Where there is pain, there is love

“When do you suppose babies became so very precious? Are they more valued now because they can survive or do they survive because they are more valued?”

Call the Midwife (Season 2, Episode 5; set in 1960)

Let that sink in for a moment……

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Poplar to Aberfan

Now let’s surge forward to 21 October 1966 to an event that still remains raw for those ripped and crippled by its devastation. At 9:13am, in the village of Aberfan, South Wales, a 34-metre-high waste tip from a nearby colliery collapsed down the mountainside, instantly engulfing Pantglas Junior High School and 19 houses with 110,000 cubic metres of thick, black, quicksand-like slurry.

144 people died, of which 116 were children.

How does this make you feel?

Sometimes words aren’t enough, and I must confess I only learnt about this when recently watching an emotive, and arguably the most gripping, episode of the outstanding cinematic TV series The Crown. It was a visceral experience to learn about this for the first time via a depiction that was crafted with dignity and finesse to capture the purity of joy, innocence and love lacing the everyday events of children’s lives, and the pain that roared throughout this Welsh valley and beyond following the avalanche.

How did I feel? Shocked. Fascinated. Devastated.

Why? Largely because they were children, and the feeling in my gut that this was preventable.

Children and Young People

Why is it that people are very protective of children and young people? Why is there so much emotional intensity surrounding them? What makes them so precious and valued?

In the immediate response to the waste tip collapse ‘women were clawing at the slurry – “some had no skin on their hands” – trying in vain to reach children who could be heard crying’. The site of the school was a hive of activity filled with desperation and despair as thousands of volunteers, experienced miners (including parents of the school children) and trained rescue teams exhausted themselves to unearth any children from the rubble. The efforts of volunteers reportedly hampered the work of the miners and rescue teams yet they were driven to act by the sheer love they had for the children. As one mother reportedly said:

“There was nothing anyone could do. That was the worst, not being able to do anything. There’s nothing as bad as that”

Mother of Pantglas Junior School pupil

The urgency of the immediate response to the waste tip’s collapse conveyed the immense and unique emotional connection and effect children and young people create, particularly in times of crisis. In everyday life they can inadvertently yield great power in renewing who you are, in unveiling your armour and unearthing parts of you one didn’t know existed, and captivate you with bewilderment and love. I may not be a parent to a child myself, yet I know we can give and exchange so much of ourselves with children that we feel they give our lives meaning and become weaved into the fabric of our existence.

So when they experience harm or distress, or at worst are taken away from you, it can unravel unbounded upheaval to the extent you feel your existence has been uprooted. It must be harrowing to experience; the pain must be unbearable. Even if they are not your child to witness and experience such events can be devastating. Some survivors have reported experiencing survivors guilt and flashbacks being triggered by children’s voices. Others left Aberfan, blocked events out, never spoke of them again or returned to the village following the disaster, whilst many experienced premature deaths due to the ways they mediated the aftermath.

Yet love not only immersed and symbolised activities during the immediate response, but continues to do so 53 years on. Volunteers underwent an intricate and painstaking process of cleaning, dressing and detailing each person who had died to ensure they were not only identified but laid to rest with the dignity they deserve. A mass funeral for 81 children and 1 woman six days later took place and radiated with love and reverence for all who were tragically killed, as do the spaces of Aberfan Memorial Garden (on the site of Pantglas Junior High School) and Bryntaf Cemetery (see image below). Moreover, there are still Mothers who say goodnight to the children they lost.

I have never known love so powerful and enduring.

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PAEDIATRIC HEALTHCARE IN THE UK

One thing that is therefore certain, and arguably universal, is that when children and young people are harmed or in distress, many adults are driven, almost possessed, to do all they can to help. Yet so often people who don’t have the capabilities and capacities wish to help but end up doing more harm than good, as may have been the case in the immediate response to the Aberfan waste tip collapse. Keep this in mind as I now discuss how children and young people are medically cared for here in the UK, particularly those who are very unwell and thereby require critical care.

Paediatric Critical Care

Many hospitals across the UK have Paediatric Intensive Care Units (PICUs), or an equivalent, staffed with a range of specialist highly-skilled staff from Nurses to Consultants. The capabilities they develop from substantive training and regular exposure are extraordinary. Yet like many NHS resources they are under increasing strain, in addition to the challenges that come from medical advancements, a continuous drive for survival in children, high public expectations and demands, and litigation battles. There are also several Acute Transport Services that conduct inter-hospital retrieval and transfer of seriously unwell children who require continuous critical care.

I am blessed to have been able to witness the care in PICUs, and was blown away by the knowledge, skill, personality and energy many exuded in diligently giving each and every child the best possible chance of life. Yes, the medical technology was indeed impressive. But the extensive numbers of people that will touch the life of each child, along with the countless meetings, discussions, one-to-one conversations, clinical interactions and limitless calculations are all an astonishing mark of the compassion many of the clinicians foster for the children in their care and their families.

It was my experience here that inspired me to write this article, as the people I encountered all reminded me that where there is pain there is also love. As unconventional as it may sound, for a space that witnesses such immense pain due to the nature of care provided, I left what felt like a place of love. For this reason, it was heart-wrenching when my time there elapsed. Yet I remain grateful for how I was inspired and enriched by what I witnessed – hard work and dedication resonating with love – and will forever admire and revere the staff, children and families.

Prehospital Care

Meanwhile, I would argue that the most widely feared groups of patients in prehospital care are children and young people, and women in childbirth, for multiple reasons. These include, but aren’t limited to, the lack of quality training and exposure practitioners receive and inadequate support after challenging experiences. Generally (NOT ALL), we struggle when faced with seriously unwell children and young people and women in childbirth due to a lack of sufficient preparation, experience and support. I have witnessed at first-hand how the intensity of these often emotionally-charged situations manifest fear, significant challenges, and errors, yet clinicians often remain driven to do all they can to help:

“Ambulances will drop out of the sky for a child that’s not breathing. They just all of a sudden become available and there’s multitudes of them.”

Intensive Care Paramedic, New South Wales Ambulance (BBC 2019)

AFTERMATH: LESSONS FOR THE FUTURE

So why have I intertwined and discussed the Aberfan disaster and Paediatric Healthcare in the UK? In addition to the common thread of involving children and young people, in my view both consist of widely known underpinning flaws and fears that very little is being done to address and desist, and thereby permitted to persist; a grave ‘failure to heed clear warnings‘.

In the case of Aberfan multiple significant suspicions and concerns were raised about Coal Tip 7 collapsing upon the village, and primarily upon Pantglas Junior High School. Several pit accidents had occurred prior to 21 October 1966, including a slip in 1963 that stirred a petition from the school itself, and slurry would often run down the mountainside and block drains in surrounding streets. All these warnings were evidently ignored. Additionally, the tip was essentially built upon natural springs that went against guidelines and compounded the liquefaction of the coal waste, whilst others remained silent about their concerns due to a fear of unemployment (‘make a fuss = close the mines’).

Furthermore, in the aftermath of the disaster residents were forced to endure 76 days of submitting evidence at the public inquiry, which could have been avoided had the National Coal Board accepted responsibility sooner. Residents were also drawn into a long battle to remove all the tips from the colliery as they lived in fear within the shadow of the mountain with the concern that a waste tip would slip again (which remained highly likely). A significant amount of money was also unlawfully taken by the Charity Commission from a memorial fund setup to support the survivors of the disasters to part-fund the eventual removal of all waste tips, whilst the survivors also encountered stringent restrictions in accessing this fund.

“What we can do, however—in this week of the 50th anniversary—is try to focus the attention of many in Britain and beyond on the lessons of Aberfan, lessons which are still of profound relevance today. They touch on issues of public accountability, responsibility, competence and transparency”

Huw Edwards; journalist, presenter and newsreader (2016)

Similarly, in the case of Prehospital Paediatric (and Obstetric) Care, the fears, challenges and concerns prehospital clinicians including Paramedics possess and encounter is arguably common knowledge (and has been for a long time), yet why isn’t this being sufficiently addressed? Serious Incidents (SIs), Preventing Future Death (PFD) reports and Coroner reviews demonstrate common themes concerning the care (or potential lack of) received by seriously unwell children, women in childbirth and newborns, whilst litigation claims concerning these people are high in number and value.

Nevertheless, prehospital clinicians are largely expected to access substantive learning and regular practice in their own time and to use their own personal resources to implement the relevant clinical guidelines they are held accountable to when providing care. This despite often having little experience and practice of caring for seriously unwell children and young people and women in childbirth, and receiving inadequate support when encounters have been challenging.

Is this fair? Is this enough?

It is unjust that these problems persist, particularly when the issues are not reflective of the desire prehospital clinicians have to do well for these people. As many arguably lack sufficient capabilities and capacities to provide for them there are multiple disappointing cases of practitioners doing more harm than good, of not doing what was necessary and required.

As was the case with Aberfan, much of this is arguably preventable and unjust for practitioners tasked with delivering prehospital peadiatric and obstetric care. Moreover, the children and young people arriving into this world, and making their way in the world, along with their loved ones, deserve better. Lessons thereby must not only be identified and heeded, but also acted upon.

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Further Reading

To learn more about the Aberfan Disaster, the following are some resources you could explore. Some of these resources have also informed this article:

Austin, T. (1967) Aberfan: the story of a disaster. Hutchinson & Co: London

BBC: Aberfan: The mistake that cost a village its children, by Ceri Jackson https://www.bbc.co.uk/news/resources/idt-150d11df-c541-44a9-9332-560a19828c47

Davies, E. (1967) Report of the Tribunal Appointed to Inquire into the Disaster at Aberfan on October 21st, 1966. Her Majesty’s Stationery Office: London

The Telegraph (2016) Aberfan was a man-made disaster. 50 years on, we must remember this, by Huw Edwards https://www.telegraph.co.uk/men/thinking-man/aberfan-was-a-man-made-disaster-50-years-on-we-must-remember-thi/

McLean, I., and Johnes, M. (2000). Aberfan: Government and Disasters. Welsh Academic Press: Cardiff

McLean, I. (2009). “Lessons from the Aberfan Disaster and its Aftermath”. British Academy Review (12) pp. 49–52

The Guardian (2019) How filming the agony of Aberfan for The Crown revealed a village still in trauma, by Vannessa Thorpe https://www.theguardian.com/tv-and-radio/2019/nov/17/television-drama-the-crown-portrays-aberfan-disaster

Turner, B. (1976) “The Organizational and Interorganizational Development of Disasters“. Administrative Science Quarterly, 21 (3) pp. 378–397

Wales Online: Aberfan, edited by Steffan Rhys and Adam Walker https://aberfan.walesonline.co.uk/

Wikipedia: Aberfan disater https://en.wikipedia.org/wiki/Aberfan_disaster