Yearly Archives: 2017

Speaking from the very inside of myself

Deborah James

 

I don’t know whether it was the vibrant colours, the softness of the felt, or the fragility of the fabric that made Claudia Stein, Research Director of WHO Europe, reach out and take the weave from my hands last year in Newcastle upon Tyne at Fuse’s International Conference on Evidence in Impact in Public Health (http://www.fuse.ac.uk/events/3rdfuseinternationalkeconference/). She stood there in front of me, holding the weave; silent for a moment, looking down and then responded, “This is the next generation of healthy children”. I was delighted. She got the metaphor.

 

 

The weave was a co-creation of the early years’ workforce from health and social care in the NHS England Cumbria and Tyne and Wear region. The project, funded by NHS England, was designed to support the health visiting workforce during the transition of their commissioning from the NHS to local authorities. In 2015, when we were designing the project, we didn’t know how the wave of austerity in public health would be felt on the ground, but we knew that the transition of commissioning, like any change, would produce both gains and losses. During times of change, we narrate our identities to help make coherence through the chaos.  With this in mind, we designed a series of large workshops across the region that focused on perspective taking. I wanted the workshops to provide a space for reflection so that each person could narrate the motivational force that led them into their respective work roles. A time to stop and think about themselves – their story line, and I also wanted to find out how they used the perspectives of service users in the construction of meaning in their own work. In addition, the workshops were designed to provoke curiosity about the system leadership that created the context for the changes they were facing. Could they see the change from the perspective of the policy makers who had called for action?

 

About 100 people from the health and social care workforce came together in five events across the region. In the workshops, the practitioners and workers shared their examples of best practice, worked on developing a shared understanding of the common purpose of their work in small groups, and fed back their ideas individually about the meaning of their work from multiple perspectives (themselves, their colleagues, and service users). More details about the project are here; (https://www.northumbria.ac.uk/media/6588781/supporting-transition.pdf). The participants created the metaphor as they wove their line, their story line on fabric in with the other participants’ fabric. This was the integrated health and social care workforce; an enactment of narrative testimony and witness that drew the subjects into a collective. People, connected with other people, speaking from the inside of themselves – speaking from the first person perspective.

 

Like the workers weaving their story lines, the first person position is the place from which I can access my own values, beliefs and unique understandings of the world. But the first person is also the place from which I give voice to my unformed thoughts, to my not knowing and even to my chaos. It is the first person position that I need so speak from if I stand any chance of creating generative outcomes from the narrative interface with someone else. The first person position is the antithesis of the third person specialist position, the place that, as academics or professionals, we normally set up for ourselves. I think it is an act of courage to speak from the first person. Speaking from the first person reveals something of who I am, whereas speaking from the third person reveals something of what I do.  As Donald Winnicott said (1971), “’I am’ must precede ‘I do’, otherwise ‘I do’ has no meaning.” It strikes me that many of our interventions in the early years start from an assumption that ‘I am’ is established (in the parents and in the child by the time he or she is ready for school). So, our interventions focus on the doing; ‘do this’, or ‘do it this way’, ‘best if you don’t do that’, or perhaps, ‘why do you do that?’ If the doing has no connection to the being there can be no generative sustained change from it. A more developmental set of assumptions might go something like this: our identities, the “I am”, are constantly evolving, that evolution is likely to be related to our ability to exchange positional perspective with another, and this positional exchange is probably most often achieved through story-telling. If these assumptions were robust foundations for supervisory practice, they would help the workforce articulate the mechanisms of change in their work with families. During the workshops, we used survey monkey to ask participants about their work. The health-visiting workforce usually found it difficult to accept the perspectives of other workers and the families on their role. When asked about what they did with families that brought about change, the overwhelming response was that they supported families. In the context of austerity, claiming and naming a supporting role with families is probably not enough to safeguard the ratio of relatively high payed/high skilled work roles. Critical reflexive supervision, with developmental assumptions about the identity work of the self and the other as outlined above could help develop a refined and specific articulation about how ‘supporting’ families leads to change during families own times of transition. It would also help make the case as to why investment in the early years’ workforce will create not only the next generation of healthy children, but also a more open society.

 

In the time since I visited Exeter in October last year and writing this blog, I fractured my wrist. It gave me time to stop and think. When I come to think now, when the truth of a previously trusted positional voice is being frequently questioned and challenged, I think that we, those who may influence intervention policy and practice in the early years,  have an important role in resisting the present drive towards ‘telling how’.  We need to rethink and examine how we can support the evolution of the person – the person who is capable of creatively adapting to the circumstances that cause suffering, the person who is able to act with relational agency to find a way through the chaos.

Sean Connery and a Coca Cola: Alleviating Fatigue in the Air

Natasha Feiner

In the twentieth century crew fatigue was a major health and safety concern in the aviation industry. Alongside other health issues, such as cardiovascular function and eyesight, crew fatigue was tightly regulated. Flight time limitations, which regulated the hours of work and rest of pilots and cabin crew, existed at both the state and company level. As my PhD research shows, however, flight time limitations did not completely eliminate fatigue in the aviation industry. As such, workers often had to find other ways of managing their fatigue. Based largely on the oral testimonies of ex-pilots and cabin crew, what follows here outlines how crews personally managed fatigue in the air.

 

Food and Drink

For some people eating a cooked meal on board was important. Others preferred to graze. Joshua* a cabin attendant who worked for BOAC in the 1960s and 1970s used to ‘cross the Atlantic’ on bananas and cheese rolls. For Jane, a cabin attendant who worked for BOAC in the 1970s, Coca Cola was important:

I must have drunk half of the cans of Coca Cola on the aircraft because it was an instant hit of sugar. Any instant hit of sugar that could keep you going. I don’t touch anything like that now, I’m on mineral water or herbal teas, the odd coffee. But at the time Coca Cola.

For others, alcohol played an important part in managing fatigue. Gerry, who worked as a pilot for BOAC throughout the 1970s and 1980s, suggested that alcohol was used as both a stimulant and a sedative:

But I have to say that that night in America when you got there, it was something, you know go and have a few beers, was a way to stay awake, socialise, I mean I know alcohol eventually sends you to sleep, but initially when it’s still a social thing, you know, it kept you going so that’s what people did.

 

Sleep

In-flight rest was very important for crews operating long-haul flights. From the 1970s, bunk-rest was mandatory on long-haul flights. Though some crew members found this helpful, others struggled to sleep in bunks. William, who worked as a flight engineer in the 1970s and 1980s said that bunks were not ‘conducive to good sleep’. For pilots and flight engineers, an informal culture of flight deck napping – sometimes referred to as ‘controlled rest’ – was important. Although the safety of this was called into question in 1972 after an entire flight deck crew was found to be asleep at the same time en route from Sydney to Honolulu, from the ex-pilots I have spoken to, it seems that the practice remained widespread regardless.[1] As William noted:

It was quite common. It was approved really, everybody you know captain or first officer would say to the others, ‘can I close my eyes for a minute?’ and he’d [the captain] say yes or no.

A similarly informal napping culture also existed in the cabin. According to Eleanor, who worked as cabin crew for BOAC throughout the 1970s and 1980s, crew would informally allow each other breaks. If there was a spare seat in the cabin, crew would ‘pull a blanket’ over themselves and have a twenty-minute nap. For some, sedatives played an important role in pre- and post-flight sleep. A number of the flight engineers and cabin crew I have interviewed have told me that they used sleeping tablets, often prescribed by personal GPs, during their working lives. While some took Temazepam, others were prescribed Magadon. Though some used sleeping tablets frequently on long-haul trips, others treated their prescription as a ‘back up’, as Eleanor explained:

My doctor gave me some. I explained to him that I rarely, I rarely felt exhausted but would it be a good idea, I was seeing him about something else, would it be a good idea if I had some with me so that if I started to feel it building up with the time changes… he’d known me for a long time, he knew I wouldn’t be silly with them and take them as a matter of course. I made it clear to him I didn’t want to. Just, it was a, it was a sort of back up if you like.

 

Socialising

For pilots, socialising with the cabin crew was important. According to ex-pilot Adam, cabin crew played a key role in alleviating the fatigue of flight deck crew. Not only would cabin crew bring pilots meals and coffees, but they intermittently came in to chat. According to Adam this social interaction helped pilots maintain alertness. For some cabin crew, socialising with passengers was the best way of maintaining alertness. For Joshua, when the first signs of fatigue began to show, he would seek out celebrity passengers:

Every aircraft you had a passenger list. Every single person was down there and the important ones were highlighted so if I was feeling really really tired and I didn’t have another hour left in me, I thought I’ll go and bother Sean Connery for a minute.

Reflecting the subjective nature of fatigue, then, different modes of managing fatigue worked for different people.

 

*Pseudonyms are used throughout.

[1] Arthur Reed, ‘Ministry Inquiry over BOAC crew asleep at controls of jet flying 30,000 ft’, The Times, Dec 13 1972.

Balancing Lifestyle and Health: Reflections on a Public Engagement Worksop

‘Balancing Lifestyle and Health’ was a one-day workshop run at Exeter Library by the University of Exeter and Libraries Unlimited on 11 November 2016. Here, Dr Martin Moore discusses the event, summarises its discussion, and highlights where future collaborations might lead… 

For a slightly longer reflection, please see the discussion at the Libraries Unlimited site: 

‘Balancing Lifestyle and Health’ was a one-day, participant-focused workshop. It brought together a mixed audience of service users, public health practitioners, health service professionals, clinical commissioners, representatives from community and non-governmental organisations, and members of the general public, all to discuss ideas about balanced lifestyles.

The event itself was divided into four one-hour mini-sessions, framed by a short introductory talk by the organisers. Aside from these ten-minute prologues, the sessions were given over to participants to discuss the issues raised, and to record their conversations.

The programme of the day is appended to this post. However, to briefly recap, session one focused on “living well with illness” – a topic covering everything from illness and identity, to managing daily life. Session two began with an exploration of the successful Books on Prescription scheme, after which participants explored the relations between community and lifestyle balance. Session three (fittingly appearing after lunch so as to alleviate any pre-meal guilt), tackled the tricky subject of “balanced diet”. And session four asked participants what is meant by “work-life balance”, and whether any such balance is possible or even desirable.

Broadly speaking, then, the aim of the event was to simultaneously foster critical discussion, and to facilitate new links, between people who might not usually have sustained contact. By putting members of the general public in touch with service commissioners and public health professionals, for instance, we thus sought to help everyone involved come away with new perspectives, and enable them to develop lasting collaborations.

As might be expected from an event covering quite diverse topics, the day’s discussion was wide-ranging. There were, nonetheless, a number of themes that consistently reappeared throughout the day.

Responsibility

Perhaps unsurprisingly, a number of debates and conversations repeatedly centred on the theme of responsibility and reform, where discussants asked and answered “who is ultimately responsible for maintaining our health and wellbeing?”

Responses were diverse. Some participants raised the point that perhaps individuals have to be ultimately responsible. They argued, for instance, that we ultimately decide our eating habits, and that perhaps we have become too reliant on expert advice. The appropriate response across any number of spheres, they suggested, was to create much more of a cultural emphasis on self-care and self-management, and to orient our systems towards signposting and training, rather than “nannying” and treating.

On the other hand, many other participants highlighted broad structural problems that needed to be addressed. Maintaining health, and living well with illness, for instance, was deemed difficult within profit-oriented systems that only valued individuals for what they could consistently produce and monetise. Those “left-behind” and deemed “useless” suffered financially, physically and mentally, whilst those in work were also being pushed to their limits and scared to disclose health problems. Similarly, unhealthy working practices – such as long hours and poor pay – combined with changing geographies of work to threaten to healthy diets and work-life balance. Unreasonable work demands had resulted in quick, individual “al desko” lunches, which restricted sociability and nutrition. Long commutes reduced time and energy resources available for cooking, caring, and leisure pursuits. New working cultures and even regulations were proposed, alongside important educational programmes for children and adults, to ensure healthier diets and more balanced working and social lives.

Cultural Change and Community

Culture, sociability, and community, also reappeared in other discussions.

Throughout the workshop concerns were expressed about community breakdown and cultures of community engagement. There was little consensus about the cause of such decline. Nonetheless, discussants highlighted community and family dislocation as a possible cause for growing rates of isolation, for declining health, and for poorer eating habits. In terms of the latter, the decline of communal eating was felt to prevent transmission of good habits and to divert attention away from social elements of consumption. More positively, participants did praise the work of community-based organisations – such as libraries and arts groups – and felt it offered a way to combat community breakdown. How we can evaluate such work in a pseudo-objective, “outcomes”-focused, funding environment, though, remained a consistent concern.

Technology

Some participants did see a role for technology here. It was suggested that digital technologies had allowed for new communities and new forms of social activity to thrive. Yet, it was admitted that novel technologies could also be a double-edged sword. Some felt that digital networks still helped bring the loss of “real” local community. Likewise, other participants suggested that, although central to “flexible” working, new technologies also allowed work to become a “24 hour” pursuit. On the one hand, then, new technologies could enable people to better integrate work demands with family responsibilities and leisure pursuits. On the other, emails, “smart” phones, and work laptops could also risk generating new expectations that we should always be available and “connected”.

No “One-Fits-All” Model or Solution

Of course, what worked for one person was not taken to work for another. And in some respects, this was the core message of many discussions.

In dietary terms, the ideal diet varied from person to person, and a consensus appeared that there were no universal responses that could be put into operation to produce “better” or “healthier” diets. According to many participants, such a lack of agreement could be traced to an inability to find coherent messages from various expert sources (or sauces). Such advice needed to be taken with a pinch of salt (and aromatic five-spice). (My apologies for peppering this section with so many bad pun(net)s.)

Likewise, some discussants suggested that defining what was “life” what was “work” was difficult, and that we shouldn’t assume that less work would offer greater joy and “balance”. Life (as supposedly separate from work) could actually be very stressful and demanding. Caring duties could be financially and emotionally stressful, for instance. Equally, vocational jobs, although running the risk of exploitation from demanding employers, could also be incredibly enjoyable. Thus, participants proposed, no single model was preferable, and a holistic approach was needed to ensure we could tailor diets and working lives to our own needs and preferences. 

Problematics of Language

And, in many ways, these final discussions brought out one last recurrent theme: that of the problematics of language. Participants consistently questioned phrases like “balance”, “moderation”, and “work-life”, asking who defined such terms and how. This desire for a new – or at least a clearer – language also appeared in discussions of “living well” and “illness”. Both these terms came in for questioning, and it was suggested that talking about “illness” could be misleading. Similarly, the way in which labels and language could shape a sense of self was raised. For some discussants, diagnoses and labels opened up access to resources, provided a sense of solid identity, and helped explain what was wrong (and thus alleviated anxiety and self-recrimination). For others, defining oneself in terms of a disease or illness – or being defined in such way by others – could restrict employment or social activity, and trap people in a stigma. Finding new ways to talk about these issues was considered crucial.

Where Next?

 As can be noted even by the preceding discussion, the event contained a considerable amount of discussion, agreement and debate. And if there was one criticism of the day, it was that we tried to do too much, or at least had to curb discussions that could have filled whole days in themselves.

In spite – or possibly because – of this, the event proved to be extremely well received, and we managed to fulfil our two broad briefs for the day.

However, “Balancing Lifestyle and Health” was only ever intended as an event to lay foundations.

We will soon be making contact with participants to see what sort of events they would like to see in the coming months and years. For ourselves, we believe that running half-day workshops on each of the workshop themes – diet, community, work-life, and living well with illness – would be productive. We would also like to move beyond the city, into Devon more broadly, and perhaps to think in terms of more concrete policy and workplace solutions.

For now, however, we would like to thank everyone who contributed to the day. As organisers we found it incredibly enlightening and invigorating. And we very much look forward to running further events with you in the future.