Am I an NHS apologist ?

Yes.

Am I a BBC apologist ?

... uh ... not any more.

When the BBC interviewed a masked member of the Irish Republican Army (IRA) in the 1980s our PrIme Minister Margaret Thatcher went ape-shit and subsequently introduced legislation to prevent the BBC from having any contact with them.

The BBC protested in vain. I was appalled.

In the more recent past, the BBC has conducted interviews with Taleban spokespersons in Afghanistan ... you know, those guys killing ¨our boys¨. Those ones labelled as ¨non-combatant¨ and ¨terrorists¨ (and thus not POWs).

But did I hear a whisper out of Whitehall about the Beeb interviewing terrorists?

Something smells ...

Today, Thursday, at 00:01 UTC, the National Audit Office (NAO) published its report NHS Pay Modernisation: New Contracts for General Practice Services in England which examines the financial administration of the contract with the state that GPs signed in April 2004.. The National Audit Office is independent of the government but answerable to Parliament.

I haven´t waded through the whole 57 page report yet (that will have to wait until the weekend) ... just the nine page Summary. It is clear that the NAO is blaming the government for bad financial and health policy planning rather than the GPs for being avaricious.

As of writing the Department of Health has not reacted - I assume it is considering its response carefully.

But in line with the government´s Department of Health general GP-bashing spin, the BBC toed the party line without even a DoH press release as a hint, pre-empting tomorrow´s DoH reaction and twisting the NAO report to claim that GPs are paid too much for much less than under the old contract.

Or I could invent a conspiracy theory ... the DoH briefed the BBC before it issues its press release ...

And (on the BBC website) all in one sentence paragraphs. The BBC, formerly the Times, latterly the Independent or Guardian of radio and television journalism has become a populist tabloid.

The government is trying to dumb-down the NHS - it (and I am not necessarily blaming nu-Labour for this) has already dumbed-down much of the BBC. In return for regular GP bashing, it allows them to interview Taleban which, generally, we´re not particularly interested in.

Trade offs.

P.S. Friday 16:00: still no response from the DoH.

The Haematology Lab

Leeds Teaching Hospitals' Haematological Malignancy Diagnostic Service have an excellent, but very technical, website on the diagnosis of a whole range of blood disorders (lymphomas, leukaemias etc) and diagnostic techniques.

Doctors in Store II

Supermarket chain Asda has confirmed it will be starting OOH GP services at its stores in Hounslow, west London and in Boston, Lincolnshire on selected evenings and Saturday mornings later this year.

This follows on from our earlier post about GP services starting at Sainsburys in Greater Manchester in March.

NHS Manga

I have toyed with the title of this post ... Manga, Manga Medicine, Medical Manga ... but finally decided on the above.

I am totally ignorant of the Japanese cartoon and comic book art form of Manga (with both adult and children´s sub-cultures) but its influence on the cartoons now shown to UK Children is interesting as the photo of our TV screen by Jaime shows. And I would probably have been into it had I grown up at the right time.

I used to watch Tom and Jerry, Scooby Doo, Tom Cat and various other Hanna & Barbera productions, and when they are repeated on the BBC, Jaime and Kezia are equally enchanted.

However, kids are now into the enormous Manga-influenced cartoon industry and Hanna & Barbera and Disney seem to have gone out of the window.

It is notable that the violence of children´s cartoons has never changed. Tom and Jerry´s and Bugs Bunny´s sticks of dynamite may have changed to laser guns or whatever other fabulous weapons´ technology, but the violence still exists.

I don´t remember the name of the cartoon from which Jaime took his television shot but it was certainly one of his better digital photograpy efforts. He discovered the capabilities and special effects (video, colour negative, sepia, B & W etc) alot sooner than I.

In other IT developments the medical community is slowly becoming aware of the potentials of Web 2.0 - there is a small but growing awareness of how this can potentially help the medical profession.

However, the trialling of Google Health in the States, whereby patient medical records are stored on Google servers, is leading to security and privacy concerns even if one does not doubt the reliability of Google´s IT infrastructure. Certainly, in the UK, we would protest most strongly at the involvement of Google Health in our NHS IT infrastructure ... but ironically, they would probably do a better job at it than our government´s IT spine project.

Ironically, this US poster is impressed by NHS London´s use of the Web 2.0 application Second Life to promote Polyclinics. (What percentage of NHS London patients go to 2nd Life?).

Methinks, however, the BMA should shurely respond with their own 2nd Life versions of a polyclinic and a current GP practice ...

In the meantime ... I think we should use Manga-like 2nd Life avatars to teach our medical students surgery, general practice, oncology etc ... or maybe even train our NHS managers.

CureClimb 2008

"First you spend three years keeping your kid alive; then you spend the rest of your life worrying about him."

Our friend Rob (of Memory Pebble) is preparing for a sponsored climb of Mt Rainier in June in aid of the National Cancer Research Foundation. He has a new blog here.

In his latest post he points us to this Newsweek article on the long-term effects of treatment of leukaemia.

The National DNA Database

After last week´s latest government IT data embarrasment in which DNA profiles of dangerous criminals were ignored, questions have been raised with the politicians about the need for a national DNA database which would store the DNA profile of every UK resident, criminal or not.

At the suggestion of leading coppers who argue such a scheme would greatly increase crime detection rates, the government has bowed to popular pressure and will consider initiating such a scheme.

I am somewhat shocked. But who am I to argue?

Of course, this will be an enormous boost to the DNA profiling lab industry, which I assume (a guess, I admit) is awarded government contracts under its Private Finance Initiative. It it will increase the employment of highly-skilled lab technicians, IT technicians and generally benefit the economy as a whole as we become world-leaders in data storage technology and identifying our citizens ... oh, and, of course, I will feel much more secure on the streets

My somewhat delicate constitution had already received a bit of a jolt last week when I learned of the Children´s Information Sharing Index (henceforth IIS).

What a marvellous scheme! I won´t have to worry about Jaime and Kezia´s welfare so much, as I know the government is keeping an eye on them for me!

This database will record Jaime and Kezia´s ...

1. Name, date of birth and address.

2. An ID number.

3. Mum´s and dad´s names.

4. Our GP´s, health visitor´s, midwife´s, school nurseś cocial worker´s etc etc details.

5. School details

... and anything else considered relevant.

Who will supply and have access to this database ? The list is as long as my arm and I am pleased to see it includes everyone concerned with our children´s welfare. I´m very sad I was not picked up at school smoking a spliff and then sent to a Youth Correction Centre for the rest of my education. Now I know that if Jaime is one day picked up for underage drinking he will be classified as at risk and I will be appropriately admonished, classified as an inadequate parent and if I reoffend, the government will find him another parent.

Alan Johnson and Gordon Brown - I am very grateful for the concern you show my children - can´t I make this so much easier and volunteer all the information you require? Give me a long form with tickboxes and ¨Go to Section 6¨ navigation tools, and I´ll willingly fill out the 45 pages.

All this for a price of £224 million to set up and £41 million per year to run - a bargain!

I hear that you want to put our medical records on a central database as this would allow the polyclinic at our local supermarket to look at our medical records when we go shopping on Sunday morning (I admit I was somewhat cynical that the ASDA clinic would have access to my records - but I am reassured).

Now, if Jaime is caught smoking a spliff, the school can record it in the IIS, the police can pick him up and charge him with a drug offence, his DNA can be profiled, the magistrates can put him in a drug rehabilitation programme and a psychiatric problem can be put on his health record ... oh and he can be found a new parents through Social Services foster parents´ networks. I´m grateful.

Now I have a word of admonishment - all these multiple databases ... surely it´s a waste of money?

Can´t you integrate a national DNA database, IIS, the various NHS databases, Electoral Rolls, census data, your idea to issue all of us with ID cards, tax info., criminal records, Immigration and Nationality Directorate records etc etc into one big database? We would all be so much more secure and surely it would achieve vast economies of scale.

_________________________________________________________________________________________________

Note: the UK government has delayed the introduction of legislation for a national ID scheme until, at least, after the next election and yesterday, unsurprisingly, totally balked at the idea of a national DNA database. The government is being taken to the European Court of Human Rights for maintaining DNA profiles of people arrested but never convicted.

I will be questioning our consultant John, and possibly the Patients' Advisory and Liaison Service, as well as our GP, about our records when I next go back in April.

Links:

Dr Rant yesterday.

Ross Anderson, Professor of Security Engineering, Universtity of Cambridge in February's British Journal of General Practice.

The No2Id campaign.

The Big Opt Out campaign - which explains how you can have your confidential medical records maintained by your GP or hospital without them being uploaded to the government´s central database.

Opening Hours

Dr Crippen states that his practice is open 55 hours a week. In the same post he continues by "publicising" Southwark PCT's independent (private) GP provider the Melbourne Grove Medical Practice.

However, Dr Crippen fails to mention that the Melbourne Grove Medical Practice is open on average 54 hours per week.

War Child

"War Child works with children affected by war in Afghanistan, Iraq, Democratic Republic of Congo and Uganda. Our work with former child soldiers, children in prison and children living and working on the streets gives them support, protection and opportunities. To make sure we provide them with what they need we involve them directly in all our decision making."

An excellent cause!

Now a group of bloggers is organising a book to raise money for this charity and if you too have a blog you can contribute - but you better be quick as the deadline for contributions is 29 February. Details here.

Doctors in Store

It's started! And right in our backyard! From 3 March the Heywood, Middleton and Rochdale Primary Care Trust is to run OOH GP services at the Heaton Park (Greater Manchester) branch of the supermarket Sainsburys. Two more are likely to open soon in the centre of Rochdale.

The Sainburys OOH GP service is being run by a private company aptly named Doctors in Store. And they'll have access to your medical records via computer!

BBC report here.

Labelling Patients

Dr Crippen posted yesterday on the government´s latest swipe at GPs - issuing ¨Sick Notes¨ for time-off-work and Invalidity Benefit, insisting, in its relentness spin against GPs, that they should not be issuing ¨Sick Notes¨ but ¨well notes¨.

I totally agree with Dr Crippen - how is he meant to know whether a condition precludes me from being a forklift truck driver in a certain factory/warehouse unless he has conducted or is presented with some kind of workload analysis?

He questioned particularly how a one-off independent evaluation of mental health patients could be justified in classifying the patient as ¨fit-for-work¨. Again I agree with him totally.

But that is not the point of this post ...

In the comments he was roundly criticised by a psychiatrist for calling people with schizophrenia ¨schizophrenics¨. Dr Crippen retorted by quoting the Newer Oxford Shorter Dictionary.

I contributed with this somewhat facetious comment ...

"Is my daughter leukaemic or even a leukaemic? Perhaps she's just plain cancerous ... :) "

On this post Lucia and I and Potentilla discussed as what we wanted to be labelled. Our tentative conclusion - neither ¨victims¨ nor ¨sufferers¨ nor ¨fighters¨ - at worse ¨cancer (or name of particular cancer) patients¨ or better still ¨people with cancer¨ as the far more politicised HIV/AIDS community is now termed.

However, given the vagaries of the etymology of the English language (across all its many variations), I think the Psychiatrist in the comments of Dr Crippen´s post yesterday distracted grossly from Dr Crippen´s argument about government health and employment policy.

Labelling of ¨social deviants¨ varies through the English language.

In politically correct culture, you will not hear the following ...

¨I am a gay¨ (noun).

but you will hear

¨I am gay¨. ¨He is gay¨ (adjective).

And acceptable in most UK male homosexual society.

¨I am queer¨ (adjective). ¨I am a queer¨ (noun).

Acceptable male homosexual to male homosexual, but ¨queer¨ in the context of heterosexual male to homosexual male is almost always derogatory.

I could continue with the terms of lesbo/dyke, nigger/black, spastic/cerebral palsy ...

Much of the terminology above is fairly recent and rapidly evolves (gay/queer have surpassed fairy) ...

But the language of mental health has not changed ... particularly as relatively few severe mental health patients can fight for themselves. I agree, Pyschiatrist, that a person with Schizophrenia should not be a Schizophrenic, but that is how Mental Health is in the English language, and until Mental Health patients or their advocates, particularly GPs like Dr Crippen, can fight for them to be recognised as people with an illness (which they are), but who have been abandoned by the NHS to non-psychiatric GP community care, then leave Dr Crippen, and the other GPs, who are totally behind the health and employment rights of the mental health patient, alone.

People with HIV/AIDS may be half way to winning their lingustic fight (principally through the efforts of gay men). They still have quite a long way to go otherwise (health, employment etc).

I would much rather be a schizophrenic or a diabetic than a schizophrenia or diabetes sufferer, fighter etc.

Dr Crippen is totally behind the rights of the mental health patient - don´t undermine it.

Linguistic fights are not appropriate on our blogs except when we talk about linguistics.

Dr Crippen will change his language when the language changes.

The Lighthouse of Pharos

... was one of the Seven Wonders of the World. Located offshore Alexandria, Egypt, it was 120 metres high by far the tallest man-made structure of its time. As well as its beacon, it purportedly had lenses allowing it magnify specks on the already 120 m high horizon. In this way Alexandria survived any attacks upon it.

This a telecommunications/IT post so if you are not interested in such things (and that which constitute my line of work), exit here.

In January much of the Middle East and South Asia suffered enormous telecommunications (and hence Internet) failures when five undersea fibre-optic cables were accidentally cut. An interesting analysis of both the technical and financial impact of the cuts can be found here (the link is to the first post in a series of seven).

I was also pointed to a fascinating article by Neal Stephenson in the journal Wired, dating from 1996, about the development of international digital communications from ancient times until now, and our current dependence on under-sea fibre-optic cables (illustrated multiple web-page version here, print version here). The Lighthouse of Pharos was obviously part of this - its mirrors and lenses being a ¨reflection¨ of equipment invented in the 19th century to read and write the first digital signals transmitted over transoceanic cables.

The Lighthouse of Pharos fell - the Byzantine Empire put out some misinformation that Alexander the Great´s treasure was buried underneath it and the local ruler of Alexandria ripped up the foundations and ... it fell over.

In a stunningly ironic piece of deja-vu the 1996 Wired piece by Neal Stephenson states:

¨The collapse of the lighthouse must have been astonishing, like watching the World Trade Center fall over.¨

Alexandria was now defenseless and the Byzantine Empire proceeded to walk in.

Acknowledgements: Thanks to The Yorkshire Ranter for the links cited. Alex is now moving TYR over to Wordpress. New link here - I´ll update the sidebar when he has completed the transition.

To organise a piss-up in a brewery

In a country of 60 million Drs Crippen and Rant obviously think the UK National Health Service cannot.

Hey guys, you´ve got it good.

This country has had 13 democratic governments in 16 years.

So I cordially invite Drs Crippen and Rant to stage a coup d´etat, bring over the entire coterie of NHS management and run this country of 160,000.

There are two (!) biodiversity NGOs in this teeny-weeny country. Maybe a maximum of ten members each. I will call them x and y.

Two big international biodiversity NGOs (let us call them a and b) visited last month with ideas of grand projects with local partnerships involving local NGO x and local NGO y.

So international NGOs a and b, who I believe talk to each other sometimes, tell local NGOs x and y to talk to each other as well.

And we all (a & b, x & y) sit around the table, nod our heads and say ¨great, fine ... we´ll sign a protocol ... we´ll get to work¨.

a & b go their way. x & y are left here. x says y can´t do it without x but x is too busy to help y to execute the plans of a because it is executing the plans of b.

So last week x told y, at the very last moment ¨sorry we´re not available¨ to help you out with a´s project and y, not having much field experience really cannot do it without x.

Having been co-opted into y and getting increasingly pissed-off at x´s non-cooperation with y, I said to y ¨I´m not waiting for x any longer - let´s fucking go ... ¨ and so me and Alzira (y) grasped the bull by the horn and went ...

What did we do ?

Not much really - but a start. And without x, who says they have too much on in the coming weeks to help y, y has got to learn to stand on its own two feet.

So Drs Crippen and Rant maybe we don´t need all your NHS managers - sorry to disappoint you. Maybe we can do it by ourselves - I wonder.

But maybe we can do it without 160,000 bureaucrats in-between - we have enough bureaucrats per capita of our own.

RSS Feed

We now have a link to sign up to an RSS feed of Life with Leukaemia - just below the blog links on the right.

Danny

Danny was a cook on EU trawlers fishing off the west/central African coast.

He returned to land sometime in 1992 and I met him at our local palm-wine shebeen. We hit it off instantantly.

Laconic, tall and thin, a thin moustache, handsome and constantly with a cigarette in his mouth, through which he talked and talked never taking the cigarette out - hours of working with both hands and a bit of sterile ash in the stew won´t do much harm.

From 1991-92 I taught one class of 10th graders (i.e. 15-16 year olders) in the country´s high school. I introduced ¨project work¨ to their English curriculum. And producing propaganda against HIV and AIDS was part of that. The daughter of the Cape Verdian consul, Eneida, produced a wonderful graphic, which little to her knowing (as she had returned to Cape Verde) was reproduced 5 metres high on the outside wall of the school´s gymnasium years later.

The country ignored and remained ignorant of HIV.

Danny and I struck up a friendshp and were soon walking the forest together. I managed to get him a job in an EU-financed biodiversity project but when the funding ended, his job ended. The opportunity arose to go back to sea. A Spanish trawler fleet called in, recruiting, and he was taken on.

He fell ill. His employers (decently I would say) evacuated him to Portugal where he was diagnosed with AIDS. I don´t know what treatment he received.

In 2001he was accompanied back here as a reverse medical evacuation accompanied by a Brazilian doctor. He died on or just before arrival. His wife and children, who I little knew, apparently wanted little to do with the Brazilian doctor.

Certainly, he picked up HIV as a sailor ¨whoring¨ in every port.

He was the first known case of HIV/AIDS in this country. I have since seen others die of what I suspect has been undiagnosed AIDS.

Now in-country HIV testing is standard for pregnant women and encouraged for others. Condom use is promoted.

But it has taken since 16 years for the medical services of the country to wake up.

P.S. I didn't realise the pertenance of this post on today's date until I saw Dr Crippen's offering today!

Medical Update

Routine. As we said, yesterday was the beginning of Maintenance Phase 4.

Vincristine injection. Counts back up so back on oral MTX and 6-MP. The Dreaded Dexamethasone over the next five days.

Jaime went to the hospital as well as they are in the half-term holidays. When I rang at 15:30, they were still at the hospital awaiting transport.

Nanda was thoroughly pissed off.

Where are we now ?

I don´t mean geographically (I´ll leave you to work that out - maintaining blog anonymity is not easy) but in terms of Kezia´s treatment and our disjuncted, dysfunctional family life.

Time to take stock.

Today will see Kezia´s first consultation of UKALL2003 Maintenance Phase 4. Only another three 3 month maintenance cycles to go - that takes us up to November.

Is there any light at the end of the tunnel?

Maybe a pin-prick (sorry for such an apt pun).

After off-treatment (OT) in November, our consultant John wants Kezia to say in the UK for 6 weekly check-ups for at least 18 months. May 2010. Kezia will be seven years old, Jaime will be ten years old. The medical profession will only consider Kezia cured after five tears of Event Free Survival.

The pin-prick becomes smaller.

There is a slight, as yet unexplored, possibility that Jaime and Kezia could continue their education in the UK at a private, charitable and means-tested boarding school of 400 years standing and reputed academic excellence - which would certainly be advantageous to their futures. However, an initial tentative probe of Nanda was not favourably received ... but she does have a tendency to jump off at the deep-end and then, after due consideration, change her mind.

When or will we ever become a physically united family again? Ever?

So far John has not precluded Kezia, Jaime, Nanda coming back over for a holiday during those first 18 months. It would certainly help.

The Wingless Fly

Continuing the zoological theme, perhaps one of the most unusual beasties I have come across here is a wingless fly.

A valley in the north-west of the island boasts a hydroelectric system built in colonial times. At an altitude of 600 metres, water is diverted from stream into a man-made channel or aqueduct that runs for several kilometres before dropping down a metre-diameter pipe to two turbines and back into what has now become a river. Most of the water channel is covered with concrete slabs but on its way to the chute it passes through eight tunnels carved through the mountainside where the channel is uncovered. The tunnels vary in length but are divided by a waist-height concrete wall between the water channel and a pathway. Needless to say, this concrete wall has developed leaks and the pathway can be muddy at best, and at worst gives you distinctly wet feet.

One of the tunnels is home to a colony of bats with their associated guano, smell and fauna (including a giant gecko).

I took some friends for a hike along the aqueduct - it´s a fantastic walk. The views of perhaps our largest and deepest valley are spectacular. As you just walk along the 600 m contour, it is not physically very taxing in a country noted for its extreme relief.

We got to the bat tunnel and the pathway floor was flooded ankle-deep so my friends decided to edge along the top of the dividing wall using their hands to the roof to maintain balance.

Having passed the bats we returned to daylight ... I had wet feet, but they were covered in little beasties which provoked revulsion and had to be picked off one by one. I have never seen a group of humans acting so much like mutually grooming primates!

But I got to looking at these creepy-crawlies - they ran around like little jumping spiders, but surely they couldn´t be - they only had six legs!

What the hell are they?

I had some collecting tubes and alcohol with me so pickled a few which I then sent to a friend who works at London´s Natural History Museum ...

They turn out to be Wingless Flies (order Diptera) parasitic on bats! Obviously, they no longer need the power-of-flight (the bats do it for them!). In a tightly-packed bat colony they just crawl or jump from bat to bat. Fascinating! Evolution in action!

As the hike involved returning along the same route ... everyone got wet feet!

The Wide-mouthed Frog - Domestic Wildlife

Here is one of our non-paying lodgers.

The resident fauna of a house in (our part of) Africa and the UK have both similarities and differences.

The cockroach spans climates and continents. Domestic cleanliness is in order and, thankfully, we are not honoured with their presence either in Africa or the UK.

House spiders are also common to both localities.

Mice and rats, not so common in the UK nowadays, are more common here. In fact, I had to rent a cat (I pay her board and keep) to evict a rat last year. She is a pain-in-the-proverbial - but preferable to a rat.

I seem to remember ants being ubiquitous in the UK - here they are rarely seen inside a house.

I have different feelings about different residents - our friend above is quite welcome as its diet includes other, unwelcome, residents. Other welcome residents are geckoes and the house spiders - although in a previous residence in the city we found a Tarantula in the backyard. Obviously, the cat loves them - a cat stalking a gecko is quite fun to watch (shall we bet on the outcome?). The frog stands less of a chance.

Coincidentally, I have just phoned my great friend Talia, down in the city, who has this morning found a snake on her living-room floor. So we discussed domestic wildlife and she complained of the pan-tropical Scolopendra centipede which gives rather a nasty bite - fortunately, not a problem here 250 metres higher.

Unfortunately, our frog and gecko lodgers cannot cope with all our unwelcome guests or find them unpalatable.

There is a tiny but visible fly, associated with the tree Cedrela odorata (good timber). This tree is ubiquitous and there are various around our house. The fly gets in and has a bite, although not malaria-carrying, comparable to that of a mosquito.

Oh Sara

Going back to your Guardian blogpost of Friday, I would really like to see where the public´s backlash to the government´s spin campaign against GP´s is? I feel like a lone voice. Am I the only one of that 84%?

Misrepresentation

On Friday, a Guardian (UK national newspaper) journalist, Sara Gaines, claimed on the newspaper´s blog that I was in favour of Saturday morning GP opening based on this post.

No, Sara, I am not.

Drs Crippen and Rant and every other GP in the UK I must apologise ... I am not in favour of you doing OOH on Saturday mornings and I am not in favour of the NHS and doctors and nurses ¨abusing¨ the EWTD, even if that means longer training time. I hope, if you read that post, you did not interpret it as Sara did.

If she had read the post more analytically perhaps, she would have seen I am in favour of the government fulfilling Out-of-Hours services as it said it would (but hasn´t) and that queues of ambulances outside A & E Departments would not exist (but do).

Ok - now I am in favour of polyclinics and walk-in centres. They should function from 19:00 to 08:00 and weekends with a full-service of lab techs, nurses, quacktitioners of every breed, cleaners to mop up the blood, MRSA and C. difficile and oh ... uh ... doctors ...

... maybe an NHS IT Spine.

We want to see a Doctor.

Medical (mini) Crisis

Yesterday, Friday, was notable.

My day started when I overslept.

You know, the alarm goes off, you switch it off for an extra 10 minutes. Annoyingly, the alarm´s default Snooze setting seems to be 2 minutes so just as you´re dozing off, you have to switch it off again. And then 40 minutes later you wake up and know that you will be late for work.

As I am running around, having a shower and a shave, making a quick cup of coffee, pulling out the day´s work-clothes, Nanda rings.

¨Kezia´s got a temperature. She woke up at 4 am, I´ve given her cool showers ... can you ring the hospital? Can you skype me when you get to work?¨

¨Oh shit. Ring Pete¨. [my brother, just round the corner].

My running around becomes almost a sprint and I drive like a maniac to work ignoring the potholes i.e. driving through them not round them). No traffic police to stop me and give me a hard time. I arrive and skype Nanda. They are going to leave calling the hospital for an hour as transport will be much easier to organise through the clinic than the ward.

An hour and a half later Kezia´s temperature has returned to normal ... no need to call the hospital.

A busy morning at work ...having cancelled (to remain skype-close to Nanda) an appointment at the national TV station to install a firewire card in an Ubuntu Linux workstation we are donating to them, I was involved in taking some transformer oil samples.

I skyped Nanda again at lunch-time. Situation good.

Thursday afternoon I found a web-post that this firewire card is recognised by Ubuntu. And this morning I find this blog had been cited on a Guardian (national UK newspaper) blog.

The day slowly gets better.

This afternoon I relaxed a little bit and tested this firewire card in a legacy workstation with Xubuntu (a ¨lite¨ version of Ubuntu). Xubuntu saw it! I would hate to turn up at the TV and for it not to work.

At the end of the afternoon, I received the email in the previous post from Jaime´s teacher, skyped Nanda ...

Kezia ok, maybe a little mucositis.

From crisis to routine to high.

From Jaime's Teacher

"Hi Angus,

Hope all is well for you. We finish for half term today, so i thought I'd give you a quick update on Jaime's progress at school. He is currently in good work assembly showing the rest of Key Stage 2 his literacy work. He wrote a newspaper-report styled piece of writing about Humpty Dumpty falling off his wall and turning into scrambled egg! He used lots of lovely adjectives and used the correct punctuation. He typed the writing up on the laptop and could insert pictures and graphics and used editing skills to make the finished piece aesthetically pleasing. He will probably bring this piece of work home to show Mum too!

In Science, we have been creating electrical circuits- lighting bulbs with a battery and leads. Jaime's work has improved greatly, and he keeps up with the rest of the class and joins in discussions appropriately.

We are encouraging a scheme called 'talking partners' in which the children are encouraged to talk to a partner to discuss an answer to a question before offering the answer to a teacher. This is excellent for Jaime as he feels confident to finalise his answer with his 'partner' before being asked to share it with the class.

Hope you are having a good month.

I will keep you updated in the 2nd part of this Spring Term too!

Thankyou, See you soon,

(Jaimes yr4Teacher)"

Overwhelming Pride

Funerals

I cannot say I am a great fan of them and I really don´t know what came into my head two minutes ago to make them the subject of a post.

I have been to four in a life of 45 years (but should have been present at six). That is one more than the number of weddings (one of which was my own) I have attended. Pretty good going for someone who doesn´t like funerals ...

The first I went to was I guess when I was around 15 years old for the mother of a contemporary of my brother from the ¨roughside¨ of town who had taken a bit of a shine to me.

The second that I didn´t go to was my father´s about six weeks after I had arrived here. My dad had a heart attack shortly before I was due to come here. Although he was still in hospital, my parents insisted this should not delay my departure to the new job and that if anything happened (like dying), there was no point in coming back. He seemed to recover and was discharged - but six weeks later died in his sleep at home. VSO offered to pay for me to go back to the UK ... but for what? A funeral.

After a wait of several weeks (sound like the NHS?), he was cremated and Mum drove around with his ashes in the boot (trunk) of the car for a few years until she could decide what to with them. It became a bit of a standing joke - ¨Is Dad still locked up in the boot?¨

The third occurred (and the second I attended) here when a great friend of my ex-partner and myself, affectionately known as Aunty, with her two grown-up children overseas, died in her fifties.

Th fourth (and the third I attended) was when the father of my ex-partner died. Her mother had gone overseas seeking treatment for cancer several months before but it had been too late and she had died. Father had a minor stroke and there remained but months.

Throughout the world it seems traditional to have a post-funeral function. This varies in form and solemnity. The stereotype of the Irish Wake and East End horse and carriage with brass band contrast with the ¨traditional¨ English post-funeral tea with sandwiches and cake served on the best china. Here too we have a variety of traditions as regards post-funeral functions depending on social status and ethnic group and ranging from a raucous party to genteel courtesy.

But my ex would have none of it.

We were chief mourners at the funeral and threw the first spades of earth over his coffin. Having done this, we turned around and walked out of the cemetery and defied tradition. Instead of returning to her father´s house, we went home. It was up to others, her father´s friends and relations, to organise the post-funeral ¨do¨.

The fifth (and the fourth I attended) was that of my trusted retainer, Antonio, who lived up here before we had built this house. He died from old-age and malaria. Myself and his son organised the funeral and I sobbed and sobbed as his coffin departed here and sobbed and sobbed as we buried him. An old rascal, I had known him for ten or more years and he had often consoled, comforted and given advice.

The sixth (which I didn´t attend) was that of my mother. She woke up one morning, brushed her teeth, got dressed and was just about to go downstairs to make breakfast when she had a stroke and dropped dead. A friend, with whom she had a pub lunch appointment discovered her later that morning. It was Nanda´s birthday.

My brother, of course, instantly dropped everything and drove down after ringing me at work.

Again funeral waiting times and uncertainty ...

So we discussed ... what do you want me to do? Come back for the funeral or come back and help out with the disposal of the house, the belongings etc etc? The latter was going to be more practical.

So once again I missed the post-funeral tea.

One of my first jobs when I arrived in the UK was to collect her ashes from the local Funeral Director´s. We had decided, in our inimical family style, that half her ashes would be scattered here (as Mum had been planning one last visit) and half in the UK so I had to get an export certificate from the undertaker - quite common practice it seems as many UK Hindus want their ashes scattered on the Ganges!

A last night in a sleeping bag on the living-room floor of Mum´s house.

I took my ¨half¨ of the ashes the two hour walk up to their final resting place, scattered them, and being alone in the middle of the rainforest, sobbed and screamed my heart out.

At least she didn´t live in the boot of a car for two years!

To GP or not to GP?

... or do we Polyclinic at Asda?

I can imagine the four of us going down to Asda on Saturday morning and myself saying ¨You get the sprouts Nanda ... I´m just popping into get my blood pressure taken and then a new prescription for Adalat to keep it down¨.

Unlike the queues at Asda´s check-out, I face a queue at check-in.

20 minutes later I pass the ¨till¨ although unlike Asda, the NHS is free at the point-of-entry, free at the point-of-need etc etc.

I finally see a doctor. I have never seen him before. A locum is substituting for the normal salaried doctor who is off sick.

¨Ah Mr .... Good Morning. I see you have a history of high blood pressure and that you´ve been taking Adalat ...¨, he comments turning his head briefly from the computer screen.

Oh shit ... I imagined that last paragraph. Rewrite.

¨Doctor I was too lazy and inconvenienced by my GP´s opening hours to get down there at 6 pm yesterday and get a prescription for my high blood pressure¨.

¨Let´s look up your history ...¨

As per usual NHS IT is Spineless ... he cannot access my records ... in Asda on a Saturday morning ...

¨Hmm ... (as I cannot access your records and don´t want any litigation) I would like to run some tests. But there´s no nurse here this morning so I suggest you go and see your GP on Monday or you could, of course, trundle down to A & E ...¨

I am between the ages of 18 and 60, employed and one of the 4% (the Department of Health tells me) who would like to visit a GP on a Saturday morning (sure as hell beats the fuck out of traipsing round Asda with Nanda, Kezia and Jaime!).

Bypassing on-going negotiations (which will include a ballot of members) with the doctors trade organisation, the stuffy fuddy-duddy British Medical Association (BMA) who have in principle rejected the government´s proposal that GPs provide an extra 3 hours of Out of Hours (OOH) work per week for no compensation, our Secretary of State for Health, Alan Johnson, ¨personally¨, wrote to every GP in the country ... and put the boot in!

Reneging on a GP contract it negotiated, accepted and signed, thinking it would be able pick up OOH through the Primary Care Trusts without providing the PCTs with any extra money, in the face of its own abject failure to provide OOH primary care, and its increasing pressure on PCTs to cost-cut by closing local A & E services, it now wants to backtrack.

The spin to brainwash Joe and Jane Public, in spite of the evidence of the Department of Health´s own surveys, started with Patricia Hewitt - a new generation of spin and confrontation has begun.

Methinks this will go to the High Court.