Life at the sharp end of medicine

PATIENTS vary widely in their acceptance of injections. Vusi Ngubane turned up monthly without fail at one of our mobile clinics, insisting on a jova whether indicated or not. He was the local headman, always traditionally dressed in skins, bare chested, a sacred feather embedded in his hair, bangles on the ankles, strings of dried seeds round his chest, bare-footed and with a brutallooking knobkerrie in one hand. He generated a lot of noise and disruption – I found it satisfactory for all parties to give him a large shot of vitamin B immediately on arrival, after which he shouted with satisfaction and left, still shouting, at a run.

Over the years I’ve taught countless nurses to give injections. Timing is crucial and the chosen site, usually a buttock, is smacked with one hand a fraction of a second before the other delivers the shot. The patients feels the smack but not the pain of the needle and often does not realise the deed is done until it’s all over.

In the past few years, doctors worldwide have become aware that the use of intravenous drips and injections has become excessive and often unnecessary. In many clinics in Africa, setting up a drip is almost automatic and gives the patient and relatives the impression that something is being done, whether a diagnosis has been made or not. In the wards, many medicines are given intravenously although oral tablets and mixtures are just as effective. In private medicine, one reason is economic – you can charge the patient more for a drug given by drip than orally.

After the Aids era, disposable needles replaced the old steel ones which were kept in surgical spirit for re-use and sharpened as required. In our part of Africa, drug addicts still re-use the disposables.

Not surprisingly, health workers are wary about accidentally puncturing themselves while giving an injection or taking a blood sample from a nervous adult or child whose movements may be unpredictable. Should it happen with an untreated Aids case, you will find yourself taking antiretrovirals for the next month and then waiting for your own HIV test – most of us making no assumptions, I might add.

Worse still is that if, as in Uganda whose neighbours have had recent outbreaks, you encounter a suspected Ebola case. Several tropical diseases in their early stages are similar to Ebola but not lethal. This is not a consolation if the blood test result is not available and the patient needs another blood test or a drip. Often only double gloves and masks are available – not at all reassuring if you have not been vaccinated.

My younger colleagues’ jaws drop when I tell them about exchange blood transfusions in the newborn suffering from Rhesus disease. These babies died or were brain damaged because their blood cells began to burst a few days after birth by which time they were deeply jaundiced. The treatment was to exchange the toxic blood for fresh stuff via tubes inserted up the newborn’s umbilical cord. It could take hours and spasm of the transfuser’s fingers was an occupational hazard. Today, the mother at risk of a future affected pregnancy is given an injection and Rhesus disease is very rare.

Similarly, before the arrival of haemodialysis machines to treat kidney failure, we were limited to peritoneal dialysis. A small steel trochar and canula were guided into the abdominal cavity then several litres of sterile fluid followed and were drained back out after a few hours. This contained the toxins that non-functioning kidneys were unable to deal with.

Chemotherapy for certain cancers involves intravenous drugs. Some years ago I would return from the nearest oncology unit with a drip in one arm being fed from a cute little ball of cancer drugs nestled in my shirt pocket. The clinic staff told me that several patients, observing this haggard white man with a tube coming out of his chest, muttered to each to each other, shook their heads, sighed, and left the premises.

Dr David Vost studied medicine at Glasgow University and works at a hospital in Swaziland. He and his family live on a farm in Northern Uganda near the Albert Nile. davidvostsz@gmail.com

THIS week saw the biggest Fife derby ever as Dunfermline Athletic and Raith Rovers fought out the Premiership playoffs. Both stadia should have been rocking with five-figure passionate crowds. There was little atmosphere. Fans watched on the clubs’ live streams or listened on the radio.

This has now become intolerable, 14 long months after the World Health Organisation confirmed that this virus does not transmit outdoors.

The virus has to navigate wind, rain, sleet, snow, heat and humidity to leap between people. UV from sunlight destroys the virus particles. It does not survive on a hard surface. Indeed, to be in any danger, someone in front of you would have to cough directly into your face at the very moment you inhale with no mask.

One can google numerous academic studies from the UK, the United States, Canada, the EU, Russia and China to find similar evidence. In one Chinese study, 76,000 patients were examined and not one got it from airborne transmission.

On that basis, sailing, fishing, tennis, golf, kayaking, bowls, outdoor swimming and putting all returned. Football and rugby were sidelined.

The Scottish Government has said 500 fans can attend outdoor sporting events from May 17 in Level 2 and your local council can agree more. This is simply unacceptable. What was the point of 300 fans attending 21,000-capacity Pittodrie or 700 at 64,000-seated Murrayfield more than six months ago, given there were no similar experiments nor any subsequent matches with increasing crowds? How, then, is TRNSMT going ahead?

The reality is that last June, half a million turned up at Bournemouth beach and there was no spike. Nor was there at the Liverpool or Leeds United or Rangers championshipwinning celebrations, yet all attracted near-hysterical, hostile newspaper headlines.

The Scottish Government has been commendably cautious although as we are not yet independent, we could not follow Professor Devi Sridhar’s advice and emulate similar-sized Denmark (which has had 2,491 deaths to our 7,660) when it was the first to shut down and close its borders and first to reopen.

Now pressure will mount on Holyrood as England sees fans at the FA Cup Final, Ascot, Wimbledon, cricket

Test matches, the Grand Prix, 10,000 at EPL games, and, ironically, Scotland at Wembley.

Our club chairmen are not asking for packed stadia in the short term but socially-distanced gates with relevant hygiene measures and stewarding. Away fans will not be allowed to travel but fans can watch their clubs’ live PPV stream. Fans in beanies, gloves and scarves will be safe with no hospitality on offer and staged arrival and dispersal.

Forty-three per cent of Scottish club income comes through the turnstile and clubs are about to put their season tickets on sale. It is imperative fans are allowed to return.

John V Lloyd, Inverkeithing.

What hope for the Rest and Be Thankful?

I READ with interest the cost involved for consultants to attempt to fix the 15-year problem of landslides on the A83 Rest and Be Thankful (“Ministers criticised over 10-year wait for A83 solution”, May 2).

This involves a 10-year plan and spending £25 million on consultants alone – that’s before the road itself is fixed. We can only surmise the eye-watering cost of that venture.

Meanwhile, we all have to traverse daily on roads that are more akin to farm tracks.

It does not give you much hope that the Rest and Be Thankful will ever be fixed if our roads remain in the condition that they have been allowed to get into.

Neil Stewart,

Balfron.

Heathrow expansion may hit Scotland

SIGNIFICANT tightening of UK carbon emissions policy (net zero for Scotland by 2045, 78 per cent of the way to net zero across the rest of the UK by 2035) and the inclusion of aviation among the targets for cuts, could well impact upon Scotland were Heathrow expansion to proceed.

Because, in confirming that there can now be no net expansion in UK aviation capacity, the UK Government’s Climate Change Committee has now stated that expanding Heathrow – in the already economically advantaged south-east of England – would need to be offset by restrictions, and quite possibly closures, at other UK airports. And this could include those in Scotland.

Other than Heathrow’s foreign-based shareholders, who might advocate for such a relegation of economic opportunity?

Paul McGuinness,

Chair, No 3rd Runway Coalition, Teddington, Middlesex.

Before long Covid there was ME

ON Wednesday, MEAction will hold #MillionsMissing events, calling for governments to take action on the ever-growing crisis of ME.

There will be more than 25,000 people in Scotland still in “lockdown” – missing from work, education and family life – due to myalgic encephalomyelitis (ME). A quarter are housebound or bedbound. Long-term illness and disability can be triggered by viral infections – 80% of ME cases are initiated by an infection. We now talk about “long Covid” which is devastating and the NHS must offer science-backed treatment to the 10% of people who have long-lasting Covid symptoms, many of these similar to ME, and to people with ME.

Some ME sufferers remain ill indefinitely. The commonly-offered treatment, graded exercise therapy, is now regarded as dangerous. People who have ME or long Covid with symptoms of ME need to rest and pace themselves.

My daughter had ME from the age of six until 19, and missed most of her schooling and any normal life in that time. I know many clever, motivated young women who are missing higher education, starting a career or family. About 75% of ME sufferers are women. Is this perhaps why the medical profession has turned its back on those with the illness and left it to a few psychiatrists to “specialise”, who say that this is not a physical problem but a mental one?

Helen McDade, #MEAction Scotland, Pitlochry.

Join the debate on antidepressants

THANKS to Helen McArdle for her excellent and detailed investigation