I apologise that I am a week behind in writing this, I know that this is something probably only I have noticed! In fact D has reminded me when I fret about it that people probably have been surviving this week perfectly capably without feeling the need to wait by the computer for my weekend blog post.
The last three weeks since I wrote have been a bit of a whirlwind of weddings, exploring Liverpool, making new friends, lectures and hours of looking down microscopes. In fact since arriving in Liverpool I have not yet spent a weekend here and D and I have developed a regular Saturday morning routine of getting up in the crack of dawn at 4am to stagger blurry eyed out of the house and onto various forms of public transport. The second of these was on the 19th of September when we flew to Northern Ireland for the lovely wedding of Harrison and Emma, friends of ours from Edinburgh Uni. We stayed with some family friends of D, a picture perfect family with four children all under the age of 10, home-schooled, owning chickens and kittens – like my own family when I was growing up but with more matching kitchen crockery. We pick up our faithful friend S, who in a hangover from the days when he and D were inseparable “let’s spend all our free time at university playing computer games and sitting on sofas and eating Greggs” companions, always follows us to wherever we are staying for weddings. P the lovely mum of the home we were staying in pulled me to one side to check if it was “definitely ok” for “Stuart to sleep at the foot of your bed” which apparently D had assured her was “completely fine” in advance! The speeches at E and H’s wedding were very emotional, they are a couple who are extremely kind, make you feel happy and genuinely interested in everyone and this was reflected in the speeches. At the end the hotel kitchen manager took the microphone to say with tears streaming down his face that “this was the loveliest wedding he had ever been at” – it felt like we were in a film!
Third wedding on the 26th of September started with a 5am nap at Nuneaton station and then an arrival into a deserted Coventry town centre at 8am, D and I made our way to what brother B highly recommended as “the only acceptable coffee shop in Coventry” and I decided in a fit of exuberance and early morning delirium to have a Bloody Mary to drink with my mushrooms on toast. Bonny and Laura, who were getting married in a sunny marquee on top of rolling hills past an old English pub next to a canal bridge, are old friends of ours from growing up and so happily this was the first wedding for a long time that our whole family in its newly expanded state of 12 was invited too! It was a great honour to be invited as we made up almost a fifth of the wedding guests! We were all gathered from all over the country, L and S arriving glamorous and glowing from first few months of being married in Sheffield, B initially in Grandfather’s painting overalls because J was “bringing his purple velvet jacket” coming from London with glitter still on his face from a night out. All of us were coincidentally wearing various mismatched items from a combination of either L or my wedding day outfits. B was best man and him and Bonny wore beautiful matching wool suits with Indian moccasin slippers! B spoke extremely eloquently in his best man speech, perfectly combining being very funny and exceptionally kind and also somehow even managed to embarrass me by bringing up a childhood plot he and I had to try to “get rid” of Bonny who consistently and disarmingly tried to befriend us after moving from India. At the time for two teenage home-schooled siblings trying to desperately climb the social ladder – if felt we could not afford any hangers on! It was a wonderful day full of laughter, old friends, fire-works, dancing and slightly inappropriate impersonations of Indian accents. I also got the chance the next day to see one of my oldest friends E who came up from London for the day, E and E make up what we affectionately call ‘the tripod’ and are perfect examples of the saying “it doesn’t matter where you are but who you are with” (if that even is a saying?) as the three of us often dedicatedly track across the country to meet up on train station platforms, park benches and now Coventry town centre!
The last three weeks at LSTM (Liverpool School of Tropical Medicine) we have covered ‘The Big Three’: Malaria, TB and HIV. Together these three diseases are responsible for huge numbers of deaths worldwide each year and the majority of these deaths happen in Sub-Saharan Africa. The highlight of Malaria week for me was the series of lectures on the biology of mosquitoes, which were delivered by a slim auburn haired American woman wearing a mustard yellow top who I immediately, in my usual measured and unexaggerated style, decided was “the most beautiful lecturer I had ever seen”. In addition to this she was able to bring the subject of telling one mosquito from the next to life and I enjoyed her personification of different mosquitoes. She had a particular favourite species and when showing us a picture of it would turn to us to make sure we agreed saying: “this is arguably a very attractive mosquito”. During TB week we were shown a film which shadowing the lives of three patients with a type of TB that is resistant to the current medication we have for it – MDR TB (multi-drug resistant), their stories were shown with great attention to the details of their lives such as love of football, dancing, humour and family loyalty that stood starkly against the desperation of the disease and it’s archaic and protracted treatment regime which involves up to four different drugs for at least 12 months. We also learnt in HIV week about the fascinating history of a disease which, for the majority of us in the room, did not exist before our birthdates. A real case study of the way our world responds and adapts to a very present threat to a huge number of lives. In some area’s incredible progress has been made due to the dedication and commitment of many unknown individuals worldwide and because of amazing discoveries regarding ART (anti-retroviral therapy). However this week highlighted again how we have also failed to react as we should. One film which I would highly recommend called “Fire in the Blood” details the horrifying way that pharmaceutical companies denied countries in which HIV was most present access to the drugs that could save literally hundreds of thousands of lives because of concerns about profits and patents. More sobering was the involvement of international agencies and governments who facilitated the continuation of a case where a drug which could be made for 365 dollars a year per patient was being sold under patent at 9,200 dollars per person.
A thread which runs twisting throughout these three weeks has been that of inequality. We were shown a graph of rates of TB worldwide and interventions attempting to reduce TB incidence. Out of all these attempts what has had outstandingly the most impact on rates of TB and deaths from TB was not anything to do with advancements in health care systems but instead the economic growth of the country. Another observation made continually on the course, very familiar to some, is that within cities and countries there is huge variation in how long someone can be expected to live based entirely on where they live, how rich or poor they are. Despite the first glance implications of this, money does not necessarily seem to be the answer. America, which spends almost the highest amount of its GDP on healthcare ranks below many European countries on factors such as childhood health. What seems necessary for true stability and development and health in a country increasingly clearly seems to be equality between people within a country.
On Monday last week a group of us from the course spent our lunch time scavenging for cardboard boxes from various supermarkets, sticks from skips and marker pens to make signs to take to a protest march in Manchester against the government’s current plans for a new junior doctor contract (junior referring to anyone from just graduating medical school up to any doctor until they are a consultant). Ironically, now that we are all out of the NHS for a year we had significantly more time to dedicate to composing what we thought of as hard hitting and witty slogans for our signs, this was summed up well by one doctor’s placard which said “this protest would be twice as big if half of us were not on call”. I have included some short links about the new contracts below but in short it changes rules about our working hours, dramatically cuts doctors pay especially in already overstretched areas such as A&E and GP and the way it has been enforced is hugely demoralising to NHS staff who are already holding together services through their own generosity and dedication. Heads of different specialities in the NHS have described that this new contract would: “severely damage morale of trainees and jeopardise the future of the NHS. It could lead to a brain drain of the brightest and best of our….trainees. The detrimental effect of this would result in the closure of many hospital emergency services and adversely affect the quality of patient care”. There is another deeper fear that these changes are gradually step by step a move towards privatising health care and the loss of the NHS as a free at the point of care service which is so wonderful and unique. A service which allows our old to die with dignity regardless of their ability to afford pain relief or care, which treats those who arrive at its doors with the upmost quality of care whether that person sleeps in a castle or on the streets. In TB week we learnt about the idea of “catastrophic costs”, when families have to spend so much of their income on health care that it pushes them into poverty. We currently live in a country where despite its many flaws, people are able to access care when they need it irrespective of their ability to afford it. I think that any step away from this vision which this contract seems to threaten would be a great step away from equality and justice within our society.
Our weeks are full of stories and I feel this post has already overextended its welcome so will stop here and report more next week. We have finished ‘up-cycling’ our table now so I have no excuse not to work and write more. Please message me if you have any questions/disagree entirely/want more facts and less emotion about anything I have written. Thank you for reading this far, it means a lot to me!
Social injustice is killing people on a grand scale – Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health
A nation’s greatness is measured by how it treats its weakest members –Ghandi