Warning: mostly not about Covid-19, but On Operations and Lockdowns

This is not a Covid-19 communique but rather a standard blog post. Don’t feel you have to read on. The reason for the change in emphasis this week is that Covid-19 events simply passed me by. The explanation is that I was engaged with the National Health Service (NHS), finally having elective surgery for an umbilical hernia. It has been a long road to get here, I am relieved to have it sorted.

I have always considered myself fit (but overweight), playing squash, touch rugby and running. A few years ago, I noticed I was developing bulge in my belly button. It was confirmed as an umbilical hernia. All the sources of advice: doctors and the internet recommend these occurrences need to be dealt with, and that means surgery. Two years ago, I arranged to have the hernia operation in Durban. It could have been a day surgery but, stupidly, I decided to spend the night after the operation in the hospital. It was that or go back to the flat. The surgery was straightforward, the hospital experience was not great. Unbelievably the morning began, at 05h30 am, with inappropriately cheerful nurses. I was on a men’s ward where all had more serious conditions and concerns, and felt somewhat fraudulent.

The original surgeon gave me options for the repair. I selected stitching rather than putting in a mesh. This was a mistake, as I realised, when the bulge reappeared some months later. This time I did more homework and consulted with medical professionals in Waterloo, Norwich, and Durban (as well as qualified friends). The consensus was it had to be redone, but with a mesh. In addition, I learnt I would have to wait at least a year before a surgeon would even consider reopening the wound.

Covid-19 meant that, after arriving in Norwich in December 2019, I have not travelled outside the UK or even on a plane for 14 months. (I am seriously tempted to go for a flying lesson as soon as it is permitted just to get in the air!) This in turn necessitated arranging to have the surgery in Norfolk. I began the process and expected to have to wait for at least a year. As it happens it was quicker than that, but my word it became a complicated process, and it has been an insight into the amazing NHS and how they function in time of crisis.

The centre for these surgeries in Norfolk is the James Paget Hospital. This is in Gorleston on the Norfolk coast, about 50 minutes (or 30 miles) away. The process involved visits for assessments, an MRI scan, a Covid test and other ancillary events. The surgery was originally scheduled for January 2021. However, the government unwisely relaxed restrictions in England at Christmas, and the number of cases soared. On 8th January 2021, they peaked at 68,192 up from just 12,386 on 12th December 2020. The hospital called me to say, regrettably, the surgery would be postponed. I expected this!

I was quite happy to wait, after all it was elective, and not urgent. The next, and unexpected development was the hospital called and offered me a date, at a private hospital in Colchester, some 60 miles away. One of the ways the NHS is trying to manage their waiting list is to outsource some procedures to the private sector. I declined the option and eventually heard from the local surgeon who said that the surgery could be scheduled for 2nd March. As an aside the number of new Covid-19 cases across the UK on that day was 6,411.

On the day, I had to get to the hospital by 7 am. Ailsa drove me down and dropped me off. I checked in to the day procedure ward and was wheeled into the theatre at 11 am. I had hoped it would be earlier. This delay was entirely my fault. When we got up, just before 5 am, I had a cup of tea with milk in it. Note to self: read the instructions carefully and follow them! I could have had water or black tea; it was the milk that was the issue!

Apart from extra hygiene precautions and wearing masks, the part of the hospital I was in appeared to be functioning normally. There is a separate terribly busy Covid section. The biggest obvious difference is visitors are not allowed at all. This makes for a very much quieter environment. The day procedure centre was active, but not manic and the nursing staff were caring, professional and calm. Everything went smoothly and, after passing urine, (a non-negotiable apparently) I was discharged in the evening. I left with a ‘goody bag’ of everything I needed for post-operative self-care.

My ‘N’ for hernia operations is now 2. The first was an incision while this second was done laparoscopically, through five places on my stomach. I had to take a few painkillers, far fewer than prescribed. Generally, I have been fine although getting up and lying down have been challenging. In addition, I was given about 10 preloaded syringes with blood thinning medication, to inject into my stomach. Not a pleasant process. I have been really impressed by the standard of service in the NHS despite the Covid-19 crisis. This also needs to be seen against the backdrop of a public sector pay freeze except for nurses, who have been offered a derisory 1%. They are furious, feeling it as a slap in the face, and I quite understand. I recognize the need for fiscal conservatism to pay for the Covid-19 response. It has cost billions, not just care costs, but also keeping families and supporting the furlough programme so people have jobs to return to. This stingy pay offer to core staff stinks.

I have taken several lessons from this experience. The first is to read and follow instructions carefully. Second is that the health service is amazing. Even when it is under immense pressure, people are seen and treated. At the same time as this was going on, the government is rolling out a vaccination campaign. I was able to go online and book both the appointments I need, the first on 12th March and the second three months later. My hub is the Food Court, in the currently shuttered, Castle Mall Shopping Centre in Norwich.

I do have a few quibbles though. The main one is about ‘joined-up’ thinking. The provision of a decent health system is part of the social contract, but the major challenge faced by humankind is climate change. I have been taken aback by the use of resources in the health service, much of which probably can’t be recycled. I was given 14 disposable syringes, each in separate plastic wrapping. It may be that there are no options! However the instructions and pamphlets were on recycled paper.

I have talked before about how fortunate I feel we are. We have a home, an income, and a family close at hand. The children are coping with this as well as anyone. My extended family are all OK, although no one is very happy. In addition to that, our environment is changing in two significant ways. First with regard to Covid-19, the numbers are falling, and the vaccination programme is working very well. Second, there are signs of spring. I can see the first leaves beginning to bud on the rose bushes and today we spotted blossom on the trees in the neighbour’s garden. It is still chilly but there are signs of spring.

This good fortune was brought home to me when we walked to a local shop to get some essentials and the Observer newspaper. The rule is only one person from a household should go in and so I waited outside. There is a ‘security guard’ at the entrance to make sure people wear masks and sanitise their hands. I think he is from Norwich. I started chatting with him and this is his story: he worked on cruise ships out of Fort Lauderdale in Florida and was also paid as an American Football Player. I know this may come as a shock to readers of this blog, but there is a league in the UK and Norwich has a team which he was part of before going off adventuring. He said he played in Australia, before going on to join a team in Vladivostok in Eastern Russia. Covid put an end to this, and I think he was lucky to get back to Norwich. I would never have known any of this. What a story. The next instalment will be interesting, and I am looking forward to it. End of personal stuff, some COVID-19 coverage next.

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Covid-19 Watch: Green Shoots!

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

There had been no rain in Norwich for six weeks and the garden was looking decidedly wilted. Finally, on Sunday night, the heavens opened, and to the accompaniment of thunder and lightning, sheets of rain fell. The lawn had been brown and within 24 hours was transformed into a green swath. The rain butts filled within a few days as showers continued to march across East Anglia. It was a reminder that nature is beyond our control, and Covid-19 is a reminder that it can turn on us. Zoonotic events like the one that gave us SARS-Cov-2 are becoming more frequent. We must both prevent them through better stewardship, and be prepared for them. The Wall Street Journal has an interesting analysis: ‘A deadly coronavirus was inevitable. Why was no one ready?’ the subheading: ‘Scientists warned of a pandemic for decades, yet when Covid-19 arrived, the world had few resources and little understanding’. The authors conclude withdrawal of support to the Atlanta based Centers for Disease Control meant early warnings mechanisms were lost.1

In general, the epidemic is beginning to become more predictable and there are a growing number of countries where daily cases have peaked and are now falling. This includes South Africa, the subject of this week’s guest contribution, where the number of new cases peaked towards the end of July. Across much of Europe the daily number of new cases was declining but some countries, notably Spain, France and the Netherlands have, over the past week, reported increases. Boris Johnson’s government has imposed quarantines on people arriving from certain countries, the footnote sets out the complex governance in the UK.2 Wales, Scotland and Northern Ireland have different rules and regulations regarding gathering and could, but don’t yet, have different quarantines.

In this blog I wanted to make some predictions about the future. It is time to think about where we are going and how long this may take. I am aware that this is inadvisable, after all Sir Arthur Conan Doyle’s Sherlock Holmes said: “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts”.3 In addition, I am aware that this week’s offering is becoming too long, so I will hold that over for a week.
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Covid-19 Watch: Reflection and consolidation

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Introduction

It has been five months since the first blog was posted in early March, ‘Covid 19 (the SARS-C0V-2) and you’. Since then it has become a weekly event, often bolstered, and supported with the help of friends writing guest columns. The pandemic has exceeded my worst fears; numbers are increasing almost exponentially. On 4th March there were a mere 93,000 cases, mostly in China. Today there are close to 19,000,000 and the largest number is in the US. I watched the pandemic and the responses particularly closely in the UK and South Africa. In one, the reaction has been confused and inconsistent, and in the other ineffectual. See below!

The first post was meant to be a quick ‘fact sheet’: what we know, what we don’t know, and what we need to know. How did we get to this parlous situation five months later? This is my blog, so I will touch on what Covid-19 has meant for me. As I am on sabbatical this year, I am not in Waterloo Ontario, but in Norwich with my family. We have a pleasant garden and so I have not felt confined, however, this would not have been the case in Waterloo.

Our lockdown in the UK began on 19th March. We were told to stay at home, except for essential trips, and for one hour of exercise per day. We took the exercise instruction seriously, but being rebellious, I spent between up to two hours walking or cycling. The pandemic means I am considerably fitter! Unfortunately, increased alcohol consumption means I am not any thinner!

Cycling is something I have not done for decades. Once I had the bikes unearthed and serviced, I re-discovered how much fun it is. The ride to Norwich market, at a sedate pace, takes 40 minutes. On Monday I cycled to The Eagle, a ‘gastropub’, which means a good menu and excellent food for lunch with a friend from University (45 years ago).

The Eagle was named originally for Michael “Eddie the Eagle” Edwards, who represented Great Britain in the 1988 Olympic ski jumping, the first Briton since 1928. He got into the team through amazing persistence and finished last in both events he entered. There is a 2016 film called, unsurprisingly, Eddie the Eagle. He ranks alongside Eric Moussambani Malonga, (Eric the Eel) the 2000 Olympics Equatorial Guinean ‘swimmer’, who won his heat as other competitors were disqualified and holds the record for the slowest ever Olympic 100 metres freestyle.1

Norwich is well known for pubs and churches. It used to be said that there was a pub for every day of the year and a church for every Sunday. Cycling home, I passed one church that never ceases to amuse me. The Zoar Baptist Chapel, built in 1886, advertises itself as “Zoar Strict and Particular Baptist Chapel St Mary’s Place”. It would be worth going to a service just to experience it.

Part of the reason for going out for my lunch was because it was the first day of the ‘meal deals’ announced by the British Chancellor. In August, from Mondays to Wednesdays, half the cost of a meal, up to the value of £10 per customer, will be paid by the government. Sensibly alcohol is excluded from the offer. This is one of the ways Chancellor Sunak hopes to get the economy moving. It begins as the generous furlough scheme ends. There are still furlough options, but employers have to contribute to the costs now. The next few months and years will be exceedingly difficult for many.
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Family and Travel

March should mark the end of winter in England. There are clear signs that spring is approaching. Some of the trees are covered with blossom. The daffodils in our garden are almost all in full bloom. However, despite the signs that nature is stirring, the weather has been rotten. We experienced periods of sustained strong winds and rain for nearly two weeks at the end of February. The western part of the country has had flood after flood, houses and homes have been wrecked. I find it quite confusing to see car roofs protruding from the middle of floods, surely you can drive a car out of harm’s way.

Of course, the serious floods over the past fifteen or so years meant defenses have been built, and in many cases they have worked. It could have been so much worse. The problem is that there are just too many houses built in vulnerable places (unbelievably on floodplains), and the nature of these storms is that they are ever more intense, a month’s rain in 24 hours. Yes, global warming is real, and it is affecting us in the UK in clear and measurable ways.

I had been organising a lunch in London with our extended family in mid-February. It turned out to be the wildest and windiest weekend of the month and public transport was greatly disrupted. As my sister and her husband are not youthful, canceling the gathering seemed appropriate, and indeed this turned out to be prescient. Fortunately, we made the call to postpone before I finalised the restaurant booking.

My brother, Derek, was passing through London for a day on his way back from the United States to Cape Town, and so we decided to have a smaller lunch the following weekend, on Saturday, 22 February. The plan was for Douglas and I to take the train down to London and meet up with the family at a restaurant they had booked near Notting Hill Gate. This was a central location and gave easy access to and from Heathrow for Derek as he had a limited amount of time.

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Month One of English Living

Now that I am in Norwich for a spell I am in the process of organising my office and activities. This involves something of a clear out. I have been going through huge quantities of paper. Many printed papers have been recycled, the realisation is that I am neither going to reread or refer to them.

Books get appraised for their usefulness now and in the future, and there is a high bar if they are to remain. I probably have 300 CDs and they too need to be gone through. Anything that I am uncertain about is being put on the player. If there are scratches on the disc, or it is something I will never listen to, it either goes in the bin or the charity pile. In a few months I expect to have a very much more habitable and organised office.

Since London is where so many interesting things happen, I anticipate going down reasonably regularly. This is made easier because the ‘over 60’ railcard I have makes travel more affordable. In addition, to my surprise on looking at the train timetable, I discovered there is now a train that has cut 30 minutes off the two-hour journey, a few times a day. That does make it a great deal easier to travel down. I went at the end of January for the day – leaving Norwich at 9.30 and getting back at 10.30, not sadly, on the fast train.

Decades ago, I joined the Royal Commonwealth Society (RCS). This was a club on Northumberland Avenue, very close to Trafalgar Square and only about 100 yards from the Embankment station on the Circle Line. When I first joined it was a bit dusty and old fashioned, but the club had a library, meeting rooms, a restaurant, lounge, bar and bedrooms. It was a great place to hang out and meet people. I organised meetings, seminars and dinners there and even, occasionally, stayed overnight. Unfortunately, over a period the offering dwindled, first the bedrooms, then the meeting rooms, until the club finally closed in 2013. I had been pondering what to do to get a London base and came up with a solution earlier this year.

In 2009 I was appointed as a Senior Research Fellow for the British Department of International Development. I held this fractional post for several years. It was great fun and I really enjoyed the experience of working in the Civil Service. This means I will get a small British Government Civil Service pension. It also meant, I realised, that I was eligible to join the Civil Service Club, very close to where the RCS was. The address is ‘Great Scotland Yard’! I applied and was accepted. The fees are modest, which is a real plus. Towards the end of January, I had occasion to visit London. I went to the club for the first time and got my membership card sorted out. I would not describe it as modern or flashy, but it has all the amenities one could want, and it is a place one can meet people, hangout and relax without feeling pressure to consume. There is a very nice patio for the summer and the street is extraordinarily quiet.

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New Decade! New Life?

The 1st January 2020 marks the start of a new decade as well as a New Year. I am aware that some purists (or pedants) think that the decade does not actually officially start until 1st January 2021, I am not part of that group. This is it! A new decade!

The next year will be interesting, I need to adapt my lifestyle. The first order of business will be getting used to living full time in Norwich. At the moment I have absolutely no travel planned for the next calendar year. As I am on sabbatical I don’t have to think about teaching but I am ‘on the books’ to the end of 2021. What should I do? This will become clearer in the next few months.

I returned to the UK on the 23rd December, just ahead of Christmas. My last few weeks in Waterloo were crammed with wrapping up the term and students and seeing and saying goodbye to friends. I also had to pack up the apartment for rental. Fortunately, I had help. The estate agent who is handling it for me, Dave McIntyre, is hopeful it can be let furnished. This means crockery, cutlery, furniture, linen and books were left out, but could be packed away if necessary. Dave is the chap who sold me the place originally and who will take care of the sale in due course. He is not just an estate agent but a decent and trustworthy person.

I did not write about this in my last post (not enough room), but at the end of November I went, with my friend Dana, to the event Dining with the Dead! This was held at the Kitchener Museum which had a themed exhibition on the afterlife. The way it was advertised was as a

“one of a kind dining experience! To coincide with the Exhibition at THEMUSEUM, we’re hosting Psychic Medium Kerrilynn Shellhorn (who) will utilize her strong connection to the other side to bring messages from lost loved ones while you dine on a delicious 3 course dinner.”

The food was excellent and the service great. The séance was, well, medium. There were about 35 diners. Only a few were given messages from the departed. I was not convinced but will chalk it up as an interesting experience.

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Frying in Norfolk

Anyone who denies climate change, and more specifically, global warming, is seriously wrong. At the end of August we had record temperatures in Norwich. Fortunately it cooled down in the evenings so sleeping has not been too difficult. However, this summer the rowan tree in the front garden died from a mixture of disease and heat stress. Ailsa has been using the water from the rain butts to keep some of her favourite plants alive, but it is an uphill battle. It presents a dismal picture and I really wonder what the next 10 to 20 years will hold. I am increasingly aware of my contribution to this crisis, particularly through flying, but I do not consider myself to be a flamboyant consumer of other things.

Having said that, I have to begin this blog by reflecting on my travelling over the past month. My final class in Waterloo was on 30th July. I had to complete the marking and submit the marks by 8th August. I was able to do this, and almost all of the students should have been pleased with the outcome. The temperatures and humidity gradually rose in Waterloo, and I was glad to be heading for Norwich. I did not realise how hot Norwich was going to be.

I travelled over on Sunday 11th August, flying via Amsterdam. Toronto to Amsterdam is not all that long, just 7½ hours. This is not long enough to take a sleeping pill, so I sat and watched the film ‘Red Joan’. This was about a British woman who became a Soviet spy in the 1940s and 50s. Oddly I was reading a book called ‘And Is There Honey Still For Tea?’, by Peter Murphy, set in the same time period and covering the same topics. It is hard to believe how much skullduggery there was going on then. I guess it is still happening, with electronic surveillance playing an ever-increasing role.

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Sunshine and students

There are three semesters at the Balsillie School, and across Canada. The Autumn term starts in September and ends just before Christmas; the Winter term is from January to April; and we are completing the Spring term which lasts from May to July. The terms are longer than in the UK and Europe at 12 weeks.

I taught two courses in the Spring and will teach two in the Autumn. Next calendar year (January 2020 to December 2020), I am on sabbatical and am very much looking forward to this. This is the first time I have been in Waterloo for the Spring term, and while it might have begun as spring it ended as summer – which is the one term we do not have. My word it was hot and humid for weeks at a time. Fortunately there were occasional thunderstorms that roiled across the region and brought some relief.

It has been very hot across much of Europe as well. We have a friend who has been in hospital in Norwich for some weeks now. The Norfolk and Norwich Hospital was opened in 2001. It was built on a greenfield site near the University, which means that UEA is able to offer medical degrees which was not the case when I was a student. It replaced a Victorian establishment in the centre of the city.

The new hospital is ‘state of the art’, except that there is no air-conditioning! This is OK for 10 months of the year. When there is a heatwave, as there was in July, it means that everyone from the consultants to the patients really suffers. It is miserable and sadly I don’t think there is any way that AC can be retrofitted into the building. The other major problem is that the hospital is not easy for the public to get to. It is an expensive and inconvenient bus journey, while those who drive have to pay car parking charges.

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Autumn and Spring Showers

The month of April began in the Cape and ended in Canada via Norwich. In the first week we ran the scientific writing course in Stellenbosch in the Cape. There were 19 participants from across Africa. Tim Quinlan did most of the teaching and the event was excellent. We are beginning to see results in submitted and published manuscripts from earlier years. I hope the project will be renewed, but if it is not then we have achieved a great deal. As my travel was from the southern to the northern hemisphere, I experienced autumn one day and spring the next. In England the daffodils have bloomed and are past their best. In Canada, or at least in this part, they have yet to blossom and it is still decidedly chilly.

Of course visiting Cape Town is also a chance to see family. My brother and sister-in-law were away but I caught up with my aunt, various cousins and a niece for Sunday lunch. I felt that I had not talked properly to niece Sarah, and she was good enough to join me for lunch on the Monday before I flew back to the UK. We walked across from the City Lodge to a new restaurant right next door. It was good to have a decent conversation and catch up with family news. Because the flight from Cape Town is so late (after 11 pm), I only watched one film: The Great Buster, a biopic of filmmaker and comedian Buster Keaton. He was one of the few stars who transitioned successfully from silent films to sound. It was not demanding so was good to watch in the small hours.

I had a relatively short spell in England. My sister came up from London for Easter and her birthday. We went to a show at the Norwich Playhouse, where Rowan works. It was an amateur production of A Sound of Music. It was outstanding. There were a few wrong notes, but not many at all. The set was imaginative and the acting most impressive. I think amateur productions can be excellent because people really throw their hearts into the show.

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Surgery and Sunshine

I was offline for a few days in March, an interesting experience especially during the time of crisis in the UK. It was my birthday on the 18th and I celebrated by returning to South Africa on the 16th for a series of elective medical procedures. I took the 06h15 KLM flight from Norwich to Amsterdam where I connected on the 10h15 flight to Johannesburg. The journey takes nearly 11 hours. My case was one of the first to be unloaded and appear on the carousel, these little things matter.

There are no connecting flights to Durban that late. My standard operating procedure is to stay in a hotel at the airport and connect the next day. Normally the travel agent’s opening proposal for the connection is a plane at an absurdly early hour, 07h00 for example. On this trip I was sensible and got a flight a little after 13h00. It allowed me ample time to sort myself out, and have a leisurely breakfast.

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