As you can see, The ElliottEar is still here! Arthur and Beryl Peacop had built it into something so good that we just couldn’t let it die, and now instead of only two of them doing everything, we have a team of about a dozen, each bringing differing skills and able to give varying amounts of time, but all wanting to carry The ElliottEar forward.

This first edition under our joint efforts will probably be the most difficult, as we come to terms with new things, and it may not be as amusing and elegant as the Peacop issues, but we shall learn as we go. If you have any comments or suggestions for us, please tell me (gently!) and we’ll take note of what you say.

There are no jokes or other funny snippets this time as we only received two, but if you can send us more for future issues, please do.

Also, if there are any topics you would like considered for inclusion in the Ear please tell me, either in writing or by phone. If you are visiting the Medical Centre and want to leave something for the Ear, do ensure that it is very clearly marked “For Lesley Walmsley, The ElliottEar”, so that the receptionist can tell me that it’s there.

I am very grateful to everyone who has helped with this issue, in particular to Sharon Casteldine our designer, to Mela Ragusa who helped find a printer and also edited some articles, to Cyril and Anne Flood for constant help, and of course to the Doctors and Nurses for their articles and encouragement.

The gratitude of all of us goes to Arthur and Beryl who have given us this great gift. We wish them much enjoyment of whatever they want to do with the time now at their disposal.

Have a happy and healthy summer.

Lesley Walmsley Co-ordinating Editor

Hands up those of you who thought that No. 19 would be the last edition of the ElliottEar? As you can see, the publication lives on. Within a few days of delivery of No. 19, a number of people rang me to offer their services, and I am therefore delighted to welcome the new team. Lesley Walmsley, has kindly agreed to act as co-ordinator, and Suzanne Smith (nee Hearnden) has taken on the job of advertising manager. The various production and distribution jobs are undertaken by a group consisting of Sharon Casteldine, Helen Macintosh, Hilary Morgan and Mela Ragusa, but we have had offers of help also from Gilly Newman, David Prowse, Chris Rogers, Mr. Shah, Helen Spillane and David Stodell, and we plan to involve more of them as things progress.

Many thanks to Geoffrey Davies for his sterling work as advertising manager for the last couple of years.

I am sure you will be pleased to know that Beryl and Arthur Peacop are thrilled that a new team has come forward. It would have been terrible for them to witness the demise of a publication to which they have devoted so many hours, and I must repeat my heartfelt thanks to them all for all they have done to make The ElliottEar such an excellent publication to hand on to their successors. I am very happy that Arthur has kindly agreed to remain on the Committee of the Association.

Now another appeal for help: the Transport Service has been in difficulties in recent months and has actually has to turn down some requests for help. PLEASE, if you can help even in a small way, contact David and Pat James.

Finally, may I remind you of our AGM, when after the business section (normally about 15 minutes) our guest speaker will be Mr. Robert Moore, Director of Primary Care at the Harrow Primary Care Trust (Full details appear on page 3).

Cyril Flood Chairman

Notice is hereby given under Rule 6 of the Rules

Of the

Elliott Hall Patients’ Association that the

Annual General Meeting

Of the said Association will be held at

HATCH END FREE CHURCH HALL

Rowlands Avenure, Hatch End

On Tuesday, 13 May 2003 at 8.00 p.m.

AGENDA

1. Apologies for absence 2. Chairman’s Annual Report

3. Hon, Treasurer’s Report, presentation 4. Election of Officers

of Statement of Accounts and Adoption 5. Election of Independent

of same Examiner of Accounts

6. Any other business

Hon. Secretary Mrs. Janice Berry, 11 Carew Way, Grims Syke Manor, Carpenders Park, WE1 5BG

The three present Officers are eligible for re-election and all have agreed to stand again. Any other nominations for the positions of Chairman, Vice Chairman, Hon. Treasurer and Hon. Secretary, must be proposed and seconded by members of the Patients’ Assocciation and send in writing to the Hon. Secretary by 30 April 2003. After the formal AGM, Mr. Robert Moore, Director of Primary Care at the Harrow Primary Care Trust, will speak on the work of the PCT.

From the Hon. Treasurer

Having been gently coerced into becoming Treasurer, I must share with you the fun that goes with the job. The banking arrangements caused some merriment, as I had asked the Committee for permission to move the account to a bank nearer to home. This entailed the completion of many forms, necessary to ensure that the signatories are not attempted money laundering. Most of us would not know how to launder money except by passing a wallet through the washing machine, which in my case my wife did on one occasion.

In my innocence, I thought it would be a good idea to put funds not immediately required into a deposit account. When seeking to transfer from deposit to current account, to enable me to pay the printers, the bank staff transferred the other way, with the result that the cheque bounced, incurring charges and interest. After an interval the charges were cancelled and the bank made a donation to our funds by way of apology.

Things have now settled down and the job entails banking cheques from donations, advertisements in The ElliottEar and the money charged for transport. There are also cheques to be paid for normal expenses, affiliation, floats for events and equipment for the surgery. Cyril Flood is a tower of strength, and has made my initiation run smoothly. Committee meetings with a strong team give an insight into the mysteries of how a busy Practice operates.

URGENT APPEAL

FOR DRIVERS

for Transport Service

A service which many of our elderly patients depend upon is in danger of disintegrating. We are desperately short of drivers, who are the lifeline of this service.

The transport service was started 10 years ago when the EHMCPA was founded, and we have been able to help many patients with journeys to the surgery and to local hospitals. Recently we have had to turn down requests due to the lack of drivers, and unless more are found this trend will continue and get worse.

Our system operates by volunteer drivers naming days when they are available, although this is not cast in stone and any driver can refuse any journey they are unable to make. In the Practice, unless there are special circumstances, we only ask each driver for one journey a week – though of course anyone wishing to do more could be accommodated! Seventy-five percent of our journeys are to the surgery, and drivers wishing to do only these journeys would be welcome.

If you feel that you could help please pick contact Pat & David James .We will willingly explain the system in detail and then provide you with the necessary application forms. Please do not be put off by form-filling which is necessary for your own protection and that of the patient.

WE AWAIT YOUR CALL

We take this opportunity to thank our present drivers, many of whom have been with us from the start. Without their dedication our service would not continue. There are not sufficient words to express how much they are greatly appreciated by us, the patients and indeed by the Doctors and Nurses at the Medical Centre.

David & Pat James

Transport Co-ordinators

****************************************************************************************

Babble and Chat

Come and have some fun with us,

Do some craft

And sing “Wheels on the bus”.

We meet in Tuesday,

Come rain or shine,

And we always have a jolly good time

New friends to make,

And games to play,

We are sure that you will want to stay,

So come along,

We look forward to seeing you,

And don’t forget to bring Mummy/Daddy too!

Carole Lesser

Babble and Chat meets every Tuesday afternoon, 12:45 to 2:45, in The Clubhouse, situated in Saddler’s Mead Park, off Clonard Way, Hatch End. Further information and a map are available on the Patients’ Association notice board in the waiting room at the surgery.

Lisa Harvey and Carole Lesser

As a member of the Social and Fundraising Committee, I am planning to set up afternoon teas to be held every 4 to 6 weeks on a Sunday afternoon.

There are many patients in our practice, young and old, with little opportunity to socialize, get out and about and meet others in a friendly environment.

SO HOW CAN YOU HELP?

Can you help with your time, energy and enthusiasm? I need about 15-20 volunteers on a rota basis to ensure success so that we can plan ahead. Help covers everything from transport to help on the day for approximately 2-3 hours, on a Sunday afternoon. It would be very rewarding, knowing that you are helping those less fortunate in our community. Please lend a hand.

Contact Tova Salomon

CARERS’ SUPPORT GROUPS

Are you a Carer? Would you benefit from meeting other Carers and “airing and sharing” problems? Talking with other Carers does not make the responsibility and strains go away, but it helps to know that there are other people with stresses similar to your own.

Why not join us at our daytime meetings, held informally in members’ homes on the third Thursday morning of each month

from 10:30 a.m. till 12 noon, the dates and venues of which are given below. Come for as long as you can manage, and a sitter for the loved one you care for can be arranged.

If you would prefer to attend an evening meeting, we hold them on the second Tuesday of each month, again in members’ homes, from 8 p.m.

Further information about either of these Groups, and to receive a home visit of you prefer, can be obtained from Beryl Peacop, or Anne Flood.

Date	Venue
10 April (second Thursday)	67 Oxhey Lane, Hatch End
15 May	15 Dove Park, Hatch End
19 June	67 Oxhey Lane, Hatch End
17 July	70 Rowlands Avenue, Hatch End
21 August	62 The Avenue, Hatch End
18 September	Outing for members
16 October	52 Dove Park, Hatch End
20 November	6 Boniface Gardens, Harrow Weald
18 December	70 Rowlands Avenue, Hatch End

Volunteer Services

Transport Service

Aim: To provide transport for patients to the Medical Centre and local hospitals

Co-ordinators: David and Pat James .

Operation: The system is operated by volunteers at the Medical Centre on Tuesday and Friday mornings from 10 a.m. to 12 noon. Patients are asked to ring the Medical Centre on 020 8428 4019 at this time to book their journeys. Drivers do not take bookings. In the event of emergency appointments, patients should contact: David & Pat James .

Shopping Service

Aim: To provide shopping Facilities for

the housebound.

Co-ordinator: Carole Levy

Volunteers needed urgently

Home Visiting Service

Aim: To provide visitors for housebound and isolated

Patients, for young families in difficulties, and to

Give respite to carers.

Co-ordinator: Anne Flood

Social and Fund Raising

Aim: To provide social and fund-raising events and

opportunities for patients to meet in a “relaxed

atmosphere”.

Babble and Chat

Aim: To provide opportunities for parents and

Grandparents to meet, and babies and youngsters to play.

Co-ordinator: Lisa Harvey

Parents of Children with Special Needs

total confidentiality and anonymity, in a

relaxed atmosphere.

Aim: To provide opportunities for discussion in total confidentiality

and anonymity, in a relaxed atmosphere.

Co-ordinators: Monique Lauder & Lisa Hawes

Carers’ Support Group

Aim: To provide help and information for carers

Through regular monthly meetings in

members’ homes and by individual visits.

Co-ordinators: Beryl Peacop & Anne Flood

Bereavement Visiting Service

Aim: To visit the bereaved in their own home and

give them the opportunity to talk in

confidence, and offer support.

Co-ordinator: Anne Doulton

S T O P P R E S S

The Harrow PCT have decided to change the structure of child development checks in line with reorganisation of the health visiting scheme.

All babies will be offered a check with the Doctor and Health Visitor at 6-8 weeks. Routine checks with the Doctor will then cease but there will be a Health Visitor contact at 8 months and at 2 years. The Health Visitor will have more time to spend with needy families.

Any parents with concerns can continue to make contact with the Health Visitor at any time by calling 020 8421 5947.

Our current Health Visitor Claire Leed (nee Maxwell) will be going on maternity leave soon, we wish Claire and Paul much happiness for their expected arrival. Details of the Health Visitor(s) to cover Claire’s absence will be posted on the EHMC website as soon as they are finalised

Thank you.

Dr Reena Majus

CHANGES TO REPEAT PRESCRIPTIONS: IMPORTANT INFORMATION FOR PATIENTS

From 1 February the practice has started to change the quantity of medicines allowed on repeat prescription to 28 days’ supply. This applies to all patients eligible for free prescription, the majority being our older patients, aged 60 and over.

FAMOUS NAMES IN MEDICINE

William Marsden

William Marsden was born in Sheffield in 1796. After school he was apprenticed to an apothecary. He wanted to become a surgeon, so he went to London in 1816 and became apprenticed to a surgeon-apothecary (the equivalent of a General Practitioner today) in Holborn. At the same time he attended a School of Anatomy, and later went to lectures at St Bartholomew’s Hospital. He lived in the surgeon’s house, near St Andrew’s Church, Holborn. One cold winter night near Christmas 1827 he was passing that church when he saw a young woman lying on the steps. He found her to be dying of disease and exposure, and took her in a carriage to his hospital. St Bartholomew’s. The warden would not have a letter of recommendation from a subscriber. In those days either a subscriber’s letter or payment was required before a patient was admitted to hospital. Marsden met with a similar refusal at St Thomas’ and Guy’s Hospitals. He arranged lodgings for her at his own expense but she died soon afterwards.

Marsden was very distressed at this incident and decided to do something to change the situation. In February 1828, with the financial help of 27 businessmen, he took over a house in Grenville Street Covent Garden, and established “The London General Institution for the Gratuitous Care of Malignant Diseases”, where patients were admitted without payment or a contributor’s letter. It soon became known as “The Free Hospital”.

At first it treated only out-patients, but in 1832 in-patients were admitted (in two rooms on the top floor). For many years Marsden had difficulty making ends meet. In 1833 the hospital was renamed The London Free Hospital and, when giving her patronage in 1837, Queen Victoria asked that it be known as The Royal Free Hospital. It moved to Gray’s Inn Road in 1843, and to its present site at Pond Street, Hampstead, in 1974. The teaching of medical students began at The Royal Free in 1853, and in 1877 it was the first hospital in England to admit women medical students.

Marsden had always been concerned at the conditions of the sick poor in Victorian London. In 1851 he instituted measures to establish another hospital, The Cancer Hospital (Free) in Cannon Row, Westminster. Patients were again admitted without charge or a recommending letter. This was the first hospital in the world devoted exclusively to the treatment of cancer. It moved to a small house in West Brompton in 1852 and to its present site in Fulham Road in 1857.

At first the Queen declined to contribute to a hospital “for the exclusive treatment of one disorder”, but her subsequent

It just doesn’t seem possible, as I see the flowering cherries begin to blossom outside of the Medical Centre, that it has been ten years since we moved into the “new” Elliott Hall Medical Centre on 13 March 1993.

With great clarity I remember the public meeting in 1990 in the “Elliott Hall” of the Harrow Arts Centre, when many of you joined Drs Elizabeth James, Alan Byers and me to hear of the proposed Safeway’s development. For some years my partners had lobbied the local authority for assistance in helping us either to develop our wholly inadequate premises or support us with a new site.

This unfortunately had been unsuccessful and we continued to work from the cramped ground floor flat at 118 Uxbridge Road, with only two consulting rooms for three Doctors, two Nurses and a Health Visitor. Compared to the high profile of a superstore we clearly did not carry the sex appeal required to make it happen! That all changed when the planning officers and local government representatives were asked at the public meeting how they could justify giving planning consent to a superstore when the health care for local residents was being provided from such cramped surroundings. This was my first direct experience of “Patient power” as I witnessed the massed crowds present applaud Alan Byers as he raised the issue. Gareth Pryce, the Director of Planning, offered to support our quest, and three years later we were moving in.

Needless to say, there were many obstacles to overcome – finding a suitable site, designing a building, obtaining planning permission, engaging architects, engineers, builders, let alone arranging finance! Well, for some this is all second nature, but for busy GPs I can honestly say that we were well in up to our necks.

We received considerable support and advice from many sources during the preparatory years, but in particular Arthur Peacop (our recently retired ElliottEar editor) helped rescue us on several occasions, with sound guidance and excellent advice. The close partnership that was developing between the practice and its patients would eventually blossom into our fabulous Patients’ Association, with which we as the Medical Centre are so proud to be associated.

In 1998 we then enlarged the premises and built our extension. The paralleled development in Docklands of the Millennium project did lead to the nickname of “the Hatch End Dome” as the scaffolding was erected.

So ten years on we are now a 4-partnered practice with major teaching and research commitments. Our close working with patients has been held up nationally as a model of good practice, and we believe we are able to offer a high standard of care, making full use of the extensive facilities we have on offer.

Doctors never talk of their consultation with patients, but occasionally we find ourselves consulting patients. There is little doubt in my mind that had one particular consultation not taken place we would not have the Medical Centre as it stands today. I remember the evening well. My surgery had started late as we had been delayed with our architects, and there was a waiting room full of patients, with others standing in the corridor (in those days, as many of you will remember, there were no appointments). Our meeting had been difficult, there were problems with the planners, the most recent costing was considerably over budget, and the partnership was feeling very exposed.

Mr Tomlin had consulted me several times in the past for ongoing medical issues, and on the last few visits had informally offered support should we need it… on one occasions he had left his visiting card. On this visit there was no beating about the bush. We dealt initially with the health issues and this was followed by a direct statement from the patient which no longer asked how the project was faring but was about me and how I looked … pale, downbeat and stressed I guess! Mr Tomlin (Ivan) advised me that he was a well experiences project manager (not that I knew what one of those was at the time), a Past President of the Institute of Builders, and that he would make no charge for his advice. “Tonight, when you eventually finish work, I will see you at my house!.

Over a glass of Rioja I was left in no doubt of the immense skills of our newly found self-appointed volunteer Project Manager.

The project was a mess on several fronts but Ivan set to work reviewing all the costings, plans and proposals. From the outset the then architects

refused to work with a third party, leaving us with no choice but to release them. Costly as it was, the savings made of re-tendering met this and other overspends. We were now within budget. Ivan met with us regularly (usually late in the evening after surgery and on Sunday mornings), always available and professional. Our accounts were always balanced to the last penny, contractors knew where they stood, and now we had an architect in whom we had absolute confidence.

Dust if you must

Dust if you must,

But wouldn’t it be better

To paint a picture, write a letter,

Bake a cake or plant a seed . . .

Ponder the difference between “want” and “need”

Dust if you must,

But there’s not much time,

With rivers to swim and mountains to climb,

Music to hear and books to read,

Friends to cherish … a life to lead.

Dust if you must,

But the world’s out there

The sun in your eyes, the wind in your hair,

A flurry of snow, a shower of rain,

This day will not come round again.

Dust if you must,

But bear in mind

Old age comes … and may not be kind.

So make the most of every day.

Good luck, good health, in every way!

Anon

Calling all Mobile Phones and Printer Cartridges

Do you have any old mobile digital phones lurking in drawers at home, or do you throw your printer cartridges away at the end of their life?

If so, we have a solution! A group called Carers UK have teamed up with a company which pays them for every digital mobile phone or toner cartridge sent to them. On top of that, all such phones are reconditioned and sent to areas of the world where an ordinary landline is unavailable, thus,

opening up communication to people who would not otherwise have it.

So, if you have any digital mobile phones or printer or toner cartridges please place them in a clear plastic bag and give them to the receptionist at The Medical Centre.

“Doctor Heal Thyself”

It was Wednesday 19 February, “the operation day”. Part of me was glad that the surgery to my ankle would soon be over, but in some way I knew this would just be the beginning. I had signed the consent form in the clinic the week before, “Of course there is always the risk of infection, 1:10,000 risk of paralysis from the nerve block similar to the anaesthetic – this being the major determinant to getting back to some form of normality!

Despite popular belief, GPs also have GPs, and I am fortunate in having a very good one. “When did this ankle start giving you problems?” I had been asked at the surgery. “About 25 years ago,” I replied causing something of a raised eyebrow. I remember the accident well. Jumping for joy at being given some good news, I had leapt down a flight of 12 steps, caught the bottom step, finding myself shortly afterwards in the local casualty department being trussed up in Elastoplast for “a badly sprained ankle”. Six weeks later, the strapping was removed, but unknowingly the damage was done.

Over the next 25 years repeated sprains playing football, or falls in the mountains, progressively weakened the joint. I found myself having to give up Five-a-side football two years ago, and I cut back a little on other outdoor pursuits as just the slightest uneven surface could make me fall, causing yet further injury. The telling moment was whilst supervising a teaching session,

when an orthopaedic teacher asked for a volunteer with an ankle

… “why have you never had this sorted?” he remarked abruptly, following the session and away from the learners. Like many people, I guess I was just ignoring the problem, possible in naivety and the mistaken belief that it might just go away.

Just after 7:30 am on Operation Day the consultant and his disciples arrived on the pre-op ward round. Up until then I had been rather oblivious to the somewhat technical and specialised procedure about to be carried out on me. I had absolute confidence in “the experts” and had been far more preoccupied with the professional and social implications such surgery would have on others around me.

The evening before, in response to my request to see a diagram of what they proposed to do, the registrar produced a large textbook from a bag he was carrying on the ward round.

With great enthusiasm he proceeded to open it to a page of small print with a technical drawing of the ankle, which could have been upside down to my level of understanding. In response to my suggestion that they leave it for me to look at and digest, they remarked that they needed it for the operating theatre but would return with it at a later stage.

Several hours later, as I recovered from the anaesthetic, I was visited by the surgeon on the ward. Noting my interest and intrigue, he informed me that the operation had been a success and asked whether I would like to see what was done. I responded positively, imagining for a moment that an artistic drawing was about to be revealed, only for him to produce a digital camera from his pocket. There was a photo of extraordinary clarity actually showing him at work during the operation. It was impressive, even if I was a little too embarrassed at the time to admit that I was still unclear as to what they had really done!

This was the first time since being a junior doctor I found myself staring out over the long “Nightingale Ward”; the Royal National Orthopaedic Hospital has several such wards. Certainly a “sociable” experience and one all Clinicians should undergo. It’s an eye-opener to see and hear how little confidentiality there is behind curtains!

One week later I am now home and non-weight-bearing crutches, having passed my safety test with the physiotherapist. I do a poor impersonation of s flamingo and have enormous respect for anyone who has the misfortune to have the use – either temporarily or permanently – of one leg. On reflection, a couple of weeks in the gym working on the upper limbs would have helped. Just about all activities of daily living that require one to be standing are, to say the least, challenging. Carrying a cup of tea is impossible and managing stairs where there is no banister a challenge for any acrobat.

But seriously, I found myself totally dependant upon a specialist team in the hospital, for whom I have the utmost respect. Balancing the various demands on an already over-stretched health service whilst delivering the personal needs for difficult patients like me is no easy task.

I must also thank all of those patients who will have put up with my absence over the next few weeks, and those who have been kind enough to send their good wishes to me – this has meant an enormous amount.

Finally, a big thanks to all the team at EHMC who have covered for me, and to Dr Elizabeth James, who once again has returned out of retirement to help support the team whilst I have been away.

Chris Jenner

South Africa (SA) is 6,000 miles south of here and is 5 times the size of the UK, with a population three-quarters that of Britain. I popped over there in February for a week’s fascinating medical conference, both on British and South African medicine.

South Africa is divided into 9 provinces, and our conference was held in Cape Town, the capital of the Western Cape Province. SA is the “Rainbow Nation” as Archbishop Desmond Tutu first called it. She is made up of 78% Africans, 9% Coloureds (“mixed” parentage), 10.5% whites and 2.5% Asians, but statistics are unreliable partly because there are lots of people coming in unofficially across SA’s northern borders melting into the cities and townships.

SA has 11 official tongues: English (now the official number one), Afrikaans, and 9 Bantu languages including Zulu and Xhosa. 51% describe themselves as Christian, 1.4% Muslim, 1.3% Hindu, 0.2% Jewish (106,000). The rest are of unspecified religion, African Traditional or agnostic/atheist.

Generally SA seems to be making a great effort to provide the best health care she can with her resources and is preoccupied with trying to have equality of health care for all her population,

Apartheid 1949-1991 is still fresh in their minds, and all races seem to be trying hard to make co-existence work.

Cape Town and the Western Cape Province used to have the greatest per capita health expenditure and the best health statistics of SA, but as their Health chief, Professor Craig Howson, told us, their Healthcare Plan 2010 involves a great redistribution of finances in the interest of equity of access to NHS care, so that the Cape will have to endure great cutbacks.

Although 7-8% of SA’s GNP is spent on health, only half of this goes into the public sector, and this has to cover at least 75% of the population, mostly black. What follows concentrates on the SA NHS/State sector. The private sector to which most who can afford it subscribe via various insurance schemes, has standards on a par with those of the Western World. South Africans are proud of their private health care standards and like to recall that in 1967 SA’s own Chritiaan Barnard performed the world’s first heart transplant operation.

We were split into 3 groups and visited 6(2 each) of various types of health care facilities in Cape Town. Some sae their famous children’s hospital – the only specialist children’s hospital in the whole of Africa. Some went to a sexually transmitted disease (STD) clinic. I was taken to a sparse but clean Primary Care Centre and an urgent medical and surgical trauma general hospital on the outskirts of Cape Town, serving a mainly township population of at least a million people, many of whom live in no more than shacks the size of my small touring caravan. This hospital “G.F.Jooste”, sports 184 beds, with a sister 40-bedded hospital nearby for AIDS and TB. Multiple drug resistance TB is on the increase and costs 100 times more to treat than a non drug-resistant strain. TB and AIDS often go hand in hand. While I was there

AIDS. Clinicians hope that his going public will assist in destigmatising HIV/AIDS, which would help the fight to control it.

Shockingly, 10.5% (4.7 million) of SA’s total population of 45 million is HIV positive. (As you know, HIV is the Human Immunodeficiency Virus which leads to fully blown AIDS in average of about 10 years.) In the Western Cape, 25% of all pregnant women are HIV positive and they have decided to try and treat HIV with antivirals only given to pregnant women.

Everyone else is given some vitamins and an explanation, but no specific treatment, unless they can pay for it. There is no palliative care in the state sector for people who are or will soon be dying. Families are generally simply told to get on with it!

Every month the G.F.Jooste hospital deals with 50 cases of gender violence – rape or assaults – and has a special little unit with bath/shower and change of clothing and facilities for tests where some counselling is given at the time. Security to get into the hospital is quite strict, with all entrants being scanned for weapons with an airport-type beeper. There is a special large room full of armchairs, called the intercostal drain room, where patients have the blood and fluid drained from their chest following the latest stab or gunshot wounds, and walk around carrying unwholesome looking drainage bottles. We were very impressed by the dedication of the whole medical team, who do a great job under difficult conditions, and at some personal risk.

The NHS treatment is all “free” to the public, and all medicines on a basic list of drugs are free too. However, statin anticholesterol drugs, for example, are considered luxury drugs for which everyone has to pay the full price. Some AIDS antiviral drugs are available at 600 rand (£50) a month – the drug companies have sold cheaper drugs to SA, and generally medicines are less expensive there. Waiting for 3-4 hours at a primary care centre or at a pharmacy is nothing unusual.

No one gets to see a doctor in the state sector unless a nurse thinks it is necessary. In SA, the first point of contact with a health professional is a nurse, not a doctor. In fact on the UK now, as you know, we have a mixed approach, with sometimes a nurse and sometimes a doctor being the first post of call. SA is very concerned about the shortage of health professionals in general and nurses in particular. They complain that we in the UK are poaching their nurses, who find a British nurse’s salary attractive. The probably do not realise how much more expensive the cost of living here is too! If you want a screening cervical cytology smear for cancer of the cervix or a mammogram to detect breast cancer in the SA NHS, you can forget about it – unless you go privately. There is no national programme for smears or mammograms.

A baby in SA today has a life expectancy below 60 years of age. If the current AIDS epidemic is not checked it may fall to under 50 within 5 years. (The figures are much better than this though if you are a white South African which

Immunisation Clinic

This clinic is now run every Friday afternoon from 1:30 p.m. by Sister Jane Lewis. It is run in conjunction with the clinic of the health visitor, Claire Leed, in order to minimise inconvenience to parents.

The immunisations currently recommended for children are listed below.

If you have any concerns regarding any immunisations please contact Jane or Claire. There is a lot of information available at the surgery to help you make the right decision for your child, based in the facts.

The Department of Health are to introduce a Haemophilus Influenza type B (Hib) Vaccination catch-up campaign. This is in response to a recent rise in cases of diseases caused by Hib infection. Children requiring immunisation between the ages of six months and four years will be called for immunisation in the near future.

When to immunise	What is given	How it is given
2,3 and 4 months old	Polio Diphtheria, tetanus, Pertusses & Hib (DTP-HIB) Meningitis C	By mouth One Injection
About 1 year old	Measles, Mumps, Rubella (MMR)	One Injection
3-5 years old (pre-school)	Polio Diphtheria, tetanus & acellular pertusses (DtaP) Measles, Mumps & Rubella (MMR)	By mouth One Injection
10-14 years old	BCG (Against tuberculosis) Sometimes given at birth	Skin test then, if needed, one injection
13-18 years old	Diphtheria & Tetanus (Td) Polio	One Injection By mouth

Tobacco: A brief history

Tobacco is made from the leaves of the plant Nicotiana, which grows in many countries with a warm climate. American Indians used it from time immemorial; they burned the leaves and inhaled the smoke through a pipe called a tabaco. Tobacco was brought to Europe from Mexico by a Spanish physician, Fernando Hernandez, in 1559. Its use spread rapidly and smoking was valued for its medicinal and pleasurable qualities. It was smoked in clay pipes.

In England and elsewhere in the 18^th century smoking gave way in part to snuff (ground tobacco, sometimes scented) which was inhaled through the nose. Fine decorated snuff boxes appeared. They were made of wood, silver, gold or jewels, and miniature painters produced some beautiful specimens.

The cigar, a roll of tobacco leaf, was one of the earliest forms of smoking, widespread in South America when Columbus visited there. The cigar came to England in the 19^th century and gradually displaced snuff-taking.

Cigarettes were popularised by soldiers returning from the Crimean War in 1856. At first they were made by hand; nowadays they can be machine-made at the rate of 1,000 per minute, In 1761 John Hall, an apothecary, published a book, Cautions Against the Immoderate Use of Snuff, in which he reported “polypuses of the nose caused by taking snuff”. It was the first report of cancer due to tobacco. Today there is overwhelming evidence that tobacco-smoking can cause lung cancer, breast cancer, cardiovascular disorders and bronchitis.

The first modern study proving an association between smoking and lung cancer was published in The Journal of the American Medical Association in 1950 by Drs E.L.Wynder and E.A.Graham. Earlier, in 1947, the British Medical Research Council had asked Richard Doll, a British Physician, and Austin Bradford Hill, a statistician, to analyse the possible causes of lung cancer. Their report appeared in The British Medical Journal soon after the American paper. They studied 1,465 cases of lung cancer and 1,465 non-smokers as matched controls, and confirmed that smoking was an important factor in lung cancer.

Later the Royal College of Physicians of London and the US Surgeon General produced evidence that death from lung cancer was 70% high in smokers than in non-smokers. There was also a greater risk of heart disease.

A half of all smokers will eventually be killed by their habit. The death rate from lung cancer and smoking is about 104 per 100,000 among males in the UK.

More deaths are caused by smoking here than in any other country. Passive smoking (inhaling the fumes caused by other smokers) kills hundreds every year. It increases the risk of cancer by 70%. Recently it was reported that in London alone about 650 new cases of asthma in children are caused every year by passive smoking. Smoking costs the NHS

about £1.7 billion (£1,700,000,000) a year!

Recently the World Health Organisation warned that five major cancers (cervix, liver, stomach, kidney and a form leukaemia)

were caused in part by smoking, but that there is little evidence of prostate cancer through smoking.

A recent study has demonstrated a link between smoking in teenagers and future breast cancer.

Leslie Morton

Helping to Build Better Bones

One in three women and one in twelve men over the age of fifty will suffer from osteoporosis, a condition where the bones become so fragile that they break following the slightest knock or fall. Up to 14,000 people a year die in the UK as a result of hip fractures associated with osteoporosis, and many more suffer pain and disability.

The National Osteoporosis Society is working with GP practices to identify the women at highest risk of osteoporosis. By doing this we hope to improve the quality of life for our older people

EHMC has applied to have one of the specialist osteoporosis nurses to work with Sister Jenner to undertake an audit of the risk status of all our elderlu female patients. Each lady will be sent a brief questionnaire to complete.

The returned questionnaire will then be checked and each person’s risk of osteoporosis assessed. Patients considered to be at high risk will be invited to see a nurse, and offered detailed lifestyle advice and/or some treatment options.

If you are a lady over 75 years old you will receive a questionnaire during the next six months, and we would be grateful if you could complete it and help us with our work on osteoporosis.

Can I Prevent Osteoporosis?

Many factors can increase your risk of osteoporosis, but the way you live your life also affects bone health.

Follow a “bone-friendly” diet

Healthy bones need a well-balanced diet with calcium being especially important.

Take regular weight-bearing exercise.

Good bone-building exercises include running, skipping, aerobics and tennis, but even a brisk walk can be of benefit. Try to exercise at least 3 times a week for a minimum of 20 minutes, and choose an exercise you enjoy.

What else can I do?

If you are a smoker- give up! Smoking may increase the risk of hip fracture in later life, and not smoking will benefit bone and general health, Watch what drink! Drinking too much alcohol is damaging to bone turnover.

TAKE ACTION NOW TO AVOID FRACTURES IN THE FUTURE!

The National Osteoporosis Society

01761 471771

www.nos.org.uk

Sister Helen Jenner

Janet Ambridge, and senior receptionist Sharon Hopkinson, who have all left to take up new challenges.

Our new team us now fully reconstituted and I am sure will continue to flourish. We have a new Practice Manager Denise Lavey, joining us from a Practice Manager post in Wembley, a deputy Practice Manager/IT manager in Carole Dixey, and a Practice Administrator in Ann Knight. The reception team has our reception administrator Laura Knight, senior receptionists Julie Cockburn and Carol Trump, and our longest serving staff member, Beryl Jardine. They are joined by three new receptionists, Jackie McHardy, Lynne Peermohamed and Christine Elton.

We also have a new pair of cleaners, Peter and Martha Haynes, following the retirement of another husband and wife team, Eric and Reenie Pope.

We look forward to much success and happiness working alongside the biggest team of all – that comprised of all our patients.

Best Wishes.

Reena Majus

Dr Naomi Vaughan

MBBS FRCS DRCOG

I have been asked (actually, told) to make a contribution to The ElliottEar. Apparently the Patients’ Association may be interested to know something about me and my background though I find that difficult to believe, because my life outside work is filled with domestic mundanity, but I am originally from Barry, in South Wales. My family are still there and I remain passionately Welsh. All references to and questions about the current state of Welsh rugby will, however, be ignored.

I came to London to go to St Mary’s Hospital Medical School in Paddington, and have been in England ever since. I qualified in 1991 and initially had a career in General Surgery, with a particular interest in breast surgery.

I married a doctor who was in the same year at medical school – he now works at Northwick Park Hospital as an anaesthetist. We moved to Harrow in 1999 and have since had two boys, Joe (3) and Charlie (20 months). After having the children I decided that my family life might be better balanced with work outside the hospital. I was also starting to feel at home in Harrow and wanted to be part of its community, so moving into General Practice seemed the obvious next step. I did some further training in obstetrics, gynaecology and paediatrics, and finally moved to Elliott Hall in February. I am a GP registrar there and work three days a week which seems an ideal balance.

Now, a month later, I’ve almost got the hang of the computer, I’ve almost learnt everybody’s name, I can usually remember the code for the doors, and have learnt a few of the road names in Hatch End. I have definitely worked out that I’m very lucky to be training in such a good practice though, and I am looking forward to the next nineteen months very much.

Naomi Vaughan

Jane Lewis

I qualified as a Nurse in 1989, joined the Army as a Nursing Officer the following year and was deployed with a field hospital in Saudi Arabia during the Gulf War. Throughout my Army Service I was involved in Primary Care for soldiers and their families. Since leaving the Army I have worked in a variety of nursing environments,

including Accident & Emergency.

I am married, with one son who is six years old.

Jane Lewis

Denise Lavey

I joined Elliott Hall Medical Centre in March as Practice Manager, having previously been Manager of a smaller practice in Wembley.

I consider myself a local girl, having lived and worked in the area for over twenty years. When I’m not at work I enjoy swimming and cycling, and have a keen interest in watching athletics and show jumping. I am a regular supporter of the local athletics club, and can generally be found in a muddy field on a winter Saturday cheering on cross-country runners! (The track season can’t come soon enough!!) I am very excited to be part of a team, and hope to meet many of you in the future.

Denise Lavey

It must be pointed out that the accuracy of any statements cannot be warranted, nor any products or services advertised in The ElliottEar be guaranteed or endorsed.

Please remember how important feedback can be.

From the Editorial Team

Babble and Chat

CARERS’ SUPPORT GROUPS

The Expert Patient Programme

THE EHMC WEBSITE

“Doctor Heal Thyself”

Tobacco: A brief history

Helping to Build Better Bones

Healthy Heart Clinic

Dr Naomi Vaughan

Jane Lewis

Denise Lavey