We're human. Our relationships are everything.
From the home to our mental and physical health. From our bank accounts to the environment. Our relationships and interactions with the world around us mean everything. So we have to think about how we move away from the metrics of care and back towards its meaning.
In August this year my 99 year old Grandmother developed an infection in her eye. As it was the summer holidays my nearly-13yo son came with me, twice, to collect her from her care home, take her to her hospital appointment in East Kent (wait for an hour and 45minutes for a 10minute assessment with a registrar) and return her back to her room. These were two important trips. Not only to get an appropriate ointment for her poor beleagured eyes, but for them both to spend some time together. The ravaging effect of COVID-19 on care homes, and the policies introduced as a result, have meant that my children have spent precious little time with her over the past three years (this severing of family ties is likely to form the basis of another blog).
On the way home he was stung by an interaction he had observed between staff and an elderly woman, who was confused about where she was. He couldn't believe how abrupt they had been when they spoke to her, and how bored they seemed by this woman's confusion and distress. On the way home I gave a brief overview of our fractured social care system: yes, the women who work there (and yes, they are all women) get paid chicken-feed; yes, it's hard to complain because this is a private home, and they set the rules; yes, there is such a thing as the CQC and it is supposed to prevent these things from happening; yes, GG is happy there overall, and yes the disruption of moving her at 99 could be overwhelming; yes, how do we know that elsewhere is better; no, the people who work there aren't bad, but there isn't enough time or money for them to actually care.... and then he asked, is it possible to pay people to care? Isn't care an emotion, not a task?
Back to work this morning, now my Darlings are at school, and a chance to pick up some outstanding work and reading before ploughing through the wealth of emails. Top of the list is a paper from the BMJ, which has been lingering in my 'to-read' pile since Easter this year. It was well worth the wait, and developed helpfully on this August conversation;
Iona Heath and Victor M Montori
The British Medical Journal (BMJ)
This is an open access paper, and a short, accessible read. I highly recommend you take 5mins to savour it over a cuppa today.
Nearly 20 years ago Sheila Kitzinger talked about the dangers of bureaucratic care to women in labour and birth. Yet despite recent reports and strategies (including the 2016 Better Births report and 2022's Women's Health Strategy) we really are no farther forward in delivering these forms of care. And it really matters - not only in maternity care, but in all forms of health and social care, and beyond. We are not entirely disconnected and separate entities, existing in glorious isolation and conscious rationale. We are deeply connected and embodied at each and every level of our existence. Although we tend to think of our bodies as 'closed systems', bordered in impermeable skin, bobbing about the world bouncing off the other hard and impenetrable forms we encounter, nothing could be further from the truth. We are entirely and perpetually subject to the world we exist in. Our hormones respond to touch, fear, hunger, sunlight, hope (what there currently is of it), and excitement. We change in response to those hormones, physically and emotionally; feeling loved, a boost of energy, buying a cake, sunburn (or applying sun cream), gratitude and optimism, the lurch in the belly that comes with anticipation. So they way in which we do health and social care matters as much as what we do. Continuity of care matters (and I was delighted to see this idea relating to general health care, not just maternity). It matters partly because continuity means we can do health care more efficiently, but mainly it matters because it matters to our human experience, which really, at the end of the day, is all we have.
Our relation to the world around is everything. It changes how we feel and how well health care can be done. Whether we feel connected to the people and places we navigate has the power to bring joy or loneliness. If we believe we are connected to the world, and that our actions matter, and can bring improvement, we can make positive change. Even finance, money and the economy is, ultimately, relational. Without acknowledging and valuing that truth - that we are relationally connection to people and the environment - our future in our world, is compromised.
You cannot live forever. We will all die. The question is how well can we live?