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The intense year of GP Shakib Sana: ‘I saw patients gasp and ask for a vaccine, but then it was too late’

It’s Monday evening, a little after seven. General practitioner Shakib Sana is in the car, on his way from his practice in Delfshaven to his hometown, about an hour’s drive from Rotterdam. He’s just had an unexpected emergency meeting about the booster shot, so he’s calling on the way. “Speaking to the media, that often takes a while. But I do think it is my responsibility to explain.”

And not only to the media, explains Sana (42). In the TV studio in Rotterdam he met internist Robin Peeters from Erasmus MC. Together, they are setting up a plan to reduce the information gap about vaccination, amid concerns about low vaccination rates in deprived areas. Over the past year, the two, together with other general practitioners, could be found weekly at the market to talk about the jab.

In addition, he is also working on a PhD research project at the university into the effects of corona on general practitioner care and he is a board member of the Landelijke Huisartsenkring Rotterdam. And all this in addition to his GP work. What drives him?

Why did you have an emergency meeting with GPs?

“We feel the hot breath of omikron and wanted to see whether, in addition to the large-scale vaccinations by the GGD, we could also contribute something to booster injections. Think of a walk-in location or informing the vulnerable – people without DigiD, or who are digitally literate – to help them make an appointment. It is a lesson from the first vaccination rounds: not only large-scale injections, but also small-scale, fine-meshed, accessible.”

Does it make you despondent, the new variant and the new lockdown with the holidays?

“When I heard that we were probably going into lockdown again, I was sad and despondent for a while. But I actually put that back into action during the day. You actually have no choice but to help again, as a doctor. It is now important that we give everyone a booster as soon as possible, so that we can all get out of it.”

Yeah, are we going to get out like this?

“Of course there may be a new variant, so that is not certain. But I keep hope. On the one hand, we have recently seen how much misery humans can cause. But it is also the time when we see how much good man can do. We can now do so much more than we could at the end of last year. We already know a lot more about that disease, and we can treat more people at home. That gives me hope, also for 2022.”

What could have been done better in the vaccination process?

“Vaccination is a multi-layered problem. Part of the problem was communication. For a long time the idea was: we will be there after the summer, when everyone has been vaccinated. But now it’s Christmas and we’re still not there. That makes it difficult. What I notice most in practice is that people say: ‘Doctor, I don’t understand.’ They simply lack information and ask, for example, ‘Why, if we’ve already had two shots, also a third? Do we also need a fourth? When will it stop?'”

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“Which also plays a role: for some people the government is unreliable, because of the Allowances affair for example. We focus our information campaigns on them and on people who lack information. Because ninety percent of people still trust the doctor, research shows. A conversation in a familiar environment, the market, with a familiar face, their GP, helps. Then they have to make their own choice. That is also important: we listen, but do not push.”

Why did you become a GP?

“I used to want to be a pilot, that will always be a childhood dream. But I decided to go for a doctor anyway; I really wanted to help people. The great thing about being a doctor is that you can put a complaint in perspective. As a general practitioner I build a bond with patients, whom I sometimes know for a whole life. As a result, I do not treat a disease in the consulting room, but a person. With one I make a completely different decision than the other, even though they have the same diagnosis. Much more can play a role: age, family composition or other risk factors.”

You’ve taken on a lot of extra tasks this year: You’re also on the market, talking about your work on TV, and devising booster injection strategies. How much extra time do those tasks cost you?

“A lot. From the moment we thought of being on the market, we are there every week, except for the summer holidays and the autumn holidays. Now with the lockdown, it’s not possible for a while. That was an assault on your time: on Saturdays I’m in Delfshaven. In addition, we supported colleagues in other parts of the country where necessary, when they took to the streets.”

How do you keep it up?

“The most important thing: the home front. My wife is also a GP, so she understands what I do. Her support keeps me going. But also the support of colleagues who step in at important moments and clear their agenda if necessary. In addition, I try to make choices: to separate main issues from side issues. Otherwise you will be lived ten, twenty hours a day.”

“And I rest well. When I’m home, I’m home, and I get a good night’s sleep. I take my moments to go for a walk outside, connecting with friends and family. That’s how I charge.”

How do you look back on 2021?

“On the one hand, I am satisfied. We make use of the opportunities that we had as a general practitioner. The call from Robin Peeters and me to provide better information was listened to. We managed to put that on the political agenda, Hugo de Jonge came by after we wrote him a letter about the information gap. He launched an information campaign, also in other languages. So that’s good. But we are not there yet until information is accessible to everyone. That is why an initiative such as the Doubt Telephone is so important. People can use that to call if they have doubts about the vaccine.”

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Have you also had difficult moments?

“I have had to say goodbye to many people. It is most painful when patients die because of disinformation. I’ve had patients gasp and say, “Doctor, I want a vaccine.” But then it was already too late. Those moments really touch me. Not so much of: ‘man, man, man, that’s your own fault’. Absolutely not. But real sorrow of the effect of disinformation. As doctors, we are always – and rightly so – approached when we give incorrect treatment or incorrect information to people. But the moment someone is more or less exposed to misinformation social media if he dies, it has hardly any consequences. That hurts.”

You also regularly joined the talk show tables and always take the time to speak to the media. Why are you doing that?

“The first time was exciting: representing a group of general practitioners comes with a responsibility. Words have meaning and can have consequences. But it is important to do, the need to inform is high. I remember it exactly: my first this pandemic on April 9 at Rijnmond. On April 24 with a national appeal at NOS. At RTL4 and in the evening at Nieuwsuur with Robin Peeters. Those are important dates for me that I don’t forget – just like personally important dates such as the birthday of my children and my wedding day.”

You are from Afghanistan. It must have been a tough year with the Taliban taking power in your native country, too.

“It certainly was. The country has now been put twenty years back in time in one fell swoop, which is very painful. Afghanistan was a country where in recent years there were opportunities to go to university and, however small, to build something for yourself. That is now in danger of being lost. Soldiers from the Netherlands have also been there for years, to prevent what has now happened. Very sour.”

Do you have a lot of family there?

“We still have a whole family in Afghanistan. Cousins, nieces, uncles and aunts. They are now going through the same thing as we were more than twenty years ago. When I was sixteen I fled to the Netherlands with my parents. That to me is quite a personal story and painful, something I don’t say much about. It touches you when you are forced to leave your home country. As you get older, homesickness sometimes kicks in.”

How did you experience those first moments in the Netherlands?

“A world opened up for me. In the asylum seekers’ center I had a lot of contact with other young people who had grown up in other cultures and countries. Everyone had their own story, and I was curious too, as a young man. So I looked my eyes out. There are several teachers from the language schools who motivated me to make something of my life. Ultimately you have to do it yourself, but you have to be given the opportunity and the confidence. That is the most important. And when that comes together, you can go quite far.”

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Does 2021 also feel like the year of the GP’s reappraisal?

“That applies to doctors in general, including general practitioners. General practitioners have taken over a lot of care from the hospital in 2021. For example, we held the difficult conversation about someone’s wishes, should corona knock on the door, to prevent doctors from having to ask someone who is gasping for breath. And now we are also putting on the glove: the immobile person living at home is pricked by the GP.”

“What worries me though: As a general practitioner you try to guarantee accessibility in healthcare. That is especially under pressure at the moment. This is partly due to the government, but partly to the people themselves. It strikes me that people have little knowledge about their own bodies. I think we need to gain more confidence in our health and learn more about our bodies. So that everyone knows whether he or she should call the doctor or not.”

What is required from the government?

“The close-knit GP locations are very important for the long term. When a new neighborhood is being built, a place for the GP is not always taken into account. That is a missed opportunity: if the GP has a good location, they can treat and inform all patients in the district better. That way we can raise a generation that is healthy.”

You have already written a novel about a boy who flees Afghanistan. Is corona also worth a book?

laughs. “I occasionally post on LinkedIn at the moment. With that I try to put some thoughts that come into my mind on paper. Sometimes I feel that need. We experience many moving, inspiring moments during this time. But for a book I have to let everything crystallize first. Who knows in the future.”

What are your plans in the new year?

“I would like to further narrow the health gap. By that I mean that your socio-economic status actually determines how many qualitatively healthy years you have. Just imagine: if you have fifty euros to spend a week, it is difficult to fill your stomach with healthy food. Then it is easier to switch to food with a lot of calories, with all the associated risks. That is the new gap that we will have to close in the future. By closing that gap, we are building a healthy generation and can handle a new pandemic much better.”

“I just want to be able to go on holiday again. I’d like to go back to Afghanistan, but that’s not possible. So then I dream of a tour in my wife’s home country: Turkey. Without QR codes, face masks and forms.”

What is all this effort – on the street, in practice during the pandemic, but also in the media – costing you?

“I can’t spend the time this takes with my family. My two-year-old is growing up during this pandemic and I miss moments of that. It is time that passes and never comes back.”

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