Dear Doctor

Thank you for taking the time to listen to my concerns. I feel that we have made great progress in working out how to help Dad. I know that you don't feel that the recent dementia campaign is widely beneficial, and I appreciate that you may be seeing more of the worried well as a consequence of the campaign. But for the families of people who may be affected by dementia, having a public campaign like this will make it easier for us to have the difficult conversation and to make plans for Dad's future care.

You see, Dear Doctor, at the end of our allotted time of 7 minutes, we will only have scratched the surface of a deeply complex condition, for which Dad will eventually need specialist care. 

And as most people who come to see you, Dear Doctor, actually have 4 or five things to discuss, it's hardly surprising that we have to return to see you time and time again, until we eventually give up and live with the pain, or we are referred to a Consultant.

And so, Dear Doctor, I was surprised to find that the Royal College of General Practitioners is running a consultation about the future of general practice and patient care in general practice. Surely, the future of this most vital service would be of wide interest in communities? The consultation is running until 8 October - I hope that many patients will take part.

And finally, Dear Doctor, I signed up for the Patient Participation Survey at the Surgery. I was asked today about what I consider to be the most important aspects of general practice care. These are my responses.

1. Length of appointment time with GP (appointments are very rushed especially for older patients with complex issues)

2. Better information about late running clinics (maybe a text message if the doctor is running more than 30 minutes late)

3. End of life care at home (better planning would help patients and families)

4. Out of hours care (ThamesDoc is a tedious process often of several phone calls followed by 'come to the walk-in centre')

I look forward to our next meeting, Dear Doctor. 

Gross Anatomy: the death of an inspiration

I was saddened to read of the death of Professor Phillip Valentine Tobias, one of the iconic South African academics of our time. He inspired me, and gave me a life-long love of science and the human body. How many young scientists can say that about their teachers today? 

RIP PVT.

This was first published on The Camel's Hump in April 2012, but it seems appropriate to reproduce it here as my tribute to Professor Tobias.

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Gross Anatomy

POSTED BY SHACKLEFORDLB ⋅ APRIL 18, 2012 ⋅ 6 COMMENTS

FILED UNDER  ANATOMY, DISSECTION, EDUCATION, MEDICINE, RESEARCH, SCIENCE

I went to Medical School in 1987. It was an incredible experience, crammed full of learning from inspirational Professors at the peak of their careers. My stand-out memory is the first day of Gross Anatomy. Faced with dozens of cadavers in shrouds, fresh-faced students in crisp, clean white coats, and that smell – I couldn’t wait to get started. Such a privilege.

Each precious body had been donated to medical research, to help train doctors, nurses and physiotherapists. We stood next to our allocated body, four students in a group, and recited a modified Hippocratic Oath. We were to dissect the body over the academic year, 565 hours of dissection, in detail, covering all organ systems, blood vessels, nerves and the brain. Our bible for the year was Man’s Anatomy by Tobias and Arnold, in three volumes. Professor Tobias and Professor Arnold were the big beasts of Anatomy. We were in awe of them. They were known affectionately as PVT and JCA (behind their backs of course)!

Getting started was a hand-trembling affair, guided by this illustration. Skin preserved in embalming fluid is very tough. But once you’re in, you’re in – and the delights of the human body were ours to explore. Over the weeks and months, we committed to memory all the arteries, veins, nerves and bones (oh, my poor parents had that box of bones in their living room); using mnemonics to remember the long lists. For example, Peter And Paul Masturbated So Much Their Balls Shrank refers to the branches of one of the thoracic arteries (I wish I could remember which one)! I can remember, though, that this one refers to the twelve cranial nerves: Oh Oh Oh To Touch And Feel A Girl’s Vagina Very Happily (or something very like it). The point is, we were drunk on anatomy for that year. We were walking encyclopaedia of lists of body parts, our text books were marked in wax pencil (I still have one I used in 1987), and nobody would share the lift with us because the smell permeated our clothes and hair. We knew it and we didn’t care. We were doing something that not many people ever get to do. It would shape our lives in the future. Some would go on to be world class surgeons, some physicians, sports scientists, pharmacists. I decided on a career in research.

Who knows how a career will turn out. I didn’t even do Science at school. I was expected to study Languages at University. I’m grateful to a Biology teacher for showing me something different, and changing my life. She asked me to help her clear out the cupboard in the lab. What we didn’t find in there. And lurking at the back, in a dark jar, was the most gorgeous pig foetus. We changed the preserving fluid, to reveal the tiny, perfect animal; when was he put in there, kept for me to find? I was hooked.

And so, standing in the dissection hall, several years later, in the basement at Medical School, I knew I was in the right place. I grasped the scalpel with both hands and made the first cut. Nine months later, the Technician was standing over the cadaver we had been working on. It approaching the final Lesson – the brain. He used a tiny, whirring saw to remove the cranium. He revealed a clean, shiny brain in situ. In order to complete the study, we had to remove the brain, with all the cranial nerves in tact. I had the smallest hands and I put them on either side of the brain, inside the skull. I tugged gently and felt around the base of the brain, to free the nerves from their restraints. A little more tugging, and I had the brain in my hands. We prepared the dissection and made 1cm slices through the brain, sectioning it in cross-section. I have never forgotten that moment. And neither will countless other medical students. That brain, sectioned, preserved and displayed can still be seen in the Anatomy Museum at Wits Medical School.

Gross anatomy? I don’t think so. Stunning, wondrous anatomy, is more like it.

Educating Africa

I am joining Salt and Caramel's blog hop today. Lynn is in Kenya, exploring the issues of life, health and education in Africa. Please do read Lynn's blog to find out more.


I wrote the post below after my holiday in South Africa in May this year. I was struck by how far the country had come since we left seventeen years ago. Then, it would have been almost unheard of for a young Zulu woman to go to school, have a career and decide for herself when and with whom to start a family. Now, we were heartened by the efforts of the recently elected politicians, to educate young people about contraception, having healthy babies, and the prospect of an HIV-free generation. This is good news for South Africa.


Two more brief anecdotes from my life in Africa in the early 1990's. My husband was training to be a doctor, and had to do an obstetrics block in a rural hospital. He said it was gruesome, sometimes delivering three babies at a time. No pain relief, episiotomies performed by experienced but extremely busy midwives. During his training, he delivered one hundred babies naturally and performed thirty Caesarian births. Today, he is a Cardiologist.


I went to discuss contraception with my GP just before we got married. As Dr B was still in training, we didn't need the added pressure of a baby! Her comment still rings in my ears: do you know what they call people who use condoms? Parents! I have been using the contraceptive pill ever since, but I do wonder whether that was the most balanced advice she could have give me.


Please read on, a story about a small part of Educating Africa.

The Cavern escarpment

My story begins with Sthoko, a young South African woman who gave my feet a wonderful pedicure after walking in the Drakensberg mountains in South Africa last week. Sthoko is one of the new generation South Africans, proud of her heritage and looking forward to a happy and successful economic future. Sthoko is educated and has a good job in a resort spa. She hopes to find a good and decent man to marry and start a family. But for now, she lives in a remote region of South Africa where three provinces meet at the escarpment. Mobile phones are plentiful in South Africa, but outside of the metropolitan areas, coverage is sparse and internet access is patchy to say the least. Satellite TV provides most of the news, but it’s expensive. Sthoko is lucky – she can read so will be able to find out about current affairs for herself. She wonders, for example, why the Zimbabwean people are not rising up en masse against Robert Mugabe. But there are many others who are not so fortunate, who are unable to read or write.

Travel conditions in rural South Africa

Royal Drakensberg Primary School

Which is why education is so important for South Africa’s next generation. In the eight years since we were last there, infrastructure has deteriorated. Roads in particular are most badly affected. If children are unable to get to school, or are unable to communicate with a teacher via the internet, using Skype for example, how on earth can they be educated? We spent some time with Megan Bedingham at The Cavern Resort. Megan and her family have set-up and built a school, The Royal Drakensberg Primary School, for local children. This local school means that the parents of little children no longer have to find the money to travel an hour by taxi to school. No money means no school for many children. The South African government provides no financial support for the school, so it must find funding for teachers and supplies from other sources. Parents are, however, expected to pay R400.00 (about £30.00) a month for each child at the school, and that is a huge sum of money for most of these parents whose main employment is at The Cavern Resort or the neighbouring hotels. The remainder of the school fee is generated by tireless fundraising.

A homemade school in South Africa

The problem for the education of girls is even more desperate. In this area of South Africa, Zulu tribal traditions are very strong, which means that boys are born with more advantages than girls. Girls are still growing up and working in domestic service. Of course, this will always happen, but it is said that the education of children is only as good as that of their mother. So, unless we can educate the mothers of tomorrow, children in South Africa will never rise above the basic level. I believe very strongly that there needs to be more focus and commitment on educating girls, empowering them through education, to healthier, happier lives as confident women in South Africa’s future.

The newly appointed health minister Dr Aaron Motsoaledi has declared his aim of an HIV-free generation. The recent public awareness ads are hard hitting and make it clear that responsible sexual practice will be a major contributor to halting the spread of the infection. South Africa cannot afford the widespread use of anti-retroviral drugs forever.

While in South Africa, I listened to a debate on broad-based black economic empowerment, which the local people refer to as BBEE. Eighteen years after Nelson Mandela and the African National Congress came to power, this is still the main concern amongst young black South Africans. May is Africa month, a celebration of all things African. But everyone is wondering if this generation will enjoy true economic freedom and independence, that which previous generations have fought for.

African sunrise

Oprah Winfrey has started a girls’ school in Johannesburg to address just this issue. I have previously written about Thandulwazi, a maths and science academy in Johannesburg. And now, I’m asking you to consider the Northern Drakensberg Khanyisela project. Khanyisela means to enlighten. Thandulwazi is the love of knowledge. Two more projects inspiring brighter futures for South Africa and its children.


For a photo story board of our trip and experiences in South Africa, please pop over to Christmas Pie Crafts, where I am guest blogging today.


Photo credits

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