Malawi; the warm heart of Africa!
The final phase of our journey began as we left Australia for Malawi. The route took us via Johannesburg where we were entertained by Prue and Mike Baker. Prue whom we first met on our tour of South Africa with the Harrow School Colts Rugby tour has been exemplary in keeping in touch. They looked after us generously and with warmth, and talked without bitterness but with realism about the security situation in South Africa. It certainly affects your view of the world if you have to live behind gates and seldom venture out at night.
On arrival in Blantyre we were met by Pat, a consultant paediatrician who was using Olly’s car. We were taken to see the town, the hospital and Olly’s house, where we are staying. The bright sunlight and the verdant vegetation give a disarming backdrop to the evident poverty and relative disorder of the landscape.
The house is plain, but well equipped, both with servants (house boy, gardener and night watchman) and stuff. It is rather pleasant to be our own masters, though with no phone and no internet connection we feel slightly bereft. This is an interesting and very recent phenomenon and shows how quickly we move from regarding things as luxuries to essentials, TVs, freezers and dishwashers all have become essential, as has air conditioning in cars. The fact that one persons luxury is another’s essential has challenging resonances here..
After arrival Olly had booked us into Mvuu Lodge. Mvuu means hippopotamus in Chichewa, Malawi’s language. This was inspired and inspiring. The drive across was pleasant, with the scenery reminding us of bygone days in Kenya. We were met by the Shire (pronounced Sheerey) River and sped on a boat to the lodge, passing raft after raft of hippo and seeing several crocodiles, as well as being given a foretaste of the feast of bird-watching that we were to experience over the next forty eight hours.
The lodge was a dream, five separate chalets, set in the bush alongside a lagoon, with a central dining area, a terrace for dining in the open and a small swimming pool. All this was approached over a wooden walkway from the jetty. There were three others in the lodge and we all joined together for game drives. There were plenty of baboons, monkeys, wart hogs, impala and water buck, fewer bush bucks and sable antelopes, and the occasional jackal and buffalo. We only saw elephant, of whom there are plenty on our last morning. The real delight is the birds, we saw over a hundred different species, not all remembered or recognised by me. However I did learn a lot, not least about sorting birds into types and looking for likely places for them to perch.
The quality of guiding was outstanding. The hospitality was personal, and the food excellent. In fact of all the places we have stayed in on our trip it is one of the two that I can thoroughly recommend, the other being the Peace and Plenty Inn in Auckland. This was a privileged way of seeing wildlife.
After these delights real life would be a problem. Being in Malawi we had to visit the Lake, and looking at the guide books it seemed that Cape Mc Lear was the closest and had the most choice of accommodation. The drive was interesting, it had rained the ni9ght before and part of the road was flooded. This was a popular event and hundreds of local villagers were on hand to give advice and guidance. We were adopted by a few young men, who ran in front and alongside and gave instructions, it was a hair raising experience, having to keep the momentum of the car going through the flood waters avoid the young men running in front and listening to instructions coming at me from all angles. We managed it without mishap.
Then Cape Mc Clear, despite its remoteness and the approach roads being like farm tracks, it is a popular place with the travelling backpacker, WIFI on the beach! The place where we elected to stay was situated on a perfect beach, with our chalet giving on to the foreshore. Somewhat surprisingly the menu was pretty ambitious, and though there were not many mistakes simple fare might have been more appropriate in this setting. On the Sunday we set off for home, noting with delight that there were large numbers of smartly dressed villagers going to church, what a testimony to the early missionaries who planted a church here late in the nineteenth century. The journey home was in driving terms untroubled, the floods had receded and good progress was made. However any journey of this length in Africa always provides incident, the first was a “matola”, a minibus filled to the brim with paying passengers. This overtook us recklessly, lost control and bounced into a ditch on the other side of the road, after a number of alarming ricochets it came to rest on a grassy mound in the upright position and the doors opened disgorging the passengers, shaken but not as far as we could see broken.
The next incident was when were waved to a halt by a North American maiden in real distress. She was driving a hire car, having lost her driver and had a drunken and bruised motorcyclist in the back, who she had rescued when he fell off his bike, and had planned to take to hospital. However he was belligerent, as were the crowd at the scene and she had taken flight. When we me her she was beside herself. She posed quite a challenge to the ageing gappers. However they have their strengths and with the help of a passing ambulance crew sense and pastoral care were introduced. We took her to the police station in Blantyre and the whole matter was resolved, including getting her escorted home. Phew! We were so grateful that Olly had a small and discrete stock of wine to calm the troubled spirits!
We came to Blantyre because we wanted to see where Olly was working, however when it was clear that we would be out of phase, Olly being interviewed in the UK, whilst we circle the globe, we arranged a series of meetings with the senior staff here. So today I went to the post take hand over, and Paediatric Surgery ward round and talked at length to Eric Borgstein the Professor of Surgery. I felt rather sorry for him, because not only had he to deal with me ( a self invited guest), he also had a team of Plastic Surgeons from Southern California, doing their “pro bono” bit for mankind and a delegation from St Andrews enquiring into undergraduate education. It is rather like Uganda ten years ago, it is difficult to move without bumping into a well meaning western well wisher. What was really impressive is how the surgeons have been quietly developing a robust surgical curriculum.
Enfin
After this posting we will be homeward bound. It has been a great experience and a real privilege to have been given this amount of time to think about surgical training in the UK and look at other systems. I hope to write something of use and to get a platform from which to share my insights. A time away like this is excellent for its physiological, psychological and social value. It is to be recommended!
Wednesday, April 4, 2007
Australia south and west
We flew from Melbourne to Adelaide moving from the hospitality of old friends to the hospitality of old friends
I have known Bill and Ros Hague since we were at Cambridge together in the late 60’s, they then came to Thomas’, Bill for his clinical and Ros to do the graduate nurse course that was just starting. They have three young, roughly contemporaneous with ours and so there was much to share.
Adelaide is a gentler city than most, apart from a Saturday night when the town is busy, boozy and boisterous as we inadvertently discovered when we were returning late from a concert. They were wonderful hosts and arranged some meetings with the local educational leaders and some worthwhile outings. We had a bush tramp seeing a koala at close quarters in the wild, many birds; laughing and blue winged kookaburras amongst others. We had a highly informative visit to the marine and immigration museum. This explained the manner of immigration to Australia better than any other account I have seen in our whole trip. It explained what happened in a graphically, with old photos and contemporary film strips to colour the picture. There was considerable hardship involved and in our age of material sufficiency one wonders at the privation and poverty that the immigrants were escaping from, to seek a better life in what was a pioneering situation, as recently as fifty years ago.
The social highlight of our visit was a trip to a concert in Bundaleer forest. This was an enormously engaging musical festival in t a the woods of northern South Australia. A contra punctual element was added by my tooth, which chose to ache on the day. It was a severe ache which engendered sympathy, which in turn led to action. We were driven to the concert via a winery in the grounds of a Jesuit monastery; the others were hungry and suggested lunch which was bacon, egg and sausage sandwiches, good in their place but a mistake for the sore of tooth. My beloved seeing my anguish enlisted the help of the paramedics, who did not have much else to do and we experimented with penthrane, which I am sure is good for some sort of pain but not this particular variety of toothache. It was then decided that I should be bundled in a truck and driven to the local hospital, by one of the charming paramedics. This is one of the spin-offs of relative misfortune, it opens avenues not normally available. We were told that Jamestown, the site of the concert was a much safer place to bring up children than Adelaide, and Charlie’s, the paramedic and local builder proudly pointed out his son who was playing cricket on a pitch we passed on the way to the hospital. His daughter was taking part in the concert, which had a mixture of local input and internationally famous performers. The hospital was neat and welcoming and under threat! We were given the medicine necessary to alleviate suffering and returned, with the accommodating Charlie to the concert. Pain in temporary abatement we had a pleasurable two hours hearing engaging performances as we walked from glade to glade, al capella singing, oboe and cello solos, then supper and, what do you know, more anguish So I was taken to the coach, where, a useful discovery, there is a bed. When the pain was under control sleep overtook me, and I was awakened by some wonderful singing, by Simon O’Neill a tenor from the metropolitan in NY and Teddy Tahu Rhodes. They are both New Zealanders and we were treated to a masterful display of the most wonderful singing. Whether it was therapeutic or not it marked the beginning of the end of the self absorption that pain leads one into.
The next day, before church I was seen by a delightful oral facial maxillary consultant who deemed the tooth worth persevering with and with that Bill and I went to church. They worship in the oldest Anglican church in downtown Adelaide. It has several services on a Sunday. Ros and Jane had been to the early one and Bill and I went to a lively family service in the next door cinema. This use of secular venues has some virtues, not least in putting the Christian message into a place where it is not normally expected to be heard. The message was a good one, and we have learnt a lot from the various service we have attended on our trip.
One of the privileges of this trip has been being involved with our hosts’ families; we have sat down to dinner with the children of all our hosts, and what a delight it has been. They are all confident, polite, the girls beautiful and the boys handsome. They all do different things, but often one can see glimpses of their parents as one used to know them.
We left Australia via Perth, a place I have longed to visit as it is the home of David, my brother in laws’ family. It too is a gentle city; we walked rapidly around the centre that is possible downtown in Australian cities. Perth has a unique site for city viewing, in Sydney the harbour is the place, in Brisbane the river, in Melbourne the south bank on bicycles and Adelaide the northern parkland, in Perth it is a concrete staircase, much used by joggers and those hoping to get fit. We strode up it in the gathering dark and had a glistening view. Too little time to do anything more than walk eat and sleep, before we set off again to another continent for the last phase of our journey, today Australia and today Africa!
We flew from Melbourne to Adelaide moving from the hospitality of old friends to the hospitality of old friends
I have known Bill and Ros Hague since we were at Cambridge together in the late 60’s, they then came to Thomas’, Bill for his clinical and Ros to do the graduate nurse course that was just starting. They have three young, roughly contemporaneous with ours and so there was much to share.
Adelaide is a gentler city than most, apart from a Saturday night when the town is busy, boozy and boisterous as we inadvertently discovered when we were returning late from a concert. They were wonderful hosts and arranged some meetings with the local educational leaders and some worthwhile outings. We had a bush tramp seeing a koala at close quarters in the wild, many birds; laughing and blue winged kookaburras amongst others. We had a highly informative visit to the marine and immigration museum. This explained the manner of immigration to Australia better than any other account I have seen in our whole trip. It explained what happened in a graphically, with old photos and contemporary film strips to colour the picture. There was considerable hardship involved and in our age of material sufficiency one wonders at the privation and poverty that the immigrants were escaping from, to seek a better life in what was a pioneering situation, as recently as fifty years ago.
The social highlight of our visit was a trip to a concert in Bundaleer forest. This was an enormously engaging musical festival in t a the woods of northern South Australia. A contra punctual element was added by my tooth, which chose to ache on the day. It was a severe ache which engendered sympathy, which in turn led to action. We were driven to the concert via a winery in the grounds of a Jesuit monastery; the others were hungry and suggested lunch which was bacon, egg and sausage sandwiches, good in their place but a mistake for the sore of tooth. My beloved seeing my anguish enlisted the help of the paramedics, who did not have much else to do and we experimented with penthrane, which I am sure is good for some sort of pain but not this particular variety of toothache. It was then decided that I should be bundled in a truck and driven to the local hospital, by one of the charming paramedics. This is one of the spin-offs of relative misfortune, it opens avenues not normally available. We were told that Jamestown, the site of the concert was a much safer place to bring up children than Adelaide, and Charlie’s, the paramedic and local builder proudly pointed out his son who was playing cricket on a pitch we passed on the way to the hospital. His daughter was taking part in the concert, which had a mixture of local input and internationally famous performers. The hospital was neat and welcoming and under threat! We were given the medicine necessary to alleviate suffering and returned, with the accommodating Charlie to the concert. Pain in temporary abatement we had a pleasurable two hours hearing engaging performances as we walked from glade to glade, al capella singing, oboe and cello solos, then supper and, what do you know, more anguish So I was taken to the coach, where, a useful discovery, there is a bed. When the pain was under control sleep overtook me, and I was awakened by some wonderful singing, by Simon O’Neill a tenor from the metropolitan in NY and Teddy Tahu Rhodes. They are both New Zealanders and we were treated to a masterful display of the most wonderful singing. Whether it was therapeutic or not it marked the beginning of the end of the self absorption that pain leads one into.
The next day, before church I was seen by a delightful oral facial maxillary consultant who deemed the tooth worth persevering with and with that Bill and I went to church. They worship in the oldest Anglican church in downtown Adelaide. It has several services on a Sunday. Ros and Jane had been to the early one and Bill and I went to a lively family service in the next door cinema. This use of secular venues has some virtues, not least in putting the Christian message into a place where it is not normally expected to be heard. The message was a good one, and we have learnt a lot from the various service we have attended on our trip.
One of the privileges of this trip has been being involved with our hosts’ families; we have sat down to dinner with the children of all our hosts, and what a delight it has been. They are all confident, polite, the girls beautiful and the boys handsome. They all do different things, but often one can see glimpses of their parents as one used to know them.
We left Australia via Perth, a place I have longed to visit as it is the home of David, my brother in laws’ family. It too is a gentle city; we walked rapidly around the centre that is possible downtown in Australian cities. Perth has a unique site for city viewing, in Sydney the harbour is the place, in Brisbane the river, in Melbourne the south bank on bicycles and Adelaide the northern parkland, in Perth it is a concrete staircase, much used by joggers and those hoping to get fit. We strode up it in the gathering dark and had a glistening view. Too little time to do anything more than walk eat and sleep, before we set off again to another continent for the last phase of our journey, today Australia and today Africa!
Wednesday, March 21, 2007
Iconic cities and sporting venues
Melbourne and Sydney are the two largest conurbations in Australia. They are both striking cities, with different virtues. Our experience of them was so different that comparison would be invidious, in the one Sydney we were at a major international conference and at the other we were staying with one of Jane’s oldest friends, celebrating over 50 years of shared experiences. In one we stayed in an old club and in the other a family home, in one in the city centre and in the other a suburb, in one we worshipped in the cathedral and in the other a local, lively parish church, in one we looked at the city centre from a harbour launch and in the other from a bicycle. Both satisfy, both are superb cities with immense virtues.
We arrived in Sydney from Brisbane, buoyed up by the professional and personal aspects of our visit. We were driven to the club, a few hundred yards from the opera house and after unpacking we set off. We looked around on of the most impressive cityscapes in the world, thronging with people and with a bewildering number of weddings on attractive vantage points, all seeking the bridge and the opera house as their backdrop. We strolled round the harbour and wandered across the bridge, in the cooling early evening, then took a ferry to Darling Harbour so we could check out the conference venue. Then after a waterside supper we went to bed in the club. The next morning I jogged in the park, seeking the view of the opera house and bridge that has graced so many post cards and formed the backdrop to Saturday’s weddings. Then we went to church, I had long wanted to visit Sydney’s Anglican Cathedral and we were not disappointed, the service was fairly traditional and the message good expository preaching, the welcome afterwards was generous and warm.
Then we took off to register for Jane’s hand conference, booked on a harbour cruise and saw the harbour from the water, with a commentary which was pretty informative but contained much that was salacious and more appropriate to the columns of “Hello” magazine. Then we had the opening ceremony for the conference, in which the collection of performances were truly memorable, finger silhouettes to virtuoso trumpet playing, followed by an opportunity to network.
The following evening we went to the opera, to hear and see La Traviata. The opera house is intimate; we had excellent seats and witnessed a great performance, greatly aided by the surtitles. After this extraordinary two days anticlimax could be expected, but happily we jumped from one high point to another, a memorable supper “a deux” on the harbour, with that memorable backdrop, a stroll to the rocky headland at the entrance to Sydney harbour, a phone call to the son of my original mentor in ENT, and visiting our latest Australian Registrar and his five day old baby.
After this how could Melbourne compete? It did by being different. From the moment that we were met by Gill Austin at the airport we were surfed on a wave of love and friendship. A trip to Phillip Island, to swim, have tea, see Wallabies and picnic in a prime position before seeing the fairy penguins make their way across the shore. These little chaps are about 30 cm in height and spend the day fishing in the waters, at dusk they come crashing out of the waves, form up in small groups called rafts and wait for a safe moment to cross the beach and get home to their burrows, which are scattered throughout the sand dunes. However they complicate this simple task by imagining that there are all sorts of demons which are out to get them. As they gather, and prepare for the waddle, one will lose their nerve and retreat into the waves, they all follow. The craven is a more compelling leader than the brave. Eventually several hundred made the trip, but not after some had had several false starts and indeed one group needed the guidance of one who had made the journey already before they ventured across the sandy foreshore.
The next day started with a leisurely breakfast and then a trip into town by tram, which took us to the centre of town and we were able to go up the second highest building to look at the city from the observation deck. This view gives the orientation and the scale, but in the brown of a prolonged drought, with the widespread traces of industry peppering the landscape, it does not show the townscape to its best advantage.
After lunch I scuttled to the College of surgeons to meet with john Collins, the Dean, an affable and committed man, he has a clear idea of the educational needs of the young surgeons in Australasia. I was able to get fully up to speed, meet with Jane and Gilly scoot round the town again before John and his wife Jenny took us out to supper. They lived in an elegant city centre flat, with a uninterrupted view over the nearby park and university, interestingly showing the townscape to great advantage!
The next day it was the Yarra and bicycles. It was the way to see Melbourne and its surrounds. We were reminded that there was a great televisula event taking place that weekend with the unceasing hum of fast cars from the Grand Prix circuit at Albert Park. It is quite clear that Melbourne is committed to sporting endeavour as there are sports stadiums of world renown, within minutes of the centre of town, the Melbourne Cricket Ground, the Rod Laver Stadium and the Grand Prix Circuit, amongst others, being within half a mile of each other. I used to think that living within half an hour of Lords, Wembley, Twickenham, Wimbledon, Ascot and Henley put me in the centre of the sporting universe, now I am not so sure!
The thing about cycling is that you can cover enough ground to see beyond the obvious and you can stop anywhere. We used a “punt”, a small motorised flat bottomed boat, with no concessions to safety, which was hailed by waving a broken flag. If w had stumbled across it on the Zambezi we would have wondered about its safety, as it was we paid our three dollars (one way, no returns and no timetable) without a murmur. That evening we all went to a talk on service in Cambodia, for which I spent most of the time awake!
It was great to go to church with Gilly and Bill on the Sunday, a joyous service with clear preaching and a real sense of fellowship. Lunch was the traditional Barbie, steak and chicken, followed by a Koala watch in the gum trees near their home.
What a great few days, it has really helped us understand why people are so happy here. Our next move is Adelaide and other old friends, Bill and Ros Hague.
Melbourne and Sydney are the two largest conurbations in Australia. They are both striking cities, with different virtues. Our experience of them was so different that comparison would be invidious, in the one Sydney we were at a major international conference and at the other we were staying with one of Jane’s oldest friends, celebrating over 50 years of shared experiences. In one we stayed in an old club and in the other a family home, in one in the city centre and in the other a suburb, in one we worshipped in the cathedral and in the other a local, lively parish church, in one we looked at the city centre from a harbour launch and in the other from a bicycle. Both satisfy, both are superb cities with immense virtues.
We arrived in Sydney from Brisbane, buoyed up by the professional and personal aspects of our visit. We were driven to the club, a few hundred yards from the opera house and after unpacking we set off. We looked around on of the most impressive cityscapes in the world, thronging with people and with a bewildering number of weddings on attractive vantage points, all seeking the bridge and the opera house as their backdrop. We strolled round the harbour and wandered across the bridge, in the cooling early evening, then took a ferry to Darling Harbour so we could check out the conference venue. Then after a waterside supper we went to bed in the club. The next morning I jogged in the park, seeking the view of the opera house and bridge that has graced so many post cards and formed the backdrop to Saturday’s weddings. Then we went to church, I had long wanted to visit Sydney’s Anglican Cathedral and we were not disappointed, the service was fairly traditional and the message good expository preaching, the welcome afterwards was generous and warm.
Then we took off to register for Jane’s hand conference, booked on a harbour cruise and saw the harbour from the water, with a commentary which was pretty informative but contained much that was salacious and more appropriate to the columns of “Hello” magazine. Then we had the opening ceremony for the conference, in which the collection of performances were truly memorable, finger silhouettes to virtuoso trumpet playing, followed by an opportunity to network.
The following evening we went to the opera, to hear and see La Traviata. The opera house is intimate; we had excellent seats and witnessed a great performance, greatly aided by the surtitles. After this extraordinary two days anticlimax could be expected, but happily we jumped from one high point to another, a memorable supper “a deux” on the harbour, with that memorable backdrop, a stroll to the rocky headland at the entrance to Sydney harbour, a phone call to the son of my original mentor in ENT, and visiting our latest Australian Registrar and his five day old baby.
After this how could Melbourne compete? It did by being different. From the moment that we were met by Gill Austin at the airport we were surfed on a wave of love and friendship. A trip to Phillip Island, to swim, have tea, see Wallabies and picnic in a prime position before seeing the fairy penguins make their way across the shore. These little chaps are about 30 cm in height and spend the day fishing in the waters, at dusk they come crashing out of the waves, form up in small groups called rafts and wait for a safe moment to cross the beach and get home to their burrows, which are scattered throughout the sand dunes. However they complicate this simple task by imagining that there are all sorts of demons which are out to get them. As they gather, and prepare for the waddle, one will lose their nerve and retreat into the waves, they all follow. The craven is a more compelling leader than the brave. Eventually several hundred made the trip, but not after some had had several false starts and indeed one group needed the guidance of one who had made the journey already before they ventured across the sandy foreshore.
The next day started with a leisurely breakfast and then a trip into town by tram, which took us to the centre of town and we were able to go up the second highest building to look at the city from the observation deck. This view gives the orientation and the scale, but in the brown of a prolonged drought, with the widespread traces of industry peppering the landscape, it does not show the townscape to its best advantage.
After lunch I scuttled to the College of surgeons to meet with john Collins, the Dean, an affable and committed man, he has a clear idea of the educational needs of the young surgeons in Australasia. I was able to get fully up to speed, meet with Jane and Gilly scoot round the town again before John and his wife Jenny took us out to supper. They lived in an elegant city centre flat, with a uninterrupted view over the nearby park and university, interestingly showing the townscape to great advantage!
The next day it was the Yarra and bicycles. It was the way to see Melbourne and its surrounds. We were reminded that there was a great televisula event taking place that weekend with the unceasing hum of fast cars from the Grand Prix circuit at Albert Park. It is quite clear that Melbourne is committed to sporting endeavour as there are sports stadiums of world renown, within minutes of the centre of town, the Melbourne Cricket Ground, the Rod Laver Stadium and the Grand Prix Circuit, amongst others, being within half a mile of each other. I used to think that living within half an hour of Lords, Wembley, Twickenham, Wimbledon, Ascot and Henley put me in the centre of the sporting universe, now I am not so sure!
The thing about cycling is that you can cover enough ground to see beyond the obvious and you can stop anywhere. We used a “punt”, a small motorised flat bottomed boat, with no concessions to safety, which was hailed by waving a broken flag. If w had stumbled across it on the Zambezi we would have wondered about its safety, as it was we paid our three dollars (one way, no returns and no timetable) without a murmur. That evening we all went to a talk on service in Cambodia, for which I spent most of the time awake!
It was great to go to church with Gilly and Bill on the Sunday, a joyous service with clear preaching and a real sense of fellowship. Lunch was the traditional Barbie, steak and chicken, followed by a Koala watch in the gum trees near their home.
What a great few days, it has really helped us understand why people are so happy here. Our next move is Adelaide and other old friends, Bill and Ros Hague.
Tuesday, March 13, 2007
Queensland a special experience
The flight from Cairns to Brisbane is simple, picking up the car was simple and driving across town to arrive at the Blacks was uincomplicated, we arrived on the dot of four, like a Swiss train.
Professionally my time in Brisbane was relaxed but useful. I met some of the leaders in surgical education, not least my host who is the Chairman of ENT in Australia at present. I also spent a couple of half days with Rob Hodge, he and I had been senior registrars at Mary's together in 1981-3. I met with Bill Coman who has mentored many of our Oxford trainees over the years. In fact Rob H and Bill C have been responsible for the advanced training of over twenty UK consultants, we are in their debt. On the whole they have been very successful, and it is interesting that the only concerns they have had are where shared those concerns too. The head and neck clinics were well structured and well, but differently, chaired. The conclusions on the complex and challenging problems were humane, the decisions on the straightforward in line with good evidence based practice. many years ago whn I was a fellow in San Francisco, I saw similar clinics, there is much to be gained for the patient in being considered by many, amongst many.
On a personal note we had a great time. Rob B and Ann were wonderful hosts, generous and thoughtful. They put us in their "shed", an air conditioned studio, with a shower room and kitchenette, giving on to the swimming pool. A tough life for the travellers! Though we were given our own space we were not banished and ate with them and their family, ate with friends (the Hodges and Perrys, a sample of Mary's and Royal Free senior registrars from the early 80's) and ate out. Eating out with those who know, does mean you get excellent food.
We also looked at and around Brisbane. even though we had a small and very good car, the best way to see Brisbane is by public transport, a four dollar plus ticket lasts the whole day and takes you everywhere, on the train, on the buses (superb new bus lanes) and on the river. So we saw what the tourist should see, the historic buildings (not many), the botanic gardens (two), the shops (plenty), the river, the galleries and the city centre beach. We ventured out to Surfers Paradise and Tambourine mountain.
There has been much to learn, professionally and personally. But as this trip is teaching us learning is not just knowing, it is doing.
Professionally my time in Brisbane was relaxed but useful. I met some of the leaders in surgical education, not least my host who is the Chairman of ENT in Australia at present. I also spent a couple of half days with Rob Hodge, he and I had been senior registrars at Mary's together in 1981-3. I met with Bill Coman who has mentored many of our Oxford trainees over the years. In fact Rob H and Bill C have been responsible for the advanced training of over twenty UK consultants, we are in their debt. On the whole they have been very successful, and it is interesting that the only concerns they have had are where shared those concerns too. The head and neck clinics were well structured and well, but differently, chaired. The conclusions on the complex and challenging problems were humane, the decisions on the straightforward in line with good evidence based practice. many years ago whn I was a fellow in San Francisco, I saw similar clinics, there is much to be gained for the patient in being considered by many, amongst many.
On a personal note we had a great time. Rob B and Ann were wonderful hosts, generous and thoughtful. They put us in their "shed", an air conditioned studio, with a shower room and kitchenette, giving on to the swimming pool. A tough life for the travellers! Though we were given our own space we were not banished and ate with them and their family, ate with friends (the Hodges and Perrys, a sample of Mary's and Royal Free senior registrars from the early 80's) and ate out. Eating out with those who know, does mean you get excellent food.
We also looked at and around Brisbane. even though we had a small and very good car, the best way to see Brisbane is by public transport, a four dollar plus ticket lasts the whole day and takes you everywhere, on the train, on the buses (superb new bus lanes) and on the river. So we saw what the tourist should see, the historic buildings (not many), the botanic gardens (two), the shops (plenty), the river, the galleries and the city centre beach. We ventured out to Surfers Paradise and Tambourine mountain.
There has been much to learn, professionally and personally. But as this trip is teaching us learning is not just knowing, it is doing.
Tuesday, March 6, 2007
The Great Barrier Reef
One of the privileges of this trip has been the opportunity to see sights which we have longed wanted to see. It must have been in the late fifies as a small boy in Malaya that I first saw a film of the “Great Barrier Reef”, what majesty, what a thrill to be able to see something so magical.
Well fifty years on, we did. We arrived in the pleasant resort of Port Douglas and booked into our “Boutique” Hotel, this increasingly used epithet means a small hotel independently run. We had a pleasant suite overlooking the magnificent four mile beach, forgive the slight hyperbole, we could see the sea, palm trees and a small section of beach from our balcony.
We had booked in for a four day stay, half way through our unfolding odyssey. On the first afternoon we joined a small river craft and steamed up the estuary on a crocodile hunt, we saw where the crocodile was nesting but saw none, though we did see several raptors, eagles, osprey and learned about mangroves.
The next day bode stormy so we avoided the reef and set off to the rainforest habitat on bicycles. Damp but successful, we saw many indigenous birds, several crocodiles and an abundance of marsupials all set in a sympathetic and easily accessible environment. This was followed by a cycle ride on the four mile beach and a quick sortie into the large and internationally famous hotel resort just out of town. Then sitting round the pool and romantic walk on the palm girt strand in the evening seeing the beautiful sunset..
Then, the reef. We had decided to use the biggest operator; Quicksilver, as they gave the most options, and would not be a wash out if the weather was difficult. We enlisted for the adventure snorkel, a masterly move. The reef is about an hour from the shore in the massive and speedy catamaran “wave piercer”. We were ushered off through our own private exit and loaded on to an open boat, by which we were sped to the diving and snorkelling spot. We were given sound equipment, and led off to an underground coral mountain, favoured by barracuda, a “barracuda bommie” in the local argot. Then off to the reef a few yards away, this is a mesmerising kaleidoscope of colours, coral and fish of every different shade and hue, size and texture all blended into a living tapestry, beyond description. Time sped by and we were soon back on the boat, quick (but very good lunch) before an outing in the semi submersible, twenty minutes of viewing the fish with a commentary in the dry. Ths was followed by another snorkel this time just out from the platform, guided by one of our party on the morning’s expedition. Every moment was spent happily looking at fish and coral, what a delight!
The next day we planned a short outing to the rain forest, were picked up from our hotel and set off. The path was simple, the forest magnificent and well interpreted by the occasional sign, It was transformed by the swimming which we able to do in two rock pools, one small and private, and the other large and picturesque.
Then we returned to the hotel for admin, swims (sea and pool) and an attempt to see the sunset from the port, thwarted by dense clouds. However this meant we were in the right position to claim the last unbooked table at one of the best restaurants in town and have a superb meal. Meals are a problem on this type of trip, one gets a bit fed up with eating out night after night (believe me!). So for two of the nights in Port Douglas we used the excellent kitchen in our suite and prepared a salad, eaten “a deux” on our sea view balcony, after wine and cashews.
Another recurring challenge is to find a church service, theologically acceptable ( the only reason for this is that it is not helpful to come out of a church so critical of them that the point of the worship is lost), and timed to fit in with travelling and other inescapable commitments. We have been pretty successful, and were in Port Douglas. There was a church which met in the community hall, was lively and friendly. So we joined them after a walk on the beach, a swim and packing, but just before we had to leave for Cairns and our flight to Brisbane.
Then travelling, arriving at the expected time with Rob and Ann Black, old friend and colleague from the Royal Free. They have a shed in their garden, air-conditioned and with bathroom, kitchenette and internet access (what a fortunate life!). Jane and I are installed for the week.
One of the privileges of this trip has been the opportunity to see sights which we have longed wanted to see. It must have been in the late fifies as a small boy in Malaya that I first saw a film of the “Great Barrier Reef”, what majesty, what a thrill to be able to see something so magical.
Well fifty years on, we did. We arrived in the pleasant resort of Port Douglas and booked into our “Boutique” Hotel, this increasingly used epithet means a small hotel independently run. We had a pleasant suite overlooking the magnificent four mile beach, forgive the slight hyperbole, we could see the sea, palm trees and a small section of beach from our balcony.
We had booked in for a four day stay, half way through our unfolding odyssey. On the first afternoon we joined a small river craft and steamed up the estuary on a crocodile hunt, we saw where the crocodile was nesting but saw none, though we did see several raptors, eagles, osprey and learned about mangroves.
The next day bode stormy so we avoided the reef and set off to the rainforest habitat on bicycles. Damp but successful, we saw many indigenous birds, several crocodiles and an abundance of marsupials all set in a sympathetic and easily accessible environment. This was followed by a cycle ride on the four mile beach and a quick sortie into the large and internationally famous hotel resort just out of town. Then sitting round the pool and romantic walk on the palm girt strand in the evening seeing the beautiful sunset..
Then, the reef. We had decided to use the biggest operator; Quicksilver, as they gave the most options, and would not be a wash out if the weather was difficult. We enlisted for the adventure snorkel, a masterly move. The reef is about an hour from the shore in the massive and speedy catamaran “wave piercer”. We were ushered off through our own private exit and loaded on to an open boat, by which we were sped to the diving and snorkelling spot. We were given sound equipment, and led off to an underground coral mountain, favoured by barracuda, a “barracuda bommie” in the local argot. Then off to the reef a few yards away, this is a mesmerising kaleidoscope of colours, coral and fish of every different shade and hue, size and texture all blended into a living tapestry, beyond description. Time sped by and we were soon back on the boat, quick (but very good lunch) before an outing in the semi submersible, twenty minutes of viewing the fish with a commentary in the dry. Ths was followed by another snorkel this time just out from the platform, guided by one of our party on the morning’s expedition. Every moment was spent happily looking at fish and coral, what a delight!The next day we planned a short outing to the rain forest, were picked up from our hotel and set off. The path was simple, the forest magnificent and well interpreted by the occasional sign, It was transformed by the swimming which we able to do in two rock pools, one small and private, and the other large and picturesque.
Then we returned to the hotel for admin, swims (sea and pool) and an attempt to see the sunset from the port, thwarted by dense clouds. However this meant we were in the right position to claim the last unbooked table at one of the best restaurants in town and have a superb meal. Meals are a problem on this type of trip, one gets a bit fed up with eating out night after night (believe me!). So for two of the nights in Port Douglas we used the excellent kitchen in our suite and prepared a salad, eaten “a deux” on our sea view balcony, after wine and cashews.
Another recurring challenge is to find a church service, theologically acceptable ( the only reason for this is that it is not helpful to come out of a church so critical of them that the point of the worship is lost), and timed to fit in with travelling and other inescapable commitments. We have been pretty successful, and were in Port Douglas. There was a church which met in the community hall, was lively and friendly. So we joined them after a walk on the beach, a swim and packing, but just before we had to leave for Cairns and our flight to Brisbane.
Then travelling, arriving at the expected time with Rob and Ann Black, old friend and colleague from the Royal Free. They have a shed in their garden, air-conditioned and with bathroom, kitchenette and internet access (what a fortunate life!). Jane and I are installed for the week.
Monday, February 26, 2007
New Zealand
New Zealand
The flight from San Francisco was long, untroubled and only physiologically three hours difference in time, despite a lost day. Auckland was sleepy and warm when we arrived and had a traffic free drive to the Peace and Plenty Inn, a charming bed and breakfast, on the waterside at Devonport. This suburb is just over the harbour from the main city and so travelling in is rather fun and very quick by the Fuller’s ferry which docks a couple of hundred metres from our Auckland abode.
So restful was the place that we settled here for all our Auckland time, now I am sitting in the garden amongst the ferns, alongside the goldfish pond with the cicadas energetically noisy. The breakfasts are a treat, on the sun kissed balcony eating Belgian waffles, syrup and bacon with a cornucopia of fruit: melon, pineapple, blueberry, pomegranate, raspberry, grape, cherry, banana and, of course, kiwi fruit all crowded on to my plate this morning. The coffee, a NZ enthusiasm is locally blended and perfectly delicious.
The modern traveller, equipped with computer and Skype telephone, cannot rest until they are on line, so here sitting in the garden typing away, wirelessly connected to the world this modern traveller is content.
Well what of the country? It is beautiful, crowded around Auckland (one third of the country’s population lives within twenty miles of the city centre) and surrounded by sea, oceans, inlets, bays, peninsulas and islands which are the backdrop to the rolling and sometimes mountainous terrain. We spent the weekend at the Bay of Islands, the site of the initial contact that the west, in the person of Captain Cook and the Endeavour had with the Maoris. This beautiful seascape had an adventurous past and was once the main port of call from all voyages in the south Pacific, for re-victualling and repair. The abundance of Kauri (a large evergreen tree, native to New Zealand that has oval leaves and is valued for its strong timber. Latin name: Agathis australisthis) and flax (for making rope) meant that the 19th century sailing ships could undertake running repairs as well as trade.
In Russell the bed and breakfast we stayed in had matchless views across the bay, much enjoyed when we had a “sun downer” with our host, before setting off to a pleasant meal overlooking the now moonlit bay.
The highlight of our stay was a trip in the R Tucker Thompson, a tall ship, in the historic design of a North West American Halibut Schooner. We sailed , and motored, around the bay and were privileged to have a couple of representatives of the NZ Historic Places Trust, who gave us enthusiastic and detailed accounts of the happenings around the bay in the late 18th and early 19th century.
I have not lost sight of the purpose of this journey, and last week spent a profitable three days in Melbourne, guest of the Royal Australasian College of Surgeons. I was privileged to be admitted to their inner councils and see something of their governance. I was impressed by their ability to be forthright and courteous at the same time. Much of what they are doing in Surgical Education mirrors our efforts and one of the benefits of a journey such as mine is that you can see various solutions, some which might transfer to different cultures.
Meeting colleagues in NZ has been a joy; they are hospitable, relaxed and purposeful. They are conscious of being able to do a great and worthwhile job in a beautiful country, of which they are very proud. The trainees I have met are like all trainees, courteous, loyal and have a different take on the changes that are being carried through. In NZ they are adopting a single entry point to surgical training, so that if someone wants to embark on a surgical career and hey apply and are accepted they should finish, provided they cross the relevant hurdles. The essence of this is humane. It is clearly unfair to recruit two surgical hopefuls to junior posts and only to allow one to progress, however good the one who has to find an alternative career path is. However the transition has delivered some rough justice and the trainees I spoke to ere unhappy that a couple of their colleagues, of whom they thought highly had to seek training in another specialty, despite the time the they had already committed to a surgical career.
Tomorrow it is proper holiday and Port Douglas in Northern Queensland.
The flight from San Francisco was long, untroubled and only physiologically three hours difference in time, despite a lost day. Auckland was sleepy and warm when we arrived and had a traffic free drive to the Peace and Plenty Inn, a charming bed and breakfast, on the waterside at Devonport. This suburb is just over the harbour from the main city and so travelling in is rather fun and very quick by the Fuller’s ferry which docks a couple of hundred metres from our Auckland abode.
So restful was the place that we settled here for all our Auckland time, now I am sitting in the garden amongst the ferns, alongside the goldfish pond with the cicadas energetically noisy. The breakfasts are a treat, on the sun kissed balcony eating Belgian waffles, syrup and bacon with a cornucopia of fruit: melon, pineapple, blueberry, pomegranate, raspberry, grape, cherry, banana and, of course, kiwi fruit all crowded on to my plate this morning. The coffee, a NZ enthusiasm is locally blended and perfectly delicious.
The modern traveller, equipped with computer and Skype telephone, cannot rest until they are on line, so here sitting in the garden typing away, wirelessly connected to the world this modern traveller is content.
Well what of the country? It is beautiful, crowded around Auckland (one third of the country’s population lives within twenty miles of the city centre) and surrounded by sea, oceans, inlets, bays, peninsulas and islands which are the backdrop to the rolling and sometimes mountainous terrain. We spent the weekend at the Bay of Islands, the site of the initial contact that the west, in the person of Captain Cook and the Endeavour had with the Maoris. This beautiful seascape had an adventurous past and was once the main port of call from all voyages in the south Pacific, for re-victualling and repair. The abundance of Kauri (a large evergreen tree, native to New Zealand that has oval leaves and is valued for its strong timber. Latin name: Agathis australisthis) and flax (for making rope) meant that the 19th century sailing ships could undertake running repairs as well as trade.
In Russell the bed and breakfast we stayed in had matchless views across the bay, much enjoyed when we had a “sun downer” with our host, before setting off to a pleasant meal overlooking the now moonlit bay.
The highlight of our stay was a trip in the R Tucker Thompson, a tall ship, in the historic design of a North West American Halibut Schooner. We sailed , and motored, around the bay and were privileged to have a couple of representatives of the NZ Historic Places Trust, who gave us enthusiastic and detailed accounts of the happenings around the bay in the late 18th and early 19th century.
I have not lost sight of the purpose of this journey, and last week spent a profitable three days in Melbourne, guest of the Royal Australasian College of Surgeons. I was privileged to be admitted to their inner councils and see something of their governance. I was impressed by their ability to be forthright and courteous at the same time. Much of what they are doing in Surgical Education mirrors our efforts and one of the benefits of a journey such as mine is that you can see various solutions, some which might transfer to different cultures.
Meeting colleagues in NZ has been a joy; they are hospitable, relaxed and purposeful. They are conscious of being able to do a great and worthwhile job in a beautiful country, of which they are very proud. The trainees I have met are like all trainees, courteous, loyal and have a different take on the changes that are being carried through. In NZ they are adopting a single entry point to surgical training, so that if someone wants to embark on a surgical career and hey apply and are accepted they should finish, provided they cross the relevant hurdles. The essence of this is humane. It is clearly unfair to recruit two surgical hopefuls to junior posts and only to allow one to progress, however good the one who has to find an alternative career path is. However the transition has delivered some rough justice and the trainees I spoke to ere unhappy that a couple of their colleagues, of whom they thought highly had to seek training in another specialty, despite the time the they had already committed to a surgical career.
Tomorrow it is proper holiday and Port Douglas in Northern Queensland.
Sunday, February 18, 2007
More from California
Travelling surgeon
It is a glorious evening in San Francisco. Jane and I have left the Merzenich’s and are waiting to start the next part of our journey, to Auckland.
We really enjoyed revisiting California, where I had been a research fellow twenty three years ago. Much was the same. Some of what was unusual then has become commonplace in English society, we are much more informal than we were quarter of a century ago, we use disposable utensils for our eating away from home, we use the mobile in the street and we say “enjoy”! – or at least some of us do! However on the financial side we did note a difference: when we were here in the early 80’s the dollar was nearly worth a pound, now a dollar is worth just over 50 cents.
I had planned a slightly less intense time in California, so we could spend some time together and could visit my aunt and uncle in Santa Barbara., and with Mike and Diane. All four have been most generous to us, now as then.
My aunt and uncle are in their early eighties, have had their share of maladies (some interesting and challenging) but both approach life with zest and vigour. We arrived at dusk and were immediately whisked downtown to a crowded steak house, so crowded that we left and had a Chinese meal, returning for our steak on the following evening. We spent a couple of hours going through family photos before lunch the next day. These times are invaluable, because they give you a perspective on your lot in life, and in my case make me reflect how fortunate I have been. Then a walk with my uncle, we were all for telling him not to exert himself, but we would have been denied a great walk if we had succeeded. Like most people who know an area well, the walk was perfectly judged, Jane and I would not have done it on our own. We walked around the estate of a rich man, that is we circumnavigated it. I mention this as we did the same the next day, when we visited Hearst castle.
We decided to drive up Highway 1, the wonderfully scenic and sometime precipitate California highway that hugs the coast of the state, and gives a splendid view of the Pacific, as it belies its name and crashes into the seashore. Hearst castle was interesting, it was out of our reach when we were here with the family. You are boarded on a bus and taken up the five miles to the “ranch”, more like a small Italian hilltop town, with several villas (guest houses) and the cathedral or parish church, in this case the main house, complete with two bell towers. The swimming pools are pure fancy, with reconstructed Roman and Greek remains built into a pastiche of the ancient world, which works surprisingly well. The house itself was impressive, and the magpie collection of innumerable valuables in none generation, which then stopped, was fascinating. However without the story, this part was less impressive, we are fortunate in having dozens of stately homes in England, some enormous and internationally known, some only locally known but none the less impressive, with large rooms and the evidence of one or more energetic and acquisitive owner. We watched the film, and were thoroughly immersed in the life of William Randolph Hearst.
Our day was finished in Carmel, the small town just to the south of Monterey that is the home of film stars and the haunt of golfers, Pebble Beach lying just to the north. When we came they had just said goodbye to a great number of people following a golf tournament. We had stayed at a pretty little in 10 years ago and it was still there, with a room and ideal in every way (or almost, breakfast was served in disposable cups and plates).
All the rest of the time we spent with Mike and Diane. Mike is a neuroscientist, who was originally involved in the cochlear implant project but has moved to more central disorders of the brain. He is awash with ideas, energy and goodwill. Part of his current life involves developing the small holding which he and Diane have, about an hour out of San Francisco. They have a very productive kitchen garden and orchard, beehive and a vineyard. We visited this just before we left, and were most impressed, it is in a lovely spot, with uninterrupted views over the Bennet valley (near Sonoma, California wine country) perched on a hillside, with terraces, a small, wood, a creek, a swimming pool and most rewarding of all the signs of active grand-parenting wherever you look!
The remainder of the time we lived in their small guest annex in their San Francisco.
The whole episode was a wonderful demonstration of friendship and generosity.
Arrived Auckland, more sun, more charm and more excitement!
It is a glorious evening in San Francisco. Jane and I have left the Merzenich’s and are waiting to start the next part of our journey, to Auckland.
We really enjoyed revisiting California, where I had been a research fellow twenty three years ago. Much was the same. Some of what was unusual then has become commonplace in English society, we are much more informal than we were quarter of a century ago, we use disposable utensils for our eating away from home, we use the mobile in the street and we say “enjoy”! – or at least some of us do! However on the financial side we did note a difference: when we were here in the early 80’s the dollar was nearly worth a pound, now a dollar is worth just over 50 cents.
I had planned a slightly less intense time in California, so we could spend some time together and could visit my aunt and uncle in Santa Barbara., and with Mike and Diane. All four have been most generous to us, now as then.
My aunt and uncle are in their early eighties, have had their share of maladies (some interesting and challenging) but both approach life with zest and vigour. We arrived at dusk and were immediately whisked downtown to a crowded steak house, so crowded that we left and had a Chinese meal, returning for our steak on the following evening. We spent a couple of hours going through family photos before lunch the next day. These times are invaluable, because they give you a perspective on your lot in life, and in my case make me reflect how fortunate I have been. Then a walk with my uncle, we were all for telling him not to exert himself, but we would have been denied a great walk if we had succeeded. Like most people who know an area well, the walk was perfectly judged, Jane and I would not have done it on our own. We walked around the estate of a rich man, that is we circumnavigated it. I mention this as we did the same the next day, when we visited Hearst castle.
We decided to drive up Highway 1, the wonderfully scenic and sometime precipitate California highway that hugs the coast of the state, and gives a splendid view of the Pacific, as it belies its name and crashes into the seashore. Hearst castle was interesting, it was out of our reach when we were here with the family. You are boarded on a bus and taken up the five miles to the “ranch”, more like a small Italian hilltop town, with several villas (guest houses) and the cathedral or parish church, in this case the main house, complete with two bell towers. The swimming pools are pure fancy, with reconstructed Roman and Greek remains built into a pastiche of the ancient world, which works surprisingly well. The house itself was impressive, and the magpie collection of innumerable valuables in none generation, which then stopped, was fascinating. However without the story, this part was less impressive, we are fortunate in having dozens of stately homes in England, some enormous and internationally known, some only locally known but none the less impressive, with large rooms and the evidence of one or more energetic and acquisitive owner. We watched the film, and were thoroughly immersed in the life of William Randolph Hearst.
Our day was finished in Carmel, the small town just to the south of Monterey that is the home of film stars and the haunt of golfers, Pebble Beach lying just to the north. When we came they had just said goodbye to a great number of people following a golf tournament. We had stayed at a pretty little in 10 years ago and it was still there, with a room and ideal in every way (or almost, breakfast was served in disposable cups and plates).
All the rest of the time we spent with Mike and Diane. Mike is a neuroscientist, who was originally involved in the cochlear implant project but has moved to more central disorders of the brain. He is awash with ideas, energy and goodwill. Part of his current life involves developing the small holding which he and Diane have, about an hour out of San Francisco. They have a very productive kitchen garden and orchard, beehive and a vineyard. We visited this just before we left, and were most impressed, it is in a lovely spot, with uninterrupted views over the Bennet valley (near Sonoma, California wine country) perched on a hillside, with terraces, a small, wood, a creek, a swimming pool and most rewarding of all the signs of active grand-parenting wherever you look!
The remainder of the time we lived in their small guest annex in their San Francisco.
The whole episode was a wonderful demonstration of friendship and generosity.
Arrived Auckland, more sun, more charm and more excitement!
Tuesday, February 6, 2007
A tale of two centres
Chicago and Toronto are two major North American cities, both with several University teaching hospitals. In Chicago I visited Northwestern and in Toronto the University Hospital Network, the several teaching hospitals in Toronto working together.
What strikes you as you enter them is the considerable local philanthropy which has gone to build them. The buildings are all named after local benefactors, whose name does not necessarily have world wide resonance, Galter in Chicago and Eaton in Toronto are both people of local rather than worldwide renown.
It is also apparent that North America views health care with great seriousness. They are both impressive medical complexes, with space for patients and for teaching. They have both made considerable investments in surgical education, both at under and postgraduate level. Both have well resourced, charismatically led surgical skills centres and both let me have an office for my stay!
In both I met a whole series of committed clinicians, research scientists and teachers, who gave generously of their time and expertise. In both I was fed copiously!
In both the leader is one of the major players in surgical education in North America. In fact there is a foursome, renowned as the main initiators of surgical education, Richard Reznik in Toronto and Debra Da Rosa at Northwestern, as well as Ajit Sachdeva in Chicago at the American College of Surgeons (right next to Northwestern) and Gary Dunnington at Southern Illinois. They have all inspired each other and all worked together on the Surgeons as Educators programme. All were extremely welcoming and all gave me an inspired view of their units.
In Chicago, I spent three hectic days looking at and listening to the scope of the programme. I met the main teachers and the researchers and was allowed to try their simulators, meet their residents and speak to the main players. They have some interesting ideas, they have created an apprenticeship scheme, whereby a trainee is attached to a trainer for a couple of months and does everything with them, this sits alongside the normal programme which fill the rest of the time. I saw a talented trainee at the end of their training being taken through a complex operation (a pancreatectomy), both trainer and trainee filled you with confidence, this was an operation done with tempo and clarity, each step was discussed before execution. The student who was second assistant was expected to know the anatomy and physiology, and did!
I then spent half a day at the American college of surgeons, where they very kindly put on a seminar for me outlining the work that they were doing. They have great energy and address problems with panache.
The University of Toronto had three facilities associated with education, the Wilson Centre primarily concerned with educational research, the Skills lab for surgical skills simulation and the Faculty development unit which was concerned with faculty development. I spent time in all three, and all gave me plenty of ideas of how we might do things. The skills lab was used by first year trainees every week as in SIU and they had a clearly structured programme to follow, with six faculty teaching week by week. The Faculty development unit ran courses for teachers, but in the main had only managed to recruit surgical trainers who were in difficulty. There is a case, as back home, to use development resources for all staff, good and bad. Then I was told about the regular evaluation that went on for the faculty. They were all told how they performed on a regular basis and this was particularly helpful for the struggling trainer. As usual it was not as simple as that, and one of the faculty told me how demotivating it was to receive moderate reviews (you are the 52 most popular trainer!) and we both agreed that feedback needs to be distilled rather than given raw!
Both had rigorous assessment programmes, involving local and national tools. There was several knowledge based tests that all the trainees undertook, there were clinical skills vivas , which were fairly structured. They both used OSCEs (Objective Structured Clinical Examinations) and OSATS (Objective Structured Assessment of Technical Skills).
There was much to admire and plenty to adopt at both places. Thanks to all my hosts for their kindness and concern.
Main points to be considered for use in the Oxford Programme:
Recruit theatre nurses to run surgical skills lab
Recruit nurse educators to help deliver training, for students preparing for surgery and residents.
Have regular surgical skills training, rather than separate courses
Consider part of a trainees training as an apprentice to a particularly good teacher
Develop faculty, encourage sharing of ideas as the best way to teach surgery
Now for Stanford and the University of California San Francisco.
Chicago and Toronto are two major North American cities, both with several University teaching hospitals. In Chicago I visited Northwestern and in Toronto the University Hospital Network, the several teaching hospitals in Toronto working together.
What strikes you as you enter them is the considerable local philanthropy which has gone to build them. The buildings are all named after local benefactors, whose name does not necessarily have world wide resonance, Galter in Chicago and Eaton in Toronto are both people of local rather than worldwide renown.
It is also apparent that North America views health care with great seriousness. They are both impressive medical complexes, with space for patients and for teaching. They have both made considerable investments in surgical education, both at under and postgraduate level. Both have well resourced, charismatically led surgical skills centres and both let me have an office for my stay!
In both I met a whole series of committed clinicians, research scientists and teachers, who gave generously of their time and expertise. In both I was fed copiously!
In both the leader is one of the major players in surgical education in North America. In fact there is a foursome, renowned as the main initiators of surgical education, Richard Reznik in Toronto and Debra Da Rosa at Northwestern, as well as Ajit Sachdeva in Chicago at the American College of Surgeons (right next to Northwestern) and Gary Dunnington at Southern Illinois. They have all inspired each other and all worked together on the Surgeons as Educators programme. All were extremely welcoming and all gave me an inspired view of their units.
In Chicago, I spent three hectic days looking at and listening to the scope of the programme. I met the main teachers and the researchers and was allowed to try their simulators, meet their residents and speak to the main players. They have some interesting ideas, they have created an apprenticeship scheme, whereby a trainee is attached to a trainer for a couple of months and does everything with them, this sits alongside the normal programme which fill the rest of the time. I saw a talented trainee at the end of their training being taken through a complex operation (a pancreatectomy), both trainer and trainee filled you with confidence, this was an operation done with tempo and clarity, each step was discussed before execution. The student who was second assistant was expected to know the anatomy and physiology, and did!
I then spent half a day at the American college of surgeons, where they very kindly put on a seminar for me outlining the work that they were doing. They have great energy and address problems with panache.
The University of Toronto had three facilities associated with education, the Wilson Centre primarily concerned with educational research, the Skills lab for surgical skills simulation and the Faculty development unit which was concerned with faculty development. I spent time in all three, and all gave me plenty of ideas of how we might do things. The skills lab was used by first year trainees every week as in SIU and they had a clearly structured programme to follow, with six faculty teaching week by week. The Faculty development unit ran courses for teachers, but in the main had only managed to recruit surgical trainers who were in difficulty. There is a case, as back home, to use development resources for all staff, good and bad. Then I was told about the regular evaluation that went on for the faculty. They were all told how they performed on a regular basis and this was particularly helpful for the struggling trainer. As usual it was not as simple as that, and one of the faculty told me how demotivating it was to receive moderate reviews (you are the 52 most popular trainer!) and we both agreed that feedback needs to be distilled rather than given raw!
Both had rigorous assessment programmes, involving local and national tools. There was several knowledge based tests that all the trainees undertook, there were clinical skills vivas , which were fairly structured. They both used OSCEs (Objective Structured Clinical Examinations) and OSATS (Objective Structured Assessment of Technical Skills).
There was much to admire and plenty to adopt at both places. Thanks to all my hosts for their kindness and concern.
Main points to be considered for use in the Oxford Programme:
Recruit theatre nurses to run surgical skills lab
Recruit nurse educators to help deliver training, for students preparing for surgery and residents.
Have regular surgical skills training, rather than separate courses
Consider part of a trainees training as an apprentice to a particularly good teacher
Develop faculty, encourage sharing of ideas as the best way to teach surgery
Now for Stanford and the University of California San Francisco.
Tuesday, January 30, 2007
Springfield
I had an outstandingly rewarding visit to Southern Illinois University(SIU), greeted warmly by Reed Williams and taken to my hotel, the Abraham Lincoln. Springfield is the birth pace of one of America’s most loved presidents and you cannot move more than ten yards without being reminded of this!
We had a very pleasant dinner in the country club, with Gary Dunnington, clearly the boss, Debra Klamen a charming psychiatrist in charge of teaching in the medical school, Stephanie Donnelly a trauma surgeon and an education fellow from the Mayo Clinic, David Rogers a paediatric surgeon with a special interest in teaching and Reed. Reed is a quiet man with a PhD in education who has an attachment to the surgical division, he fulfils the same sort of role as Debra de Rosa in Northwestern.
The next day dawned early (or so I thought, the American is industrious and Gary Dunnington started his elective operating in a private hospital at 7.15am. I was collected at 8.00 by Reed and taken to the Memorial Hospital. This is a six hundred bedded institution, which together with one other hospital in town serves Southern Illinois, from Chicago 200 miles to the north to St Louis, Missouri, 90 miles to the south. In the energetic style characteristic of the American, they have attracted senior staff from all over the country to help deliver their programme of training and service to their population.
I went to meet the Associate Dean, Debra Klamen who greeted me in her well equipped office (all the Americans I have met on this trip have had large offices, with conference tables). We discussed various things, including their problem based learning curriculum, widely used in N America as in many UK medical schools. At SIU, they have hybridised their PBL (one of the purposes of this trip was to pick up the jargon) with a structured teaching course that followed. I asked how she would incorporate changes into the curriculum, for example an increase in anatomical teaching. She said any changes had to be supported by data.
Then I went to the skills lab, where half a dozen medical students were doing a course in preparing them for surgical residency. This was a series of classes over a month which incorporated skills teaching and practice. They opened abdomens and made surgical airways. These were all done with a series of highly inventive low tech models, devised by the two theatre nurses who had been recruited to run the centre, Janet and Jenny. This was inspirational, because it showed how with enthusiasm, a space and dedicated personnel skill teaching could be achieved without massive capital investment. They did have a simulator but it was “down”.
After a further meeting with Reed examining the extent of the academic output of the department, I returned to the lab later and was taken through all the manuals and shown several of the models they had made. I was able to share with them the Leong and Aldren model of the artificial ear drum.
I then gave a short presentation on the state of surgical training in the UK. They are very courteous and listened with patience. We then explored how they manage their programme, and really the biggest unanswered question is how effective the skills training is. There is some evidence that it helps to identify completely unsuitable trainees and it speeds up the rate of skills acquisition
Then I met with Gary privately, in another large office. Like many surgeons he is adriven man but has created a really outstanding tertiary referral unit in “the sticks”. By his devotion to education he has brought alongside him a team of committed and likeminded individuals. Their commitment is shown by the fact that they all put 5% of their income into a communal pot and this is then divided amongst those who have put them most into education, measured by the credits that they have earned for academic activity.
Then I met the nurse educators. Margaret Boehler, and Cathy Schwind and had an inspiring hour with them. They coordinate all the training, provide support for the ready for residency programme and generally provide the glue which keeps surgical training going. They were both charming enthusiasts and believed in what they were doing.
Finally I met with Stephanie and Lesley, two research fellows in the department. Stephanie is a surgeon from the Mayo clinic and has come to evaluate the place of skills training in the training of young surgeons and Lesley a second year resident who is undertaking a masters in surgical education and has been inspired to follow in the footsteps of the medical educators that she has come across. They very kindly thought it would be good to meet off site and they took me to a quaint tea house, rambling like an un-restored 19 century vicarage in a once prosperous suburb. There were whole rack of delectable cakes and tarts, the American has an unashamedly youthful taste, and we all tucked in. They, my hosts, were lovely. They like all the other young surgeons I have met were uncomplicated in their love of their work. The resident in America earns a stipend of $30,000, less than a nurse. In m any towns they have to live in rented accommodation, though in Springfield they can buy a one bedroomed condo for as little as $50,000, and the average house price is twice that. They all have large debts at the end of their training which can take years to clear and yet they still want to be doctors!
Well what are the take home messages? The first is that any project needs clear sighted and charismatic leadership, problems can be solved in innovative ways, programmes do not just need doctors to deliver them, good ideas come from anyone and to work towards something of which you are proud will probably enhance patient care.
I had an outstandingly rewarding visit to Southern Illinois University(SIU), greeted warmly by Reed Williams and taken to my hotel, the Abraham Lincoln. Springfield is the birth pace of one of America’s most loved presidents and you cannot move more than ten yards without being reminded of this!
We had a very pleasant dinner in the country club, with Gary Dunnington, clearly the boss, Debra Klamen a charming psychiatrist in charge of teaching in the medical school, Stephanie Donnelly a trauma surgeon and an education fellow from the Mayo Clinic, David Rogers a paediatric surgeon with a special interest in teaching and Reed. Reed is a quiet man with a PhD in education who has an attachment to the surgical division, he fulfils the same sort of role as Debra de Rosa in Northwestern.
The next day dawned early (or so I thought, the American is industrious and Gary Dunnington started his elective operating in a private hospital at 7.15am. I was collected at 8.00 by Reed and taken to the Memorial Hospital. This is a six hundred bedded institution, which together with one other hospital in town serves Southern Illinois, from Chicago 200 miles to the north to St Louis, Missouri, 90 miles to the south. In the energetic style characteristic of the American, they have attracted senior staff from all over the country to help deliver their programme of training and service to their population.
I went to meet the Associate Dean, Debra Klamen who greeted me in her well equipped office (all the Americans I have met on this trip have had large offices, with conference tables). We discussed various things, including their problem based learning curriculum, widely used in N America as in many UK medical schools. At SIU, they have hybridised their PBL (one of the purposes of this trip was to pick up the jargon) with a structured teaching course that followed. I asked how she would incorporate changes into the curriculum, for example an increase in anatomical teaching. She said any changes had to be supported by data.
Then I went to the skills lab, where half a dozen medical students were doing a course in preparing them for surgical residency. This was a series of classes over a month which incorporated skills teaching and practice. They opened abdomens and made surgical airways. These were all done with a series of highly inventive low tech models, devised by the two theatre nurses who had been recruited to run the centre, Janet and Jenny. This was inspirational, because it showed how with enthusiasm, a space and dedicated personnel skill teaching could be achieved without massive capital investment. They did have a simulator but it was “down”.
After a further meeting with Reed examining the extent of the academic output of the department, I returned to the lab later and was taken through all the manuals and shown several of the models they had made. I was able to share with them the Leong and Aldren model of the artificial ear drum.
I then gave a short presentation on the state of surgical training in the UK. They are very courteous and listened with patience. We then explored how they manage their programme, and really the biggest unanswered question is how effective the skills training is. There is some evidence that it helps to identify completely unsuitable trainees and it speeds up the rate of skills acquisition
Then I met with Gary privately, in another large office. Like many surgeons he is adriven man but has created a really outstanding tertiary referral unit in “the sticks”. By his devotion to education he has brought alongside him a team of committed and likeminded individuals. Their commitment is shown by the fact that they all put 5% of their income into a communal pot and this is then divided amongst those who have put them most into education, measured by the credits that they have earned for academic activity.
Then I met the nurse educators. Margaret Boehler, and Cathy Schwind and had an inspiring hour with them. They coordinate all the training, provide support for the ready for residency programme and generally provide the glue which keeps surgical training going. They were both charming enthusiasts and believed in what they were doing.
Finally I met with Stephanie and Lesley, two research fellows in the department. Stephanie is a surgeon from the Mayo clinic and has come to evaluate the place of skills training in the training of young surgeons and Lesley a second year resident who is undertaking a masters in surgical education and has been inspired to follow in the footsteps of the medical educators that she has come across. They very kindly thought it would be good to meet off site and they took me to a quaint tea house, rambling like an un-restored 19 century vicarage in a once prosperous suburb. There were whole rack of delectable cakes and tarts, the American has an unashamedly youthful taste, and we all tucked in. They, my hosts, were lovely. They like all the other young surgeons I have met were uncomplicated in their love of their work. The resident in America earns a stipend of $30,000, less than a nurse. In m any towns they have to live in rented accommodation, though in Springfield they can buy a one bedroomed condo for as little as $50,000, and the average house price is twice that. They all have large debts at the end of their training which can take years to clear and yet they still want to be doctors!
Well what are the take home messages? The first is that any project needs clear sighted and charismatic leadership, problems can be solved in innovative ways, programmes do not just need doctors to deliver them, good ideas come from anyone and to work towards something of which you are proud will probably enhance patient care.
Sunday, January 21, 2007
The first leg has been accomplished, and I am in Chicago.
Transatlantic flight is commonplace these days, but as this is a journey of exploration it seems sensible to reflect on all its aspects. Lots of people fly, lots of people use Heathrow and O'Hare in Chicago, and the majority show humanity if you trouble to engage with them. The check in staff, the immigration officials, the security guards and your fellow passengers light up to a friendly word, a curious comment or a supportive observation.
Both Heathrow and Chicago have superb facilities cheek by jowl with tawdry examples of poor planning and poor stewardship. In Chicago, the excellent and efficient Blue Line train that speeds you into the city centre, needs a lick of paint, and some investment in the rolling stock, but boy it's inexpensive, only two dollars for the ride!
Club Quarters, where I am staying on the 33rd floor is a fine old building, on the southern bank of the Chicago river. My window looks down Michigan Avenue, the street which to the north forms the magnificent mile. It is plain and efficient. Food is provided by a charming little Italian restaurant in the lobby. The solitary traveller must beware as the portions are gargantuan, and those who started life under rationing must guard against their lifelong habit of clearing their plate!
My church in Gerrards Cross has been much influenced by Willow Creek community church, a burgeoning Christian congregation in the outer suburbs of Chicago. It is brilliantly and charismatically led by Bill Hybels, whose wisdom reaches way beyond the converted. However the visitor dependent on public transport cannot get to Barrington, the prosperous suburb where the church is situated, on a Sunday morning, even though the service startsd at 11.00 and the church is only thirty miles out of town. There is another option, just fifteen minutes walk from my lodgings (an Americanism or "Dickensism" depending on your point of view) Willow Creek have started a service in down town Chicago. This is held in the Auditorium Theatre, a 4000 seater late 19c building with near perfect acoustics. The congregation was 1200 strong and heard an inspiring sermon, relayed by video, on the place of wealth in the Christian life, lessons for us all. Like all good sermons it was littered with memorable anecdotes and personal reflection and requiring a response. An amusing illustration that I had not heard before wa that Modern Art is a conspiracy between the artists and the very rich to persuade the rest of us that we are stupid!
Then we had a snack in an adjoining hotel, where I srtuck up conversations with an accountat working for Boeing and a young man working in Real Estate.
Then a snowy walk of exploration around the city, locating Northwestern, of which more later.p
Transatlantic flight is commonplace these days, but as this is a journey of exploration it seems sensible to reflect on all its aspects. Lots of people fly, lots of people use Heathrow and O'Hare in Chicago, and the majority show humanity if you trouble to engage with them. The check in staff, the immigration officials, the security guards and your fellow passengers light up to a friendly word, a curious comment or a supportive observation.
Both Heathrow and Chicago have superb facilities cheek by jowl with tawdry examples of poor planning and poor stewardship. In Chicago, the excellent and efficient Blue Line train that speeds you into the city centre, needs a lick of paint, and some investment in the rolling stock, but boy it's inexpensive, only two dollars for the ride!
Club Quarters, where I am staying on the 33rd floor is a fine old building, on the southern bank of the Chicago river. My window looks down Michigan Avenue, the street which to the north forms the magnificent mile. It is plain and efficient. Food is provided by a charming little Italian restaurant in the lobby. The solitary traveller must beware as the portions are gargantuan, and those who started life under rationing must guard against their lifelong habit of clearing their plate!
My church in Gerrards Cross has been much influenced by Willow Creek community church, a burgeoning Christian congregation in the outer suburbs of Chicago. It is brilliantly and charismatically led by Bill Hybels, whose wisdom reaches way beyond the converted. However the visitor dependent on public transport cannot get to Barrington, the prosperous suburb where the church is situated, on a Sunday morning, even though the service startsd at 11.00 and the church is only thirty miles out of town. There is another option, just fifteen minutes walk from my lodgings (an Americanism or "Dickensism" depending on your point of view) Willow Creek have started a service in down town Chicago. This is held in the Auditorium Theatre, a 4000 seater late 19c building with near perfect acoustics. The congregation was 1200 strong and heard an inspiring sermon, relayed by video, on the place of wealth in the Christian life, lessons for us all. Like all good sermons it was littered with memorable anecdotes and personal reflection and requiring a response. An amusing illustration that I had not heard before wa that Modern Art is a conspiracy between the artists and the very rich to persuade the rest of us that we are stupid!
Then we had a snack in an adjoining hotel, where I srtuck up conversations with an accountat working for Boeing and a young man working in Real Estate.
Then a snowy walk of exploration around the city, locating Northwestern, of which more later.p
Sunday, January 14, 2007
Surgical Traveller
On 20th January I am flying to Chicago to begin a round the world tour looking at Surgical Training.
Since the late 1990s surgical training, in the UK, has undergone several necessary changes. Some of these changes were a result of the widely publicised failures of some individuals and departments to uphold the trust placed in them by the public and the government. There have also been changes in legislation which have changed the shape of the working week, no longer is the surgeon in training expected to stay on duty for over a hundred hours a week. As well as this there have been changes in society, the young doctor expects to have a life outside medicine.
The old patterns of training, where a Registrar was expected to work alongside their boss for years, as a type of apprentice, has gone. There is disappointment over this and a scepticism about the alternatives, a programme based training programme.
However elsewhere they have long recognised that training can be delivered in a programmed mannner, but it needs careful and constructive management.
I have long wanted to see how training was delivered elsewhere, and with the help of Jonathan Meakins, Nuffield Professor of Surgery, Oxford, and several old friends around the world, I put a trip together.
In outline it is as follows:
22nd January Chicago: Northwestern University, American College of Surgeons, University of Southern Illinois
29th January Toronto, Wilson Centre, The University of Toronto.
5th February Stanford
12th February University of California, San Francisco (where I was a research fellow in the 1980s)
19th February Auckland (20-22 Royal Australasian College of Surgeons, Melbourne)
28th February Port Douglas (holiday!)
4th March Brisbane
10th March Sydney
15th March Melbourne
19th March Adelaide
28th March Blantyre, Malawi
5th April Nairobi
10th April London
It is around the world in 80 days, provided Swiss Airways manages to keep to schedule on the final leg of the journey!
Tony Jefferis
Sunday 14th January 2007
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