Friday, September 28, 2007


As I have explained previously, my boss wants to give away a bunch of old NT 4 workstations to the local state-run media (radio, television and press agency). NT4, no longer supported by Microsoft (i.e. no security updates), the fact that we cannot buy anything (we are not an aid agency), as a government agency cannot provide pirated copies and cannot protect them from Windows viruses.

After some experimenting with different Linux versions for older machines and in our own language, I came up with the Brazilian Kurumin Lite. Flew … except CUPS and HPLINUX printer support don’t work. It is based on Debian which has a reputation as being very stable and conservative.

So I took the Kurumin machine down to the national radio last week and, guess what, it wouldn’t connect. Put in the DNS IP server addresses in the /etc/resolv.conf file etc.

Finally, after four hours of work on a Saturday morning with A. from the local ISP who knows much more about Linux than I, we discovered the switch downstairs (where we were working with the Linux box) was not connected to the switch upstairs and thus not connected to the broadband modem. Duh!

A. recommended Ubuntu. I’ve downloaded a “lite” version, Xubuntu that has multiple language options including our own and like it – the bundled word-processor (Abiword) is far superior to Kedit.

However, there seems to be a big video driver problem in that Xubuntu does not like NVidea video cards and after the initial boot from the Live CD the screen goesblack.

Later ..I’ve managed to get to a command prompt … so we will see tomorrow.

Update: Ahhh! It seems the standard installation needs 192 Mb RAM to install, but 128 Mb to run. This workstation has 128 Mb RAM. Maybe it’s not the video card. There is an “alternate” iso that only needs 64 Mb RAM to install so I am now downloading this – painfully slow, Equinox sunspot activity seems to be effecting our download rates.

Random Musings

Driving home from work today, I dwelled on the pain Kezia must go through on these bad bad bad Dexamethasone trips. Four days a month for the remaining year of treatment. Kezia and Nanda went to town today – Kezia loves going on the bus, but they didn’t get very far before Kezia said “Nanda, Kezia doesn’t feel good” and they went home … but not before buying her a (toy) mobile phone on which she apparently phoned me and roundly chastised me! For what I don’t know.

Nanda and I talked about how she is beginning to verbalise her pain which makes it a bit easier for Nanda and Jaime to respond appropriately.

I cannot bear to think about these dex trips but must. Kezia, Nanda and Jaime must live with it.

Nanda and Kezia saw Lucia and her mum at the hospital in Tuesday. It was Lucia’s first off-treatment appointment and she’s doing well (as she writes here). Nanda showed Lucia and her mum a photo of our house here. And Nanda saw a photo of YOBS with our consultant John and wants me to take a photo of Kezia with John (and I think we should include Teresa, our social-worker) as well - to show family here and for Kezia to remember.

Travel plans – I hope to spend two weeks with them from the middle of October. I am on a waiting list. The once-weekly direct flight to Europe is fully-booked for six weeks. L. at our local travel agency has assured me she has got me put at the top of the waiting list. A new passport arrived today after four months and six countries! Today I took the precaution of reserving a Xmas/New Year visit as the plane will be packed on the 22 December – L. has told me reservations are already being made.

During the last few days a wonderful perfume has surrounded the house, especially at dusk – the coffee flowered, orange and tangerine blossom …

Work is going well this week – I managed to get a computer we are donating to the local radio and running Linux connected to their broadband link. They had the cabling between two network switches fucked up.

So onto a techie post …

Wednesday, September 26, 2007

Medical Update

Kezia had a hospital visit yesterday. Vincristine injection and collecting prescriptions. Neutrophils well up at 1.7. Four days of Dexamethasone started this morning and it has already kicked in - when I phoned she was crying and didn't want to speak to me. So she'll be off school this week. Next appointment in two weeks so I guess John is happy.

I want to be consulted!

Dr Ray reported (and follow-up here) on Lord Darzi’s Citizen Jury consultations on the planned closure of NHS District General Hospitals and replacement with dumbed down polyclinics.

Apparently, the public delegates are not offered a reimbursement of their train tickets and tea and biscuits as they mingle with DoH staff after the main event. Nor are they even offered a buffet lunch.

No not at all!

After the medical delegates are shooed from the room, they are given £75 in cash!

And after Dr Ray’s exposure, the DoH actually admitted it!

DoH, invite me!

Patient Information and Decision-making

This last weekend I have been reading a Picker Institute (an NGO) report entitled Evidence on the effectiveness of strategies to improve patients’ experience of cancer care commissioned (I assume that means paid for) by Macmillan Cancer Relief (another NGO) for the Department of Health’s (DoH) Cancer Reform Strategy.

It is not very good.It is mainly based on more general research into patient participation in their healthcare with very little specific to cancer treatment. This may be due to a lack of cancer-specific research, in which case, why commission an expensive report that pretty much reports the same findings of non-cancer patient participation reports?

However, I have more gripes about how the report deals with certain issues. Obviously, the discussion below is based on our own experience.

Firstly, there is a big difference between patient/carer information and patient/carer participation in clinical treatment decision-making. The two are overlapped in this report. As long as Kezia is responding as expected by the doctors, we are going to follow the UKALL 2003 protocol as representing the best T-cell ALL treatment knowledge to date.

If Kezia were to react badly to protocol medications and modifications to her treatment were required, I would expect information from the consultant, I would expect recommendations and we would certainly follow them. Who are we to know better?

Onto other gripes …

Given the DoH’s stated emphasis on correcting ethnic inequality in healthcare provision it is surprising to see “[Patient information needs] are shaped by demographic characteristics including gender and socio-economic beliefs, preferences and styles of coping”. No mention of ethnicity, no mention of Sickle Cell Anaemia in African or Afro-Caribbean communities, no mention of the problems of HPV/cervical smearing in Muslim communities, no mention of consultation with Muslim communities over the forthcoming HPV vaccinations for young teenagers.

The report does not adequately distinguish between public participation in preventive programmes – smoking cessation, HPV/cervical smears, breast examinations etc – from active participation in cancer treatment.

Our own participatory needs are most important in the active treatment of Kezia (yes, of course, I need to give up smoking and Nanda needs to have a cervical smear). Home chemotherapy treatment has been an empowerment, especially with the administration of Cytarabine through her Hickman Line during the first year of treatment. We received training and, being able to execute a seemingly complex and daunting procedure, increased enormously both our confidence and sense of participation.

Equally, explanation and provision of Kezia’s blood test reports has helped.

Information – the report states “The research indicates that many patients want more information than they currently receive and that health professionals tend to overestimate the amount of information they supply”. Leaflets have little real impact and websites are often full of Quackery – patients/carers need to be led to reputable sites which provide information at the level of general, health and scientific literacy they require. And it has been reported that information personalised to the individual is better (hence the importance of medical personnel communication skills).

Health literacy is identified as an issue – Nanda and my own levels of health literacy are at very different levels.

Let us start with me. I want to know all about Acute Lymphoblastic Leukaemia at all levels. The information provided by Cancer Research UK was finally not adequate, the slightly more sophisticated information provided by the Leukaemia Research Fund just wetted my appetite and then I found Patty Feist’s Pediatric Oncology Resource Center which admirably explains or points to explanations at all health literacy levels.

I am not a scientist. Yes, I have a Masters degree. And over the years here I have developed knowledge of biology – I roughly know a gene from a chromosome, DNA from RNA …

The scientific journals fail us patients/carers – dear publishers, you would not have many of us asking for an article and you could easily create a system to check up if we were bona-fide patients - or the UN you could put us in the WHO free medical journal scheme … Open-source …

Patty, whose son had leukaemia and being the Laboratory Coordinator at Columbia University’s Organic Chemistry faculty also found the level of material low for her personal needs. She was not even allowed to see a copy of the treatment protocol and had to obtain a “blackmarket” copy – so I am very happy at the openness of the UKALL 2003 trial in making their protocol free information over the internet.

Let us move over to Nanda. Most information is not available in any other language. A few leaflets are available in Urdu, Punjabi etc. Nothing in EU languages. No NHS or DoH websites seem to be available in other languages. The Cancer Research UK, Leukaemia Researh Fund, Clic Sergeant, Macmillan Cancer Support sites are not available in ethnic minority or EU languages.

Conclusion … the DoH and the EU should address these issues, perhaps through European-wide institutions such as European Cancer Organisation (ECCO) or other European-wide cancer organisations.

Friday, September 21, 2007

NHS Choices ??

I’ve been reading the minutes of first meeting between the UK Parliament’s all-party Health Committee and our new Secretary of State for Health, Alan Johnson back in July.

Our Health Secretary believes we the patients and carers will override our GP’s recommendation of a particular consultant on the basis of hearsay.

However, Drs Rant and Crippen and the Committee have noted that Choose and Book does not allow them to choose individual consultants. So neither the GPs’ recommendation nor the patient’s preference for a particular consultant can be exercised.

This is, in my opinion, also demanding that the patient/carer make some clinical decisions. Our Health Secretary thinks we, the patients and carers, can make decisions on the advantages and disadvantages of invasive or non-invasive surgery for our particular condition. Yes, I have the right to weigh up advice from my GP or my consultant on this, but I really do not have the medical knowledge not to follow their recommendations.

And I have a Masters degree.

On the day we arrived, we were given a preliminary diagnosis by the (trainee) Senior House Officer and he shot us off to the Royal Manchester Children’s Hospital – no choice. But the right decision.

On arrival we were not given a choice of consultant – I am happy we were allocated to John and not T. – John is less “patronising” in our own and others’ opinions (T. does need some lessons in patient – doctor social interaction!). But the clinical treatment would be the same. The support of the nursing staff would be the same. The support of social services would be the same. Our favourite two volunteer ambulance staff who take them all to hospital (i.e. two retired people volunteering their own cars, get paid fuel and nothing else, who were at first crotchety old people and who are now wonderful young people and are marvellous!) would be the same.

The Rt. Hon. Kevin Barron, Chair of the meeting, pointed out that patient/carers choices are currently more concerned with distance to the hospital, car-parking fees and waiting lists. And rightly so.

The healthcare professionals, whether GPs, nurses, consultants, ambulance drivers, paramedics, social services’ workers, physiotherapists, teachers etc are paid to take decisions for us. Even the RMCH clown (paid through charity not government) has to make a decision whether a child is up to their decision to entertain!

So Mr Secretary of State, give us the power to choose distance to the hospital (local hospitals!), car-parking fees and waiting lists. And give our GP the right to choose our clinician!

Kezia's teacher says ...

In reponse to my message to her yesterday warning about next week's dexamethasone

"Kezia is doing very well she has made lots of friends and communicating well. She especially likes it in the home corner making pretend food for all the children and staff! I will note down her hospital appointment and keep a very close eye on her if Nanda chooses to bring her to nursery."

Wednesday, September 19, 2007

Kezia starts school

Kezia started school yesterday.

She has been so looking forward to it that it seems she hardly slept on Monday night waiting for school to open.

No looking back to Nanda … except Nanda had forgotten her indoor shoes and had to go and fetch them.

And when Nanda went to pick her up, Kezia hadn’t been sure of the (NHS-speak) “protocol” for telling teacher that she wants to wee-wee, so was crossing her legs.

“Angus doesn’t have a teacher, Nanda doesn’t have a teacher, Pete doesn’t have a teacher, Paula doesn’t have a teacher, Stefan doesn’t have a teacher, Hamilton doesn’t have a teacher … but me and Jaime have teachers!”.

She will have to miss school for one day most weeks to go to hospital and we are concerned how she will be when she is on the dreaded Dexamethasone for four days a month, when she is moody and lethargic – first time round begins next Wednesday. Will she want to go school? If she does, how will she be? Her teacher has been briefed and we will just have to play it by ear.

I am relieved. Another milestone … not directly part of the leukaemia story but certainly related.

American English and Russian

The Russian poet, Vladimir Mayakovsky visited the USA in the 1920s …

“But just consider my situation. A poet’s been invited. They’ve been told he’s a genius. A genius – that’s even better than being well known. I arrive and right off say “Gif me pliz am tee”.

They serve me. I wait a bit and then , “Gife me pliz …”.

They serve me again.

And I keep it up, varying the intonations and the phrasing. “Gife me de sam tee, sam tee de gif me”. I say my say.

The evening proceeds.

Bespectful old fellows listen reverentially. “There’s a Russian for you. Doesn’t waste words. He’s a thinker … Tolstoy … The North”.

But the ladies move away when they hear for the hundredth time that same request for tea, even though it’s enunciated in a pleasant bass voice. And the gentlemen distribute themselves in the corners of the room laughing at my expense.

So I shout to Burliuk: “You translate this to them. Tell them that if they knew Russian, I could, without even dirtying my shirtfront, nail them with my tongue to the cross of their own suspenders, that I could roast this whole collection of insects on the sharp turnspit of my tongue”.

And the honest Burliuk translates. “My eminent friend Vladimir Vladimirovich wants another cup of tea”

Tuesday, September 18, 2007

NHS Choices?

Get out or she dies. Choice ?

11 am Sunday morning. She’s not bleeding, she’s not broken, she’s not crying.

But we are in the local Out-of-Hours Walk-In Centre after an hour or so on two out-of-hours buses … in the pouring rain.

Fortunately, we’re early enough to miss the Saturday night casualties of drunken domestic violence and nightclub brawls – instead our company is concerned Muslim mums with, like us, sick kids.

“See your GP tomorrow”.

“Look at this”. We tender the doctors’ report from here. “Oh … now would you prefer the A & E down the road?”

“No – we want to see a doctor”.

“Which one do you want to see?”

“Any fucking one!”

“Well, at the moment, there is only one … ok … just take a seat …”

… “ok, we’d like to take her up to Paediatrics (you know it’s closing soon?) to see the doctor there but, of course, if you want to go, at your own cost, to Paediatrics 20 miles away and which has a far better reputation than our own … of course, if she dies on the way …”

“Let us see a fucking doctor!”

“Hmm … I think she needs a blood test. We can do it tomorrow when the lab is open or we can send it over to the hospital 20 miles away and get the result later on .Which would you prefer?”.

Meanwhile, Dr Fuckwit sees the word Africa and we are in isolation because we may have Ebola …

The result returns.

“We think your daughter has leukaemia … now then, which Centre of Excellence would you like to attend?”

Thank your Deity it was not like that. Thank you NHS nurses and doctors for taking decisions for us – because that is what you are paid to do!

Friday, September 14, 2007

NHS - England, Northern Ireland, Scotland, Wales

Our country’s official title must baffle many from other countries – the United Kingdom of Great Britain and Northern Ireland. I’m not sure when the official title was passed into law. The country of England conquered Wales in medieval times and never really conquered Scotland. They were only united when the only direct heir to the English throne was King James IV of Scotland upon the death of Queen Elizabeth I of England. The Irish history is even more complex but when the Republic of Ireland became an independent state in the early years of the 20th century, the people of the north chose to remain allied with Great Britain but as the name suggests like some sort of bastard rump (that is not meant to be offensive, just a reflection that the name suggests you are not British, although part of the country).

In recent years much political and administrative power has been “devolved” to the individual countries or regions to the extent the Scottish Nationalist Party now forms the government in Scotland and is, again, promoting independence from the United Kingdom of Great Britain and Northern Ireland.

The National Health Services of the four regions are, to a greater or lesser extent independent of each other, although all receiving their funding from central U.K government.

On Monday Dr Rant, in a wonderful piece entitled Hypocritic Oaf, ranted about an episode of the daily domestic BBC Radio 4 current affairs programme Today in which the BBC journalist John Humphreys interviewed our Secretrary of State for Health and widely slagged off our GPs. I have not been silent myself in criticism of the BBC’s coverage of the NHS. At times its seemingly unbiased reporting is very much on the government’s side, and I believe it does need a new Health Editor.

However, on visiting the Today website, I find quite copious, comprehensive and balanced information about NHS reforms.

I was particularly impressed that the BBC commissioned reports from the King’s Fund (a public health independent charitable think-tank), which has recently undertaken a review into funding, and its structure, of the national NHS.

I have downloaded and read, so far, the King’s Fund/BBC Today reports on the NHS in England and Scotland.

There have been many criticisms of the availability of cancer drugs in NHS England and Wales - not approved, often for financial reasons, by the National Institute for Health and Clinical Excellence. The Welsh drugs approval authority kowtows to NICH (see this BBC report about the availability of the cancer drug Sunitinib and the All Wales Medicines Stratgey Group's statement about its relationship with NICH), Scotland has its own approval body which has approved them (though not Sunitinib). There have been several cases where cancer patients have had to move to Scotland to receive certain drugs.

Looking at the Kings Fund/BBC Today reports into NHS in the four regions I am somewhat surprised.

NHS Scotland’s report runs to 24 pages, NHS Northern Ireland 18 pages, NHS Wales 13 pages and NHS England to 10 pages. Same questions.

NHS Scotland obviously has better statisticians or realises the importance of data for planning or has more statisticians per head of population or pays them more or …

The standardisation of data across the Scottish health boards far surpasses that in the various types of English trusts, the data collection and analysis of which follows no national standards. Better data collection and analysis should certainly lead to more informed planning.

NHS Scotland reported 45 hospital openings and 56 closures since 1997.

NHS Northern Ireland reported 1 hospital opening and 13 closures since 1997.

NHS Wales responded “We do not currently have records which detail this information as requested.

Ok – you are dumb as the fuckwit dumb bureaucrats reported for NHS England (see below).

But NHS Wales reasonably continues:

We consider that to do so would create misleading data as the figures and comparison make a simplistic comparison which is unrepresentative of the overall position from which improvements across delivery of health services takes place, We would point to the fact that (small) facilities are often replaced by (fewer) more joined up, modern, bigger facilities whilst also recognising that there have been many schemes where developments have taken place on existing hospital sites. Additionally, the requested information would take no account of changing modes of care”.

Fair enough – but you are saying our local facilities are being replaced by further-afield facilities!

NHS England reported 82 hospital openings and about closures cynically responded “The information is not held centrally”.

Jaime and his girlfriends

Nanda told me on the phone yesterday that Jaime’s school friends, those he plays with at school playtime, are all female! He appears to be popular with the girls!

He is also getting asked how come his younger sister, who goes to meet him at the end of school each day, is coffee-with-cream coloured and he is chocolate coloured. He explains that I am not his biological father.

An early knowledge of genetics.

And, if the womanising is anything to go by, he takes after both his biological and adopted fathers – although, having had far more children with various women, the former is far worse! When Jaime gets to puberty, I’ll throw a condom at him!

Wednesday, September 12, 2007

Quilts 4 Leukaemia

Kezia's going to get a present - see here and here and here. I think she will be thrilled! Thank you very very much!
Photo courtesy of Clare.

Medical Update

Kezia had her intrathecal methotrexate today. Bloodcounts good and doesn't have an appointment next week. School starts next Tuesday so with no hospital she won't miss the first day which she is very much looking forward to!

Tuesday, September 11, 2007

UKALL 2003 - the Protocol, the Regimens and Kezia's path through it

I know that Dr Crippen and Dr Rant hate checklists and flowcharts guiding them through diagnoses but in clinical trials they are necessary to obtain standardisation between participating centres and thus statistically relevant data – I am sure that Dr Crippen and Dr Rant will agree.

In the UKALL 2003 trial there is an initial diagnosis flowchart by which patients are allocated to the three treatment regimes being compared. Below I partially reproduce this up to the point where Kezia, at Day 8, was allocated to the most intense regimen.

Once our consent had been obtained to participate in the trial, the oncologists and haematologists are not obliged to follow the regimen strictly – if something is amiss, then they will, to the best of their judgement and with the parents’ consent, try non-regimen treatment. This has been the case with our friend’s teenage daughter, H., who seems to have gone through every drug side-effect in the book.

However, it was pointed out to us in the first week that there is little difference between an established protocol and the trial protocol – especially with Regime C which is a typically aggressive treatment not based on the level of Minimum Residual Disease, used partly to choose between the less-aggressive treatments of Regimens A and B (but which also take into account bloodcounts etc), but solely on the traditional clinical measurements based on bloodcounts and genetic abnormalities.

Regimens B and C during the first 28 days are the same but differ later.

Kezia’s path through the flowchart is in bold.

Under 12 months ? yes Interfant trial


B-cell ALL ? yes Regimen C


BCR-ABL ? yes Regimen C


MLL rearrangement ? yes Regimen C


Hypodiploid yes Regimen C

(≤ 44 chromosomes) ?


AML1 amplification ? yes Regimen C


≥ 10 years ? yes Regimen C


White Blood Count yes Regimen B

≥ 50 x 109/L


Regimen A.

Marrow morphology at day 8/15

If on Regimen B, aged 1-15 years: yes Regimen C
> 25% blasts (M3) at day 8 ?

Monday, September 10, 2007

Cancer months

As Rob as pointed out, stateside September is National Childhood Cancer Month. It is also Leukemia and Lymphoma Awareness Month. In fact nearly every month is a cancer month. Here’s the schedule!

January 2007

  • National Cervical Cancer Awareness Month
  • Great American Health Check (Jan. 19)
  • Healthy Weight Week (Jan. 21-27)

February 2007

March 2007

  • National Colorectal Cancer Awareness Month
  • National Nutrition Awareness Month

April 2007

  • National Cancer Control Month
  • National Minority Cancer Awareness Week (April 15-21)
  • National Volunteer Week (April 15-21)

May 2007

  • Skin Cancer Detection and Prevention Month
  • Melanoma Monday (May 7 – American Academy of Dermatology)
  • American Cancer Society Relay For Life® Signature Weekend (May 19-20)
  • Women's Health/Cancer Awareness (Mother's Day - May 13)
  • National Woman's Health Week (May 13-19)
  • World No Tobacco Day -- (May 31)
  • National Physical Fitness and Sports Month

June 2007

  • National Cancer Survivors Day (June 3)
  • Men's Health/Cancer Awareness (Father's Day - June 17)
  • National Men's Health Week (June 11-17)

July 2007

  • UV Safety Month

August 2007

  • Great American Eat Right Challenge (Aug. 16)

September 2007

  • National Ovarian Cancer Month
  • Childhood Cancer Month
  • Gynecologic Cancer Awareness Month
  • Prostate Cancer Awareness Week (Sept. 16-22)
  • National Prostate Cancer Awareness Month
  • Leukemia and Lymphoma Awareness Month
  • Take a Loved One for a Check-up Day (Sept. 18)

October 2007

  • National Breast Cancer Awareness Month
  • National Mammography Day (October 19)

November 2007

  • Great American Smokeout (Nov. 15)
  • Coaches vs. Cancer Classic® Weekend (Nov. 15-16)
  • Lung Cancer Awareness Month
  • National Family Caregivers Month
  • Pancreatic Cancer Awareness Month
  • National Healthy Skin Month

December 2007

Suggestions please for February and December!

Friday, September 7, 2007


The local, I should say national ISP, that happens to have a telecommunications monopoly, has blocked Skype.

Don’t worry regular readers – I can still use Skype to speak to family from work as we have our own independent satellite and Internet connection.

However, we (myself and a colleague) have started to investigate workarounds. Regular international telephone calls (fixed and mobile) are exorbitant – if you look at Skype computer-to-fixed/mobile tariffs, our country is in the top five at 0.79 per minute beaten by Diego Garcia – and who calls there over a regular telecoms link?

I don’t have a fixed line as the telecoms company says they don’t have capacity in our area – so I cannot experiment.

First we need to find out what sort of filtering the ISP has installed – are they targeting Skype servers’ IP addresses or are they identifying Voice over IP (VoIP) data packets? In the former case everyone can just use a different VoIP service, in the latter it appears we can use Tor (link), eProxy (link) and BCap to get past the ISP’s filtering.

VoIP blocking is a notorious device whether for financial or political reasons. In the United Arab Emirates, another ISP/telecomms monopoly, it is financial, in China it is both.

Here, I am sure, it is financial.

There is a moratorium here on civil service calls to overseas – general abuse.

Even though the software is free, Danny and I will make a killing on installation fees

The Diagnosis

I had to translate the initial diagnostic report from our central hospital. For the record, here it is:

NAME: Kezia Lima Gascoigne

FATHER: Angus Robin Gascoigne

MOTHER: Fernanda Soares Lima



Swollen spleen for investigation.


On Internment

The child was prescribed antibiotic treatment for impetigo on 02/05/06. Although this was effective, she developed a swollen spleen and lymph nodes and was admitted to the Paediatric Service on 05/05/06, where she was tested, diagnosed with severe anaemia, given a blood transfusion and prescribed more antibiotics.

On 10/05/06 she was allowed to return home and prescribed to take antibiotics (Clavox 250) for a further 7 days.

On 16/05/06 her mother noted facial edema, ambulatory difficulties, general pallidness and swollen lymph glands in the cervical region.

Physical Examination

a) Cervical region (dorsal): adenopatic, in the form of hard consistency packets.

b) Swollen spleen to 14 cm below the costal rib.

c) Liver: swollen and hydrated.

d) Other: facial edema


After testing for haemoglobin with a level of 4 mg/dl, she was given a further blood transfusion (Group A+), intravenous crystalline penicillin and folic acid.

On 20 May we were on the plane.

Wednesday, September 5, 2007


I wrote here about the malaria eradication campaign in our small country led by the Taiwanese. I noted that the insecticide, alphacypermethrin, used to spray the inside of houses is claimed to be ecologically safe.

However, today I was talking to the wife of a colleague who has developed an allergy to alphacypermethrin and is being treated by our workplace doctor. So I got to looking it up on the web and found this information from the US Environmental Protection Agency:

"These modern synthetic insecticides are similar chemically to natural pyrethrins, but modified to increase stability in the natural environment. They are now widely used in agriculture, in homes and gardens, and for treatment of
ectoparasitic disease.

Pyrethroids are formulated as emulsifiable concentrates, wettable powders,granules, and concentrates for ultra low volume application. They may be combined with additional pesticides (sometimes highly toxic) in the technical product or tank-mixed with other pesticides at the time of application. AASTAR (discontinued
1992), for instance, was a combination of flucythrinate and phorate. Phorate is a highly toxic organophosphate. Nix and Elimite are permethrincreams applied to control human ectoparasites.


Certain pyrethroids exhibit striking neurotoxicity in laboratory animals when administered by intravenous injection, and some are toxic by the oral route. However, systemic toxicity by inhalation and dermal absorption is low. Although limited absorption may account for the low toxicity of some pyrethroids, rapid biodegradation by mammalian liver enzymes (ester hydrolysis and oxidation) is probably the major factor responsible for this phenomenon. Most pyrethroid metabolites are promptly excreted, at least in part, by the kidney.

The most severe, although more uncommon, toxicity is to the central nervous system. Seizures have been reported in severe cases of pyrethroid intoxication. Of 573 cases reviewed in China, there were 51 cases with disturbed
consciousness and 34 cases with seizures. Of those, only 5 were from occupational exposure. Seizures are more common with exposure to the more toxic cyano-pyrethroids, which include fenvalerate, flucythrinate, cypermethrin,
deltapermethrin, and fluvalinate. There are no reports in the literature of seizures in humans from exposure to permethrin.

Apart from central nervous system toxicity, some pyrethroids do cause distressing paresthesias when liquid or volatilized materials contact human skin.Again, these symptoms are more common with exposure to the pyrethroids
whose structures include cyano-groups.Sensations are described as stinging, burning, itching, and tingling, progressing to numbness.The skin of the face seems to be most commonly affected, but the face, hands, forearms, and neck are sometimes involved. Sweating, exposure to sun or heat, and application of water enhance the disagreeable sensations. Sometimes the effect is noted within minutes of exposure, but a 1-2 hour delay in appearance of symptoms is more common. Sensations rarely persist more than 24 hours. Little or no inflammatory reaction is apparent where the paresthesia are reported; the effect is presumed to result from pyrethroid contact with sensory nerve endings in the skin. The paresthetic reaction is not allergic in nature, although sensitization and allergic responses have been reported as an independent phenomenon with pyrethroid exposure. Neither race, skin type, nor disposition to allergic disease affects the likelihood or severity of the reaction.

Persons treated with permethrin for lice or flea infestations sometimes experience itching and burning at the site of application, but this is chiefly an exacerbation of sensations caused by the parasites themselves, and is not typical
of the paresthetic reaction described above.

Other signs and symptoms of toxicity include abnormal facial sensation, dizziness, salivation, headache, fatigue, vomiting, diarrhea, and irritability to sound and touch. In more severe cases, pulmonary edema and muscle fasciculations can develop. Due to the inclusion of unique solvent ingredients, certain formulations of fluvalinate are corrosive to the eyes. Pyrethroids are not cholinesterase inhibitors. However, there have been some cases in which pyrethroid poisoning has been misdiagnosed as organophosphate poisoning, due to some of the similar presenting signs, and some patients have died from atropine toxicity."

I also discovered it is toxic to butterflies! Hence my suspicions expressed in the previous post have been confirmed - as I said before neither biodiversity impact assements nor epidemiological studies on adverse reactions are being undertaken. Additionally, it is being used in higher concentrations than normal in agricultural use.

Rainwater Harvesting

A torrential tropical rain started 30 minutes ago – I love it!

Much middle-class and almost all higher-class housing is made from concrete blocks constituted from beach sand and cement. Given the small area of our coastline and the fact that the beaches are even more limited, given we are a precipitous volcanic island, the extraction of sand has had, in some places, a disastrous environmental effect with beaches destroyed and communities at risk of falling into the sea.

Wood, even our superb tropical hardwoods, are generally viewed as a lower-class construction material – except by a few, of whom I am one! Obviously, the exploitation of tropical hardwood is also a great problem but most of our wood is coming from current and abandoned plantations rather than primary forest, where trees (if the will exists), can be replanted.

Our house has ended up about 75% wood and 25% concrete. The wood is mostly local African Teak (a different species from the most-valued teak, but still very, very good) and Jackfruit (stairs and bathroom counter-tops), another very good white hardwood.

Most of the urban population depends on public taps supplied with mountain water from a colonial supply system probably 50 years old, just patched up over the years Rural populations collect, often contaminated, river water. Our nearest clean freshwater supply is a kilometre or more away … once upon a time there had been buried underground piping from the source to the nearest public tap but someone stole it! The local rural population relies on rivers and springs.

So I decided on rainwater collection.

Everyone here thinks rainwater is unclean, even given the occasional cholera outbreaks resulting from contaminated river water.

The rich will construct a cuboid semi-subterranean tank from the aforementioned concrete blocks and mortar with water supplied from the public water supply network. The problem here is threefold – “cylindrical or spherical shapes optimize the use of materials and the wall strength”, the joints between concrete blocks sealed with mortar are points of weakness as are the joints between vertical and horizontal.

We constructed our first hemispherical ferrocement tanks of approximately 40 m3.

The inspiration for the design and construction technique came from the drawing below with some modifications.

Firstly, the size – I halved it as the tank in the drawing was for a rural primary school in Kenya! The modifications were as follows:

a) the draw-off pipe is not at the bottom of the tank for various reasons. We send water from the tanks to a 2000 litre tank on small tower with an electric pump which we connect when necessary. The water falls by gravity to the house taps. Water just below the surface will be cleaner than at the bottom of the tank where detritus will accumulate. So the draw-off pipe is a hose tied to a buoy that rides up-and-down a vertical pipe wedged in-between the roof and floor of the tank.

b) as we do not have a bottom draw-off pipe, we did not construct the 5 cubic metre run-off reservoir.

c) we have had a problem with our very large overflow pipes (4 inch – necessary because of the intensity of the rain) - of giant African snails crawling up and drowning at the bottom of the tank – solution has been a small piece of mosquito netting and inner-tube rubber to secure the netting to the PVC tubing.

d) filtering – from the guttering around the house and bloody great metal boxes on each corner of the house (to try and capture the sheer quantity of water that occurs during a tropical storm), the water passes through a coarse filter of stone chips and then a finer filter of mosquito-sized netting

The three years, four starts of rainy seasons, have been a learning experience … A torrential downpour on 30 September 2004, a late beginning of the rainy season, the day we moved in … so a planned purchase of water was not necessary.

During our first rainy season, supply with one tank was more than enough, but come our dry season from May through September, there is no rain and the one tank would get lower and lower … Nanda insists on washing clothes by hand in a wash-tank practically everyday in spite of a washing-machine! They don’t trust washing-machines, thinking they can do a better job by hand and not understanding they are beating the shit out of my clothes! Perhaps Nanda would feel differently if she had to trek to the river! Anyway, I had wildly underestimated our consumption.

Over the first year it soon became apparent that 40 m3 would not be enough for an entire year so we constructed another tank of c. 30 m3.

In 2005 and 2006 the rains also started late. This year, with obviously much less domestic consumption, the rains have already started.

So what is ferrocement?

Basically we made a net of chickenwire and barbed wire and applied a cement-powdered stone (not wanting to use beach-sand which as being ecologically would have leached out salt) mixture in layers over this. As it is subterranean the underlying earth will provide support.

Reference: John Gould and Erik Nissen-Petersen. 1999. Rainwater Catchment Systems for Domestic Supply. Intermediate Technology Publications.

Tuesday, September 4, 2007

Night Time

Crickets, frogs and bats chirrup, croak and shreek the night away.

Two Cows

Via Dr Rant - this is very very funny!