Peter Lapsley: 20/20 hindsight

Peter Lapsley It is a pity that I did not see Mark Haran and colleagues recent BMJ research paper, “Single lens distance glasses reduce falls in active older people” before my wife, Liza, and I went on holiday to Egypt in early April this year – a week spent cruising from Luxor to Aswan, to be followed by a few days in and around Cairo.

On the cruise, we visited, inter alia, the Valleys of the Kings and Queens; Edfu and its great temple dedicated to Horus, perhaps the god best-known to non-Egyptologists for his handsome falcon mask; then on to Kom Ombo, with its twin, fused temples; and, eventually, to Aswan, to be awed by the High Dam.

On our first morning in Aswan, our third of the cruise, we visited the granite quarries from which every ancient Egyptian obelisk was cut. I was wearing a new pair of varifocal, polarising sunglasses, and my wife commented that I seemed a little uncertain of my footing, which indeed I was.

We were then ferried across on an ever-shuttling fleet of tourist boats to the temple on Agilka island, four miles south of Aswan and a short boat ride from the shore. (The original temple site, the Island of Philae, was submerged following the construction of the Aswan Dam, but in an ambitious project supported by UNESCO, the temples and ruins were moved from Philae to nearby Agilka.)

The temple’s surrounds were monochromatic and monotonal, offering little sense of perspective – the same pink granite as was quarried from the site we had seen only an hour earlier. As I strolled back to the visitors’ café, there was what I saw as an 8-10 ins step down to a pathway. As I stepped down and my foot kept going, I realised far too late that the 8-10 ins was, in fact, 3-3½ feet. I rolled as I fell, landing on my right hip, and distinctly heard the sharp “crack” as the ball at the head of the femur bade farewell to its neck.

What followed was all a bit of a whirl.

Impressive were the speed with which a team of paramedics strapped me to a gurney, commandeered a tourist boat to get me back to the mainland, bundled me into an ambulance, and took me to the Aswan Military Hospital to be x-rayed. With an Egyptian army medical officer, we were looking at the x-rays within an hour of the accident. I was then transferred to the Aswan General Hospital, where I remained for what seemed like a lifetime but was, in fact, only two and a half days.

Immensely impressive too, was the thought, time, and effort, our travel company devoted to supporting Liza – a European woman alone in southern Egypt and confronted with a completely alien culture. Their local representative put himself completely at her disposal for the remainder of our stay. Nothing was too much trouble for him, at any time of the day or night. Fortunately, our boat was staying on in Aswan for a further two nights, so Liza was at least able to sleep on board and bring me meals from the dining room – a huge bonus.

The same may be said of our travel insurance company and the air ambulance company they worked with. Between them, they organised a remarkably smooth and efficient transfer to the UK, leaving the Aswan military airfield in the middle of the afternoon, arriving in Stansted via a refuelling stop at Dubrovnik at just after 10:00 p.m. The aircraft, a Learjet 25, has a surprisingly slender fuselage, and I guess that I, lying down, was more comfortable than Liza, the doctor, or the paramedic, all of whom were seated.

I would not criticise the general hospital in Aswan. The staff there did what they could. But it did bring home very graphically how different the healthcare expectations are of people from more and less developed countries, and of those with abundant resources and those with few. I was provided with necessary analgesia and my leg was put into traction to stabilize it, which helped a lot. Beyond that, though, the hospital had little to offer. With cigarette ends all over the floor and cleaning being limited to slopping some water about and then swilling it around with an ancient mop, it would be stretching a point to describe it as “clean.” It was not exactly reassuring to see the woman who emptied the bed pans coming round five minutes later with lunch, apparently having had no time to wash her hands. And it was a bit disconcerting to have whole families wander into one’s “private” room to stand at the foot of the bed, gazing at one in protracted, silent curiosity before wandered out again.

The contrast with the Charing Cross hospital was dramatic, even though we arrived late on Easter Saturday night, when the place seemed initially to be almost as fully staffed as the Mary Celeste. It was warm, clean, and comfortable. I was expected and a bed had been prepared for me. The staff combined urgency and professionalism with kindliness, and there was a strong sense that everyone cared. There followed a rapid succession of x-rays, meetings with surgeons and anaesthetists, a whole hip replacement two days later and a series of excellent sessions of physiotherapy prior to my release six days after the operation. Now, two months later, and thanks to the skill of the Charing Cross surgeons, I am walking comfortably if a little slowly, with neither a stick nor a limp, and have just been told I may drive again.

I do wish I had read that BMJ research paper before we left for our holiday. There can’t be many things more frustrating than 20/20 hindsight.

Peter Lapsley is patient editor of the BMJ.