There are many differences between healthcare and medical education in Tanzania and in the UK, but the concept I find hardest to understand is “attendance or sitting allowance.” This allowance is paid to all staff who attend courses for their healthcare education and it seems that staff will not attend educational events unless they are paid their attendance allowance. The allowance can be a significant sum and the educational facility providing the training event is expected to cover the cost.

Apparently this practice originated many years ago when the WHO began running educational events and courses about HIV/AIDS and now seems to be ingrained. I am used to a society where we seek and pay for medical education and now with the reduction of study budgets it is common practice to self-fund attendance at courses and meetings. more…

Dust has blown up around the Kuchlak health centre near Quetta. A gritty wind that hurts the eyes, matts the hair, and coarsens the teeth. Dust clouds have utterly concealed the nearby mountains and obscured even the sun. This is an unfamiliar meteorological phenomenon for me:  “a rain of mud” one of the health workers suggests. And indeed a fine layer of dirt quickly settles everywhere: on the windshield of the MSF people-carrier that brings city staff to this semi-rural location, on the scattered huts and ramshackle dwellings that line the roadside near the health centre, and on the clothing of Shafiq so that he creates a miniature dust storm as he pulls the shirt of his shalwar kameez over his head. Nine year old Shafiq shows me an ulcerating lesion the size of a postage stamp on his shoulder, another on his arm, and the one on his cheek is unmissable. This is an unfamiliar dermatological pathology for me: “the year-long sore” is the local name I am told; a reference to the duration of the lesions. more…

Tuberculosis used to be (and sometimes still is) the great scourge, causing death and disease on a global scale and changing the course of human history over millennium. It is often called consumption—partly because the disease seems to “consume” the body.

Those who do not learn from history are destined to repeat it. The evidence strongly suggests that the biggest global health threat we now face is due to another sort of consumption: unfettered use and disposal of resources that leads to unmanaged climate change; something we understand much more that we care to admit, and certainly in enough detail to warrant much more action. But, as the Nobel Laureate Sherwood Rowland says, “What’s the use of having developed a science well enough to make predictions, if all we’re willing to do is stand around and wait for them to come true.” more…

In 2007 I arrived in Beijing at the start of a philanthropic exercise, and as I was driven into the city and stared at the modern buildings I thought: “Why are we funding something here? This could be Minneapolis.” Later I learnt that there are at least three Chinas: western China, which is as undeveloped as Africa; an Eastern seaboard that is developed; and a large centre that is like a middle income country. And although China showed its modern capabilities in the Olympic buildings and plans to put a man on the moon, it lacks some things that developed countries have—and one of these is highest quality children’s heart surgery. more…

Earlier this year we received news of a social enterprise, Neighbourhood Midwives, providing midwifery services in the community in London, and a private company providing midwifery services for NHS Wirral Primary Care Trust. One to One, in the Wirral, promotes itself as offering the kind of continuity of care in pregnancy and maternity that midwives have wanted to provide but have often been unable to, for decades. It heralds its high rates of home births—part of which it, bizarrely, appears to attribute to the launch of the BBC drama Call the Midwife set in the East End of London in the 1950s. Of course women would prefer a single familiar and friendly midwife to see them through pregnancy and labour, instead of  a roll call of harassed and overworked ones who they may only meet once, or one who barks commands as she flits between different women on the labour ward (a la real life in One Born Every Minute, Channel Four). Of course what women most want is a safe delivery and a healthy baby. more…

Integrating care across the NHS and social care holds the promise of giving patients a better service at the same time as cutting costs. But a study for the government of 16 integrated care pilots shows just how difficult it is to do. The dream of happier patients, greater productivity, and lower costs never materialised.

The evaluation of the pilots by Rand Corporation and Ernst & Young showed that after two years patient satisfaction was down, emergency admissions were up, and there was no clear evidence of cost savings despite falls in elective admissions and outpatient appointments. more…

“We’re doomed” was the familiar catch phrase of Private Fraser—the dour, Scottish ex-undertaker turned home guardsman from the popular BBC television series Dad’s Army. According to his Wikipedia page, Fraser was also president of his local Caledonian Society but was the only member.

I was reminded of Private Fraser during my daily ritual of perusing the overnight musings of various pharmaceutical and medical device companies on the social media site Twitter. One giant Pharmaceutical company manufacturing cancer drugs tweeted the other day “One-third of estrogen receptor positive #breastcancer patients see their cancer return,” which is probably not the message that anyone just receiving the diagnosis would want to hear. Women with a recent diagnosis of breast cancer have to make difficult enough decisions about the pros and cons of embarking on unpleasant and mutilating therapies without being told that they have a one in three chance of disease recurrence. Presumably due to the 140 character limit imposed by Twitter, the author of the aforementioned tweet was unable to add the additional comment “unless you take our drug.” Astonishingly this is an identical Twitter faux pas to the one committed by a rival company back in the autumn of 2011. more…

Some things divide us fundamentally. Are you male or female, gay or straight, right wing or left wing? Another fundamental division, I suggest, is whether we want to be burnt or buried.

It’s important to get this clear with your loved ones. John Lanchester begins his memoir about his parents with the realisation just after his mother’s cremation that she wanted to be buried.

Somebody who is very close to me but doesn’t like to be written about is adamant that she wants to be cremated. She hates the idea that she might be buried when still alive. That fear was common among Victorians, who developed strategies like phones in coffins. (On reflection, I’m not sure why she is more relaxed about being burnt alive rather than buried alive. I suppose that the discomfort would be shorter, and there’s more chance that your knocking will be heard.) more…

According to the plan, we should be well along the path to rebirth, but in reality, foolishness has continued, and nihilism and despair have only spread.

Hayao Miyazaki: Nausicaä of the Valley of the Wind (1994)
(Translated from the Japanese by Matt Thorn)

In the afternoon on the 11 March 2012, I was standing on the tsunami-hit coast in Iwaki, Fukushima prefecture, gazing alternately at the Pacific Ocean and the ruins of the town. The Pacific looked beautiful. On the opposite side, however, there spread a vast expanse of bare land, where, on the first anniversary of the disaster, several people came to pray for those who were killed by the Great East Japan Earthquake, and in particular the victims of the ferocious tsunami which hit there on the 11 March 2011. It seemed to me that several of them were still looking for some shred of evidence that would make them believe their loved ones were not dead after all. One year on, how far—if at all—have we progressed towards full recovery? How much have we accomplished in terms of the reconstruction of our society? more…

A group of doctors is threatening to stand candidates at the next general election in revenge for the Health and Social Care Bill. The anti-reform medics plan to target at least 50 senior Liberal Democrats and Conservatives with small majorities, running on what Clive Peedell, co-chair of the NHS Consultants’ Association, describes as “the non-party, independent ticket of defending the NHS.”

It would be mere quibbling to point out that 50 candidates standing on a common platform would be a party, not a non-party, nor independent. More salient is that the history of similar movements and independent candidates in general elections offers little encouragement for Dr Peedell and his colleagues. In 1990, a group of GPs established the NHS Supporters Party, with the identical aim of standing 50 parliamentary candidates; the peak of its success was to achieve ninth place in the Mid-Staffordshire by-election of that year, with 102 votes. more…