Tag Archives: medics

Champion the Truth

If you don’t live in the UK, you may have missed the junior doctor contract row that has been brewing for a few years but has escalated over the last couple of months. If you live in the UK and rely on major media outlets to keep you informed, you may think the dispute is about junior doctors asking for more money. I would suggest you turn to social media for more accurate information from doctors, other NHS staff and more importantly their families. Long and short of it is that the dispute is about our Government deciding we junior doctors need to work longer hours whilst our pay is cut and refusing to do the simple arithmetic that would show that if you want more junior doctors working around the clock, you need to recruit more of them because we are already working long hours and we absolutely will not do me as it would put our lives and the lives of patients that we hold so importantly at risk. I mean, how is it fair that the Government has voted to pay its MPs more and they can still claim vast amounts on expenses yet the very same Government says we have no money in the coffers to pay for more junior doctors? Isn’t that ridiculous???

I digress, please read up on Facebook, twitter and blogs writing on the issue. Plenty of truth out there is you care. The baseline is that at least half of the junior doctors who have voiced their opinions have stated either that they have made up their minds to quit the NHS or are at the very least, looking into alternate careers or going abroad. The simple truth is we as a group of junior doctors think the bottom line is that the Tories have vested interest to tear down the NHS and privatise our healthcare and hence line their pockets. There is also strong evidence out there that the current fool we call our Health Secretary has been a champion of NHS privatisation for many years and probably owns share in private health insurance conglomerates like Virgin Health.

This blog is actually about the one good thing that has come from this attack on junior doctors. We now have an online Facebook forum called Junior Doctors Forum which is by invitation only. It has 63,000 members and counting. Not all of them are junior doctors. We have consultants, medical students, nurses, midwives, paramedics and other allied healthcare professionals plus a few lawyers, journalists and even politicians about the forum. What I want to do is big up the passion of those on the forum and champion them sticking to their guns and being honest about how they feel and what this is doing to us as a group. Never has there been so much unity within the profession. Medicine is a very hierarchical and competitive profession and although we all start as one, we generally sub-divide as we become more senior and choose specialisation programmes. Our world then shrinks even further so all we know is related to the one field eventually. Our only contact with the outside specialities is if they are part of the multi-disciplinary team that we need to make sure each patient’s care is optimal with the inclusion of all relevant expertise.

So it is all good news though? No. Unfortunately when you get 63,000 opinionated voices with the top 1% in terms of IQ and ability to rationalise, debate and analyse, you get varying opinions. I am all for freedom of speech and embracing our differences. However, as with all other aspects of life, some are excessively worried about how other people interpret our opinions. An article was published based around a discussion we had on the forum and people are getting all uppity about all coming across professional and un-emotional. Why? If this was about professionalism only, we would all continue our stony silence whilst we get attacked as we give our all for the greater good. This time, we have stood up and shouted NO because not only have they attacked us (we have thick skin because of the nature of being medics who take enormous responsibilities day in, day out) but they are threatening the very fabric of the health of our nation. Their proposals are not only ensuring that many of us want to leave because we choose life and living than putting ourselves in danger from physical and mental exhaustion, they are also meaning that we are now less willing to carry on doing extra unpaid hours for no thanks.

The NHS has been running on the goodwill of its junior doctors for a very long time and things have been in a steady decline for the past decade yet this is the first year that doctors have threatened to strike. We love the NHS and have been carrying its weight to the detriment of our mental, physical and psychosocial health for far too long. This is the straw that will break the camel’s veritable back. It is because we are passionate that we are fighting the proposed changes which may start with junior doctors but we all know will extend to the rest of the hardworking staff the NHS is lucky to have as its employees. How then can anyone ask that we lie about how angry and betrayed we feel? How upset we are that we are being made to reconsider our futures? Whether we can afford to have children and continue to be there for our patients? How the lies of Hunt et al are demoralising us? How we don’t feel it is worth it anymore to carry on in the NHS when all we get for breaking our backs for a pittance (£11/hr 6 years after graduating for me compared to a plumber who can earn up to £50/hr) is abuse and an Etonian ignoramus vilifying us for caring.

Well, I am here to say that no. I will not be unemotional. If I didn’t care for the NHS, I would have quit after my first foundation year when I became a fully licenced medical practitioner. If all I care for was the money, I would be abroad today with a private clinic, dictating my hours and pay. If I didn’t care, I would not be attending protests and spending what little I have left over after my living expenses and medicolegal expenses on supportive merchandise. I care and I am not afraid to show it.

Hunt is only the face of the Tory campaign to break the NHS and leave privatisation as its only viable option. The Tory Government is libellous, dishonest, spineless and un-democratic. If the general public continues to buy the bullshit the Government is peddling, it will be the British public who will pay the price in the next few years. So unless you are all dying with something that will kill you with certainty in the next couple of years, wake up and realise facts. Fact is the NHS as we know it will be no more unless the whole of the British public fights this. Just google how much it’d cost you to pay for your health insurance in the US and imagine the UK going the same. Doctors are in hot demand the world over. We can and will be forced to leave the UK and the NHS is this horror continues and we will be fine. I assure you. So the fact that I am getting emotional is not because I am a greedy lazy overpaid privileged posh kid as Hunt and co would have you believe. It is because I care and I am not afraid to show it. Fact!

Mythical Malaria

My mama came back to London from a visit home to Nigeria in 2002 and felt feverish. Like most people where we come from, she thought it might perhaps be malaria but wasn’t unduely worried so decided to wait and see. On the Monday, she had the typical malaria vomit so she thought ‘I best get some antimalarials before it flattens me’. That evening, I came home from college, cooked dinner and waited for my mum to be home around 7pm as usual. 7pm came and went. Then 8pm which is when I realised something was up. I called her phone which went straight to voicemail. She did come home late sometimes especially on Mondays so I wasn’t all that worried but I did feel she shouldn’t work so hard.

She came in at 9pm irritation written all over her face. ‘What did she do this time?’ I asked, assuming it was the lady who had recently been promoted to the top position in their human rights NGO office who seemed to have gone power-mad and was intent on taking all the joy out of my mama’s life. My mum shook her head and over dinner told me about her ordeal in Whittington Hospital. Basically, she had tried to call her GP for an appointment and had no luck (what else would you expect in a London GP?). After work, she went straight to the closest A&E (Whittington Hospital) rightly thinking that she should not wait until her GP had an appointment for her to get treatment for malaria. Rookie that she was, she got straight to the point when asked what the matter was. I think I have malaria, she said. Pandemonium broke out. She was ushered in ahead of everyone else into a side room to isolate her. She had blood drawn before she could say ‘what’s up?’ and they were admitting her to a ward. When she finally got someone to stop and talk to her, she was informed that she would be going to the ward shortly and they would need at least 2 more blood samples off her as per the malaria protocol and she was being isolated. I wasn’t there but I know the look of amazement that my mama would have had.

Long story short, she refused to be admitted. She told them under no circumstances was her daughter going to be left alone all night, never mind I was 16 and had stayed the night alone before, in fact more than 1 night in a flat alone in Lagos at the age of 15 which was a damn sight more dangerous than Muswell Hill in London. Anyway, the doctors were beside themselves and there was a lot of hand wringing because malaria in UK is kind of a big deal and there are strict protocols and the Health Protection Agency red tape to jump through. My mama was not to be persuaded. She said she would be off within the hour and either they give her oral medication to go home with or she would walk out without. Either way, she was going to her baby. After a lot of negotiation, they gave the oral medications and she came home to tell me the story. The deal was that she had to go back in for her second blood test before work and for them to make sure she hadn’t developed cerebral malaria and died on them. Mama and I rolled around laughing at all this hoo-hah over something as simple as malaria.

So obviously we are not entirely looney and we know malaria is potentially serious and in a few cases even fatal despite medication. Since you, my readers, are not all medics like me I will explain the things that the media and doctors in the UK it seems don’t appreciate at first glance. There are 4 strains of malaria and 1 of these strains is the bad boy of malaria. It is called Plasmodium falciparum or P. falciparum. The millions of deaths from malaria are mostly due to this strain of malaria but actually most malaria is of the other 3 strains and in Nigeria, most people will get at least one bout of malaria in their lives. As children, we all got malaria several times. I think I was one of the lucky ones who only got 3 bouts of malaria in my life and the last time I had malaria was when I was in primary school (coming up to 20 years ago). Actually a lot of the malaria burden is probably not even malaria because we are so used to malaria that anyone who has a fever longer than a day and that is high enough to make them want to lie down, self-diagnoses malaria and trundles off to the chemist to get antimalarials (we don’t need prescriptions per se).

Now back to P. falciparum. This bad boy is the strain that causes cerebral malaria i.e. it likes to infect the brain and so makes you delirious and causes seizures and can rapidly kill you because the fever is so high causing all your body enzymes not to work (so your bodily processes a.k.a. your metabolism stops) and the seizures can be very hard to control so starve your brain of oxygen, turning it into mush and in most cases, killing you unless you get IV (intravenous) antimalarials and fluids very early on.

I do not make light of this malaria at all. I worked in FMC Yola for 4 months and I saw more children die from it than I would like to recall. It is terrible. But let’s put it into perspective. The Centres for Disease Control and Prevention (commonly known as CDC) has the following stats. Nigeria is one of the countries where malaria is endemic and transmission is rife, everywhere in the country. In 2012, there were 207 million individual cases of malaria reported worldwide and of them 627,000 died. That makes it a death rate of 0.3% – which is not as high as pneumonia or diarrhoeal illnesses. And that includes P. falciparum and the other 3 strains of malaria.

Now here are my own stats. Of all the cases I know that have died of malaria, they are mostly children or very old or people with other illnesses making them too weak to fight off malaria like those with sickle cell disease. Usually, these patients would have had the fever for longer than a week and their bodies would have tried to fight for so long and then got to the stage they have nothing left to fight it with so that by the time they are admitted, they are wasted, dehydrated and their body salts are so abnormal that this is what gives them seizures and kills them. Even those with the bad boy strain are usually completely fine if they get treatment in a timely fashion. And this treatment is highly effective for majority of cases and is just as effective given orally as long as the person is not vomiting copiously (which sadly does happen with malaria).

So I am writing this not only to debunk the knee-jerk panicked reaction of UK-trained and UK-based doctors with no first-hand experience of malaria but also to educate. Some strains of malaria can be as bad as the common cold. Some can be as bad as avian flu which although it is a ‘cold’ virus is more dangerous and needs treating. All malaria infection should ideally be treated even if it is a mild infection. People like me who lived a long time in a malaria endemic area develop resistance so malaria for us is much less of a big deal generally than for a malaria-naïve person. Also those of us with the sickle cell trait have extra protection against malaria. But for you who are not so lucky, you should absolutely take antimalarials when you travel to endemic areas. You should absolutely have mosquito repellents and in addition, wear long sleeves (or as Nigerian girls do have a light scarf wrapped over your neck, shoulders and arms) to prevent the persistent mozzies from nibbling on your ‘fresh’ blood. If you are white or even just a fair brown person, be extra careful as mozzies are attracted to fairer softer skin too. I would also sleep under a mosquito net.

Take it from me because although I am fairly immune to malaria I think, I am one of those ‘special’ people that give off the pheromones that drive the mozzies wild. It doesn’t matter if there is only 1 mozzy that gets into the room of 20 people and they are all in bikinis or even bare-chested, I will be the one bitten through my scarf and long skirt. I will be the one walking around scratching the large lumps left behind by each mozzy that found me. I will be the one waiting impatiently for my near-abscesses to heal weeks after I have come back to Birmingham. Le sigh!

Unfortunately despite your best efforts, you may still catch malaria. So if you have recently been to sub-Saharan Africa (or the other endemic regions, see CDC for more information) and you develop a fever high enough to give you the shakes (rigours), run to the doctor. If your bones and joints all begin to ache and all you want to do is sleep in addition to a fever even if mild, I would get tested. And definitely pack an overnight bag if you develop a fever then start to puke up your guts and the vomit is green has such a bitter taste it makes you want to puke again despite having nothing left. That is the malaria vomit (bilious vomiting in medical speak) and you will be admitted and isolated and the whole she-bang if you do seek medical advice which you should. In fact, pack a bag that will last at least 3 days and make sure you have books/a laptop/cards/smartphone/sketchpad or whatever else you need to keep your sanity because being in isolation is no fun. Also be prepared to be pricked several times for blood cultures. But it is for your sake that all this is being done so don’t hate on my fellow doctors ok? Stay safe!