1.       Latest Report from Jan Adams
2.       Olaf de Costa
3.       From Kidderminster to Kilimanjaro - David Malcomson
  W(h)ither Postgraduate Medical Education? - Paul Newrick
5.       Dr E. George
6.       Editorial - Where do we go now?

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Latest Report From Jan Adams
The Blue Water Rally
Tenerife to Panama

It took us 23 days to cross the Atlantic - the winds were light and the trade winds almost non-existent. We saw a few whales and plenty of porpoises and even stopped for a swim on a few occasions.  We sometimes went up to 3 days without seeing another boat or light.  It was really hot in Antigua (Jolly Harbour which used to be called Mosquito Bay) we were all bitten to death by noseeums' and were glad to move out after a week and visit some of the the many beaches around Antigua and have a little breeze to cool us:' 

We started heading south through the Caribbean Islands from 17th December spending Christmas in St Lucia and New Years Eve on Carriacon. We visited most of the islands but found them crowded with many yachts and as the trade winds were now blowing quite, strongly we all needed secure anchorages at night. We did manage one or two lunch time stops where we had a bay or island to ourselves. After Grenada we seemed to lose most of the holiday charter yachts and headed towards the North Venezuelan Islands of Los Testigos and Blanquilla, These were lovely after the hassle of the Caribbean - the locals very friendly and anxious to chat and give us fish and lobster. We usually returned the favour with a T-shirt. Blanquilla is a flat island 5 miles by 5 miles. We sailed along the north and west side and saw no sign of habitation. The snorkelling was the best so far with fabulous lush underwater vegetation and healthy coral and many different fish, We went to Las Rochas and then on to Curacao  visiting the capital Willemstad and Spanish waters then going north along a beautiful coast line before setting sail for Aruba.

Aruba was quite different, some people hated it. We found it very pleasant after about 10 days of being away from civilisation. It was like a small Disney World of casinos, malls and hotels, one of which had its own private island on the reef. We enjoyed 2 days of using all the facilities we could use and then set off on a five- day sail along the Colombian coast to the San Bias islands. It blew like mad with what felt like square waves but
we survived and arrived at the 360 or more small idyllic islands that make up the San BIas home of the Kuna Indians, a colourful people of small stature who live in bamboo and palm houses and still use dug out canoes of mango wood with wonderful dexterity. Some have made sails of twigs and old flour bags sewn together like a patchwork quilt. The many children fly kites of twigs and plastic bags and the embroidery cotton from which they sew very colourful appliqued patterns for the bodices the women wear. 

We spent 5 days here amongst the reefs and clear water. In contrast, we arrived at Colon (or Custobal) to wait to go through the Panama Canal where we were locked in a compound and could only go out in daylight in a taxi. Armed guards were in all supermarkets and banks. The Panama Canal was an experience that I think we will all remember; 3 locks together rising 85 ft into a huge man-made lake of 25 miles - no sign of habitation just forest and water. It was quite strange to see large container and cruise vessels disappearing behind the trees. We anchored overnight in Lake Gatun to move on the next day through 3 further locks out into the Pacific Ocean. We are now furiously stocking up the boat to set off to Equador, the Galapagos and 3000 miles to the Marquesas.

Jan Adams

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Olaf De Costa

I did my Orthopaedic Training in the Birmingham Training Programme from 1970-74 and was in the first batch to receive the Accreditation Certificate. I joined Kidderminster General Hospital as a Consultant in September 1994. It was a new post resulting from the split up of the North Worcestershire H M C. My colleagues. were John James and Nat Lalljee.

I  introduced the A 0 system of fixation of fractures, a system which was the vogue at that time. I also introduced diagnostic arthroscopy of the knee but had to do open meniscectomy as there were no cameras or special instruments then. Modern total knee replacements had just become available and I did them on a regular basis. In 1991 I became part of a National Audit on  I.B.11  total knee replacements. There are 1500 cases in the audit of which I have contributed 250 cases. The preliminary 5 year results will be published this year.

Bill Parker and I were involved in a programme to avoid bed blocking by rehabilitation of fracture Neck of Femur cases that had been treated surgically, This work was recognised by the DOH and I was appointed a member of the Duthie Committee on the Management of Waiting Lists. 1 also did sessions connected to the Droitwich Centre for Rheumatic Diseases, working with John Popert, Richard Taylor and Ian Rowe. I ended up doing the lower limb surgery for the Centre which is now located in Worcester.

Kidderminster has always been a happy place to work in. The hospital is small enough to know everyone from the porters upwards. One could get anything done with a kind word in the right place. I appreciated the close management of patients with their GP's. The personal touch and the quick
communication was something unique. Working in a small town one could not duck the issues. I remember a telephone engineer repairing the 'phone in our house. He was talking to my wife and lifted up his trouser leg to show the scar I had given him from fixing his fractured tibia.All this  contributed to the high standard of care provided by the medical profession in Kidderminster. I am proud to have been a part of it.

Olaf de Costa

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September 24th 1998.

It was at our practice Christmas party in 1996, that Tim Wadsworth and I were talking about life and the Cosmos. Good friends of Liz and I had climbed Kilimanjaro that autumn and had come back enthused and consumed by their adventure. The die was cast. 

Without hesitation we were given special dispensation to leave the practice two men down. The two friends who had first enthused about the ascent, quickly decided they would like to do it all again, despite the hardship they had experienced. More friends and relations, including five from Cape Town joined the party until we were a seemingly cumbersome party of nineteen. In the event the chemistry of that group was the icing on top of what turned out to be a very large cake. We had a travelling Welsh male voice choir of four, an Irish wit and the man who makes the best ice cream in Swansea (if not the World) eleven medics and a dentist. 

Valuable advice and encouragement was given by local Kilimanjaro veterans; Alastair and Angie Miller, along with Julian Sonksen. This consisted of anything from the correct drugs to take at altitude to the correct underwear. Tim had to he persuaded that technology had advanced since sensible socks and a good Harris tweed deerstalker were in vogue. Kilimanjaro is the highest point in Africa and unlike other mountain peaks is free standing, rather than the highest in a range. The highest point is Uhuru Peak and stands at 5,980meters above sea level, which is just under 20,000ft. for any non-Euro. The oxygen at this height is at half the concentration at sea level. 

We did not meet Julius Minja, our guide until the first day of our walk He spoke in slow deliberate tones about how we would walk in a slow deliberate way "poley poley" (Swahili for slowly) and how sure he was that we would all make it to the top. His reputation is huge and he has a success rate of >90% for his parties against a background of <70%. We had chosen to take the longer Machame route for two reasons. First it would give us a better chance to acclimatise and secondly it is by far the most scenic route. The first day was a steady ascent through rain forest from 1700 metres to2980 metres. The forest was strangely quiet, but then I suppose we were strangely noisy to any creature that may have thought of squawking in our vicinity. The weather closed in a bit and there was mizzle in the air as we entered the heather forest. The Kidderminster contingent pulled put their collapsible umbrellas to much mocking mirth from the South Africans. We slept in two man tents, whilst the porters slept in the inhospitable huts or in the open. We had a frost that night, as we did every night. 

The second day was spent walking higher and higher past giant lobelias and groundsels. We headed ever upwards until we came over the edge of the Shira Plateau, which spreads between the main cone and the remains of a once even higher cone to the West. This is dramatic scenery and the altitude was very apparent. The plod was easy, but any extra exertion literally took your breath away. A dull muzzy headache developed as we approached our campsite, which perhaps was not surprising as we were now at 14,00Oft. We looked down at a sea of cloud below us; the multiple horizons of the edge of the plateau surfacing above the cloud and the old peak called Shira Cathedral crowning them. As dusk approached the mist rolled away, the air was crystal clear and the snow clad summit showed itself in the pink and orange glow of an equatorial African sunset. As the darkness rapidly enveloped us the milky way became brighter and brighter -- I have never, ever seen it clearer, with absolutely no light pollution, as the moon was new and only just showed a thin crescent. 

The third day and fourth day were spent acclimatising, walking high and sleeping low. The terrain was exceedingly barren; scree, scoria, tussock grass and not a lot else. Every night we had a dull headache and at the end of the second day, we had our first victim of Mountain Sickness. He recovered quickly with the aid of dexamethasone and never looked back after this. By the evening of the fourth day we had reached our camp at the Arrow Bivouac, which is flanked by two glaciers. We gazed down on the previous 2 days walk, the scale not apparent unless you had the local knowledge of having slogged all the way. 

That night everyone was a bit nervous. We were briefed by Julius, who told us that we were a "strong group" and he felt confident that we would all make it. Certainly the morale was high and we all had good appetites, which is an excellent prognostic sign. We were to be woken at midnight and were to be walk by 1.00am. We would then walk for 7 hours in the dark with the aid of head torches - no moon that night. The plan was to be at the rim of the crater for sunrise, having ascended a further 3,500ft. If all was well we would ascend the last 500ft to the top - Uhuru Peak-at a height of 19,500ft (5980m.) If not, there was no way back and we would have to traverse the crater to rejoin the path and then descend 11,000ft to just above the rain forest. We finally went to bed at about 7.00pm having nervously rearranged our kit for the 'n' th time. All water had to be kept close to your body otherwise it would freeze overnight. The temperature was to drop to minus 15 degrees that night. Camera batteries refuse to function when it's cold, so 'take a spare and keep it somewhere warm". Deep inside the underwear seemed the best place. All was ready for a rapid getaway in the "morning". We all lay still for the next five hours, but I'm not sure that anyone slept, automatic pilot took over as we were woken and all got ready. We then ascended slowly up what was obviously very exposed scree and scrambling very like the Bristly Ridge in places. It was probably a good job that it was dark, as the degree of exposure could not be fully appreciated. As ever, Julius led and set the pace-poley poley. The pace slowed as some members of the party were starting to suffer, but ever onward, ever upward we plodded. The hours slipped by.- Little was spoken. We rested frequently and forced fluid down, despite not feeling the slightest thirst. 

The only way of measuring our progress was the passage of time, until a grey glow started to creep over the surrounding cloud several thousand feet below us. The shadow of the mountain then appeared on the cloud below. Tim Wadsworth, as cerebral as ever, thought that this was a Brocken Spectre. He will explain this to anyone prepared to listen! Then, magically we crested the crater rim to be engulfed in blinding horizontal sunshine.

The sensation and elation at this stage are very hard to describe. You are surrounded by a deeply rutted gleaming snow field fringed by glacial cliffs. Everyone embraced in relief and joy that we had done it! We then tottered slowly across the treacherous snowfield, to the wonderfully- named Furtwangler glacier, which we crossed. We walked along the inner rim of the crater edge to where the path ascends to Uhuru Peak. At this point two of the party decided that discretion was the better part of valour and they would traverse the crater and meet us at Stella Point, at a height of 5,800m. The rest of the party continued. There were loved one's ashes to be cast to the winds from the summit and a 'Red Nose' to be buried as part of a sponsored climb that brought in 7,500! 

It hurt a bit to start going up again, but the prospect of standing at the highest point of Africa was very appealing. An icy snow scape, a slowly rising slope and thus ever-disappearing summit ensured that it seemed a long haul. ' But - PHEW - it was worth it. All embraced, lots of photos, lots of emotion. The most emotional moment for me was phoning Liz just as she was leaving home to go to the surgery! One of the South African contingent had brought a satellite phone. There is quite a delay in the speech, but the signal was crystal clear. It may seem incongruous and naff to have done this, but all who phoned their loved ones had a tear in their eyes after! The descent took many hours and was complicated by a case of pulmonary oedema and a collapse from dehydration plus exhaustion. That day finished in the dark twenty hours after we had set oft. It is only with the aid of hindsight and the retrospectroscope, that the we realised the implications of our potential plight if things had taken a real turn for the worse. The next day, the sixth and final day, dawned crisp and clear. All were in amazingly good heart, considering the emotional and physical experiences of the day before. We gazed toward the snow capped peak and thought "were we really up there?". We slowly descended, heckled by a screaming party of Colobus monkeys, through the thick rain forest that eventually gave way to lush coffee and banana plantations. Civilisation and a hot shower beckoned.

The next day was spent unwinding with the help of a few beers whilst collapsed and reclined around a rather murky swimming pool. As I lay there looking skywards, the sun was blocked out momentarily by a low flying Maribu stork. An unidentifiable kite circled and a brightly coloured kingfisher sat watching us from a perch at the end of the pool. Thoughts of reality and Kidderminster started to encroach but only momentarily. We all wearily boarded the plane later that night, as we wondered whether we would ever see our luggage again. Handing your luggage in to the baggage handlers in a small equatorial African airport, with Birmingham on the label, or Teesside or Edinburgh or Gatwick seemed a singularly optimistic act. Valuables -- ie. photos and memories were kept close to the soul. 12 hours later, after a stopover at Dar-es-Salam, a change of plane at Amsterdam (with many fond farewells) my grubby smelly baggage appeared through the rubber doors of baggage collection at rainy Elmdon! Magic!!

David Malcomson

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 W(h)ither Postgraduate Medical Education?

You cannot fail to have noticed the new car park emerging behind the PGMC. It sits on the site recently vacated by the old pharmacy and will allow us to bring mobile cardiac catheterisation and MR scanning to KGH. That's the good news. Less welcome is the fact that we do not have, and have little prospect in the immediate future of a new all-singing all-dancing education centre. We had grand plans and envisaged an exciting modern building straddling the existing PGMC site and what is now dusty tarmac. The vision, which we as a Medical Society shared, was of a dynamic purpose-built multidisciplinary education centre. Now, of course, we are in a post-apocalyptic age following the outcome of the Strategic Review - bricks and mortar developments seem rather unlikely at present. Does this imply that there will be no longer be a need for a medical education centre at the hospital? Should we allow it to wither? Will educational activities 'retreat' entirely from hospital into surgeries and community clinics? Unlikely, I think. I firmly believe that there will be a need for some 'central' educational activities. Clinical effectiveness and clinical governance are now here. These, admittedly double-edged, weapons mandate more education, more multidisciplinary learning (and more protected time to do so). Continued Professional Development and its close relation, Continuing Medical Education, need to be undertaken in a learning environment that brings together primary and secondary care doctors, nurses and IPAMS. All these individuals need access to modern library and information facilities assisted by a specialist (i.e. a modern librarian). With the process of integrating the Staff Development Centre with PGMC and the forthcoming appointment of a librarian we are well on track to provide much of what the punter needs. Kidderminster IPGMC was built in 1971 and the building is showing its age. We need to preserve an educational base in the hospital and also a home for the KMS but I don't think we should spend our own monies on the fabric just yet. A vibrant educational scene supported by all should ensure that the new future combined Trust truly 'invests in excellence'. Please let me know if you see it differently!

Paul Newrick

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Dr. E. George

I have been a doctor since 1976. I graduated from a medical school in India, and further gained my master's degree in Trauma and Orthopaedics from the Christian Medical College, Vellore. I started my career working at a mission hospital near Madras. I was there for five years, mostly doing general medical and surgical work among the rural population. My specialisation in Orthopaedics enabled me to perform reconstructive surgery in leprosy and polio. I have been in the United Kingdom since 1989. I have worked mostly in Trauma and Orthopaedics at Blackpool, Swindon and Bath. I also had the opportunity to work at Waterford in the Republic of Ireland for two years before taking up my current post as a Staff Grade doctor in the Accident and Emergency Department at the Kidderminster General Hospital.

My special interest is in trauma, and I hope that my recently acquired FRCS would help me pursue a career in Trauma. In my spare time I like to
relax by playing tennis at a local tennis club. I try to keep fit by swimming as often as I can. I take great pleasure in playing and listening to music. My wife Cynthia is an English teacher at a school in Cradley. My son Sudhakar is doing his A levels and my daughter Sandhya has just completed her GCSE from King Charles 1 High school, Kidderminster. 80th are keen to follow a career in medicine.

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???? WHERE ????   DO WE GO NOW

The Medical Society's solid foundation is the membership, which consists of Consultants, General Practitioners, Dentists and Vets. This mixture of professionals has worked extremely well together for many years. Suddenly we are in the position where one of the largest parts of the membership (consultants) will no longer be working full time in the area but will come in for clinics etc. - at least for some years. We do hope that. our Consultant members do continue with their membership and furthermore support functions wherever possible. In the longer term we would hope that we can encourage more of our Dental and Veterinary colleagues to join the society. Finally, we are convinced that in the long run the Health Authority will realise it has made a terrible mistake and it could be in due course that new Consultant colleagues will return to the area. The Editors are extremely saddened by the decision of the Health Authority but we hope that we can look forward to a different but hopefully equally exciting future.

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