A Visit to A&E

I have just spent most of the weekend in the A&E of my local hospital. It isn't the first time, unfortunately I am someone who gets far more than their money's worth from the NHS. I never cease to be grateful for the care & skill of medics. How they cope with the sheer volume & variety of patients & the working conditions continually amazes me. Morale & care seems surprisingly high considering what they have to put up with, so I would never criticise the people who actually work in the NHS.

I do think the system needs a serious overhaul though & have blogged about it before. If they were to follow patients journeys through the system I think they might see opportunities for improvement.

I don't need to bore you with the detail of the circumstances that sent me there, but I will tell you the progress through it. 

14.30 - medical incident -> phoned 111-> initial speedy triage (efficient) -> 2nd triage, same questions but much longer & very inefficient. Took about 45 minutes. Both my daughter & I found it very difficult to understand the person asking questions -> doctor eventually rang hours later -> told to go to out of hours appointment at 19.00 -> a wonderful, competent, GP who sent me to A&E with a printed copy of the notes she took of all the neurological tests she did -> A&E 20.15 receptist + nurse then waiting room -> 9 hours in various waiting areas in a chair! Eventually triaged, same questions, ECG, Bloods, Blood pressure. Doctor eventually, same questions & tests as previously & a CT scan. No one was very interested in the very good notes the out of hours GP had given me. Everyone wanted to go through the same tests & questions themselves & didn't seem to know what the outcome of the previous persons questions & tests were. Long gaps between every interaction with no information -> eventually discharged at about 05.15 next morning. 

I was utterly exhausted having had no sleep & in quite a bit of pain because sitting in really uncomfortable chairs triggers some of my normal health conditions. 

I can completely understand why everyone a patient sees has to ask name, DOB & address. They need to know they are treating the right person. 

What I simply don't understand is why so much time is apparently wasted answering exactly the same health & incident related questions & doing exactly the same neurological tests. Why don't medics have ipads to enter the information as they go & share it with everyone treating that patient? In fact, does a single patient really need to be seen by so many people?

Triage means the preliminary assessment of patients or casualties in order to determine the urgency of their need for treatment and the nature of treatment required.

If my condition had been more serious than it turned out to be I would possibly have been dead after the time that elapsed.

When I got home at about 06.00 next morning, after waiting for a taxi, I went to bed. The hospital apparently tried to phone me around 9.30 to call me back for another CT + angiogram. My phone was turned off, but fortunately I woke up at about 11.00 & my daughter got through in time to collect me & take me back.

I'm fine now. But at 79 with several chronic conditions that experience was very trying. 

I completely understand from far too much experience, as far as a patient can, the difficulties the NHS operates under, (apologies for the pun). I just think that one of the great failings of the system is effective communication & sharing of information. In this age of modern technology it is really not acceptable to be wasting so much time in repetition. The use of ipads might be expensive initially but they could also be linked to the whole NHS computer system & from that every surgery & hospital could access a patient history in real time.

There must be other ways technology could be used to make the system better for medics & patients. 

 

Life Goes On....

How resiliant are you? 

Life doesn't tend to be a "bed of roses". There are so many idioms about this - "a dogs life", "as you sow so shall you reap", "calm before the storm", "come rain or shine", "get a life", "a taste of your own medicine"... We all need to be able to deal with the good & bad days, the kindness & cruelty of life & other people. 

Some people have to cope with far more though. Some people are tested to the limits of endurance. The bandwidth of adversity is extremely wide. From unkind, cruel or bigoted speech to physical harm & even murder & genocide. Until we have to face adversity we really don't know how well we will cope. I imagine most of us hope that we will deal with whatever happens well, with consideration for others & care for ourselves.

Life really does go on. We cling to existance in the most adverse of circumstances. The great driver is to continue to live. 

In todays unstable world I really wish that there was more understanding, empathy & human kindness & a lot less judgement, self absorbtion & protectionism. When we are faced with "bad actors", (people or organizations responsible for actions that are harmful, illegal, or morally wrong), I wish we all had more moral courage to speak out & take action against them. It seems to me that we increasingly manage to compartmentalise what we see & know. We tell ourselves that our actions won't make a difference, that it's someone elses responsibility, that we will make matters worse...So nothing is done & the "bad actors" win by default.

This is true at a micro & macro level. If someone says or does something that I think is untrue, offensive  or harmful & I do nothing, I am jointly responsible in allowing that to continue. If we as a nation see what is happening at a macro level internationally & do nothing, we are perpetuating evil & discrimination.

The really sad thing is that it is a repeating pattern. We even ignore the lessons of  recent history. We repeatedly say "this must never be allowed to happen again" when we are forced, by evidence, to face up to the consequences of our inaction. Other people are seriously harmed.

There have been so many Public Enquiries in the UK - Covid, The Post Office, Contaminated Blood....Wikipedia has a huge list. There have also been political documentaries like the BBC "Corridors of Power - Should America Police the World"  https://www.bbc.co.uk/programmes/m0020xmq  looking into what happened in Iraq, Bosnia, Rwanda, Kosovo, Darfur, Libya, Syria - Repeated failure to act, over & over again.

We are now doing it again. Unbelievably Syria has continued since 2011. The first Sudanese war lasted from 1955 -1972. The current one has continued for 17 months. What is happening in Ukraine seems likely to go on for as long as Putin is in power. The situation in Gaza & the West Bank has rumbled on for decades, but currently is by far the worst. 

For millions of people life doesn't go on & we just watch on our TV's & smart phones.

I Wonder Why?

The older I get the more perplexed I become. I have always been fascinated by how much the behaviour of people varies. Not only the behaviour of peoples from different cultures & countries, or even within the UK, but specifically in England. We appear to be becoming more & more polarised. Ever more extreme. 

For example why do people mindlessly believe what they are told by social media, "influencers", the press, the TV even? Why do they not use the amazing tools we have to verify information before they react? 

Why do people react aggressively or violently to situations & information without digging deeper to find out not only the truth, but also the underlying causes of whatever has happened?

Why are women targeted by men the world over & treated really badly, abused & even killed?

Why are so many children abused & not cared for properly?

Why is there such a wide discrepency in both opportunity & wealth in all countries?

Why do we think that it is acceptable for a very small percentage of individuals to have more wealth than actual countries? In fact why do those individuals think that squandering their money on mega yachts & several palatial houses is acceptable when there are people who don't have clean water or anywhere to live?

Maybe that is the answer to all my questions. We have allowed our world to become extremely unfair. We have allowed the people who have the wealth & the power that goes with it, to have control over more or less everything from business to politics to economics. We have allowed the richest 1% to own almost half of the world's wealth, while the poorest half of the world own just 0.75%. They literally rule the world & the poorest struggle just to survive. 

Don't even start me on the dictators & truly evil leaders, who squirrel away billions of their countries wealth, while watching the mass of people struggle to live. The Pandora Papers published in 2021 exposed use of "offshore havens" by the wealthy.

If we are to survive & prosper, that prosperity has to be shared more evenhandedly. We need to grow economies to generate income to lift people out of poverty & develop sustainable infrastructure. Everyone needs to contribute to that according to their ability to pay. We do need to have entrepreneurs with vision, but it is not acceptable that if successful they are allowed to amass vast amounts of wealth & then pass it on to their offspring. That just perpetuates privilege.

Not everyone is equal. Humans vary a lot. But everyone should have the Maslow basics & everyone should have equal opportunity to live & succeed.

https://wir2022.wid.world/chapter-4/

https://wir2022.wid.world/www-site/uploads/2021/10/ANIM_F4.3a.mp4  

 

Normal?

We all think we are "normal", but what is normal? How do we define it? Is it behavior that conforms to the most common behavior in the society we live in? In which case how do we reconcile the very different, cultural, accepted behaviours worldwide? Is it the most common behavior for  an individual, whether or not it conforms to society norms? Statistically 'normal' means not significantly deviating from the average. I can only compare myself to my friends, family & aquaintances. My social group, like most people's, is relatively homogenious. So how do I know that represents normality? It is only normal for my group & even within that group there is a wide range of behaviours & beliefs.

We learn what normality is initially from our parents. Like it or not, our parents teach us by conditioning, habituation & imprinting. Our version of what is "normal" depends on who parented us & their social strata. It is "learned behaviour". Teachers follow on from parents & there is an argument that education is also indoctrination.

One definition of normal human behavior is any behavior, including speech, that does not bring harm to  individuals or people. "First do no harm" is probably a good mantra for anyone, not just medics. 

When I compare the world today to the world of my childhood, teens & early adulthood there is some similarity, but not much. My world today is much better in many ways, certainly more financially secure & technologically sophisticated. The world I remember was simpler & more relaxed. I have had to adjust to a new "normal".

The thing is, has that adjustment meant that I accept things that would have been anathema to the younger me? In some ways yes, I'm less judgmental & emotionally volatile. But my moral compass is the same. I'm just far better informed & understand the complexities better. I have the web at my fingertips & can research & verify information.

The most worrying thing is that "normal" seems to mean something so different today that I just can't come to terms with it. Wars, mindless violence, corruption, failed states, poverty, famine, waste, polution, unsustainable lifestyles ..., all of this & more has become normal.

We are in danger of accepting all of this. If we don't resist this new "normal" our society will collapse, because it isn't normal. It's all very abnormal. 

 

International Diplomacy

In theory international diplomacy enables sovereign states to communicate, negotiate, and cooperate with one another. As well as those 3 it's functions are intelligence gathering, image management, policy implementation & promoting interests. In international negotiations there needs to be a clear goal and strategy of what can be exchanged to reach an agreement. All very noble, but does it work?

There are organisations that rely on international participation such as the United Nations, the World Trade Organisation & the International Monetary Fund. NATO, (North Atlantic Treaty Organisation), is different in that it is a political and military alliance of countries just from Europe and North America.

According to the Carnegie Endowment UN aid programs save lives but are often slow, bureaucratic, and occasionally marred by cowardice and/or mismanagement. Particularly the Security Council, is in desperate need of reform. It is definitely one of the most dysfunctional parts of the UN, largely due to the widening ideological gulf between the five veto-wielding permanent members, (P5),usually Russia and China on one side and the United States, UK, and France on the other. Numerous member states have competing interests which challenge international order. Time and again, the Security Council has failed to take any action because one or more P5 members blocks things using their veto. The organization has to become more efficient and less political to tackle the multitude of crises it faces. It's a toothless tiger.

I have recently seen amazing documentaries showing just how America & it's European allies failed spectacularly in the Jugoslavian war of 1993 - 1995. UN troops watched the Srebrenica genocide & were unable to do anything. Then again, in the Rwandan genocide of 1994, when 1,074,017 people were brutally killed  94% of whom were Tutsi.

Today the Israeli government is waging war in Gaza & allowing atrocities in the West Bank. There is a real danger that will escalate to Lebanon & Iran. Russia invaded Ukraine in February 2022, but the war has continued on & off since 2014 when Russia annexed Crimea. War began in Sudan in April 2023, but little appears in the press or media & it's hard to see that there is any international diplomacy going on. 8.2 million people have been displaced. More than 25 million need humanitarian assistance, and deteriorating food security risks are triggering the worlds largest hunger crisis.

More than ever we need international dialogue & international solutions to the dire situations that beset us. Overarching everything is the Climate Emergency, which will never be solved unless all countries act in the interests of everyone. All to often, particularly in America, (but they are not alone), self interest overrides the necessity for hard choices to be made for the benefit of others. If you live in a war torn country where death & devastation mark every hour of every day you need a United Nations that can force a cease fire & negotiation. If you are in danger of starvation, through no fault of your own, you need a United Nations that can deliver temporary food supplies & a long term, concerted, effort to ensure it doesn't happen again.

I have just lost faith that we have the people or organisations that can get us out of this. Our only hope is the NGO's, the Charities, who understand the problems & can see what needs doing. Diplomatic language won't solve this mess. We need people who will speak truth to power & we can all do that in our own way. 

We should care. We should make ourselves heard.

Changing your Mind

Is it better to be a "my mind's made up" person or an "I've changed my mind" one? 

"A wise man changes his mind, a fool never will." — Spanish proverb. "You will find that it is necessary to let things go; simply for the reason that they are heavy." — C. JoyBell.

I'm not saying that vacillating,"wavering between different opinions or actions; being irresolute", is a good thing. I'm also not saying that being indecisive works well. I have known people who were unable to make their mind up what they wanted for breakfast, never mind who to vote for in an election. I find that level of indecisiveness very irritating & time wasting.

On the other hand I find people who are completely unable to see a different point of view almost impossible to cope with. It's like having a conversation with a brick wall. It's deeply arrogant to believe that you know everything there is to know & therefore your opinion must be right.

I am unashamedly liberal socialist in my views. I think that the many extreme disparities between peoples & individuals are at a crisis point. I believe that we are at a critical point in the climate emergency & the very future of our world as we know it is at risk of oblivion. I believe that if we are to survive we need to make serious changes in how we live together in our ecosystem. 

But if reliable evidence to the contrary were to emerge, I hope that I would be capable of changing my view. The crucial ingredient is reliable evidence. 

We humans are too impressionable, too willing to follow the herd. Why on earth do we follow unelected "influencers" in our millions. Why do the Taliban believe that their "vice & virtue" laws relating to women are acceptable? They include a ban on women’s voices and bare faces in public. Why do people tolerate & even believe in authoritarian dictators like Assad, Putin, Kim Jong Il? Presumably it's both indoctrination & fear.

 

If you live in a democracy & are free to think & speak out you are very lucky. That is one of the reasons I think that "no platforming" is so deeply worrying. We are able to challenge what someone says & believes. We can bring evidence to support that challenge. There are many countries in this world where that is not possible. Where people who have tried to do that are either dead or in prison. Dissidents & journalists are brave in the face of repression.

We simply cannot know everything there is to know about something at a given point in time. We need to be open & flexible. The ability to change your mind is a valuable freedom. We need to protect it. 

 

 

Food Security

I was shopping in a big supermarket yesterday. The mange tout & sugar snap peas came from Peru. The green beans came from Kenya. Why aren't we growing these basic vegetables in the UK? It is the season when they can easily be grown here. My husband grew green beans every year. They are prolific. 

Beans from Kenya come by air freight. Kenya is 4,475 air miles away. Kenya sends out about 350 tonnes of vegetables and cut flowers each night ready to be sold next day in UK supermarkets. Leguminous vegetables (peas, beans, mange tout) constitute the largest proportion of Kenyan imports to the UK. Kenya is on the East coast of Africa.

Peru is on the West coast of South America. Air transit time from Peru to an airport in the UK is approximately 3 days. It is 4,032 air miles away. Transit time by sea from Peru to port in the UK is approximately 28 days. Peru is now the world leader in blueberry exports, growing from 223 metric tonnes in 2021-22 to more than 286MT in 2022-23. It is the UK's largest source of blueberries.

I fail to see the logic of transporting basic foodstuffs half way round the world by ship, never mind by air. The cost, financially & in terms of air pollution, must be huge. Then there is the ethical & human cost. The key to this is money. Agricultural workers in countries like South America & Sub Saharan Africa get minimum wages. The minimum wage in the UK is much higher. We get cheap food because the people who harvest it are not paid as much as we would have to pay workers here.

We routinely buy fruit & veg out of season. I would say we shop quite mindlessly. We just select what we fancy or what we need for a recipe. Much of it is frozen & that impacts on the quality. I'm tired of complaining to supermarkets because apples rot when left at room temperature after being frozen. I spent much of my late teens & twenties in rural Herefordshire, where there were orchards everywhere, log ago grubbed up because there weren't enough people to pick them. I've now reached the point where I'm looking at the origins of all the fruit & veg I buy because so much travels huge distances in refrigerated containers. 

We are an island. We need to be as self sufficient in food as possible. We should have learned that after 2 world wars. Hopefully there won't be a third, but that really isn't the point. In a world disrupted by the climate emergency food production is being adversely affected worldwide. Wars elsewhere impact on food production. Acute hunger remains persistently high in 59 countries with 1 in 5 people assessed in need of critical urgent action.

It isn't just fruit & veg. There is a dark side to the flower trade. There is widespread exploitation of workers. In numerous flower-producing regions, the rights of laborers are trampled underfoot. Workers, predominantly women, are subjected to grueling hours, meagre wages, and rough working conditions. The danger of pesticide exposure is a risk, with many bearing the brunt of health issues due to insufficient protective measures.Then there is the environmental toll taken by the flower trade. From water-intensive farming to the rampant use of fertilizers and pesticides, the industry has carved deep scars into our environment. Even the process of shuttling these blossoms across continents leaves a carbon footprint that feeds into our mounting climate crisis.

Like so many areas of so called civilised life our choices & decisions are coming back to bite us. We really didn't think enough about the long term impact & results of so many consumer choices we made over the years. We became mindless consumers. We didn't think things through or even care what our choices were doing to our world or to people in other countries.

Well we do know now. The evidence is easily accessible & overwhelming. We need to stop, think, & make better choices for everyones sake.