Take some Pudding home…

This is a heartfelt plea to see if anyone would be able to provide a home for our dog Pudding over the next year.

Myself, Katherine and our children are all off to South Africa from the end of August until July, working in a hospital, and trying to avoid being eaten by hippos.

Unfortunately, its too difficult and expensive to take our two lovely dogs with us for this period. Hezebelle, our 8 year old collie, has a temporary home with a friend for 11 months, so we just need somebody who would like to support our work over this year… by looking after a slightly annoying Labrador.

IMGP1455Pudding is 6. She is half collie, half Labrador, and 75% moron.

She plays well with children, and other dogs – there might be a settling in period for a day or two with dogs – she loves to be with people and animals.

She is a scaredycat - we have chickens, its funny to watch her run away from them round the garden. If you don’t have a chicken, we can lend you one. She will bark at your front door, but she shuts up pretty quickly, and there’s no aggression in her, she’s just saying “OH NO, THERE’S SOMEONE AT THE DOOR?!”.

She is fully housetrained. That said, she is still an animal, and she is known to eat ridiculous things, so I can’t guarantee that you won’t have one or two episodes over 11 months – but it shouldn’t be more than that.

She is a food lover. She will eat anything you offer her – and the occasional poorly guarded thing that you don’t – but she is reasonably well behaved. For example, if you put cake on a table and said “Pudding, do not eat that cake!”, you can be pretty sure the cake is fine. If you put a tub of butter on a chair, and just wander away… there’s a reason she is called Pudding. We will pay for her food whilst we are away.

She is lazy. She is happy with 5 walks a day, but she also manages with 2 a week. Half the time we have to call 3 times to wake her up in the morning to go out. She will likely not even notice if you leave her alone for the majority of the day at work, and has been threatening to become wider than she is tall ever since we got her.

She is a much loved part of our family, and I’m confident that she would settle into yours too. If you think this is something you would be able to take on, please give us a call, an email, or whatever. In looking after her, you’d be supporting a young family as they go on mission to help those in need in Africa.

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Snakebites and sad goodbyes

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Dermatology. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

A final morning chapel followed our joyful late night escapades last night, with a combination of Amazing Grace and We Are Marching to get a bit of the African clapping vibe working. The photo below is from earlier in the week, but since its the last day today, it seems appropriate to share it…

Beautiful_photo_DHC_2014

Dermatology

Clare Fuller showed us lots of very interesting graphs. Dermatology complaints are known to under present, be poorly treated and lead to people avoiding healthcare for other important issues.

In some studies, more than 60% of Dermatological prescriptions were inappropriate in a Developing world setting.

Also, distance effects health seeking behaviour in Dermatology more than other conditions: if there is a clinic within 1km, people attend with their fever, their pain, their rashes. If the clinic is 10km away, they will only go with their fever or pain, according to one study.

Apparently 10-20% of children with scabies will still have haematuria 10 years later! That’s terrifying, and only something that’s recently coming to light.

Skin lightening products

Using topical steroids for skin lightening leads to low birth weight and vaginal bleeding in pregnancy.

Generally dangerous

Cutaneous bacterial infections

Very common in the tropics, can be difficult to identify which one in particular.

Treating cutaneous bacterial infections

  1. Wash skin – clean water, disinfectants
  2. Remove crusts, debris, necrotic tissue
  3. Topical anti-inflammatory/anti-biotics, honey, etc.
  4. Oral antibiotics

Eczema

Acqeous cream should not be left on the skin – can inhibit barrier function.

Otherwise the greasier the better.

Snakebites

Approach will vary depending what snakes you have in your area.

I saw a snake on my balcony, and was concerned, so asked a colleague what to do.

Their response, “Have you tried the exposure test?

“What is that?“, she replied.

Let it bite you, and see what happens

Fond goodbyes

I was feeling desperately sad by the end of the day, but it was time to say goodbye to everyone. I got bullied into starting a Developing Health 2014 facebook group, so feel free to join if you came along – it’d be great to stay in touch.

Thanks to everyone who came along, everyone who donated their time to teach, and the course organisers: I’ll be processing everything I’ve learnt for months…

Ladies, feet washing and goodbye curry

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is More Women’s Health. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

Cross Cultural Care

Mary Hopper delivered a talk that usually marks part of a 30 hour course over 6 weeks. In 55 minutes.

Your race is a constant.
Your culture constantly changes.

She recommended reading a book called “Desert Flower”, by Waris Dirie.

She mentioned that simple things like Dermatology books rarely have pigmented skin, making medicine itself culturally inaccessible, but then Marli emailed me an African Skin Guide, which is not added to my ridiculous pile of things I need to read…

Labour and Obstetrics

A maternity dashboard sounds like an excellent way of keeping track of statistics and aiming to improve them across a whole hospital.

We had lots of very useful workshops, which included resolving a shoulder dystocia, and delivering a breach. I also had some great one-on-one tuition from Julie-Rachel, a midwife working in Zambia, who invited all of us to stay out there – she has ridden on an elephant! I definitely want to ride on an elephant, so now I just need to persuade Katherine that the experience is worth 20 hours or so of travelling…

Final evening

jesus-washing-disciples-feet-by-taklaIt being the last evening before the end of the course, there was a goodbye service in the chapel, where Ian spoke about Ephesians 1 again, and talked about the big transformation present in so many biblical lessons: imagining a U shape, starting high, dropping low, coming high. Jesus is Lord, coming down to mankind, dying an ignoble death, then rising up again.

He ended with John 13:

Jesus knew that the Father had put all things under his power, and that he had come from God and was returning to God; so he got up from the meal, took off his outer clothing, and wrapped a towel around his waist. After that, he poured water into a basin and began to wash his disciples’ feet, drying them with the towel that was wrapped around him.

He came to Simon Peter, who said to him, “Lord, are you going to wash my feet?”

Jesus replied, “You do not realize now what I am doing, but later you will understand.

No,” said Peter, “you shall never wash my feet.

Jesus answered, “Unless I wash you, you have no part with me.

Then, Lord,” Simon Peter replied, “not just my feet but my hands and my head as well!

Jesus answered, “Those who have had a bath need only to wash their feet; their whole body is clean. And you are clean, though not every one of you.” For he knew who was going to betray him, and that was why he said not every one was clean.

When he had finished washing their feet, he put on his clothes and returned to his place. “Do you understand what I have done for you?” he asked them. “You call me ‘Teacher’ and ‘Lord,’ and rightly so, for that is what I am. Now that I, your Lord and Teacher, have washed your feet, you also should wash one another’s feet. I have set you an example that you should do as I have done for you. Very truly I tell you, no servant is greater than his master, nor is a messenger greater than the one who sent him. Now that you know these things, you will be blessed if you do them.”

John 13:3-17

Last time I was on the course, I felt a calling to wash everyone’s feet. This time we did it again, myself, Marli and Jayde. As always, it was an intimate, humbling experience – an honour for all of us.

CURRY!

Several of us had wanted to go out for an evening meal, but Vicky was sad about people leaving on the very last night: we compromised with an Indian takeaway. In the largest order I’ve ever made, we ordered £120 of curries, rice, poppadums and naan breads. We pulled together 3 tables, and sat round them, laughing, sharing, and trying not to think about saying goodbye.

After the food was finished, we spent some good old fashioned time singing Irish songs, National Anthems of every country round the table (we didn’t do all 11 verses of the Norwegian one), reading out poetry and spoken word, and telling jokes.

Worship in the dark

By around 10, a small group of us – Me, Jayde, Marli, Jakob, Ingvlid, Richard (until his wife summoned him away) – headed to the chapel, where we started playing worship songs. We turned off the lights, with just a small torch lighting up the music on the piano, and stayed together for hours.

It was a peaceful end to the course, and an honour to share with friends who were strangers to me 2 weeks ago. Around 1am, we prayed for each other, and headed for bed.

I stupidly also chose this time to pack, but because I’m a disorganised man, it only took me about 5 minutes to shove everything randomly into bags

The Ladies are Dying

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Women’s Health. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

why are  women dying?Maternal death

Afghanistan – “One of the worst places in the world in which to be pregnant”
UNICEF

Has a Maternal Mortality Rate of 6,500 per 100,000. Which is the highest ever recorded, anywhere in the world.

Reducing those MMR stats is simple: we know the answers…

  1. Improve access
  2. Ensure skilled staff at deliveries
  3. Increase Utilization
  4. Education and Family Planning

Female Genital Mutilation

Studies have shown that it is not really a religious tradition but a cultural one. It is barbaric – and the pictures and case studies just confirmed that. I’m pretty proud of our country that they have made it illegal for UK nationals or residents to perform FGM anywhere in the world. Maximum sentence 14 years!

There were some interesting discussions about this though: if you deliver a baby, and the mother gets a tear, relating to her FGM, you breach the law if you repair it to how it was previously, rather than trying to reverse the FGM – regardless of the patient’s choice!

Women, depression and domestic violence

There is a big correlation between depression and suicide in women in the developing world – in the UK, men are about 3 times more likely to be successful in suicide. In Bangladesh, there is no statistic distinction between the two.

Being poor, worrying about family, about health, about money, about social insecurity, domestic violence: all these things are stressful.

In some studies, 20-36% of women in Asia suffer from post-natal depression.

Group work

We had a range of group workshops, where we talked through loads of case studies. Very informative, very useful. Just like yesterday, where I ended up teaching a group how to perform a spinal anaesthetic, today I realised that I actually have something to contribute, based on my professional experience. Last time, I knew very little about gynaecology, but this year I had 4 months on experience, and was able to participate actively in the discussion.

The Cutting Edge…

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Surgery. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

I started my morning devotion with starting to read through John 1. I was completely unsurprised to find that the word enlightened came up immediately, just like Ian’s talk from the first night, and bringing me back to that Ephesians 1 passage again:

The true light, which enlightens everyone, was coming into the world.
John 1:9

Anaesthetics

Following that, Hilary Edgcombe taught us about many cool intelligent things in the world of Anaesthetics.

“Is Ketamine a wonderful drug with terrible side effects, or a terrible drug with some useful side effects?”

She talked about Ketamine: It is not a fail-safe airway option… Give it over 5 minutes to reduce chances of impacting airway.

We touched on the terrible under-resourcing of many Majority world settings, from an anaesthetics perspective. The video below shows a bit of that – I shared it last time as well, but its still interesting.

On the Developing Health USB stick, there is an amazing link to a free online Developing Anaesthetia textbook for use in resource poor settings. It’s pretty brilliant…

A quality history and decent examination are important before anaesthetics. Just like Ian has been saying all week, a probing history, a thorough examination, appropriate investigations and careful synthesis is the fundamental base of clinical medicine.

She also recommended http://update.anaesthesiologists.org - which is a good resource for information about coping in resource poor areas.

Surgery

surgical questionsColin Binks and Mike Puttick took us through the next session on Surgery for the Non-Surgeon.

Two big questions: Can I do it? Should I do it?

Seeing red

If you see haemorrhage, pack it, pack it, pack it, pray, pack it, etc.

If the liver won’t stop bleeding, give the portal vein a squeeze.

Seeing green

Likely small bowel or gallbladder perforation. Wash and go approach.

  1. Clean it out.
  2. Close it up.
deadbowel

Necrotic Bowel – its black, so you excise it

Seeing black

This means there is necrosis.

  1. Excise the dead stuff.

The Acute Abdomen

An interesting talk, with lots of stuff that was way over my head: I think I am not competent to start popping in bowel anastamosis yet. The message was repeated from yesterday that:

“The solution to pollution is dilution.”

Lots of irrigation with saline in your friend in surgery.

With both talks, it was really useful looking at case studies, saying “What can you do, what should you do?”. It was recommended again that we buy the Primary Surgery book, which helps with knowing how to do things, if we decide doing them is the right option.

Anaesthetics tutor

We had some group work in the afternoon: in one of the sessions, the anaesthetist was teaching how to do a spinal anaesthetic. Given that I had more experience in this area than anyone else, I ran one of the stations. Whilst I may not have been particularly good, it was quite uplifting for me – namely that work I’ve done in previous years to learn clinical skills has led to me having skills that my 2012 self did not.

That’s a professional development reflection for my e-portfolio right there…

One cool tip the tutor gave us for finding the spine, especially if someone is laying on their side:

A patient can always find the middle of their back, so if you are struggling to find it, let them point to it for you.

Late night fellowship

Fellowship has been a great component of our time together on the course. Late this evening, me, Marli, Mike, Jakob, Justus and Linda all sat in my room, and shared Coke, alcohol free beer, prayer, bible verses, songs (inconsiderate after midnight?) and stories of how each of us came to know Jesus.

It was very uplifting, if a little tiring (we went to sleep after 1am). We ended by reading Philippians together:

Brothers, join in imitating me, and keep your eyes on those who walk according to the example you have in us.

For many, of whom I have often told you and now tell you even with tears, walk as enemies of the cross of Christ. Their end is destruction, their god is their belly, and they glory in their shame, with minds set on earthly things.

But our citizenship is in heaven, and from it we await a Savior, the Lord Jesus Christ, who will transform our lowly body to be like his glorious body, by the power that enables him even to subject all things to himself.

Therefore, my brothers, whom I love and long for, my joy and crown, stand firm thus in the Lord, my beloved.

Philippians 3:17-4:1

Joining bones (and mission partnerships)

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Orthopaedics. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

New Relational Partnership…?

We started this morning with a meeting with the missions agency that phoned me last week. Katherine, Joen and Neriah all came out to Oak Hill college with me, ready for the meeting. We met with a lovely chap with an accent that can best be described as “miscellaneous”, since he has lived in about 5 countries for significant periods of his life. His wife was also there.

Just that little fact made me feel more comfortable: if you meet with a corporate CEO, or similar, there would never be such an immediate focus on relationship, on meeting our family as we meet theirs.

UBurn Contracture Healednderstanding the concept that he is not alone in working – as a married couple, all our work, to some extent, is done in partnership.

Anyway, it was a thought provoking meeting, that may lead to a long term partnership: more on that as it develops…

Orthopaedics

Due to our meeting, and my general tiredness, I missed most of the morning, by the earnest, funny and heartfelt Chris Lavy (I sat with him at lunch, he was awesome). I did catch two recommended websites for finding recommended physio techniques and general reference material: Summit Medical Adult Health and WheelessOnline.com.

However, I managed to attend most of the afternoon sessions with tutorials and workshops on fitting people for casts, putting legs in traction, and how to splint burns.

I think the biggest take home message for me was that burns need appropriate splinting, for at least 6 months to prevent developing significantly disabling contractures (see right).

Ideally you want a burn to heal within 2 weeks, as that makes risk of contractures much less likely.Burn Contracture Healed

The Hidden Introvert

The Mission Agency asked us to identify our Myers-Briggs types: Broadly, Katherine is an INFJ, and I am ENTP. Which is nice, as the conventional wisdom is that having 1 field the same (possibly) makes for stronger relationships. It’s interesting to read through – not a massively evidenced based approach, but an interesting window to use to inspect your own mentality.

Unsurprisingly, I am classified as an Extrovert. But, I have a hidden Introverted side that I never knew existed…

This week has been socially intense, making instant, deep, wonderful friendships with people from all over the world, but with fairly similar visions and life views to me. I’ve had a fantastic time, but it has been hard work. For the first time… ever… I had to go and spend an hour in my room on my own this afternoon!

I was excited about this: Vicky Lavy pointed out that the fact that after an hour I was back out, talking to everyone, means that I’m unlikely to be at risk of reverting to total extroversion…

Africa and Zulu

The evening talk was a chat with Peter Saunders. His story was slightly haunting for me: around 20 years ago, he felt called to work in Africa for a year, went to work in Kenya for a year with his wife, a 1 year old and a 3 year old. They felt convinced they would end up in Africa long term: but never lived there again…

My last activity before bed was my first Zulu lesson with my SA friend Linda. I discovered my first concepts of Zulu prefixes, and learnt to say Kubu Hlungu Ikhanda (My head hurts).

I am not fluent yet.

Baby, baby (and other paediatrics)

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Paediatrics. I made notes on the whole course in 2012 - you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

After all the fun of last night, it is no surprise that there was lively worship this morning. After two hours last night, and half an hour this morning, my fingers are tired of strumming!

Greeting from BotswanaNeonates in the Developing World

There were some big messages, and scary statistics.

No more shall there be in it an infant who lives but a few days, or an old man who does not fill out his days, for the young man shall die a hundred years old
Isaiah 65:20

If you include stillborn babies, then 75% of deaths in under 5s are in neonates.

50% of neonatal deaths are in the first 24 hours. 75% are in the first week.

Malnutrition

Nutrition is responsible for 30-50% of child deaths, and also leads to low birth weights due to maternal mortality.

Urgent referral for kids:

  1. Inability to drink or breastfeed
  2. Vomiting everything
  3. Convulsions
  4. Lethargy or unconsciousness

32% of children in developing countries have stunted growth due to malnutrition

Stuff to read, when I stop being useless…

  • On our CMF USB stick, there is a highly recommended Pocket Book of Hospital Care for Children, which I shall read, when I sort myself out.
  • Unicef State of Child Health.
  • Lancet Global Health Series can be read free online.