Child Population Health Theme Lead, Sonia Saxena, marries data and social justice in healthcare
Professor Sonia Saxena’s first experience of a pandemic was in the early 1980’s as the UK’s HIV crisis was emerging. She and other staff at St Bartholomew’s Hospital, where the young doctor was training, had heard about the first cases in California.
Her formative years as a newly qualified doctor were spent diagnosing and treating patients – many of them young gay men – who would come in breathless with a new form of pneumonia, caused by the virus weakening their immune systems.
“It was so unexpected because our training had equipped us to deal with older people with longstanding medical problems like heart failure, cancers or dementia,” she says. “But instead there were these articulate young men in the prime of life with minimal signs at first such as Kaposi sarcoma, purplish blotches that appeared on the skin, but whose health rapidly took a downturn with pneumonia, weight loss or fits with so many dying right before your eyes.”
40 years later: A new pandemic
Sonia's research group at Charing Cross Hospital, 2019
The realities of caring for seriously ill patients became relevant more than 30 years later when Sonia served on the front line of another, much more recent pandemic.
During COVID-19, she not only worked in primary care as a general practitioner, but was also one of several GPs who volunteered to lead research and advise on health service re-organisations as part of Imperial’s COVID 19 research and policy response team throughout the pandemic.
She now leads the Child Health Unit at the School of Public Health. Her group studied both the direct effects of the pandemic on children’s health and also the indirect effects of lockdowns and school closures on their social and physical health and access to care. For example, she reported how GPs rapidly switched to a combination of face to face and remote consulting so parents could continue accessing healthcare for their children. Since COVID-19 vaccines became available, she has also written research and strategy briefings to increase the uptake of COVID-19 routine vaccinations amongst children, pregnant women and minority groups who still lack vaccine protection.
For Sonia, the increasing use of data in medical and health care has enabled research on a greater scale than ever possible before but the increasing use of big data is posing one of the biggest challenges facing research.
The introduction of computers into general practices was a big leap forward compared to the relatively analog systems she first worked with at the start of her career. She remembers how doctors wrote free-form entries onto paper records during the AIDS epidemic.
“We struggled to decipher paper records covered with illegible writing. The other medical staff would handwrite calculations for medication because they did not trust the still-alien technologies trickling in,” Sonia says. “So slowly, we've got to the point where everything's digitalised.”
Now, digital records are able to capture a huge breadth of a person’s medical history – from regular visits to a GP to major hospitalisations: “They contain coded information on everyday contacts that people have with clinicians.”
Sonia has invested time in ways to transform this routine data into usable numbers for observational studies that can tell us how effective healthcare interventions are, something that will only become more significant when dealing with health crises in the future.
Often, Sonia will produce her research directly with the communities she works with. Many of her investigations into COVID-19 were structured with patient participation in mind – creating a dialogue with patients and communities she has seen face to face and virtually.
“All of my research comes from questions that patients ask, regular discussions with colleagues or patient and professional groups.” - Sonia Saxena
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