“The ethos of St George’s meant that we survived and flourished as a group, and as individuals”
Published: 10 July 2020
Group Captain Andy Green.
Group Captain Andy Green graduated in Medicine from St George’s in 1981. A member of what’s now known as the ‘Guinea Pig Year’, he was part of the first cohort to study on the new St George’s site when it first moved down to Tooting from Hyde Park Corner. A Consultant in Clinical Microbiology, Group Captain Green is now Director of Infection Prevention and Control for the Ministry of Defence. He acts as an adviser to the Surgeon General on all aspects of infectious diseases and their control, including biological warfare. He spoke to us about his journey into the prevention and control of communicable diseases and how our understanding of infectious diseases has developed over the years.
Talking about his career pathway, Group Captain Green explains: “When I qualified from St George’s I had no real idea about what to do, and had never considered joining the Armed Forces. But then I saw a glossy advert in the British Medical Journal showing a doctor leaning on the wing of a Royal Air Force Harrier Jump Jet – and the rest is history.” He trained in General Pathology before specialising in Medical Microbiology. On appointment as a consultant, he also undertook additional training to become one of the first Consultants in Communicable Disease Control.
Group Captain Green’s career has taken him across the world, investigating disease outbreaks in the Falklands, Ascension Island and even on-board Her Majesty’s Yacht Britannia. The latter involved a dinner hosted by the Queen for 54 Heads of State at a Commonwealth Conference, which led to a yellow (quarantine) flag being raised for the only time in the Royal Yacht’s history as a result of an outbreak of salmonella amongst the crew.
Picture above shows Group Captain Green in 1978, as a second year Medical Student.
As a newly accredited Consultant he was involved in the first Gulf War, and subsequently the various military deployments in the Balkans. The change in Government strategy during the late 1990s led to greater British involvement with United Nations peacekeeping missions, as well as humanitarian and disaster-relief efforts. The actions to defend the Sierra Leone population in 2000 from rebel forces resulted in significant infectious disease impacts, most notably from malaria and Lassa fever.
Group Captain Green adds, “The events of 9/11 changed the world in many ways, and the effect on the Defence Medical Service was profound for the next 13 years. There were constant challenges from infectious diseases in both Iraq and Afghanistan (and still are, since personnel remain in both locations), but especially from battle trauma. There were many remarkable leaps in medical care during this time, including significant improved outcomes from battlefield infections.”
Andy was part of the team that identified previously unrecognized fungal infections caused by environmental organisms embedded during injuries caused by improvised explosive devices, which led to in excess of 100 individuals recovering from injuries that should have killed them – the so-called ‘unexpected survivors’.
During the summer of 2014, Group Captain Green was one of the national leads advising on the Ebola outbreak. He had been instrumental in establishing the RAF Air Transportable Patient Isolator capability in the 1990s, and had periodically repatriated British nationals with highly transmissible infectious diseases to High Security Hospital Units in the UK. Over the following 12 months the RAF mounted a series of moves of extremely ill Ebola patients both from Africa and within the UK, and were firmly established as international leads in the field. Following Ebola, he has been engaged at national and international level with the development of standards of care for patients with High Consequence Infectious Diseases, and establishing international networks.
Speaking about his experience of the last few months, Group Captain Green says, “Like everybody else in 2020, I have been fully engaged with Covid-19. In my case, however, I also have previous experience to draw on from the outbreaks of SARS, Swine Influenza, and MERS-CoV.
“I had also been involved in cross-Government work in 2013-2014 that identified the potential national threats posed by novel infectious disease outbreaks, and focused on the areas of concern outside of immediate medical management. These included the economic effects, communication approaches to the public, the impact of novel technologies, and the importance of understanding what mathematical modeling could (and could not) offer for a disease that was previously unknown.”
He talks about the difficulties presented by the pandemic, explaining, “the contribution of the Armed Forces has been extensive but not always obvious to the general public. High profile activities involved building Nightingale Hospitals, assisting with delivery of personal protective equipment (PPE) and Mobile COVID-19 Testing Units.
“Less obvious was the support to the civilian authorities in the background, with over 70% of the Defence Medical Services fully employed in Covid-19 activities and everyone placed on 24 hours’ notice to deploy. However, the prime role of the Armed Forces remains the security of the UK, and the pandemic has seen no lessening of threats from aggressors in either the homeland or overseas. Ensuring that such activity continues in a safe way with respect to Covid-19 is extremely challenging, particularly given that many overseas locations are at very different stages of the pandemic.
“A large amount of my time is spent reassuring politicians and Senior Officers that uncertainty is acceptable and indeed normal in the face of a novel disease, and that the key approach is to retain flexibility of response when faced with new knowledge as it appears. Novel ideas and technologies may play a role, but there is no substitute for clear and logical thinking with defined aims and objectives.”
On his time at St George’s, Group Captain Green adds, “St George’s trained us to follow reflective practice, which is a fundamental part of any medical activity. The unique challenges posed by being part of a fledgling Training Programme in a new location, meant we were all adept at coping with unforeseen problems for which there were no ‘textbook solutions’. The ethos of St George’s meant that we survived and flourished as a group, and as individuals.”
He concludes, “Would I be doing what I do now if I’d trained somewhere else? Who knows. But I do know that I would be doing it differently, and probably not smiling as much as I do today.”