1.       Bill Parker (retired January 1994)
Could I Have an Ambulance Please
From Kidderminster to Kilimanjaro
Goodbye Verna
5.       Peter M. Clarke

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BILL PARKER (retired January 1994)

I qualified at St. Mary's in 1959 and stayed on there to do my first job as house physician. My time in the RAMC was enjoyable. Gill, two small children and myself were posted to Penang . As Regimental Medical Officer to a light infantry battalion, I was sent off to Borneo for two spells of active service, mainly in Sarawak . Leptospirosis, Amoebiasis, typhus and malaria were common. I also provided care for the locals including Kampong obstetrics.

The absence of laboratory tests and X-Rays helped to concentrate the mind. I was later in charge of a 60 bed medical ward in the British Military Hospital in Singapore . Following my military interlude I entered General Practice in Hertfordshire. The long surgeries and excessive visits deterred me from staying in General Practice. Taking 3 months off, I studied hard for the MRCP and entered the hospital service. Whilst senior medical registrar back at St. Mary's, poor pay and itchy feet took the family to Perth , Western Australia . We had an idyllic three years in Perth , and during this time I was appointed consultant and lecturer in clinical medicine to the University of Western Australia . The family blossomed in the relaxed atmosphere and lovely climate and we had a further two children.. Having enjoyed our wanderings, the time to provide a stable base for the family became necessary. So back to the old country, the NHS and Kidderminster General.

I started work at Kidderminster in September 1973. At that time the geriatric service had 200 long stay beds distributed between Mill Street and B Block. The patients were looked after by Donald Black, Tom Mackie, Brian Lamb, Ruth Lillie and Pat Campion. They were all friendly and supportive, as was the matron, Pat Thursfield. The assessment ward soon started, and within 6 months, the day hospital and rehabilitation ward came into action. Pat Campion increased her sessions, to provide medical cover for the day hospital and rehabilitation ward patients. To see our-'elderly patients in decent accommodation when the new B Block opened was a great joy. Over the years, the nursing staff developed their skills to form efficient, dedicated teams; sadly, some have been broken up due to ward closures. In latter years, John Sanford joined the unit, and it was a boon to have a colleague with whom to share the patients and the problems. I have enjoyed my years at Kidderminster General Hospital , but am relieved to retire from this 'silly season' where the patients are values more for their financial potential than for themselves.

Bill Parker

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The thought of a trip to Africa can excite the imagination of even the most seasoned travelers and adventurous holidaymakers - a safari in Kenya , to scale the heights of mount Kilimanjaro or perhaps to explore the wildlife of the Serengeti - it all titillates a sense of adventure, romance and mystery.

On the other hand, to be asked to manage the medical repatriation of a British citizen from the same continent immediately stimulates a feeling of doubt and anxiety, and a deep foreboding feeling that you're not being given the whole story. This was what went through my mind when the call came through asking me if I could cover a trip to

Malawi to bring back a 20 year old University student who had been taken ill with cerebral malaria. Not the nicest of illnesses to contract when away from home as at best the chances of survival hover around the 50% mark. The pre flight information was sparse to say the least which is one of the first problems one encounters when faced with the communication facilities available in parts of Africa . It seems that our student had been on an organised field trip to the east coast of Africa and during a sortie into Malawi , had been taken ill and admitted to the local hospital. His friends having done what they thought was their duty busied themselves off on their field trip leaving him in a 500 bed district hospital staffed by 3 nurses and a weekly visit by a doctor (none of whom could speak English).

A semi skilled diagnosis of malaria was made (clinically, without blood analysis) and treated accordingly. When his conscious level deteriorated and he became unrousable the diagnosis was amended to cerebral malaria and the unskilled heads nodded knowingly whilst administering the antimalarials. In Africa, nursing care is very literal and does not include feeding, watering and general hygiene - these are the obligations expected of the relatives but - our student did not have such luxuries and so was literally left to rot in a corner for 7 days - until :- Just by chance, two New Zealanders happened to pass through and were fortunately told that there was a white man in the hospital who was very poorly and with no-one to care for him.

From this point the jungle telegraph was spurred into action and the British High Commission in the capital at Lilongwe , some 400 miles away, was put in the picture. Within 24 hours arrangements had been made to transfer our sick student to a hospital at Lilongwe the capital, his parents in England had been contacted and put in the picture and the repatriation company in London had been asked to take charge of the case - which is where I first became involved. Attempts to glean even scraps of information was at first difficult but as the High Commission became more involved in Malawi the picture became a little clearer. But it was not until I arrived in Malawi , some 10 days after the first admission to the original hospital, that I was in a position to make a clearer assessment of the case.

Perusal of the available hospital notes, the various communications from the High Commission, examination of the patient and a discussion with his parents, who had arrived 48 hours before me all took place within 6 hours of my arrival. It became clear at a very early stage that the student had been mis-diagnosed and mistreated right from the start. In the first instance, the 'friends' should have had a little more common sense than to leave him in the dubiously capable hands of an African bush hospital so sparsely staffed. Secondly, a diagnosis of malaria, even in an African bush hospital, without the back up of basic laboratory investigation leaves a lot to be desired. And lastly, to leave a patient's medical and physical condition to deteriorate very obviously, without making any effort to seek help or advice, or to offer basic nursing care can only be described as inhuman and far below the caring standards one would expect from even the poorest country.

Unfortunately in Malawi , investigative procedures such as lumbar puncture and laboratory investigation such as CSF culture and sensitivities are as far beyond the local budgetary considerations as is a total organ transplant beyond that of fund holders in the United Kingdom . Nevertheless, meningitis of unknown aetiology was missed and accordingly, the condition of the unfortunate student certainly did not show any signs of Improvement until high dose parenteral antibiotics were fired in blind before repatriation.

The student was repatriated as quickly as possible (NB. backhanders to local ambulance personnel, customs and immigration staff, baggage handlers and airport officials are all reclaimable under expenses) and within hours after arrival in the United Kingdom was making a dramatic recovery in a South West Regional Hospital. His original weight which had fallen in just a few weeks from a healthy 11 stone to under 7 stone was making a rapid recovery and after a year  out of action he has restarted his studies.

Medical repatriation of those who are unfortunate enough to be taken ill or who are injured when abroad is certainly an interesting and rewarding alternative to the various demands of general practice in the United Kingdom . It gives the opportunity to see parts of the world which most people would never imagine traveling to, let alone being sick in ! Unfortunately, it also gives the opportunity to see the comparative squalor some of our colleagues in the medical profession have no alternative but to work in and their patients have to live under. Perhaps we are spending too much time deliberating on the intricacies of fund holding, complaining about the rising local cost of a serum rhubarb level and a mere 3% rise in remuneration. Surely less time and considerable expense should be spent trying to justify introducing donor eggs and sperm to those who nature decreed should be sterile and we should be making efforts to brighten the existence of those living under the umbrella of medical poverty.

However, the one fact which is underlined time and time again on these sojourns into the unknown - make sure your holiday I travel vaccination and advice clinic is active and totally up to date on current trends and above all - make sure you don't end up as the client in a medical repatriation I!!

Barrie Davies

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I resigned from my G.P. partnership in Kidderminster in September 1987, but did occasional locums during the next year, in between studying at Trinity College , Bristol . I finally said farewell to the N.H.S. and moved to Tanzania , at the end of 1988. Five years on, despite the hardships of life here, I would rather be doing my job here than your job there!

I am no longer in full-time medicine though there would be plenty of medical work to fill up every minute if I could find the time and sufficient  medical supplies. Those of you who are fund holding will perhaps feel that you divide your time pretty much as I do , when you read that the other part of my job is to be in charge of the college finances, officially as 'internal auditor', but frequently as office cashier as well. Having confused those of you who haven't a clue what I do, I'll fill in a few details: my husband, John, is a lecturer in a Theological College in the centre of Tanzania , training students to become pastors in the Anglican Church. I am college medical officer and look after the health needs of the college community, the students (around 120), staff, workers and everyone's families. In addition, I am unofficial G.P. to various families in the nearby village. Often they first come because of an emergency, ego broken arm, axe injury, scorpion sting or snake bite. Later they bring other family members with more ordinary complaints.

Frustrations of the Job. I am sure that the categories of frustrations I list are identical to those you face, although the circumstances are different. 1. Lack of investigation facilities: I often have to over treat because I don't know if ego a severe childhood fever is malaria 0r tick borne relapsing fever, so I have to give treatment that will cover both diagnoses. 2. Lack of back-up facilities: if a patient presents with a problem that cannot adequately be dealt with in any clinic, referring the patient to the local hospital is fairly pointless as they have no investigation facilities and often have no medical supplies. The next hospital is better supplied, but often the patient cannot afford the bus fare, so no one attempts more than one should, as the alternative is no treatment for that patient. 3. Lack of medical supplies: I have various sources of assistance in purchasing supplies for the college, but I can't justify using these for those outside the college, and so I am very grateful for the assistance of the Overseas Medical Aid Trust, Aylesbury which sends me supplies of basic medications, dressings etc., a couple of times a year (support groups fund this for me).

Some differences in medicine as practised here: 1. Fever is usually malaria, not 'a virus', and one therefore can't afford to wait 2 to 3 days to see how he goes! 2. Many children are malnourished and at increased risk of ill-health, and poor resistance to common ailments. 3. Water is a scarce commodity so sanitation is often poor in the homes (how much water would you use if you had to collect it by bucket at 5.30am from a tap 4 miles away?). There is cholera in villages 5 miles from the college. 4. AIDS is in the community and must be considered in the differential diagnosis. In Africa, the incidence of Herpes Zoster closely correlates with the incidence of AIDS (several reports show that the percentage of patients in Africa with Herpes Zoster who are HIV positive is around 90%). I see quite a few cases of very severe shingles in young men and women in their 20s, which is bad news for them and the community. 5. To encourage you to reach for your pen and apply to move to Tanzania - administration in my type of community medicine is minimal! Leisure opportunities: As if the attractions of medicine here are not enough (and which of us doesn't enjoy the chance to actually save lives by the prescription of simple medicines ?), Tanzania has several excellent tourist attractions. There is Mount Kilimanjaro, which John conquered last year, there is the Serengetti, Ngorongoro Crater and Lake Manyara ! (Welcome). Finally, a very big 'THANK YOU" for the grant to purchase, for our leaving students, the book 'Where There Is No Doctor', in the Kiswahhili translation.

Phyllis Oxberrow / Chesworth

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Goodbye VERNA

I first had contact with Kidderminster over three decades ago. Then, my headquarters was at Worcester with visits and emergency cover to Kidderminster and Bromsgrove. There was only one consultant paediatrician, Dr. Aldridge, who was appointed at the beginning if the health service. He covered Worcester , Bromsgrove and Kidderminster . There were outpatients at Evesham and Malvern. There were shared housemen at the three hospitals - and me ! You can imagine the milage.

When we moved to Hartlebury I concentrated more and more at Kidderminster . Initially, the ward and outpatients were at Mill Street . Our first move was to the ground floor of the old A Block. That became unsafe and. we were moved to a temporary ward in a great hurry. We were told that it would be for about 18 months, but were there for about 10 years until we moved to the present ward 10 years ago.

It has been marvelous to have a purpose built ward with the ward and outpatients together. We were allowed a very free hand on the planning I hope not too many mistakes. Outpatients has also had its moves; from Mill Street to the ground floor of the old A Block, to the top floor of B Block to the school of nursing. The we had nowhere to go ! I came home and with the aid of Yellow Pages, found two secondhand Portacabins in Surrey . The Hospital bought them the next day - it was different in those days!

There are now 9 consultants and numerous junior staff covering the three hospitals. So there have been many changes in my time - all very stimulating and I have enjoyed my contact with Kidderminster . I wish it well in the future.

Verna Nicol

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Peter M. Clarke

I was born in Dudley, West Midlands on 13th June 1960, the youngest son of 2 general practitioners. My parents had run their own general practice for over 30 years. Having lived 'above the shop' for part of that time I had at an early age decided that medicine was not for me! I have a brother who is also a dental surgeon, and a sister who has a degree and PHD in Zoology. After attending St. James' School, Dudley, The Royal School Wolverhampton, and King Edwards' Grammar School Stourbridge, I entered Dental School in Birmingham in 1979. My pre-clinical year was spent at the medical school in Edgebaston, and from there to the dental hospital in the city centre. My father sadly passed away during my final year, but I am sure that he would have been pleased that along with two others in my year I was awarded an honours degree. I also gained the final years prizes in periodontology, paediatric dentistry, orthodontics and the dental society award for my elective study. After qualification in 1984 I completed 12 months voluntary vocational training attached to Dudley Road Hospital Birmingham, and joined Roger Jones at Bewdley Dental Practice. I worked as an associate to Roger until 1988 when I became

Roger's expense sharing partner. We are now a 3 dentist / 2 hygienist practice working mainly in the NHS, looking after 13,000 patients. I have been married to Suzanne for 10 years. Suzanne has an honours degree in International Studies gained at Birmingham University where we met as students (at the windsurfing club). We have 4 children, Alexander aged 8, Twins Edward and Josephn aged 7 and Charles Age 2. We live at Heightington, having recently moved from Kinlet to a larger house to accommodate those children. Our main interests are sport (tennis, badminton, " skiing and, more recently, golf), animals (2 dogs and a horse) and of course, the children (God Bless Them !).

Peter Clarke

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