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.

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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

Lionesses have brought it home!

Written by: Georgia Dossis

I’m sure that everyone can agree that history was well and truly made last night in the most spectacular way!

Not only was the 2-1 win from the Lionesses their first time winning the Euro’s since it’s begun, but it was also the first big time win for the England teams for 56 years. An absolutely stunning victory.

The extra time goal scored by Chloe Kelly, will forever change football and adds to the timeline that hasn’t exactly been straight forward.

Did you know that women’s football was banned in 1921? It was actually considered unsuitable for women to play football. This changed by the end of the 1960’s when they formed the WFA (Women’s Football Association) but imagine if this hadn’t been the case? There’d have been no representation of women in the sport and last night would’ve just been an ordinary Sunday night.

The players within the whole of the association should be proud, not only to represent England, but for inspiring younger generations everyday as they represent change and inclusion which is so very much important.

Celebrations are being held in London today between 11:00 – 14:00 for all fans and is well deserved after the efforts put in. A huge congratulations to bringing it home!

The Positivity Card!

Written by: Craig Arnott

First things first; welcome to Dene Healthcare’s blog, specifically written for those working in or interested in the crazy and chaotic, yet wonderful world of General Practice! 

My name is Craig Arnott, I am the Commercial Director at Dene Healthcare and have been working in and studying the sector in depth for the last 15 years.  In that time I have learned more acronyms than I ever thought possible (although subsequently forgotten the majority), read more white papers and directives than any human could be expected to action and gained a deep understanding, as well as respect, for all those working in General Practice (well – certainly the vast majority).

The Doctors and Nurses by default have my admiration and appreciation, as anyone who devotes their lives to the care of others should.  They are the ‘heart and soul’ of General Practice!  This blog, however, is for the ‘mind and body’ (for lack of better metaphors), in other words intended to be targeted more toward the Practice and Business Managers, as well as all operational and administrative staff.    

I am a long-term admirer of the endurance, adaptability, and strength in the face of adversity that this largely hidden army embodies!  They drive the industry, navigate the many pitfalls and at present, take most of the hits, at least from the public (particularly readers of the Mail).

General Practice has always been an ‘easy target’ and has historically been blamed for pretty much everything as wide ranging as NHS backlogs, increases in A&E admissions through to lists of failings in the health and social care system too long to mention but recently, things have gotten worse!

The last 2 years have been crazy, and nowhere more so than in the wonderful world of General Practice, however a rather toxic mix of national pent-up frustration, combined with enforced restrictions, government miscommunication, public misunderstanding and poor reporting has led to the most negative and depressing period in General Practice that I have known.

All industry related news is discouraging, the directives – most likely unattainable, the expectations unrealistic and the negativity has become infectious, and for the first time I am witnessing the scars of battle on even the most resilient, bubbly, and strongest of characters in General Practice.

So, I’d like to propose that everyone in General Practice does what General Practice does best; band together, focus on the patient as you always do but take time for each other too.  Accept you can only do what you can do and start to break the vicious cycle of negativity contaminating your workplaces.

There are always exceptions to the rule but regardless, try to do one thing to make a positive difference to a colleague and if they thank you ask that they pay it forward (love that concept and the film but if anyone asks – I’m all about the Italian gangster films – Scarface etc).

Today, you should hopefully be receiving a thank you card from the staff at Dene Healthcare, regardless of you using or even knowing who we are and what we do.

Let’s defeat the negativity with the thing it hates most – positivity!

Thank you for reading, we’d love to hear from any aspiring bloggers who would like a guest slot.  We understand how precious your time is and we’ll be more than happy to compensate you accordingly.

Thanks again for your time and thank you, thank you, thank you for all the amazing work you do!