How My Liver Rested in the Confusion of Karachi

I arrived at Karachi airport at 05.30am last Friday morning. The place was chaotic and reminiscent of Bedlam. The noise was incredible and un-relenting. The queues to get through customs and collect one luggage were the biggest I have ever seen in a life time of travelling. Thankfully I was rescued and fast tracked through all the processes –this meant it took two hours rather than a life time.

I was allowed to rest at the hotel for four hours before being picked up and accompanied to the main offices of SIUT (Sinda Institute of Urology and Transplantation). I was there as part of a delegation from our Faculty and partners from practice. Together with these colleagues I then spent the next six hours being shown around the SIUT facilities.

It was the Director of SIUT, Professor Adib Rizvi, who welcomed us with warmth and sincerity. He spoke of the unremitting challenges in trying to provide healthcare to a large and predominantly poor population of the country. The aim of SIUT is to provide healthcare in the field of Urology, Nephrology and Transplantation to all, entirely free of cost and with dignity. Pakistan has a high burden of urological diseases.

Basic health care is not widely available in Pakistan. Only 1% of the GDP of Pakistan is allocated to the health sector. Private hospitals can be afforded by no more than 2-4% of the population. As with other developing countries, 20% of the population utilise 80% of Pakistan’s resources. Likewise, Pakistan faces a constant struggle over the injustices of illegal child labour, oppression of women and an increasing disparity between the rich and poor. SIUT was there to help those who are poor. Indeed their mission is ‘we don’t let them die because they cannot afford to live’. Starting out as a 8 bedded unit in a local hospital in the 1980’s it has grown to a become a 500 bedded Institute sited on two sites in Karachi, with satellite clinics in the neighbouring areas.

Our visit started in the old facilities. These were, on first impression, a throw back to the dark ages. Wards and clinical areas with beds in corridors and aisles, little privacy and the activity and noise was constant. But a huge number of patients were being seen each day. In 2009, nearly 700,000 patients were seen, 544 renal transplants undertaken, 144,107 patients received dialysis, and 4246 Lithotripsy interventions performed. Additionally, nearly 200,000 outpatient appointments were provided. There is a new 300 bedded unit now that also provides state of the art oncology services. Everything that is provided is provided free to the patients, including long term follow up medication. SIUT receives some 40% of its running costs from the State, the rest comes from voluntary donations.

It was humbling to watch, for a while, this activity being carried out with commitment, dignity, dedication and real skill. In the UK with all our shiny new health care toys, it can sometimes be difficult to discern such high levels of service being provided to a other. Magdi Yaqoob, the internationally renowned transplant surgeon noted that SIUT provides medical care to patients that is as good as that of any premier institute in the western world.

The SIUT wants to agree a partnership with our University and School of Nursing aimed at bring their pre and post reg nurse education and training up to the standards found in the UK. They have run a School of Nursing since 2006 and this has provided  basic three year general nursing programmes. This year has seen the initiation of a specialist BSc in Renal Nursing.

I am sure we will be able to agree such a partnership, despite the desperate political and other related security issues. Somewhat ironically, I think that such a partnership would actually provide more possibilities to extend the role of the nurse than perhaps some of the opportunities we have in our own context.

And the saving of my Liver. Well, for religious reasons, Pakistan really is a dry state. Alcohol can not be purchased anywhere, not in the hotel or even the magnificent Sind Club, an exclusive ex colonial establishment where we provided with a fabulous meal one night by our hosts. Everyone we met was fantastic. We were never left unaccompanied and people were most generous with their conversation, smiles and friendship. However, being driven through the streets of Karachi along with what were millions, yes millions of other road users was made more difficult knowing their would not be a nice G+T to sooth ones shattered nerves at the other end.

I shall be returning to the UK on Tuesday evening, ready to Chair what I think is going to be an exciting day on Wednesday. This is what I hope will be the first in many joint Humanities/Mental Health Seminar Workshop Days. This first workshop day  is entitled: A Novel Opportunity: Reading, writing, and performing to aid the explication of Mental Health and Well-Being – and we have some cracking examples of peoples work to enjoy and learn from.

Solicitors, Service Users and Concrete Sheep

I was in Islington this week, attending the latest Mental Health Academics UK group meeting. This has to be one of the best groups in the mental health nursing world. Many of the leading contributors to contemporary thinking on what makes for an effective mental health nurse and how we prepare individuals for this role were there.

Coming home, I sat opposite a solicitor who spent much of the two hour journey on his Black banana shouting at one of his staff. The unfortunate victim of this mans wrath was a subordinate who had received 9 emails from a customer about a deal that was aimed at establishing a line of credit, and apparently he hadn’t responded to any of these emails. I am glad it wasn’t me on the other end of the phone. There wasn’t much I felt I could learn from Clive’s management approach or his interpersonal skills, but I could connect with his notion that customers are important and that to ignore them was likely to only result in disaster for everyone.

Coincidently, I was sitting on the train peer reviewing a paper that looked at Consumer Participation in Australian mental health services. Sadly, the paper wasn’t very good and I was struck by the ‘political correctness’ in the approach being reported upon. I was uncomfortable with what I was reading and whilst rhetoric is at times, very useful, this paper depressed me.

I had this in mind as this week the School had two important ‘customer’ events. The first was the inaugural service user, carer, practitioner conference – the theme was compassion and care. Partly the conference was our contribution to recognizing and celebrating National Carers Week, but partly it was the realization of a long held ambition of our Service User and Carer Group in the School. This group celebrates its fifth anniversary as a group. Their contribution tour Schools life has grown year on year. This year also sees the first group of students who participated in the first of what has become a hugely successful service user, carer and student conference graduating at ceremonies in July.

My colleagues in the School and our partners in the Service User and Carer group did us proud. The event was a success. Over 130 people attended and they were once again reacquainted with the realities of what it might be like to be a carer. The second event was a participation event looking at how to more effectively engage with children and young people in all aspects of our work, but particularly, with our research activities. Again this was a very successful event and provided much for us to think about in taking this work forward.

And talking about children, my eldest son and his wife presented me with my fifth grandchild this week. It is a slightly spooky feeling, but of course I am so proud and happy for them. As it is the digital age, I was able to see photos within a hour of him being born – despite the birth happening in Hastings, New Zealand! Intriguingly, the clock tower in the centre of Hastings is surrounded by a small flock of concrete sheep. It appears that uunknown Hastings residents seem to find it an unending source of amusement to leave real sheep droppings behind the concrete sheep. I think it is called having fun in New Zealand. I have been there three times and every time I come away thinking it is along way away from anywhere else in the world.

Anywhere else in the world was just where I wanted to be last Sunday! The six foxes that have taken up residence in our neighborhood came like Ninjas in the middle of the day and took and killed all our chickens. They did so while we were in the kitchen preparing lunch. All that escaped this ferocious attack were a couple of one week old baby chicks and Jemima – the duck who thinks she is chicken. Heroically Jemima has literally taken the two orphaned chicks under her wing.

But it is now a new week and today is Fathers day. I have just been presented with a great big bottle of malt whisky from my youngest daughter. Yes we start our days early. The whisky is called Monkey Shoulder. Readers of earlier blogs will recall that this whiskey has a special significance for the two of us. As with all my children, I have always tried to ensure they understand how much of burden it can be to carry someone else’s monkey on your shoulder.

Stitches, Smash, Science and the Red Skins!

Last week I had a number of stitches removed from a small wound on my back. It was a relief, both to have them removed, but also to be able to have a proper shower. What amazed me was that the stitches were a delightful pastel blue colour and so thin. Things had clearly changed since my day, when all that was available was the ubiquitous black suture.

The company Johnson & Johnson was founded more than 120 years ago on the then unique idea that Doctors and Nurses should be able to use sterile sutures, dressings and bandages to treat peoples’ wounds. At the time, J&J employed nine glassblowers whose major role was in the manufacture of sterile sutures and ligatures for surgery. They were the largest producer of sterile surgical dressings in the world, and were the largest manufacturer of catgut ligatures in the world, producing an astounding 10 million feet per year. In 1917, these ligatures were stored ready to use in glass containers.

It was J&J who also Your Future in Nursing, a training programme that combines the interactivity of video computer gaming with real-life nursing scenarios. This programme allows both new and future nurses to practice their skills as nurses in a risk-free virtual environment in order to develop the communication skills required in making the transition from classroom to bedside.

It was my colleague Sue Bernhauser who noted that such programmes are important as over the next 15 years and beyond, nurses will need to respond to the challenges arising from changes in demography, disease patterns, lifestyle, public expectations and new technologies. Cleary the changes planned for pre-registration nurse education must equip nurses to lead and deliver both compassionate care and ensure that the practitioners of the future have the skills and knowledge to work in a modern healthcare system. Sue is the Dean of the School of Human and Health Sciences, University of Huddersfield, and Chair of the Council of Deans for Health.

It was said that Huddersfield was the place that the Smash aliens landed. For younger readers, Smash was a rather disgusting idea where one poured hot water onto a powder to get instant mash potato. In the 1970 advertisements, the aliens arrived to make fun of people who still used the old fashioned potato to cook with. And such discussion continues. A three year trial has just begun at the Sainsbury Laboratory to field test a genetically modified variety of potato that would be resistant to ‘late blight’ The global annual cost of crops lost to the disease is estimated to be £3.5bn.

The Sainsbury Laboratory is part of the Gatsby Charitable Foundation, established in 1967 by David Sainsbury (now Lord Sainsbury of Turville), from whom all of Gatsby’s funds have come. Gatsby acts as an enabler for projects across a small number of selected fields. These include: Plant Science; Neuroscience; Science and Engineering Education; Africa; Mental Health; Arts.

The Sainsbury Laboratory Project is aimed at testing the potato plants' resistance to naturally occurring pathogens which cause blight. The genes, taken from inedible wild plants that grow in South America, were used to produce a genetically modified Desiree variety. For me a better overall potato than the Desiree, is the Rooster. The Rooster is a red-skinned but slightly duller colour than the Desiree with floury yellow flesh. It has become Ireland's number one variety of potato; in 2002, it accounted for 33% of Irish potato production. The Rooster is extremely versatile, and can be used for chipping, mashing, boiling, baking, and roasting. A Rooster can also be a Chicken of course!

Whilst I am not sure where I stand on the wider GM debate, I do acknowledge that human beings have constantly striven to improve and change that which is provided by nature. I am very glad that it was the modern synthetic sutures that had been used on my wound and not those hard old fashioned cat gut varieties!

Gum, Tangled Tongues, Pledges and Music without Borders

I start with what has become the almost ubiquitous food element of my weekly blog. Yesterday morning I had breakfast sitting outside, on the side walk, in up-town Chicago, in the shadow (literally) of the Wrigley building. My breakfast was horrible, but I will come back to that. Willem Wrigley (Jnr.) moved to Chicago in 1891 – to sell soap ad baking powder. As part of his sales campaign he gave away chewing gum to his customers. When he discovered how popular chewing gum was, he started to make and sell his own. The rest, as they say is history. However, history is not without its problems. An international industry has grown up around the need to remove from public places dropped chewing gum. In the UK we spend some £400 million on street cleaning, of which, almost 20% goes on chewing gum removal. Cleaning Trafalgar Square today of dropped chewing gum would cost over £20,000. Being a pragmatist, Wrigley argued that educating people not to drop chewing gum on the street was the most effective long term solution to this problem! The company first printed the advice to ‘Use this wrapper to dispose of gum’ on packaging in 1933 and this continues still today.

I was in Chicago for a conference. This was held in the Drake Hotel, the oldest hotel in town. I thought the best view of the hotel was from the 95th floor of the John Hancock Centre, which is currently the fourth-tallest building in Chicago and the sixth-tallest in the US. Interestingly, given where we are economically, the original construction of the tower was briefly halted in 1967 due to a similar credit crunch. For a number of years the building was left at a diminutive 20 stories.

I was both amused and slightly perturbed to learn that Wrigley’s newest gift to the world is something called a Starburst Tongue Tangle. As regular readers of this blog will know, this time of the year is a desperately anxiety provoking one for me as the lead up to Graduation gathers momentum.

Pronouncing people names has, and perhaps will always be, my nemesis. Additionally this year, I was confronted with a request to get our nurses and midwives to make a pledge at their graduation ceremony. The suggested pledge was a modified WHO version of the one doctors tend to make. Whilst I don’t have a problem with a pledge per se, (I would like us to adopt and adapt the pledge suggested in the PM Commission on Nursing and Midwifery’s ) the thought of trying to get this sorted by July filled me with despair. Fortunately, common sense has prevailed and we will work towards introducing a multi professional pledge for the student’s graduating in 2011.

To celebrate individual and shared achievement is always a good thing! Two Fridays ago, the University held a Thank You event. I went and participated, and of course shared the self congratulatory good feeling and bonhomie. However, the tug of war event was a little unexciting (but maybe that is how accountants get their kicks), and listening to the choir was difficult in the heat of the afternoon.

I was thinking about this as here in Chicago, the first of a series of open air concerts entitled Music without Borders was held in the fabulous out door arena in Millennium Park. The music was brilliant and was provided by bands whose membership was international. People picnicked in the park, enjoyed each others company and great fun. I wondered if we could consider something similar for our next Thank You event.

Finally that breakfast. Well I eventually found a place called the YOLK. They provided what was a wonderful breakfast, gave great service and it was a lovely place to be in. BUT the noise of all those people talking and having breakfast fun was almost over whelming. I hope our EGG space in MCUK doesn’t end up with similar problems!