The Life Scientific: Kevin Fong

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1:03Hello, my guest today describes himself as a sort of Doctor Who figure who's been lucky enough to enjoy multiple career reinventions. I don't know how much luck comes into it, but with a CV that runs from astrophysics and trauma medicine to working with NASA, becoming a helicopter emergency doctor and presenting award-winning science programmes, you do start to wonder whether there might be some time travel involved just to fit everything in. Kevin Fong is a consultant, anaesthetist and professor of public engagement and innovation at University College London. During his career, he's worked on the front line in hospitals, dealing with major incidents and helping shape policy.

1:44But Kevin's also stayed true to his childhood passion for space, working on multiple projects with NASA and even going through the astronaut application process himself. And as if that wasn't enough, He's also become a well-known figure in science broadcasting through his various radio and TV shows. Surely he must have a TARDIS hidden somewhere. Professor Kevin Fong, welcome to Life Scientific. Thank you, Jim. Now, you worked with NASA on and off for over a decade on various space medicine projects, looking at the health care of astronauts. And in 2015, you presented the Royal Institution Christmas Lectures under the heading How to Survive in Space.

2:23So what do we need to know? What are your tips for anyone planning on intergalactic travel? Don't go. It's very dangerous. There's a significantly non-zero chance that you won't survive. Noted. So I love the idea of how you look after people in space because it's sort of this boundary condition challenge. Everything you can think of in healthcare doesn't work when you take away gravity or gravitational loading. And so it's all about how you keep the body healthy while it's deployed in space and then what you do if things go wrong. and all of that opens a whole can of worms that you can spend your whole life looking at.

3:00I also mentioned in the introduction your role as a member of an emergency medical helicopter crew. Now, it's not a spaceship, but you're still flying. What's it like? I imagine very often you're dealing with extreme crisis situations. Yeah, this is a part of my job that I love the most for lots of reasons. I'm a doctor with air ambulance charity, Kent, Surrey, Sussex. We cover the whole of the South East. and you sit around a hangar and when the phone goes, you're never sure exactly what you're going to or where you're going and it's the best and toughest teamwork I've ever done. Well, Kevin, let's hear more about your passion for space and how it came about.

3:39You were born in London in 1971. Your parents had moved over to the UK from Mauritius in the 50s and 60s, your dad first, then your mum. Tell me about them. What did they do? their stories of coming to this country are epic in their own way i mean dad turns up off the boat to france and then train up through france to calais and then across turns up with nothing and does that thing that immigrants do when he arrives and he he sort of works himself up off the ground and make something of himself my mum comes to and then it's this enormous adventure of exploration really tough but they're trying to make something of themselves and neither of them at that point had had much of an education.

4:21I'm pretty sure my mum didn't study past the age of 14, I think. But when I was born, they'd been here, I guess, 10 years. And they both knew that they had to give me something to aim for. And it was this idea of space exploration. It's the 1970s. Apollo is everywhere. So although I say that space exploration is what got me interested in science, it's actually my parents using space as a vehicle for that fascination. I gather one of your very early memories is of your mum waking you up to watch the Apollo-Soyuz test on TV. I mean, this would have been 1975. 75, yeah, absolutely. The Apollo-Soyuz test project and the docking of the Soviet spacecraft and the American spacecraft and those crews shaking hands across the airlock and swapping flags.

5:06This happens, I think, in late evening. So I remember her coming up and waking me up and bringing me downstairs to watch this enormous event. And for me, that was the fire to spark interest. Right. Well, you certainly got hooked. In 1990, you started at University College London studying astrophysics. And you also had your first taste of working in the media via the student newspaper. Yes, I ended up taking photographs of them being the picture desk editor. I'd have a go at writing a few articles. and at one point this interview came up with Morris Wilkins. This Nobel laureate had been the Nobel Prize winning team alongside Crick and Watson for the double helix structure DNA and he was in an office somewhere at King's and so I sort of turned up with a tape recorder and he was good enough to let this rubbish amateur student journalist interview him for an hour or two.

5:58So he had started off as a physicist and in fact before all of that had worked on the Manhattan Project and the uranium refinement team and he was always troubled by that, his contribution to the building of the first nuclear weapon and he talked about why he went from physics all the way over to biophysics and he said, you know, I decided after the war to go from the science of death to the science of life. While I didn't feel it the same way he did, I think it did turn in my head this idea of there's this wonderful inanimate universe but there is the animate universe that might be fascinating too and I think that's partly what led me on to medicine.

6:36Well, certainly once you'd completed your astrophysics degree, you stayed on at UCL and started a medical degree. But apparently you couldn't entirely pack away your love of space because you started writing letters to NASA. Now, what did they say? So at the end of my medical degree, I kind of realised that I really did love space exploration. So I wrote letter after letter after letter to NASA. I mean, the sort of naive letters that only a person in their mid-twenties can write. And you've just got rejection after rejection after rejection. And then one day I remember being in my flat and this letter comes through the letterbox.

7:13And it's a NASA envelope and I'm sort of unwrapping it. You know, like Charlie and the Chocolate Factory looking for the last golden ticket and the last chocolate bar. And inside there's this letter that says, stop writing, please. Leave us alone. But we have this course in aerospace medicine, four weeks, Houston, there's four places apply. And I filled in the applications and then they offered me a place. So my final year of medical school, I go to do an aerospace medicine clerkship out at Johnson Space Center, home of mission control. And it's like all my dreams come true. It lived up to expectations.

7:48Ah, more than lived up to expectations. You're inside the fence at the place where they controlled the Apollo missions. everything that you've ever followed all of your life. And in the morning, you get lectures about space exploration. And in the afternoon, they take you a tour of the facilities, and it's like Disneyland for adults. And you just mouth agape. At the end of those four weeks, they even got us out onto the Vomit Comet, the parabolic training plane that they trained to do weightless operations in. And, you know, as a student flying around in the back of an aircraft with actual astronauts who are training, you're like, pinch me, what is this?

8:25okay let's talk a bit about space medicine what are the specific health challenges when someone's going into space i've had british astronauts helen sharman and tim peak on the program and they both spoke about the incredible toll that living in zero gravity can take on your muscles but presumably there are other health hazards to think about as well yeah and this is the fascinating thing you know this is an extreme environment it has system-wide impacts on your body. So we knew that muscles and bones would waste because they're dependent upon gravitational loading to maintain their mass and their strength.

8:59And then of course the heart, which is also a muscle pump, we knew that would be affected. So we guessed about that in the very early days, but we looked further and then we'd see problems with hemopoiesis. So your blood forming and we saw space anemias and problems with the immune system. And now most recently we're looking at problems with fluid shifts that cause swelling of the brain so bad that in some astronauts it compresses their eyeballs and alters their vision and so just keeping someone healthy in that environment is hard enough and then you have to get into the whole thing as a doctor of what do we do after all that deconditioning if something goes wrong what can we do up there with the equipment and skills that we have because you're restricted by weight power and volume i was going to ask you what sort of facilities are there on a spaceship yeah or on the international space station for example when people are actually spending months and months there yeah we're all conditioned aren't we like to think about sort of uh star trek and sick bay and dr mccoy but there's none of that there's no sick bay there's a few bags with a bit of equipment your average london ambulance is far better equipped than the space station doesn't always have a doctor on board and so all of this is part of the conundrum how do we skill people up what can they deliver and how and when do you come home if you get into a pickle?

10:16Well, going back to your very first NASA placement, clearly the experience struck a real chord with you. And it was the first of many return visits to NASA over the next decade or so. I remember clearly walking out of the gate at Johnson Space Centre after that first visit with the guys who I was on rotation with. And I said to one of them, you know, if we don't come back, it'll be a disaster. And so we, between the two of us, We'd always find ways to go back. We would do anything. We would carry boxes. We would pour test tubes. We'd do it for free and we'd do it whenever we could. And we'd just find a way to continue to annoy them so they would let us hang around.

10:50And so, yeah, I kept going back. It just goes to show what persistence and an intensive letter writing campaign can do. But once you completed that NASA internship, you had another American placement lined up, this time a medical one, in the trauma unit at a hospital in Washington, D.C. I imagine that was quite a gear shift. It really was. So, you know, Washington, D.C., you think of in the films, you think of this, you know, lovely place and the reflecting pool and the White House and everything. But in the suburbs, there's a lot of quite violent crime. So we were seeing shootings all the time and it was extraordinarily sobering.

11:28You know, you'd watch people die most nights from handgun injuries. But I learned a lot and actually developed an interest also in that idea of trauma resuscitation. I mean, it didn't put you off, clearly, because after that, you came back to the UK to start working in London as a newly qualified doctor. and just a few months later in 1999 you were part of the medical team called out to the scene of the Soho nail bombing. Listeners might remember that horrific incident. It was the third in a series of nail bomb attacks targeting ethnic minorities and LGBTQ plus communities in the capital and in this particular bombing three people were killed, 79 injured, many of them seriously.

12:09Do you remember much about the call out? Oh I remember everything about that you know it's a bank holiday weekend it's a fine evening so everyone who's got plans has left the hospital and there's only the on-call team left and there's a phone in the accident emergency department they call it the bat phone and when it rings you know something bad's coming this time it rings the nurse picks up the phone and then every pager in the hospital goes off and you can hear the noises coming out of every room They've declared a major incident. There's been a bomb put in a pub by a far right-wing terrorist and there were so few of us around.

12:45I ended up in the back of an ambulance and then we arrive in Soho in this awful, awful scene. You know, it is the aftermath of a bombing and the pub is still on fire and people are very badly injured and we're in amongst it. What sort of effect did it have on you?

13:03Gosh, look, it was awful. and I remember in that moment learning the difference between what you train to do on paper and what it's like in real life and then you're there and you're with a team and you have to work out very quickly your place within that team and how you're not going to come to pieces in the moment. I found it very difficult in the weeks afterwards but I suspect that that is normal and over time I remember reflecting that these things that we do I think in medicine very often they can be emotionally extraordinarily negative, but also at the same time professionally positive and that you were there and you had something to set against it and you did your job.

13:44And that day, despite my lack of experience, I think I certainly didn't do any harm and I may have done some good.

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14:53Well since then you've been involved in treating patients in various other high pressure crisis situations including the Potter's Bar rail crash in 2002 and the London suicide bombings in 2005 and in the wake of the 7-7 London bombings you worked with the Department of Health's Emergency Planning Division on the issue of surge capacity at hospitals dealing with major incidents what exactly were you trying to do? So it was interesting because at the time if you'd asked departments how many critically injured patients can you take before you fall over there was a sort of finger in the air estimate of that there wasn't any real attempt to understand what the limits of your ability to cope were because most departments never reached those and yet after the 7th of July London bombings you saw five large hospitals get quite close to the edge of their ability to cope on not a very large number of patients.

15:50And so I started to look at the mathematical modelling of these incidents and what we could learn and how we might more objectively assess what that so-called surge capacity is. And so, working with an analyst, we sort of built these very rudimentary models to illustrate the point that all systems have a finite capacity of coping and that capacity is actually much smaller than people think. Well, that issue of surge capacity limit would, of course, resurface quite dramatically during the COVID pandemic. And we're going to come back to that. In the meantime, though, Kevin, you went on to specialize in intensive care medicine and anesthesia.

16:27And alongside your hospital work, as we mentioned earlier, you were traveling to the US on a regular basis for short placements with NASA. But in 2007, you got a Nesta Fellowship, that's the National Endowment for Science, Technology and the Arts, which allowed you to spend a whole year there. So you and your family temporarily relocated to the States. How did you enjoy it? Well, it was a lovely, lovely time. I'd not long been married. Our eldest boy was 16 months or so. The youngest hadn't been born yet. and we were sort of a family living out there in the suburbs of Houston just on this fantastic adventure and I'd been on call since I'd qualified as a doctor I think best part of a decade now and here I was sort of running an almost 9 to 5 job in this thing that I had always loved.

17:14And that year at NASA was also feeding into a Masters in Astronautics and Space Engineering that you were doing at Cranfield University. Yes, so I persuaded Cranfield, they were very nice to me and allowed me to take on this research, Masters, where I looked at how you look after a crew going to Mars because, of course, Mars is very different from going to low Earth orbit or the moon. You know, you're talking hours and days in those cases, whereas Mars is a mission of months, probably years, and the medical problems become quite substantial at that point. You were even working on how crews might manage in incredibly futuristic new types of spaceship.

17:56NASA do that whole edge of possibility thinking and one of the proposals was this idea of artificial gravity which sounds very sci-fi but actually is grounded in some reality. The reasoning went like this. Look when we go into space we take our light, our heat, our water, our air, our food, everything, our atmosphere. We take it all. Why don't we take gravity or some facsimile of gravity? And of course you can do that by rotational forces. and so there were well mapped out architectures which had these vehicles that looked sort of like a that was called the fire baton the sort of thing you know that a cheerleader would twirl in the air so there was a crew compartment at one end a counterweight at the other and if you span it at four revolutions a minute you would get one g of loading in the crew compartment It's the idea that you're being thrown outwards and so if you stand with your head towards the middle and your feet outwards it's as though gravity is holding you down The way that Arthur C.

18:53Clarke always told us we should do it. And exactly like that. While we're on the subject of space travel, and particularly going to Mars, what do you make of Elon Musk's ambitions? I mean, he's pledged that his company, SpaceX, will launch its first human crew to the red planet by 2031. Yeah, I think you need to do a bit of separation between the man and the company here. SpaceX have done many things that people said they would never do. And I think, you know, when I was at NASA in the early 2000s, people didn't really think that private companies would have a role to play. But some of the stuff they've done there, their reusable first stage launches are kind of incredible and have changed the game.

19:36So will it help us get to Mars, those advances in technology? Yes. Will it happen faster now because of it? Probably. Will it happen by 2031? I'm less sure about. And would you ever be interested in going to Mars yourself? Oh, that's a really great question. So low Earth orbit in a heartbeat, the moon in three or four heartbeats. Mars, you have to really think quite hard about it. That's a commitment, isn't it? It's a real commitment. It's a significant fraction of the rest of your life and a significant chance you never come home. But what an adventure. Yeah. Well, on that topic, the European Space Agency held their most recent selection round for astronaut training in 2021.

20:15you applied and made it through to the final 91 candidates from something like 23 000 what was that process like oh gosh i almost applied as a joke because they'd extended the age limit from what was 35 before to you had to be under 50 on a certain date in 2021 and i was 50 the day after the deadline so i thought well there's a message from the universe there somewhere and I applied and I didn't expect to get anywhere because I was literally the oldest person in selection but then they take you from 23 ,000 and they cut you down to 1 ,500 people who get to go to Hamburg and do some psychometric testing and do some maths and physics exams and play some video games and then they take the top 25 % or so of those and they send them on to Cologne and I didn't expect to get through that bit but I did and then I find myself in Cologne with 400 finalists and the whole day was such a thorough beating up.

21:15You know, you spend an hour and a half with a French psychiatrist, you tested in groups, in pairs, and on your own. You have an hour and a half selection with an interview panel, including an astronaut. And amazingly, I got invited to the next round after that. Then you're down at the last 91. And at that point, stuff's getting pretty real and, you know, you have to have a conversation with your family about what might happen, even though you think it probably won't. So you got to that final 91 and didn't get any further. Yes. So the last stage is you go to Toulouse and you sort of check into hospital for five days and they look at everything, everything.

21:53And although there wasn't a major disqualification, I had a few bits and pieces that were sort of on the edge of acceptable. and in the debrief afterwards they said look we think we could fly you right now but the median time to flight is about four to six years and you may not fly for 10 and we're not sure that these problems won't be big problems in a decade's time so we can't take you and so that was that was that well kevin jumping back a bit in 2011 the welcome trust created a fellowship program in public engagement and you received one of two inaugural grants in fact you also secured a second one in 2016.

22:33The idea of these was to create a new generation of science communicators in the UK who could help build trust in science through public engagement. Since then, you've been involved in numerous TV and radio shows, often exploring the world of health or space. And of course, it's tough choosing favourites, but I gather a documentary about the final space shuttle mission was particularly special for you. Oh, hugely special. Having had Space Shuttle so much part of my childhood, you know, having grown up with that, to be there for the last mission, standing on the edge of the runway in the darkness in this humid Florida morning.

23:14And I remember watching it touch down and thinking it's kind of like watching a mythical creature like a unicorn sort of disappear into the darkness for the last time. and it was like a real moment to be there, real privilege. And so that's the privilege of broadcasting in many ways. So you had all of this going on, working as an anaesthetist, doing emergency helicopter call-outs, developing your broadcasting and then, of course, Covid struck. In March 2020, you were seconded to NHS England as, and bear with me, this is quite a mouthful, National Clinical Advisor in Emergency Preparedness, Resilience and Response for the COVID-19 incident.

23:53Yeah, it's quite hard to write on a checkbook. So what were you working on? Part of my bit was to work across the different silos of the response because there was public health, there was the NHS response, there was intensive care, there was the mathematical modelling groups and I would work across them and try and put those signals together. One of the things that we were doing was gathering data and satisfying ourselves that we kind of knew what was going on. But I was ringing the units. I'd worked in some of these units and the people would be screaming at you down the phone and telling you that the numbers were wrong and telling you that what you were seeing in data wasn't what was happening.

24:31And so my biggest job became trying to close that gap, trying to get the right information to the right people so that we could make the right strategic decisions. And so I organized a series of teams of people who went out to our hardest hit units to support them and then to try and guide support to them. And actually, we should mention that alongside the pandemic, you were dealing with a huge personal loss yourself, because in the early days of COVID, your mum passed away. Yeah, I remember that just as I get seconded. My mum falls very ill with cancer, very aggressive cancer. It was only 10 weeks, actually.

25:08And literally, as she's in intensive care in a side room, I remember peering through the glass of the very first COVID patient comes to intensive care at UCH. and my mum dies very shortly afterwards just as everything's kicking off with Covid and so it's a very, very strange time but, you know, my mum was in my place with my people looked after by my friends at the end and you couldn't want for any more or any better and I'm very grateful to my colleagues. Well, Kevin, you also recognise that this was a time of huge pressure on many working in healthcare and in 2020 you organised a large-scale survey examining the mental health of intensive care staff during the pandemic, which gathered more than 6 ,000 responses.

25:56What did you find? We found enormously high rates of poor mental health, rates of probable post-traumatic stress that were comparable to that which we saw in British military veterans who were deployed in combat roles during the Afghanistan war, and part of that paint a picture of a system which was exceeding its surge capacity. I mean, we're back to where we were earlier in my career. Last year, you gave evidence to the government's COVID inquiry and were actually reduced to tears when recalling the huge pressure healthcare workers were under. You also co-authored an article for the British Medical Journal highlighting the issue, a warning of the tremendous and continuing toll of the pandemic on NHS hospitals and staff.