On the Radio!

Click here to download our interview with Tiffany Truscott on BBC Radio Cornwall – 

So it turns out that being interviewed on the radio is quite the experience. We decided that we would turn up before time, prepaired, practised, calm and collected. As we screeched to a halt outside the studios ten minutes before we were due on air, I wondered what that would have felt like. The BBC, at least, were organised; we were ushered through, given a quick ‘interview 101’, told not to worry, and suddenly the red light was on and looking expectantly at us.

Luckily our interviewer, Tiffany Truscott, seemed to have done this before, and steered us through in what felt like a reasonable organised fashion.

We left elated, amazed that we had managed to avoid pregnant silences and (major) expletives. We had just one rule… In no circumstances were we going to listen to the interview!

If however you would like to listen to our interview, it can be found HERE. Jump to 27 minutes to find us.

Inequalities in Health Care

Image

A couple of years ago the London School of Tropical Medicine and Hygiene piloted its famous Diploma in Tropical Medicine course in East Africa. Obviously it’s been a huge success, as not only do you get to learn about exciting medicine from a world leading institute, you get to do it in vivo, with unequalled access to local expertise and clinical cases. As one of the many hopefuls applying for this course in 2013, I was interested to note human resources for health as their choice of topic for discussion on the enrolment form.

Human resource for health (HRH) involves analysing the distribution and quantity of healthcare workers worldwide, treating them in a similar way to more traditional ‘resources’ such as coal, minerals, etc. This allows for powerful analysis of the data available, which in turn is used by policy makers and governments to make decisions about the number of healthcare workers they need to train and employ.

It is just such a topic where one might lead a wonderfully fulfilling life without being aware of its importance, until its implications are brought to bear on one’s health system. Almost universally, the statistics about HRH make for pretty grim reading. Did you know for instance that there is a worldwide shortage of health care professionals to the tune of about 4.3 million? Even worse, of the 57 countries deemed to have severe shortages of healthcare professionals, 36 are in Africa. One more shocking fact? Although Sub-Saharan Africa shoulders 24% of the world’s disease burden, it is home to only 3% of the world’s healthcare workers.

The reasons for this inequality include a lack of workers being trained, migration (the ‘brain drain’), anomalous data on HRH, and burden of disease. It’s a complex problem, and one that is gaining increasing recognition as being the next big barrier to improving healthcare in Africa. The development of the Millennium Development Goals has mobilised a lot of funding towards healthcare in Africa, but without the right people on the ground money alone cannot solve the problems.

We’ll be revisiting this topic on our trip, as well as reporting on any examples we encounter, and looking at the potential solutions to the HRH crisis.

 

(Image adapted from the WHO Health Report 2006)

A New Objective

According to the World Health Organization, just under 300,000 maternal deaths occur worldwide each year, with over half of them in Sub-Saharan Africa. Amongst the more major causes of mortality is eclamsia, a condition of unknown cause which can result in the death of both mother and foetus. Blood pressure monitoring in pregnancy helps to identify those at risk of eclampsia, and facilitate appropriate intervention. However, delivering a service that provides regular monitoring and intervention in Africa is currently a huge challenge.
With this in mind we are pleased to announce that we have agreed another major additional objective to our trip. We have been in communication with Kings College London regarding their CRADLE trial, which is an international research project supported by the Bill and Melinda Gates Foundation with the following objectives:
–  Improve the data that we have on maternal mortality across Sub-Saharan Africa
–  Pilot the use of a new compact, solar powered blood pressure monitor
–  Investigate the effect of the regular use of this monitor on the rates of maternal mortality in Sub-Saharan Africa
–  Allude to the cost effectiveness of establishing blood pressure monitoring services in Sub-Saharan Africa
We will work to introduce these devices to Ethiopia, and gather and analyse data from their use over the period of approximately a month. We are hugely excited to be a part of this project; we’ll keep you updated as we know more.

The Locum Phenomenon

A curious yet seemingly essential phenomenon in filling medical staffing rotas nationally is the existence of the locum doctor. ‘Locums’ are generally short term, (reasonably!) highly paid contracts, similar to supply work for teachers, or subcontracting for builders. A doctor is parachuted into a new team, often in a hospital where they have no previous experience, and potentially into a role where they have had minimal post-graduate experience. The roles filled by locums are often key to the functioning of a given team within a hospital (such as general medical, general surgical, and orthopaedic teams). Often a fairly hair-raising and exhausting experience, veteran locums become hardened to unfamiliar work environments, clapped out NHS on-site accommodation and loneliness (if working in new pastures for short times).

 These contracts are highly costly to NHS trusts, but I suppose are justified by the logic that ‘anyone is better than no-one’. Trusts cannot leave themselves open to criticism by leaving these key roles unfilled lest a patient come to harm from understaffing. However from the inside it often appears as though many of these holes in rotas are predictable – there must be a better way!

 One solution might be to adopt a similar system to the antipodes, where junior doctors are required to complete a ‘relief run’, a period of 3-4 months where they plug holes in rotas in a similar way to locums but are paid a salaried wage. I duck as I write this however, for this suggestion may bring slander and outrage from my colleagues who would consider this period to be of poor educational value.

 An arguably unnecessary waste of NHS money perhaps, but until a better system is devised, locum shifts will continue to plug the gaps in essential medical rotas throughout the UK. They are great for the three of us however, as back to back locum shifts are what we are depending upon to finance our expedition!

October Send-Off Bash

From time to time one of us will take a little breather from the self-induced chaos that is our day-to-day life and realise that time is in fact ticking on, and we are off on really rather a big and involved trip in the not-too-distant (in fact frighteningly all-too-soon) future. I’m writing this in just such a gulp of air that involves an evening off with a stubbornly uncreative brain, a handful of peppermint tea and an internet dongle that has far too much autonomy.

My task for the evening: inform you all of a wondrous event that we are heralding in October. Bass, Dan, Guy and I have been lucky enough to live together in Perranporth for the last year, which in its self has been an amazing experience. One of the best things about our year has been the warm friendship and membership of the local Cornish choir, The Perraners. We’ve shared many a great evening of laughter and song in Perranporth with these great people.

The Perraners sing at sunset on Perranporth Beach. (RWH)

We’ve organised this evening as an excuse to get old friends back together, sing our favourite songs, eat some good food, and raise as much money for charity as we can! Having set our departure date for the next day, we thought it would be an ideal send-off bash. Luckily we don’t have too far to go on Day 1 – a bleary-eyed drive to Somerset and Bass’ family home!

Allow me to furnish you with The Headlines:

–          A hearty sit-down meal with wonderful home-made food, courtesy of Seiners

–          A charity auction/raffle

–          Cornish songs with the Perraners

–          Other guests TBC

–          October 7th, probably 7pm!

–          Tickets £10 (meal included)

Please get in touch if you’re interested; cornwalltocapetown@gmail.com

Much love,

R, B & D

Wonderful Charitable Fun!

So distracted have we been by the last few weeks that only now have we managed to tot up our collection from the charity fundraiser held on the 27th July! We raised a fabulous £229.33, which is a great step in the right direction, and had a great evening doing it, so our thanks to everyone that attended and made it what it was. Special thanks go out to our donors, who were remarkably generous in their prises for the charity raffle, which included coasteering, surfing lessons, romantic restaurant meals and cream teas. Thanks also to the Treliske Doctor’s Mess which endorsed our social as an official hospital ‘PayDay’. We hope to do it all again soon before our departure!

Charity Fund Raiser

 
We are planning a social in assiciation with Treliske Doctor’s Mess this coming Friday to welcome new doctors to the hospital, bid adieu to the old ones, raise money for charity, and generally have a cracking time.
 
We’ve booked the upstairs of Vertigo in Truro for such things as dancing, music and raffles. Many thanks to Vertigo for providing us with such a great venue. We hope to see you there!

The Components of Adventure

“So, when do you guys head of on this trip of yours?”

I’m standing in the hallway of a house party, having failed to penetrate any further. Still holding my coat and without a drink in hand, I reel off what is becoming a well rehearsed explanation.

“We hope to drive off at the beginning of October, our main problem at the moment is getting into Egypt from Europe. The Arab spring has made both Libya and Syria no-go areas but a new ferry has opened up. We’re looking for medical placements in Kenya and Cape Town, gathering a bit of data for the London School of Tropical Medicine and raising money for some African charities. We hope to be in Cape Town by April/May time.”

My eyes drift past the friendly chap making small talk and survey the scene. The Community surrounding the Royal Cornwall Hospital where we work is an interesting mix of staff and students. Far out west, there is a cut-off and intimate feel to the place. Pick up the telephone to make a referral and the odds are you’ll speak with somebody you recently saw in the pub or out surfing. A walk down a corridor usually entails a series of meetings and greetings. Everyone knows each others business. Rich, Dan and I are known as the boys planning ‘that huge trip to Africa’. This has been reinforced by the fact we’ve been bouncing around Cornwall for the past month in an intimidating long wheel-based 110 Land Rover Defender with raised suspension and a custom roof rack. It looks like it eats other cars.

“ Wow, it sounds amazing. I’m so jealous.”

Responses to my now reflexive explanation can be broadly classified into anxiety and envy. People either say we’re mad or express their wish to do a similar thing. Cornwall probably has a higher proportion of the adventuring sort.

“You should take guns!”

This unusual response is a new one for me and doesn’t fit neatly into my above classification…

“Um, I think firearms might cause more problems than they solve,” I suggest.

I edge further into the party.

This enthusiastic envy gets me thinking. What is it specifically about this project that catches people’s imagination? The journey seems fraught with back to back problems or ‘challenges’ as the optimistic call them. There is certainty of discomfort, boredom, disagreement, mechanical failures, crippling beaurocracy, risks to our personal safety and a thousand other ‘challenges’ we have yet to identify. A cynic would say that an adventure is a holiday with a series of problems. Surely a year long holiday should earn greater envy? I think it boils down to human nature and the way we are wired. Adventure gives purpose. Becoming totally immersed in overcoming these daily challenges, adapting and changing the plans, gaining new experiences and stories along the way, all the while with a cause in sight, is the fundamental appeal.

I’m sure Dan, Rich and I have varying reasons why we have chosen to embark on such an adventure, at this time in our lives. We have all separately travelled before, in a variety of places for our medical electives as students. I certainly look back at the three months I spent working in Tanzania and Ethiopia as a very challenging but life-affirming time. I think a common reason is that, in medicine, with its clear hierarchal progression, one can see where you will be in a few years. None of us have yet entered training programmes, the ladders to the specialities. If we want to do something like this, now is the time. We had been living together in a house on Perranporth beach on the north coast of Cornwall. We were renting a rather nice holiday home for the off season months (far beyond our combined means). Through the winter, as the westerly winds lashed at the walls, we spent many an hour at the kitchen table, drinking tea or whiskey, and talking. Cut off from the rest of the world our ideas tended to spiral…

Dan pranced downstairs one evening, fiery-eyed (as he can be, whether he’s raging against life’s deep injustices or denouncing cheap tea). I think he had just finished Conrad’s Heart of Darkness and it had clearly made an impression, as many a book does.

“I think we should all go through Africa together,” he pronounced, gesturing to a convenient map on the wall.

Our adventure began sooner than expected…

Of all the chance journeys an e-Bay purchase could have taken us upon, I cannot envisage a stranger encounter. On that particular day we decided to look for a Land Rover, we found one that we knew we had to have. It was a fine red 20 year-old, fully kitted out Defender that we believed would withstand the ravages of Africa. There were two snags: 1. It was far up on Rannoch moor in the Highlands of Scotland. 2. It was already sold.

A phone call solved the second problem. The owner on the other end of the line was a man a talkative man called Malcolm. One of his sons had put the car on e-Bay but it had sold for far below what he wanted for it. We’re unsure as to how he got out of the deal but he was keen to sell to us. We established a good rapport with this enthusiastic Cornishman who, for some reason was residing up in a vast Scottish wilderness.  His asking price seemed reasonable so we arranged to fly up and ‘have a look at the car’.

Dan, Rich, Guy and I flew up on one weekend in early spring in a small aircraft from Newquay to Glasgow. Arriving on Saturday afternoon, the plan was to hire a car and drive into the Scottish wilderness, get the car and drive it back to Cornwall in time for work on Monday. This was almost scuppered by a hire car administration error, leaving us stranded in the airport. Fortunately we were rescued by a kindly sole from another company, who arranged for us to borrow one of their cars.

We drove through Scotland in the golden evening light, racing past castle and loch, making good time. Eventually we turned off the main road and began to wind our way into the highland. As the light faded and the deer to human ratio shifted strongly in the favour of the latter, we began to appreciate how isolated our destination was.

Over a rocky mountain pass, along a dark loch and at the end of a long dead end road we arrived. In the last phone call before we lost signal, Malcolm had said,

“Just head for the castle,”

And this we did…

It was a starry dark as we reached the end of the drive. Although we could no longer see the snow-tipped horizon, there was a feeling of vast and blackened highland above us. We looked up at a turreted castle. After a period of staring at this lofty clan stronghold, we knocked on the door. Behind a threshold that had probably withstood a clan feud or two, a bearded face with a cautious smile appeared. Hands were shaken and we ushered through into a panelled hallway, festooned with hunting trophies. Monarchic antlers interspersed the heads of big African game looking down in anger or surprise.

In the grand living room, under more trophies, we were offered a whiskey. We hadn’t eaten for most of the day but there was a sharp chill in the air that our mild Cornish blood wasn’t used to. Malcolm was a Cornish man who had made his fortuned in ‘speculating’’ as he called it. He was living up on Rannoch moor with his wife and eight children and had a very ‘opt out’ approach to society. When he had bought the place several years ago, it had been a school.

We stayed that night in one of the old teacher’s houses and awoke at crack of dawn to a cloudless spring morning. There were deer on the lawn and the air was thick with birdsong, running water and nothing else. The plan had been to set off bright and early after the purchase as we all had work the following morning at the other end of the country. However we were unable to resist the surroundings and spent the day exploring by foot and Landrover as well as having a celebratory bottle of champagne in the sun.

It was half seven when we finally returned our rental car to Glasgow and crossed the border. The weather was closing in and the sky was bruising. The following Nine ours stand out as a surreal and desperate string of service station stops and driving shifts in non-stop driving rain.

From Abstract to Reality

An overland trip to South Africa has been a pipe dream for us for quite some time; with an career break* on the horizon, what better time to give it a go before family, a mortgage, and “real life” take over?

We quickly realised that a big dream becomes a Sisyphean task; something which it would be easy to put off indefinitely. We needed something to cement the concept, to force us to invest in the project. We needed a vehicle.

Many animated conversations ensued over pints of Betty Stoggs, but in the end there was only one conclusion. It had to be a Land Rover.

As it turns out, you actually pay quite a lot for an old Landie. We quickly found that our budget limited us to a minimum age of 15 years, a high likelihood of some holey bodywork, and an engine with at least 100,000 miles under its belt (‘just worn in’ is how most Land Rover boffins describe this land mark – we’re not convinced).

After weeks of looking we found a 20 year old Defender which looked like it would do the job. The only hitch was it was in Scotland…

*career break = conscious avoidance of any serious career-shaping decisions