"The gentle act" by Rachel Stredwick and Tamara Enthoven
The walls shrink closer,
But the outside fall further away
Left inside, a small dot shuffling between rooms
Only the scratch of the carpet rings out
Lingering over memories, absent, aimless
Time has rubbed away the corners
Battered the bones
Consumed friends and forgotten family
Stillness grips the throat
While loneliness holds your hand
At home, bound in melancholy
This illness roots itself in the soul
A weed – strangling
But compassion, the stronger seed,
Can out compete
Like a daisy with its yellow sun
And white petalled halo
Stretching out beyond empathy
An overflowing meadow
Growing through the cracks in the walls
Overpowering loneliness
Unbinding the bound
Compassion is healing
A remedy with a blossom scent
Sweet with respect
Rich in love
The balm of Primary Care
Applied to soothe achy souls
A kindness beyond measure
A gentle act of humanity
Reflection
As we entered the flat of a patient with chronic COPD, untangling the lead of their oxygen tubing as we walked down their short and narrow corridor, we felt the loneliness and social exclusion weight heavy on our hearts.
General practice is a place in the heart of the community where health inequalities cannot be avoided and disregarded but confronted and challenged. Housebound patients can be left forgotten by society, and many do not have family close by to rely on, leaving memories left as photo frames on dusty, cluttered surfaces, covered with unopened post and unread magazines.
Home visits are unique to primary care, imprinting unforgettable images in the minds of those who visit which is hard to transform into words but was attempted in the first few stanzas. Only by seeing into the nature of this suffering with your own eyes is deeper compassion achieved, not just empathy and kindness. This level of compassion can metaphorically be seen as an extra layer unique to primary care, the ‘balm of primary care’.
‘But the outside falls further away’ can show the effects of chronic disease on patients due to the deterioration of communication. Our patient was so breathless that he could not complete a sentence in one breath and became so fatigued within a short amount of time. This is where a listening ear, an observing eye and a compassionate heart can momentarily help a patient feel that they do have someone looking out for them.
Additionally, language barriers leave many patients unable to understand the information that they have been told, leading them to retreat further into ‘illness’.
‘Weeds, daisy, roots, seeds, petals’ can be seen as a metaphor for the environmental inequalities faced by many people and patients. Ethnic minority communities are disproportionately burdened with health hazards through policies and practices that force them to live in proximity to sources of toxic waste, major roads and sewage works.
London is already in a climate emergency and a four-lane tunnel under the River Thames in East London is only increasing early deaths due to respiratory and cardiac diseases. In addition to this, summers are hotter than ever and winters colder with unaffordable heating bills, leading to the increasing need to access primary and secondary care services.
Community centres and outreach groups can bring people together, particularly patients like this though some even two years after Covid-19, have not been reinstated due to cuts in community funding. Links between primary care and community-based health and social services can improve patients’ access to health care to improve health and wellbeing. They can often support people with multiple, complex health needs, helping patients feel that they have a purpose, to stay alive as well as possible for as long as possible.
At the foundation, a compassionate approach to healthcare must be fundamental, the greatest of the medicines. Through a compassionate practice we can reach out into the community and meet them where they are able to better understand the inequalities faced and their solutions.