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
COULD I HAVE AN
AMBULANCE PLEASE
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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FROM
KIDDERMINSTER
TO KILIMANJARO
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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