The avalanche danger level was the second highest possible this week in most parts of the Alps. But the warning did not help: six alpinists died in avalanches within 24 hours in Austria. Although the scientific knowledge about the pathophysiology of being buried under an avalanche has improved, and the number of hospitals with technical equipment allowing resuscitation of deep hypothermic avalanche victims without spontaneous circulation have grown, the number of people who die in avalanches is not declining. Wolfgang Ladenbauer from the Austrian Mountain Rescue Organisation told me that the reason is the absolute number of ski mountaineers has increased considerably. Also, the efforts to teach alpinists about alpine dangers and better equipment may have lead to a decrease of fear rather than an increase of knowledge in alpinists. So therefore the number of casualties has not declined.

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Memory is short. I learned this early when, as a junior doctor, my consultant retired.

He was a legend, irreplaceable, the backbone of the hospital. But, it takes less than a year to be forgotten. You soon become that nameless old buffer at the cocktail party- remembered only by former colleagues and a few senior nurses. The junior staff have moved on and any residual links are lost with the second crop of replacements. The new consultant is already established, has put their stamp on the department, and systems have changed. It’s a little sad to see the old tyro lurking around the hospital corridors, picking up locums to recapture past glories and struggling with their self esteem. Now history, they don’t see it that way and would be horrified to be thought of as yesterday’s men or women. No matter how deep our footprints, the next tide leaves no trace. There is a time to move on. more…

Pakistan, like most developing countries, is experiencing rapidly rising rates of cardiovascular disease, diabetes, obesity, and chronic obstructive pulmonary disease, and it has developed a draft national plan for countering chronic disease. It’s an impressive and elaborate plan, as I discovered when I discussed the plan last week with people from the health ministry in Islamabad. It will, however, be an uphill struggle to implement the plan and make a difference. more…

In the BMJ editorial office, we often come across interesting articles, blogs, and web pages. We thought we would share these with you. Some are medical, some techie, and some just general.

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I’ve been in Pakistan teaching around 30 young women on the day that the Taliban has bombed a girls’ school in north west Pakistan killing three girls and injuring another 62. For the Taliban it’s a crime to educate women. For me the women I taught were an inspiration.

The conventional view of women in Pakistan is that they are horribly oppressed, and of course many are. Some 80% are illiterate. Many after they are 8 years old are not allowed to mix with men apart from their immediate family. Most of those who are married can do nothing without the consent of their husband, including, as one woman in my class explained, go to hospital to give birth when in labour. None, even those who are the most liberal and educated, can wear a skirt. more…

What do risky media sensationalizations and my African death risk have in common? They are the remaining mental imprints of the two lectures I have attended so far in the Darwin Risk series at the University of Cambridge. In the first lecture titled, “Trying to quantify our uncertainty” by Professor David Spiegelhalter, I learnt a wonderfully horrid word - “micromorts” - meaning a unit of risk measuring a one in a million probability of death. In the second on Science and the Media, Dr Ben Goldacre gave a very captivating presentation on how health risk reporting can be sensationalized in the media.  As always I try to relate this to Malawi, where I am from. more…

Compared with 7% of the population who went to private school (in the UK known as “public” schools, for historical reasons), 50% of doctors did, with the proportion not budging these past 20 years. Does it matter? Couldn’t private school attendance just be a marker for academic ability, with potential medical students needing high grades to get accepted? more…

I have just been ill. Not very ill. Not ‘under the doctor’. Just a lingering cold, a touch of manflu. In the end I took a day off. I woke in the morning from an uneasy sleep and thought no, not today, today I’ll struggle no more. My wife took the children to school and then went to work. I made myself a cup of tea, took a few paracetamol and slid back under the duvet, a fugitive from reality. It would be an exaggeration to say that the house was of a sudden robed in silence – nowhere in south London is robed in silence – but it did go rather quiet. I sipped my tea. I stared at the ceiling, hovering between wakefulness and sleep. more…

A fellow medical student held onto my arm and marched me across the seminar room, first in one direction and then another. Dragged and tripped all over the place, I felt utterly out of control.

The whole thing was to be repeated again. But this time I had to imagine I had long tree roots spreading into the ground. No longer did I feel such the wanderer, but like I was grounded; my actions were my own. more…

Hospital management. In my various hospital jobs in the UK, I have had very little direct contact with the practitioners of this dark art. Missives to my compulsory trust email address were the main evidence that “the Managers” existed. Tales of targets and other woe from disgruntled A&E staff seeded doubts about their intentions. more…