Reaching out: A new lifesaving drive shows how to connect with Scotland’s diverse communities

Grandfather Shabir Beg was celebrating Muslim festival Eid with friends, family and colleagues when his adult son Shazad had a cardiac arrest.

The room at Glasgow’s historic Trades Hall was packed and Beg went into what he says was a state of shock. That was in June last year and though Shazad, who is in his 40s, would recover, the sense of helplessness Beg felt would spur him into action to address a need for cardiopulmonary resuscitation (CPR) know-how in the Scottish Asian community.

What was a near-tragedy for his family, he believes, can help avoid heartbreak for others. “I was helpless,” Beg says. “My other sons were there, my nephews were there, and we were all helpless. If we had known CPR, we would have known how to react. 

“There is a big, big gap.”

Beg says that gap covers other minority faith and ethnic communities too, and he is working with the Scottish Ambulance Service (SAS) to spread knowledge of how to save a life through targeted awareness sessions. Beg, who was awarded an OBE for his interfaith work with the Scottish Ahlul Bayt Society, has used his vast network of contacts to invite in representatives of diverse Asian and African communities to join the drive, and there are plans too to involve Scotland’s significant Polish and Romanian communities. “We are not going to hold back,” he says. “This is a gathering of the clans.” 

Cheryl Pyott, community resilience paramedic team leader at SAS for the west region, is amongst those working on the project. The SAS has teams dedicated to outreach, she says, but Beg’s move is one with the promise to connect to “the widest possible audience”. “There hasn’t been an opportunity like the one Shabir is bringing to the table now. It’s opening so many doors,” she says.

There are a lot of jigsaw pieces that are missing

“We didn’t know we were missing so many different people until Shabir brought everybody in to this. There are a lot of jigsaw pieces that are missing and it’s just fitting them all together to make one ultimate image.

“Cardiac arrest can happen to anyone at any time, regardless of their age, where they come from or what they believe in,” she goes on.

According to CPR campaign Save a Life for Scotland – which is involved in Beg’s initiative – around 3,200 people in Scotland undergo attempted resuscitation after a cardiac arrest every year. Of those, only one in ten survive. But in parts of the world where bystander CPR is common, that figure doubles. And while paramedics will rush to the scene of an incident, the patient’s chances of survival drop by 10 per cent for every minute that passes in cases where CPR is not performed during the wait for the crew to arrive. 

The campaign wants to train up one million people with the skills to respond by 2026. And with increasing diversity amongst the population, that will mean reaching across ethnic and cultural groups. “The message is there for everybody,” Beg says of national awareness drives and materials. “It’s how you take that message. This is not just an issue in the Asian community or ethnic [minority] communities, everybody should know this because it can save lives.”

While we await the publication of the latest census data, results from 2011 show around four per cent of Scotland’s people are from “non-white minority groups”. The figure is expected to rise to seven per cent within the next decade, with the arrival of Ukrainian refugees further adding to the cultural mix. These groups are often described as ‘hard to reach’ within a public health context, though some counter that the truth is that they are instead ‘easy to ignore’ within systems which lack a baked-in equalities approach and therefore overlook the needs of those who don’t fit the standard patient profile. Whichever description is adopted, the terminology tries to give a name to cohorts who fall through the cracks and can be applied to many other groups in society, including people with disabilities, addiction issues, LGBTQI people and those living in poverty. 

In an influential paper, What Works Scotland – a collaboration between the Scottish Government, the Economic and Social Research Council (ESRC) and the universities of Edinburgh and Glasgow – said more needs to be done to tackle the inequalities faced by both “communities of identity” like LGBT+ groups and “communities of interest” like women’s groups. Lack of understanding from policymakers leads to difficulties in forming solutions to problems, researchers said, and “inequalities faced at large in society – education, confidence, resources, responsibilities (work and caring), language barriers, disabilities – often constitute the key barriers that prevent people from taking part” in efforts to engage with their communities. 

That was in 2017 and Christopher Harkins, public health programme manager at the Glasgow Centre for Population Health, says that while progress on inclusion has been made, the job is not yet done. “I would probably say, without throwing anyone under the bus, there’s a lot more can be done, that’s absolutely certain.” Black women in the UK are three times more likely than their white counterparts to die through pregnancy, he says as an example, and the evidence is that they experience barriers throughout pregnancy which can harm their outcomes. Disabled people are much less likely to attend cancer screening, he goes on, while LGBT people “don’t always get” inclusive care. 

It needs strong leadership in government

It’s not that the will is lacking, Harkins says, and there have been shifts in the messaging used within public health to bring this “in line with the latest equalities insights”, but quality data on the experiences and needs of specific cohorts is lacking. The most recent census may help to flesh out the picture, he adds, but will still leave out much of the detail that would ideally be in place to enable authorities to design the most effective approaches to resolving public health problems. 

And there is a limit to what can be done by services hamstrung by funding limits and heavy demand. “In a lot of public services, it feels like firefighting. You’re saying to those services, ‘you need to do more’. Within the NHS there are record levels of burnout amongst staff. It’s quite hard for staff who are foot-to-the-floor all day, every day, to start to get into some of the equalities issues properly and say ‘how can we make this service more inclusive?’ It needs strong leadership in government and a willingness from healthcare providers to open their doors because there is a lot of expertise already there. Systems that support population health have to have aspects of humanity at their core rather than being just systems.”

The ambulance service, Pyott says, is “looking at every group” and though there is a way to go, one ‘hard to reach’ cohort for it is the 20-40 age bracket – those too old for classroom-based outreach and too young for the local group sessions with older people that the service does so much of. 

That population isn’t perhaps the first that comes to mind when considering who falls into the public health gap and Harkins points out that there can be no one-size-fits-all approach to public health. “That’s the reality of being human, isn’t it? The intersectionality of characteristics has become more of an area of study and it can play out in quite a complicated way.”

Beg says he can never repay the “phenomenal” SAS paramedics for saving the life of Shazad, nicknamed ‘Simon’, but he wants to try. And the Scottish Ahlul Bayt Society, from which he stepped down as chairman late last year, has long been working to lower and remove health and other barriers affecting the Shia Muslim communities it serves.

Now in its tenth year, its Imam Hussain Blood Donation Campaign Scotland holds blood drives across Scotland’s cities, working with synagogues, Hindu mandirs, Sikh temples and mosques as well as minority ethnic community groups. “It’s made a big, big difference,” he says of the team effort. 

It's about bringing our community together

There were people of all faiths, too, at the dinner where Shazad’s cardiac arrest happened, Beg says, “and they were all praying”. “Shazad’s whole lifestyle has changed now – he’s under doctors orders and he’s not going to run about the way he did before – but he is here with us.

“If we pull this off,” he says of the new initiative, “we are saving lives.”

Pulling the project together is “a learning curve for the services” involved, says Pyott, “because there’s always different communities and religions and so we have to make sure the training is culturally appropriate,” like having male and female trainers for specific groups to avoid self-exclusions by people uncomfortable for cultural or religious reasons from working with a member of the opposite sex. But the message remains, she says, that when a person goes into cardiac arrest, it is important for the person with the skills to act, regardless of who is in front of them. 

“This effort is more than just a project. It’s an invitation for all of us to overcome our hesitations and discover how we can all make a real difference,” she says. “It’s about bringing our community together, showing that with a little courage and the right skills, we’re all capable of life-saving actions.”