Thursday, January 31, 2008
Wednesday, January 30, 2008
Yesterday hospital - neutrophil count down due to last week's Dexamethasone so off medication. As stated before, this is actually good as if the counts were "good", it would mean the medication is not working.
Nanda and Kezia had to wait yonks for transport home so I imagine Nanda will chew me out today.
Tuesday, January 29, 2008
A friend of mine - ok, I´ll ´fess up - the son of an ex-partner has become a craftsman and budding entrepreneur to boot.
Lu is 24 years old. I passed most of his teenage with him. And as teenagers are, he was a bit of a handful, but as teenagers go, he was relatively good. I would say to his mum ... ¨come on, what´s the problem ? When I was his age, I was underage drinking, smoking pot ...¨.
During my years with them, the most serious escapade he got into was to let off a banger (firecracker) in the school corridor. Exams were looming and the headteacher suspended him. If he didn´t take these exams, he would have to repeat the whole year. I went and pleaded to the headteacher and she allowed him to take the exams.
Blimey - I dropped my trousers and did a moonie in infants´ school in front of the entire playground ! The headteacher gave me a stiff talking-to as to what was appropriate behaviour and left it at that.
Lu got through the last year at school here at the second attempt. We do not have a university and he has not managed to get a grant to study overseas, just as the majority of our secondary/high school students.
He was a bit at a loss of what to do with himself. At one point he and some friends made a rap video which got played on local television but wasn´t very good. As the years ticked by, futilely trying to get a study grant, it became obvious he had to find something economically useful to do.
He has begun to make jewellry.
Craftwork here is not particularly good - there is no tradition and it is a pale imitation of what is found on the African continent which reminds me of the international African trade in crafts. Senegalese works are widely sold in Cape Town - there is a large enough market of undiscerning tourists who just want something ¨African¨ and don´t care about its provenance.
However, Lu´s earrings and necklaces, illustrated below are of exceptional quality. He collects all the shells himself from a local beach. If any of our readers are interested in purchasing, either individual items retail (USD 5 for the earrings, USD 10 for the necklaces + p/p), or for resale gross (rates negotiable), do please get in touch at
Monday, January 28, 2008
School lunches will be controlled for their nutritional value. (Hasn´t that been tried before?).
Packed lunches provided by parents who opt out of paying for school-provided lunches will be inspected for their nutritional value and non-complying parents appropriately admonished. Moreover, every secondary school will be obliged to give every 11-14 year old obligatory ¨Food Technology¨ lessons.
The government also wants the food manufacturers to take on a more responsible approach to their food labelling,
So, surely, as we are contracting out so much of the National Health Service to private companies through the Private Finance Initiative (and I imagine most NHS culinary services are already contracted out), we can contract Tesco, Morrisons, Sainsbury´s and Asda to provide healthy school lunches ?
McDonalds can already award academic qualifications so surely they are qualified to provide school lunches.
Give our daugther some Dexamethasone and chips.
Thursday, January 24, 2008
I used to greatly admire Peter Kazil´s site on Urban Landscapes and Urban Adventuring in Rotterdam and other European locations. Many beautiful photos and great geeky tales of urban adventuring. He personally admits to not being ever so adventurous but has certainly done some very neat adventuring and buildering (crossing bridges on their underside, exploring in-construction underground railway tunnels etc). And today I revisited it ... and I have linked right
He has given me a much greater appreciation of urban landscapes. In spite of the human ingenuity in the construction of urban facilities, and the technology involved, they are often stark and bleak.
But railway depots, gas storage tanks, power stations, a deserted bus station at 4 o´clock in the morning, a block of flats, docks etc etc can have a strange strange beauty.
Here we haven´t got much in the way of Urban Landscapes and opportunities for Urban Adventures are few.
However, he did inspire me to one.
Our central bank was established on the ground-floor of an eight-floor appartment block. Although there were gates on the doors to the appartments above, the locks did not work. On a reconnaisance trip, I discovered there were no locks on the doors to the roof.
I discussed the idea with my dear Filippino friend Arthur and his visiting brother Alex. They were game - Alex would assist me on the roof, Arthur would provide getaway transport and video the event.
Late on a stormy Sunday afternoon, as light was fading, Arthur drove us up to the bank block. Alex and I quickly ascended to the roof. I explained how I wanted the rope rigged - two belay points for safety. He rigged as I put on my harness and rack, then threw the rope over the parapit - ¨Alex, as soon as I signal I´m down, derig and get down quick¨.
And I abseiled down the side of the Central Bank.
Into Arthur´s car and away. Someone cheated on us and called the Administrator of the building who called the police - we watched from afar!
Unfortunately, Arthur´s video is murky.
Remaining to be done? Well, this building has two non-functioning lift-shafts ...So below are some more photos of UK Urban Landscapes from December ...
Tuesday, January 22, 2008
... is apparently not significantly different from the African brain drain in other professions.
A new study quantifies in a more accurate way the origins and destinations of African doctors and nurses.
It is not surprising that the African countries from which, percentage-wise, most African doctors and nurses originate are countries with current or recent conflicts, but what is interesting in the difference in countries of origin between the two professions:
Doctor top 6 origin list:
Sao Tome e Principe
Nurse top 6 origin list:
Sao Tome e Principe
Clearly, in our Doctor List the first four are from conflict countries. No. 5 is probably the most repressive in Africa.
In our Nurses List I am not surprised by nos. 1 and 2 and 5. Again conflict zones. But nos. 3 and 4 are calm and collected.
Oh, and no. 6 in both lists ... no fucking comment.
The differences must be based on socio-economic and educational differences in different countries.
A few off-the-cuff remarks:
- Gambia and Mauritius nurses are probably well-trained in good programmes in their own countries.
- it is easier and cheaper, and a wiser healthcare strategy, to train nurses than doctors when you want to spread basic primary healthcare. Drs Rant and Crippen have made many criticisms of Nurse Practitioners in the UK but it does make sense in Africa.
- I am surprised that the D.R. Congo is so far down both the Doctors' and Nurses' lists given its recent history.
- on the recent Ama Sumani case, certain UK politicians have pointed to the deficiencies in the Ghanaian healthcare system and that the solution to cases such as Ama´s should lie in improvements to the Ghanaian health system. I couldn´t agree more ...
I will draw their attention to the DWIB Leukaemia Fund which is struggling to support the establishment of bone marrow donation and transplants in Ghana.
I will also draw their attention to the fact, as did the BBC´s Correspondent, that 56% of Ghanaian doctors, and 24% of Ghanaian nurses work overseas. 590 doctors (20,1 % of Ghanaian doctors) and 2381 (16% of Ghanaian nurses) are working in the UK.
Friday, January 18, 2008
Yesterday I came across two very impressive websites run by a charity DIPEx based at the Department of Primary Care at the University of Oxford which supports the DIPEx Research Group. From the little I have read so far, it should be essential reading for all those dealing with serious illness.
Their stated aims are as follows:
- To share the experience of illness or a health problem and to provide support for patients and carers who may feel that they are on their own.
- Answer the questions and problems that matter to people when they are ill or have a health-related problem and to help them make informed decisions about their healthcare.
- Provide reliable, evidence-based information about illnesses or advice on health problems.
- Be an educational resource for health professionals.
- Promote better communication between patients and healthcare professionals.
The main content of the sites seem to be interviews with patients on their experiences. The illnesses range from heart disease to strokes to cancers to obscure things of which nobody has ever heard (unless, of course, you´ve got it). The founders (seemingly, medics themselves ... but don´t be fooled not every Dr. is a medic) of the charity and research group were themselves at the receiving end of treatment, inspiring them to initiate this project.
Much on the various leukaemias obviously.
The project does have a serious academic side which results in various papers each year which, I am sure, are a valuable contribution to the quality-of-life aspects of medical treatment (one aspect of the ALL trial, UKALL2003, in which we are participating, concerns quality-of-life issues).
The interviews are, given the serious, ¨academic¨ (Lucia said ¨geeky¨!), certainly non-patronising and interesting. I found that a lack of a distinct section for parents caring for young children was a slight weakness.
I would rate these sites up there with the Pediatric Oncology Resource Center and will duly link to them. And perhaps Cancer Research UK, the Leukaemia Research Fund, Teenage Cancer Trust, Macmillan etc should link to them as well.
And the Youth Health Talk section on What makes a good doctor should be required reading in every medical school!
The Leukaemia Research Fund press release is here. Unfortunately, the original paper in Science is not free.
Thursday, January 17, 2008
There has been alot of justified criticism of the BBC iPlayer which since earlier in 2007 has allowed you to download BBC domestic programming over the Internet for later viewing on your own computer without the need for an Internet connection. Just before Christmas they introduced a streaming version whereby you can view programmes over the Internet.
The criticisms are manifold and I list some below:
1. The iPlayer has, so far, only been provided for the Windows XP and Vista platforms. Linux and Macintosh forget it.
2. The programmes for download on the website are only available for 7 days (for either streaming or download).
3. Digital Rights Management (DRM) has been applied to downloaded files - after 30 days they become unplayable.
4. The iPlayer uses Microsoft´s ActiveX coding so in theory, and the BBC tells you so, you are limited to using Microsoft´s Internet Explorer browser. No Opera, Mozilla Firefox etc.
5. Users overseas are prohibited from either streaming or downloading content. The BBC´s reasoning is that UK TV (obligatory) licence payers finance BBC programming. They forget that I am paying a UK TV Licence now, that the huge UK expat community live six months abroad (missing Eastenders)and six months in the UK, or that you want to catch up with EastEnders whilst on holiday..
I have heard that criticism no. 1 can be overcome for Linux and iPlayer streaming using Wine and associated lbraries (but not for downloads). I have also heard that criticism no. 3 has been hacked.
But here I will address nos. 4 and 5 (in reverse order).
When you access a website server, your computer sends your IP address so that the website server can look up where to send its data. The BBC looks up your IP address, and as IP addresses are allocated on a geographical basis, can decide if you are a UK resident or not and make a decision whether to allow you to access their programming.
So we have to fool the BBC into thinking you are connecting from the UK.
The following tools and explanation are in debt to the Electronic Freedom Foundation who have done pioneering work on Internet censorship and how to get round it. And apply to Windows XP and FireFox only.
1. Download the Tor programme from http://www.torproject.org. The core programme, Tor, is an anonymiser, i.e. it hides your IP address, sending your web requests through a series of servers with their own IP addresses. The Tor programme comes with a GUI frontend called Vitalia and a locally installed firewall called Privoxy.
2. Windows installation is easy - just accept the defaults.
3. But Tor, by default randomises its default servers and exit points to the the web through its network of servers so we need to specify where the Tor network exits to the web i.e. somewhere in the UK.
4. To do this, you need to edit the Tor configuration file, named torrc, in Notepad. Find and open it. By default it is empty. Add the following lines:
The StrictExitCodes command specifies only to use the Tor servers listed as exit nodes in the next line, which happen to be in the UK. You can get a list of current Tor servers by country from the Vitalia Network Map option.
Both Vitalia (Tor) and Privoxy icons should be in your toolbar but you might have to reboot. If they are not, manually start them from the Windows Programs menu.
5. Next edit the Privoxy configuration file using Notepad and unremark (delete the #) before ¨forward-socks4a¨. Save.
6. Then you need to change some settings in your browser and I will dscribe these for Mozilla FireFox. Go to Tools/Options/Advanced/Network/Connection/Settings. Tick Manual Proxy Configuration, for http enter ¨localhost¨ and port ¨8118¨. Tick the Socks v5 box.
7. In the bottom right corner of your FireFox screen you will see a button. If it says Tor Disabled, click on it to enable Tor.
7. Go to the site http://torcheck.xenobite.eu/eindex.php? and it will tell you if your Tor exit node server IP address is in the UK.
I hate to be tied to the Internet Explorer browser and much prefer the open-source Mozilla family of browser/email applications - SeaMonkey, FireFox, Thunderbird etc. BBC iPlayer states it will only work with Internet Explorer because it only works with Microsoft´s ActiveX controls. Bullshit!
If you are using Mozilla Firefox for Windows, download and install the plug-in from http://ietab.mozdev.org. This plug-in allows you to open IE pages in Firefox tabs. And with a right-click you can change from FF to IE renditions within FF.
My experiments showed you didn´t need to open an ¨IE Tab¨ for the streaming view but did for the Download.
I tried this with the Channel 4 progamme viewer 4oD as well. No success. It uses the Kontiki Distributed Management System which uses the http port 8080 by default, without any option to change the port.
Update: I downloaded the iPlayer Download Manger today and find it is also based on Kontiki - but it works in a somewhat different way in that when you hit the download button, it opens up the iPlayer download page in Internet Explorer - I haven't got enough bandwidth to download a file so I can't test whether you can download through port 8118.
Wednesday, January 16, 2008
The doctor or nurse or emergency responder or other health-worker, or social-worker, or teacher etc are widely perceived to have chosen their profession because they want to do good to the world.
Sorry to disillusion you.
We choose it, we do it, because, we think, we, maybe, will be good at it. And if, by chance, we are, we earn good money sometimes.
And that applies to the shop-assistant, the road-sweeper, the bank-manager and ...
After finishing my Bachelor's degree, I went to work in Darfur. Out of an altruistic desire to help ¨poor¨ Africans? Far from it. Out of a desire to see the world, out of a spirit of adventure, to see if teaching suited me - yes. And if I did something good along the way, fine (then I can feel warm and fuzzy inside).
This government now wants to renege on the contract it negotiated with the General Practitioners and force them back to providing out-of-hours (OOH) services but, unlike our Altruistic Plumber who is all too willing to provide OOH for a price, with no extra compensation. And the Doctors are obliged to comply with the European Working Time Directive (EWTD) which, I am sure our Altruistic Plumber is not or can easily ignore.
The NHS Trusts were charged, after the new GP contract, with providing OOH services, and have failed miserably (not necessarily their own fault). So, as sticking-plasters they are coming up with ideas such as Nurse Practitioners, Walk-In Centres in supermarkets and High Streeet pharmacy chains, ontracting these to VirginHealth, all held together by the NHS IT Spine.
One NHS Trust, NHS Grampian, the BBC reported yesterday, has come up with an innovative solution to the provision of OOH - they fly in eastern European doctors for the weekend!
At least you will get to see a real doctor. Of course, no guarantee of EWTD compliance ... so you will probably get to see an over-tired, stressed OOH practitioner.Don´t sue the Trust, sue the government!
Tuesday, January 15, 2008
An online petition (regrettably, only open to doctors) can be found here. And the organisation Medical Justice is here. To any doctor readers we may have - we hope you will sign the petition.
Sorry to disillusion you.
We choose it, we do it, because, we think, we, maybe, will be good at it. And if, by chance, we are, we earn good money sometimes.
And that applies to the shop-assisasnt, the road-sweeper, the bank-manager and ...
... the Altruistic Plumber.
It's freezing outside. Its not just freezing, it's enough to freeze the proverbial balls off a brass monkey. And it's enough to freeze all the water-pipes in your house and as the cold spell warms up just a little bit, you find water dripping through the upstairs ceiling, through the bathroom floor and down the stairs into the living room.
It's 10 pm in the evening on a Sunday.
What do you do ? Ring the Council HelpLine ? You get a recorded message ¨Our offices are now closed. Our opening hours are 8 am to 5:30 pm Monday to Friday. Please ring back".
Put a bucket under the drip, which is dripping ever faster (as you just turned the central heating on). Take a paracetamol.
You have initiative - you grab the Yellow Pages and look up "Plumbers". You find a boxed entry proclaiming "24 Hour Emergency Plumbing". The number is in a town 20 miles away. There are apparently none nearer.
Oh shit! The bucket is half full! The drips are getting faster! Turn the water off ... no, no before that fill the bath! The tap dribbles.
You ring the number in the Yellow Pages. It rings for what seems ages. Eventually a sleepy voice responds ...
"That'll be £x an hour plus materials and expenses".
You don't really register how much the x is. "Ok, ok ... anything".
And, having some experience of this, you don't expect him for an hour and a half ... after all it's a cold night, he has to get out of bed, get dressed, have a cup of tea ...
Nearly 12:30 am now. The quantity of water in the bath will get you through, the bucket is filling ever more rapidly ... ok, turn the water off. Oh shit - where is the mains tap?
Toot, Toot ... he arrives. "What's the problem luv/guv?"
"Burst water pipe in the attic".
He brings in his ladder, his flashlight, his toolbox - he muddy's your carpet - he climbs into the attic and fixes the problem. But it takes two hours.
You offer him a cup of tea, a glass of whisky ...
"So how much do I owe you?"
"That'll be £100 an hour plus materials and expenses and VAT. But as a favour, well make it a square £300".
"Can I claim it back from the Council ?"
¨You've got to be joking!"
"What about my house insurance?¨
"Depends on your policy".
So I pay him ... and sit down to read the House Insurance. It does not include damage from burst pipes
Friday, January 11, 2008
A few years ago I lived in a quiet suburb of the capital city in the house of some local friends. The neighbourhood decided to build a new Roman Catholic chapel and had it dedicated to Our Lady of Yes.
The reasoning was, of course, that any wish-fulfillment mentioned in their prayers to Our Lady at this chapel, would never be denied.
On Wednesday the BBC ran a story about a Ghanaian woman, Ama Sumani, who needs weekly kidney dialysis as a result of multiple myeloma and has just been deported to her home country. She needs a bone marrow transplant. She is an illegal immigrant, albeit not of the most serious kind. She is not a health tourist, she became ill in the UK. Yes, she did abuse her Student Visa. Having applied for a banking course but not being able to pursue it because of language difficulties, she started working (so not requiring state support). Due to her language difficulties, it is quite possible that she didn´t understand the immigration rules.
Although the dialysis was seemingly given on the NHS, the rules say she cannot be given a bone marrow transplant on the NHS. This is both ridiculous, inhumane and uncharitable given that bone marrow donors come from all across the world (and Ghana has just set up the first tropical African bone marrow register and is seeking international certification) and that the procedure itself is relatively inexpensive and simple.
According to Ghana's High Commission in the UK the country has two hospitals that can offer dialysis, and, as we know, one hospital attempting to set up bone marrow transplants.
If she has paid Ghanaian social security, yes, the treatment will be free. But in Africa unless you are paid by the small formal sector (whether state or private), this is exceedingly rare. She has little choice, I suspect, but to go private which whether for dialysis or a bone marrow transplant is very likely to be beyond her means.
Please support the DWIB Leukaemia Fund.
January 15 Lancet editorial here.
Thursday, January 10, 2008
Now that can mean one of two things, especially here in Africa.
Either the politicians are squabbling, often with guns and militia ... or there's no electricity.
Ours being a pacific country the former doesn't happen ( just bickering and metaphorical backstabbing). The latter frequently (although less frequently than in the past) does ... only this time with a difference.
There are no candles available in the country.
Talking with Lucia fills me with fear of the future when Kezia comes OT.
Nanda would like to be back here yesterday. And really, I also would like us to all be together here yesterday.
The longer Jaime and Kezia are in the UK, the less they will want to come back. I started preparing Nanda for the probable 18 months of observation John will want Kezia to be under on my last visit and she seems to slowly be coming to terms with this. Nanda cannot even handle the idea of a relapse of which I am well-aware - but she has not even considered either the medical or personal implications.
And the first phase of OT (!) will come to an end as Jaime is ready to start secondary school.
Jaime expresses verbally he doesn't want to return, Kezia pretty much expressed it when she outrightly rejected a traditional toy I brought for her this time.
Here there are many advantages - no serious crime, no paedophiles, kids can play in the woods and go to school alone without mum and dad unduly worrying etc etc - like when I was a kid. But health and education are worries - and now they are there, it would be stupid and selfish to bring them back if we can find a way for them to stay ... and preferably without Nanda staying in the UK full-time and preferably with us all meeting up either here or there two or three times a year.
I've started working on it ... watch this space.
I rang up Lucia soon after getting back knowing she was off to the USA on the 29th to visit an aunt for a week and realising that, once again, we were fated not to meet.
In recent posts she has hinted at her disillusionment with (the lack of) off-treatment (OT) support.
She overwhelmed me, she let rip.
As Rob has observed, we are waiting for the other shoe to drop, and this can never perhaps be more so than in the first few months OT when you do not have the psychological reassurance of frequent hospital visits, regular bloodcounts etc. And it must be even more so when you are a young adult who feels your own mortality more acutely than a young child.
Lucia is somewhat bitter at this lack of support - it's there when you're on-treatment, and suddenly it's switched-off when you're off-treatment ... but the medical-scientific community does not consider a leukaemia patient "cured" until we have passed five years of Event Free Survival ...
She is also somewhat critical of the Teenage Cancer Trust. Firstly, for the issues discussed above but also for the emphasis on special teenage-equipped units rather than day-to-day support to teenagers on the paediatric ward, on the adult ward or OT (I am all to aware of this, working in Africa, "here's the photocopier", but there's no paper or toner ...).
Lucia also ironically observed that leukaemia doesn't come by itself but always comes coupled with another problem. I'll leave her to tell you her "partner" in leukaemia if and when she wants to, H. and A. have had to cope with dad and husband dying from cancer, we are having to cope with separation across two continents and nationalities etc ... nothing is easy when it comes to cancer.
Lucia is angry.
Tuesday, January 8, 2008
The Guardian ran an interview with Lord Darzi the doctor-cum-health minister with the remit to conduct a "once in a generation" review of the National Health Service in England. His interim report, published in October, was not warmly received by his medical colleagues.
Many of the opinions attributed to Lord Darzi are justifiably derided by the medical profession (and patients and carers), but given my own (previously-stated) views on patient choice and decision-making, I find the following somewhat reassuring:
"To be fair, it's not for the patient to know where these places [centres of excellence for a particular condition] [are], but for the people who place them."In other words give the medical practitioners more Choice, not the Patients.
I went down the local pub at 5 pm on Christmas Eve. There was me, Babs the landlady and six six-feet plus tall "lads" in their twenties talking about various violent incidents they had been involved in. They had me and Babs laughing at on the face of it not very funny incidents. They had particular respect for a "Rasta" in Oldham.
I went outside for a smoke as they were leaving. The driver amongst them opened the boot and took out a baseball bat and placed it next to him in the front seat. "What d'you need that for?" I innocently asked. "You never know" was the reply.
All through Eid, Christmas and New Year I hear ... sirens.
We all go down to Asda on the Eid. A big mistake. Chocka. Most of the taxi-drivers here are Muslim so most of them were "off" and we had to wait 45 minutes in the cold for a taxi back home.
The pub opens mid-day and I am the first customer so chat with Dennis (the landlord) about the other day's conversation with Babs - "D'ju ever have any trouble? Y'know underage drinking, drugs or violence?" "Nah ...anyway I keep a rounders bat under the bar ... it's made from balsa wood!"
Many old British pubs have a "Smoking Room" signed in stained glass above the door. Our local is now making good use of this. Two women from the Council came round soon after the smoking in public places ban was implemented in July. They haven't been back. Now trusted regulars go to the Smoking Room, not an ashtray in sight, replaced by no-smoking/know-your-alcohol-limit beer-mats, so we drop our butts into a bucket that can be whisked away at a moment's notice.
At 1 am on the Monday before New Year Kezia has a temperature. Telephone the hospital. "Bring her in". They send an ambulance. An hour later the "guys in green" turn up - an easy job for them ... no vomit, no drunkeness, no knocking the door down ... they are grateful for an easy job. I know it as well and joke with them. She efficiently enquires the situation and I efficiently brief her. He knows Tom Reynold's Blood, Sweat and Tea - we are all grateful.
Kezia and Nanda are back at 3 am - Kezia's blood counts are good. Thank deity.