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SA Orthopaedic Journal

versão On-line ISSN 2309-8309
versão impressa ISSN 1681-150X

SA orthop. j. vol.19 no.4 Centurion Out./Dez. 2020 



Lessons learnt from a pandemic: How to create resilience



Birkholtz F

MBChB, MMed(Orth), FCOrth(SA) Orthopaedic surgeon at Walk-a-Mile Centre and extraordinary lecturer at the Department of Orthopaedics, University of Pretoria, South Africa





As I write this, we are coming to a plateau phase in the COVID-19 pandemic and things seem to be slowly returning to some form of normality. We hope that fears of a second peak will not be realised and that our country will indeed proceed to a semblance of its prior self. Despite the last chills in the air, spring is also setting in and there are blossoms on the trees and birds singing in the garden. In the veld it is time for the baby animals, and new life abounds. At this time of renewal after the long and hard winter, it is useful to reflect on lessons learnt during this pandemic. In the words paraphrased from and attributed to Winston Churchill: 'It would be a shame to let a good crisis go to waste.'

In this spirit, allow me to share some observations and lessons learnt during these interesting times. The three important lessons I have taken to heart are resilience, gratitude and simplicity. We will focus on resilience in different spheres of life and how that can position us to withstand life's storms. Resilience in this sense is not about resisting change, but about being able to withstand a changing and challenging environment and how to thrive despite the turbulence around us.

This unprecedented worldwide situation has decimated economies, destroyed livelihoods and taken lives. In South Africa we have been hard hit against a backdrop of an already struggling economy.

It is clear that the ability to weather different aspects of this storm has been essential in surviving through these tough times. It will also be a key aspect in being able to negotiate a future which seems uncertain in most places in the world. This resilience is needed on a personal, family, community and business level to survive and eventually thrive.

On a personal level it has been exceptionally important to remain strong and fulfil our leadership roles in different spheres of life. It has been important to withstand the storm and to remain mentally calm and strong - despite the lack of an alcoholic beverage or two! I have found that regular exercise prior to the pandemic has created a mental toughness which has been very useful in withstanding the psychological stresses of the pandemic and lockdown. During the lockdown phase, exercise continued to create resilience by providing a much-needed daily routine as well as a sense of purpose in a world that seemed to have gone crazy.

At family level I have been incredibly impressed with children transitioning into online schooling with reasonable ease despite the challenges of not having sports or social events. Of course, this came at a price - an astronomical bill for internet services and data! It is important to build resilience into children and to empower them to be strong yet adaptable. For younger kids, a routine is critically important and, coupled with age-appropriate information, it turns a seemingly hopeless situation into something that they feel they have some control over. Older children respond well to chores, responsibilities and boundaries, all of which serve to create tenacity. Again, the power of exercise cannot be overstated. Burning all the extra nervous energy is extremely useful, but so is the mental tenacity needed to push through pain and fatigue boundaries. Being increasingly self-sufficient in terms of water, electricity and food is a growing worldwide trend and can improve a family's resilience greatly. A good starting point is to grow a vegetable and herb garden, keep a few chickens and to collect rainwater. Installing a solar panel electrical system or generator can be extremely useful, especially against the backdrop of loadshedding starting up again. All of these strategies will serve to improve resilience of the family unit.

At community level it has been inspiring to see communities banding together to help themselves, but also others. Community resilience can be improved through initiatives like neighbourhood security groups, bartering and exchange of goods and services and by buying products or services from local providers. Setting up a community-based directory to list all available service providers and their contact details within a community is a useful way to facilitate this.

As a doctor and orthopaedic surgeon, it has always been my belief that the sacrifices made as a student and registrar early on in life would be offset by job security later on in our careers. It has become clear that job security for specialists in private practice is a somewhat fuzzy concept. Within a very short space of time, our ability to work and earn a living was severely impacted due to no fault on our part. Elective surgery effectively ground to a halt and hospitals became no-go zones for patients. Many a colleague wondered whether it would be beneficial to start doing trauma calls again.

It is clear that our practices are not immune to crises and that we should build resilience here too. Group practices have the benefit of having multiple partners with slightly different skill sets. This allows practices to function in different teams during the pandemic, effectively protecting the continuity of the business should any one team member get infected. Having different skill sets or interests allows the practice to continue functioning and surviving even when one type of procedure is limited or impossible. A good example during the pandemic was that trauma orthopaedics could continue somewhat despite the fact that arthroplasty ground to a halt in most practices.

Being up to date with tax payments and also assistants' and service-provider payments prior to a crisis allows a practice to postpone or stagger some of these payments in the event of a crisis, optimising cash flow. Remember that buying the latest car or hunting rifle does not constitute a crisis!

Having a healthy overdraft facility as well as a sizeable nest egg in the bank account is essential in weathering cashflow storms in the practice. Advice from business coaches and business analysts is to have approximately three months' worth of operating expenses in the bank in case a crisis hits and earning potential is limited.

Having staff that are motivated, loyal and multi-skilled means that in times of crisis a practice can cope with less staff if need be in order to limit the effects of a high wage bill during a crisis.

Working in different facilities and also having day clinic lists improves resilience greatly and allows a practice to continue working even if one facility is compromised.

Creating different revenue streams has been shown to be not only useful, but in a certain sense essential in having a resilient practice. Orthopaedic surgeons generate income most effectively when operating. It is, however, useful to add additional revenue generators like medico-legal reporting, educational consulting and product development work to the practice.

Outside of the practice it can be beneficial to develop an investment portfolio to render a passive income revenue stream. Property is a useful asset in this regard, provided that it is not over-leveraged.

At the end of the day life will present us with challenges which are mostly outside of our control. It is up to us to position ourselves to be able to respond to these with purpose and resilience and to thrive despite them.



Dr Franz Birkholtz

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