Sunday, 28 February 2010

Naming and Shamming: my nemesis (and a few brief encounters)

I received an email this week alerting me to the date and times of the Schools Graduation Day this year. I both love and hate occasion. I love Graduation as I get to dress up in fine academic gowns, be on the stage and perform to an international audience via the web. It is a time of celebration and reflection, a brief moment when we can sit and watch our students receive their awards, and be glad they achieved their dreams. We share this wonderful time with families, friends and over the last two years, our ceremonies have been supported by most of the entire School staff.

To my shame, it is also a time I dread. Despite my life long love affair with words, I struggle with the pronunciation of non-English words. All my life I have shied away from languages other than English. I struggle to learn even the odd phrase of a foreign language. I cannot visualize these words, and even when each word is presented phonetically, I find it difficult to then pronounce the words out in a way that doesn’t leave them shredded and incomprehensible. This state of personal being is not helpful when it comes to presenting students at the graduation ceremony. Many of our students have names that are not of English origin. I can practice and practice but can still end up with my anxieties over producing the correct pronunciation completely destroying my self confidence. I then get locked into a vicious circle of a self fulfilling prophecy. This year I am seeking advice from those who know about such problems and will (apart from undertaking a course of brief interventions (CBT and the like) listen and act upon what they have to say (Cura te ipsum).

Interestingly at last years Graduation our Executive Dean, wondered out aloud as to why we didn’t get our nurses to make a public pledge of their professional intent and commitment to nursing and midwifery at the Graduation ceremony. Whilst it is unlikely we will do anything this year to take this idea forward such a pledge is one of the many recommendations coming out of therecently published Prime Minister’s Commission on the Future of Nursing and Midwifery. This recommendation has not been greeted with universal approval and in some places, even ridiculed by those within the profession. However, perhaps a statement of purpose, one that celebrates the potential, power and values of nursing, along with its unique role is long overdue. When I qualified in 1978 we didn’t have a Graduation Ceremony as such, but we did have the Chief Nursing Officer come and present our certificates and along with parents, family and friends, we all took time out to celebrate nursing and all that this meant. But that was a long time ago.

Also a long time ago I grew up in a place that claims to be the start/end point of the Northern Line (the Black Line on the Underground map). It is also known for being an ancient hamlet in the county of Middlesex, and the place of dastardly deeds by the Highway Man – Dick Turpin, and has one of the largest Jewish populations in London.

The town is called Edgware, and I took my Mum and Dad back there this weekend. The church we all went to as a family was celebrating 75 years of existence, and my parents had been part of the church and community from 1954 - 1974.
It was a strange trip, and one I hadn’t taken for some 40 years. Everything had changed, but also very familiar. There were people at the celebration who clearly remembered me, although I had no recollection of who they were. I am ashamed to say this included a couple of former girlfriends – more brief encounters. I wandered down to look at the house I grew up in. I am the eldest child of seven children, all of whom were born and raised there. The house now seemed very small and not as I remembered it at all.

As I sat there and listened to the many stories, joined in the singing, laughter and shared the reminiscences of people, places and progress, I felt a real sense of disassociation. I was mindful that despite all that has been achieved in the world since that time some forty years ago; much has also been lost from our lives and communities. As I drove back up to Manchester and started to think about making my personal preparations for this year’s Graduation Ceremony I also thought, actually a Nursing Pledge might be a good thing for the profession to embrace. At the graduation ceremony such a pledge would be a very public demonstration of the values and beliefs that are important to us as professionals, people and possible patients.

Sunday, 21 February 2010

Everyone (but particularly Elton when it comes to my Mum) Hurts - sometime

Acetylcholine (ACh) a neurotransmitter, has been shown to be the most important inducer of REM sleep. I mention this as on my flight back from India on Tuesday, when I was trying to sleep, I took advantage of Emirates extensive CD collection and spent a couple of relaxing hours listening to some very fine music. REM was one of the groups I listened to. They produced one of my all time top 10 favourite songs: Everybody Hurts. This is song to be found on their most popular CD Automatic for the People.

Everybody Hurts, was the song chosen by the music entrepreneur Simon Cowell as a way many famous pop and rock stars (and Susan Boyle) could help raise money for the victims of the recent devastating earthquake in Haiti. It sold 453000 copies in the first week of its release and looks lightly to become the best ever selling single of all time – more of which later – but first back to ACh.

ACh was formally identified in 1914 by the pharmacologist Henry Dale. His work explored the action of ACh on heart tissue. It was later confirmed as a neurotransmitter by the Father of Neuroscience and fellow pharmacologist Otto Loewi. Both Henry and Otto received the Nobel Prize in Physiology or Medicine in 1936 for their work.

On going work in this area has shown that damage to the cholinergic (ACh producing) system in the brain is associated with the memory deficits characteristic of Alzheimer’s disease. Alzheimer’s disease is a unique brain disorder that affects the parts of the brain that control thought, memory, and language. Alzheimer’s usually begins after the age of 60.

Elton John, who although originally thought to be involved in recording the REM song for Haiti, for some reason didn’t contribute. Elton is 62.

In an interview this week, Elton said that ‘I think Jesus was a compassionate, super-intelligent gay man who understood human problems’. This is from a man who likes to dress up in Donald Duck costumes. Unlike the two scientists Henry and Otto it is difficult to see how such contributions increase our understanding about humanity, society and the human condition.

Elton made these comments in the magazine Parade. In the article he talks about the death of John Lennon, Princess Diana, Gianni Versace and Michael Jackson. In his characteristically PC oblivious way he notes that ‘Two of them were shot outside their houses. None of this would have happened if they hadn’t been famous. Fame attracts lunatics’.

‘I never had a bodyguard until Gianni died. I don’t like celebrity anymore’

Yeah Right!

Sitting here watching the snow fall, it all feels a long way from last Sunday morning where I was writing my blog in Chennai and the temperature was 30C. I knew I was well and truly back in the good old UK when I read about the Jobcentre in Newcastle who refused to accept an advertisement for a ‘Junior Stylist’ at a local hairdresser. Apparently the term was seen to be discriminatory against older people. Having visited my hairdresser today, I am reliably informed the term ‘junior’ refers to someone’s level of experience not their age. Such indiscriminate interpretation of what is discrimination appears to be a national issue. In Norfolk, Nicole Mamo also tried to place an advertisement for a domestic cleaner on her local Jobcentre Plus website. The advertisement ended by stating that applicants for the post ‘must be very reliable and hard-working’. She was told that her advertisement could not be displayed. A Jobcentre Plus worker claimed that the word ‘reliable’ meant they could be sued for discriminating against unreliable workers!

Finally, and coincidently given last weeks blog, many CONGRATULATIONS to Amy Williams for getting her Gold Medal at the winter Olympics.

Sunday, 14 February 2010

GPs Customs and Contracts (the PhD reprise) Chennai and Cream

Hats off to Dr Martin Scurr. He is of course, the Daily Mails resident Doctor. On Tuesday this week he launched a blistering attack on the greed of GPs, said to be second only to that of MPs. Dr Scurr’s concerns in the main relate to the introduction of 2004 GP contract and the changes in service provision that have resulted. As you may recall, this was the contract that put in place an approach to paying GPs based upon the perverse incentives of achieving so called ‘public health targets’. For every box GPs could tick they got a payment.

In reality of course it was often nurses who were giving vaccinations, undertaking cervical smears and generally providing MOTs for older people. (Just as an aside, I failed these weeks Daily Mail MOT for men. I achieved a big fat red cross against each of the 12 tests of health and well being.

GPs now earn more than they ever did for doing less than they perhaps ever wanted to. They gave up out of hour’s provision, and many other aspects of the once cradle to grave approach to health care they once represented.

And all this in the week that saw the results of the inquest into the death of David Gray alleged to have been caused by Daniel Ubani, a German doctor working here in the UK as a locum GP. David Gray was a 70 year old man who was suffering from kidney stones and renal colic and in need of relief from pain.

Interestingly, the 2004 contract resulted in many hundreds of doctors like Dr Ubani coming into the UK to provide weekend out of hours services at a cost of some £4000 a weekend. Nice work if you can get it.

Whilst we don’t want a return to the Dr Finlay’s Case Book era of soothing words and nice but not NICE proven tinctures and potions, we do deserve something better than we have today.

I came face to face with Dr Finlay’s world in my quest to find a bottle of red wine here at the conference in Chennai, India. In India wine is not a popular drink, and even in the hotels it can be difficult to find or buy. The government adds a ‘70% of the purchase price’ tax onto the price of overseas wine. It is only a 57% tax for local wines, but these are not so renowned as a drink. Whichever you chose the price can be exorbitant. While traveling between my hotel and conference centre I asked the taxi driver if he could take me to a wine shop. After a couple of false attempts we found one who had just three bottles of red wine left. After a bit of a haggle I bought two, the bottles were wrapped up, and I returned to my hotel feeling smug. However, the wine when unwrapped turned out to be rather ancient tonic wine and totally undrinkable. Just the smell of it made it impossible to get from glass to lip, and some readers will know just how much I like a glass of wine now and then.

In 1955, the year I was born, ‘Sanatogen’ was the most famous tonic wine of its time and a great favourite of my Grandmothers. Whilst the You can feel it doing you good - In these hustling, bustling days, when every hour seems a rush hour, there's a particular need for ‘Sanatogen’ Tonic Wine... may have been an applicable slogan then it certainly wasn’t in up-town Chennai on a 31oc sunny afternoon.

I will report on my experience of contributing to the conference more fully in future blog’s. India is a wonderful place, full of contradictions and excitement. Extreme wealth sits along side extreme poverty and squalor. It is a huge busy, bustling place.

Two completely unrelated and random early thoughts from this experience, the first was that despite many enquiries from delegates across India about the possibilities of coming to the UK to study and work, listening to the presentations and having many conversations with others delegates it was clear that people in Indian health care systems have much to offer us in terms of their experiences in promoting health and well being. The second thought was that as I write this blog, it is the second day of the winter Olympics, and despite the tragic news of the death of a luge contestant during a training run, the event seem to have passed the conference delegates by.

Finally, in 1940 Ginger Baker was born. He was of course, the drummer in the original super group Cream. The significance of this fact might pass some of the blogs younger readers by. Now some 70 years later he is to marry 28 year old Kudzai Machokoto, a nurse. They live in South Africa. Kudzai will be his forth wife. They are reputedly not looking to have any more children.

Sunday, 7 February 2010

Those Dangerous Days of Childhood

The Times this week, reported on the 20 DANGEROUS things every parent should allow their children to do! These activities ranged from: licking a 9volt battery, playing with fire, sleeping in the wild, learning dramatic sword play, exploding a bottle in a freezer and building a rope swing. Each of these activities came complete with its own health warning, and range of safety equipment that should be deployed when attempting the activities. I wasn’t sure if this was a tongue in cheek piece of advice or just a sad reflection of publishing in such a litigious age. However, I was struck by the fact that every one of these so called dangerous activities were things that had been part of my childhood. I was a Boy Scout, and spent many a happy hour engaged in just these so called dangerous activities. I even took part in an in-door archery competition in front of the Queen, which given my poor hand-eye coordination, was probably more dangerous for the queen than it was for me.

Of course the original Scout and eventual World Chief Scout Lord (Robert) Baden Powell, has many connections to nursing, health promotion and the well being of boys. During the Siege of Mafeking in South Africa, for example, his cadet corps (an all white group for boys and the precursor to the Scout movement), were used as health care assistants in the field hospitals. It was his book Aids to Scoutmastership, which illustrates how far ahead of his time he really was. This was a book was first published in 1919 and sets out what Baden-Powell described as the ‘science’ of scouting, which he claimed as being neither abstruse or difficult, but a jolly game to be played – my kind of science. Chapter Two in this book is entitled Health and Strength and is a brilliant blueprint for ensuring the health and wellbeing of individuals. Its scope is fantastic, ranging from taking exercise, eating healthily, no smoking, and good sexual health and even a paragraph on sexuality. In terms of health education and promoting health and well being, it still holds great relevance today. It was last updated in 2005.

Baden-Powell’s own health wasn’t always good however. For example, he suffered from persistent headaches, for which no physical cause could be found. The headaches started very soon after he got married. He received treatment in the form of dream analysis. Freud famously described psychoanalytic dream-interpretation as ‘the royal road to a knowledge of the unconscious activities of the mind’. We don’t know what lay in Baden-Powell’s unconscious, but we do know that his headaches disappeared after he started sleeping on the balcony of his bedroom.

Despite girls also wanting to be Scouts, Baden-Powell did not believe it would be right. Girls formed their own organisation (the Girl Guides) in 1910, some three years after Scouting started. Just like Mafeking, the Guides provided similar help and assistance during the 1914-18 war. Unlike the Scouts, Guides were awarded a War Service badge after working for 21 days in a hospital or if they knitted at least 15 articles, including socks and a bed jacket, for war heroes. Since that time a number of high profile women joined the Guides, including Clare Short, Julie Burchill, Mo Mowlam and Glenda Jackson - have passed through their ranks. Interestingly, the Guide movement now has 650,000 members, which is substantially more than the now-mixed Scouts movement can boast.

I am not sure what Baden-Powell would have thought of Tescos decision this week to refuse to serve a young lady with cigarettes because she was wearing pyjamas. If he was still around today, perhaps his next edition would have advocated that in the interest of promoting health and well being, supermarkets should only sell cigarettes to those people wearing pyjamas