Tuesday, December 26, 2006

Joburg Hospitals reduce intubation weight of babies to 900 grams

More Ubuntu stuff soon... Keep reading! Some important news though... just in.

It happened the other day. Anything 900g or less must breathe by itself or die. There are reasons of course, like not enough staff or intubators. Studies have also shown poor prognoses in lower grammages. Therefore those with a higher chance of surviving - will get the intubators.

This one is 3500 grams. Makes you think. Doesn't it?

Sunday, December 24, 2006

Happy Christmas!

To all our readers...

And a great New Year...

Ubuntu Medical: Centralised patient databases in the African context

Andy eventually got me to sit down and give some prelim views. The trickiest thing, if you REALLY want to make a difference in South Africa is planning. There are a couple of lovely third world things that get in the way:

*Egos of management
*Concentrating on PATIENT MANAGEMENT, not financial management.

For instance, if the open source community can help with the situation I'm about to describe, and just this, you have no idea how much of a difference it will make to primary healthcare in this country. Build the "system" so it can be grown, sure. But little steps is the only way you'll get anywhere in a third world country.

Here's the situation. Primary healthcare patients (GP-based needs, meant to go to clinics, both rural and metro BEFORE they get referred up to secondary and tertiary centres - where they would get seen by specialists and clog up already clogged hospitals) HAVE to carry around a green piece of cardboard - their clinic card.

This card links to a manually filed medical history inside the clinic archives. To get to a hospital, you're meant to get referred - thus creating the link. If you don't, hospital doctors are practicing blind, because there is absolutely no way to retrieve paper-based files from clinics around the country.

And most patients believe they can just pitch up at hospitals with primary care problems (translation: trivial from a hospital's point of view). Small wonder we're understaffed? Especially Baragwanath.

Hospital doctor's don't need every little bit of previous scrawl - but there are some critical pieces of information that should be kept centrally on a patient database - and easily accessed at critical times. Such as: Patient diagnoses (incl the controversial HIV + - status, in code), current medication / dosages, allergies and relevant major tests (eg. CT SCAN, ECG, major blood work).

Solve that problem and you've taken a huge leap forward.

Saturday, December 23, 2006

Medical Ubuntu: Coverage and first round of interesting articles.

So far, our little post-on-a-whim "Ubuntu across the medical industry" idea has been featured on (and mighty thanks to!):

We've also started doing a bit of digging... nothing like a good idea to inspire some late night surfing-with-purpose...

Mercy Hospital Opens Arms to Open Source... (Tina Gasperson)
"For almost 100 years a group of women called the Sisters of Mercy have been instilling a spirit of excellence into Baltimore's biggest hospital, appropriately named Mercy. Right from the start, the Sisters have made it their goal to push the medical institution beyond the ordinary by creating teaching affiliations, feeding the hungry, building state-of-the-art emergency services, and launching a neighborhood health center for the inner-city poor. In today's world, all that excellence requires a solid technology infrastructure--and one open source management package to manage a variety of systems.

"Mercy's data center houses more than 200 machines running Windows, Linux, Solaris, AIX, and other, more obscure operating systems. Mercy CIO Jim Stalder says about 160 of the servers are Windows-based, but because the health care services industry is 'fragmented,' with many essential applications available only on other OSes, he also has to maintain dozens of non-Windows machines..."

OpenVista is the open-source version of VistA, which is an enterprise grade healthcare information system developed by the U.S. Department of Veterans Affairs (VA) and deployed at nearly 1,500 facilities worldwide.

MedPix Medical Image Database Uses Healthy Dose of FOSS (Michael Stutz)
"MedPix is a sprawling online medical images database and diagnostic tool that's used around the world by radiologists, nurses, physicians, and medical students--and the whole system is powered by Linux and open source software.

"MedPix is hosted by the US federal government's health sciences university, the Uniformed Services University in Bethesda, Maryland. It's the brainchild of James G. Smirniotopoulos, M.D., a USU professor of Radiology, Neurology, and Biomedical Informatics and Clinical Sciences Chair of its Department of Radiology and Radiological Sciences..."

Interview with Fred Trotter: The Medsphere (Tony Mobily)
"Recently Medsphere, supposedly an 'Open Source' Medical Software Company, has sued its founders Scott and Steve Shreeve. Why? Medsphere claims that the Shreeves illegally released Medsphere software to Sourceforge. An 'Open Source' Software company is suing its founders for releasing code under a free license... that's a bit like Ford suing its employees for making cars.

Recently Fred Trotter has come forward with evidence that he claims makes the Medsphere lawsuit baseless. Read on for an email interview with Fred Trotter regarding who did what in the Medsphere lawsuit, and why every free software developer should care about what is happening to the Shreeves..."

Raw Matter: Free Software and Quality
"Ben Chaff argues that Free Software is better than average in terms of security when compared to the proprietary software market, but falls short of the standards that apply for software used in crash-and-people-will-die type of mission critical applications.

"I fear I have to cry foul here: developing software for the kind of systems he describes (nuclear power plant controlling, medical equipment, ...) means developing software with a large budget and a limited, relatively well specified functionality..."

Ubuntu Linux in the Medical Industry... The ball rolls.

Hello chaps... Thanks for all the interest shown in the Ubuntu story so far. We are quite serious about pursuing the merits / sustainability of such an idea - with a view to handing over implementation to a non-profit... Any feedback would be greatly appreciated.

A special thanks to the first couple of people to prick up their ears: Mike Stopforth, Aaron and Farrel. We'll keep gathering interested parties together and see what happens. That's usually how these things start.

Things we're particularly interested in, and will research for a couple of new year posts...
  1. 3rd World PC Projects. Who exports old PC's and to where?
  2. Sustainability. Nothing is for free anymore. If the idea on the table allows national collaboration in the medical field, and empowers the medical profession to be more efficient - who pays the bills?
  3. Software. I'll bring SA Doc into the fold here - we need to figure out firstly, what do hospitals / doctors / nurses ACTUALLY need in terms of software? What's available on the Linux platform.

As Farrel says in his comment on the initial post - this could be done by pretty much any Linux distribution - but why not use the perfectly good South African one then eh? (Note to self: Proudly South African involvement?).

Would be nice to get a response out of Ubuntu themselves. These ideas sometimes have a tendency to run away with themselves - the developers and distributors themselves may be able to push this thing along the right path...

We've already started digging for interesting stuff. That post coming up next...

Oh, and a shout out to the Ubuntu Blog (unofficial) - who was looking for interesting stuff being blogged - about Ubuntu!

Thursday, December 21, 2006

Using Ubuntu Linux to solve South Africa's Medical Issues

The start of the argument about Health 2.0 got me thinking. As sexy, functional and efficient as the health software trend may be - I think we all agree on the fact that it's just not applicable in the African context... yet.

So what might be applicable? SA Doctors need lab results, need to do research, need to store and retrieve patient records (on demand)... How do you get a connected, low cost, easy to use, low maintenance technology infrastructure into South Africa's hospital system? And then keep it there?

We've been using Ubuntu Linux (a proudly South African distribution of the Linux operating system - with our very own billionaire Mark Shuttleworth as the brains) around the office a bit - mainly to do tricky techy stuff, but I've been absolutely blown away with the new version (6.06 I think). It's funky, it's African, it's VERY easy to use (provided you don't mess with settings / use installed packages - which are more than ample for everyday use) and it runs on fumes.

I've personally run Ubuntu on a P3 256mb RAM - like lightning on the highveld.

So here's the challenge:

and all the folks at UBUNTU Linux:

Well done, chaps, excellent job. How about a project? We could secure funding (Government?) for an independent, empowered, Section 21 company to create an Ubuntu network of computers linking all SA's primary, secondary and tertiary care hospitals together.

  1. It's low cost because the operating system is free.

  2. It's low cost because it runs on the kind of computers America is throwing away.

  3. It's low maintenance, because once the networking protocols, any required software and web browser have been installed - the OS can be locked down and user logins/passwords managed fairly easily.

  4. It doesn't get viruses. Including the ones spread by the nasty germs on the kettle in the tea room (whole new post, different time).

  5. It could network and interlink over a low cost dialup, sponsored by Telkom.

  6. It could encourage the open source community (multiverse, universe... I get confused) to get together and develop some simple software for storing patient records, lab results, X-Rays and making them available to the right channels at the right time.

  7. It doesn't crash!

I think I'm onto something - if I dare say so myself. South Africans are too ready to throw away local solutions when faced with more expensive, inappropriate overseas ones. A project like this, while creating jobs and uplifting infrastructure would equip and empower our medical industry to fight a battle they're not getting a lot of help with. And we'll be doing it, the South African way.

Baragwanath is 2km wide. How would you like to run a kilometre (the phones just don't get answered) and wait in a queue (only 5 terminals work currently) for those lab results as your patient lies gasping on the slab?

This is a call. Who's in? Are the folks at Ubuntu interested in pursuing a project like this? Is there anything going on at the moment?

If I'm not mistaken - movements like this ARE the spirit of Ubuntu. Leave a comment, we're really interested in your views...

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Wednesday, December 20, 2006

Health 2.0 in Africa 1.0

Software like Click 4 Care is a great idea if you were trying to manage a million dollar medical aid company or private hospital. In fact I'm sure Discovery and Netcare already have something similar.

But in the public sector (where management in this country is needed most) it would never happen. The Public Sector can't seem to even afford to keep the Pentium 1's running (and thus provide us with lab results)... How on earth would they manage to network entire systems and then control/manage them?

Great idea in the 1st world.... but alas, Africa will just sit and look from the side line again.

Monday, December 18, 2006

Health 2.0? Noooo...

It's arrived. Just when we're truly sick and tired of Web 2.0, Business 2.0, Consumer 2.0. Agh! Drumroll please... Health 2.0

Just what is it? Will have to find out. Here is, apparently, an example (got this off The Health Care Blog - worth a read).

Click4Care is a relatively new software company (although a lot older than most of those Health 2.0 companies I've been featuring) that’s spent a lot of time building a very, very complex system for what can broadly be described as care management, sold primarily to plans and payers—with United HealthGroup being the marquee customer so far.

Hmmm. Will wait for SA Doc to wash off the snot - and take a look at what this means in a South African context.

(SIDEBAR: SA Doc is on call at Coronation Hospital tonight. Thinking I should encourage a blow by blow pictorial of 8pm to 7am in the scary kiddy ward?)

Medical Cartoon #3

Har Har. Good one. More here.

Blog Flatline

No, we're not dead. Just too many Christmas snotty noses and Blogger Beta is giving us a LOT of hassles!

Wednesday, December 13, 2006

Medical Terms. Redefined.

There's a dearth of medical news. SA Doc is treating snotty noses and stress... and I'M NOT EVEN A DOCTOR. But I can find funny doctor stuff. Har Har. This one's peachy.

Artery - The study of paintings.
Benign - What you be after you be eight.
Bacteria - Back door to cafeteria.
Barium - What doctors do when patients die.
Cesarean Section - A neighborhood in Rome.
Cat Scan - Searching for Kitty.
Cauterize - Made eye contact with her.
Coma - A punctuation mark.
Dilate - To live long.
Enema - Not a friend.
Fester - Quicker than someone else.
Fibula - A small lie.
Hangnail - What you hang your coat on.
Impotent - Distinguished, well known.
Labor Pain - Getting hurt at work.
Medical Staff - A Doctor's cane.
Morbid - A higher offer than I bid.
Nitrates - Cheaper than day rates.
Node - I knew it.
Pelvis - Second cousin to Elvis.
Post Operative - A letter carrier.
Rectum - Darn near killed him.
Seizure - Roman emperor.
Tablet - A small table.
Tumor - More than one.
Urine - Opposite of you're out
Varicose - Near by

Friday, December 8, 2006

DSTV responds to 'Be Unfaithful" advert

Vindicated! Yes!

I wasn't as much of a zealot as I thought I was. The DSTV Streetpole ad series that featured pouty-lips Rihanna with a subheading 'Be Unfaithful' - of couse referring to decoders at a special special low price... has been changed.

It now says Visit Paris. That's clever, while not encouraging promiscuity. Win win.

PS. Buhle Dlamini wrote a piece for Business Day on the same subject. Published 5 December. Self-congratulatory pat on the Scrubbed Up back for scooping the story by 15 days!

Wednesday, December 6, 2006

A Medical view on "Googling your symptoms"...

Andy's post (Google Health... some thoughts), although opinionated and not medically based - is correct.

I understand and support the notion that a patient HAS to be educated. They take their pills regularly, they look after themselves, they’re more compliant patients if they understand what’s happening to them.

But... What’s wrong with the Internet is that patients have no guidance on what they’re educating themselves with – what to hold onto vs. what to discard. They end up wrongly informed – which is far worse than not informed at all.

I worry about Google's content rating system. You’re asking non-medical, ignorant people to judge the relevance of medical content. There’s a reason doctors study for 6 years and then practice for 2! It’s like me trying to make a judgement on the performance of the latest BMW – I just don’t have a clue!

Prime Example. Had a patient the other day who’s 6 year-old daughter has rectal prolapse. She’s been seen by a GP and paediatricians and no sinister cause has been identified. Mommy went to the internet and looked up rectal prolapse – and of course - out pops the textbook list of causes. She then arrived at the Practice with her mind made up. Her daughter now had cystic fibrosis – and I should investigate accordingly. Cystic fibrosis is barely even a contender in this diagnosis btw.

Now. I had to explain to Mommy and her superior Internet knowledge that cystic fibrosis occurs in BOYS - almost exclusively! And that if there were any signs of cystic fibrosis – the signs would have manifested as increased mucus at the age of 2!

Two consultation sessions later, and a bunch of time wasted trying to explain to Mommy that just because it's on the internet – doesn’t mean its true... a mild example of what can go wrong with layman internet research.

Don’t believe me? Try it out for yourself. Go to Google.com. Type in “rectal prolapse”. Conveniantly, Google picks this up as a medical term and offers you Treatment, Causes, Diagnosis, For Patients, Alternative Medicine etc. etc. examples. Click Tests / Diagnosis. Result number 3 is E-Medecine. And there, for all to see and interpret, is a pretty damn scary list of causes.
- Advanced age
- Long-term constipation
- Long-term
- Long-term straining during defecation
Pregnancy and the stresses of childbirth
- Previous surgery
Cystic fibrosis
- Chronic obstructive pulmonary disease
Whooping cough
Multiple sclerosis
- Paralysis (Paraplegia)

This isn’t differentiating between age, gender or pre-existing illnesses – three of the most fundamental differentiators. That’s WHY doctors have consultations. To narrow down, or eliminate lists of causes before a proper diagnosis.

Little Susie is now a potential victim of Whooping Cough and Multiple Sclerosis – and if Mommy is paranoid enough… Chronic Obstructuve Pulmonary Disease (Translation: Emphysema. Do you really think the 6 year old has been smoking 20 cigarettes a day for 20 years?)

Empower the patient - definitely! But who's going to help us undo the influence of bad research?

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Tuesday, December 5, 2006

Googling your symptoms & medical history is dangerous territory...

Here's something. Reading an article on the Official Google Blog called "Health Care Information Matters". This is a really fascinating argument that seems to be resurfacing. Interesting link back to the TV Doctor Showdowns that we've been doing... House MD has been making a LOT of jokes in Series 1 and Series 2 about the danger of patients diagnosing themselves. Ah, the Internet. Diagnosis tool of the future. No, you don't have "insert-ridiculously-rare-tropical-disease-name-here"!

So, Google is getting in on the action. Their blog post says:

In the end, one key part of the solution to these problems is a better educated patient. If patients understand their diseases better -- the symptoms, the treatments, the drugs, and the side effects, they are likely to get better and quicker care -- before, during, and after treatment. We have already launched some improvements to web search that help patients more easily find the health information they are looking for. Using the Google Co-op platform, Google and the health community have labeled sites and pages across the web making it easier for users to refine their health queries and locate the medical information they need. Do a search on Google about a medical issue or treatment like diabetes or Lipitor and you'll see some choices for refining your query, such as "symptoms," "treatments," and so on. If you click on "treatment," your search results are refined and reordered so that sites that have been labeled as being about treatment by trusted health community contributors are boosted in the rankings. Note that how trusted a contributor is -– and thus how much they affect your search results -– is dependent both on Google's algorithms and on who the user decides they trust. For example, if my doctor is a Google Co-op contributor and I indicate to Google that I trust her, then when I search, the sites she has labeled as relevant will show up higher in my search results.

This presents an interesting quandry. Do you empower patients with the information, to help them through weak "support" sections of a national health system at the risk of placebo sickness? As a non-medical patient essentially - I think the risk is terrifying. Google my symptoms - and come up with the wrong set of suggestions? I would get hives on the spot.

How much can we trust the Google Search Algorithm, or its users' quality rating of the information it returns? When it comes to correctly equipping me with the right information about my health? I don't know...

The post goes on:

Patients also need to be able to better coordinate and manage their own health information. We believe that patients should control and own their own health information, and should be able to do so easily. Today it is much too difficult to get access to one's health records, for example, because of the substantial administrative obstacles people have to go through and the many places they have to go to collect it all. Compare this to financial information, which is much more available from the various institutions that help manage your financial "health." We believe our industry should help solve this problem.

I'm all for empowering the individual - it's something Google does really well. But a Doctor's handwriting is illegible for a reason! I'm kidding. But the pressing issue here is having health records available via the Internet. Just by definition - private medical records opened up to a world of hackers / crackers and identity thieves has me quivering in my paranoid Internet boots!

How does that suddenly translate to a South African context - where we hold things like HIV status absolutely SACRED. In SA, a medical representative is not even allowed to consult/reveal HIV status to a spouse.

Am I being naive in terms of how such information could be protected on the Web? Or will this open a whole new bag of stigma worms in a country like ours?

Kudos to Google for continually trying to improve and empower. Perhaps we need to take a quick step backwards and consider the consequences?

Monday, December 4, 2006

TV Doctor Showdown. To be continued...

Just realised I don't know any more TV doctors. Well enough to write about them at least.

Thinking of adding Dr. John Dorian (Scrubs) to the contestant list - but I used up my "Appletini, STAT!" picture... and that just ruins the comedic value of the post. I've got the one above, but those shifty eyes...

Then there's George Clooney (so hot!) and a couple of others. Further research and some DVD box sets needed. The Showdown will continue at a later stage.

In case you missed out, here are the current contestants, in order of merit:

  1. Dr Perry Cox (Practices in Scrubs and scored 6 / 10)
  2. Dr Gregory House (Practices in House MD and scored 5 / 10)
  3. Dr Meredith Grey (Practices in Grey's Anatomy and scored 4.25 / 10)

Friday, December 1, 2006

The origin of the word... STAT!

This word, STAT has always bemused me, being around Doctors so much. STAT. What is it? It sounds so doctory... We all know what it means, but can only the cool doctors say it? Or is it part of medical vocab and something more serious. Good 'ol SA Doc tells me it NEVER gets used in the South African context. Porter! Move that bleeding patient. STAT! Unlikely.

So, turned to AskYahoo (nice service by the way) for an answer.

We've all heard the harried medical team on ER call for something "stat." From the context, we knew it meant "quickly," but had no idea what the normal definition of the term was. We turned to the Net to cure our ignorance.

After various searches on phrases like "stat terminology" and "stat meaning" failed to provide an answer, we sat down and rethought our strategy. Several of our searches had turned up acronyms for the term, and while they weren't what we were looking for, they did point us in a new direction.

Remembering a helpful site we'd used in the past, we pointed our browser to Acronym Finder, a web site devoted to decoding mysterious combinations of letters. Typing in "stat," we hit the "Find" button and awaited a diagnosis.

As it turns out "
stat" stands for a number of things, ranging from the obvious (statistics) to the not so obvious (Society of Teachers of the Alexander Technique). However, the very first entry provided the answer to your question. "Stat" in medical parlance is actually not an acronym; it's short for statim, the Latin word for immediately.

That made sense, considering many medical terms have Latin origins. Next time we get a similar question, we'll know to head to our
Latin dictionary. Stat.

Hope that helps eh? In the immortal words of Dr John Dorian.

"Appletini. Stat."

Call for BritMedBlogs... How about the South African ones?

Great fan of the NHS Blog Doctor - such a spoofy, yet real insight into a health system where you have to get a consent form before giving an injection! Here's to hoping that Dr John Crippen Esquire - take's a look at some of the fantastic medical blogs coming out of South Africa!

Read more here... NHS Blog Doctor: The BritMeds

Or take a turn by some of SA's finest...

I actually thought there were a couple more when starting this post. Hmm. Any others out there? I'm sure I'm missing a bunch...

Thursday, November 30, 2006

TV Doctor Showdown! Dr Gregory House MD

This All Scubbed Up series gets underneath the fake blood, fake smiles and excessive use of shock paddals…

Who? Dr Gregory House MD
His Playground? House MD

An impersonal genius who harks back to the glory days of chauvinistic medicine.

Hot or Not: [3 out of 10] – No better looking than Dr Cox. I might get hit with the cane if he doesn’t like this answer.

Apparent Medical Skill: [8 out of 10] – A few good ideas, and a lot of luck. Excessive use of trial and error method. The bugger often treats up to 6 differentials - poor patients end up undergoing numerous cardiac arrests, seizures and anaphylactic reactions. Seizure hit-rate way too high for one doctor!

Bedside Manner: [3 out of 10] – Issues with race. Obsessed with white boards and black markers. Patients would hate him. Students would be amused… and then terrified. No-one likes the guy who says what we’re all actually thinking. Horrible rash, Dr House. Well, that’s fine, at least he won’t have to live with it for more than a week – being dead and all.

Ability to survive in Baragwanath: [6 out of 10] – Patient contact way too high. Bara is like a clinic-time hell. And patient histories would pose a problem. What would really kill it though is that his rare diagnostic skills would be absolutely wasted. Bara just doesn’t seem to get the incidence of rare tropical diseases that plagues his poor hospital. From leprosy to Cushing’s in an afternoon? Then again, arguing with myself – he’s got a super team. They have this uncanny ability to be porters, radiographers, psychologists, investigative reporters, hospital management, lab technicians, devilishly good-looking and rare-disease-diagnostic-experts all in one. THAT would be useful. The porters at Bara have tea.

What would I say if I woke up in his ward? Not much. He wouldn’t be there.

Doctor Showdown SCORE
[5 out of 10]

He’s everyone’s anti-hero. Personality of a huggable walrus. Too high maintenance. Manto wouldn’t tolerate him.

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Monday, November 27, 2006

Red Bull + Jagermeister = Rape Cocktail

Spotted in The Saturday Star, a wonderfully non-investigative lambasting of Energy Drink Cocktails. Hold on tight - this one's gonna get tabloid.

Firstly, let's state the obvious. People who drink a lot, don't remember what happens to them. Duh. Yes, by adding stimulants like caffeinated energy drinks, you're slightly masking how drunk you really are. But the cold hard truth remains, it's not the energy drinks causing young girls to wake up in a stranger's bed - it's the 7 vodkas that got mixed with it.

Nothing has changed. You drink 7 vodkas. You get plonked.

So, let's analyse. The article reads like a high-school scare poster. BIG warnings about drinking energy drinks, going to the bathroom in pairs an avoiding scary men... but coffee and espresso cause the same medical issues! If you suffer from high blood pressure or pre-existing heart disease, even a wild afternoon in the coffee shop can be as dangerous.

What they say is vague and generic enough to be true, but it's completely sensationalist. Can you imagine the ignorant, the parents and the tee-totalers running around all panicky over the cheeky Red Bull they had last night? To compare it to Rohypnol is irresponsible and likely to attract a lawsuit from both Red Bull and Jagermeister, who have been plastered over this article like a Tokoloshe on the front page of the Daily Sun! What could have been a scientific re-examination of an old argument, shed in some kind of new light, has been turned into tabloid rubbish.

Christine/Shereen (the esteemed journalists), please focus on the real dangers that beset ladies in the clubbing world. Real, scary drugs that get slipped in people's drinks all the time. And the big bad men that do it. Not this crap.

If you don't believe us? Trust the Google Diagnosis (that wonderful laymans approach to Googling your symptoms or suspected problems). In fact, there's so much Google Diagnosis that I'm convinced The Saturday Star was on a tight deadline and rehashed the same crap that's been around for as long as drunk kids in clubs. Please, oh please, take the following articles with a pinch of salt!

Friday, November 24, 2006

TV Doctor Showdown! Dr Perry Cox.

This All Scubbed Up series gets underneath the fake blood, fake smiles and excessive use of shock paddals…

Who? Dr Perry Cox.

His Playground? Sacred Heart Hospital, Scrubs.

With quotable quotes like: “God? My brilliance is becoming quite a burden…” Ol’ Perry is fighting for first tee-off in the I-Am-God-Fourball (with Gregory House MD… of course).

Hot or Not: [4 out of 10] – He takes his shirt off all the time. Which is OK. But doesn’t lift him out of the realms of George Clooney’s ugly cousin. In fact, he’s not the eye candy I watch the show for (Dr. John Dorian has those crazy eyes!)

Apparent Medical Skill: [8 out of 10] – It’s a swoop in, swoop out, recite the diagnosis and the differentials type affair. He’s the typical Physician who knows his stuff. Has uncanny ability to impart wise teachings while belittling the life out of you. Make him your doctor. Don’t beat him at basketball.

Bedside Manner: [3 out of 10] – Has strange ability to extend one word into unusual amount of syllables. Re-he-he-he-he-he-he-heally… Also tends to confus the gender of male colleagues. Frequently. Pretty intimidating, really.

Ability to survive in Baragwanath: [9 out of 10] – A Baragwanath hero in the making. Completely tough nut to crack. No bending under 180-patients-in-one-night pressure. Deals with drunks, malingerers, psychotics and self-diagnosing Indian ladies with clinical efficiency.

What would I say if I woke up in his ward? Nothing. Anything I say would be used against me. Just let him do what he does.

Doctor Showdown SCORE
[6 out of 10]

Consummate medical skill unfortunately pulled down by odd gender bias and fascination with own pecks. Helluva teacher though. Wish I’d had someone like him in Anat Path.

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Thursday, November 23, 2006

The largest hospital in the world!

So, Google Maps just opened its warm capitalist arms to South Africa. We took a quick trip to show the world of blogging... Baragwanath Hospital. Old Bara is apparently the biggest hospital in the world by bed count. It's also the most multi-cultural Doctor-fest around. SA Doc had a Russian, Yugoslavian, Pakistanian, Congonese, Indian and 4 South Africans... just in one unit!

Feast your eyes ladies and gents. Note size of shacks bottom left and houses middle top. Just under 2km in diameter - no wonder the porters laze off.

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Wednesday, November 22, 2006

TV Doctor Showdown! Meredith Grey...

This All Scubbed Up series gets underneath the fake blood, fake smiles and excessive use of shock paddals…

Who? Meredith Grey.
Her playground? Grey's Anatomy.

Something about Meredith is just so flaky. I don’t know whether it’s the raspy possum-like voice used to narrate her way around the pitfalls of sleeping with her colleagues… Or, the mousy I-wish-I-was-the-girl-next-door looks.

Let’s be fair. It’s just the first season.

Hot or Not: [6 out of 10] – You kinda think she would look hot. And then she kinda does, but kinda doesn’t. I just don’t know with this one. It’s hot, but condescending I-went-to-a-better-private-school-than you hot.

Apparent Medical Skill: [5 out of 10] - Maybe as a psychiatrist she’d get a higher score. Although definite minus points for having a cry while shagging the shy doctor (George). Was expecting a better performance out of dear Meredith. With that name, and those “mature” looks – she must have bummed around as a Chicken Licken sales lady before becoming an Intern. Just not fresh-faced and innocent enough.

Bedside Manner: [5 out of 10] - That flaky voice just doesn’t inspire much confidence.

Ability to survive in Baragwanath: [1 out of 10] – She’d cry on the first day, sleep with all her mates and then get vomited on by that drunk guy. This would obviously ruin those designer pyjamas. Tickets.

What would I say if I woke up in her ward? Does this come in a nurse outfit?

Doctor Showdown SCORE
[4.25 out of 10]

But then you didn’t really have to be a good doctor to make it onto TV, did you?

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Monday, November 20, 2006

An HIV Zealot?

A DSTV StreetPole ad recently caught my attention. In true DSTV style, it offered out some big words, some sexy pictures and a great special on decoders. It was the words that got me thinking. Score Big. Go Wild. Be Unfaithful. DSTV R599. The Be Unfaithful portion of that ad came complete with smacker lips Rihanna looking seductive (pretty sure it was her).

You can't really fault the ad (can you?) - because then you'd have to fault every magazine cover and E! Entertainment programme this side of 1989. But it does get you thinking though.

In public media, where do you draw the line between sexy, suggestive tease and promoting unsafe behaviour? We live in a country that is more uneducated regarding sexual issues than we care to admit. Just where and when, I wonder, should the public start asking questions?

Or am I just turning into an HIV zealot?

Saturday, November 18, 2006

Naked Doctors tradition to continue?

It’s nearing that time of year again. Med Students getting sweaty, trying to cram 6 years of lungs, guns and antibiotics into a mind already warped by the smell of formaldehyde. They’re dosing up on whatever they can get there hands on (with the imminent promise of Schedule 5+ if they can just… get… through… this).

That’s because, after November at the University of Cape Town – 6th year medical students become DOCTORS.

The class of 2003 used to mark these momentous yearly occasions with their own brand of cleansing ritual. The whole class, dressed to theme (Doctors by Day, Victoria Secret by Night was my personal favourite), would flock to an arbitrary building on the side M3. They would quickly and clinically get themselves boozed… and flash the traffic.

This wasn’t any ordinary flashing of the traffic. With stethoscopes flying, lab coats swirling and SA’s finest wiggling their jiggly bit – the event made KFM news 3 years in a row, and was responsible for more than a few dented bumpers.

I’d like to say I met my anonymous SA Doc like that… Idling down the highway, afternoon traffic, sweet sounds of some boy band playing (dial obviously stuck – irony is students just don’t listen to KFM!)… There she would appear, like a vision… Mouth open in a drawn out Savanna-induced whoop of delight. Her nipple catches my eye… It would be love.

But alas, I was usually the sucker holding the bra.

At All Scrubbed, we’re wondering if this great tradition is going to continue – and would like to appeal to our readers to get in touch with any UCT medical student they know. Spread the word – it would be a crime to deprave the M3 of its most exciting yearly onslaught.

Tuesday, November 14, 2006

Americans investigate guided missile to TERMINATE HIV.

Recently spotted on BodyHack, a Wired Magazine blog about medical stuff. Raised the heckles a tad, no?

"In some cases the best way to fight a fire is to light a fire of your own. But could the best way to fight AIDS possibly be with AIDS?

Researchers at the University of Pennsylvania are testing the idea that a modified strain of the HIV virus, called a lentivirus, could be turned into a sort of anti-AIDS guided missile that could directly target the HIV virus already in patients. Naturally safety was the primary concern.

The Scientist reports:

One safety concern with using lentiviruses as gene delivery vectors is that they might form replication-competent lentiviruses, but Levine and his colleagues found no evidence of this in any of the patients. Another concern is vector mobilization, which the researchers saw in the first 60 days after injection, but not after that. This mobilization probably doesn't mean the vector isn't safe, said Richard Sutton of Baylor College of Medicine in Houston, who was not involved in the study, but he acknowledged that it is "a little bit concerning. Usually we don't like these vectors to jump around once they're inside a person."

While safe, the therapy still has a long way to go before it could be used for treatment. In the trial on 5 patients, only one showed a significant decrease in their viral load. "

Now, don't get me wrong, I'm all for research, innovation and striving beyond the boundaries of our little human imaginations in order to help cure/prevent the most obnoxious virus of our time... But, typical Americans think that everytime there's a hope and a prayer, it's worth publishing it to the world! Doesn't that grate?

This idea is in its infancy - we've come so much further in our HIV/Aids vaccine studies - yet our media coverage is merely a dribble. Even if this "guided missile" is as potent as they hope, Africa could never afford to use it.

Ain't it kak, in a world of shrinking borders - somethings still push the third world further and further away?

As for the comments, well that just adds fuel to the stereotypical fire - the garlic and parsley brigade can bite my ass. Manto called... she wants her idea back.

Medical Jokes... Bad handwriting results in?

And to end of this Tuesday with a bang (and because no-one died today, or ran around parading a venereal disease) - here's some rather chuckly medical "notes" blunders... Pilfered from Medical Jokes. I guess this is what happens when the bad handwriting thing gets out of control.

Note to self: Idea for further blog posts... Scan copies of scripts / notes and have a handwriting competition. Stereotypes, my ass.

1. The skin was moist and dry.

2. Rectal exam revealed a normal size thyroid.

3. The patient had waffles for breakfast and anorexia for lunch.

4. She stated that she had been constipated for most of her life until 1989 when she got a divorce.

5. Between you and me, we ought to be able to get this lady pregnant.

6. The patient was in his usual state of good health until his airplane ran out of gas and crashed.

7. The lab test indicated abnormal lover function.

8. The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.

9. Exam of genitalia reveals that he is circus sized.

10. I saw your patient today, who is still under our car for physical therapy.

11. The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.

12. Bleeding started in the rectal area and continued all the way to Los Angeles.

13. Both breasts are equal and reactive to light and accommodation.

14. She is numb from her toes down.

15. Exam of genitalia was completely negative except for the right foot.

16. While in the emergency room, she was examined, X-rated and sent home.

17. The patient was to have a bowel resection. However, he took a job as a stockbroker instead.

18. The patient suffers from occasional, constant, infrequent headaches.

19. Coming from Detroit, this man has no children.

20. Examination reveals a well-developed male lying in bed with his family in no distress.

21. Patient was alert and unresponsive.

22. When she fainted, her eyes rolled around the room.

23. We will follow her eyes and nose with a foley catheter.

24. By the time he was admitted, his rapid heart had stopped, and he was feeling better.

25. Patient has chest pain if she lies on her left side for over a year.

26. On the second day the knee was better and on the third day it had completely disappeared.

27. The patient has been depressed ever since she began seeing me in 1983.

28. The patient is tearful and crying constantly. She also appears to be depressed.

29. Discharge status: Alive but without permission.

30. Healthy-appearing decrepit sixty-nine-year-old male, mentally alert but forgetful.

31. The patient refused an autopsy.

32. The patient expired on the floor uneventfully.

33. Patient has left his white blood cells at another hospital.

34. The patient's past medical history has been remarkably insignificant, with only a forty-pound weight gain in the past three days.

35. She slipped on the ice and apparently her legs went in separate directions in early December.

36. The patient had a rash over his truck.

Thursday, November 9, 2006

All Scrubbed goes cooking with Prixige...

Nope. Not part of the Anarchy Cookbook on interesting ways to heat up an anti-inflammatory - but rather some pharmaceutical DRM (that's Doctor Relationship Management for those in the know).

The Wicked Food Cooking School played host to the latest round of Novartis talks on Prixige's Lumiracoxib - the Cox2 inhibitor (not as rude as it sounds) to end all Cox2 inhibitors - or so they tell me. The introductory speech washed over me like morphine - very few intelligent questions from the nonDoc. Except one interesting case scenario:

56 year old banker. Presenting with Osteo-Arthritis in the knee. Panado just wasn't cutting it because the poor bugger was walking 5km, 4 times a week. Stop me when it's starting to sound like crazy talk... but what 56 year old South African banker has the time to walk 20km a week!? God is in the details after all.

Turns out the answer was easy. Prescribe Lumiracoxib. (PS. That's why doctors are so smart... you can only prescribe Lumiracoxib if you can SAY Lumiracoxib.)

Jokes aside, the message was pretty clear. This wasn't any old anti-inflammatory. And in the days of some pretty serious gastric ulcers - you want a drug with the least gastro-intestinal side effects that also keeps those CV issues (yes, at first I was wondering whether it was my high school or university education that was threatening) at bay. The cardio-vascular ones.

Then to the cooking. At first, I must say, I wondered about the brand connection between an anti-inflammatory and cooking. Then I stopped wondering. As if in a surreal dream, I was cooking next to Barry Lambson. His wife, the lovely Dr. Lambson had hauled him away from the 1987 reruns of Western Province vs. Orange Free State at Newlands. Pharaceutical event. Barry Lambson. Box wine. And some spicy tomato soup.

As the haze of Claret Select finally descended... Barry left me. I think I was taking too long chopping the mushrooms - he went in search of greener pastures - the can opener for a particularly stubborn can of tomoatoes most likely.

All in all, great evening. I was left pining for samples and prepped with enough knowledge to dangerously convince someone I knew what I was talking about.

Can't wait for the Cox3 function.

(Note: Thanks to Dawn and Zama for making it a helluva evening. Also thank to the Wiki Wicked Food School for whipping my culinary skills into shape. Highly recommended.)

Wednesday, November 8, 2006

Striking the Medical Ethic

Ran across this video on YouTube... And instead of making up a thousand reasons why I should link to it, it kind of brought up the whole issue of medical ethics. Our friend, Ali, goes on about cloning, euthanasia and plastic surgery - with his own unique brand of "bedside manner". He leaves out one of the most important issues though, one that people don't really think about.

Do doctors strike? Can they?

A couple of months ago, a whole bunch of Zim doctors went on strike - evidently $57 million a month was just not enough. It seems they had to bring their own scalpals to work, which cost $58 million. Ah, what can you do? Seriously though. Good on them. And better on them for sitting in the hospital pub for all but the most critical of patients!

Do our hospitals even have pubs? A quick search revealed basically nothing. The closest we get is a pub 226m underground in a mine shaft in Gold Reef City. That shaft, used to have a hospital.

I digress.

Medical ethics is such a broad blanket protection for everyone we treat - it pretty much prevents us from striking. We're not like lawyers (they don't strike because they can't bill for it) or Pick 'n Pay workers (How hard can it be? Ya Pick. Ya Pay). But we do seem to care.

You can't save a patient if you're on strike. And let's face it, people just don't not get sick.

So, even when this country subjects Interns to more than 90 hours a week (go look up the Basic Conditions of Employment if that doesn't sound like a lot), mediocre pay and such horrific working conditions that the tea room is usually the source of the infection... We still don't strike.

In fact, the most simple task of trying to get a bunch of doctors together to fight with SAMA against the government is nigh impossible. We're too busy caring about others, to fight for ourselves.

What's with that?

Saturday, November 4, 2006

The ForeSkin. Part II. Revenge of the Sif.

Right. As promised... the second post - bringing this whole sticky argument to a head. Cough. If you weren't convinced last time - three more points to try and sway it.

1. You will have a proven, lower risk of contracting STD's - not harbouring crawlies under there will help.

2. You therefore have a lower risk of contracting HIV. Less microtears. And, you did know that STD's and HIV like to hold hands?

3. And finally, come on guys, it just looks better! The "extra inch" it adds is more than compensated by the apparent increase in girth.

Not much more we can say, aside from thanks for the comments that are still coming in about the first post. It's obviously a touchy issue. Cough.

Some interesting foreskin envy links:

- Artificial Foreskin

- The Fate of the Foreskin: A Study of Circumcision?

- Would you rather be circumcised or uncircumcised?

- Speaking of Uncut

- The Unkindest Cut of All: Circumcision no longer a popular choice?

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Thursday, November 2, 2006

MANTO WATCH: Condom Crusader

Wah! Is this a joke? Is this a viral campaign? Is she a virus? No-one knows, but recently spotted on CherryFlava was a Manto video for the Pronto Condoms brand.

She dicey, she's quick and she's more slippery than Zuma in the shower. Pranto Manto.

Get the video here!

Friday, October 27, 2006

To chop or not to chop?

This is going to be a one-sided argument. Because I'm writing it. Do you have any idea the kind of gunk that can get underneath a foreskin? An unlopped, useless piece of disease-harbouring flesh? Shudder.

Maybe I have weird friends, but this topic has come up more than once. There's always three sides. Don't cut it off. Have your parents cut it off. Have it be your decision whether you keep it or toss it (yikes!)

Oh dear Lord, please don't start me on the pro-choice argument. Yes, we live in a world of free choice - but parents make medical decisions for their kids ALL THE TIME! Try immunisations on for size (yes - it's a choice, some people don't believe in the MMR shot).

And to even name the foreskin argument over the much heftier Abortion Gig? It's a whole different ballpark to the manky extra slinky inch.

Do you really, really believe that having a foreskin gives you extra sexual pleasure? Aren't men battling to make the dreamy 10 minute mark anyway? You want them to feel more!?

Ok, ok. So you're chopped. You're obviously looking at all these dangly foreskins in the locker room, feeling this intense, brooding jealousy. Foreskin Envy. Yummy.

Well, there's hope! Now you too, can grow it back - seek out the the "professionals" who have this uncanny knack of stretching it out again. No kidding.

Next post - The ForeSkin. Part II. Revenge of the Sif.

Partly inspired by some silly chops on Carte Blanche.
Visit their site for links to the stretchy people.

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Tuesday, October 24, 2006

Medical Cartoons!

It's actually quite hard to find good medical cartoons on the Internet. A quick Google Image search yielded some horribly poor results. But... we try harder. A some good 'uns we did find!

Hopefully courtesy of McHumor!

We don't have permission to reprint this - the nature of digital blog surgery being so quick and stuff - but kudos to the author / artist - and hope you like the publicity!

Monday, October 23, 2006

The Good Side of Manto?

So, people are always bashing on our Minister of Health... including us on this blog, I suppose. But perhaps we should take a tiny step back, not slip on the magic condiments and have a look where Manto has actually done some good.

For instance, when you're enjoying your next smoke-free dinner, courtesy of the glass cage that smokers are now confined to... Who do you have to thank? Manto!

Did you also know? Our friend Manto is following through quite nicely on the process started by Zuma (not the showering one) to implement more Primary and Secondary level care in the country. Now, although that means less money pumped into ICU's, specialised surgery and specialised skills development - it does mean more access to primary medicines, increased immunisation and better preventative care. Small steps, but certainly the right direction.

So, there's some Prozac at the end of the rainbow then?

PS. Manto is still a complete idiot when it comes to HIV. The country despairs!

What happened to firing Manto!?

While she remains in the news, what has happened to that wonderful collection of wit, anger and HIV curing fruit? We lament the loss of www.firemanto.co.za.

Why? Anyone know what's going on?

Thursday, August 17, 2006

Scalpel... STAT!

The South African Medical Fraternity has been buggered around for too long. We've been Manto'd through thick and thin. We've worked 90 hours a week. We've been stuck, jabbed, vomited on... and that was just yesterday!

There's a story to tell. Just what exactly is underneath the gown? Join us to see the inner-panty of SA's non Cuban indsutry!