Thursday, June 26, 2008
Today we have a government, we have electricity and candles. Matches are in short supply ... and we have no kerosene/paraffin on which most of the population depends for cooking.
Hi Dr Z.
This a difficult post but I want the few readers of my own blog to read your own, realise it takes all sorts, and that professionalism and knowledge is neither dependent on biological sex nor gender stereotypes.
Your empathy with your patients makes me wish you are a haematology/oncology consultant treating our 4-year old daughter, Kezia, for her Acute Lymphoblastic Leukaemia. In fact, our consultant, John, is amazing. The Royal Manchester Children's Hospital is also amazing.
In spite of my own faith in the National Health Service, or rather the RMCH and the treatment Kezia is receiving there, your own “faith” (as an insider) surprises me when I hear so much negative about the NHS from the UK health blogs I read - Dr Crippen, Dr Rant and Tom Reynolds. The first two GPs, the latter an emergency technician for the London Ambulance Service. Drs Crippen, Rant and Tom qualified long ago ... and they are strong critics, and rightly so, of MTAS, the Darzi Debacle etc etc
So it is refreshing (and depressing!) to read a blog by a “trainee” doctor. And it is even more refreshing to read a blog by a transexual doctor.
To the rest of my readers:
When I was much younger (in my twenties), I was (as regular readers may have read) somewhat ambiguous about my sexuality. Sex was with both men and women. I even considered sex-change but Janice Raymond's The Transexual Empire, a feminist treatise on male-to-female sex-change, changed my mind. (Female-to-male sex-change hardly figured in her otherwise well-spoken book.}
In the late '80s Manchester had already developed a “gay village” around Chorlton Street. The clubs and pubs were mostly male but there were a few lesbian nights frequented by the "political feminist" (of various degrees) lesbian community where males of any sexual persuasion were excluded (no criticism here - it was necessary).
But far beyond the “gay village”,with its flash up-market (male) clubs and pubs, up in Oldham Street, was Dickens where working-class lesbians (uninterested in politics and feminism) and MtF transexuals hung out. You had to ring a doorbell to get in. It was not classy, in fact it was downright seedy - a pool table. a tiny dance floor, threadbare carpets, sofas and chairs that had seen much better days, a bar serving grot beer ...
It became my favourite club ... a sort of Working Men's Club populated by lesbians, transexuals and the odd gay man. It was friendly despite the odd fight between jealous lesbians.
There were no FtM transexuals ... or at least I never came across any.
Tuesday, June 24, 2008
So what's new?
Dr Crippen reported last week on NICE's choice of the two Human Papillomavirus vaccines, Gardasil and Cervarix, that will be offered and administered to teenage females throughout the world to prevent cervical cancer. However, in the UK it seems, contrary to the rest of the world, NICE has chosen Cervarix that protects against less strains of cervical cancer and does not protect against genital warts. Why? Because it's cheaper, of course. Oh, and even though boys can spread around HPV and develop genital warts (which in their turn can spread HPV), there are no plans to extend HPV vaccination to boys (as I reported here - come on Dr Crippen, don't you ever read me?).
Dr Rant reports that top surgeon and health minister Lord Darzi, on whom the Department of Health is depending to push through its National Health Service reforms, found time to appear on BBC Radio 4's Desert Island Discs on Sunday. For our non-UK readers Desert Island Discs is a weekly radio programme that has been running for decades whereby a famous personality is requested to select ten pieces of music s/he would take with her/him if s/he were to be abandoned on a Desert Island + three other items.
Perhaps, 50% of Lord Darzi's musical choice I was in agreement with ... but his choice of a pencil and notepad seriously lacked a pencil-sharperner ... or perhaps even a knife - then he could perform surgery as well as sharpen his pencil.
Oh ... and we are honoured to have been added to Dr Rant's list of links.
Monday, June 23, 2008
We didn't actually do very much except have a few drinks and chew the rag. It turns out that we are mostly Ubuntu (in its various versions) and Debian users. As well as its inevitable Windows machines, the NMI has a Debian machine and Bernardina has had some experience of Ubuntu whilst on training courses in Brazil. She got me to download OpenOffice a couple of weeks ago via the Synaptic Package Manager – given our slow Internet connection I left it running and walked away ... the next day she told me it was working perfectly. Valentim has a legacy machine (donated by my employer) running Xubuntu. Aguinaldo from CST says his company is planning to transition to Unix/Linux servers, Aguinaldo, owner of Club Tropicana and partner with the owner of our national domain (one of Sweden's largest ISPs), is a great fan of Ubuntu but has been limited by non-Linux support for the thin-client boxes he has been using to set up thin-client networks around the country. I discovered last week that the company making his thin-client boxes has just produced beta Linux software to support these. Bastien has managed to procure a laptop for the NGO he is working with and it is now loaded up with Ubuntu and he says the users are having no problems at all using OpenOffice. I descrbed how I had just got my US Robotics “Windows” Skype phone working on Linux. Valentim asked me to look into a Portuguese spell-checker/dictionary for AbiWord. I showed Bastien Slax running off a USB pendrive.
All-in-all it was a great success.
Friday, June 20, 2008
Thursday, June 19, 2008
It was noted that more deaths are attritutable to cancer than malaria, tuberculosis and AIDS combined. Whereas 80% of childhood cancers are cured in the developed world, the figure stands at 5% in Africa. I could go on ...
We haven't heard much from AfrOx since. However, it now seems to be getting off the ground. A revamped website with the conference's final report "Building Sustainable Cancer Capacity in Africa: Prevention, Treatment and Palliation" sets out the organisation's vision and strategic guidelines.
It is ironic that after the cruel deportation from the UK of Ghanaian myeloma patient, Ama Sumani, and her subsequent death earlier this year that AfrOx has chosen to collaborate with Ghana in its first project to develop a National Cancer Plan.
Professor David Kerr of the University of Oxford and Alan Millburn (Labour MP and Secretary of State for Health from 1999 to 2003) have just returned from a visit to Ghana (accompanied by two BBC reporters!) where they met with representatives from government, medical institutions (it seems there are only two consultant oncologists in the entire country), the Cancer Society of Ghana and civil society.
As well as developing a national cancer plan, or rather as part of it, AfrOx aims to facilitate training for doctors, nurses etc.
David Kerr and Alan Millburn's visit to Ghana was funded by a one-off donation by a rich benefactor. AfrOx does need to raise its UK fund-raising profile.
Ghana was chosen as a starting-point due to its political stability, its links with the UK - although a country with a population of 23 million. To make an impact on cancer in Africa - where do we start? I understand the choice of Ghana - its easy - but why not Sudan, Chad, Zimbabwe, Zambia, Kenya, Mali, Niger, Senegal, Congo ... ?
Wednesday, June 18, 2008
Rob has posted on Judy Freemans's comment in a Boston's Globe piece on Senator Edward M. Kennedy's recent crisis and diagnosis of brain cancer ...
"Fight, Ted, fight!"
Back in March 2007 Christian, Lucia and I had a discussion on how cancer and people with cancer are semantically "dealt with". The metaphors and similes - "battle with", "fight against", "sufferers", "victims", "carers", "waging a war against" ...
We weren't happy.
Last week Own Your Health posted "To fight - or not to fight. Is that the question?" inspired by Ted Kennedy's problems. She misses the point but a US commentator picks it up ...
"... I never felt that I fought anything. All I did was put one one foot in front of the other, found doctors who were willling to fight for me, signed up for a clinical trial and then show up for my appointments , treatments and procedures.
The only fight I had was with my insurance company who initially refused to pay for anything.
I agree, it is a patient's choice. I've met other patients, dx'd with a lot lower stage than I, and chose to do nothing. Some are no longer with me.. But I never struggled with my disease. If I had any problems, I informed the awesome medical personnel, and they did their job and they fixed me ... again I did not suffer, I did not struggle, I did not fight.
I just put one foot in front of the other, and at that, they were baby steps."
Rob quotes the Wikipedia entry on Susan Sontag's "Illness as Metaphor" in which she argues that cancer too often serves as a metaphor to explain the outward ills of the world and the inward failings of the person. She notes the peculiar reversal that "With modern diseases ... the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease - because it has not expressed itself. Passion moves inwards, striking and blighting the deepest cellular recesses."
At first Nanda sought reasons for Kezia's leukaemia, blaming me, my family, something I'd done, my sins.
I and others have noted that Ted Kennedy was not rushed to some famous prestigious hospital such as John Hopkins but was admitted to his local general hospital.
The last word I will leave to Two Tony's correspondence with Shaun Atwood in Jon's Jail Journal ....
Wednesday, June 11, 2008
Peaches has finally posted the the list of those to be published in “You're not the Only One”, the book of blogposts in aid of War Child. Unhappily, neither of my two offerings (here and here - there were 400-odd in total) were chosen but this one of Rob's deservedly was.Buy the book, support the cause.
“The European and the African have an entirely different concept of time. In the European worldview, time exists outside man, exists objectively, and has measurable and linear characteristics. According to Newton, time is absolute: “Absolute, true, mathematical time of itself and from its own nature, it flows equably and without relation to anything external.” The European feels himself to be time's slave, dependent on it, subject to it. To exist and function, he must observe its ironclad, inviolate laws, its inflexible principles and rules. He must heed deadlines, dates, days, and hours. He moves within the rigors of time and cannot exist outside them. They impose upon him their requirements and quotas. An unresolvable conflict exists between man and time, one that always ends with man's defeat – time annilhates him.
Africans apprehend time differently. For them, it is a much looser concept, more open, elastic, subjective. It is man who influences time, its shape, course, and rhythm (man acting, of course, with the consent of gods and ancestors). Time is even something that man can create outright, for time is made manifest through events, and whether an event takes place or not depends, after all, on man alone. If two armies do not engage in a battle, then that battle will not occur (in other words, time will not have revealed its presence, will not have come into being).
Time appears as a result of our actions, and vanishes when we neglect or ignore it. It is something that springs to life under our influence, but falls into a state of hibernation, even nonexistence, if we do not direct our energy toward it. It is a subservient, passive essence, and, most importantly, one dependent on man.
The absolute opposite of time as it is understood in the European worldview.
In practical terms, this means that if you go to a village where a meeting is scheduled for the afternoon but find no one at the appointed spot, asking, “When will the meeting take place?” makes no sense. You know the answer: “It will take place when people come.”
I will stop quoting here ... I could quote the whole book – The Shadow of the Sun by Ryszard Kapuśiński. It is perhaps the best book I have read about contemporary Africa.
I began work in the local education system. “When is term to start?” “Oh the Ministry hasn't announced it yet”, “In a few weeks time ...” etc etc. The ministry, with two weeks antecedence, would announce the beginning of term two weeks later after which the teachers would (or would not) turn up to find no pupils who would (or would not) turn up two weeks later.
Soon after I started my current employment with an international radio network which has a relay station here, I was encharged with the recruitment of local technicians. Jorge and Victor are probably te best in the country so we poached them. Sitting with Jorge over a beer one evening, he remarked to me “So what if the news doesn't go out at 00:00.00 and goes out at 00:00.48?”. I couldn't agree more.
There, somehow, exists a difference between European and African timeviews.I recall as a child long interminable summers interspersed with long interminable school-terms ... the only reason we children would appear would be a previous notification from the school to our parents and the inevitable school-bell – it didn't really matter to us. School happened when school happened, when us children turned up