Meet Dr Shade Agboola. Her passion for treating preventable diseases started in Nigeria while working to help prevent children dying from malaria and malnutrition. Now in Warwickshire she’s doing the job that is arguably the most critical to local government’s response to the pandemic – the director of public health – as it’s the link between the NHS and councils. West Midlands Employers caught up with Shade, Warwickshire’s Director of Public Health (DHP), to find out what it’s been like to be on the frontline of the pandemic – and what needs to change for the future.
What’s it been like being a new DPH at this critical time of covid-19?
It’s been a baptism of fire. I started last October and it’s my first Director of Public Health role. When I got the call from Public Health England late March informing me about the first case of Covid-19 case in Warwickshire, I never imagined that things would be where they are now! That was the beginning of an unbelievable experience for me; I’ve never been so busy and I’m still working every weekend. No amount of training could have prepared me for what was to come.
On the positives, I inherited such a good team – 20 altogether with five consultants in public health reporting to me. I also think I’ve managed to stay ‘unruffled’ under the pressure, partly because I’m very organised and keep lists on everything and I’ve got a good memory – those skills have really helped me as a new DPH.
What have your priorities been during the pandemic?
The priority was, and remains, to contain the pandemic and that means getting those health messages out locally. Even before the start of lockdown Gold Command – the top level of emergency planning group which includes senior officers in the Council was meeting daily to decide the actions required to implement the Government’s Coronavirus Action Plan, making sure we, as a Council, were doing all we needed to do in our services and in our support to our communities.
I spend a lot of time working with partners across Warwickshire – especially the district and borough councils making sure everyone is kept up to date. I realised that this was the time to step up and I worked at establishing relationships with partner organisations very quickly.
Some things in the early days were very practical like talking to all Faith Leaders about closing Mosques and other places of worship – some didn’t want to do that initially, but were persuaded – before the Government lockdown.
Part of the challenge was the speed at which things were happening. At the peak of the pandemic there was so much guidance – we could barely keep up. For example the guidance on the use of PPE changed over time – and was very different in different settings such as care homes, schools or the workplace. We had to translate what that meant and get that to people very quickly. We provided a lot of support to care homes 24/7 too and brought in testing when it was clear it was essential. We set up an Out of Hours rota of support to our homes.
What lessons have you learned?
I learned the value of communication – I have learnt to tell people everything, even if they don’t need to know it all, that’s better than people making up their own message, which is often what happened when people don’t get enough information.
I’ve learned to never forget partners. Everyone needed to know what was going on and had a role in helping to reduce the impact of the pandemic; from environmental health, regulatory services, leisure centres, housing to trading standards.
What’s taking up your time now that we have reached 100 days of lockdown?
All of my time is spent on Test and Trace – it’s dominating everything now that it’s finally up and running! While I’m disappointed there isn’t an app yet, traditional contact tracing can be very effective and essential to contain local outbreaks. We are one of the 11 national Beacon projects, with Coventry and Solihull Councils and the West Midlands Combined Authority, to pilot how we work together on our Outbreak Control Plan, then share that learning with other councils. Our Plan has just been launched and sets out how we will quickly identify and isolate cases to help us stop and manage outbreaks.
What’s your view on the recent easing of lockdown such as the social distancing change?
I have mixed feelings. The risk is still with us. But I’m also concerned about the mental health impact on those people who have been shielding for three months now, often with very little human contact. I know we’ve had an increase in calls about mental health. So while I do welcome easing of the lockdown, I don’t want anyone to think that this is over – that’s not the case.
What do you think about the PHE findings about the BAME community?
I think it shows the importance of the wider determinants of public health. The Public Health England report showed that people from BAME backgrounds are at a higher risk of dying with coronavirus – partly due to lower socioeconomic status, higher prevalence of diabetes, heart disease and obesity – with poorer health outcomes.
It highlights the need for some real discussion on public health and prevention post this pandemic. Even in Warwickshire we have a life expectancy gap between the more deprived north and the south of the County. How we address this isn’t quick – it’s structural change. Health campaigns and messaging tend to reach those with higher incomes who can respond to them. My DPH Annual Report will certainly be focused on health inequalities.
We also still have an NHS that remains a treatment service – more emphasis needs to go into prevention and the entire system needs to change. I worked on a Stroke Pathway once – all the emphasis was about the care after the stroke not how to avoid a stroke from occurring in the first place.
What were you doing before coming to Warwickshire?
After medical school I was working in northern Nigeria, a very poor and deprived part of the Country. I was treating largely preventable diseases including malnutrition and malaria in children. I was helping mothers to ensure they don’t have stagnant water around their homes and to use mosquito nets and repellent. I got real pleasure from that health prevention approach. I decided to complete a Masters in Public Health at the University of Nottingham followed by a PhD in Medicine on Smoking Cessation and Relapse Prevention.
What should everyone do to improve their own health – and avoid ‘underlying health conditions’ like obesity?
There are two things – what we eat and how much physical activity we do. Eating ‘clean’ for example, eating lots of vegetables and unprocessed foods and regular physical exercise are two of the most important things we can do as individuals to improve our health. There are other factors beyond our control but most of us can control what we eat and how much and how much activity we get.
What do you do to keep yourself fit?
I’m doing the couch to 5k again and getting out at least 4 times a week for a walk or run! I have realised how much activity I normally do day to day in the office walking between buildings and up stairs – far more physical than now with my desk in my front room. But it’s a lot less hectic now at home as my kids aged 16, 10 and 6 are in school. Initially I thought I’d be able to home school – that quickly fell apart and as a key worker they’ve been in school virtually this whole time. They loved it – no school uniforms or school dinners!
