Be kind, focus on equity, avoid complacency, stay connected – and other pandemic reflections

How are health professionals sustaining themselves and their networks amid the demands and disruption of the COVID-19 pandemic?

In the Q&A below, Associate Professor Kelvin Kong, a Worimi man and an ear, nose and throat surgeon, reflects upon the upheaval and life-changing lessons of the past several months. He works at Newcastle in NSW, on the country of the Awabakal people.

This article is published as part of Croakey’s occasional series, Caring for the Frontline.

Q&A with Associate Professor Kelvin Kong

Q: When did you first hear about the novel coronavirus, and do you remember your first thoughts about it?

Yes, I remember well. We have always been concerned with virus outbreaks and some of my colleagues and I had a recent preceding conversation about SARS prior to the outbreak. I was doing radio interview for otitis media and the broadcaster asked if I knew about COIVD 19…

Q: How has the pandemic affected your family and life over the past several months? Do you have any stories to share about this?

I truly believe life has changed forever in how I do things.

Initial reports had ENT surgeons with a high infection rate compared with other medical professionals along with mortality, so as an ENT fraternity, we were strong in solidarity and rapid with response including ways we work.

This significantly impacted on the family, so many things we take for granted. I was sent much advice from different forums across the globe, but much from my wider ENT surgical family.

My daily trip to work changed, minimising personal exposure at work and avoiding bringing COVID home.

Many smaller things about my day have changed too, like I no longer take my wallet – luckily Apple Pay has been so successful. I carry my phone in a sandwich bag to allow for wiping down with isopropyl alcohol wipes between each patient if used. Phone remains in pocket or bag, not to be placed on work surfaces.

I never ‘steal’ another pen from a nurse, much to their delight! I purchased several pens, left them at work and never brought them home, frequently coated with alcohol gel.

My wardrobe changed forever. I have become what we see in US television, wearing scrubs to and from work. No longer wearing nice shirts and suits. I am now dedicated to minimalist work clothes. T-shirt and scrubs, no belt, no jewellery and no watch. Forget trendy lanyards, they just harbour bugs. 

Coming home now involves a new routine, shoes off outside, no hugs, clothes off at front door, hot wash work clothes and reusable shopping bag. Immediate hot shower, fresh clothes, then cuddle my children. They found it unusual and initially hard to understand.

Often, I would call my wife, let her know I am nearly home, so she could distract kids to allow me to sneak into the shower. So sad as the best time of day is coming home to smiling happy kids that missed you.

We kept a low profile, no socialising, concentrating on changes with work. Although many conferences were cancelled, my days were quickly filled with COVID requests.

I am from a big family and one of the things I missed immensely was extended family time.

So, on Easter, I decided to arrange a zoom catch up for my extended family. It was hilarious, getting more than 30 of my extended Koori family on Zoom, many of whom had not experienced Zoom before. It’s important we do what we can during this time to stay connected. Not realising the etiquette, nor caring…one of the funniest meetings I have ever had and one I will never forget – yes, I recorded it 🙂

Q: How has the pandemic affected your work and professional life? Can you share any stories about this?

Work has changed, with everyone needing to be much more cautious. When COVID first had an impact, as ENT surgeons we stopped operating immediately, the transmission and mortality was alarming.

We were also concerned for our trainees who were vulnerable on the front line. Not only had our lifestyle changed, my work had increased in intensity, having the requirement to rapidly change to cater for the new and concerning environment.

Learning and devising new techniques to ensure protection of staff and patients. A tracheostomy, for example, was one of the highest risk operations. But unlike isolation, it’s hard to say no to help a patient, who is in extremis already, hence requiring an artificial airway. The operation had to be thought out to protect staff and patient. Things that seem so different, now take a thought.

Things like, how the patient enters the operating room, passing many staff and patients just in terms of physically getting there from the ward. What precautions the operating assistants needed, what protective equipment needed for staff, we all wore respirators in one case.

Even dressing up for theatres, requires sterile scrubs, so how to put all the equipment on and take off safely, had to be worked out.

The best analogy is like scuba diving, where there is so much equipment and teaming with a buddy, so you could see that each other is protected and not contaminating anything.

Seeing in theatre was harder – we normally wear specialised headlights, but these cannot be worn with the respirators we had, so we had to source new lights.

How we give an anaesthetic changed, it was so important not to have a patient coughing before or after, risking spreading COVID-19.

When operating in an environment with COVID, aerosolised particles may sit for a period of time, so the theatre not only needed a deep clean, the air needed to be vacuumed out (negative pressure room) and allowed to be cleared before the next operation.

Then the personnel who were in the theatre need to clean themselves, walk into change room, not socialising between cases, shower and change scrubs…this represents a highly summarised version!

Q: How have you been involved in responses to the pandemic, whether through your work, or with your family and community?

At work, I continue to be involved in regular meetings on management, new techniques, simulation labs to practice techniques, protecting staff, wearing new and claustrophobic protective equipment, we are constantly learning and adapting to our new environment to keep our patients and community safe.

Family continue to be my strength. Especially on hard days, or frightening days. But also, on successful and happy days. My family continue to inspire me to help get through each challenge.

In response to concerns from community, we’ve also held multiple information sessions for community and health workers to be kept abreast of the situation. It’s truly been a humbling experience, as I continue to learn a lot more than I have contributed.

Q: What have you done for self-care during this time? What has helped keep you and your family well and strong?

Family time is always important, but now more than ever.

We regularly go for walks along our pristine coastline through National Parks, where we could almost be the only people around.

Exercising and spending time with family on country is the support I craved, required and enjoyed to rejuvenate me.

Q: What are some of the issues you’ve observed for colleagues?

Like most, uncertainty in employment and fear of illness.

As time progresses, the addition of bills and lack of income adds to the stress of colleagues, family and friends.

We are fortunate in the health sector, that we have job security. The resilience of my community and colleagues has been wonderful.

We are lucky that we did not experience the wave of infections, in our First Nations communities, as we first thought, but we need to remain mindful we are still high risk. The need to look after each other, as a whole community, really surfaced during this time.

Q: What are some of the issues you’ve observed for patients and for your community? How is the pandemic affecting peoples’ lives and wellbeing?  What are the key issues you’d like to see governments and policy makers address now, and going forward?

The fear of the pandemic is very real and still valid.

We have been lucky to avoid this impact, especially on some of our most at risk First Nations communities, but there is still multiple heath issues that need addressing.

I was still diagnosing cancers that needed operations and many chronic illnesses were suddenly thought of as not important by some patients. But we need to keep up regular health care and appointments to prevent long term health.  

As we tackle a new era, health is paramount.

We must find models of care to ensure we address the ongoing unmet needs of healthcare. This must be in an environment that supports prevention of the spread of COVID-19.

Awareness of community driven responses must be supported by safe, evidence-based practice.

Q:  The Aboriginal health sector’s response to COVID-19 has been widely praised. What are your observations about what strategies have been helpful and why?

I am so thankful that we have not seen the devastation that we have seen in other First Nation populations across the world.

COVID-19 is such a travesty to all of us. But it really highlights the inequities we have as health service providers.

We are lucky geographically that we were able to shut down communities so quickly.

The Aboriginal leadership across the nation needs far more praise in its ability to get the message across.

Messages that communities could relate to and believe was, and continues to be, paramount in the response.

I feel communities more than ever are about understanding and behaviour changing.

Paternalistic approaches never work. This is why our sector has done so well. When I first shut down our outreach, it was pleaded to me to continue. I am so glad I listened to community voices and ceased for the betterment of the community.

Often our good intentions can have disastrous outcomes. This was a great team commitment to protect the community. I was really terrified and ready for helping if it did break out. But it’s important to remember that we are still under a dark cloud, the risk of COVID is not gone, and our communities remain at risk. 

Q: As you look at the wider government responses to the pandemic, what do you think has worked well? And what could be improved?

This is a hard question. No one could predict this devastation. What we need is behavioural change. We need people to understand and appreciate the widespread affects.

When we have frustration, limitations on life and fear, it stirs emotional responses which compound stressful times. Local responses to community needs very important and a leadership that can support the restrictions we require.

Q: At this stage in the pandemic, how are you feeling about the future? What are your hopes? And what are you fears and concerns?

My biggest fear is complacency.

It’s so important that we all stay strong, we need to look after one another. It is also time to appreciate the role of public health measures more in social determinants of health, particularly for our First Nations people.

Let’s address our inequities we can see more clearly now 🙂

But overwhelmingly, let’s continue to keep our mob safe.

Q: Seven months in, is there anything that you know now that you wished you’d known at the beginning of the pandemic? What have been the most significant learnings from the pandemic so far?

Be kind and be useful.

Q: Are there any other general comments you’d like to make? Or reflections to share? Or advice and take home messages for Croakey readers?

All of us have experienced some personal deprivation to control COVID-19. All of us are now in a better position to understand the deprivations experienced by First Nation peoples.

All of us now have an opportunity to give First Nation peoples real equity, not just a symbolism.

The COVID-19 pandemic has been an incredible public health experience for Australia and more so New Zealand.

How often did we hear the phrase “we are all in this together”?

Together, arguably for the first time outside of war, we have sacrificed.

Together, as one country-sized community we have managed to drastically ‘flatten the curve’ and change the course of the COVID-19 pandemic avoiding the devastation seen across the globe.

Of course, we cannot be complacent and careful strategies to de-escalate these sacrifices will hopefully avoid any catastrophe.

This can be a celebration of public health policy and our collective belief in the strategies that have worked well.

Māori and Aboriginal and Torres Strait Islander peoples have not seen the expected infection rates, and consequently, outcomes have, thus far been a huge relief.

Nevertheless, an acute sense of the pending threat of devastation to our communities, language, and customs (particularly our elders) has been superseded with mixed emotions.

Mixed emotions because why can our countries do so well on a general public health measure now, but not, after all this time, for First Nation Health?

First Nation people have lived the experiences of colonisation and the resultant social, economic and health disparities. We have never seen such a public health emergency response for the inequities we have lived in First Nation health.

Even in the current measures, there are perceived and real systemic inequities in the COVID-19 response. Health access barriers are dramatically increased and disparities in health outcomes widened.

Social isolation enforcement measures that are punitive tend to expose First Nation people to the elements of law enforcement. Management of the isolation is harder, as overcrowding, cultural customs, poor income and lack of infrastructure making it difficult to adapt to the new measures and to comply.

This further marginalises our people and places them at higher risks of poorer health outcomes and financial stress, not to mention more unnecessary contact with the justice system.

De-escalation measures could see a different and novel approach to First Nation health. Many ill First Nation patients must be feeling isolated from medical care and need to be advised how this disconnect affects their condition. 

Principles of equity must be embedded from the outset in all surgical initiatives, responses and systems. Prioritising vulnerable and at-risk patients must be considered with any de-escalation.

First Nation voices must be included in any solution, but it would be an incredible system change and message to prioritise our First Nation people in any de-escalation plan.

• Associate Professor Kelvin Kong is also an ambassador for the NSW Government Keep our Mob Safe campaign. Follow on Twitter: @KelvinKongENT

Watch the video

Also watch this discussion about his work with head and neck cancer patients, as reported recently for Croakey by Julie McCrossin.