Playing Catch Up Again...

--Tent in front of the old hospital and duck pond where the NHS 60th parties will take place--

Work has really picked up the last few days. I've been working 4 or 5 hours every night on my prison paper after getting home from the office. I've finished most of it but it's nearly 22 pages which is at least twice the length of the longest paper I've written to date. I'll have to provide a link to it, as well as a better explanation of what I've experienced this week when I have some time on Sunday.

Until then, I'll give a running list and hope that works for now. On Monday I sat in on a meeting on the dreaded Nora virus which is important here since there were 4 outbreaks on the island last winter. Apparently 2 of them were at 700+ kid summer camps and there is a cloud of litigation still settling. The meeting was interesting because it involved the tourist industry heads, hotel managers, lawyers, and public health officials so there was a lot of translation in both directions.

On Tuesday I experienced my first Joint Partnership Prison Meeting which included reps from the prisons, hospital, public health, and medical commissioning office (administrators of NHS). I told them of my intended paper topic and they all seemed receptive though I'm sure they're not necessarily thrilled to hear someone else tell them areas in which they need to improve. Apparently there is a contagious protest going around in the prisons at the moment in which prisoners smear their own feces over themselves and their cells in an act of defiance. Definitely effective but unclear as to what exactly they're protesting at this point.

Next stop was the HPV immunization (spelled immunisation here) meeting with the school heads (principals). That was interesting as most of the public health officials here, and some in the States as well, don't think this vaccine is a great cost effective measure to reduce cervical cancer. However, they had to represent the government so everyone went in ready to do battle with the faith-based schools. It was immediately apparent to me again how much I dislike principals. I'm sure they're all very nice people but I think I'll always be biased against them. What brought this prejudice to my attention again was how difficult the principals made the discussion. In the end, the only person who could refuse the vaccine was the student...even if the parents gave consent...yet the principals were not happy with the moral implications of vaccinating pre-sexually active girls against and STI and definitely made everyone suffer for it.

Today I sat in on what would be the most revealing look into the NHS I had seen so far on my trip. I believe the title of the meeting was called Low Priority Case Management which basically equated into 4 of the top local NHS officials, including Dr Bingham, sitting down to discuss whether or not to approve controversial treatment for patients who had requested it. I mean controversial in the sense that these patients were seeking treatment that did not fall in line with common practice or were asking for new, clinically unproven options. If you've ever seen "Thank for you not Smoking" and remember the trio of death (a rep each from the alcohol, firearm, and tobacco business who ate lunch every week to compete on how many people their products killed) you'll understand what this meeting was like. I don't mean of course that we were joking about killing people...but the detached, often morbid humor, was pretty overwhelming.

To be honest, some of these patients were asking for ridiculously expensive and/or unnecessary treatment, like the woman who wanted her breast size reduced from a 33EE to a 33DD to lower her buoyancy while working in the water on the side of her sailboat. However, the majority were requesting chemotherapy or internal defibrillators and they either did not fit the profile for recommended recipients (courtesy of the National Institute for Health and Clinical Excellence) or the treatment had just opened up on the market. Many of these requests would be accompanied by a plea from the GP threatening to get more expensive, yet approved treatment if the council denied the request or other threats bordering on blackmail. Others had letters from pharmaceutical companies (no doubt the ones who made the drug) validating the efficacy of the new drug.

What this meeting should have been called is rationing the NHS's funds. I know rationing occurs in all health care models (for most things, we ration by cost) but I'd never had the reality of it so close to home and I never thought we'd spend 50-60% of the afternoon joking. I suppose it's inevitable and understandable...hey the buoyancy jokes were really funny...but behind the papers were requests from people in pain and suffering looking for a miracle cure. Unfortunately the advising body, the National Institute for Health and Clinical Excellence again, was not necessarily up to date with its protocols and so some patients were requesting drugs that had shown progress recently but hadn't made it through the line to approval.

Well I guess this turned out to be more than a run through...my B

Oh yea, the picture above is taken of the tent where the NHS 60th anniversaries will be held. I think the actual date is July 4th and everyone here will be partying hard that night. I'll be celebrating something else though. There were 70 something flags up outside the tent and each represents a country that has a member working on the island's PCT. Diversity indeed.