Being a health protection nurse specialist

In the last blog I finished by talking about calls that came directly from members of the public. These were the kind of calls that you never really knew where they would take you or what you would be talking about but these were often when our responses really made a difference to people’s lives.

A great deal of our daily work revolved around calls related to notifiable diseases. By law, all notifiable diseases are mandated to be reported to the local Health Protection Unit. This included cases of food poisoning, unusual illness presentations, cases of meningitis and other infectious diseases. These prompt specific actions from the team of nurses and doctors to identify where people could have picked up their illness from, recommend treatment and ensure no further spread could occur.

But there were other calls that took time to properly understand and investigate. These required the use of many different tools to understand where the source of concern was coming from. Here you would need weather patterns to understand prevailing winds, google earth to get a full topography of the area, historical maps to understand what was previously in the location and local GP practice support to see how many other similar reports there had been in the area.

I spent one summer working with a family experiencing odd smells from their downstairs living room that was associated with headaches. They lived at the bottom of a hill at the top of which were other houses and a small garage. The garage had maintained and fixed cars from the local area but has used to sell petrol. Working with the local environmental health officers and the family GP, we investigated to find the type of smell, what weather patterns made it worse, if anyone else in the village had similar issues and what other possible causes there could be.

The house was about a mile away from an old waste sorting centre that was now set to recovery. Grass had grown over the slowly decomposing waste and gas release pipes had been put in place to prevent build up. A first thought was that methane was blowing towards the house and settling in the dip. We quickly ruled that out as this was not within the right geographical range for the prevailing wind to blow towards the house.

Further investigation with local residents revealed that the source was closer to home. The petrol storage tank at the garage had recently been dug up and a split had been uncovered. A large amount of petrol had leaked down the hill following the contours of the land and settled underneath the family’s house. Petrol contains polycyclic aromatic hydrocarbons (PAH). The PAH’s in the petrol were slowly breaking down and the odour was seeping up through the old foundations of the cottage. These were thought to be the cause of the smells and the headaches.

The family moved out and the contaminated soil and aggregate were removed and replaced. An impermeable barrier was placed to ensure that any residual petrol did not continue to seep down the hill and cause a recurrence of the issue. Over time, the family were able to return to their house, odour and finally symptom free.

Finding a source for the issue or concern was reassuring to the person who called, but sometimes the response we gave was more about providing reassurance and evidence to support that opinion.

A local vicar from one of the parishes in Dorset contacted us concerned that a close group of people all living in houses that drew water from the same private source had experienced a similar illness. Each one of the households had a member of the family who had been treated for some sort of cancer in their lifetime of living in the village. The vicar had contacted us as a representative of the concerned people who had come to the conclusion that this was all linked to the water supply.

Working closely with leads from the local authority public health teams, we were able to provide reassurance and evidence to back this up, that this was no more than a coincidence and that the illness each of the people had been treated for was more common than they initially appreciated.

This took time to resolve, with several phone calls and letters to households with our findings. In the end, to fully reassure all those concerned, we set up a number of joint meetings in the local town hall with all those involved. These weren’t easy but were essential and came to good outcomes.

Having stepped away from providing direct patient care, these were the type of calls that gave me my ‘nursing nourishment’. They allowed me to make a difference by using my experience and communication skills to make relationships with people that often would only ever be over the phone. This was where I pulled on the experience of having difficult conversations within intensive care and as a clinical risk advisor as well as through my training

Responding to these calls during the day was made easier due to being surrounded by experts and colleagues to bounce ideas off.

Out of hours however this was less simple. With just a mobile phone and a list of contacts to get advice from on call always seemed to attract a different type of call….but that will have to wait till the next blog.