What value a surprise can bring

Sometimes, surprise can really add value to relationships. I am going to be a little brief and cryptic, since that is the meaning of a surprise. However, if you are following my blog, stay here, or visit me after a couple of days, and I will reveal what the surprise is all about. As for now, I have set it in motion. And some folks are going to be ... what can I say ... really surprised.

Bye for now.

Fits and starts ... but things are moving ahead

Dear readers, 

You have all been following my blog so religiously, and I know that you all cannot be bothered to comment, but it's okay, since you have let me know,through the social media, through messages and also through calls that you are all keenly following my European adventure, so thanks.

Those who are new to this blog: this is an update to some of my previous entries pertaining to my struggle to understand and cope with a highly complex health service, the NHS. It has been over two and a half months since I joined here officially, and although I am now in better shape to manage the work that defines a middle-grade doctor, I am still miles away from attaining the competence required of me. Yes, I am slowly but surely getting there. In the past few weeks, I have been working hard to stay on the ward beyond the usual duty hours, finding opportunities to do procedures on children, and seeing patients who present to the ongoing assessment service on the ward. It has been a very humbling and educative fortnight. I have, to some extent, learned how to "clerk" new patients presenting to the assessment unit. Clerking, essentially, is the rigorous history-taking and examination of the child who arrives for relief. After clerking, I would be expected to present the child to a registrar or consultant and then see if my management plan and theirs coincides or not. To be honest, there is a lot of work to be done.  

Finding and cannulating veins on a sick child is really difficult work, and this is the main area where I seek to improve my skills. It's just that I don't find enough opportunities to do so. I am hoping that I will quickly learn to do these things soon. 

Attending deliveries on the delivery suite and in the operation theatre (in case of a Caeserean section) is the third area where I am seeking to improve myself. I have begun to go for deliveries, and I hope to attend a sufficient number of them so that I am able to manage the newborn at birth. 

This, then, is the progress on my work. I would really welcome some comments, some encouragement, and perhaps, some constructive criticism as well. Thank you for reading my entry. Do look out for the next one, which might be a few days away, or may be very soon.

Enjoyed a talented circus-cum-music performance on the weekend

If you are among those who follow me on the social media, then you might have already had a look at my post on FB where I have put up some pictures of the troupe that performed before the audience at the Blackpool Tower Circus - the program was called Klaxon by Akoracro. This unusually talented group of about a dozen performers backed by their admin and back-stage group has performed at many places across the UK, and perhaps all over the continent. 

Their performance marked the culmination of the SHOWZAM week at Blackpool, an entire week of performances of all kinds. I had booked a ticket to this performance over a month ago, online. I wasn't really sure what their performance might be all about, but the intrigue over their unusual name made me book the ticket anyway. 

The venue is the Blackpool Tower building which has, within it, many areas where one can attend performances or play games, etc. Of course, one can also visit the Blackpool Tower itself, as well as the Dungeons. It was my first time inside, and I was completely floored by the interiors. Everything was so well planned. To reach the circus arena, one had to first pass through several gaming arcades and past rest rooms, snack bars and so on. Eventually, I made my way to the first floor, where a fairly large crowd of circus enthusiasts had already gathered ahead of me. A photo kiosk was set up, and I posed in the way prescribed for them to create digital images of me against interesting back-drops. (The image that I bought for keepsake had me balancing myself on a rope stretched across the circus arena!)

The arena itself was large and very beautifully decorated. Aisles led down to the front rows, where most of the crowds had gravitated to. Children were there in large numbers, and their presence added the required colour to the whole experience. 

The show finally began at half past two. It was slow to begin with, but as the performers got into their routine, it picked up in intensity. The remarkable thing was that nearly all the performers were multi-talented. For example, one of them, the young man who often play-acted as a clown, or an idiot, was actually able to play musical instruments, perform acrobatics, and do the trapeze acts all with the same level of professional expertise. Most of the others did multiple things as we could see. The only female was similarly talented, although I did not see her playing any musical instruments.

The arena itself was so beautiful. The corner decorations were a delight to see. The technical arrangements were brilliant. Within minutes, the troupe artists could hoist a trapeze system, and within minutes, they could dismantle it. The players who performed on the trapeze were, apart from the couple I already talked about, a medley of others. The sweeper did a lot of balancing acts, danced within a steel ring that was the size of his height, jumped up and above other performers, and did many other entertaining things. The grand-master of them all, a coated man who showed his talent more than once with the viola you see in the centre of the arena in the picture alongside was almost always shouting commands and talking in what I think was a central European tongue. He was a delight to see.

The other performers were all entertaining. The trapeze artist who mostly stayed on the top of the swings was a strong guy who controlled the comings and goings of the others who chose to swing with him. 

The show lasted for just over an hour and twenty minutes. However, the entertainment was superb. They had us all in their thrall. The children among the audience were enjoying themselves immensely. Photography was not allowed during the show, but I did manage to squeeze in a few frames on the sly, and here they are, for your viewing. 

Before I go, thank you again for your visits to my blog. Do let me know about your own blogs through the comments section, and I will manage to get the time to visit you back. 

One more week down the line

I have now completed three months in the UK. The last week has been staid, but the work has always been challenging. The real pressure was during my taking of the Newborn Life Support (NLS) course on the 12th of the month. This is a full-day training-cum-assessment course that prepares the health worker to know how to resuscitate (= revive) a newborn baby after birth or soon thereafter (but within 1 month of birth) when they fail to breathe on their own. 

The course format was teach, teach, teach, then interact, interact, interact, and finally, sit for an assessment that included answering 50 multiple-choice questions in a paper, followed by practical demonstration of the skills learned by the candidate before one or more of the faculty members, who sat in as examiners to evaluate the candidate. The teach part consisted of didactic lectures where the faculty went through power-point presentations, teaching us the knowledge of how newborn resuscitation works. The interaction involved creation of scenarios where the faculty taught us how to do the resuscitation on different cases, followed by simulations, where the candidate learned how to do it hands-on. Finally, we had assessment, which we needed to pass in order to get a certificate of the NLS course. 

During the course, I met several doctors and nurses who were not only from our hospital (where the course was conducted), but from different parts of the region of NW England. Knowing them was the cherry on the pie. It was interesting to meet the faculty as well. One of our local consultants was the director of the entire course (Dr. Kate Goldberg). Our Advanced Neonatal Nurse Practitioner ANNP Liz Morrison was a faculty member too, as was another one of our Neonatal nurses. We had tea breaks, a lunch break and a lot of fun in between. All in all, it was a fantastically conducted course. I am happy to report that I cleared it. 

In other news, life for me goes on. My duty begins with my arrival in the handover at half past eight. It culminates in the evening handover, usually between half past four and five. However, I try and stay past this time to work and get more experience under my belt. Making friends is the pleasant side-effect of working here. I must mention that I miss the doctors who left for other posts at the end of January. In particular, I would miss the following names - 

a) Dr. Elisabeta Ene (Letty): She is a Romanian doctor training here since the past several years. A very nice person, Letty and I vibed well with each other. She has moved to a neonatology post at Burnley.
b) Dr. Ahsan Ul Haq: This very skilled Pakistan-origin doctor has been in the UK for over 12 years, and he has moved on to his new post in Burnley as well.
c) Dr. Michael Sharrat: He is a very knowledgeable and skilled second year Paediatric resident who taught me many things. 
d) Dr. Selma Mohammed: She is a very capable Sudanese doctor who has also moved on to her next post at Burnley - which makes her the third middle-grade doctor to move on to Burnley. 

Two other middle-grades continue to work here at Blackpool, viz. Dr. Yogesh Kuba (a fellow Indian), who is now a permanent staff member here, and Dr. Evelyn Chia (A Malaysian Chinese), who will move on after 6 months. 

From the foregoing, it is clear that we have a mixed-origin work force in our hospital. This makes working here a fun experience. 

That is about it for today. I hope you enjoyed reading this post. 

P.S. I believe in sharing my experience with health professionals who are interested in taking the same steps I have taken over the last five years. Hence, if you wish to have help in moving to the Saudi Arabian health service or the UK one, do not hesitate to write to me. 

An eventful Sunday

After the dreadful news of the unexpected passing away of my brother-in-law Mr. Kuldeep Singh in Mumbai, India, yesterday, I was wondering how I could pay homage to his soul sitting here in Blackpool while my wife grieved at the loss of her brother in Mumbai. It was providence that I received a phone call from a new acquaintance of mine, a Sikh Punjabi man by the name of Gurdip Singh, who offered to take me to Preston as he was going there by car with his family. He had already previously met me with his daughter whom he had brought to the hospital for a check-up. I jumped at this chance, since I already knew, thanks to his previous conversations, that he usually also went to the local Gurudwara in Preston.

The entire experience was very satisfying. The Sikh community in the UK is fairly large, and today being a Sunday, there was a big congregation at the Guru Nanak Gurudwara in Turnbridge Street at Preston. The flag (nishan saheb) was the beckoner to the main door. Inside, you were expected to remove your footwear and wash your hands before ascending to the first floor where the Gurudwara is located. On the ground floor, they have the kitchen, where devotees or anyone else who wants to, can come to eat food - breakfast in the mornings, then lunch, then tea and then dinner ... depending on their time of arrival. The free food (known as "parshaad" or blessings from Wahe Guru - God) is known in their lingo as the "langar". I found the dining area very clean, and, unlike the langar in the various Gurudwaras in India, the place here had many tables and chairs, where people could even sit up and eat food.    

I arranged for an Ardas prayer for the soul of Kuldeep singh, and stayed at the Gurudwara until this was finally done. In the end, we had lunch at the langar. It was delicious and consisted of Chhole, Chapati, Sweet rice and Bundi raaita.  

The family with whom I was travelling also made two stops, one at a Gujarati-Indian run shop for sweets and Farsan, and one at a Kashmiri shop which stocks and sells Indian food. At the former, I picked up several items like khandvi, dhokla, salted shankarpara, as well as some other stuff. At the latter, I picked up stuff that is normally not available in Blackpool. In the end, when we returned to Blackpool, I had three bags full of provisions and food! Gurdip, his wife Amandeep and their 5-year daughter Harleen, were excellent company and very accommodative towards me.

Earlier in the morning, we also paid a visit to the local Hindu temple, where my hosts wished to do darshan of Goddess Saraswati. The temple is quite big, and their complex also has a large hall where they have Navratri festivals, wedding receptions and the like. I will try and put up photos of my entire trip in a day's time, once I have uploaded the pictures from my cell phone on to my laptop.

Thank you for reading this entry. Do leave your comments in the section below the entry for some interaction. Cheers!

For those aspiring to work in the UK

This is a special post for Paediatricians and those interested in Paediatrics as professionals and wishing to know more about working in this country. Before I begin, let me declare that I am not an expert on advice regarding this, and I am basing whatever I am writing here on my own experience, so please cross-check whatever I advice you on.

First of all, this is not the best place to work if you are looking to make money. This is a fact, and I want to tell you that if the government of the UK, their Department of Health, and the NHS have their own way, salaries might go further south in a year's time, as they are planning to impose a new, less generous salary structure for junior doctors (this includes house officers and registrars in training posts). I have left a far more lucrative job in Saudi Arabia to work in the UK because money was secondary to my first desire, and that was to work in a world-class healthcare service and professionally advance. 

Doctors who wish to work in the UK may either choose to come here first on the strength of their performances in the PLAB exams, or qualify with a Membership of the Royal College of Paediatrics and Child Health (the M.R.C.P.C.H.) and apply for registration with the General Medical Council (the G.M.C.). No one can work as a doctor unless they are so registered. The final step in G.M.C. registration requires the aspiring doctor to visit their offices in Manchester for an identity check, but you can delay this by upto a few months and do this once you have the job and travel visa to come here to work. The category of application is VERY important. You should choose to go for the "Full Registration with a Licence to Practice" and use the M.R.C.P.C.H. certificate as an "Acceptable Post-graduate Qualification". Many paediatricians from India (including yours truly) get stuck because they think the route applicable to them is applying as a "Specialist Paediatrician" using the CSER route, which requires things that doctors from India have never been exposed to such as audits, research, and what not. Re-read this paragraph again if you wish, but please select the right alternative on the GMC site for your registration. You can accept a job offer before you complete your identity check, but you cannot begin to work until the ID check is complete and you get the information that your licence is approved. The actual certificate may take a fortnight or more before it reaches you, but your name appears on the GMC register, and you can take out a print of this to show to your new employers. 

So, the big question is: how to get a job? There are several routes to working in the UK. The easiest one is the one I took. I set up my profile on some job sites, this site being the most important one. There are hundreds of advertised jobs for doctors on this site, and you need to complete a few things such as posting your CV, posting your picture, posting your "Application Letter" and so on, but once you have done all this, the applications are automatically made by the site's servers with just one click on the "Apply for this job" that appears at the bottom of each offer.

Jobs are also advertised on the NHS jobs site, and you may want to try that as well.

The second route is to opt for a Fellowship of 2 years (the so-called Medical Training Initiative route). This is done via a separate pathway that you can study more about on the UK Visa site and THIS site...

The final route is where you come to the UK pretty early in your life on a student visa and complete your medical studies here. In which case, you need not read all the things I have written above, since, in a space of the next six years, you would probably have become a British citizen, and won't need a visa to work here. 

Last, but not the least, those who wish to work here must remember that a big chunk of their salary will go to taxes, and more will be collected as pension. The pension amount will come back to you in your old age, but this is compulsary, unlike in India, where one can re-invest pensionable money into tax-saving instruments. 

I hope this entry is of some help to people like you - young doctors or paediatricians who dream of working with the NHS in the UK. One thing, though, is clear. They need doctors here, and very badly as well. 

Change of blog name due to change of perception

After nearly two and a half months in this new country that has become my working nation, I am humbled in more ways than one. I thought I would be "flying high" in spite of being overworked and tired. Well, to be honest, I AM enjoying myself in my new role. However, I am firmly grounded in Blackpool, and certainly not flying high. Here are some reasons:

Firstly, some issues with my contractual arrangements with the administration of the Victoria Hospital at Blackpool have led to them appointing me as a day-time doctor with no emergency duties. This has freed me up from night and emergency duties, enabling me to be free on Saturdays and Sundays. However, this has also meant that I get paid only my standard salary, with no extra payment for doing calls and emergencies. This is a situation that has caused me some grief as well as some happiness. Let me explain how. The grief is naturally because it means that I will be saving less money for  the needs of my family, for my old age and to pursue my hobbies. The happiness lies in enabling me to be free to do things that others who have emergency duties etc. cannot because they are stretched to their limit. Also, when I first arrived here, I did not know how steep my learning curve would be in the NHS. Sadly, I realised this after some weeks. Although I have enough experience to manage routine stuff, my practice in India or in Saudi Arabia had not prepared me for the immense complexity of doing structured medical practice as it is done in the UK under the auspices of the NHS. Shared care between district hospitals and central hospitals is so deeply entrenched and so systematic here, that one feels overwhelmed. Also, the superior care that children receive here means that survival rates of children with chronic, complex disorders is very high, and understanding their management is really difficult. 

Sometimes, files of such children can be as thick as eight to ten inches! Going through such files has enabled me to understand how the system works ... and believe me, it does. That, alone, has been more educative than all the medical text books that I have read in the past three decades. 

In the balance, therefore, the experience has been very, very satisfying, and I have only now begun to enjoy doing what I am doing. 

The second reason has to do with the availability of so many new things around me. I have been shopping here and there, mostly online, and the range of stuff available here has been astonishing. Every business, whether it is a grocery store, a barber, an electronics outlet, or a restaurant, has a website with a lot of interactive capabilities. They will all have a twitter account, a facebook page, an online store, and so on. It is not merely a web-presence that they are seeking, but a full experience for the prospective customer. This, in itself, is so remarkable, because it does become difficult to resist buying something or the other on each of these sites. I have sometimes ended up adding stuff in my cart that I do not need, and it has taken me some resolve to cancel my purchase and exit. On some occasions, though, I have been unable to resist, and the end result is the growing inventory of things in my house, both in my clothes cupboard and in the kitchen, apart from electronic gadgets, utility items, books, and what not. 

In the balance, I am really enjoying myself, but I do need to balance my life with saving more money and spending less. 

And now, the final reason: finding friends and colleagues from so many different nationalities and walks of life. But more on this in my next entry. 

Do respond in the comments section with what you think of this entry. Thank you. If you are unable to comment, do write to me through the shared link on twitter or facebook, or email me on drtaher@gmail.com