Showing posts with label NHS. Show all posts
Showing posts with label NHS. Show all posts

Wednesday, 1 January 2014

SO THAT WAS 2013, THEN

Years never end in quite the way that had been anticipated on 1st January, and this was certainly the case with 2013, which began with a sunny 1st January, continued with a late spring, and eventually provided a good summer, with a long, late autumn.  In between, I visited New Zealand, something completely unenvisaged on 1st January, while in September, our grandson, Oli started school, and the year ended with an unexpected work assignment in Vietnam.  

That’s the personal stuff. Meanwhile, on the national scene, there has been an  increasing awareness that the government,  which reassured the electorate that the NHS would be save in their hands, is systematically dismantling and flogging off chunks of it to the private sector, EU competition legislation being conveniently deployed to aid and abet this process, while the sinister (and evidently deaf and deceitful) IDS (Ian Duncan Smith) is ‘rationalizing’ the social security system with maximum ill effect as the hugely complicated IT systems needed to implement it limp behind schedule. 


A new lexicon has entered the language: ‘bedroom tax’ has become the label for one of the government’s vicious little schemes, while ‘reform’ has become the deceitful label for anything that the government (sorry, ‘Coalition’) is doing in pursuit of ‘efficiency’ and ‘austerity’ and ‘fixing the mess left by the last government’.  Beware ‘reformers’. (See thoughtful article by ex MP Tony  Wright on ‘What is it about politicians’ in latest issue of The Political Quarterly at http://www.independent.co.uk/voices/comment/sunni-monarchs-back-youtube-hate-preachers-antishia-propaganda-threatens-a-sectarian-civil-war-which-will-engulf-the-entire-muslim-world-9028538.html )

On the international scene, the Syrian situation goes from bad to worse, with the Assad regime looking likely to stay in power as being the lesser of two evils, the greater being ANF, SIF, SILF and the Islamic State of Iraq and Greater Syria (ISIS), forces associated in various ways with al-Qaeda. (See NYRB article by Sarah Birke http://www.nybooks.com/blogs/nyrblog/2013/dec/27/how-al-qaeda-changed-syrian-war/ )

In fact, the Arab Spring – a term which surely invited disaster– has turned into Arab Winter in Egypt, while in non Arab Turkey, that some time darling of the Western world, Recep Tayyip Erdoğan, has proved to be a winner takes all politician with a self serving and distorted notion of democracy.  His current corruption problems are entirely in line with this set of attitudes. Meanwhile, that stalwart of the rule of law and human rights, Vladimir Putin, has been named not only Russian Man of the Year (by the Russians), but also International Person of the Year for 2013 by that erstwhile great journal of record, The Times.  Is this parody, I wonder, on the same level as Obama’s 2009 Nobel Peace Prize? 

Two notable and, one hopes, beneficial events in 2013 were the Snowden revelations, which have, worryingly though not surprisingly,  created few ripples among the political class in the UK (cf the USA ), and the election to the papacy of  the hitherto obscure Cardinal Bergoglio from Argentina.  See a very thoughtful review of the Pope’s first year by James Carroll in a recent New Yorker: http://www.newyorker.com/reporting/2013/12/23/131223fa_fact_carroll

Tragically, but all too predictably, the conflicts in both Iraq and Afghanistan continue. Fortunately for her own good, Malala Yousafzai, didn't receive a prize in Oslo, but what can she and others like her do in the face of the corruption, veniality, incompetence and blindness that seems to characterize the situation in her ruined home country?  As to Iraq, it appears have joined Syria as the site of a proxy war between the Sunni world, pay-rolled by Saudi Arabia, and the Shia world, under the aegis of Iran.  The fragile détente reached between the ‘West’ (i.e.,  the USA ) and Iran could be, as they say, a game changer, but the influence of the Saudi regime can be, and is,  nothing  but malign and they will work to destablize any rapprochement. (See Patrick Cockburn in a recent Independent article:  http://www.independent.co.uk/voices/comment/sunni-monarchs-back-youtube-hate-preachers-antishia-propaganda-threatens-a-sectarian-civil-war-which-will-engulf-the-entire-muslim-world-9028538.html )

And so one could go on, and on and on.   What about climate change?  A climate change denier is now PM in Australia.  Yet, the scientific consensus appears to support man made climate change.  The kind of climate instability that is increasingly common, as in the hugely destructive typhoon in the Philippines,  is in line with predictions made years ago when climate change first became an issue.

As is the movement of populations in pursuit of land, water, security and that elusive goal, ‘freedom’.   The harrowing instances of foundering vessels and drowning passengers en masse in the Mediterranean is in line with the kind of population movements predicted in the past and which, thanks to climate change and political instability, are now so common.  The response of the world at large has been pretty paltry and mean spirited.  

I have written at length elsewhere on my visit to New Zealand, a country which itself is undergoing significant demographic changes, together with a realignment of identity as a Pacific and near SE Asian nation, rather than being an antipodean version of the Old Country.  This reorientation is entirely realistic as the hemisphere combining Indonesia, Singapore, Malaysia, Thailand, Vietnam, South Korea and, above all, China, has become a major centre of the world economy and a significant market for Kiwi produce, as well as a source of new citizens.    

My year ended with a visit to this very region, albeit one country within it: Vietnam.  I first visited Hanoi in 1995, and more recently I’ve worked in Danang, as well as paying brief tourist visits to Hue (old imperial capital) and HCMC (formerly Saigon).  This visit took me via Bankok (change of flights) to Hanoi, which has, like VN itself, moved on from being a country emerging from a period of prolonged economic underdevelopment, to an almost frighteningly vigorous and booming nation. 

The road traffic symbolizes this transformation.  The motorbike and scooter remain the predominant means of transport, thanks, I was told, to the coming to market of cheap Chinese machines which have brought this means of transport within the means of large swathes of the population.  And I mean large swathes, as men and women of all ages use them, they are the usual form of family transport (2 parents + 2 children are a common sight) and from the viewpoint of mobility and economic emancipation, they have had a tremendous, beneficial effect.  Since 1995, with accelerating prosperity, motor cars (including luxury brands like Bentley) have also increased by huge numbers , so now there is a frightening mix of two, four and multiple wheels at large on the roads which, in the main cities are pretty good, if crowded, but are woefully inadequate inter-city.

Although there are some traffic lights in the major cities, much traffic is unregulated, and conventional adherence to rules of the road,  as normal in the UK, seems to be largely unknown and, if known,  unpractised.  Even so, the system does work, albeit  in a way which is both unnerving and baffling to a foreigner -- and despite everything, the traffic keeps moving.  One principle appears to be to ignore any traffic coming behind you, it being the responsibility of a driver who can see traffic ahead to take whatever evasive action is needed.  Performing U-turns in the face of on-coming traffic is common,  it being their job to avoid you,  as is changing direction with little concern for following vehicles.  The worst challenge, however, faces the hapless pedestrian, who, unless at a rare light controlled intersection, must try to identify a break in the traffic stream, and set off at a steady, confident pace across the highway, in the hope that on-coming traffic really will take evasive action.  Loosing the plot, and stopping half way across is to invite disaster. 

In Saigon, I was staying on an ‘island’ from which, fortunately, I didn't have to stray on my way to work, five heavily polluted minutes from my hotel, the colonial Continental Hotel Saigon.  However, obtaining sustenance other than at the hotel required an expedition ‘off shore’, and this certainly gave an edge to the appetite! The main concern was the number of life-threatening crossings to ‘spend’ en route to a targeted restaurant. 

The overt chaos and hidden system of traffic management did seem to sum up our experience as trainers.  Andy and I were contracted to run three two week leadership courses for university lecturers as part of major national curriculum reform (or ‘restoration’) in foreign language teaching (i.e.,  mostly ELT).   Promulgated in the form of a ‘Decision’ in 2008 (i.e.,  legislation), and now the subject of a cascade form of implementation, NFL2020-P as it is called, is already about two years behind schedule.  This is partly because of the unwieldy nature of the system itself, as well as a result of multi-agency machinations and lack of coordination within the Ministry of Education and Training (MOET). 

It is a characteristic of a regime run by an autocratic party like the Vietnamese Communist Party (which is doggedly and determinedly clinging on to power and privilege, like its Chinese equivalent), that information is difficult to obtain, and is acquired in dribs and drabs from a variety of sources. Even then, it’s difficult to form a coherent picture of the system. Thus it proved to be for Andy and me, and even at the very end of our venture, we were still making discoveries. For instance, during my final week, I learned that the ETCF  (English Teachers Curriculum  Framework), largely the product of an American advisor, had not yet been signed off by MOET,  so it exists in a kind of administrative limbo as it isn't yet ‘official’. Until it is, the ETCF doesn't seem to be fully in the process of being implemented.  Of course, reluctance to implement decisions and guidelines that aren’t yet fully ratified isn't confined to members of the Vietnamese education system, but learning about this administrative glitch helped to explain why decisions take so much time to put into effect and why, despite the NFL2020-Pl egislation and the curriculum development that has already been achieved, the project is into penalty time already. 

Combined with a dearth of linkage across divisions and agencies within the education system, the slowness of decision taking and dissemination helped account for what we regarded as a woeful absence of coordination.  People attending our courses had been told with very little notice (like 24 hours) that they were to attend. In many cases, this meant arranging at short notice overnight train journeys and accommodation at the venue.  In virtually all cases, it meant rearranging their university and private classes, not to mention making considerable domestic rearrangements (a majority were married women with families).   The coup de grace came when the Danang group were told by the representative of the P2020 office that he wasn't sure when their promised expenses would materialize.  To say that this put quite a dampener on the rest of the afternoon is an understatement, the participants not being alone in feeling angry and upset by this state of insouciant mismanagement.

The apparently ramshackle and corrupt way things are run in VN makes visitors wonder how come it has an expanding economy?  Evidently, within private sector enterprises, things can and do run efficiently, as witness the overnight tour I did to scenic Ha Long Bay, near Hanoi, or the superb theatre troupe, AO,  performing original and imaginative acrobatics with a modern twist at the Saigon opera house.  Why, one wonders, can't these skills be scaled up to national level?  It’s very clear that Vietnamese are diligent, hard working and, given the right kind of leadership, as in the AO troupe, are able to perform wonders.  They are quite different from their near neighbours, the Thais (who are regarded as, to put it diplomatically, too easy going), and although much influenced by Chinese culture, they are in turn quite different from their mighty northern neighbours, with whom they maintain a very ambivalent relationship, there being a long history of Sino-Vietnamese border conflicts from 1979 to 1990, while the Spratley Islands (their Vietnamese name: Quần đảo Trường Sa) dispute is on-going.   We hope that ultimately it gets back on track.  

Apart from the well maintained and rather fruity architectural relics of French colonialism, such as the Saigon opera house opposite my hotel,  and the occasional food influences, such as the baguettes which are widely available as street food, in Vietnam there was another unexpected and ubiquitous influence from the West: Christmas.  Within days of arriving in Saigon, our hotel, the Japanese owned Nikko, sprouted a splendidly dressed two storey Xmas tree in the lobby, which is no surprise to anyone who has lived in Japan, while outside, other even more extravagant seasonal decorations appeared at the posh shopping malls.  The absolute climax of Christmas decorations and lighting was to be found in booming Saigon, where they were a major attraction for the Saigonese, who came on their motorbikes in droves to photograph and be photographed.   Taking selfies and family pics and artful shots of young women fetchingly posing became a virtually 24/7 activity in the centre of Saigon.  Few Vietnamese are Christian, but all recognize a retailing opportunity, which says much about their flair in making the best of an imported cultural and commercial influence. 

After a day trip to part of the Mekong Delta, a vast agricultural area which produces three rice crops a year, I started the long journey back to Blighty via Hong Kong (don’t ask: I didn't make the travel arrangements).  This provided time for a brief spell in another Asian phenomenon, including a visit to the Peak, where, since my last visit, a huge visitors’ centre has been constructed at the top of the cable car route.  Ignoring this crowded attraction, I walked along Lugard Road, overlooking Central and Kowloon and the harbour.  When we spent a month at the nearby HK University in 1992, this walk, in the company of many locals, was part of my morning routine, and I always try to retrace it whenever I visit the city.   On this occasion, I found that a luxury hotel wishes to situate itself above the route, and is seeking permission to close part of Lugard Road for its unique benefit.  A protest movement is in progress.  This intrusion of rude commerce on part of the island’s heritage (and on a much used and loved public walkway) left me with a sadly sour taste as I took a taxi down to Hong Kong station and travelled in the Airport Express to the splendid British designed terminal (Foster and Partners) to await my midnight flight back to LHR, and the country, parts of whose former empire are now at the heart of a significant new economic, cultural and political hemisphere. 

1st January 2014









Sunday, 8 April 2012

My painful friend

Just before Christmas, I slipped on some invisible ice and landed resoundingly on my left buttock, twisting my ankle as I fell. Initially, my concern was with my ankle, which, after a couple of weeks and daily applications of Ibuprofen gel returned to normal. At about the same time, I started to feel an ache in my left hip area, which over the weeks spread the full length of my left leg, in the process becoming very painful indeed.

So, I went to the doctor (by now about six weeks had elapsed since my fall) and she did some tests to establish that nothing had been broken in my leg or ankle. She suggested that I should see a physiotherapist, but as there was a 4 month waiting time, I'd be best to think about going private, which I duly did.

The physio did a much more thorough examination and prescribed some exercises. After a week doing these assiduously, there was no improvement so I returned. She did some more manipulation, during which it became clear that the site of pain was in my lower back. Throughout, the physio kept using the term 'referred pain', which means that the pain is displaced from the actual site of any injury. In this case, the sciatic nerve had been trapped somewhere as a result of the fall and the pain was referred throughout the length of the nerve down my left leg.

What I had become friends with was sciatica.

Continuing exercises -- including one with a tennis ball, obtained from a toy shop which, it turns out, supplies other invalids for the same purpose -- had no effect. So, I returned to the doctor. Not much joy.

My painful friend was now inhibiting any attempts at walking other than around the house. Curiously, though, I could cycle, which I continued to do on a daily basis. While cycling, my friend was just a background presence, but within yards of dismounting, sciatica returned with a vengeance as if reminding me that I should't have been fooled into thinking that my nagging companion had gone away.

By now I was getting more than a little fed up. So I went to a chiropractor. She carried out manipulation, confirming the main site of the pain, and plugged me into a machine which was to stimulate blood flow around the site. In addition, she prescribed the use of an ice pack to help reduce inflammation. And she suggested continuing some exercises and asking the doctor to prescribe an anti-inflammatory as well.

So, now into the third month since the fall, I was on a daily routine of pain killer (paracetamol, and at night a blend of this with codeine) and an anti-inflammatory (diclofenac). My twice weekly sessions with the chiropractor weren't having any noticeable effect, and, in fact, for the last session I was in considerable pain. At this point, the chiropractor more or less threw in towel and suggested that any further treatment be suspended until I had had a scan. (A private scan could be arranged for £200, which would also involve a trip to London -- not very practicable given my limited motility.)

By now I had asked my doctor to refer me to a specialist and, surprisingly, within a few days I had a call from the Nuffield hospital in Oxford to go there for an assessment,this being essentially a triage procedure to decide whether my case was serious enough to warrant a scan. (I had already had an X-ray, which simply revealed age related wear and tear.)

Getting to and from the hospital was in itself a bit of a problem, since I was still not able to walk very far. However, I drove to a park and ride car park nearer to Kidlington than Oxford and took a shuttle bus which plies a route from the car park to the Oxford hospitals, terminating at the one I was to attend. The bus journey took the best part of half an hour, during which I discovered that Oxford is not just the city of dreaming spires, but is also Hospital City.

At the hospital, a physiotherapist examined me and took a case history. The outcome of this is that I now have an appointment at the more convenient Royal Berks Hospital for a scan later this month -- four months to the day from my initial accident. She also suggested that I ask the doctor to prescribe a neuropathic drug to help sleep, and this was duly done so I have an addition to my drug routine.

Meanwhile, I saw the haematologist on 2nd April for my routine 6 month check up for Chronic Lymphocytic Leukemia (CLL), and he confirmed that I am still in remission (I had six months' chemotherapy a couple of years ago), but he was slightly concerned about one test result which suggested the liver was unhappy -- probably the result of the' cocktail of pain killers' I was on.

Great!

My son, on learning this, suggested milk thistle as a treatment for the liver. So I've added this to my daily intake.

Fortunately, the sciatic pain is abating, and yesterday I managed to walk in and out of town. This is no big deal, as the entire journey would be about half a mile, but it represents progress. However, my painful friend is still present and seems determined to ignore all hints that it's time to pack up and leave. I am confronted with a dilemma though over the scan: if my condition does improve radically, i don't think that a scan is justified. I'll have to ask the doctor for her advice on this.

This whole exercise has provided an insight into the limitations of the NHS. Whereas my diagnosis and treatment for CLL has been excellent, dealing with my present problem has shown that even before the various cuts and reorganisations that are to take place in the NHS, resources are restricted when it comes to dealing speedily with something like sciatica resulting from physical trauma. Going private is expensive and, indeed, prohibitive for anything involving either major or prolonged treatment. I have an awful feeling that the Coallition's NHS 'reform' will not, in fact, improve things and all of us are going to be haunted by painful friends that we can't afford to dislodge.