maybe harder in some ways, but easier in other ways? I'm thinking particularly about.
Perhaps it's less commercialized or something like that.
But that's just one thing in my head.
Thank you, Barbara.
Barbara? Yeah, sure.
Yeah.
So what's so interesting about if you go to countries that are, or have been for a while, low income countries, a lot of the work that's done has to rely on the, the sort of what's on the ground, you know, the, the basic as they, as you say, community-based assets.
And so in many of those countries, community health workers play a significant role and they play a role in two ways.
One is that they are able to go to communities and do delegated work, such as vaccinations, prevention, some of those things, but the other is they can feed back the information to the center.
So it's, you know, it's the old systems thing of feed forward feedback.
So when there's an outbreak, and you may have wondered about this, sometimes there's an outbreak in the, a corner of the Democratic Republic of Congo, let's say, which is a troubled place, but we hear about it on the BBC news.
It's in some remote part.
And how does that happen? So it happens because there are community health workers who know what to look for if they're looking for Ebola, for example.
And so that message then now, and especially now in the days of mobile phones, it's possible to digitally send that message to say there's an outbreak in this village, to the center to Goma.
You know where the university is.
They will then send somebody to or get samples, see what's going on, and then measures are put in place, which may be international if it's something that could spread internationally.
But the whole world is alerted and usually through WHO.
So then Gomer would talk to the WHO, our office in Africa, who had talked to the one in Geneva.
And here we have it.
This is news.
And today with our connectivity, that news can be almost instant.
We, this is how we hear about these things.
And those systems are old systems.
They've been community health workers in Africa, many African other countries too.
Not only African countries, but other countries for many, many years.
And they are a network that can set up those systems that are in communities and if you can give them a way of reporting in, so feedback, information.
Then you can hear what's going on.
You can build a picture.
And this is what I found.
I was very humbled by the work that was being done in some countries that the person who was in charge of public health for the ministry would be able to bring up a picture on, on a slide of all, you know, where the populations were, what the epidemiology was, what the demography was in the country, and that was how they would instantly know.
That you know, what was going on.
And I think to me that was that as it was sensitivity to the importance of networks and systems was what was a huge strength there.
Because if I wanted to go and talk about the care that was getting to stroke victims in a remote area, then they could set that up for me.
I.
Through a series of networks that were in place.
It was amazing.
I mean, I was just staggered.
Sometimes I would, I'd be on a bus or on a plane the next day and they'd say, yep, sure.
Go meet this person.
She'll take you around the hospital.
She'll show you this.
You know, the networks were like that.
And I just thought that is, and of course, sometimes the countries are smaller, so it's possible.
And you do know a lot of the, the people and you maybe, you know, some of the people in the center were from those communities.
Originally, but it showed me the strength of networking and the strength of knowing what's going on in your neighborhood.
And so in Brazil, for example, I saw this great example of these community workers.
I think there may have been nurses and there may have been community workers, but going round each household in their neighborhood.
And saying who's in there? You know, is it elderly people, young family, babies? What are their needs likely to be? And so they could map their entire neighborhood and they would know exactly what resources they should be asking for.
So if they had predominantly baby populations and they were gonna need vaccines for the next five years, so they could look at that, they could project that.
And I thought this is a model.
And it's interesting that when I, I've come back to the UK since 2018, but I've been away for more than 20 years, and now I notice they're asking for community, uh, I don't think they call 'em community health workers, but community something.
There's adverts up in the doctor's surgery in my town asking for these people, you know? Hooray.
I mean, this is, it's a great model that we could learn from, but.
Unfortunately, pre our awareness of imposing our own models, we've always thought that the traffic was from us to poorer countries, that we would bring our great ideas, but in fact, there are great ideas already there, which we should be learning from.
And one of those is that, as you were alluding to, Ruth Health is made at home, hospitals are for repair, and we haven't.
Got to grips with that, I think, and that was said by Francis o MAs, who is a doctor of public health in Uganda.
Very, very wise man that I met at WHO and have kept, I'm still in touch with him and he's back home in Uganda and I'm back home here and he's got such a, a wealth of knowledge about public health medicine and I think he's absolutely right.
We need to look at how we make health at health at home.
Thank you Barbara, and again, absolutely fascinating and I was wondering what is it, what was it that you were going to say, you know, that that made that, but of course it came down to something that I'm quite passionate about myself, which is that networks talking to people, meeting people across the system, you know, so often my latest role when I was working in the NHS was that I was the advanced practice lead.
So I would meet with some of the advanced practitioners, particularly those I thought were moving up to that sort of consultancy level and say, well, who is it that you are linked in with? And there was one particular nurse at the time, Heidi Edmonds, who has been on my show, who really start, who I was really wanted on because she had already started to build those networks across the system.
But so many of them would say.
Well, am I allowed to, can I do this? And I would say set up a network.
And there was almost this thing that people felt like they needed permission to be able to do that.
And of course what this does, it takes it another step to not just networking across what we see as a system.
'cause so often when you talking and I'm talking healthcare, particularly here, we think of the system as being the healthcare system.
Actually it's the social care system, the schools, the police, but it's also our communities.
That still isn't quite in there that that network needs to include.
You know, there's a lot about co-production now.
A lot about having people in with lived experience.
Are we really doing that? And are we doing it well? And I'm sure there's some people doing some fascinating stuff, but actually we haven't quite got that.
And that's about building that networks.
And of course the primary care home, which is around the what the.
Primary care networks was developed from is about the fact that you can walk around that area and know everybody, that you haven't got too many people and everything's been made bigger again.
So there's so much that we can learn and I'm just loving that comment of health is made at home.
And the one things I was reflecting on on from Cormack Russell this morning was around the fact that he was talking about that, uh, we see health, we see it as illness, and we see it as prevention, but actually we need to flip it to see it as health.
Then it's only when you need repair that you go into to hospital.
So thank you.
That's fascinating.
So I just want to ask you one last thing before we start to end, which is one of the things that I'm always fascinated about as well is from your experience, have you seen how the health of say, um, and I'm just gonna say Africa's, 'cause it's the area that you've been talking about, the health of one area compared to another area in the world.
So I'm gonna say the UK 'cause that's where we are.
Does that impact each other in your experience? Is there, does it matter if we are healthier here than somewhere else, other than on the fact of a, a moral standing, but actually, does it make a difference how the health of the world is as a global whole and the people in that world? That's a really interesting question and there are a number of ways that it could be answered.
I think one way that in nursing has become very important is our use in this country of nurses from low income countries that we recruit to fill the gaps in our own nursing workforce, and one of the impact of that.
On what's available in their country of origin can be extreme.
So if they're very short staffed, let's take Kenya for example.
Although Kenya's doing really well, to be fair at the moment.
But when I first went there, they had terrible shortage of staff and real shortage of nurses.
And where were the nurses? They were here in the uk, but, but.
Those nurses that came here and got successfully employed were actually able to send money back to their families for education, for healthcare, and it made a huge difference to families.
And so there's also a school of thought that the remittances that migrant nurses send home are actually much more effective at alleviating poverty than international aid.
That's a really interesting perspective and I'm raising that only to say that the whole question of does our health impact somebody else's health? Is economically speaking a fascinating question because yes, of course.
You know, we, we recruit nurses and doctors here and we deplete the ones who are in the home country, the source country.
So in that way, yes, we get great health workforce, but those people back in the place we recruit them from, they may have no healthcare at all because we recruited their nurse.
And even if that nurse goes back, and I saw this myself in Uganda, you know, a British nurse going back from a London teaching hospital where they'd been trained as in intensive care.
To a really basic poor hospital, not in Kampala, but out in the the countryside in Uganda.
What could they do? How could they use those skills? They'd learned, you know, clinical skills.
There wasn't the equipment, there wasn't the opportunity.
So I think we have to think very carefully about the way globalization affects us all, and migration is kind of the most obvious example of that.
But of course there's the whole business of aid and how international aid is given by we rich countries and used, and how important that can be to health because sometimes it buys basic things like drugs, vaccines, it's not always used for projects.
It can be used to buy really basic things, insulin.
Things that may impact the health of people there.
Drugs to treat cancer.
And I was based in Palestine for two years and Palestine's been in the news a lot recently because of Gaza.
But one of the things that was so, oh, impactful on me there was that even though they could diagnose a range of cancers, they didn't have the treatment.
They didn't have the facilities, didn't have the drugs.
There were some things we could do about that, which we did, but mostly they had to refer those cancer patients outta the country.
And of course, that was a bit of a lottery.
If you were lucky enough to get referred you, you got referred.
So in the sense that our international aid buys some basic commodities for very poor countries, we have to be aware that that is something that affects health and what.
I mean, it's not a direct effect of what we do, but I think migration is both migration of people into our country, but also nurses, particularly the way we, we value our migrant nurses.
You know, in the past we haven't, there've been terrible, terrible stories of racism and, and not making those nurses welcome and when you think.
Of what it's cost.
Those people in emotional terms as well as monetary terms to get here, we need to do better.
So in that regard, I think we are globally linked.
And then of course, viruses, as we know, do not respect borders.
They just go where Dickens they like.
And so if there's an outbreak of Ebola.
Or Monkeypox, even mpo, which we've heard about recently, somewhere in a remote corner of DRC.
It may well end up here.
So of course we are intertwined.
Of course we are, are interdependent as a globe and, and that's really the passion that I brought to writing that book, global Health and Nursing, because I do believe that we need to be aware of the rest of the world.
Thank you Barbara, and that was an absolutely fascinating answer.
And yes, as you say, globally, viruses can spread, but there there's so much more on complexity.
So I'm sure you could have spoken about it a lot longer, but just wanted to touch on it, um, before we finished.
So my final question to you is, are there any key points or even challenges that you would like people, nurses, or anybody else who's listening to take away from today? What I would like to see in our profession, our wonderful profession of nursing, is that nurses take center stage.
And I think too often we are the supporting cast in what's going on.
And I've seen this in many, many places.
And partly it's because we are a female dominated profession.
And even though we're in 2025.
We have a long way to go on looking at the role of women in society in general, the role of women in leadership, and there was a report from WHO, I think it was 2019, that said Healthcare Delivered by women.
Led by men.
And I urge you to read it.
It is so, so I, I would say.
One message to nursing is we have to step up.
We have to be globally aware what's going on.
We have to be aware of the systems we're working in and be willing to talk about them.
Not as you know.
Oh, and we have a nurse in the corner here.
Would you like to say something? But as the person who convenes the meeting and too often we're the token nurse.
Oh, we've got a panel together and we forgot to include nurses.
I'm asked this all the time.
Could you possibly step up and be the nurse, the woman, or both? And it's absolutely shocking in 2025 that this should be the case.
We should be convening the meeting.
So this is what I'm so passionate about.
Young nurses, you need opportunities.
You need to be able to step up to those opportunities.
And take them and become those leaders, and they are.
To be fair, these young nurses that I'm working with recently are fabulous, and they are stepping up and stepping out.
We need to not be in the background.
We are the central characters in the healthcare story, and we need to really be able to acknowledge that and to act on it.
Thank you, Barbara.
That was wonderful.
And as a nurse, I absolutely agree with you.
So it, it's not easy always stepping up because as you say, nursing is led, you know, healthcare is delivered by women, but it is led by men.
And having worked within an integrated care board, ICI know that and I've seen that and, and how difficult that can sometimes be to make sure your voice is always heard and there.
So is there any last points before there Any last points before? I don't think so.
Ruth, it's been a wonderful opportunity to talk with you and thank you so much.
I, I know I'm, you know, at the end of my career, but I have great faith that things are going to change.
My granddaughter is a nurse and I'm very proud of her, and I know she has it in her.
To move forward with this profession as, as I know young nurses do.
So onward and upward.
Thank you, Barbara.
And on that no, I'll say goodbye.
Thank you very much for joining me today.
I've really enjoyed it.
bye Ruth.
Bye.
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