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How foot and mouth disease affected a rural continence service

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VOL: 97, ISSUE: 40, PAGE NO: 59

SANDRA BEATON, RGN, is continence adviser, Carlisle and District Primary Care Trust

The worst of the winter came late to our area this year. I live 20 miles from the clinic, and during the last week of February we had blizzards and heavy snowfalls that prevented me from getting into Carlisle for three days. We had no electricity and no way out, since the road was blocked for two days. During this time we were unaware that foot and mouth disease was erupting around us, but with power restored and roads reopened it became obvious that we were at the epicentre of this terrible outbreak.

The worst of the winter came late to our area this year. I live 20 miles from the clinic, and during the last week of February we had blizzards and heavy snowfalls that prevented me from getting into Carlisle for three days. We had no electricity and no way out, since the road was blocked for two days. During this time we were unaware that foot and mouth disease was erupting around us, but with power restored and roads reopened it became obvious that we were at the epicentre of this terrible outbreak.

It is difficult to describe to anyone not involved the absolute terror that this awful disease causes among rural communities - it affects everyone due to restrictions on movements. Our local press was soon comparing it to medieval plagues such as the Black Death, and at times it felt as if we had made little progress in disease management since that time.

As has been the case in so many disasters, we had no idea of the scale of the outbreak. In our area we are used to short spells of bad weather and at first we thought that the plans we used for dealing with this situation would be sufficient. We know our clients always keep a few spare pads or catheters 'just in case', and staff save a few days annual leave for emergencies, such as not being able to get into work. Within the first two weeks it was clear that this new situation was going to be much worse.

Our continence service covers Carlisle and District and Penrith and Eden Primary Care NHS trusts. We began our first home delivery service for pads in November 2000, amid problems with fuel supply and widespread flooding. Now we had to contend with ever-increasing restrictions on access to the countryside. With the assistance of our pad suppliers we contacted everyone days before they were due for a delivery to ask for specific instructions. With 1,600 clients and the situation changing daily this in itself was a huge task.

We assumed that all farms were out of bounds unless the farmers told us otherwise. Our delivery driver faced detours due to closed roads most days as livestock was culled and carcasses were burnt. Every country lane had disinfectant mats or straw in place that considerably slowed his progress. He diligently disinfected his van and footwear as required. Since March he has gone through two pairs of boots, as the disinfectant used ruins footwear.

All farms set up collection boxes at their entrances for mail, and with the farmers' permission pads were often left there. All our pads are delivered in plain blue plastic outer wrappers, so the contents were not identifiable. In some cases elderly people who required medical or nursing care chose to move to stay with relatives in villages rather than risk introducing the virus to their farms.

Initially most animals were burnt on huge pyres on the farm where they were slaughtered, and this was the image that was widely represented in the media. What could not be portrayed was the overwhelming smell emanating from the fires and from livestock waiting to be burnt. Continence company representatives visiting Carlisle and district were visibly shaken by the sights and smells as they entered the area - many fires were beside the motorway. We had planned a study day for May which had to be postponed, as it was to be held at the local agricultural college.

The trust was very supportive of staff as many live on or near farms and were afraid of spreading the disease to their own or their neighbours' livestock. Some nurses who were in this position were able to work in the city area, while nurses from the urban areas covered their areas. Regular updates were supplied by the public health department of the health authority, but the picture changed almost hourly and a farm still clear in the morning could be suspect by lunchtime, which made clinics and visits very difficult to organise. Trust guidelines decreed that a nurse visiting a farm that was infected could not visit any other farm for seven days.

We run clinics across the trust and most of these are in community hospitals, so each week we contacted those with appointments to see if they still wanted to keep them. We found that even those living in countryside villages were unwilling to come for fear of carrying the virus back on their feet or vehicles. Those who did attend had only one topic of conversation - foot and mouth. It became apparent quite quickly that this animal disease was having an effect on the lives of people as well.

Near the burn sites respiratory conditions deteriorated - whether due to the smoke or stress is yet to be proved. Some of our clients had to move from their homes, others remained in their houses with the doors and windows closed. As time passed we had an increase in referrals for children who were bedwetting, often following long periods of being dry.

Some rural surgeries provided 'tea and a chat', inviting retired farmers to meet with those affected. Country people have their own way of dealing with problems, and this form of informal counselling has been used to great effect. Many of our follow-up appointments and routine reviews had to be conducted by telephone.

For me one farmer seemed to sum up the feelings of helplessness and frustration felt by all when he rang to ask for some catheters. He had contacted his local pharmacy only to be told that the 'reusable' catheters he was using had not been produced since 1999. He told me he had kept a few of the catheters around the farm building and on his tractor for use while he was working. Following the loss of his livestock the cleaning team arrived to disinfect the farm. During this operation his stock of catheters went missing. He told me indignantly: 'They burnt my sheep and cattle, and now they've even burnt my catheters.'

Many businesses have been seriously affected, and tourists are only now starting to return as more of the countryside is re-opened. Since March I have travelled to work daily without seeing any animals in the fields.

We hope we have managed to maintain a service to our clients and support to staff through this difficult time and can only hope for better days to come.

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