Trust and The Betrayal of Trust

My Lockdown Diaries 

Where to start with all of this? Here I am in a year unlike any other – my day job -which is no secret, is a public health consultant in one of the biggest counties in the South East of England. My call to action is always protect the population’s health and has been for around 20 years. I love my job and I’m proud of the profession, for its flaws and all the battering it gets. Here I am – in the job I trained for and love – facing a national pandemic, since March. Last Christmas I heard the whisperings in team meetings of a new virus – but it was just in Wuhan, hushed tones of SARS and Coronavirus. My specialist area in public health is health inequalities and mental health and substance misuse – I make no pretence to be a health protection expert. However, as a consultant, we are all trained in the management of outbreaks, in principles of health protection and data plotting epidemic curves. It’s in every public health professional’s DNA. So the second the outbreaks started we were stepped up locally, along with many others across the UK – on high alert. I kept sane by using my Facebook space and friends as a barometer, a space to place frustrations and log the grime and small sorry glory that is jobbing public health. 

Business as Unusual 

My job was not very glamorous – in March – I was (along with another consultant) put on Business Continuity – which was basically – keeping the home fires burning while the other members of my team were managing outbreaks, planning mortuary space, plotting data curves and sending out media messages – well trying to – as we often got the messages via the Press rather then via the Government. Since then I have also worked on outbreaks in allsorts of places across Kent in our all hands to the pump way. In March my job involved working out how local people could get contraceptive services, how much PPE was needed and where, what to shut down, what to divert, how to keep staff calm, how to keep addiction and mental health services going. 

I was also – in the very early days- tasked with finding out what the scale of impact was likely to be in mental health – to advise the directors of public health what to do about it. I spent a lot of time reflecting, reading about things like Terror Management Theory and the impact of disasters like Hurricane Katrina had for mental health. 

I started to realise this world had changed and worse would follow in a series of confused messages and relaxations of lockdowns and desires to get back to normal and why do we need all that stuff anyway? I realised people could not grieve or mourn in the way they wanted, that not all people’s pandemics were the same. I waited for the backlash and the conspiracy theories and they came. 

The Poetry Job

I’m also a poet. Another kind of ‘legislator’. As a poet I stood back from everything – felt like I was in a film, one of those films with Will Smith or Tom Cruise or Brad Pitt, where someone somewhere saves the world in the nick of time- but we were not at that bit of the film yet. I was in the bit of the film – in Sean of the Dead– where they all “have a cup of tea until it all blows over”. 

BUT I also wasn’t. I was- at the same time, working over 10 hours a day, zoom meetings back to back, all about COVID19 – daily team meetings often descending into a hysteria, where we had to talk about buying more cremation space, PPE, care homes. And all the time hearing policy and government advice in the press first – before telling us! I saw my old bosses on telly every day – giving presentations just like they did when I worked for some of them. We were doing our very best. Our very very best – and all the while – I didn’t think my neighbours were clapping for me – and why should they? There were nurses and doctors and refuse collectors and people delivering PPE and they were the people to clap for, and not All those bankers and billionaires – we normally clap for. My friend called me from Scotland asking me what to do, she worked in a care home and they had no PPE. I felt guilty and upset and as much as I understood people needed an outlet and a sense of community, I started to think they were clapping for themselves. I felt bad. I was done clapping. As John Lennon said “Don’t clap – just throw money”. 

And no one could write, and everyone wrote, and social media was zoom, and events still happened and we could hold hands over the cyber bridge, still love and hate each other. Slowly I started to write. I wrote two pandemic poems; one was originally a Brexit poem that became a pandemic poem. Where we were on a ship of fools trying to slay the whale of COVID19 or was the whale us, and the sea the pandemic ? – either way the captain blurts out orders in Latin and we sail round and round in circles until the whale breaches in a dying breath as we watch. The brilliant editors of Poetry Birmingham Literary Journalhelped me sharpen the poem and published it. I’m grateful for that. That great poetry journal Agenda – also wanted a poem from me which I penned while watching a documentary on Ai Weiwei and getting an unhealthy lockdown obsession with Tiktok. Agenda’s Lockdown edition will be out soon. 

https://www.pallinapress.com/submission-guidelines

Home

Stages of Grief 

Anger. 

In one of my favourite books on public health – written in 2002 – called Betrayal of Trust: The Collapse of Global Public Health – by Laurie Garrett

the author writes 

“What public health really is being a trust. That’s why I used the term ‘Betrayal of Trust’ as the title of my book. It’s a trust between the government and the people.”

We are taught in public health school – that as public health professionals our job is to protect the health of the population – in accordance with the power structures and the consent of the whole of society. That’s why it is both science and art (as all the best medicine is). Science is not blind, it exists in a context of careful degrees of trust and public policy. When Thatcher and her government buried theBlack Reportin the early 1980s because they did not agree that it was unfair that poor people died 20 years earlier then rich people and that they did not agree that their policies would make it worse – it set back the public’s health considerably – as the health outcomes of the poorest in society got even worse in the next 20 years. Luckily now – all parties acknowledge the inequalities – they just differ in ways to improve them. 

I remember giving talks on health inequalities 20 years ago – where I told local politicians (it was a Labour controlled council by the way) “the poor are dying 15 years earlier then the rich – and that’s the difference of not seeing seeing your grand children grow up” and the local council member whispered to me “remind me why we care about this again?” – and I said “I think it’s something to do with social justice and ethics – you know – fairness” and he nodded “of course of course”. 

Of course in public health we all want to be the good guys, mostly we are just the cogs in a big wheel of ‘trying to do the right thing in a bad situation’ and very occasionally, in a very British way, we get very very angry indeed. 

Denial… and Horror

A man died in the USA. Protests took place. I realised the colour of my skin is political again. I don’t want it to be. It just is. I want to be blind to it. But it is there – for us all to see. 

and Acceptance …

We are taught – in public health school – that we must first and foremost instil trust in the public for without consent – public health in a democracy, is nothing. We learned this from the horrible effects of the baseless and discredited Wakefield paper on Measles – that resulted in deaths of children. So imagine our horror, my horror, at trust being broken in a very public way. People make mistakes – this much is certain and mostly forgivable – but when rules for public good are treated with contempt and with defiance it breaks everything down to ‘might is right’ and ‘follow the science’ gets hollower and hollower. I get angry when the public health itself is blamed by the people that put the system under strain – underfunded, corroded, eroded, ignored and even misunderstood it – even after the Cygnus Report 2016 on the fragility of the Emergency pandemic system. Ah well, to be in public health is to play a long game, speak truth to power, so well then… I suppose as the saying goes “we are where we are”. We are all just trying to do our jobs I suppose, politicians included. Locally people moved mountains. I admire that.

Trust

I think we humans are programmed deep in our DNA to pick up on authenticity and depending on our concerns – we look for different cues to what that looks like. When I started working in public health in Kent – there was a BNP councillor in my local patch. I was somewhat horrified and wanted to know why the public had swung from Labour to BNP so quickly and what their concerns were. I was told by local people the BNP candidate had knocked on every single house and spoken with people – so people were picking up on the authentic strength of conviction. There is a lot to be said for that – even though I’m disgusted by their politics, at least that candidate had a work ethic. 

In poetry too, there is a need for the reader to trust the conviction of the poet. Some readers might look for one thing that gives them trust – like raw emotion, or a ‘true story’ or experience, others might look for the underlying truth in the poem, the reality of the emotion, others the syntax and grammar and structure of the thing – that holds the art together – that makes a sense of coherence. What makes you trust a poem?

Its the job of the public health system to gain and keep trust of the population in order to protect it – to persist – against the odds. Its the job of the poet – the gain the readers trust to protect a person’s soul. One of the jobs of the poet as artist is to be present to the “whole catastrophe” of the world. A witness. 

I’m in This: Staying Human, Bloodaxe Books 2020.

https://www.bloodaxebooks.com/ecs/product/staying-human-1185

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