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Backbone of Britain: Rural GP reflects on caring for his local community in 2020
A GP with roots in farming, Dr Eilir Hughes finds himself at the frontline of the fight against Covid-19 in more ways than one. He reflects on helping to keep his rural community in Nefyn on the Llŷn Peninsula safe and well during the last year. Hannah Binns reports.
Growing up on the family farm, Dr Eilir Hughes never imagined he would be on the frontline fighting a global pandemic at the hospital next door.
A GP in Nefyn, on the Llŷn Peninsula, North Wales, Eilir qualified in 2017 and works at a practise a couple of miles from his rural roots.
But the pandemic led Eilir to isolate himself from the family farm, which milks 140 British Friesian Holsteins and supplies South Carmarthen Creameries, to prevent spreading the virus after working in hospital wards with positive cases.
“Staying away from the farm was the right decision to protect my family, but it has taken its toll from a personal, psychological and emotional perspective,” says Eilir.
“This year I wanted to get the balance right between being a doctor and farming, especially as my uncle and father, who run the farm, are not getting any younger, but the Covid-19 crisis has made that extremely difficult.
“There is a real lack of resource and a need for expertise within the NHS, so it poses an ethical dilemma.
“While I have the knowledge and ability to help develop and deliver services, I miss being outdoors and it has impacted on my wellbeing.”
Farming links
Drawing on his farming knowledge in his approach to the pandemic, Eilir helped establish one of Wales’ first Covid-19 respiratory assessment units.
“As the clinical lead for the area, I was involved in planning and delivering the community health service response to Covid-19, and applied similar principles to good animal husbandry, such as segregating sick patients to one centralised place, to help prevent the virus spreading,” he says.
Yet less people sought medical help as the crisis evolved in the spring months, fearing the high-risk environment despite the adoption of technology such as telephone and video consultations.
“The NHS approved video consultation software has been worth its weight in gold, but we encountered issues with the service for patients who live in areas with poor internet connectivity,” he says.
With the age of people over 80 in the area 40 per cent higher than the national average, Eilir adds the stoic nature of the community also factored into it.
“Rural people are very resilient so there was a degree of trivialising symptoms as well as an understanding some cases had to be prioritised,” he says.
“From May onwards, it became clear people were finding it very difficult to manage their conditions, especially those which were advancing without the necessary treatment.
“People with significant chronic disease, such as lung and heart disease, had not been reviewed by their specialists and their conditions will have deteriorated.
“Those who needed hip and joint replacements found their procedures postponed, which not only affected their ability to work but caused further physical pain and psychological burden.
“As hospital services were, and remain, limited, the responsibility has fallen on GPs’ shoulders to
manage patients’ ongoing conditions instead of inputs from specialists.
“The waiting list could be years for some operations and all we can do is prescribe stronger painkillers, which is far from ideal.”
Tourists
Eilir adds that an influx of tourists during the summer months had put a strain on the rural community and their wellbeing, with people finding it difficult to cope with.
“Some 10 per cent of houses in the county are second homes and as soon as the restrictions were lifted in the middle of July, the population doubled, if not trebled,” he says.
“Residents, who had not been allowed to travel further than five miles, saw their local areas inundated with tourists and found it psychologically difficult to deal with as they felt restricted and anxious about what they were able to do.
“For farmers with diversifications, it was a difficult interplay for them, having to weigh up income and the potential risks of tourism to the health of their community.”
Population
Eilir adds the increase in population also put a huge strain on the GP practises in the area.
“To help stop the spread of the virus and make sure services for permanent residents were not disrupted, we assigned a dedicated service, funded by the area, to deal with holiday makers at a single point,” he says.
The lack of a nearby testing facility further hindered the health care service for the community.
“We need satellite smaller units with accessible testing because it is ridiculous to presume everyone who lives in a rural area can drive,” Eilir says.
“In the community, there is a lot of deprivation and many people do not have the ability to drive, purely depending on others and public transport.
“But if you lived in the far end of the peninsula and needed a Covid-19 test, you had to travel 60 miles for one, which has caused all sorts of problems.”
Eilir says the Welsh Government’s ‘firebreak’ lockdown was well received and numbers of Covid-19 cases decreased.
But he warns the NHS is in a worse state than ever before, with tired hospital staff and some intensive care unit (ICU) nurses off sick with the virus or suffering with prolonged stress.
“Rural communities struggle to recruit doctors and we have had to adapt in the last few years to provide GP services in the area, training up nurses and paramedics to become advanced technicians to help share the work,” he says.
He adds that the mood for a Covid-19 vaccine is favourable among the rural community, with farmers used to vaccinating their animals for health reasons.
“While news of a vaccine is promising, we have yet to receive an instruction it will happen this side of Christmas,” Eilir says.
“It is important we continue to stick to the guidance as it will take a long time to vaccinate everyone and for the benefits of mass vaccination to seep through.
“Already we have delivered hundreds, if not thousands, of flu vaccinations this winter and I urge all farmers to get theirs as soon as possible.”
“As the virus is airborne, I am also pleased to see the UK Government promoting stosslüften, a
German practise which involves opening windows properly, at least twice a day, to help circulation
in places where people congregate.
Mental wellbeing
One concern for Eilir is the impact the Covid-19 is having on peoples’ mental wellbeing.
“Historically pandemics have shown to cause long term negative effects on mental health, and so its impact will be felt for a significant time afterwards,” he says.
“A lot of the community is dependent on tourism and the loss of business and work will have been a heart-breaking situation.
“Older people have also had to shield and isolate for long periods of time, missing that vital human contact.
“This, combined with the seasonality effect of shorter, gloomier and darker days and people unable to congregate indoors, is a real cause for concern.”
He urged anyone worried about their health to get in touch with their GP and not to take no for an answer.
“Like in farming, early invention is often key to good outcomes, but I am really nervous people will avoid seeking help,” Eilir says.
“The practise is looking to provide extra support for farmers and has been in touch with various charities, including RABI, DJP and FCN, to create a pathway to any help or support they may need.
“It takes a hell of a lot of courage for people, farmers included, to come to us and admit they need help so we must make sure we support them in the best way we can.”
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