Malawi - Preparations

These are ongoing. Something seems to get ticked off the list daily thank goodness.

Today I went to the Travel Clinic in a local pharmacy, which my surgery suggested, to get my malaria pills. This involves a car journey. I've had Larium before with no side effects, so I thought I would just get them over the counter. When I got there I discovered you have to make an appointment with the pharmacist, so I have to return tomorrow.

I've had my jabs, which were free much to my surprise, at my surgery. All I have to do is collect the Cholera suspension today & take it. I wonder why the NHS doesn't also do the Malaria pills? I would have been happy to pay for everything. I understand that the decision is to prevent costs if someone comes back ill, but I'm chosing to do this, so it seems like a cost I should pay. I'm sure someone has done the cost benefit analysis though.

I also went to my local Carphone Warehouse to find out why O2 couldn't unlock my phone. R, who works there, is really good at his job. Apparently all recent smart phones are actually unlocked - all you have to do is ring a number & leave it open for 5 minutes, no less, to make sure it is unlocked. So I rang my home landline. Why couldn't O2 tell me that & saved me the time & effort? Could it be that they hoped I wouldn't buy a much cheaper local sim when I get to Malawi & would pay them for roaming?

There seems so much to do & fit into an already busy life. It occurred to me that I should cancel my magazine subscription temporarily because I don't want my post to clog up the hallway.

I need a notebook in every room or the thought slides out of my brain & could be lost for ever.

MicroLoan Training Centre & Office Kasungu

Volunteering in Malawi

It's now just under a month before I go.

I'm a good traveller I think. I've been to lots of countries in the world including Asia, the Middle East & Africa - I always did all the organising when my husband was alive. This is more challenging because I will be travelling completely on my own for the first time. And it involves changing flights in JoBurg both ways. But hey - I'm an old lady - people will help.

A trip like this isn't a holiday. There is a lot of planning involved. Who knew I needed a "Power Surge Protector" for example. I could guess what it was, but had never heard of one. Fortunately the internet tells you all & Amazon sells everything. My trusty packing list has had to be expanded & I've bought a bigger, lightweight suitcase.

I try to be a minimalist when travelling & usually only take a cabin case. I'm not a big believer in dressing up & wearing several outfits a day. But this is a month in Africa & it's hot. Clothes will get sweaty & dirty. Another reason not to take my best clothes.

It's the essentials which need thinking about. Medications for example. I have been advised to take over a months supply, keep them boxed & pack them in the hold case. Apparently customs in African countries have a habit of taking them off you - There is a market value for meds. Actually I wouldn't begrudge that. We are very lucky in the UK. We have the NHS, however much it's understaffed & underfunded. It's just that I need the meds. So I have to take prescriptions for everything as well as back up & hope that I can get them. Then there's the jabs (tick), & Malaria to think about.

I'm staying in a Lodge the charity uses & it doesn't have a website - I don't even have contact details yet. So I can't look up anything on the internet. In fact contact details probably wouldn't be much good in Kasungu - I gather the phone service isn't brilliant either. I'll get a local sim card if I can get my phone unlocked - O2 don't seem to be able to do it here. (Why not for goodness sake?)

What I need to know is basics - will there be soap, towels, loo paper etc. Will I have an ensuite - don't fancy trotting out in the middle of the night much. How reliable are the showers - I think they do have showers - I have been advised to take wet wipes, but enough for a whole body wash??

So, in fact packing my clothes is going to be the least of my problems. But it is all quite exciting - providing someone does meet me at the airport in Lilongwe & I do actually get there!

  

Kasungu Maternity Waiting Village 

Yes! - I'm Going to Malawi

I think I'm probably living my inner teenager.

My idea was to go and work in India or Africa when I had finished college. However marriage immediately post graduation & then a baby a year later gave me other priorities. Life, earning a living initially, a husband, a baby & home, become all consuming. Suddenly you are a grown up with responsibilities. Then a career took over & the desire to run my own school.

Life goes by so quickly. Literally in the blink of an eye your child is an adult & you are retired. You have done some of the things you wanted to, but have also had to make compromises along the way. If you are married, have a family & elderly parents, other peoples needs always come first.

So, in 2012, as a widow of 3 years, with no parents around, I got to do what I had wanted to all those years ago. I went to work for a month as a volunteer, teaching in a "Bamboo School" in Kathmandu. It was a wonderful experience, but took a bit of a toll physically.

Now I'm going out to Kasungu in Malawi in August, working for a month as a volunteer with a great organisation called the MicroLoan Foundation.

https://www.youtube.com/watch?v=kkzQ5bIHiAQ&authuser=0
(highlight, click & open link)

Kasungu is about 80 miles North of Lilongwe, (the capital), in the NW of the country close to the border with Zambia & Kasungu National Park. It's a chaotic one street town which was the birthplace of Hastings Banda the former life President, who had a palace there. Malawi is "the Land of the Lake" because beautiful Lake Malawi is the dominant geographical feature following the Great Rift Valley. Fortunately for me English is widely spoken because my Chichewa (a variant of Bantu) is non existant at the moment.

I'm supposedly going out to help set up a training programme for local people so that they can take over managing the loan book. Small loans, typically £25 - £50, are given to women to help them set up small businesses so that they can support their families, educate their children & put a little money by as savings. Over 90% of the money is repaid, so constantly recycles. 

I hope I can do what they want me to. In my experience travelling a large part of the world it's the women who keep the show on the road. Anything we can do to help them is a win win situation.

A Patients Journey 5 - Recovery

10 days on from surgery. The worst is over. The surgery pain has subsided to the extent that I don't need to take additional pain medication on top of what I already take for chronic pain. Going to the loo is no longer painful. I can walk & move about quite normally. I can do most things around the house for myself. I can walk to the shops & back. All good news & much as I expected. I never tend to anticipate the worst case scenario will actually happen.

I can't sustain activity for very long - I don't have the energy. I am exhausted & need to sit down after washing up & making my bed. My gut is still disturbed especially after eating. I also don't have the energy to concentrate on things for long periods. I'm forever forgetting things & losing things - I still can't find my MP3 player which I've been looking for for days. I'm a person who is normally on the go & at the moment I'm feeling I can't be bothered. I'm ignoring my "to do list" - That's highly unusual.

I'm still dropping off to sleep throughout the day - sometimes actually at my computer keyboard, often watching TV in the evening. So annoying - I'm missing things I have recorded because I really want to see them & keep having to rewind.

But - if I'm honest a lot of these things are my normal. I've lived with chronic pain & fatigue for years. They are just worse.

Given that this was quite major surgery I don't think this is bad.

It is difficult coping with something like this on your own. It's always much better when there is someone else around. But I think this is the new normal. According to the Office for National Statistics "in 2016, around 7.7 million people lived alone in the UK, the majority were women". The best figure I can find for the adult population of the UK is 53 million in 2012. That would mean roughly one seventh of the adult population live alone.

The old values that I grew up with no longer exist. Society has changed out of all recognition. We, as a society, need to decide how we are going to deal with this demographic. It is going to get worse & it will cost money. Everyone has the right to be properly supported & cared for in infirmity, whether it's permanent or temporary. Family & neighbourhood structures have changed for good. We need something to replace them.

A Patients Journey 4 - The First Week

Sun - I had a really good night's sleep my first night out of hospital at M's.

It was really difficult & painful  getting in & out of a convertable bed settee because it is much lower than mine at home. It was also difficult going to the lavatory, because mine at home is wall hung higher than normal. You can't rush after an op, so need to give yoursef plenty of time!

M took me home after breakfast because there are end of term school "do's" at lunchtime, in the afternoon & the evening. So I might as well be at home with my own things as being in her house. I'm actually safer because I  have a personal alarm at home in case anything happens when I'm on my own.

It would have been my 51st wedding anniversary & is the day that David died. I can't believe that it's 8 years ago. Sometimes is seems much longer, sometimes just yesterday. It is true, life does go on.

Mon - M popped in this morning & we walked to the chemist to pick up some of my meds. I sat on a bench while she got some food from M&S for me. By the time we walked back I was completely exhausted. My legs felt leaden. At least I've got some idea of my limitations. I felt very nauseous today. Not sure why - I would have thought that the anaesthetic would have worn off by now. Watched / slept through tennis in the afternoon!

Tue - M popped in again today. She is going on holiday to Italy tomorrow morning & still hasn't packed! Felt nauseous again & slept through tennis again. It's like a light going out - One minute I'm awake then I wake up & have missed a set.

Wed - I was shocked to be bleeding this morning. Going to the loo has been painful since the op, but I've not really had any "spotting". I phoned the Gynae ward & they were very re-assuring & said just to monitor it. It is good to have been given a direct contact number. It didn't continue. It would happen when M isn't here, but my friend A is coming later to stay for a couple of nights. I'm quite relieved not to be on my own & she is very unflappable. She went off to see the Raphael exhibition in the afternoon & I spent another afternoon not watching the tennis. It's ironic - can't seem to stay awake however interested I am in the match.

Thurs - It's good having A here. I'm a big believer in "Distraction Technique" & having someone to talk to & share meals means I don't think about how I'm feeling. Still feeling nauseous in the afternoons.

Fri - A week has gone by. A went home after breakfast, having taken me to drop a urine sample off at the surgery. I will miss her calm presence.
Minor panic after lunch. My stomach became more & more uncomfortable & swollen. Couldn't bear to wear the leggins I had on. I phoned the ward & they said to get an emergency appointment to see a GP.

That was interesting - the receptionist didn't seem to be able to understand what I was saying. In the end she said a doctor would phone. (I had told her that the hospital had said I needed to be seen by a GP today). The duty GP didn't seem to be any more capable of taking the information in than the receptionist had been. (I don't think I was incomprehensible, but I suppose it is possible).

He gave me an emergency appointment for 4.40. That would be about 3 hours after I first phoned.

I live alone, my daughter, my best friend locally & my neighbour are all away & A has gone home. I have just had major surgery & can't walk very far - not to mention that I am 72 with a heart condition - So I would have thought that our NHS would think that this justifies a home visit. No way. Get a taxi the GP said, knowing full well that the surgery is surrounded by double yellow lines & is on a cross road of 2 main roads, so it's unsafe to pull in & drop someone off close by.

By the time I actually saw a doctor I was fortunately feeling much better. She was thorough & concluded that it was probably trapped wind, (because it had subsided quite quickly). So monitor it & hope it doesn't return. That's the conclusion I had come to, but it was reassuring to have it confirmed.

Sat - I do seem to feel uncomfortable after eating, but not as bad as yesterday afternoon. I suppose all my intestines have been moved around during the surgery & having food to deal with causes problems. However the good news is that I have stopped taking the additional pain killers today & am just taking my normal pain meds. So all in all there is progress day by day. I have a "Do's" & Dont's" list on my wall to remind me to take things easy.

I would say that I'm recovering really well for an old bird.

A Patients Journey 3 - The Day After

Saturday mornings are quiet on the ward. Not many patients - 3 in a ward with 6 beds. Lots of checking of paperwork & screens.

The woman who was admitted & treated in the night seems to have an infection which developed after surgery. She had a high temperature, but seems much better this morning.The American student, who drove me mad on her computer last night, seems fine & is pressurising staff about having her op today. She doesn't seem to grasp that non urgent procedures aren't done at the weekend to fit into her busy schedule. Eventually I think she went home.

Staff are infinitely patient, unlike impatient patients. I was shocked to discover that nurses do 12 hour shifts & alternate day / night rotations regularly.
http://www.birminghammail.co.uk/news/midlands-news/nhs-crisis-diary-student-nurses-8279420
It can't be good for their body clocks. How can they possibly remain alert & give patients the care they need? The only reason for it I can see is financial, or there simply aren't enough nurses to do shorter shifts & better rotations. It's can only be a short term solution - nurses will leave, because no one can keep that up indefinitely.

I'm better than I thought but surprisingly tired by showering & answering emails on my phone. Relaxing on a very comfy, adjustable bed is lovely.

The surgeon comes to do the after surgery check & says I can go home - all the boxes are ticked. M comes to get me @ 11.30 in between the last day of term events at school. The journey home on Oxford's dreadful roads is very jarring & painful. By the time we get to her house I'm gripping the sides of the seat.

I have a little lunch, a mug of tea & a handful of pills then collapse on the sofa to watch the TV. M departs & then I doze through the tennis all afternoon. It is difficult & painful to move, but it is important to try to walk a bit.

M & the boys come home for supper. D & D come for a drink to see how I am, which is kind & a very cheerful interlude. Then the boys & I watch TV in the evening while M & E go to another end of term "do". The boys & I go to bed at the same time - I am completely exhausted & desperate to lie down. The pills do dull the pain, but there is still continuous nagging pain with intermittant acute pain when I move or try to do something, like getting into bed.

Sleep eludes me so I hear M coming home.                     

A Patients Journey 2 - Overnight

Well - being next to the nurses station is a mixed blessing. I was really tired by about 10pm & thought sleep was just a blink away. Not so. The nurses loud, inconsequential, chatter & laughter was just continuous. There was also a machine periodically - shredding all the paperwork? Maybe it isn't obvious that patients need quiet & sleep to recover.

In the end I pressed the button to call a nurse to take me to the loo. Afterwards I asked, in the nicest possible way, whether the lights would be turned down & it would be quieter soon.

So I did manage to drop off afterwards despite the oxygen & compression boots.

I was woken @ about 2.30 am by a bright screen in the opposite bay & someone tapping continuously on a computer keyboard. So I rang for the nurse again to go to the loo - They let me go alone. When I got back I asked, loudly enough to be heard, what the machine was in the opposite bay - I knew it was the occupant on a computer - must have been admitted since I went to sleep. Fortunately the noise stopped or I might have done physical harm. I later discovered that it was an American student at the university - didn't seem to be ill, waiting for a procedure which was interfering with her life, as I might have done had she not developed some consideration for other patients.

I was then too awake & couldn't sleep because of a loud ticking clock - It must be possible to have quiet clocks on wards.

I dozed again & was woken @ 4.30 by another admission to the ward who was bein treated. It sounded quite urgent. I felt very sorry for her. All the machines that medics use all have a distinctive sound - all very tuneful except if you are trying to sleep. I wondered why they need to make any sound at all - isn't it obvious if they aren't working?

At 6am the day begins. Obviously they don't realise that I'm not a morning person - especially when there has been too much night & not enough sleep. The checks reveal that I am still alive. It is good to make it to the loo unaided, but painful to pee.

Breakfast is a welcome cup of tea, (my mouth is very dry & tastes awful), & an overflowing bowl of bran flakes. I give up about a quarter of the way through.

A welcome shower & tooth brushing - Who would have thought that could completely transform how I felt about the world. Came back to fresh sheets & a proprtly made bed - Blissful!

A Patients Journey through NHS Surgery - Day 1

I was admitted to the JR last Friday for Bilateral Laparoscopic surgery to remove both my ovaries, which each have a 5-6cm cyst. I had to be there, clutching a urine sample & my paperwork, starved & showered at 7.30am. My daughter took me & stayed till it became obvious it was going to be quite a long wait. It was a school day, so she was teaching - Waiting would be pointless.

I can say with complete truth that I wasn't at all nervous. Modern anaesthetics are really good - it's the aftermath of surgery you have to be concerned about - Especially at my age & with a heart condition.

The whole pre surgery thing is like a dance with different partners. All giving slightly different information, but asking similar questions. 1st welcoming area -> 2nd waiting area -> 3rd private waiting area  - Staff Nurse - questionnaire & wrist bands, am I really me? / Later same area but with Anaesthetist / Later still same area but with Surgeon, (signing consent form). That all took from about 7.10 - 11ish. I was finally left in my little blue curtained world to wait to be called.

I was third on the list, but it was a long wait. You do wonder what is happening - have they forgotten you, is there a problem / emergency - will the surgery go ahead? The medical staff are continuously busy - no one seems to walk slowly. The last time I noticed before I was called was about 12.15.

Then the walk to the operating theatre.

I had a hilarious conversation with my anaesthetist & surgeon about which books we were reading / had read. (I asked them to do me a list of authors when they had a spare moment!) They inserted a cannula & that was the last thing I remember until I was on the ward & it was all over.

I was offered cups of tea - nectar of the Gods, & an eggy sandwich - couldn't eat it, my mouth was so dry & it was like trying to eat cardboard. Throat dry & sore. Everyone says it, but it's true, the staff are wonderful, (with an odd exception, but everyone is allowed an off day).

My daughter & grandsons visited & that was very entertaining. The boys wolfed down my food - they had come from sports day. They were very interested in my drip & cannula, (T noticed that it had blood in, so the nurse took it out when the drip bag was empty). Also in my oxygen feed & my electric Flowtron Boots on my legs - These are in addition to the tasteful compression stockings you wear. Both hopefully stop an embolism. It would be a shame to die when the surgery had been successful, such a waste of time & skill.

I asked to go to the loo at about 7pm, but the nurse brought a commode the first time. (I seemed to have no real urge to pee, despite the cups of tea & glasses of water, & it was quite difficult & uncomfortable. No bleeding though). Peeing after surgery is one of the boxes you have to tick. They actually measure your pee output!

Overall I felt OK. Moving was difficult & painful, but that's what I expected. Not permanently gripped with pain, so the drugs were working & presumably the anaesthesia too. The beds are infitintely adjustable & very comfy - I would really like one at home, but wouldn't know how to go about it. Normally I'm woken by pain hourly or less. Being more upright or having my knees raised would help a lot. The bed is about the only thing the patient has control over

There is absolutely constant activity on the ward. It all seems very purposeful & organised. A lot of form filling & reading & screen checking / inputting data. Medics all seem to walk fast, somewhere to go / someone to see - No one ambles. Nurses make regular checks on patients - BP, temp, oxygen, wounds.

The mix of nationalities on the ward is interesting in the light of Brexit - British, Asian, Eastern European & Black. Overwhelmingly women except for doctors & cleaners.

Eventually everyone else in the ward was discharged about 8pm so a private room for Friday night, but right next to the nurses station. How convenient is that - I expect they had worked it out.

Pre Surgery

Well it looks as if my surgery might go ahead this time - on Friday. I'm on tentahooks, not because I'm worried about the actual op, because I don't want it to be cancelled again. The worst part will be how I feel afterwards.

I stop taking my anti-coagulant today - don't want to bleed out on the operating table!

I need to think about what I have to take, bearing in mind that there's just a small, unsecure, bedside cabinet. You might think it could be possible to put some sort of lock on it - but apparently not. I guess the chances of having stuff stolen, given that there are people around all the time, is low. But the other patients & I won't exactly be compos mentis & presumably the staff are quite busy.

I'm trying to tick things off my to do list. I'm also trying to ensure that I've got stuff to eat & don't need to shop or think about anything other than fresh food like fruit & veg. I cooked a lot of Tagine last night & have ordered cook chill food from "Cook". I hope there is enough room in my small freezer. I might have to ditch some things.

It's a question of thinking & planning ahead really, when you don't really know how bad the after effects will be. The leaflet they gave me is pretty comprehensive though & I'll know soon enough!

NHS - Postponed Surgery

Having your surgery postponed causes all sorts of issues for patients. There is a knock on effect on your life & the arrangements you have to make. For some it extends the anxiety.

My surgery was cancelled because there was no anaesthetist available.

I think hospital rotas should be flexible so cover can be arranged. When NHS managers know days in advance that someone can't come in & there should be some slack in the system, with cover - like supply teachers. It's a question of paying for enough doctors to be able to deliver a health care service. We should be pressing for good health care for everyone at point of need.

Most recent Postponment Statistics for England for cancellation of elective surgery:-

Quarter 1 - April / June 2016/7  - England
Number of last minute elective operations cancelled for non clinical reasons - 18,730
Number of patients not treated within 28 days of last minute elective cancellation - 1,575

Quarter 2 - July / September - England
Number of last minute elective operations cancelled for non clinical reasons - 19,446
Number of patients not treated within 28 days of last minute elective cancellation - 1,228

Quarter 3 - October / December - England
Number of last minute elective operations cancelled for non clinical reasons - 21,247
Number of patients not treated within 28 days of last minute elective cancellation - 1,550

Quarter 4 - January / March - England
Number of last minute elective operations cancelled for non clinical reasons - 21,219
Number of patients not treated within 28 days of last minute elective cancellation - 1,668

That's 80,642 operations cancelled in one year in England alone.​

In December 2016, across Hospital and Community Health Services (HCHS), the NHS employed (full-time equivalent): 106,021 doctors; 285,173 qualified nursing staff and health visitors; 21,604 midwives; 131,791 qualified scientific, therapeutic and technical staff; 19,392 qualified ambulance staff; 20,858 managers; and 9,866 senior managers.​ The population of England is 65,511,098 - so patently that isn't enough doctors.​ I think that's one doctor for 617.90681 lets say 618 people. Obviously many of those doctors will be GP's not hospital doctors. 

I'd be interested to know how those statistics compare to European & Scandinavian statistics, but am hungry so can't research further.

There is a problem - with the current demographics it will only get worse. The time to find a workable solution is now. It can't be beyond the wit of man.

Hopefully my surgery will take place 4 days late. That's a Friday - are they still going to be able to keep me in for 1 -2 days over the weekend??? I have no idea.