Chepetsani - Reduce (my chance of stroke)

Written by: Keith & Ginny Birrell

Highlight of the week: Rabbie Burns is wrong for once: Our best laid plans are unblemished: our permits come through; our kit squares away; our flight is flawless. We reach Mfuwe unscathed.

Lowlight of the week: We say au revoir to friends and family. Until Halloween.

Maximum temperature: 26 degrees Celsius

Rainfall: In Mfuwe? Are you kidding?

Zambia is real again. Tangible. Under our feet. In the air. Hot and dry. We have arrived.

In 4 weeks’ time we will be putting our noses back to the valley doctor grindstone. Committed contractually to stay within half an hour of the national park gate. Tied to our flock, so to speak. On call 24/7. But for now, we have 4 weeks grace. Leeway to do our peripatetic clinics in the bush. Licence to explore.

Our mission, should we accept it, is to root out high blood pressure, diabetes and other health time bombs. Wherever they lurk. Peoples’ place of work is a favourite place to hide. Our flock of safari staff are captive. In their camps 25 days per month. Unable to see us doctors in our normal place of work. Tourist industry work schedules usually preclude anything except for reactive and emergency care. Safari staff have no idea when a time bomb marks them out. Blood pressures stay high. Diabetes stays sweet. As time marches on, some of them stop marching. A stroke here, a heart attack there.

Here in Zambia, high blood pressure and diabetes are offered care when unearthed. But no one really goes looking for it. And when found, treatment is usually only consistent in its inconsistency. We aim to change all of that.

Keith has created a website called: Chepetsani mwai wanga wodwala sitoloko (Reduce my chance of Stroke). A Nyanja version of his original toolkit. Part calculator, part educator. The website aims to do what it says on the tin. It will be our main weapon. But we also need to measure and test our flock. And to support them to choose lifestyle options and medications that are right for them. And to make sure that any medications chosen, stay available to them. The devil is in the detail.

We search for those marks of future ill health. But I suspect we won’t need to look very far. Last year we saw 142 people in safari camps. 39% with high blood pressure. 70% physically unfit (their waist sizes are more than half their height). 6% with diabetes. 15% smokers 14% with suspected sleep apnoea. Plenty of treatable woes.

We won’t need to look far. But we will look far. This year we will be venturing up to 4 hours from the park gate. We aim to see 200 people in this time. To understand their vulnerabilities to future ill health. And to use the new Nyanja website to deliver personal care. 12 people can be seen in a day. So, 16 busy workdays. That might leave us with 14 days latitude. Bearing in mind that we are using a foreign language website, in a world without consistent electricity and that we need the internet to play nicely. What could possibly go wrong?

We will tag peoples’ invisible risk factors. Offer options to tackle their Achilles heels. We will see people, not patients. In the lottery of life, some of these people are marked. Marked for future ill health. We hope to support people, to choose what works for them. To stay people. Not patients. When we find high blood pressure, high cholesterol or big waists, our mission is to help people to know what will work for them to stay well.

The last 2 weeks have been fraught. Preparations for our work shift have appeared chaotic. It’s not quite a standard commute. It’s not just a matter of remembering a pen, a stethoscope and a packed lunch. But closer to planning a moon shot. We shift from one perfect universe to our alternate nirvana. So much to think about, and to do. Two rooms of kit to rationalise into 4 bags. Space and weight at a premium. There are no shops to speak of in Mfuwe. No Amazon delivery. Commit and make do. Ken and Barbie will be dressing for the clinic and the bush.

We have done this commute twice before. But yet we vex. Our bags strain at the seams. We each play 3 vetoes. Excess is jettisoned. But still our bags weigh in at 150 kg.

150 kilograms. That doesn’t quite sound like 2 outfits each. Indeed, we carry several bulky bags of tricks. Kind donations from Dene Healthcare and others. Ways and means to uncover hidden risks for strokes and heart attacks. Blood pressure machines, cholesterol kits and other diagnostic tests. 

You may recall that we started this quest last year. https://keithandginnybirre.wixsite.com/intoafrica/post/faith-and-hope-and-charity The 2024 version has been rather souped up. But before I tell you about that, let me revisit last year’s exploits.

Last year’s programme “Reduce my chance of stroke and heart attack” had rave reviews. Spread over 8 camps. 142 local staff and expats. A routine quickly developed. Our labour divided. Me on tests. Keith sharing decisions. Fine-tuned over the 3 months. Always preceded by a show and tell for the assembled masses. All camp staff. Education. Explanation. Questions. Answers. Everyone knows someone affected by stroke. Colleagues. Friends. Relatives. Neighbours. Common and devastating. All are left with regret. All with a feeling of impotence in its wake. Financial hardship. Loss. But to a man, nobody knew that we could prevent strokes. And few people knew there is a link with high blood pressure, diabetes, smoking and overweight. We had struck a chord.

Our recruitment drive, now straightforward. But our time was short. Remember, this project is our side hustle. Our fourth job. When are you coming to visit my camp? Echoed around the Valley. We quickly learnt to say no. Although we wanted to see everyone, we had too little time, and too compact a range. Limited to the geographical limits of the Valley doctor’s role. Thirty minutes from the gate. But we also said yes. In fact, we said yes too often. As soon as my Diploma in Tropical Medicine and Hygiene was in the bag, we swapped our focus. All of our downtime for a whole month revolved around the programme. We toiled. Afternoons and weekends. Mornings and evenings. But the no’s still outnumber the yes’s.

The show and tell results in a patient line of customers. Not patients. But potential future patients. Our programme lands on fertile ground. Nobody who joins our show and tell opts out. A rare chance to see a doctor. Paperwork first. A consent form, since we offer a change to the status quo. A medical record book. We schedule appointments and work around working duties.

Measurements: Height. Weight. Waist circumference. Blood pressure. Tests: A urine dip. A finger-prick blood cholesterol test. The occasional finger-prick blood glucose. We lug around 25 kg of donated kit. For 2024 Dene Healthcare match last year’s generous donation with 300 more cholesterol test kits and then a whole bunch of other essential diagnostic tools and paraphernalia.

I book our worried well in at 15 minute intervals. But for my tasks, 10 minutes suffices. Then the one true Valley doctor limbers up, ready for action. For there can only be one. Doctor Keith, with his mystical powers, and his mythical website. The doctor will see you now…. Dr Keith and his ward enter the numbers into the computer. A few clicks. A few whirrs. A wheel rotates. Sometimes endlessly. The screen refreshes. And a mini Dr Keith, speaking English, jumps off the screen to share our patients journey with them. Personalised medical fortune telling. In Africa.

2023 sees mini Dr Keith waxing lyrical in English. But for 2024 Dr Keith has a new mini guest star. Perhaps Morgan Freeman has joined the team? Charles is not only a doppelgänger for Morgan Freeman, he is a retired headteacher and a pillar of the community. His new role as poster boy of our Nyanja website puts him onto the small screen. Hollywood and Morgan quake. The Mfuwe community is at our mercy.

But I digress. Back in ’23 the staff wait to see Dr Keith. Keith looks into each person’s crystal ball. And then shares with them: their odds of an untimely future appointment with their maker. He clumsily uses English. His Nyanja rudimentary. His website flawed. Fine in Sunderland and in Yorkshire. But hopelessly English. Keith enters personal numbers. Produces personal results. Offers personal choices. Shares personal options. Drawbacks. Guides and supports. They find priorities. What is doable. What works. Shared decision-making mediated with a Mac in the bush.

Our safari staff choose personal options. Healthy eating. Less salt. Activity. And even medication. But are these choices realistic or even sustainable? A single wave of the magic wand is unlikely to be enough. So, we seek to ensure that their access to medication is unwavering. Be that from clinic or pharmacy. And we offer remote support between continents. Direct access. Email. WhatsApp. Backed up by local clinicians, who now have a plan, and they now have support.

To read the full blog and donate please click here

No More January Blues

Written by: The Dene Team

No More January Blues 

As the holiday season ends and the new year begins, many of us find ourselves grappling with a common, albeit unwelcome January Blues. 

It's that time of year when the festivities have faded, and the reality of cold, dark days sets in, leaving many feeling tired, unmotivated, and fatigued. We first must acknowledge that these are more common than we think. In January 2023 NHS Inform wrote an article explaining that SAD (Seasonal Affective Disorder) or the ‘Winter Blues’, as some call it, can affect 2 million people within the UK and more than 12 million people across Northern Europe. 

There are many things that contribute to our January Blues such as the post-holiday letdown, financial stress from Christmas, and setting unrealistic New Year’s Resolutions, however we want to help find ways to combat these feelings and make January one of the happiest months, to start the year fresh and get you up and going! Here are some ideas and inspiration for you to take on board for your 2024 beginning!

Embrace the Light

Seek out natural light as much as possible. Open curtains, take short walks during daylight hours, and consider investing in a light therapy box if you live in an area with limited sunlight. Doing this will help increase your serotonin levels, which in turn will increase your energy, and help keep you calm, positive and focused. 

Maintain a Routine

Establishing and sticking to a daily routine can provide structure and stability during the post-holiday period. Set regular sleep and mealtimes and create a schedule that includes activities you enjoy, even if it is as small as baking or reading. 

Practice Self-Care

Prioritize self-care activities that boost your mood, such as exercise, meditation, or hobbies. Taking care of your physical and emotional well-being is essential for overcoming the January Blues as seeing small changes in yourself can lead to increased productivity.

Set Realistic Goals

Instead of setting lofty New Year's resolutions, opt for smaller, achievable goals. Celebrate your successes, no matter how small, and remember that progress takes time.

Socialize and Connect

Maintain social connections by reaching out to friends and family, even if it's just for a virtual chat. Sharing your feelings and experiences can provide emotional support and help combat loneliness.

Budget Wisely

Take control of your finances by creating a realistic budget and a plan for paying off holiday-related debt. Financial stability can alleviate stress and contribute to a more positive mindset. You can even make it fun, why not create your own little piggy bank to stash away some savings just for a rainy day, or even use the 100 envelopes challenge as a fun and different way to store some cash away!

To conclude the January Blues are a common experience, but they don't have to define your year. By implementing these strategies, you can navigate this challenging period with resilience and optimism. Remember that it's okay to seek professional help if your symptoms persist or worsen. With the right support and self-care, you can overcome the January Blues and look forward to a brighter and more fulfilling year ahead!

A Christmas and New Year e-mail to the Dene Team from our Director

Written by: Craig Arnott

Good morning all,

With Christmas and the New year approaching I wanted to take the opportunity to quickly recap on another amazing year for Dene Healthcare and thank you all sincerely for your phenomenal work ethic, commitment and drive.

The creation and growth of Dene Healthcare has been amazing to witness and something I am incredibly proud to have contributed to. I hope you are able to take the same satisfaction from your part in the Company’s growth and appreciate each of your colleagues value too.

Over the years Dene has seen and overcome its fair share of obstacles and setbacks; everything from market crashes and server lockouts right through to the loss of key staff and a pandemic.  Regardless the trajectory and improvement in all departments has been a constant.

2023 started with what could have been another disruptive change via the acquisition of Dene Healthcare by Rocialle. While it inevitably caused unrest and uncertainty in the initial period (for me as well) I am delighted to say that we all quickly reverted to type and carried on doing what we all do so amazingly well; making Dene Healthcare a better Company for General Practice and a better and more secure place for us all to work!

It doesn’t matter to me if you’ve been at Dene for 15 plus years or you’ve just joined, you are here now for the same reason, because I believe you can make this Company even stronger next year and in the years that follow.

I’m delighted to report that we’ve managed to achieve all but 2 of our Company objectives for the year and 1 of those was missed by a single percent! (Our live chat had 99% satisfaction rating, not 100%).

I’m also delighted we were able to send Ricky back to New Zealand to see his parents for the first time in 7 years and I hope in the future we can do something meaningful for all of you.

We will achieve our financial forecasts for 2023 (barring disaster), we’ve taken the prize of Medical Supplier of the Year for the 5th time, we’ve won the Excellence in Primary Care Award at the Primary Care Impact Awards, we’ve achieved our Investors in People accreditation, significantly reduced our carbon footprint, donated and helped plant 500 trees and I believe dramatically increased the strength and resource of key teams and therefore the Company as a whole.

Thank you so much everyone! You make it a pleasure coming to work, I hope you feel the same and if not, please let me know why so I can try to improve things and get better at my job.

I’m incredibly proud of everything we’ve achieved so far and I consider it an honour to work with you all, you are all brilliant people who make one hell of a team and I can’t wait to see what we can deliver in 2024.

As a small token of appreciation you’ll shortly receive some M&S vouchers via email by way of a thank you.

I wish you and your families a merry Christmas and a happy new year!

Kind regards,

Craig

Dene Healthcare

Tel: 01132 50 50 70

Artificial Intelligence: How it Can Help NHS Staff Engage with Patients Effectively

As a healthcare professional, one of your top priorities is to communicate effectively with your patients. Whether you're trying to inform them about the latest medical procedures, or simply keeping them informed about their treatment plan, effective communication is key to promoting patient satisfaction and promoting positive health outcomes. Over the years, technology has helped healthcare providers communicate with their patients in new and innovative ways, and now the rise of artificial intelligence (AI) is set to change the game even further. In this blog, we'll explore the benefits of using AI in blogging, and how NHS staff can use it to engage with their patients effectively.

One of the most significant ways that AI can improve blogging is through the use of natural language processing (NLP). NLP can be used to analyse and understand the text in blog posts and comments and can help healthcare providers identify important trends and insights. For example, NLP can be used to analyse patient feedback and identify areas where healthcare providers need to improve their communication efforts. Additionally, NLP can be used to identify the most frequently asked questions and concerns, and bloggers can use this information to create content tailored specifically to their patients' needs.

Another way that AI can help healthcare providers improve their blogging efforts is through the use of chatbots. Chatbots are computer programs that can interact with patients in real-time and can help answer frequently asked questions or provide personalised guidance. For example, a chatbot could be used to help patients schedule appointments, or to provide information about test results or medications. This can not only free up healthcare staff time and resources, but it can also improve the patient experience by providing patients with the information they need when they need it.

In addition to these benefits, AI can also help healthcare providers improve the overall quality of their blog content. AI can be used to analyse the readability and clarity of blog posts and can provide suggestions for improving the language and structure of the content. This is especially important for healthcare providers, as medical jargon can often be difficult for patients to understand. By using AI to simplify and clarify their writing, healthcare providers can ensure that their patients are fully informed and aware of their medical conditions and treatments.

In conclusion, AI has the potential to revolutionise the way that healthcare providers communicate with their patients through blogging. From analysing patient feedback to creating personalised chatbots, AI can help healthcare providers identify ways to improve their communication efforts and provide better care for their patients. As the field of AI continues to evolve, it's likely that we'll see even more innovative solutions that can help healthcare providers provide top-notch care for their patients. So, if you're an NHS staff member looking to improve your blogging efforts and engagement with patients, consider using the power of AI to take your communication to the next level.

How the receptionist got their scowl

Written by: S. Connor

I believe wholeheartedly that of all the roles in the practice, the reception team have the worst deal. They get paid the least amount of money and they take the most crap from patients, doctors and other members of staff. They work relentlessly from the moment they arrive until they finally get to go home, and the mad thing about it is that they could all earn more money working in a supermarket or behind a bar, but for the most part they stay.

 
I think that we have all had a higher turnover of staff in general since the pandemic, and I know that we have seen a few people come and go with rapidity on reception, but the majority of the old guard have never considered leaving. I admire them enormously, and in all honesty, I do not think that I could do their job on a day-to-day basis.

They are the bedrock of general practice and the foundation upon which we build, and they get no downtime, no real break from their role. Even GPs get a break (if only for a minute) between patients, but for reception a shift is often non-stop picking up phones or dealing face to face with patients. They are highly trained individuals, who receive little to no respect for their experience, and it seems incredible to me that they put up with the treatment they receive. 

If I ever speak to a person, whether it be a patient or someone I know and they are doing a bit of reception bashing, I ask them the same questions;

How would you respond if you were told that you were useless, every day, for years, by the people you serve?
How would you feel, if on a weekly basis at least one patient told you that you couldn’t do your job, or that somehow, their own failure to order their medication was your fault?
How would you feel if you were paid less than £10 an hour and were told by a patient that if they die, it’s your fault?
How would you feel if the public you serve completely disregard your training and the questions you ask because you are only a receptionist?
How would you feel if you worked your arse off for a public who happily label you and your colleagues as dragons?

I think that over time some GP receptionists (and I must stress that it is some, not all) grow a thick skin in order to protect themselves. Perhaps the dragon scales that patients sometimes see are more of a reflection of the way receptionists are treated than of them as people. If you are relentlessly bombarded with insults surely it is only natural that a defence mechanism builds up, and that being told you’re useless results in a lack of enthusiasm when dealing with your 50^th phone call that day. It is very hard to remain breezy and full of smiles when all you see are unhappy faces, who cannot understand why you can’t immediately give in to their every demand.

This is not a piece about how to make things better for reception, because until the public change their attitude to these women, because on the whole women tend to make up most reception teams in GP land, then we will never make it a truly enjoyable job. Don’t get me wrong it isn’t doom and gloom all the time, but I must admit that particularly since the beginning of covid, our reception team seem to be given more and more of a hard time.
So much for clap for the NHS, now we’re a couple of years in people forget that without receptionists, there would have been no vaccine clinics. Without reception, the practice simply could not run.

This piece is written purely to acknowledge what receptionists do, and the fact that they do it for very little in the grand scheme of things.

If you can, and where you can, remind your reception team just how much you appreciate them. It could be making them a coffee when you know they haven’t had time to leave their desk or buying them some treats on a Friday to end the week with a bit of a sugar rush. Or even, simply thanking them for everything they do.

It’s easy to get wrapped up in your own stress in such a relentless job as this, but we aren’t the only ones working hard. Receptionists do not deserve the public reputation they have, and so now, right now, as soon as you’ve finished reading this, I want you to go and tell your team just how much you appreciate them for everything they do.

Here’s to you, the GP receptionists of the UK, I take my hat off to you all. Thank you.