Learning and contributing

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No-one knows everything, but we all know something. Together we can know more.

A statement made recently by Professor Tony Redmond, Professor in International Emergency Medicine at Manchester University during a visit to China, reminding us that everyone has something to learn, but more importantly, something to contribute.

The trip to China arose from some work we did in Sichuan province last May immediately after the Wenchuan earthquake, where approximately 80,000 people were killed, and approximately 5 million were left homeless. We were invited back to the province to speak about disaster management and spinal injuries rehabilitation. Having the capability to move 100,000 people a day during the disaster, this request made us feel somewhat humble, but we all felt that this would be a great opportunity to share knowledge. Many of the team had extensive previous experience of major disaster, and were able to share what had been learned, and also some of the key public health issues from each situation. As a nation, Britain has never had a disaster on the magnitude of the Wenchuan earthquake, and despite all our planning it is difficult to say if we would have the capacity, or capability, to manage in this type of situation. However, what we do have are national, regional and local requirements (based on legislation) to plan for major incidents, and catastrophic natural or manmade events, and it was this that the Chinese (and Sichuan) authorities were keen to learn about. There is a very real desire to learn from their experiences in the earthquake, and also to work with teams, such as ours, to plan for the future. As a team, we were also keen to learn from them, about their coping mechanisms, about the lines of authority, and just how they were able to manage mass population movement. However, we were also conscious that one size does not fit all. What is appropriate in terms of planning in Britain, within a National Health Service, may not be relevant in Sichuan. There may be a lot of common ground, especially at hospital level, but local and regional arrangements may differ significantly, which must be accounted for. In the future we hope to work with the individual hospitals, to build and train around a hospital plan, and also to work with provincial authorities on their plans.

As emergency nurses I think we are conscious that we have a breadth, rather than depth of specialist knowledge, and this was surely reinforced by the presence of the spinal injuries team who came with us. The teams in Sichuan who had invited us back were keen that we bring expertise in rehabilitation, specifically related to spinal injuries. Many of those caught up in the earthquake suffered spinal injuries either from being crushed in collapsed buildings, or by jumping from a height. As in many countries, rehabilitation is seen as a highly expensive service, and as such is often under-resourced, and in China the role of therapists, essential in the delivery of rehabilitation, are still being developed. As such it was inspirational to hear and watch the response given to the team (a nurse, a physiotherapist, and an occupational therapist), especially by the patients who attended the sessions. There was true sense of multi-disciplinary discussion, with the professor in rehabilitation interacting with the team and with the patients. The team was asked to review patients, and to advise on appropriate treatments specific to the spinal patients. They were able to relate specialist knowledge at a level that related to any clinician managing patients with spinal injuries, which is essential for those areas where specialist centres simply are not an option. Listening to the presentations reminded me just how much we, as emergency nurses, have to offer in the prevention of secondary damage to the spinal cord, much in the same way as we aim to reduce secondary brain injury following significant head injury.

One of the most significant visions of our trip was a simple conversation between two paraplegic patients. One had been injured for some time and speaks internationally on the subject, but the other was a young man recently paralysed. It was quite obvious that the young man was seeking advice and motivation about his injury, something which can only be gained on a theoretical basis from the professional. How can we truly understand what it is like to be paralysed, and what works best for the individual managing the condition? As professionals, we may be able to do this by working with patients for a long time, something that is not possible for many, or by learning from patients themselves.

Understanding this lived experience gives us the opportunity to truly make our services personal, and holistic. It becomes not about managing the patient with a spinal injury, but identifying what is important to that individual, and how best we can support them in achieving their full potential. Studies using qualitative methodologies will provide some insight into these perspectives, but so will getting the patients involved in all aspects of service provision, whether this is in commissioning, or establishing the evidence, or simply being involved in peer support. This is true not only for spinal injuries but any long-term or rare condition where the individual (or carer) will always know their own condition better than the professional caring for them.

The trip also provided an opportunity to go to the areas damaged by the quake to see the progress being made on rebuilding. At the time of the quake it was simply too dangerous to go into the epicentre, due to the ongoing aftershocks. This time we saw a little of the devastation, but also huge amounts of reconstruction. Many of those left homeless by the earthquake have returned to Sichuan, to rebuild their lives, having no desire to live anywhere else. The resilience of the people in the face of such a disaster is inspirational, and their desire to get past this event, and look forward, truly humbling.

Of course, any trip like this generates lots of work, but more importantly it reminds us that we continually learn and grow. As a team we learnt from one another, and contributed knowledge and skills. We met up with some old friends, and gained new ones. We experienced the generosity and resilience of the Chinese, and were able to share expertise. We established plans for the future, and, of course, learned a few more Chinese words (xie xie – thank you).