Cancer: Last year I received a letter from BreastCheck setting up an appointment. BreastCheck is Ireland’s National Breast Screening Programme. Diagnosed with breast cancer and still undergoing treatment (operation, chemotherapy radiation and Herceptin infusion) leads me to an exploration of the advantages of screening. Chapter 9

My education about cancer came early in life.  I grew up in a rural dispensary practice, a large Victorian house, with no central heating, on 5 acres with out-houses where workmen used to live to tend to the horses in the days before cars.  I arrived at Belper in 1963 at age 5 years and a few weeks later my brother Shane was born.  The house was in three sections, the back section which had its own avenue, the middle section and the front section which also had its own avenue.  Belper had a gatehouse which was called the dispensary which was a two roomed house which was only used on a Monday and Thursday morning for routine dispensary patients.  In those days, there were limits to transport, many people had no access to cars.

Ireland in the 1960’s, 1970’s was becoming more prosperous so one moved from having a practice that consisted of patients in receipt of medical cards to an an ever increasing number of private patients hence the medical practice was carried out in the main house.  The only suitable room for a surgery was the room in the middle section of the house where the stairs was and the hall was large enough for a waiting room.  Our playroom with the TV was upstairs so this meant we intermingled on a full time basis with patients and their families either meeting them in the car park area or in the hall.  In those days surgeries could go on until midnight and it did not end there, night calls for horrendous car accidents marked each week.  Both parents being doctors meant that practice continued 7 days a week.  Children soak up so much of their environment, my Dad used to call me rabbit ears because I constantly picked up on what I was probably not supposed to listen to and I was constantly looking for answers.  My Dad was a well read man so the post would deliver the British Medical Journal; Time magazine, the Irish Medical Times and these always caught my interest.  I never really managed to read ordinary children books.  I got bored.  I was never a diligent student, too much worry, fear replaced that spirit of altruism that is needed for the profession; anyway I never got the school grades.

I recall so many patients who had cancer; the discussions at meal time would often be stark.  Someone would have arrived at surgery and an immediate call would be made to the  relevant Consultant’s office in Dublin to get an urgent appointment as soon as possible.  You knew the warning signs and I really did hate to hear the words ‘they opened  and closed’ the no hope story.  For weeks my father or mother would call each day to see the patient diminish in health and to support the family knowing their loss.  Now it is me and I am asking if I did not have the breast screening last year, would I be idling around thinking I was tired but not realising I had cancer in my left breast.  I have to say I did say to my mother that I would just let it go its own way and she looked at me in horror and said untreated cancer is an awful way to end life – she had seen so much of it in her own life, her mother lived only a few weeks having been diagnosed with leukaemia at the Royal City of Dublin hospital, Upper Baggot Street.  I know her Uncle Donny died from cancer; as did her Uncle Bobby.  Aunt Molly lived on Waterloo Road and my Mum recalled vividly her battle with throat cancer and the impact it had on her.  Cancer and imminent death is something we are told can be avoided but do we really know if this is true?

A conundrum or so it seems and my personal experience of why silos http://www.investopedia.com/terms/s/silo-mentality.asp develop in the HSE (Health Service Executive) system in Ireland.  I have been called for the BreastCheck free service at St Vincent’s University hospital every 2 years (age range 50-69).  Every two years BreastCheck Merrion Road, Dublin  4, administratively proactive, send out a letter informing me that I have an appointment.  As this is part of a no charge screening process, I decided with the encouragement of my partner KT, that I would attend.  I am not so courageous when it comes to the CervicalCheck and by co-incidence (having confirmed this with KT today) I have never received a letter from them to attend an appointment. I have been remiss and only recently decided to check up why I had not been informed by the National Screening Service about the CervicalCheck option.  They confirmed my details and were aware I had never had a smear test under their CervicalCheck provision.  They gave me a code number and now I await the results of the smear test, the result will be posted to me.  In relation to colorectal cancer, when I reach 60 years old, I am told that the postal service within one week will deliver a test kit.  It is hard to imagine that I would be registered for BreastCheck and registered for CervicalCheck yet never called for this, but called for BreastCheck.  http://www.screeningservice.ie/

The National Screening Service (NSS) encompasses:

  • BreastCheck – The National Breast Screening Programme,
  • CervicalCheck – The National Cervical Screening Programme,
  • BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.

Cancer screening is under attack in Ireland because of the lacunae of human nature and the failure of the professionals in charge of the National Screening Service to pass on earlier results of cervical checks to service users which if known earlier, may have altered the progression of the cancer.  The fear is that the National Screening Service is now under threat of at least 200 medical negligence claims where errors occurred.  The problem for screening for cancer is that if too many people take successful medical negligence claims and massive awards are granted, this could cancel its very existence.

It is time to get perspective and where best to start but by going to that stage beyond and based on my childhood experience of looking at medical magazines from both the UK and America.  I will start by checking out what happens in America at one of its leading hospitals and my choice is Memorial Sloan Kettering hospital to see just how important it is for screening to take place. http://www.mskcc.org/cancer-care/risk-assessment-screening.   Medical professionals encourage patients not to refer to Dr Google but sometimes there are patients who want to know as much as they can comprehend.  It may not change the outcome but it satisfies their curiosity and stops them excessively fretting or worrying.   Secondly I will review the Christie  hospital (Manchester) ranked as one of the most advanced and technological cancer hospitals in the UK and in the world. http://www.christie.nhs.uk/professionals/research/research-themes/cancer-prevention-and-early-detection-research/screening/

The above two links provide in depth information about screening which can be compared with the website of the National Screening Service.

June 12th 2018 is World Empathy Day and it is my next appointment at St. Vincent’s Private hospital for Herceptin infusion.  I have to say there is no place more humbling than walking up three flights of stairs, turning right to doors that automatically open and let you in and soon you know you are in Day Care Oncology.  As a young person I recall a long walk and conversation with my cousin Jerry Kelly, who was a missionary priest in South Korea.  We walked for miles and I recall him saying you will find life hard; you have too much empathy.  I did not understand then what Jerry was really saying but as life moves on through the decades and you find yourself less sensitive to each event, based on the fact that you don’t remember what previously would have made you so sad, you understand what empathy means.  Empathy is powerful but it is essential to understand what it really means and how to establish boundaries that protect you from people who will take advantage for their own gain.

Empathy Day and where best to be but in the company of capable medical staff, nurses and ancillary staff, people who really do care about people.  There is youth and enthusiasm which leads towards hope and in an Oncology environment, this is essential.  Rachel was my nurse for the day.  Kindness is so powerful and being in a chair beside the Nurses’ Station I could observe the chemistry of a team working with conviction, professionalism, empathy and regard for all who were been treated for cancer in the Oncology unit today and every day.  Rachel went through the checklist, she took my bloods and when the results were returned she started the Herceptin infusion.  Professor Crown said we were making progress.  I had the opportunity to ask about the importance of screening and he said that screening did not apply to all cancers but it did to BreastCancer CervicalCheck and Bowel which is what is provided by the National Screening Service in Ireland and The Christie hospital in Manchester.  KT prompted me to ask how many more sessions with Herceptin and Rachel told me that it was Professor Crown’s decision but that it usually was for 12 months after the last session of chemotherapy.  I then asked if I would be recalled to BreastCheck and Rachel said no that when the Herceptin treatment stops then Professor Crown would order a CT scan.

Another world, another life.  I had not seen Elinor on this visit.  I was walking down the stairs and strangely thinking about her when there she was, looking well, and near the end of her treatment.  It was lovely to see her smile.  She has three small children and it is so very important that her treatment is effective.  She was returning from her CT scan.  As child she was all that empathy is about.  She had a particular love for her pony Patch.

KT phoned me many times and had told me to make sure to get a taxi but that was not to be today so I got the bus and it was just as well I did otherwise I would not have met my dear gentleman doctor, Martin Callinan, dapper dressed as ever and visiting his wife in hospital.  We chatted and he spoke about his early days studying medicine in the 1950’s and working in the cancer hospital in Hume Street and  how times have changed for patients with cancer, in his life time.  Martin is everything to me that a general practitioner should be, a man with empathy yet firm, an ability to diagnose and refer promptly.  It was Martin and his wife Geraldine who noticed a significant change in my health; and although retired from medicine, told KT to immediately take me to A&E in Tallaght; as it turned out I was extremely ill, I was lithium poisoned.

Martin possibly was in college at the same time as my Mum but I don’t think they knew each other.  I had always hoped my mum would leave Co. Meath and return to Dublin 4 where she lived until her twenties; she went to the Sacred Heart school in Leeson Street; and then to College of Surgeons; she lived in Dublin at spent her holidays in Co. Clare.  Now this can never be.  All I know is thoughts come hither and thither through my mind these days and I am sad for the years that could have been but were lost.  It is a great comfort to know over the last few years I met with Mum weekly and that I had met her, by chance, because KT spoke to her and asked her to meet me on Christmas week, so I saw her the Monday before the massive stroke ended her life, years before she expected to leave this earth.

As time passes, I realise that being a doctor, she was hiding her concern about me and the breast cancer especially as her own Mum died from leukaemia.  Each week she would bring little gifts, reminiscent of my childhood, and now I have them including the rug, teddies, and a rose from a dress she bought me when I was 6 years of age, they are now around my bed.  I have no access to her home since Mum passed away; nor for 12 years before that, so I have no inclusion in that part of her life which would allow me to grieve.  Acrimony and bitterness prevail yet again in my life; it is the legal profession who gain.  I know the stages of grief but I haven’t reached anger or repressed anger ie  what some people call depression.  I can say there is a sense of freedom from worry and concern about what would happen to my Mum if she became ill or incapacitated.  The house, my Mum’s home was broken into recently, but thankfully due to vigilant neighbours and the fact that my Mum was not there, she was fortunate.  However, it made me worry that there would be another attempt to break in and that she would harmed.   It must have also caused her some concern.  My Mum never had a break-in before in her life time.  My Mum’s choice to remain in her home, a large house, with an electronic gate in a rural location was a constant source of worry for me.  I could not have lived there.

Vivienne Starr, the Optician phoned KT to say the test for Glaucoma was a normal reading; such a relief.  Then it was time to get the results of my bloods from Dr Cahill, again KT phoned him to renew my three monthly prescription and get a form for my bloods.  The previous set of bloods were normal but cholesterol still remains high and I need to focus on diet or worse again go on statins medication; I want to avoid taking any further medications so I will have to focus on my diet and avoid ice cream and other delights which raise cholesterol.  All I am awaiting now are the results from CervicalCheck.

Eilish O’Regan, Health Correspondent, Independent newspaper, reports that there could be delays of up to 12 weeks due to the surge in demand for screening in the wake of the CervicalCheck scandal.

The Government was forced to offer free retests after many women became concerned about the accuracy of their result.  It followed revelations about mistakes involving 209 women who developed cervical cancer….

The Well Woman centre has all its tests (now doubled circa 300 per week) at the Coombe Hopsital who is contracted by CervicalCheck to do the work.

Dr Gabriel Scally, who is conducting the scoping inquiry into the CervicalCheck scandal, has recommended clearer information for women on the limitations of testing. 

This will emphasise the failure rate involved in screening, which can lead to unavoidable failures.

The 209 women at the centre of the scandal were given the wrong tests results as a result of an error rather than a test failure.

In future women will be asked to sign a consent form which will state clearly that there will be full disclosure in the event of any error or missed diagnosis for any reason.

As I have written before that as I passed Meagher’s Chemist on Upper Baggot Street I saw the sign for the Well Woman Centre, I called in and spoke to the receptionist and as the doctor had the time, she carried out the CervicalCheck that day.  I have never used the CervicalCheck service before because they never notified me by post and there are others who fall into this category too.

Enough nostalgia and back to what is reported in the media over the last few weeks that may be of significance.  The stage is set for a scoping inquiry led by Dr Gabriel Scally.  A very brave and altruistic Vicky Phelan had the capacity and motivation to sue the HSE and Clinical Pathology Laboratories Inc. after receiving incorrect test results.  Vicky is now on Pembroizumab http://www.keytruda.com/ since April (her third dose) and her Consultant Mr David Fennelly has confirmed that there is a shrinkage of her tumours.  Mr Fennelly said to her “You don’t realise how big this is for cancer and cancer patients”.

Every year approximately 300 women are diagnosed with cervical cancer and 90 die from the disease.  Other people screened are treated for pre-cancerous changes.  It is important to note that since CervicalCheck began it has detected over 50,000 pre-cancerous changes in women without any symptoms, as well as over 1,200 cancers.  Eilish O’Regan, Independent article 14th June 2018.

Juliana Adelman dated 14th June 2018 Irish Times article under the heading ‘Cervical Cancer screening is far from perfect’  outlines the history of the Pap smear which is used by Cervical Check.  To quote as follows:

The problem of false negatives is not new, but is part and parcel of the complexity and ambiguity of the test.

According to Monica Casper and Adele Clarke, the Pap smear “has become the most widely used and entrenches cancer-screening technology in the world”.

History:  The Pap smear is named after Dr George Papanicolaou, a Greek doctor working at Cornell University Medical centre in the early 20th century.  His research involved the reproductive cycle of guinea pigs in 1917 by removing a few cells from the cervix and examining them under the microscope.  He then took a swab of his wife, certain staff and patients.  It was 1940 when the medical community accepted Dr Papanicolaou’s test as an effective way of detecting very early cancer or pre-cancer.  To take the swab is the simple part.  To read the results takes time and expense and must be done by a Cytologist.

The classifications for observed cell changes are difficult to define clearly and have changed over time.  Despite the cost and complexity, women in the US began to demand the smear be used as a screening tool because of its potential to save lives through early detection.

The marketing strategy for screening placed responsibility on women to be alert to signs and to act accordingly.  This would mean that medical science had the opportunity to cure them.  It was frowned upon if a woman was diagnosed at Stage IV when she had the opportunity of having cervical spear tests on a regular basis.  Women must acknowledge and be aware of the fact that screening is imperfect.

18th June 2018: a weak without any treatment or appointments.  The mood is low recently and it is hard to be motivated even with my rigid daily routine.  Thankfully today provides a reason.  Cancer medications can interfere with neurogenesis in the hippocampus http://en.wikipedia.org/wiki/Hippocampus deep within the brain and this talk with some 5.6 million hits is a must for anyone who may feel low, or be experiencing what they call “chemobrain.”  It is an excellent Ted talk by Sandrine Thuret: ‘You can grow new brain cells.  Here’s how – Ted talk 8th October 2015.http://www.ted.com/talks/sandrine_thuret_you_can_grow_new_br…

At all times there is a need for different perspectives and I have to say a recent article by the Irish Examiner columnist, Victoria White, is worth reading.  http://www.irishexaminer.com/…/victoria-white/cervicalcheck-is-a-political-football-bei…  You are given the opportunity to explore the one sided narratives that have consumed our media of recent times.  I will quote as follows:

The Government is frightened because Vicky Phelan won an award of e2.5 milion against Clinical Pathology Laboratories, where her cervical smear test was misread.

Four cases relating to incorret smear results have already been listed to come before the High Court, with many more potentially waiting in the wings.  Emma Mhic Mathuna is seeking “exemplary and aggravated damages”…What the Governmen really feas is the voice of a dying woman blaming them for their plight.

Why did the Government not repeat that cervical smear testing programmes have an incorrect reading rate of about 30%; and that it was an issue about open disclosure.

…this is what we need to understand as arising from this crisis.

The women most failed by the State in the diagnosis of cervical cancer are the hundreds who contracted it in the 20 years it took to establish a screening programme after the UK and similar jurisdictions had established one.

 

 

 

 

 

 

 

http://www.youtube.com/watch?v=toV3Wj63IvA May 30, 2018 – Uploaded by MD Anderson Cancer Center The American Cancer Society has published new guidelines on colorectal cancer screening, decreasing the …

https://www.youtube.com/watch?v=UsvHeI8DC7E

 

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Essay: Trinity College Dublin – Sociology 1999/2000 (Critically examine the economic, socio-cultural and political factors which have influenced the success of Zimbabwe’s current land reform programme) Hilary Term Business Economics and Social Studies

CRITICALLY EXAMINE THE ECONOMIC, SOCIO-CULTURAL

AND POLITICAL FACTORS WHICH HAVE INFLUENCED THE SUCCESS

OF ZIMBABWE’S CURRENT LAND REFORM PROGRAMME.

Introduction:

In the light of recent events (1997) in Zimbabwe, which will be reviewed in this essay, it would appear inappropriate to refer to Zimbabwe’s current Land Reform Programme as a success.  A critical examination of the economic, socio-cultural and political factors giving rise to this assumption is required.  This involves giving one’s judgment about the merit of theories or opinions or looking for the truth in line with the facts, and to then support one’s judgment by discussion of the evidence. Having defined the word ‘Critically’, I first want to provide an outline of the essay structure.   I will  establish the historical basis which is largely responsible for the Land Reform Programme in question. Then, I attempt to answer the question – What is Land Reform?   The main content of the essay is a critical examination of the economic, socio-cultural and political factors which have influenced the success (or lack of success) of Zimbabwe’s current land programme.  My conclusion reviews the motivation factors of the colonial settlers who chose to remain,  President Mugabe, ZANU-PF and the citizens of the Independent Zimbabwean.

 

History:-

The idea gleaming and dancing before one’s eyes like a will-of-the-wisp

at last frames itself into a plan.  Why should we not form a secret

society with but one object, the furtherance of the British Empire

and the bringing of the whole uncivilised world under British Rule,

for the recovery of the United States, for the making the

Anglo-Saxon but one Empire? 

What a dream, but yet it is probable, it is possible.

Cecil Rhodes (aged 23) in His Confession of Faith – 1902

 

Cecil Rhodes – similar to religion, gave encouragement and endorsement to the people of  the declining British Empire. Rhodes referred to the fact that since Africa was lying ready for take-over, it was the duty of the people of the British Empire to acquire it. Rhodes, at the age of 21, is said to have sided with those, who believed that everyone was entitled to the same opportunity.  However, 7 years later, he no longer believed in this idealism.

The timing of  the arrival of Cecil Rhodes in South Africa is a very important contributing factor to his success.

‘An Industrial and technological revolution in Europe and the United States had given him unique advantages at the precise moment he was able to profit from them…when he arrived, it took 8 months to receive a reply by letter from England.  In the next decade, when Rhodes was ready to expand his interests, Southern Africa had been transformed.  The telegraph offered instantaneous communication.  Cape Town, and Kimberly were linked by rail and the journey to London had shrunk to 19 days’ (Thomas, A. 1996: 348)

Opportunities abounded.  Financial markets became accessible.   There was dynamite for mining purposes and electricity available.  Labour was plentiful and virtually without value, economic or otherwise. ‘Rhodes achieved a near-monopoly of the world’s diamond markets, by audacious take-overs and the secret purchase of shares.  He had a perfect understanding of public relations and the power of the press, acquiring newspapers, both openly and secretly, in the belief that ‘the press rules the minds of men”  (Thomas, A. 1996:  12,13)

 The foregoing paved the way for what is known as Settler Colonialism which began in 1889.  Cecil Rhodes by way of the British South Africa Company (BSAC) received a Royal Charter of Incorporation from Great Britain.  This meant the BSAC had power to make agreements and treaties with African Rulers and Headmen to expropriate land.  This land they then distributed to white settlers.  The BSAC exploited the mineral resources.  They hoped to find similar wealth generating deposits to those found in South Africa.  However, Rhodesia was not sufficiently mineral rich and the focus switched to agriculture.

In 1930, the Land Apportionment Act segregated land into legal racial holdings.  The European land mass was 50.8%, the native purchase areas a mere 7.7% and the native reserves comprising 22.4%.  Only 5% of the population were European settlers who could purchase land in the superior areas while Africans could only occupy poor land areas.   The ‘Divide and Conquer’ strategy was applied by Great Britain resulting in a small number of Africans being allowed to purchase land.  These were to be the indigenous ‘elite’ who would distance themselves from the masses creating hostility sufficient to prevent the formation of a united front that could challenge the minority settler population.  However, the intention was defeated by the lack of credit facilities and the existence of discriminatory pricing mechanisms which applied to this elite and not the white settlers and which excluded them from assimilation with the settlers.   It is worth noting at this stage the impact of the Christian Church on African Nationalism.  When the missionaries arrived in the early 1800’s,  to advance African Nationalism was not their concern.  In many ways, they have been visible supporters of colonial rule.  Their contribution to African Nationalism was by default.  Before the missionaries arrived in Africa, there were 700 languages but only 4 had a script of their own.  This meant a very real problem with illiteracy.  By 1959, literacy had increased to 10-12%.  Education is cherished in Africa and the ambition of even the poorest of parents for their children.

Ian Smith, The Prime Minister of Southern Rhodesia, a British colony since 1923 – rejected British conditions proposed for Rhodesian Independence in 1965.  Britain responded by imposing sanctions which fueled the internal conflict between the White 5% minority and the African majority.

‘We can safely say then that the study of history has placed very powerful political weapons in the hands of many Africans and that historical consciousness is one of the chief factors under-girding African nationalism.  The educated African has very powerful ideas and ideologies that are highly explosive and dangerous due to colonialism’ (Sithole, 1959:  61)

Reference is often drawn to the docility of the African people who had to all appearances, acquiesced to white domination.  History, the education first provided by the Missionaries, effected the dissolution of tribalism in favour of nationalism.  There was a time when African students used to resent being taught by a black teacher.  However World War II altered opinions.  For the first time, Africans saw their ‘betters’ suffer defeat.  This fostered the de-mystification of the white man.  Sithole sums it up as follow:-

‘Time has given birth to a new African who is more self-asserting, more enterprising, more aggressive and more self-reliant than his forebears. It is impossible to push this new African into Time’s womb…’ (Sithole, N.  1959: 159)

The outcome was that in April 1980, Zimbabwe became Independent.  The Lancaster House agreements with Britain brought to an end 15 years of unilaterally declared independence. The former white minority Rhodesian Government withdrew and The Zimbabwe African National Union-Patriotic Front (ZANU-PF) have been in power since 1980.  It was a coalition government with Robert Mugabe as Prime Minister, and Rev. Canaan Banana in the largely ceremonial role of president.  However, the transition was not smooth, factional differences arose between the former Guerrillas.  In 1983/84, unrest by Pro-Nkomo dissidents in Matebeland resulted in thousands of Government troops being deployed – many Matebele died and vile atrocities were carried out.  By 1988 this was resolved.  Joshua Nkomo (Matebele) and Robert Mugabe (Shona) signed a Unity Agreement and ended the conflict.

In 1991, ZANU-PF initiated a substantial economic reform process.  In the mid 1990’s, Parliament approved legislation allowing the compulsory acquisition of land by the Government, which was further facilitated by President Mugabe winning the elections held in those years.  Cracks became apparent in 1997.  The Government was accused of misusing funds intended for veterans of the Independence Struggle.  The Government responded by granting large benefits for the war veterans which were financed by increased taxation.  The response from the Trade Unions was strike action and demonstrations.  President Mugabe re-focused on the land resettlement programme, the ideal scapegoat to capture the attention of the dissatisfied masses.   In 1997, Mr. Kangai said ‘it was what he termed a fact of history that these countries had, in the past, pledged financial support for land reform in Zimbabwe’ (Internet, BBC News Online: Despatches, 1997).  He also said that the white settlers would not be financially compensated, that the obligation to remunerate them rested with the UK.  In November 1997, a list of 1,000 targeted properties was published.  ZANU-PF stated their goal to acquire 5 million hectares over a five year period.  Moreover, 223,112 hectares (120 farms) were offered for sale in 1998.

What is Land Reform?

Encyclopaedia Britannica describes it as a purposive change in the way land is held or owned, how it is cultivated and moreover how it relates to the rest of the economy. Land reforms may be initiated by Government, revolution or the work of interest groups.  In the past, the aim of Land Reform has been concerned with the abolition of feudalism or colonial owners.  The aim is to improve the conditions of the peasants.

A basic foundation for a land reform programme is that it must be concerned with restructuring an existing system of landed property.  Normally what happens is that the State acquires the landed estates at the estimated market price with the intention of subdividing them into small parcels, and to sell these with full private property rights of use and exchange, to the beneficiaries.  The rationale being efficiency and equality (Atkins, 1988). The fact that Third World poverty has not been eradicated is seen as a systematic failure by the left as well as the proponents of the market economy (Sobhan, R. 1993).  Collectivist failures have occurred in other countries such as Taiwan, Russia, North Korea but on the other hand re-distributive agrarian reforms of a highly egalitarian nature took place in Japan and South Korea.  In these cases – an external force played the catalytic role.  The US instructed the re-distribution of the 37% of arable land to 66% of all agricultural households.

‘Within the constitutional constraints inherited by the first black government in Zimbabwe, there was not much scope for major land reform, but there was scope to buy out white settlers and to bring unused lands under cultivation.  Thus abandoned farms were taken over and surplus lands under white settler farms were subsumed by the State, with payment of compensation.  ‘This was designated for distribution to the landless and the poor’ (Sobhan, R.  1993: 73).  35,000 peasant families, per consequence of this, were assembled in 50 settlement schemes.  By 1984, 18% of the land held by white settlers had been redistributed to Africans.  It is important to consider the role of  bureaucrats and bureaucratic agencies.  The reality is that they have vested interests in the protracted proceedings relating to Land Reform and in particular the Ministries of Agriculture and Lands and certain para-statal affiliated groups, who have no desire for a resolution which would entail a loss of job for them or their supporters.  Moreover international aid agencies can likewise hinder policy and planning discourse.  International aid is about shifting funds to Third World governments and sometimes it is necessary to have a vehicle to effect the transfer.  Land settlement schemes provide a useful method.  (Hulme, D, 1987).

At the centre of rural development issue is the International Bank for Reconstruction and Development, i.e. the World Bank.  The World Bank raises its money from international capital markets and re-lends it at interest to governments to finance specific projects.  The World Bank together with its associate the IMF, were set up in 1944 at Bretton Woods.  The aim was to encourage free flows of trade, investments and profits, the main promoter being the US.  Irrigation schemes are funded and sponsorship is available.  The World Bank is presently supporting ‘green revolution’ technology in line with its poverty lending focus.  The World Bank is still in favour of conservative fiscal policies, liberal trade, exchange rate policies and protection of foreign investment.  Lending policies thus favour right-wing military regimes.  In other words, those who redistribute the income and benefits derived from economic growth to the rich (Williams, G.  1981).  This falls in line with the urban-bias practice engaged in.

Over 11 million hectares of land is owned by approximately 4,500 commercial farmers (Internet, IRIN).  9th September 1998 Mugabe warned of Land Reform Anarchy while attending a conference in Harare to raise funds for redistribution of land.  Donors had pledged to provide $1.5 m but were considering withdrawing from the commitment.  Mugabe informed them that if the 5 year plan did not come into effect, squatting would increase to the point of anarchy.  The last number of months in Zimbabwe has seen a high  proportion of this reality.  There has been an invasion of white-owned farms.  The accusation is that ZANU-PF have breached their promise for land redistribution  (Internet, BBC News, 1998).

Zimbabwe, like other indigenous African countries, has a corrupt ruling elite.  They boast and display their wealth.  In a speech in 1989, Robert Mugabe similar to Joshua Nkomo, having tried to place a check on the corruption, capitulated and said ‘I suppose we have to learn how to be rich as well as having to learn everything else’  (Lessing, D.  1992: 9).    It is acceptable that it is a difficult transition, involving a whole new process of learning but one hopes that ‘in learning how to be rich’ that the corruption that ‘can’ accompany being rich, could be displaced.

Critical examination of the socio-cultural and political factors which have influenced the success of Zimbabwe’s current Land Reform Programme:

 

‘The government has no economic or social record on which to campaign.  With the country in deep crisis – long queues for diesel and petrol, increasingly frequent power-cuts, a dire shortage of foreign exchange, massive government borrowing, numerous reports of corruption in government and state owned companies – ZANU-PF will campaign on emotive issues such as land and race.  If the party win next month, it will be by exploiting the land issue, depicting the business community and especially the 70,000 white minority as economic saboteurs, and promising a new ZANU-PF, albeit with many of the same leaders’ (Financial Times, 2000)

I cannot describe the current Land Reform Programme in Zimbabwe as a success.  Based on the foregoing history and the land reform issue, it is apparent that land redistribution is mainly a ploy used by President Mugabe and ZANU-PF to remain in power.  If President Mugabe wins over the rural community and is re-elected in April, the cost to Zimbabwe will be high.  International donors – the US, Sweden, Norway, and the The Netherlands, have provided US$920,000 through the UN Development Programme, as yet another tranche of funding to Zimbabwe recently.  The purpose of this donation was to aid the Zimbabwean Ministry of Agriculture to progress the inception phase of the land scheme drafted to resettle 77,000 rural families on millions of hectares of farm land in a 2 year time period.

Why 20 years after Independence is the land redistribution issue so prominent? 1% of the population are white settlers holding most of the productive, income yielding land, the remainder are the indigenous population. Zimbabwe wanted the US$193 million which the IMF reluctantly pledged to them in August 1999 on the basis of Zimbabwe’s officials’ confirmation that it was spending only $3 million per month on keeping troops in the Congo to support the Congolese government.  October 4th, the Financial Times, had sourced an internal memo from the Zimbabwean Finance Ministry showing that $166 million had been spent over 6 months, January to June.  This highlights the reliance that the IMF and World Bank have on local staff.  The emphasis on truth and trust is made more difficult in the light of such revelations.  This method is unreliable.  Whistleblowers need to be fostered to reveal any discrepancies (Economist, 2000: 64).  Given the foregoing, the following question is pertinent but extremely difficult to answer.

Will the donors continue to fund and what will be the implications if the donors withdraw?

White Supremacy in Action, comprises white people, who equate economic power with political power.  The economically strong are also politically strong.  Given this premise, it follows that the objective of the European ideology of white supremacy is to keep Africa politically weak.  The means of effecting this is to keep it economically weak.  In other words, political domination presupposes economic exploitation. Zimbabwe is predominantly an agricultural economy, the crops include tobacco, cotton, sugarcane.  Gold is also mined.  Zimbabwe gained Independence in 1980. The Zimbabwe of 1980 was more industrialised than most other African countries.  It had a diversified productive base, a well developed infrastructure and a sophisticated financial sector.  To date, most large-scale commercial farms are owned by the white minority.  Agricultural land is the main foreign exchange earner in Zimbabwe.  From 1991 to 1995 Zimbabwean economic growth was approx. 1.7%, this increased to 7.6% in 1996 but dropped to 3.5% in 1997 (mainly due to poor performance in agriculture and mining).  Growth in 1998 was 1.6% and similar for 1999.

Zimbabwe is an now an unstable economy, exports are considerably reduced, the currency devalued 90% since November 1997.  Inflation runs over 60%.  The reality is that the commercial farms will have to be revived to generate economic returns.  An election looms, an opposition poses a threat, namely the Movement for Democratic Change, Mugabe lost the draft constitutional referendum in February, he accuses the white farmers of causing this.  To regain the much needed rural support, he has now introduced a constitutional amendment to seize white-owned farms.  Written by Mr. Mugabe himself, the clause says that Britain is obliged to pay for the land that Rhodesian colonists took from the Africans.  If Britain does not pay then the Zimbabwean Government can confiscate the land without compensation.  (Economist, 2000, 58).

Women:

Sub-Saharan Africa women produce between 60 and 80 percent of agricultural foodstuffs and cash crops.  Yet, in many parts of the African Continent, women lack legal access to land and support services for production and distribution.  As a result, women are frequently left to provide for their dependents without adequate agricultural, educational, institutional, and financial support….First, legal barriers to women’s land rights must be challenged.  Second, women have to be provided full extension and support services tailored to their needs.  Third, support must be given to non-governmental organisations and movements that actively promote women’s land rights’.  (Peters and Peters, 2000: 7)

By custom, by way of colonial policies and in such schemes as Julius Nyerere’ Tanzanian Ujamaa Village Act – women only have usufruct[1].  The advantages derived from the land or property belong to their husbands or male guardians.  This precludes women from gaining credit, joining co-operatives and being available to marketing facilities.  Women in Africa are often left to provide for their families without substantial educational, agricultural, and financial support. Women often worked 16 hours a day, and still do.  They carry out the ordinary tasks as per the gendered division of labour but moreover they are involved in the agricultural work while husbands migrate to the urban areas for work.  Yet, while permit holders, mainly men, can raise government sponsored credit, through the Agricultural Finance Corporation, women do not have access to loans in their own right.  In spite of the evident and essential contribution of women, in August 1994, President Mugabe stressed that cash crop production was the main goal of resettlement in Zimbabwe, but while saying that there should be Justice for both partners in a marriage…he rejected calls for the registration of both spouses’ names on land permits, saying that these were foreign ideas not acceptable in Zimbabwe where the man was head of the household’ (Resettlement Now 1994, 7).  This could only be described as a biased statement and unjust.

It was kinship and inheritance that provided the basis of organisation for the Shona and Ndebele.  Interestingly, land was not owned in pre-colonial Shona and Ndebele societies.  The male chief of the Patrilineage held and distributed it.  Daughters were often granted usufruct rights over the lands of their fathers, the same applied to a divorced woman.

‘Land Reform as an instrument of development policy was widely acclaimed in the 1960’s and 1970’s and was vocally, if not financially, supported across the whole political spectrum.  The broad support rested on a range of opinion which saw traditional land tenure systems as responsible for political unrest, the reproduction of social injustice and as a principal cause of economic stagnation (Atkins, F. 1988: 935)

‘For both the reformers and revolutionaries, ‘in the post-colonial era agrarian reform was seen as one of the levers to modernisation and structural change of their ‘backward’ societies’ (Sobhan, 1993: 1).

Land Reform was seen as a means of eradicating poverty.

Capitalism represented development and the reformers wanted to provide incentives to the agrarian workers so that they would engage in more intensive farm methods.  The surpluses in turn would be used to underwrite the industrialisation process.  The aim was to remove the elite of the ‘ancien regime’ (Sobhan, 1993: 1).  Zimbabwe has a high donor presence.  They include the World Bank, the European Union, the IMF etc.  Many countries also donate e.g. US, Britain, Nordic countries etc.  Non-Governmental Organisations (NGO’s) are very much involved in areas relating to Aids, gender, community development. The World Bank has 8 active projects in Zimbabwe and has contributed funds amounting to US$448 million.  Projects supported include finance, public sector management, agriculture, environment, infrastructure and social sectors (World Bank, 1999). Sustainability is a most important factor.  It involves environmental, institutional, social and economic dimensions.  The urban bias is easily identified in Harare, the capital city.  Harare 1992 provided a needy respite for world-wide construction related business.  Architects, Engineers, Contracts Managers and large international companies diverted their attention from the recession/depression of their home market in the UK and Ireland, and adapted to Third World markets, in favour of profits.  Ironically, the buildings which tended to be the largest were the Reserve Bank, the 17 Storey Post Office Savings Bank, the armed forces accommodation areas/runways etc.  What will the impact of E-commerce be?  This was not envisaged!  The locations of employment are mainly for para-statal bureacracy.  What about Eco-Tourism?

‘The external debt of developing countries climbed steeply during the late 1980’s and early 1990’s.  Servicing this debt places a heavy burden…and imposes a serious constraint on the economic and social development of the poorest and most indebted…Irish Overseas Development Assistance (ODA) is given solely as grants, never as loans…Ireland is actively involved in international measures to alleviate the debt burden’ (Irish Aid – Ireland’s Official Development Assistance 1998; 18,19).

1998 – IRISH AID TO ZIMBABWE

  • £1 million approximately
  • Population:  11.2 million
  • Human Development Report Ranking 130th out of 174 countries

Zimbabwe at one time was the 10th wealthiest country in the world but this is far from the case at present.  Equity in debt provision by donors is a key factor.  The objectives for donors i.e. apart from altruism, is to gain significant financial returns, given the risk element.   Idi Amin (Uganda), to Banda (Malawi), to Mobuto (Zaire) to name but a few, provide prime examples of how donated funds can be misdirected.  Ultimately no-one gains by corruption and particularly those 70% of the peasant population who work the land in the case of Zimbabwe.

By the time of UDI, exports amounted to 47% of GDP with imports at 36%.  At Independence, Zimbabwe’s indigenous population were better educated than their counterparts in other countries.  Large publicly floated companies like Lonrho, RTZ, BAT existed.  Historical dependence on foreign capital inflows, imported technology, and expatriate managerial inputs through transnational arrangements provided a strong support system.

Will Zimbabwe survive in the globalised markets of today?  In the case of Zimbabwe it is not a question as to whether the Government will use power, it is how they use the power?   The direction to which it is put is the prerogative and given the foregoing, there appears to be a ‘hedging bets’ strategy in place.  In 1990, Robert Mugabe formally abandoned Communism.  The Economic Structural Adjustment Policy (ESAP) was the new policy in vogue at that time.  Some commentators viewed this  as a method of getting the most out of capitalism without having to let go of socialism.  The message to the people was ‘The sugar is over’ (Lessing, D.  1992: 431).  Investment is sought by the Party from international markets.  Does this equate to pleasing the Master i.e. the Donors.  A survival by a new form of paternalism.

Conclusion:

The fabled riches of Africa – ivory, gold, diamonds, emeralds, copper.  Crops like cotton and palm oil could be grown on plantations cutting out direct sales.  Africa was too rich to be left to the Africans who they considered to need civilisation and Christianity.  The Africa they seized was technologically in the Iron age and politically divided into thousands of units.  Paternalism was the ploy used by the Europeans to win over the Africans.  Africa was a storehouse and was steadily exploited.  The Africans received only a small fraction of the wealth generated.  For the Africans, ‘Wonders have come’ – this was the general response to what the West offered.  They learned skills, they worked on construction sites, they worked as carpenters, bricklayers, they worked the land etc.   They still do.  Africans did benefit from the provision of schools, hospitals, modern administration systems, infrastructure but we must never forget that  European occupation was short but the impact was considerable.   ‘The coming of  European powers brought to Africa: the coming together of different tribes, better communications, a new economic system, the creation of new classes among African people’ (Sithole, 1959: 68).  What is interesting is that the colonial powers in their assistance with de-tribalisation paved the way for nationalist aspirations.  The development of the infrastructure also had the by-product of facilitating nationalism.  The media, the press, the radio opened up whole new areas of information to the indigenous, another beneficial resource.  The change from the tribal African to the nationalist African occurred.  I commenced this essay with an outline of the history of  Rhodesia/Zimbabwe, I then reviewed land reform.  The main context contains a critical examination of the economic, social-cultural and political factors which have influenced the success of Zimbabwe’s current Land Reform programme and under this section I have looked at women’s contribution to agriculture in Zimbabwe.  I do not consider the Land Reform Programme a success as can be concluded from this essay.

I will conclude my drawing reference to a poem called The Boss, which is referred to by Doris Lessing in her book, African Laughter.  Accompanying the poem, in a prominent position, in a Government office was the following quote.

‘Zimbabwe is run by Bosses – Robert Mugabe is a good man fallen among thieves’

 The message:  It is easy to be a ‘Boss’ but not so easy to be a ‘leader’

===================================

Bibliography:

 

Books:

Lessing, D. 1992.  African Laughter – Four Visits to Zimbabwe.  London:  Harper Collins.

Moyo, S. 1986.  ‘The Land Question in Mandaza, in I (ed.)  Zimbabwe the Political           Economy of Transition.  1980-86.  Dakar: Codesria

Rhodes, C. 1902.  ‘Confession of Faith’ in A. Thomas (ed) in ‘Rhodes – The Race for          Africa.  London:  BBC Books.

Riddel, R (ed) 1980.  From Rhodesia to Zimbabwe.  Morris-Jones, W.H.  New Jersey:       Frank Cass and Co.

Sithole, N. 1959.  African Nationalism.  London:  Oxford University Press.

Sobhan, R.  1993.  Agrarian Reform and Social Transformation.  Preconditions for            Development.  London.  Zed Books. Limited

Thomas, A. 1996.  Rhodes –  The Race for Africa.  London:  BBC Books.

Williams, G.  1988.  The World Bank and the Peasant Problem in Heyer, J. Roberts, P       and Williams G., (eds). London:  MacMillan

 

Internet Sources:

BBC New Online: Special Report.  “Zimbabwe’s History: Key Dates”:  [Internet].

2 December1998. http://news.bbc.co.uk./low/english…zimbabwe/newsid

_226000/226542

Encylopaedia Britannica.  “Land Reform”.  [Internet].  18 March 2000.

http://britannica.com

World:  “Africa Mugabe warns of Land Reform Anarchy”:  [Internet]. 9th September       1998.             http://news.bbc.co.uk./hi/english/world/africa/newsaid_1670000/167825.stm

World Bank Group.  “Country – Zimbabwe”.  [Internet] July 1999.

http://www.worldbank.org/afr/zw2.htm

Zimbabwe:  “Donors Back Land Reform”:  [Internet].  19th May 1999.

http://www.saep.org./forDB/forDB9905/ZIMlandreformIRIN99051          9.html

Zimbabwe Minister on Land Grab Plans: [Internet].  2nd December 1997.

http://BBC News/Despatches/Zimbabweminister on landgrabs

 

Journals:

Atkins, F.  1988.  ‘Land Reform:  A Failure of Neoclassical Theorization’.  World   Development.  16:8:935-946

Hulme, D. 1987.  ‘State Sponsored Land Settlement Policies: Theory and Practice’.

Development and change.  18:3:413-36

 

Newspapers:

Hawkins, T.  ‘Land Appropriation may prove to be Mugabe’s lifeline.’  Financial      Times.  1 March 2000


 

Reports:

Irish Aid, 1998, Ireland’s Official Development Assistance: 18, 19, 22, 42

Weekly Journals:

“Zimbabwe:  Official Invasion.”  Economist  11 March 2000: 54..58′

‘Zimbabwe:  The IMF rescues Mugabe.’  Economist.   11 September 1999.  Vol. 352.

‘Zimbabwe:  Creating Accounting in Africa – Hidden Skills.’  Economist.  9 October          2000:  64  Vol 353

================================

HILARY TERM SOCIOLOGY ESSAY

FOR THE ATTENTION OF T. GALVIN / SEAN REYNOLDS

FROM:  MICHELLE CLARKE – 2ND YEAR BESS 1999/2000

NO:  97810959

[1] Law, the use and enjoyment of lands or tenements without the rights to alienate such

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Trinity College Dublin (BESS) 2001: Dissertation “Advocacy for those who are classified mentally ill” by Michelle Clarke

via Trinity College Dublin (BESS) 2001: Dissertation “Advocacy for those who are classified mentally ill” by Michelle Clarke

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Trinity College Dublin (BESS) 2001: Dissertation “Advocacy for those who are classified mentally ill” by Michelle Clarke

May 23rd 2018

Thank you Shari McDaid and all at Mental Health Reform for inviting to the Oireachtas tomorrow.  I have been writing as an activist about the inadequacies in provision in both dignity, care and attention of people who are diagnosed as mentally ill.  I take this opportunity to return to the essays/dissertations I would have written while studying at Trinity College Dublin as a mature student, using whatever opportunity given to me to write about my personal experience and expectations regarding mental health provision:-

A brief outline from Mental Health Reform http://www.mentalhealthreform.ie/

Briefing note on the Mental Health (Amendment) Bill 2017 http://www.mentalhealthreform.ie/…/2017/…/Briefing-note-on-the-Mental-Health-A…

  • There is a Bill going through the Oireachtas at the moment which would update the Mental Health Act, 2001 in a few key ways. It has been proposed by Fianna Fáil and passed report and final stage in the Dáil on 14th July 2017. The Bill is due to go to report and final stage in the Seanad at the beginning of May 2018.
  • The Bill contains certain significant changes that strengthen the rights of people when they are in hospital for mental health care.
  • The Bill will also support the right of inpatients to make decisions about their own treatment by linking the Mental Health Act, 2001 with recent law that affirms everyone should be presumed to have capacity to make decisions.
    (This includes providing people with the supports they need to be
    able to make decisions.)

Email from Mental Health Reform:  meeting cancelled until further notice.

Personal experience in 1998:  It took 15 sessions of ECT that shifted a deep depression that was resistant to medications.  I am enclosing this link because for people who are drug resistant, one does not have to refer to the film ‘One Flew Over the Cuckoo’s Nest’ and feel that terrible fear that once was linked to ECT.  http://www.cbsnews.com/news/ect-is-shock-therapy-making-a-comeback/

=====================================================

9th February 2001
Student number 97810959
C\TRINITY\DISSERTATION PROPOSAL:  10/02/01

DISSERTATION PROPOSAL 

ADVOCACY FOR THOSE WHO ARE CLASSIFIED  MENTALLY  ILL?

WHO REPRESENTS  THE INTERESTS OF THESE PEOPLE?

(I was one of the 15 trainees of Cycle 1 of the Trinity Horizon project (1996/1997)

so therefore the methodology used is reflexive.) http://people.tcd.ie/mfdavis

 

Michel Foucault said that we each use the template but each revision of the source, produces a new schemata and with it a new image of the world.  Within this context, I want to review primarily the findings of the Trinity Horizon Project, an EU Human Resources Initiative.  This was both a training and research programme to facilitate the entry/re-entry of women recovering from depression to the workplace.  I do not wish to differentiate between men and women, and mental illness will be referred to instead of depression so I will be selective in findings chosen to reflect this. Mental illness is the term that refers collectively to all mental disorders which are subject to diagnosis. It has a significant impact on the functioning of society and the quality of life of citizens. ‘Some 400 million people in the world suffer from mental and neurological disorders or from psychological problems such as related to alcohol and drug abuse (World Health Day 2001, WHO).

Concept of the Problem:

Stigmatisation. demonisation, classification of mental patients functioned as a procedure of objectivisation and subjection.  Foucault differentiated between the document and monument and it is a poignant analogy.  The reality now is a move from medicalisation to a more sociological based, less State economically draining option.

Advocacy for those who suffer from Mental Illness:

My approach is to briefly review work completed by the World Health Organisation,  United Nations, European Union and the UK.  The UK have enacted the Human Rights Act in 1998 and there is a draft Bill for Mental Health under review.  The NHS, the Charity Organisations, and Philanthropic concerns, all acknowledge the impact of Mental Illness, the impact on social structure, the affect on many members of the labour force and participate at national policy compilation and implementation.  From the US, to the UK, to Ireland, the process is removal from the ‘Asylums’ to the community.  However, this process has implications.  First there is adjustment, medication compliance, contact links, support, basic necessities of keeping a home or sharing, the issue of homicide and suicide, giving rise to subsequent media interpretation.  It takes a very short time to be institutionalised but it is very difficult to adapt to being ‘outside’ as the revolving door situation of return to hospital establishes.  The argument is that the medications have improved, the hospital options are a stigmatised, non financial proposition, and Ireland must follow the approach taken in other countries.

Advocacy is required urgently.  Someone who can represent the interests of people who by virtue of illness, hospitalisation, sedation, concentration impairment, no physical exercise, no dealing with ‘everyday life’ who are discharged into a non developed community care system to survive.  There are day care centres available but they tend to be understaffed, and without a proactive system for rehabilitation.

Literature provides the framework for further research:

This is a critical summary and assessment of a range of existing  materials dealing with knowledge and understanding in a given field.  Its purpose is to locate the research project to form its context or background and to provide insights into previous works.

Overall from the readings the following policies in relation to mental illness are  encouraged:

  • to reduce the number of people who develop mental health problems
  • to help those with mental health problems to improve their overall quality of life
  • to eliminate the stigma associated with having mental or emotional problems
  • to provide effective interventions in areas in need
  • to promote ongoing research into causes and treatment of mental disorders (WHO).

‘We recognise that the brain is the integrator of thought, emotion, behaviour, and health.  Indeed, one of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between ‘mental’ and physical health.  Common sense and respect for our fellow humans tells us that a focus on the positive aspects of mental health demands our immediate attention….The investment does not call for massive budgets; rather it calls for a willingness of each of us to educate ourselves and others about mental health and mental illness and thus to confront the attitudes, fear, and misunderstandings that remain as barriers before us.  It is my intent that this report will usher in a healthy era of mind and body for the Nations’ (Satcher, M., Mental Health Organisation) http://www.ncbi.nlm.nih.gov/books/NBK44243/

The policies outlined and the foregoing statement establish sound principles and guidelines but are removed from the exposures mentally ill people encounter, in their changing society.

My personal experience of the Trinity Horizon project consolidates the foregoing.  It was a research and training programme with an objective of providing work or study to prevent participants becoming long term unemployed.  Employment outcome was 51.7% as compared to the control group of 26.7%.  Further education was 80% for Cycle 1 and 50% for Cycle 2 (Trinity Horizon Project, Centre for Women Studies, 1998: 139).  The participants were introduced to subjects as follows:-  Creative Writing, Women and Society, Group Work, Computer Training,  Personal Development, Physical Activity, Counselling Support Programme, Women and Health.  Cycle 1 lasted 6 months whereas Cycle 2 lasted 9 months.  Cycle 2 derived the advantages of a Mentoring system and a work exchange programme abroad.  The approach was innovative but did not gain support to continue. The Consortium consisted with Aware, a national voluntary organisation which provides support for people with depression.  Dr. McKeon was a member of the Advisory Committee and Dr. Sheila Greene of the Department of Psychology was also involved.  They contributed advice to the design of the research.

Advocacy is imperative to guard the interests of those who albeit are a small minority but all the same exist:  Electric shock treatment as detailed in the Mental Health Inspector’s report is still used in Ireland.  The 1981 Pippard Report http://psychiatrized.org/LeonardRoyFrank/ElectroshockArticles/Electroshock.pdf stated that  ‘an 1980 survey carried out provided ‘a catalogue of blundering and dangerous incompetence’.  100 locations were visited and only 22 met the prescribed standards of the Royal College guidelines.  A high percentage delivered an unnecessarily large electric charge.  When survey’s were held in 1998, no significant improvements had occurred.  A large number of people are not aware that electric shock treatment is still used as part of Psychiatric treatment.  The Irish report provides no similar checks to the Pippard Report carried out in the UK.  Do we really know what is happening?

In the UK, a non family member can be appointed to act on your behalf while ill.   This we need too.  The introduction of divorce leaves certain members of society without control and vulnerable to an ex-partner whom they cannot and may not be well enough to divorce and if able to, not for a minimum period of 4 years.  Likewise, the choice of an independent member to family is probable when the new Mental Health Legislation is passed in the UK.

Ireland requires a system of advocacy, a representative body, comprising of a spectrum of people.  This is proposed in the UK legislation.  It would review the law, aim to protect the individual rights, monitor the voluntary organisations and initiate policy.  As it stands we rely on the media and people like Vincent Browne and Joe Duffy to probe.

HYPOTHESIS:

In relation to psychiatric illness, sociology, medicine and the health sciences will have to work together and multi-disciplinary teams will need to exist with an overall objective of  rehabilitating the ‘mentally ill’ person.  In the UK, social workers work as part of the multi-disciplinary teams in community work.

Further background to the Hypothesis:

‘Part of the cost of excessive drinking is found in three major problems; road traffic accidents, recurrent drunkenness and true compulsive alcoholism’ (Parsons, V., 118)

Link with alcohol the 4,000 in the UK who commit suicide, the majority of whom have excess alcohol in their blood stream, this quote, written in 1967 remains harrowing. Suicide is the major killer of young men under the age of 24 in Ireland.  Road Traffic Accidents are responsible for 40 deaths already this year.   RTA’s involve mainly young people with high levels of alcohol.  I want to raise the query of state of mind of the drivers.  A car and the risk factor is an attractive suicide option yet it is not mentioned.  Again, one could add in Drug Addiction for assessment.  All three areas stand independently and in a hierarchy of  ‘Shame’.  Where is the vested interested?  The ‘Drink’ market – now a Global entity of  an MNC,  while Psychiatry might be said to be a pawn of  again a global entity of the merged Glaxo, Wellcome and SmithKline Beecham.  It is interesting to note that Glaxo have moved into ethical/socially motivated type investments and inter alia have established a global mental health resource centre.  This I want to review also.  Illegal drugs – many of the Third World countries rely on these exports for their existence.  We need funds in Ireland to sponsor Mental Health programmes and Alcohol and Drug abuse programmes.

The hypothesis is that Education opportunities be made available for those who have attended a 1 year course based on the outcome of the Research and Training of the Trinity Horizon project.  These participants should qualify for back to education assistance.  Cycle 2 reported positively about the Mentor programme and I would strongly recommend a mentoring system in the provision of future Rehabilitation programmes.    University lecturers should sponsor such programmes of pre-university intake as should people in a variety of professions and business interests.  Those participants who gain access to full or part-time employment should have a mentor assigned to them.  I recommend something similar to psychometric testing be completed to identify areas suitable to the person’s personality.

The Irish Constitution was of a paternalistic nature, this followed by a subsidised health care system or privately funded system backed by voluntary health insurance payments fostered the institutionalised approach of the mental health care provision.  The economics now alter this.  It is necessary for a change in attitudes of those affected by mental illness so that they can assume a ‘Take Responsibility Attitude’ and to foster this with Mentoring provides an ideal method.  A ‘Spotter’ network has invaluable benefits to maintenance of mental health.

In 1992, the donations made to mental health charities by the general public amounted to £6 million but to animals the amount was £43 m and to those diagnosed with cancer £82 m. (Clare, A., 1993: Depression and How to survive it).  I suspect in spite of a decade nearly passed this will not have substantially changed.  I aim to review this.

Stigma – ignorance.  Life is around a person’s potential to compete in the structured market of today.  Social policy determines fate.  People who may not be well enough or for whom adequate support is not provided, are released from hospital.  The media, the police, and many ‘ordinary’ people are not briefed to deal with mental illness issues.  The shooting dead of John Carthy http://magill.ie/archive/john-carthy-death-tale-blunder-negligence-and-cover near Granard, Co. Longford, leaves a lot of questions to be answered.

The Royal College of Psychiatrists  provide free of charge a video – The Changing Mind Campaign two-minute film’ 1 in 4′.  We need this awareness for a proactive approach to education of school going population.  I am including this link which to my mind says people remain cruel and lack what is basic compassion.  Thankfully Royal College of Psychiatrists have continued on the trend they started in 2001 and people have no justifiable reason to remain ignorant.  http://www.youtube.com/watch?v=2x0T30Kbdsw

Lack of education or knowledge about mental illness, drug addiction and alcohol addiction by people working in the medical profession, involved in education at primary, secondary and third level, is far from acceptable.  The whole area of adolescent and child psychiatry is only opening up now when precipitating factors apply to children whose parents qualify under the above health categories.  We see today but not tomorrow.  We need to learn from countries that are legislating now on these topics.

The Sainsbury Trust for Mental Health http://www.sfct.org.uk/ was established in 1985.  It is also heavily involved in the design of mental health policy.  This project is built on research and development findings and is designed to influence national policy information.  Mind http://www.mind.org.uk/ another voluntary organisation is involved in influencing policy through campaigning and education in the UK.  Aware http://www.aware.ie/, Grow http://grow.ie, and others are similarly involved in advancing the views, needs and ambitions of people with experience of mental distress but they have no provision for rehabilitative programmes.

UK legislation is fully compatible with the Human Rights legislation.

Objectives

At local level:-

  • –           there must be mental health promotion
  • –           high standard
  • –           ease to re-connect with team
  • –           care plan
  • –           support for the carers
  • –           positive efforts to combat social exclusion.
  • –           sort out the stigma
  • –           Care programme Approach

Education, mentoring, training programmes, are all imperative to attain this level of service.

One issue that is causing concern in the UK regarding the reform of the Mental Health Act is that the health laws sanction the treatment of the person in the community (removing the person’s freedom to choose) and make them comply with their medication regime.  This previously could only be done in hospital.  The implications are about the person’s right to freedom.

METHODOLOGY:

A methodological framework for the analysis of documentary reality:

Initial Letter followed up by Interview:-

Dr.  Margret Fine-Davis/Mary McCarthy/Sheila Greene/Patrick McKeon

The Trinity Horizon model of training provides the basis for ongoing education/work/mentoring system that forms part of my hypothesis.  Access to the data sources will mainly be via the Internet as most sources have a Web site.

Dr. Jim Maguire/John Kearns.  Dr. Maguire is Consultant Psychiatrist in the North Eastern Health Board.  This is the public health service which is at present engaging in the movement of patients from the hospitals to the day care centres.  The internet will provide EHB data source but direct contact with Dr. Maguire will also be possible to ask questions.

Bernie, Ann, Helen, Noreen, Maura, Mary, Clare, Una – participants of cycle 1.  They will provide feedback, opinions, answer questionnaires if necessary.  Interviews are also possible.

Brian Gallagher, Gallagher Shatter, Chairman of the Mental Health Review Commission.   By letter or appointment.  He will advise on matters of advocacy and protection (lack of protection) of the person labelled mentally ill.

Internet will provide most information.   Further clarification can be gained by letter and if necessary a meeting.

Access to the Neuro-psychology Department in Trinity – concentration, memory problems due to medications.

Occupational Therapist (partially sighted) who has worked in several psychiatric hospitals and who has interesting ideas.

In certain instances, perhaps where letters are required, I will take a positivist approach.

The area I am reviewing is embedded in law and health and vast amounts of written documentation exists.  It means sifting through it to arrive at questions that are not already answered.  Then I can be positivist.  Others question may merit the interactionist approach.  Basically the approach will be semi-structured.  I want collective stories and to give voice to those who are marginalised or silenced by society.  I will where necessary engage in a creative technique using mutual disclosure.  However, I do not intend to focus on this as my experience is that people are numbed to sad stories, they listen, they don’t hear.

The template exists, resources exist to be tapped, the market is unfortunately an expanding one and particularly for those under the age of 24.   Social anxieties exist, what is unknown is that many people mask the social anxiety disorders that result in later problems of mental illness, alcoholism and drug addiction.  People need to see and hear again!!!

I have not completed a pilot study as the research report by the Trinity Horizon team is comprehensive.  I will review this again at the time I prepare for the dissertation.

Michelle Clarke

9th February 2001

97810959                    C\TRINITY\DISSERTATION PROPOSAL:  10/02/01

Personal note:

I have made a few amendments, as necessary, and which were mainly typing errors and omitted words.  I have the benefit now 17 years on of adding links to make the material more accessible.

Excluded:

Health and Safety Act 1974 – If you knowingly allow an employee under the influence of excess alcohol to continue working and this places the employee or others at risk, you could be prosecuted.  It is estimated between 3% and 5% of the workforce are over the alcohol threshold during working hours.  ICI employees are required to attend work with no alcohol in their system; alcohol means employment terminated.ikewise, Whitbread plc, have an alcohol policy.  They have an advice/support programme for employees.  Overcome the Drink Culture – media.

=================

Bibliography:

Alvarez, A., 1974.  The Savage God.  Great Britain:  C. Nicholls and Co.

Clare, A.,  1983.  Depression and How to Survive it.  London.  Ebury Press.

Kelleher, M.J., 1996.  Suicide and the Irish.  Dublin:  Mercier Press.

Parsons, V., 1967. Ethical Responsibility in Medicine.  A Christian Approach.  Edinburg and London:  E&S Livingstone Ltd.

Report:

Fine-Davis P., and McCarthy, M., Trinity Horizon Project.  Dublin.  Centre for Women Studies.

Internet:

Mind: http://www.mind.org.uk/aboutmind

Reforming the Mental Health Act, Department of Health, UK http://www.doh.gov.uk:/mentalhealth/summary.htm

Hyper Guide Proposals for New Health Bill http://hyperguide.co.uk./mha.uk

NHS Direct Health Care http://www.nhsdirect.nhs.uk/health

Royal College of Psychiatrists http://www.repsych.uk/public/changingminds.htm

The Sainsbury Centre for Mental Illness http://www.sainsburycentre.org.uk/Who

=======================

Publications:

Mental Health and the Workplace

Challenges and Opportunities – 13th March 2000

Reforming the Mental Health Act

The new Legal Framework.

Quotation:-

“Experience is not what happens to you; it’s what you do with what happens to you” Aldous Huxley

 

 

In my case I kept writing … May 23rd 2018

 

 

 

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The Future of Cancer Treatment Is Personalized and Collaborative

via The Future of Cancer Treatment Is Personalized and Collaborative

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Radar Reveals Details Of Mountain Collapse After North Korea’s Most Recent Nuclear Test

As North Korea’s president pledges to “denuclearize” the Korean peninsula, an international team of scientists is publishing the most detailed view yet of the site of the country&…

Source: Radar Reveals Details Of Mountain Collapse After North Korea’s Most Recent Nuclear Test

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Breast Cancer in the midst of the CervicalCheck screening scandal. Chapter 8

May 1st 2018 and where has all the time gone?  I postponed my appointment to meet my psychiatrist because I had been remiss in getting my bloods tested for lithium.  I decided to make the appointment for these bloods on the same day as I was attending the hospital for my Herceptin.  Thankfully, at short notice, it was possible to make the appointment; I have to say phlebotomy works very well these days.  You make the appointment by phone or email.  It is confirmed so then there is a record if you fail to turn up.  It is shameful the number of people in the public sector who just don’t turn up for appointments – it was recorded in the media recently that some 488,000 (costing the HSE e21.5 million) http://www.cuh.hse.ie/…/Out-Patient-Non-Attendances-What-Can-We-Do-About-This-Majo… failed to attend medical appointments.  This would not happen in the private sector of medicine.

I am feeling exhausted these days; it may be that I am due my cytamin (B12) injection soon or it may be down to being a cancer patient on Herceptin and on a cocktail of psychiatric medications.  It is not yet of the severity of the ‘drop dead’ exhaustion I had with Chronic Fatigue but it is hard to keep motivated and engaged.  I feel so useless at times when I look around and see the clutter beginning to gather and know that I just do not have the energy to make changes.  I don’t even have the energy to ask someone to come and do the necessary painting and as for getting new carpets, here goes yet another year with the moth eaten carpets because I just could not face the upheaval.  Who knows maybe next year?

Next Year?  Who knows?  Everyday in the news, the documentaries, the radio, have people with cancer reeling in fear of the unknown; that breach of trust which is so  essential when you are diagnosed with cancer.  The National Screening Service http://www.screeningservice.ie/ is not about diagnosis; it about identifying pre-cancerous cells,  and this screening services is now rightfully in the Dock.  It took a brave mother of two children to come forward and rattle the cages of that monolith of bureaucracy called the HSE.  Vicky Phelan has personalised the horrors of a profession ensnared by bureaucratic chaos, to wrestle the attention of the people of Ireland to what can only be described as negligent practice of non communication between CervicalCheck, the gynaecologist, the general practitioner with Vicky Phelan and it now appears that this has happened in a number of cases.  It is at this time, as HPV vaccine is available for school going children, this woman takes her specific case of cervical cancer and shows us how secrecy or as some like to say paternalism resulted in her not being told she had cancer;  The Irish Examiner 27th April 2017 sums it up:-

In 2014, the 43 year old mother of two was diagnosed with terminal cancer but it was another three years before she was told the results of the three year old audit.  Ms Phelan took legal proceedings against both the HSE and the US laboratory, and settled in the High Court this week against Clinical Pathology Laboratories in Texas for e2.5 million.

Being almost 20 years older and with co-morbidities, I most assuredly would not have the energy to tackle what could in another jurisdiction most probably fall into a corporate manslaughter charge.  We owe people, like Vicky Phelan, Laura Brennan and others who speak out for the benefit of others, a true debt.  This is altruism at its very best; it is true compassion for our fellow human beings.  The article above goes on to state that “it is a known fact that screening saves lives and that it is essential not to jeopardise the service by failing to be transparent.”

I include this link because the power of the pharmaceutical companies is beyond the comprehension of most people and most definitely the HSE fail dismally in negotiating competitive prices for drugs when you consider that medication for schizophrenia can be Stg6 in North of Ireland and in the Republic cost nearly e60.  This link is about 20 minutes but it shows just how corrupt situations evolve in pharmaceutical industry and how they entice doctors in the US to prescribe a drug and reward them with in excess of US$300,000+ bonus.  http://www.cbsnews.com/news/the-problem-The problem with prescription drug priceswith-prescription-drug-prices/  Medications relating to cancer are very expensive.  We are told that there are in excess of 200 women facing a terminal cancer (as a result of the CervicalCheck scandal) and who will not have time on their side and who will need the medical profession and the HSE to negotiate the best deal possible to ensure they have the medications that will give them the best outcome with the least pain.

BreastCheck located my cancer but I must be honest CervicalCheck is one of those invasive tests that most of us shudder at the thought of.  In the UK when I lived there, a very diligent NHS woman doctor noticed that I did not want to have the test (I had a bad chest infection) and rather than let me make an appointment and then cancel it, her professional keen eye, persuaded me to wait and she carried out the smear.  It turned out to be faulty and having health insurance at that time, I had my first and last visit to Harley Street, London SW1.  No false outcomes were determined but then I just lapsed again into a form of denial and 30 years on, I have had one cervical smear and that is about 28 years ago.  I am within the screening age and as far as I am aware I never received a notification to go for a smear test.  This is not about blaming the service; it is about my recognition of the fear of this intrusion.  Ironically, despite nearly two weeks of media coverage and people like Professor Crown, the Irish Cancer Society, Kate O’Connell TD asking people not to be scared and to make the necessary appointments, despite the free telephone services and nurse-on-call, I am saying well if I have breast cancer why do I need a check-up for the cervix?  I am sure there are many more women like me.

The one message that penetrates and that we must take note of is that ‘Screening saves lives, but it is not infallible’.  This is the title of an article written by Dr Robert O’Connor in the Sunday Business Post on April 29th 2018.  Dr O’Connor is the head of Research at the Irish Cancer Society and of all articles that I have read, this is about clarity and sufficient  explanation  especially for people directly affected by this scandal. http://www.businesspost.ie/health-social/screening-saves-lives-not-infallible-415318

A prestigious Cochrane review published into studies of the test from around the world found that for every 1,000 women screened, around 20 will have pre-cancerous changes.  But the review concluded that the test would only identify 12 of the women, missing out on eight of them.

Generally there are two types of error in screening tests:

A False Positive:  Test finds something abnormal present when it actually isn’t.

A False Negative: Test doesn’t find anything out of the ordinary, when in fact there is.  This means that if there is cancer it can get worse and might require treatment.

The mistakes occur for a number of reasons: administrative, technical and due to human error, where the tester doesn’t pick positivity.

The article is worth reading but I will add this:-

When it comes to cervical screening in Ireland, it is important to note that the vast majority of tests are accurate and error free.  Screening saves lives by detecting cancers early, when treatment is most effective.  Each year 300 women are diagnosed with cervical cancer.

 

Back to St Vincent’s Private hospital and time for infusion of Herceptin.  I was so delighted to meet up with a friend of my Mum, we nearly did not recognise each other but we sat down and had a chat about old times and I have to say I really enjoyed it.  I miss meeting my Mum each week in the Westin hotel just near Trinity College Dublin, I find it so hard to believe that she passed away at Christmas.  There is a bond between mothers and daughters that runs deep; there may be disagreements and they may be fractious; they may hurt deep on both sides, there may be blame.  Like a lot of things in life, there are no explanations but at a deeper level, there is that special bond and especially as I have no children, it is natural that my connection will be with my mother and her family.  Maureen showed me photos of her grandchildren, 2 young boys and their sister, you could see how delighted she was with them.

Arrived in time for my 2 pm appointment.  I was early so I signed in and had a coffee.  Soon it was time for my weight check (only slightly down 78.6 kg); my pulse, followed by BP was taken and then it was time to go to my Chair for the afternoon.  All 64 chairs were occupied that morning; to be followed by more patients in the afternoon.  The nurses are constantly on the alert and tending to patients complex needs as each patient is receiving different infusions.  I met with Professor Crown (who recognises me because I have more one way conversation with him on Twitter than when I meet him).  I still have the dart of pain in my left eye, I am tired, I have an ache in my back and left breast but apart from these few ailments that I have written in my diary and passed on to the Nurse which she wrote in my file which was reviewed by Professor Crown, I am moving along day by day.  I had intended to ask Professor Crown about genetic testing but even though I had the advert from the newspaper with me, I forgot.  I am aware that close relatives of mine have died as a result of cancer and although I have no children; it may be of benefit for other family members to know.  Again, I found out from the newspapers and advert by the VHI.  According to the VHI ‘some cancers are passed down through family genes….The test involves a clinical review of your family medical history, followed by a blood test to identify gene mutations…search Vhi Genetic testing http://www.vhi.ie/Hereditary/Cancer-Tests‎  My next appointment is scheduled for May 20th 2018.

The MRI thankfully was clear.  The dart of pain could be something like a neuralgia or even sinus.  I am to make an appointment with an Ophthalmologist.  After all this the good news is that my hair is finally beginning to grow again so this means I am on the road to recovery.

10th May 2018:  Day by day more women are coming forward, women with families,  and they are facing terminal cancer because of some policy directive that nobody is willing to take responsibility for.  Swamped with information leading to confusion has resulted in much media coverage, social media, and newspaper opinions and articles.  As I am one of those on the inside track ie I have breast cancer and am keen for solutions, I have a selected the pieces I consider most relevant.

There is a key piece of advice by Muiris Houston, Irish Times Health and Lifestyle supplement, 7th May 2018, which all people but especially those in the medical profession; the HSE, and patients  should note and that is that “No news is not good news; it can be bad news and just not communicated.  http://www.irishtimes.com/…/when-it-comes-to-health-checks-no-news-is-not-good-n…  There is much emphasis in our lives today that when we don’t get feedback we take it as a given that all is okay but this is not so and we must be diligent and take responsibility, as a service user, because as we now know human error within the Professions, the Bureaucracy ie HSE and the Pathology testing companies (US also), is possible and may even be detrimental:-

The patient safety expert Carl Macrae has written extensively about patient safety.  Muiris Houston’s article states “in the handling of important test results – the absence of a confirmation message should be perceived as a sign that the communication system has broken down.”

Personal Comment:  There is a man who regularly stands outside the BreastCheck clinic St Vincent’s University hospital.  He speaks through a loudspeaker. His wife received invites to BreastCheck but she hid them out of fear and he found them after she died from cancer.  He is asking that BreastCheck go that one stage further and when they notice someone does not turn up for their appointment that they continue to make contact with the person called for screening and if at all possible with their spouse.

Muiris Houston further states that the patient safety office (and we should all be aware of its existence) of the Department of Health must “sink its teeth into this problem without delay”.  There is an urgent need to ensure that robust rules exist for the communication of test results, which must be implemented by the HSE.

The broad heading is the National Screening Service.  The unfolding crisis over the last two weeks concerns CervicalCheck (screening done every three years); but the question for me and others who have gone through the BreastCheck (screening every two years) is: do we need to make contact and request details of our earlier tests.? With the myriads of reporting on this crisis, these pertinent questions are lost in the prolific writing on the topic and the copious re-run of the same information.  Then we must ask about those people who were never called for CervicalCheck?  Where does the neglect lie here; with them ie me (fear) or with the doctor or with the service?  Now that I am diagnosed with breast cancer does it mean I have to go forward for a CervicalCheck?  Then add to this the people who are over 60 and await the receipt of the postal delivery that apparently automatically arrives after your 60th birthday; will they be required to seek comparisons to earlier checks?  Herein are a lot of questions?

Emma is the latest casualty of this awful situation, a mother of five children, with the youngest only two and half years old.  Emma appeared on the Late Late show last Friday and in shock she revealed the horrors of how it unfurled in her case that she had not been told the vital information; and now she faces terminal cancer, aged only 37.  More people will be identified.  Personally I do not believe that the media is the best place to live out a life of spectacle in the hope that other people will not be blighted with the same non-communication as happened in the case of Vicky Phelan; and now Emma.  Maybe I am naive but it takes me back to reading about mental hospitals in England where they used to put mentally ill patients out on view for the local community,  This was Bedlam and although in another century; the visibility through global media makes it equally horrific now that we have to witness the illness to be horrified into action. The duty now rests with the Scoping Inquiry to be headed up by public health expert Dr Gabriel Scally with a deadline to make its findings of June 2018.   There will be a follow-up commission of investigation.

Quotations: Everyday I read through them on the computer, sometimes choosing a name, other times it might an idea related to what is going at present.  Today, I decided on ‘Clarity’ mainly because my good friend Joe Murray BL always tackles the obiter dicta in such a way that you get right to the mens rea, just as a good barrister should do.  So Clarity is what is needed and I was delighted when I opened the pages of the Sunday Business Post and read from start to page 19, accessing more and more information about this scandal, that John Crown (Consultant Oncologist and a former member of Seanad Eireann) has written with clarity and precision.  Thankfully people have access to this article on the internet; the link is as follows:-  http//www.businesspost.ie/opinion/evidence-proves-cervical-screening-works-416442

My quote is about Clarity

“There is a poignancy in all things clear, In the stare of the deer, in the ring of a hammer in the morning. Seeing a bucket of perfectly lucid water We fall to imagining prodigious honesties.” (Prodigious “Very large, immense and wonderful”)

@ProfJohnCrown  First and foremost I start with Professor Crown’s twitter details.  For people who have cancer, lack of energy, fatigue often prevent you from activities which previously could be done without effort.  Twitter becomes a shortcut to access to information, communication and links.

We need Prodigious Truth.  We need facts.  We need honesty but honesty does not necessarily give the answers we want, especially where the diagnosis is cancer and the prognosis is often an unknown.  I highly recommend this article for people with cancer or in general because expertise comes at a high financial cost but this opinion is basically at no financial cost so its value is immense.

To start – the title answers so much in just a few brief sentences.  ‘Evidence proves the cervical screening works.  “No matter how good a screening programme, no matter how effective it is in reducing mortality in society, it will hurt some patients.”

Quotes are direct from Professor Crown’s article.

  • Medicine has developed variably successful strategies for dealing with the cancer problem.  Some cancers, such as childhood leukaemia, can be cured with drugs.  For others, prevention is best.  Lung cancer (usually, not always caused by smoking) and cervix cancer (HPV vaccination)……
  • For most cancers, the best chance depends on early diagnosis and treatment:
  • Screening is the ultimate early diagnosis strategy.   “Screening” refers to testing apparently healthy people who have no complaints, in an attempt to diagnose as yet occult (study of the supernatural) cancers or pre-cancerous conditions…..
  • Organised screening is nearly unique in healthcare.  The patient doesn’t seek medicine, medicine seeks the patient…..
  • The success of screening programme is measured by the reduction it produces in the burden of disease in society.  On a population basis, mammography (breast X-ray) screening is one of the most effective strategies available to society for reducing the death rate from breast cancer.  A screened population of over 50 year olds will have an approximately 20% reduction in the number of breast cancer deaths in comparison to a similar group without screening (I fall into this category, having been called for screening last year and cancer located)…..
  • The evidence that cervical screening works is overwhelming.  Routine screening by studying cells from the cervix, entered the medical culture in most western countries during the 1970’s… please refer to link for precise details http//www.businesspost.ie/opinion/evidence-proves-cervical-screening-works-416442
  • Patients may suffer other harms.  The “PSA” blood test is quite good at identifying prostate cancer in men, but it isn’t absolutely certain that treating these cancers with life changing surgery or radiotherapy prolongs survival, although many experts believe that it does.
  • Tragically, we still have approximately 100 cervix cancer death annually in Ireland (compared to approximately 700 from each of breast and lung cancer).
  • Hope:
  • Newer generation cervix screening technologies and widespread vaccination will hopefully reduce the number further.  We should aim for Zero.

I recommend you read the article for the conclusion. but I will include this:-

Professor Crown concludes with two questions that need to be answered promptly:

  1. Is our rate of false negative screens higher than in comparable countries?
  2. Is there a discrepancy in the “pick-up” rate between the different Irish and international labs that service CervicalCheck?

Therein is Clarity.  We now await Dr Gabriel Scally (President of the Epidemiology and Public Health section of the Royal Society of Medicine); who also engages with Twitter @GabrielScally and who has been appointed to lead the Scoping Inquiry on CervicalCheck http://www.imt.ie › News

Before I conclude I want to highlight one more reference by Professor John  Crown in The Times May 9th 2018:-

It is so important to engage with the Screening Process is the message:-

With breast cancer, Professor John Crown, the oncologist and former senator, says screening remains important, but we have underestimated the impact of drugs in reducing mortality, especially the worst type of cancers.

Modern medicine is a miracle.  Early diagnosis and better treatment saves lives but screening is not a silver bullet not is it cost-free.  The risk of turning healthy people into cancer patients is a price people should know they are paying when screening is offered.

Nobody wants to take any chances, and I’ll go for my smear and BreastCheck.  There are no guarantees, though, and not every subsequent death is a state-sponsored scandal.

There is a sting in the tail here but I will await the outcome of the Scoping Inquiry to make a judgment on this.

Back up to my local urban village Upper Baggot Street for the next stage of the treatment.  The MRI was clear so it was time to visit Vivienne Starr, Optician, who I know for over a decade now to organise an eye examination.  An appointment was arranged for the following Monday.  On Monday 15th I met with the Ophthalmologist who gave me a thorough eye check.  The eye check showed up no changes or any inconsistencies.  The ophthalmologist assured me there was no evidence of cancer in my eyes.  However she asked me to return for a ‘Field test’ and to organise same with Vivienne.  This is a test to identify glaucoma http://www.fightingblindness.ie/eye-conditions/glaucoma/

I made the appointment for Wednesday.  As I was walking I noticed the Well Woman http://www.wellwomancentre.ie/‎ sign next door to Meaghers Pharmacy.  The constant flow of media about CervicalCheck brought it to my attention that I had never been called for screening.  I decided I would  be brave and went up the stairs and spoke to members of the team.  I explained my situation.  They recommended that I contact the National Screening Service to see why I was not notified.  I asked them about a private appointment and they said it would be the following week at a cost of e120; but they did qualify this by saying they were awaiting Government intervention which could mean a lesser charge.  I returned home and phoned the National Screening Service.  With great efficiency they answered my question and then asked me their security code questions.  They had my name, my address, my age and they knew that I had never been called forward for screening.  It is hard to imagine that if you are called for BreastCheck screening how it is possible that you are not called up for the CervicalCheck?  Here we go again with bureaucracy and silos.  I have the ID number from the National Screening Service.  I am due back in Oncology for Herceptin on Tuesday so I will then ask if it is necessary for me to have a CervicalCheck.  I have had so much illness over the past two decades that I keep details in a WordPress list and I do know I have been treated on two occasions for bleeds.  You will find my details on this link https://canisgallicus.com/2018/04/12/1993-2018-traumatic-brain-injury-memory-deficits-bipolar-anxiety-ect-chronic-fatigue-to-diagnosis-2017-of-breast-cancer-a-journal-because-i-recall-little-of-all-this/

Chapter 8 is almost complete but it is time for a little of what is abstract about my life with traumatic brain injury and how I link to this article which I found by using the search key on Twitter and “Augment Memory”.  I am not a Facebook user because the intellect is insufficient to understand it.  I  can’t really explain what I don’t know.  However Twitter has been my lifeline for many years now.  Thomas Dixon is ahead of me http://www.fastcompany.com/3037432/this-man-uses-twitter-as-a-prosthetic-device-for-his-damaged-memory

When did I discover Twitter – I don’t know; it must be years ago now.  I just experimented and realised that I could use Twitter to engage with the world out there.  You may be horrified at the amount of time I spend on Twitter but you see there is purpose for me and therefore it is not an addiction.  19th May 2018:  I have sent a sum total of 404,000 tweets and I tell myself and @jack that if data becomes a commodity like oil at least I will know I will have compiled a lot of data based on the fact that I use Twitter for a completely different purpose than other people ie apart from Thomas Dixon.  I am following 2,879; and today have 2,343 followers.  Every day I tweet, 7 days a week, because then if I go out and meet people I have uploaded information in my brain that fails to recall yesterday; last year or beyond, so therefore I don’t feel so inhibited or even useless to society, I can contribute to general conversation.  Everyday I choose a quotation that I think is relevant and upload it to Twitter and retweet it where appropriate; I try to respond to mentions; and I follow what I do understand at a deeper level, where memory is not required.  Gossip is near impossible for me.  I talk politics with a keen interest in social justice and it is my deep belief that this is sourced from my childhood when my Father and cousin JJ who used to visit Ireland every weekend discussed medicine, law, politics, history and about life in general. This was the 1960’s.  JJ was legal adviser for Private Eye, News of the World, and other newspapers so his focus on a Sunday was to read all newspapers and he and my Dad, also an avid reader of newspapers, would spend hours in conversation and I would listen to them.

Twitter allows me to engage with the world news; add to this that each day, my partner KT buys three newspapers to keep me occupied for a few hours;; again tapping historic memory, mixing it with the day and often the outcome is a journal.  I sustained a traumatic brain injury when I fractured my skull in 1993 – it was a horse fall while going over a jump, and this was further complicated because I was living in Harare, Zimbabwe.  Thankfully, I have been fortunate enough to have had access to the use of a computer.  Prudential-Bache in London allowed me to take my computer when I left employment and it traveled by ship to Zimbabwe.  The computer meant I could write letters about Zimbabwe and life as an expatriate, which I still have .  When I returned home to Ireland, my mother bought me a computer and again I continued using it as a source neuro rehabilitation.  I have to admit unlike Thomas Dixon, I never adapted to the Smartphone.  I rely on my desktop computer.  Thomas Dixon and I share some similarities but also I have adapted my own techniques which differ from him.  This may be to do with different character traits and personality.  I am not interested in knowing the incidentals of yesterday, like who I met or didn’t meet.  I just live in the day, based on the experience and recommendation of a wise Jonathan Swift who said many centuries ago now and that is “Live each day of your life”.

To return to the article written by John Paul Titlow, Fast Company about Thomas Dixon:-

  • Twitter is his memory but he uses it to be able to remember what he did yesterday whereas there is no point in my case because I just don’t recall the content.  In my humble way, I think it is that my span of thought is too narrow and that I have problems with sequence but the positive is that I can use the tweets as a prompt to create new thoughts and connections based on historic pre-accident memory,  This may not make sense to others but it is how I engage with life.  This explains why I don’t use phones because in the early days they were hostile to my self esteem leaving me exposed to the fact that I could not remember content. 
  • Traumatic brain injury/acquired brain injury are referred to as the silent epidemic and as stated in the article written about Thomas Dixon ‘you wouldn’t guess from having a face-to-face conversation that his brain is damaged.  That’s because nothing about his speech or general intelligence was affected by the accident’.  To this I must add that no two head injuries are the same.
  • Like Thomas Dixon, I do not remember the accident.  In fact of yesterday’s, I remember virtually nothing.  If I read what I have written consistently over the years I am not familiar with the content. If I read a book I must highlight it because as I read I forget – I cannot memorise.  I think I share this with Thomas Dixon who describes his experience as ‘his episodic memory-specific, autobiographical details like where he was, who he met, what he ate and the like – has been compromised by the traumatic brain injury…’  He goes on to say “I’m always aware of what I am talking about and who I’m with in the moment, I just don’t know what happened yesterday or the day before. My declarative episodic memory is shot”.  http://www.human-memory.net/types_declarative.html  Thanks Google because you have just allowed me to access this link and details and therefore I know this applies to me too but ask me to use it as a defence when people want an argument; I am stifled.  Thankfully I am forever questioning and curious so I think this is how I have adapted to my groundhog day routine using the computer for email, Google  and Twitter.
  • Technology hasn’t provided all the answers for me.  I use a diary and a notebook.  One dimension focus removed my ability to multi-task.
  • Employment: Social security.  Why?  This is so well summed up by Thomas Dixon:-

“They’re putting me in this gray spot – I’m not getting hired because I can’t remember what happened yesterday”.

What an irony when the reality is that this person with TBI has super-charged their memory with tech, his natural inability to recall the episodic details of his experience could lead to trouble in any number of traditional work scenarios”. 

  • Yes Hop Skip and Jump is how I sum up my engagement with Twitter.  My crazy mind says that someone should be able to use the data and find trends that may provide answers.  So hence I have 404,000 tweets (while Thomas Dixon has 22,000).  I work in the virtual world of the now using Twitter to engage in the now.

KT said to me today what a year we have had; but for me I recall none of it.  All I know is that I am fatigued, my back aches and that my diary says next Tuesday I return back to the hospital for Herceptin treatment.  There is a reason that I have digressed to discuss my traumatic head injury, memory deficits, loss of sense of smell, deafness in one ear and that is that for people with cancer especially Vicky Phelan, Twitter is an effective way of communicating without depleting the limited energy that illness bestows on you.

16th May 2018:  It was time for the Field Test (Opticians) so I attended and Vivienne patiently carried out the test – it involved looking into a screen and using a buzzer each time a random light appears.  I await the outcome.  The following day it was time to return to see Professor Armstrong (Consultant Radiation Oncologist).  KT came with me.  I explained that I thought my breast was tender but I must admit that when he so thoroughly inspected my left breast, there was no pain or tenderness.  My next appointment is next year so this is progress.  By Monday 21st May 2018, it was time to receive a text message that said would I attend Oncology 3rd floor St Vincent’s Private at 9 am instead of 2 pm the following day.  This was fine for me and I arrived with my magazines and book ready for Herceptin treatment.  This time because there is a side effect related to Herceptin I had to start with a Heart Echo  which takes about 30 minutes and when the all clear is given; and when the bloods are taken then the treatment of Herceptin can go ahead.  Every three months I get a cytamin injection for Vitamin B12; I find it improves my ability with concentration and the spoken word.  The nurse gave me the injection.  The bloods taken by the hospital are a full blood count and the emphasis is on the liver and kidneys.  Being concerned about the cervical smear test I raised with the nurse who recommended that I ask Professor Crown about it.  I arrived with my list which goes like this:  it was on an article I had removed from a newspaper about Health Heroes Professor Rose Anne Kenny.  The TILDA study http://tilda.tcd.ie/ is her field of expertise and I am part of the study so I wanted to know if I should opt for the Genetic test.  Professor Crown patiently went through my family history and decided that my relatives who have had cancer are too far out and that for this genetic test you have to attend another consultant in Oncology.  This concluded: I asked about the cervical smear, explaining how I had never been checked (except on two occasions as detailed earlier).  He said at a later stage we could organise this but it was not a priority.  The rest was the usual:- fatigue, stiff thumb, stiff knees.  I told him I had my eyes checked and all was okay pending Field Test for Glaucoma.  It was nice to hear Professor Crown say to the nurse present that this is a most probable success story of BreastCheck screening and caught in time.

To finally conclude this chapter; I have exceeded the quota of between 3,000 and 5,000 words per chapter.  I am meeting a good friend Esther for a chat and I am passing Meagher’s Chemist on Upper Baggot Street and the Well Woman sign is there.  Contrary to Professor Crown’s advice I ended up having the cervical smear screening test done by the doctor, there was no need for an appointment and it was paid for by the National Screening Service (follow on my telephone call and the ID given by them).

Screening works and it is essential that the media hype does not inhibit people from having their check-ups.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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