Dying is not much fun. As a GP I have seen a lot of it. Its not the very end bit that bothers me. The last breath is, paradoxically, often serene and peaceful. What I find most difficult is that wretched time that starts when hope is torn away and illness sates its unrelenting hunger.  The Compass Collaborative conference in Edinburgh focused on supportive and palliative care – these folk know about dying. more…

The weekly multidisciplinary committee on drug-resistant tuberculosis (DR-TB) had assembled to discuss the case of a young man who had started treatment for multidrug-resistant tuberculosis (MDR-TB) 12 months previously.   more…

This will be my last blog from Tanzania. I’m going to spend a couple of days visiting the island of Zanzibar – pure vacation, nothing to do with work – and then begin the trek home. My time here has not been as fulfilling as I had hoped, which naturally has been disappointing. Nonetheless there have been positive aspects, and now I know how things are here I hope I can use that knowledge to ensure a more productive future visit. I have no doubt of the great need here for palliative care, although awareness of that need by many healthcare staff, and even by some deserving patients, is somewhat lacking. more…

It would be a stretch to say that I have now adapted to the African way, but after three weeks here at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, I am getting to do some of what I came here to do without, as far as I can tell, upsetting anyone in the process. The change to my program that I arranged is working and some of the staff are getting to know me and what I want to do.  Having said that, palliative care is a very unknown quantity here and so many do not know what it is or, worse in my view, incorrectly believe they know what it is. One physician thought it was long-term care and wanted me to look after his 16 patients with traumatic paraplegia. A junior physician approached me with great concern because I had seen a patient who was waiting for transfer to the Ocean Road Cancer Institute in Dar es Salaam for radiation therapy. “How can we send her if she’s getting palliative care?” she asked.  Even after I explained that palliative care would provide needed comfort for her while awaiting transfer she (the physician) still had difficulty understanding that active treatment and palliative care are not mutually exclusive.

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It used to be, and may still be, that in the tourist shops here one could buy a T-shirt bearing the words, “No hurry in Africa.”  I now understand what it means, and I’m sure that many reading this who have worked in Africa will not be surprised at my experience to date. I am a palliative care physician recently retired from my post in Corner Brook, NL, Canada.  I have come on a voluntary basis to the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, northeastern Tanzania, to help provide and teach palliative care.  The medical director is very enthusiastic about palliative care but although a few others here share his enthusiasm a formal service does not exist, and it seems not all understand the concept of palliative care (although, there are some back home for whom that could be said!). more…

The well known web site YouTube has amassed a reputation for containing a huge repository of video footage covering virtually every subject imaginable (and more). So it may come as no surprise that there are serious and educational videos to be found here. One video comes from the UK and covers cardiovascular examination. more…

It’s been a bit of a rough five weeks, as readers might have guessed from the protracted absence of blogs. Apparently I was “overdosed” on chemotherapy and ended up in hospital for 4.2 weeks. Which is four weeks too long. Though to be honest, I was so out of it during the first two I could have been anywhere. I just remember a blur of nurses, nappies (!), being bundled into an airbed (which makes little scuffling noises as different air pockets are inflated beneath you), and constant visits from my devoted family and friends  who loomed over the bed, some with horrified looks. more…

Dr Philip Nitschke, director of the Australian pro-euthanasia group EXIT International, has come to the UK to promote the launch of his ebook ‘The Peaceful Pill Handbook’ – a controversial guide to methods of suicide. The paper version has been banned in Australia and published in New Zealand with some pages blacked out. more…

Some months ago I was invited to the Anglo-German Medical Society’s 49th annual meeting, to be held in Cologne on 11-14 September 2008. As a German national who trained as a technical editor with the BMJ and who translates medical papers from German into English in her spare time I accepted. more…