Posted on: 1 June 2020

 

Meet Dr Natalie Webber, one of our junior doctors who is spending 12 months with CNWL as part of a rotational programme as a Palliative Care Registrar.

Recently Natalie has been asked by the World Health Organization (WHO) South East Asia Regional Office to help develop guidance for palliative care and Covid-19.

With a diploma in tropical medicine and hygiene, and global work experience in Kenya, and Uganda; Natalie is working on a chapter for the management of severely ill patients.

She said: “Dr Jon Martin, Dr Emily Collis and Dr Libby Sallnow have generously shared their expertise and protocols that they developed for use in the UK to help me in the development of guidance which covers the acute management of the severely ill patient, clinical decision making in a resource limited environment and symptom control. I’ve ensured that there is significant focus on what you would do for patients who don’t get better and how you manage the end of life appropriately, safely and with dignity.

I will also be involved in updating already existing carer information leaflets that were initially developed for the HIV/AIDS epidemic. This focuses on delivering palliative care in the community, and I’m looking at what needs to be changed and amended to relate to Covid-19.”

Natalie has just completed her UCLH Specialist Palliative Care rotation and is already working in the community. However, Natalie originally wanted to be a trauma orthopaedic surgeon.

It was during her time in Kenya, roughly five years ago, she saw the need for palliative care in a small district general hospital where she was volunteering.

“There wasn’t really an understanding of what palliative care was but I was seeing so much death and dying in this hospital that it felt that a basic understanding of palliative care could do so much more for patients  than expensive ICU equipment that no-one was trained to use.”

Dr Natalie Webber in Uganda Hospital.jpg

Picture: Dr Natalie Webber (middle) in Uganda

Following this, Natalie decided to apply to become a speciality doctor in palliative care in the UK.

She said: “I kind of went there (to Kenya) to work out what I wanted to do in medicine, until that point I hadn’t really considered palliative care as a career.”

Whilst working at the Royal Marsden, Natalie took a year out of training to return to Africa and volunteer in Uganda. 

She said: “That’s where my heart lies, I try to integrate it into my NHS work as much as possible. During my time in Uganda I undertook a needs assessment which showed a significant burden of chronic disease and unmet palliative care need amongst the South Sudanese refugees which was not unsurprising given that the provision of palliative care was largely reliant upon a hospice team of five or six nurses, and a small number of trained staff in local health centres. It is research like this that drives me to continue working in low- and middle-income countries. ”

And since returning from Uganda, Natalie runs remote palliative care teaching in the Democratic Republic of Congo (DRC) with doctors and nursing staff in a small hospital.

Discussing how the team is handling Covid-19 in the UK, Natalie describes the palliative care service as ‘very responsive and has rapidly adapted to a very different way of working’.

She said: “We’re a specialty that’s all about the personal connection with our patients and their relatives. In these last few months we have been met with the challenges of breaking bad news in PPE, the rapid speed of deterioration of Covid-19 patients, and supporting separated families over the phone that we have never met.

It has shown us that we can deliver good palliative care remotely, whilst it is better for our patients and our relatives if we can do these things face to face, I think that there’s a lot of translatable learning from our experiences here in the UK that will help to really accelerate the development and delivery of palliative care in low-and middle income countries, and we hope our WHO guidance can reflect this.”