The same. But Different

Written by: Keith and Ginny Birrell

Highlight of the week: We reconnect with our cats
Lowlight of the week: We crash the doc house power system
Maximum temperature: 30 degrees Celsius
Rainfall: Not a dicky bird

My nick name is Sloe Gin. The pun is intended. Not through sloth, I hasten to add. But on account of my pace on a mountain bike, or on skis. I’m not in a rush to die you understand. My tortoise nature contrasts with Keith’s Duracell bunnyness. Perhaps it’s that contrast that makes our marriage work. That slow nature is a transferable skill. It sometimes affects other aspects of my life too. But many of you will read this with incredulity. My default speed often seems to be full pelt. My speech. My work. My thinking.

Life in the slow lane might sound a little dull to some. But constantly being in the fast lane might just cause me to crash and burn. Along the same vein: I admit that I also like my fair share of orderliness. I find comfort in things being the same. But I also love the excitement of different. Should I look for a sweet spot, somewhere in between? A Goldilocks zone. A heavenly place. A land of milk and honey. Good in theory, but so so hard to find. Perhaps Goldilocks went too far? Always struggling to find that perfect existence. So, instead of searching for Goldilocks’ idea of heaven, we Birrells prefer to mix things up: with just enough different to spice things up; and just enough same to temper the spice.

Our travels can sound adventurous. Exotic places. Biking. Camper-van. Boats of various ilks. Backpacks or scuba gear. There’s a big world out there, and we see no reason that Mr Bond should have it all to himself. Still, we are yet to scratch the surface. We have a deep travel bucket list that holds lots of future gems. Places to go. Things to do. But we like to throw in a handful of the mundane. A little bit of same. A little less of different.

Yet, our list never gets ticked off. For ticking off might suggest that we can’t go back. It might suggest that we can’t do the same again. We find it hard to understand when people tell us they have done a country. What does that mean? Is visiting a country just a cursory thing? A stamp in the passport? Something to brag about? Or just something to gossip with the neighbours about across the garden fence? Either way a checklist is just not our thing.

Although we have previously joked about collecting an alphabet of countries, it held no joy. The missing X would have grated anyway. We have even contemplated collecting Stans. But we have got no further than Pakistan and Baltistan. There has to be some joy and some level of safety to make a trip pass muster. It’s not that we are total thrill seekers. Always chasing a new, better experience. We like a modicum of comfort. Less unknowns and more knowns. But so far, it’s fairly unusual for us to go back to exactly the same spot. Too much same same brings forth a quandary: An emotional impasse. Will it be as good as last time? Or will it be the same, but different?

This is the 4th year that we have returned to work in Zambia. The 8th visit if you count various holidays in the past. I must emphasise to our detractors that we are not on holiday now. Yet Zambia is a place that we keep coming back to. This time, we return to a familiar setting and to many familiar faces. But time has marched on. South Luangwa is the same. But different.

A week ago: We fly into Mfuwe International Airport. The sun is setting. The airport boasts International status because of a couple of flights a week from Malawi. They have a modest immigration team. It’s really just a small domestic terminal. A proper tarmac runway. The airport feels the same. Not much has changed here. It feels like home.

Lusaka International airport earlier that day: The airport has now come of age. It was built as a statement. It's opening, at the time of the last elections, no accident. Vote for me. It shouts. Look what I have achieved. Loans from China backed its revamp. The building feels decidedly unAfrican. Shiny and new. We are through immigration within 10 minutes of landing. Our bags arrive 15 minutes later. The customs team are undermanned and decide to go lite today. One bag in two passes through the scanner. We grab some Kwacha from the exchange booth outside and steer our oversized carts along the pristine corridor toward the domestic terminal. Domestic check-in is efficient. They decide to waive our excess excess 2 kilos of hold luggage. We have previously negotiated to have an excess of 75 kilos for this flight. Relieved we smile sweetly and walk away with our ridiculously heavy carry-on bags. Our connection was slick. A contrast to Manchester airport. Same but different.

We don’t just land in Mfuwe - we land on our feet, and we land a major coup. We have been very fortunate to move straight into the doc house. We can make it ours. Home for the next 4 months. Normally, when we come early, we have to camp out somewhere. Pam is always generous to us. Our resident favourite artist. Previously, we have stayed in her house. This year we had planned to stay in her rondaval. A little round house with a bedroom and bathroom. Her kitchen would have been our kitchen. A pied-à-terre but not our own foot space. But since the doc house is free, we score an upgrade. Our house has been extensively renovated since last year. It’s kind of the same. But different.

We approach our Kapani home from the airport. A journey of beautiful giraffes crosses the road in front of us. This road is a tad more wild than our Yorkshire ones. It is frequently crossed by all manner of wild beasts. Its name changes weekly. Today it becomes Giraffe Grove. Not quite the Wild Dog trail that Doc Ellie found on her arrival 3 years earlier. But special nonetheless. The road is as potholed as ever. Holes filled by stones and sand. Gradually worn away to be holes again. Kapani is familiar. Sandy roads branching off in every direction. But the car knows the way. We turn the corner. The doc house comes into sight. No longer the burnt orange colour we are familiar with. Now a subtle slate grey. It blends into the surroundings. The same. But different.

We unload our hoard of bags. A few journeys from car to house. The outside veranda looks spanking new. The cracked concrete removed. A new layer: smooth, pale and clean. Fresh. Inviting. Not yet fouled by the baboons and vervet monkeys. The outside furniture looks unsullied. A place to sit and deliberate. Somewhere to catch our thoughts. Inside the house, the transformation is more stark. Again, a new concrete floor. Pale. Clean. And fresh. No gaping chasm in the floor, nor up the wall. No termites determined on recycling the building back to dust. A simple wall hanging hangs on the unblemished wall. No cracks to hide this year it decorates rather than hides. The shower has been retiled. The house is amazing. It’s kind of the same. But really very different.

Our first night is spent unpacking. It takes a while to find a home for 153kg of luggage. We make good progress. Three bags full become 3 bags empty. The 4th bag, a bag too far for our first night. A 5th bag materialises too. Star Trek style, from Anna’s remote hideaway. Beamed down from Chipembele’s other-worldly store. We had stashed heavy goods, that we would not need in Yorkshire. Out of sight and largely out of mind. Our woolly memories have forgotten its contents, but our fatigue is shaken off with the excitement of opening this time capsule. It proves to be a treasure chest. 2 bottles of wine. Our collapsible chairs. Spices. Some tinned food. Yeast. Our stroke programme kit.

We settle in for our first night’s sleep. It's hot. The air con appears to be caput. But at least we have a new fan in our bedroom. And the power gods rally to our cause. A big white box sits blinking green in the corner. Our new inverter. Zambia still rations its hydroelectric power. But on day one, rather night one, we are oblivious. The same. But different.

05:30 Our first full day begins with vigour. Up bright and early with our morning baboon crashing alarm call. The baboons still like to jump on our roof at first light. The troop looks healthy and active. But the menacing male, who bothered us so much last year, is not in evidence. We do some morning yoga and weights. We make coffee. Have breakfast. Switch on the kitchen air con, in the hope that it will start working. Nothing.

09:30 disaster strikes. The lights go off. The inverter goes silent. The nice coloured lights are no longer blinking. Teresa, our soon to be ex-cleaner, tells us that there are power cuts every day from 06:00-14:00. We realise the error of our ways immediately. We have been using battery power since 06:00. Three boiled kettles and 3 attempts to run the kitchen air con have drained the battery. We need driving lessons. To learn how to drive the house. How to conserve our electricity. Lesson one is history. Never to be repeated. Our inverter takes hydroelectric power and turns it into precious electron fuel. This precious electron energy will run our essentials. The fridge. The lights. The fans. The internet. Anything else is a luxury. We message the electrician. He counsels that we disconnect the air con and kettle socket from our inverter circuit. We are determined to learn and move on. It’s the same. But different.

Other improvements to our Zambian existence impress us too. Our doc house has constant internet. Except for when we crash the power system that is. Ordinarily we might have made a play of railing against the ‘Merican axis of evil. But Mr Musk has offered us a bite of his apple and we have bitten hard. We toy with choosing mobil

Refreshing a room or kitting out brand new Practice space? Find out how Dene can help you!

Written by: Freya Keith

Spring has finally sprung, and for many Practice's it's time to think about those premises development jobs that were put on the backburner in 2024. Now that commissioners are able to fully fund GP Practice upgrades, we’ve noticed an increase in the number of practice managers approaching us about developing practice premises. With this in mind we've written this blog post to explain how Dene can offer you a tailored service to meet your premises development needs.  

Why use Dene? 

With nearly two decades of experience and a first class degree in Design Management, Sales Manager Matt Taylor is our resident expert in kitting out new surgery premises or even reimagining existing space to maximise what you already have! 

What do we mean by Premises Development? 

We fit out GP Practices, offering a free of charge managed experience from advice on the best products, providing quotations, installation and after sales service. We can help you with anything you require for clinical or office rooms! Drawing on our years in the business, we can offer advice and guidance on the best way to make your space work for you. 

How does it work? 

We can work with you from the moment you get your architects drawings and organise a no-obligation consultation to discuss options. Your kit will be delivered in two easy stages to make the process as simple as possible for you!

Delivery Stage 1

We’ll deliver group 2 items (such as wall mounted diagnostic sets, mounted examination lamps etc.) whilst your contactors are still on site. This means that they can install them for you and there’s no chance of a GP accidentally knocking a nail through a water pipe (which we have seen happen!)

Delivery Stage 2

This is the exciting part! This is when we’ll deliver all of your group 3 items (couches, chairs, desks etc) and get everything installed, bringing your space to life! 

Our two phased delivery is a side of premises development project management that sets us apart. 

Would you like to know more? 

If you’ve got an upcoming premises development project, get in touch and I’ll organise a time to discuss your needs and get the ball rolling!

Email info@denehc.co.uk to get started! 

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