tag:blogger.com,1999:blog-48305694930999154342024-03-05T05:07:08.364-08:00Contemplating EastAn Englishman abroadAnonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-4830569493099915434.post-37306729853327231622014-03-04T00:47:00.000-08:002014-03-04T00:54:29.758-08:00Karnevalzeit - Time for Carneval!<div dir="ltr" style="text-align: left;" trbidi="on">
Finally getting round to a new post! It's been a busy few months. From November to February I have been working on 'die Notaufnahme', the emergency department for internal medicine - a busy, challenging and learning-rich experience. My last shift was particularly memorable, with the first festivities of Karneval beginning that day. Imagine a drunken warzone with clowns. Shortly after being greeted by a nurse in an orange wig, I began to take a history from a Sumo wrestler. A further 15 minutes was then spent trying to persuade an argumentative Cowboy to give a urine sample for toxicological screening. Highlight of the shift however was when a patient asked me to pray with her. She'd overheard me talking the night before to another patient that I knew from my church. She said that she also trusted in Jesus but was scared about what lay ahead. It was an immensely moving experience and dare I say it provided more peace and reassurance to the patient that the senior ward round that morning.<br />
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I'm now preparing to head back to the UK. From April I will be working in internal medicine again in lovely Preston. However, before I head back to the UK, there's just about time for a trip with my friend Dilu to Mainz for Karneval (see photos). 40 days to Easter!<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-85828615192657547282013-10-06T06:14:00.001-07:002013-10-06T06:36:26.128-07:00Erntedankfest - Harvest festival<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">So, autumn is well and truly here. The leaves are falling, the weather is cool and the sun is rising later than my alarm clock. This Sunday is 'Erntedankfest' (harvest festival) here in Germany. Today in church we thought about the many thinks that God gives to us (food, materials, abilities, chances to serve) and thanked him for these! As part of this many people brought things grown in their gardens to share with each other in the church. A couple at my homegroup brought me a 5L box of freshly pressed apple juice pressed by their family here in the Saarland - it tastes really good! After hte service cake was also bountiful in it's abundance (gotta love the Omas). For lunch I cooked Sp<span lang="DE" style="line-height: 115%;">ätlzle (a German noodle dish) for the first time - my Chinese friend Dilu said it was 'lecker', so I guess it worked out! My flatmate's chilli plants are also now ripening, however after my last tongue searing taste I've decided to go for milder spices! I also found out today that we have grapes growing in our garden. The landlord knocked on our door saying we're welcome help ourselves. Photos of all these things are included beneath.</span></span></span> </div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">I'm feeling a little more at home with the day to functioning of the hospital now, however realise there is still a lot for me to learn. I also need to improve my written German to get my patient discharge letters up to scratch. From the 1st November I'll be working on the 'Notaufnahme' (Accident and Emergency), so the learning process will continue! </span></span></div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Over the past week I've been reading the letter to the <a href="http://www.biblegateway.com/passage/?search=Ephesians%201-6&version=ESVUK">Ephesians</a> from the Bible. Whilst there are many material things we can be thankful for, our real thanks to God should be for his rescue plan for the world. Through Jesus we can be made right with God and brought into a fantastic relationship with him. Fantastic news! Beneath are two parts of particular encouragement read this week:</span></span></div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span class="text Eph-1-3" style="font-size: small;">Blessed be the God and Father of our Lord Jesus Christ, who has blessed us in Christ with every spiritual blessing in the heavenly places,</span><span style="font-size: small;"> <span class="text Eph-1-4" id="en-ESVUK-29194">even as he chose us in him before the foundation of the world, that we should be holy and blameless before him. In love</span><span class="text Eph-1-5" id="en-ESVUK-29195"> he predestined us for adoption as sons through Jesus Christ, according to the purpose of his will,</span> <span class="text Eph-1-6" id="en-ESVUK-29196">to the praise of his glorious grace, with which he has blessed us in the Beloved.</span></span></span></div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><b><span class="text Eph-1-6" id="en-ESVUK-29196">Ephesians 3:14-19</span></b></span></span></div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span class="text Eph-3-14" style="font-size: small;">For this reason I bow my knees before the Father,</span><span style="font-size: small;"> <span class="text Eph-3-15" id="en-ESVUK-29250">from whom every family in heaven and on earth is named,</span> <span class="text Eph-3-16" id="en-ESVUK-29251">that according to the riches of his glory he may grant you to be strengthened with power through his Spirit in your inner being,</span> <span class="text Eph-3-17" id="en-ESVUK-29252">so that Christ may dwell in your hearts through faith—that you, being rooted and grounded in love,</span> <span class="text Eph-3-18" id="en-ESVUK-29253">may have strength to comprehend with all the saints what is the breadth and length and height and depth,</span> <span class="text Eph-3-19" id="en-ESVUK-29254">and to know the love of Christ that surpasses knowledge, that you may be filled with all the fullness of God.</span></span></span></div>
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<span style="font-family: "Trebuchet MS",sans-serif;"><span class="text Eph-3-19" id="en-ESVUK-29254" style="font-size: small;">As usual, all comments, thoughts and questions are welcome!</span></span></div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com1tag:blogger.com,1999:blog-4830569493099915434.post-70566105030464228362013-10-03T04:19:00.001-07:002013-10-03T04:31:31.858-07:00Sverige - Sweden!<div dir="ltr" style="text-align: left;" trbidi="on">
Last weekend I had the great pleasure of teaching and preaching at the Swedish Christian Medical Student conference. I was made to feel really welcome and greatly encouraged by my time with the students and doctors there. Together we looked at the Bible verses Matthew 6:31-33 and Colossians 2:6-7, considering the treasure found in knowing, trusting and growing in Jesus. We thought about what it means to 'walk in Christ' as a medical student and as a doctor, as well as what this might look like when working abroad. There was also time for food, walks, (extreme)games, relaxing and praising God. The concept of 'Fika' (swedish cake, coffee and conversation) was also introduced to me. Liz was also able to come with me, another blessing :-) Sweden is a really great place!<br />
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<b>Matthew 6:31-33</b></div>
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<i><span class="text Matt-6-31" id="en-ESVUK-23314"><span class="woj">Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’</span></span> <span class="text Matt-6-32" id="en-ESVUK-23315"><span class="woj">For the Gentiles seek after all these things, and your heavenly Father knows that you need them all.</span></span> <span class="text Matt-6-33" id="en-ESVUK-23316"><span class="woj">But seek first the kingdom of God and his righteousness, and all these things will be added to you.</span></span></i></div>
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<b>Colossians 2:6-7</b></div>
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<i><span class="text Col-2-6">Therefore, as you received Christ Jesus the Lord, so walk in him, </span><span class="text Col-2-7" id="en-ESVUK-29485">rooted and built up in him and established in the faith, just as you were taught, abounding in thanksgiving.</span></i></div>
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<span class="text Col-2-7" id="en-ESVUK-29485">In other news, I finally managed to enable comments on my blog without needing to register with Blogger. Hence, your thoughts are greatly welcome!</span></div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-39780340101424617922013-09-23T10:37:00.001-07:002013-09-23T10:37:13.425-07:00Three weeks into German life!<div dir="ltr" style="text-align: left;" trbidi="on">
Three weeks into German life!<br />
<br />
Time is a bit short this week. So, I've put together a brief photo selection from the last few weeks. Your thoughts and comments very much welcome!<br />
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1. The journey here - on an A380! <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrOkdKBG3b7zFfBMYDG5tmZeLlFMuiOTKuNXaVhVG5-uzLTNJZvxHQbVsSOjqHtslFR0q0inesYFI9VSBRqiBQerUPsF75gWL9d-K42uhgPISg3ZDQ4zfZ05AEtj3ToLqOPyCfrLc0nxRJ/s1600/IMG_20130830_061636.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrOkdKBG3b7zFfBMYDG5tmZeLlFMuiOTKuNXaVhVG5-uzLTNJZvxHQbVsSOjqHtslFR0q0inesYFI9VSBRqiBQerUPsF75gWL9d-K42uhgPISg3ZDQ4zfZ05AEtj3ToLqOPyCfrLc0nxRJ/s320/IMG_20130830_061636.jpg" width="320" /></a></div>
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2. Starting work; the walk to work, the nephrology department, my new uniform and the view from the ward!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA5u07jmw-2HUKEJSVh-ZcEM88dA5ubEyJcmE4uCHq8d6QZmgJGgLVhiAzIMVXki3tbe6ZoW4yrtPQPE3jv8dfghwy3kioj3kH-YLXwuGq9ZS9Rvr4qIeDmNzy6TjlCqc2X1AwFLtm6Niu/s1600/IMG_20130813_113258%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA5u07jmw-2HUKEJSVh-ZcEM88dA5ubEyJcmE4uCHq8d6QZmgJGgLVhiAzIMVXki3tbe6ZoW4yrtPQPE3jv8dfghwy3kioj3kH-YLXwuGq9ZS9Rvr4qIeDmNzy6TjlCqc2X1AwFLtm6Niu/s320/IMG_20130813_113258%5B1%5D.jpg" width="240" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwHz940X77nok1PDo27SSaLrqzbczizOHnMA2j6k3ebqkbkcRY1oVyb4I2BuMtFNJXe0NIqF02RbC3J_ol-bDnm8DXNyJPrJ4O72fX5whWpncRZrajEpvrWGrnpBvzAk-r3CSC5s_CePeO/s1600/IMG_20130917_193337.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwHz940X77nok1PDo27SSaLrqzbczizOHnMA2j6k3ebqkbkcRY1oVyb4I2BuMtFNJXe0NIqF02RbC3J_ol-bDnm8DXNyJPrJ4O72fX5whWpncRZrajEpvrWGrnpBvzAk-r3CSC5s_CePeO/s320/IMG_20130917_193337.jpg" width="240" /></a></div>
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3. Settling in at home: the gnome garden, Ikea furniture, my flatmates, a welcome gift from England and a reminder that God is a covenant keeper<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRzVs8RdAlAeREGi3i_nZDfBvA12UQEW-cXLDvh-X7Kx3nYv6zCf61deZbetCXKu6FC8sFIgiX4wKG08lEvmtNE2k37is9ijRBb0uc_grFOlYabu_05kKyb1iYNNkl6_tX-zH-GKNAf6Z5/s1600/IMG_20130907_132940.jpg" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRzVs8RdAlAeREGi3i_nZDfBvA12UQEW-cXLDvh-X7Kx3nYv6zCf61deZbetCXKu6FC8sFIgiX4wKG08lEvmtNE2k37is9ijRBb0uc_grFOlYabu_05kKyb1iYNNkl6_tX-zH-GKNAf6Z5/s1600/IMG_20130907_132940.jpg" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_m8rupunkvy6VquT5fJLyqNt9jtV208NvPPqidPz9Ssl0rqwNCNOutVRquRdnL82PF_qFrvAaDrsNxLzgSlZHezLJZvlrjibHSQNdO6ZZ_yUWL5jxXpxXaSWwE8-QqXNGOIWMjYLP5ph/s1600/IMG_20130814_184254%5B1%5D.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_m8rupunkvy6VquT5fJLyqNt9jtV208NvPPqidPz9Ssl0rqwNCNOutVRquRdnL82PF_qFrvAaDrsNxLzgSlZHezLJZvlrjibHSQNdO6ZZ_yUWL5jxXpxXaSWwE8-QqXNGOIWMjYLP5ph/s320/IMG_20130814_184254%5B1%5D.jpg" width="240" /></a></div>
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4. Going shopping: The state 'car boot sale' with Dilu, getting ready for Oktoberfest, the British section at the supermarket, Tyrrell's crisps(!) and gummi bear beer!<br />
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5. The election campaign.<br />
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And of course the Queen of Germany is set to rule for at least another four years.<br />
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<img alt="http://traitdunion-online.eu/tiedemann3lea3s/files/2012/01/merkel-bier.jpg" class="decoded" src="http://traitdunion-online.eu/tiedemann3lea3s/files/2012/01/merkel-bier.jpg" /></div>
Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-66620334162719310502013-09-10T12:19:00.000-07:002013-09-10T12:42:00.619-07:00Two weeks in...<div dir="ltr" style="text-align: left;" trbidi="on">
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So here we are two weeks in. It's been a somewhat intense german roller coaster ride with a mixture of challenges, blessings and encouragements. I'm feeling a little more settled now and have been made to feel very welcome. My flatmates have helped me with many questions and are correcting my German. They've also been a huge support in sorting out administrative aspects of living and working here, as well as proving a relaxed social atmosphere within the apartment - perfect at the end of a busy workday! I feel I'm now getting to grips with the 'hospital system' meaning work is becoming more manageable. My colleagues on the ward have been very patient and supportive. The work is very interesting and I'm learning huge amounts. I feel exhausted by the end of most days however! To make up for this there is a fantastic view of the town from our doctor's office on the 11th floor. Each evening I return home with a list of things to read up on - results are somewhat limited by energy levels.... Best moments have been chatting with the patients and my colleagues. Scariest moments so far have been presenting patients at the lunchtime department meeting and giving the telephone handover of all the patients in the evening to the on-call team. This may be superseded by being presented at the medical directorate meeting tomorrow morning...<br />
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Church here has been welcoming. It's great to see a mixture of familiar and new faces. I do still miss my Preston church family at All Saints however. The preaching is also thematic rather than passage based, another thing I miss. Still, I am very grateful for their support and weekly encouragements. I'm trying hard to encourage all I see there in Christ. To this end, I've been the last to leave each week! From next Sunday I'm part of the translation team and so will be proving simultaneous translation of the service and preaching into English via headsets. I should also be joining a homegroup for Bible study and mid-week fellowship in the near future. Excitingly a friend of mine here has put his trust in Jesus and was recently baptised. We met up over the weekend and have now started to read the Bible together. The plan is to start with a mixture of Mark's gospel and the Psalms. This is very encouraging indeed! I also now have a bike, making getting around and such activities a lot easier.</div>
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So, what do the next few weeks hold? At the end of the month I'm heading to the Swedish student Christian medical fellowship retreat. Here I'll be giving two talks on being a Christian at medical school and then preach from Colossians chapter 2 on the Sunday morning. I booked my flights last night and have managed to book the Friday and Monday off work. Liz, my girlfriend, is also able to come. Needless to say I'm looking forward to this weekend quite a bit! The other big event is that of medical research. The university hospital here is heavily involved in research and the vast majority of students and doctors take part in this. I've been an informal member of my Oberarzt's (registrar/consultant) research team for a few months now. We've chatted briefly about me completing a research MD as part of the nephrology team. Plan is to discuss the practicalities further after my first month's work. </div>
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Today was capped with a rainbow at the end of work - a reminder of God's promises and his provision. Regardless of yesterday, today or tomorrow's worries, he is the same and his plan for the world does not change!</div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-2386681196957991592013-08-12T14:46:00.001-07:002013-08-12T14:52:47.757-07:00Arriving in Germany<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: large;">Contemplating East --> <i>Moving East...</i></span></div>
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Perhaps fittingly, my 26th Birthday has been first day living in Germany. I've now been granted my license to practice medicine here and am underway with the remaining paperwork formalities. Work will start on the 2nd September (God willing)! More updates to come soon. In the meanwhile, I thought I'd share a view of the market square here in Homburg-Saar with you.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG6qwHRmX5Cz9FwyKoIvmBhSm0W4L1FOHIxk8DpWN6A-AszTnly4U00_7hP0auiHuxNBPwgPi9yeljQjaChdcLKjXRXPuq2DMSnlwEeFM70zDddu7rKGnow1FzATcfJKKs3W-tpBbj-Xij/s1600/PANO_20130812_164900%5B1%5D.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="99" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG6qwHRmX5Cz9FwyKoIvmBhSm0W4L1FOHIxk8DpWN6A-AszTnly4U00_7hP0auiHuxNBPwgPi9yeljQjaChdcLKjXRXPuq2DMSnlwEeFM70zDddu7rKGnow1FzATcfJKKs3W-tpBbj-Xij/s640/PANO_20130812_164900%5B1%5D.jpg" width="640" /></a></div>
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(apparently today was the first rain for two months - made me feel at home!)<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-76896310216797842322013-05-04T12:11:00.002-07:002013-05-04T12:19:29.042-07:00COPD in Russia / ХОБЛ в России<div dir="ltr" style="text-align: left;" trbidi="on">
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“The draconian nature of Russian law is softened by the non-obligatory
nature of its implementation”</div>
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<i>An anonymous Russian saying</i></div>
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This week my blog post will consider the impact of chronic lung
disease within Russia, focussing in on the role of smoking related
disease, which amongst us medics is called COPD (chronic onstructive pulmonary disease). Please see the previous post if you would like an introduction to COPD.</div>
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<span style="mso-spacerun: yes;"></span>As is often the case, Russia
has a unique situation, with its history, demographics and healthcare system
all playing their part.<span style="mso-spacerun: yes;"> </span>Intriguingly the situation of COPD in Russia has been a difficult topic to
research.<span style="mso-spacerun: yes;"> </span>Few studies seem to have been
completed to define its incidence or prevalence.<span style="mso-spacerun: yes;"> </span>With around 44 million smokers and rising,
Russia has the highest smoking total and proportional prevalence in Europe. <span style="mso-spacerun: yes;"> </span>Around 400,000 Russians are thought to die
from smoking related diseases each year.<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>There are also significant
barriers to primary care access and very limited screening.<span style="mso-spacerun: yes;"> </span>Together this suggests significant
under-diagnosis of COPD.
</div>
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A primary health study conducted by Chuchalin et al within the Ryazan
region of Russia (Рязань; population 1,306,600), ran from October 2004 to March
2005 (1).<span style="mso-spacerun: yes;"> </span>Two districts were chosen,
within which 16 primary health centres were chosen at random for
recruitment.<span style="mso-spacerun: yes;"> </span>Subjects received lung
function tests and assessment for risk factors of chronic respiratory disease
in the form of a household survey.<span style="mso-spacerun: yes;"> </span>Results
showed that whilst men are at greater risk: 60% of men smoke; 40% of men have
occupational ‘dust’ exposure; prevalence of breathlessness, cardiovascular
disease and chronic respiratory disease is two times higher in women than
men.<span style="mso-spacerun: yes;"> </span>Despite this 14% of men reported
regular sputum production (4% women), suggesting some form of respiratory disease.<span style="mso-spacerun: yes;"> </span>Low lung function was noted in 14% of the
sample.<span style="mso-spacerun: yes;"> </span>Overall COPD prevalence was said
to be 1.6%, comparable with Russia as a whole.<span style="mso-spacerun: yes;">
</span>It was noted that asthma treatment was also significantly underused,
complicating the picture somewhat (the main drug of choice is theophylline –
easily becomes toxic, many side effects, variable compliance).</div>
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What sense be made of this picture?<span style="mso-spacerun: yes;">
</span>An extremely high level of smoking and occupational chemical exposures
(especially amongst men), yet low rates of COPD.<span style="mso-spacerun: yes;"> </span>I feel this study highlights some interesting
and pertinent points within the peculiar ‘Russian paradox’</div>
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<b style="mso-bidi-font-weight: normal;">A society in smoking transition</b></div>
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Russia has been a society in transition.<span style="mso-spacerun: yes;"> </span>As the soviet-era drew to a close, supplies
of many goods became scarce.<span style="mso-spacerun: yes;"> </span>Cigarettes
were no exception.<span style="mso-spacerun: yes;"> </span>This led to tobacco
rationing, triggering the so called ‘tobacco riots’ where angry smokers caused
chaos on the streets of Moscow and St Petersburg (2).<span style="mso-spacerun: yes;"> </span>The Russian government responded by relaxing
import laws, allowing multinational tobacco corporations to enter the Russian
market. <span style="mso-spacerun: yes;"> </span>With a population of 143 million
citizens, few sales controls, low product taxation, a country previously naïve
to marketing and eagerly desiring the western lifestyle, Russia was greatly
attractive (3). <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Today a pack of filtered cigarettes can cost
less than $1 (£0.65).<span style="mso-spacerun: yes;"> </span>As a result of the
above Russia has become the third largest market for tobacco in the world.<span style="mso-spacerun: yes;"> </span>All four major global tobacco firms now have
high stakes in the Russian market, competing hard against one another in their
sales drives. <span style="mso-spacerun: yes;"> </span>The tobacco lobby is a formidable
force affecting politics.<span style="mso-spacerun: yes;"> </span>With the health
impacts of smoking typically occurring in mid to late life, the long-term
impacts of the smoking boom are only now being fully realised.<span style="mso-spacerun: yes;"> </span>With smoking prevalence so high, COPD is an
ever increasing burden.<span style="mso-spacerun: yes;"> </span>Until recently
little public awareness of the connection between smoking and chronic lung
disease existed.<span style="mso-spacerun: yes;"> </span>Hence smoking prevention
is a relatively new concept!<span style="mso-spacerun: yes;"> </span></div>
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<b style="mso-bidi-font-weight: normal;">Sociodemographic changes</b></div>
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Russia is said to be experiencing a demographic crisis.<span style="mso-spacerun: yes;"> </span>Deaths significantly outnumber births,
meaning a comparatively higher number of the elderly.<span style="mso-spacerun: yes;"> </span>Besides sub-Saharan Africa, the nations of
the former Soviet Union (FSU) are the only world region to be experiencing a
decline in life-expectancy.<span style="mso-spacerun: yes;"> </span>Key to this
is a huge gender disparity.<span style="mso-spacerun: yes;"> </span>Men die
increasingly young.<span style="mso-spacerun: yes;"> </span>As COPD likelihood
and severity increase with number of years smoked, many may never reach the
point of significant impairment.<span style="mso-spacerun: yes;"> </span>Men are
also less likely to attend healthcare facilities (some truths are
international!), and as such as less likely to receive a formal diagnosis for
their breathing problems. </div>
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<b style="mso-bidi-font-weight: normal;">Healthcare provision</b></div>
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A multinational survey from the international COPD coalition noted
several shortcomings in Russian COPD awareness and care provision (4).<span style="mso-spacerun: yes;"> </span>It was found that patients viewed their
symptoms as age/smoking related, rather than due to an underlying lung
condition.<span style="mso-spacerun: yes;"> </span>As a result, patients
generally presented at advanced disease stages and chose to attend their GP
rather than a respiratory physician.<span style="mso-spacerun: yes;">
</span>Questions have also been raised regarding limited and outdated education
of COPD treatment amongst primary care physicians.<span style="mso-spacerun: yes;"> </span>Of those patients diagnosed with COPD,
further barriers to effective care exist.<span style="mso-spacerun: yes;">
</span>Whilst oxygen, inhalers and antibiotic therapy are available within
Russia, provision varies depending on states and distance from large treatment
centres. <span style="mso-spacerun: yes;"> </span>Furthermore, treatment costs
are not fully covered by the government or private insurance schemes.<span style="mso-spacerun: yes;"> </span>As COPD is inversely associated with socio-economic
status, many people simply cannot afford regular or optimal treatment.<span style="mso-spacerun: yes;"> </span>Around 90% of formally diagnosed COPD
patients within Russia are not receiving treatment recommended by national or
international guidelines (5).</div>
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However it’s
not all doom and gloom - changes are happening…</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxKiYatIKLAlnQ7lPmTqTthfh9yJlbbp-5ud3mgdNcy1YhTUr6PPf9_Dk2PUyQQ3ZA3-5UtcjHMDfUKd13M2FCe7Z_yfEVjv-3LRDiBYyw2m6yxkxUcgQqTaf7LJ32DNrXvMdrlp-PGQKb/s1600/smoking+ban.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxKiYatIKLAlnQ7lPmTqTthfh9yJlbbp-5ud3mgdNcy1YhTUr6PPf9_Dk2PUyQQ3ZA3-5UtcjHMDfUKd13M2FCe7Z_yfEVjv-3LRDiBYyw2m6yxkxUcgQqTaf7LJ32DNrXvMdrlp-PGQKb/s320/smoking+ban.jpg" width="320" /></a></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Smoking cessation</i></b></div>
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In 2008 Russia ratified the WHO Framework Convention
on Tobacco Control, which called for a 10-15% decrease in smoking by 2015.<span style="mso-spacerun: yes;"> </span>In summer 2010 the Russian Ministry of Health
and Social development introduced warning labels on cigarette packaging for the
first time.<span style="mso-spacerun: yes;"> </span>Shortly after, President
Vladimir Putin signed the national tobacco control concept paper.<span style="mso-spacerun: yes;"> </span>Laws on public health relating to tobacco
consumption began to be debated and rewritten, including discussions on smoking
bans in public places, banning small tobacco retailers/kiosks, and limiting
tobacco advertising including banning display case advertising in larger
stores.<span style="mso-spacerun: yes;"> </span>From June 2013 smoking will be
banned in offices, school premises and around stations.<span style="mso-spacerun: yes;"> </span>From 2014 this will extent to all public
areas, including cafes, restaurants and long-distance trains.<span style="mso-spacerun: yes;"> </span>Significant fines for breaking the rules are
to be introduced (6).</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Improved data collection, training and health services</i></b></div>
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Following on from the Ryazan study, COPD has now been
mapped within a further 10 regions. <span style="mso-spacerun: yes;"> </span>Over
the past 3 years 35,000 primary care physicians have attended seminars on COPD,
asthma, and smoking prevention.<span style="mso-spacerun: yes;"> </span>The ‘Pulmobil’,
a mobile COPD diagnosis and management centre was also unveiled in summer 2012,
with the intention of enhancing service provision and coverage.<span style="mso-spacerun: yes;"> </span>Studies are now on-going to assess the impact
of these measures, including health centre utilisation by COPD patients. </div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Public
awareness and attitudes</i></b></div>
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Media campaigns highlighting the health impact of smoking are increasingly
common in newspapers, magazines and on television.<span style="mso-spacerun: yes;"> </span>President Vladimir Putin has also publicly
stated his desire for greater smoking cessation.<span style="mso-spacerun: yes;"> </span>Surveys have shown mixed public opinion on
the proposed changes; greater smoking controls for indoor public places such as
offices and schools have generally been accepted; resistance has however been
felt towards smoking bans covering shared stairwells, beaches and parks. <span style="mso-spacerun: yes;"> </span>Increasing tobacco taxation also remains a politically
sensitive topic, in particular amongst the industrial class, a loyal electoral
base for President Vladimir Putin.<span style="mso-spacerun: yes;">
</span>Critics of the proposed laws cite some impracticalities in the
authoritarian nature of the rules and also question a lack of support for those
wanting to quit smoking (7).<span style="mso-spacerun: yes;"> </span>As is a
common issue within Russia, it remains to be seen how rigidly the new rules are
enforced.</div>
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<b style="mso-bidi-font-weight: normal;">Concluding remarks</b></div>
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COPD has long been underdiagnosed and undertreated in Russia.<span style="mso-spacerun: yes;"> </span>Demographic changes are likely to exacerbate
this situation in years to come.<span style="mso-spacerun: yes;"> </span>The
past five years have seen major changes in Russia, with increased public
awareness, smoking controls and medical provision.<span style="mso-spacerun: yes;"> </span>Whilst greater access to diagnostic facilities
and provision of treatment is required, further barriers to COPD recognition
can be overcome.</div>
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Thank you for reading this far - as usual, any comments greatly appreciated!</div>
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<b style="mso-bidi-font-weight: normal;">References</b></div>
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1) World
Health Organisation (2006) <i>Global Alliance Against Chronic Respiratory
Diseases, Report of General Meeting 2005, Geneva</i>. [online] Available at:
http://www.who.int/respiratory/publications/WHO_NMH_CHP_CPM_05.4_eng.pdf
[Accessed: 4 May 2013]<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt;">
<br /></div>
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2) Greenstone.org
(1997) Untitled. [online] Available at:
http://www.greenstone.org/greenstone3/nzdl;jsessionid=E020827CE566B08981881AF4BB7ED8FE?a=d&d=HASH2255c5db003ea388a30032&c=cdl&sib=&ed=1&p.s=ClassifierBrowse&p.sa=&p.a=b&p.c=cdl
[Accessed: 30 Apr 2013]<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<br /></div>
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<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">3) Holmes D. Smoking in Russia: will old habits die
hard? Lancet. 2011 Sep 10;378(9795):973-4.</span></div>
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<br /></div>
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4) Scheld,
J. (2007) <i>ICC Country Report "Faces of COPD"</i>. The
International COPD Coalition<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
<div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt;">
<br /></div>
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5) World
Health Organisation (2013) <i>Global Alliance Against Chronic Respiratory
Diseases, 7th General Meeting Report (2012), St Petersburg</i>. [online]
Available at: http://www.who.int/gard/publications/GARDGMReportStPetersburg2012.pdf
[Accessed: 4 May 2013]</div>
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<br /></div>
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6) Rt.com
(2013) <i>Crackdown on smoking: Putin signs radical anti-tobacco bill into law
— RT Russian politics</i>. [online] Available at:
http://rt.com/politics/putin-signs-radical-anti-smoking-bill-into-law-389/ [Accessed:
4 May 2013]<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<br /></div>
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7) Harding,
L. (2013) <i>How will Russians cope with the smoking ban?</i>. [online]
Available at: http://www.guardian.co.uk/world/shortcuts/2013/feb/25/will-russians-cope-smoking-ban
[Accessed: 1 May 2013]<span style="mso-bidi-font-family: "Courier New"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<b style="mso-bidi-font-weight: normal;">Images</b></div>
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Image 1 – http://gdb.voanews.com/44A8821F-E0E1-4B9B-A29A-71D9255FA12C_mw1024_n_s.jpg</div>
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Image 2 – http://stoletnik.ru/articles/novosti/2013/03/01/v-rossii-zapretili-kurit-v-liftax-i-pod-ezdax/</div>
</div>
Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-44160390410962873132013-04-28T08:24:00.002-07:002013-04-28T08:24:24.207-07:00Diabetes in Russia / Сахарный диабет в России<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Welcome to my non-communicable diseases blog on
Russia. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Russia is not renowned for its healthy
diet... When it’s minus 30C outside your window, a deep-fried potato cake,
generous dollop of sour cream and glass of sugary tea to finish, appeal
infinitely more than a salad and mineral water. Oh, and that jog around
the park will have to wait until May – there’s 2m of snow on the field at
present…</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">In this first post on non-communicable disease in
Russia, I’ll be considering the situation of diabetes within Russia including
the opportunities and challenges facing its management. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">So, what exactly is diabetes? Diabetes (also
called diabetes mellitus) can be defined as an inability of the body to
effectively get sugars, the body’s instant energy source, from the bloodstream
into the cells. Normally, the body produces a hormone called insulin,
which allows entry of sugar into the cells. The two most common types of
diabetes relate to problems with insulin: diabetes type 1, where the body is
unable to produce insulin; and diabetes type 2, where the cells of the body
become less sensitive to the insulin that’s produced. Without
adequate treatment with either sugar controlling medications or insulin
injections, diabetes will lead to major short and long-term health
consequences. These include an increased risk of: heart attack, stroke,
kidney disease, leg ulcers, loss of sensation, loss of vision, impotence and
dementia. Unsurprisingly depression is also associated with
diabetes. Whilst diabetes cannot currently be cured, it can be managed
effectively, significantly reducing the likelihood of developing disease
complications.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Russia has a population of around 140 million people. Around
2,8 million have an officially recorded diagnosis of diabetes [2008
estimate]. However, a health screening programme in 2006 involving 6
million Russian citizens found a diabetes prevalence of 5.5%, which if
extrapolated suggests a national diabetes prevalence nearer to 8 million
individuals. With an increasing in average age and level of obesity this
figure is likely to rise still further. Significant under-diagnosis
results in frequent late presentations – by this stage it’s often too late to
reverse the disease consequences. As a result, 90% of the current health
expenditure of diabetes is spent on limb amputations, heart disease, stroke
complications, and kidney failure, with less than 10% being spent on insulin.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">So, what are the major challenges facing diabetic
care in Russia? </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">1</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">. <b>Staffing</b>: Until
recently, little emphasis had been placed on primary care i.e. general
practitioners looking out for diabetes risk factors like blood pressure,
obesity, family history and raised cholesterol. The number of
endocriniologists (hormone and diabetes specialists) is also low, with less
than one per 50,000 population.</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">2. Standardisation</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">: Until recently, there was very
little in the way of official evidence based diabetes management policies,
tailored towards the Russian population. Such guidelines have now been
produced, however providing education for medical staff and changing deeply
engrained management habits has faced some resistance. Some health
facilities also possess outdated or ineffective equipment, further frustrating
delivery best-practice. </span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">3. Patient education</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">: Many people simply aren’t aware
of what diabetes is, what the risk factors and signs are, and how diabetes can
be effectively managed.</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">4. Funding</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">: Currently state funding only provides insulin for
those registered disabled. All other diabetic medications and blood
glucose monitoring equipment is provided by the regional health
authorities. As the economic situation within the regions fluctuates, so
too does the quality and continuity of medication and equipment supplied. </span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">5. Geography</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">: Russia covers a
ninth of the world landmass. Certain regions are incredibly sparsely
populated and geographically isolated. Combined with extreme weather
conditions, differing languages and ethnicities, and varying levels of
education, providing effective on-going diabetes management is challenging to
say the least. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">However, things are now beginning to
change. In 2002 the government of Russia embarked on ‘the federal target
programme for diabetes mellitus’. The National Diabetes Institute and the
Endocrinology Research Centre (ERC) were launched within the Russian Academy of
Medical Sciences, Moscow. Within this, departmental subdivisions have been
created focussing on each of the major complications of diabetes, with a
specific department for diabetes education. Through these evidence based
national guidelines and treatment algorithms have been produced and
disseminated for the first time. A national register of patients with
diabetes has been founded with the intention of accurately recording diabetes
prevalence, incidence, disability, complications, mortality causes and rates,
as well as provision of monitoring equipment. Through the federal
programme around: 150 diabetic foot units, 100 diabetic eye centres, 20
haemodialysis units and >1000 education centres have been designated as
diabetes management units. Data collected from 2003-2008 suggested an
average decrease in measured HbA1c from 10.8 to 8.1 (HbA1c is a blood test
measuring average blood sugar level over the past 3 months).</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Steps for the future</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Currently the National Diabetes Institute is
pushing for greater diabetes screening and increased numbers of
endocrinologists to allow more rapid referral. They are also arguing for
an improved staffing ratio in rural areas to account for the distances
involved. Concerns regarding federal funding for insulin provision
(independent of disability) and the continuation of the diabetes register
(currently staffed by volunteers) are on-going. It is hoped that media
campaigns will improve public awareness and data collected showing the
cost-benefit ratio of close diabetes monitoring and so prevention of
complications will build support for further improvements and thus put pressure
on authorities regional and national to build upon the positive progress
achieved over the past decade.</span></div>
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</span></div>
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<span style="font-size: 12pt;"><img alt="" src="https://www.learn.ed.ac.uk/@@/810E03C7EA2E200D1C5B6E21D2C60B4C/courses/1/GMED110232012-3SV1FLEX/blog/_32647_1/post/_82991_1/diabet-0403.jpg" style="border: 0px solid rgb(0, 0, 0);" /> </span></div>
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<b><u><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">References</span></u></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-size: 12.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB; mso-hansi-font-family: Calibri;">Novonordisk
(2008) <i>Diabetes in Russia: Problems and Solutions</i>. [online] Available
at:
http://www.novonordisk.com/images/about_us/changing-diabetes/PDF/Leadership%20forum%20pdfs/Briefing%20Books/Russia%20II.pdf
[Accessed: 22 Apr 2013].</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-size: 12.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB; mso-hansi-font-family: Calibri;">Diabetes
Voice (2013)<i> 1 1 H e a l t h d e l i v e r y National and regional
organization: the key to effective diabetes care in Moscow </i>. [online]
Available at:
http://www.idf.org/sites/default/files/attachments/article_475_en.pdf
[Accessed: 22 Apr 2013].</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Young TK,
Schraer CD, Shubnikoff EV, Szathmary EJ, Nikitin YP. Prevalence of diagnosed
diabetes in circumpolar indigenous populations. Int J Epidemiol. 1992
Aug;21(4):730-6</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Picture
taken from</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">:
http://health.passion.ru/novosti-zdorovya/sobytiya/besplatnye-proverki-na-diabet-po-vsei-rossii.htm</span></div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-8428825905936357882013-04-28T07:45:00.001-07:002013-04-28T07:52:46.444-07:00Chronic Disease within Russia<div dir="ltr" style="text-align: left;" trbidi="on">
How healthy is Russia?<br />
<br />
<div style="text-align: justify;">
As part of my masters coursework, I've been asked to write a weekly blog focussing on different aspects of non-communicable disease within Russia. Over the coming weeks I'll be considering diabetes, breathing disorders, heart disease, cancer, mental health and more! Whilst it's only week two, it's been fascinating to see the different approaches, unique challenges and potential opportunites in providing heathcare to the largest country on earth. </div>
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Any thoughts, comments and questions would be very very useful to me - either comment beneath, via facebook or email. I'm eager to learn as much as I can from the project!</div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-21713257527558114102013-04-05T12:54:00.002-07:002013-04-05T12:58:39.043-07:00Belief in Russia<div style="text-align: justify;">
The fall of communism hailed a period of religious openness within Russia. Sadly those times seem to be fading, with increasingly tight controls on anything not perceived to be in line with government policy. Where is Russia going? The economist held a recent interview discussing the role of religion within Russia and the russian political sphere. Makes for interesting viewing. Your thoughts as comments would be most appreciated!</div>
<br />
<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-34524061341197349392013-03-08T04:03:00.001-08:002013-03-08T04:03:48.691-08:00Eastern Europe language learning<div><p>The excitement of discovering a lonely planet store in Manchester was further compounded by the realisation they sell a pocket-sized phrasebook/dictionary for eastern european languages. It covers Russian, Romanian, Hungarian, Polish, Czech and five more. Very exciting. Further preparation/procrastination ahoy me thinks!</p>
<p>PS ahoy is the Czech word for hello :-)</p>
<br/><img src='https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyJSSlFDtPNOMPHQlEXCbmjqJcbHgdR-Imr23osQ1TwuJwCMZXf3Eq8skFljAN1g8TJ_yFoSuYr4M-nIQCRXL3wZXi1m07gUR3tQYcEIyyKI3WNISvnedQeWBgafFIElI69WOdAXhGZ1M1/' /></div>Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-49223955742578030942013-02-25T05:58:00.001-08:002013-02-25T12:24:16.029-08:00Places that don't exist<div dir="ltr" style="text-align: left;" trbidi="on">
Have also been watching a really fascinating TV series called "<a href="http://www.youtube.com/watch?v=UmrLbTHBV3s">Places that don't exist</a>".
Three of the nations are in the sphere of the Former Soviet Union (including Trans-Dneister, Ossetia/Abkhazia/Ajara and Armenia/Azerbaijan).
Russia still has close involvement in each. Again, a very informative
series with a unique insight into different mindsets, the role of
conflict and the potential future direction of the FSU.<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-45558391590062659382013-02-25T05:54:00.000-08:002013-02-25T12:17:12.857-08:00Slow progress?<div dir="ltr" style="text-align: left;" trbidi="on">
Ever find that time is moving on, that organisating things is perpetual and that little of substance is being achieved? It's been about 5 weeks since my trip to Germany. I seem to have been on-call often, with my sleep-wake cycle being sent into disarray. When opportunites come emails are sent, phone calls are made, answers are few... Progress with paperwork has been at times frustrating. It's also been four months since I was last in Eastern Europe. Masters studies have been squeezed into free time, however, each week seems to run into the next. Where has the time gone?<br />
<br />
Where are things going, what am I achieving?<br />
<br />
Stop. Reflect. Perspective check. I think I sometime struggle due to defining personal success (and thus to some degree self-worth) in terms of achievement and overt productivity. The outworkings of such a philosophy can be quite dangerous. If I 'fail' to achieve, does my worth diminish? Do patience, planning, contemplation and relationship building have no worth? Does God's love for me change depending on how 'productive' I am (or what I would personally deem as productive)? <br />
<br />
Comforting to know however, is that God's plans will come to fruition regardless of my efforts. He has saved my be his grace, not through my own worth. Even if I were infirm and immobile, God's grace and love shown to me (and thus my worth in his eyes) would not change. Jesus' death and resurrection has made this certain. All work and service for Him should be as an outpouring of thanks, not as a definer of self-worth. The funny thing is, things seem to happen when you entrust the efforts to God. The results are often different to expected, yet more praiseworthy in hindsight. Afterall, he is creater and sustainer of all. Reflection makes it plain that it is far better this way - just need to be daily reminding myself of this!<br />
<br />
So, planning and preparation over the last two months:<br />
- Further discussion with the medical council of Saarland, list of required documents formalised <br />
- Teaching schedule for the Eastern European Congress of Christian Medics provisionally written<br />
- Key note speech offered to PRIME at said conference<br />
- Provisional offer to teach medical communication skills at a medical school in Ukraine in May <br />
- Potential for a further trip to Romania to teach medical communication skills to medical students later in the year<br />
- Masters coursework on epidemiology (part one) completed [means a 1/6th of the course is done now!]<br />
- Medical rota for next rotation finally obtained (many swaps will be required however...)<br />
- Getting to know people better at church. Feeling that fellowship and being able to encourage others is improving as a result! <br />
<br />
Lets see what the next few months hold!<br />
<br />
<br /></div>
Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-39555315989091756562013-01-21T14:15:00.000-08:002013-01-21T14:15:13.549-08:00Return to Saarland<div dir="ltr" style="text-align: left;" trbidi="on">
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So, this is it, the return to Saarland.<br />
<br />
After a somewhat eventful and prolonged journey; DHL lost my train tickets; my plane was cancelled at short notice; booked online tickets with Eurostar / TGV / Deutsch Bahn whilst on my way to London; telephoned and booked a hotel room in Paris; I can greet you from Germany. Highlight of the journey was definitely the TGV driver appologising that the train could only manage 280km/h due to the icy weather and then deciding to travel at 310km/h anyway!<br />
<br />
I've come back to Saarland (south west Germany) for several reasons.<br />
<br />
Firstly, I made some really great friends here back in spring 2011, when I had the opportunity to complete an exchange semester here. This was a truelly blessed and influential time, and I am extremely grateful for it. It's been fantastic to be able to catch up with some of these including those from church (instant warm welcome and lunch invitation - love it!), friends from work, and friends from halls ('gudd Gess' has been shared!). <br />
<br />
Secondly, I've had a job interview here. The interview was for the department of Nephrology (kidney medicine), one of the departments I studied within whilst here on placement. I sent off an application a few weeks back and they said that they were interested in hearing more - hence my determination to get here! Thankfully, the interview went really well and I've been accepted! The head of department was approachable and open, telling me more of what to expect and the challenges and opportunities ahead. My previous supervisor also came and put in a good word for me (I have retrospectively rewarded him with fine scotish whisky and M+S shortbread). So, I've got a few formalities to sort out with the administration, however once that's sorted I'll be able to receive the contract. Unexpectedly, my second year of the UK foundation programme may also count towards my speciality training, shortening the process by a year and letting me enter at a higher pay-grade (score!).<br />
<br />
Thirdly, I needed to figure out the German equivalent of the General Medical Council. This has proven to be the challenge of the trip so far... They required 13 legal documents, after a lengthy discussion I managed to persuade the administration to accept 2 of the documents I had brought with me. Turns out I need to become good friends with a notarist in order to legally recognise and translate my certificates, scripts and legal forms into a legislatively acceptable format. I think there may also have been further miscommuncation during the meeting, as I had to spend several minutes persuading them that I was infact a real practicing doctor inspite of not having an MD. Definite character building experience!!! (although nothing that a combination of pray with coffee + german cake can't fix). I have admin lady's email address and will be in further contact. I seems possible to get everything together, it'll just involve quite a bit of hassle, time and expense.<br />
<br />
So, it's great to be back in Germany. Job is set and the language skills are coming back. Sadly, lots of the students are away or in exams at the moment. Encouragingly my church pastor tells me that quite a few new christian medics have started this year. A christian medical group has also recently been founded. Also, incredibly excitingly, I have discovered that a russian speaking congregation have started to meet in the town - Mega Awesomah!!! Looks like there will be plenty of opportunies for Christian medical fellowship and improving my russian language skills!<br />
</div>
<div>
In summary - I'm seeing many opportunities as to how I can serve here in Germany. There will be many opportunities to learn more about people, my strengths and waekness, langauge(s) and cultures. The present frustrations are useful to me as they will prepare me for what is to come. It's also a great humbling experience and will allow me to serve others much better and to learn to rely on and work hard to honour God. Just need to remember this when they say in the administration tells me in their direct manner - Nein, das ist unmoeglich!<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-22580182651748251772012-12-15T14:15:00.000-08:002012-12-15T15:46:03.632-08:00Looking backwards, looking forwards, looking east!<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0khMpb5bdjDCWSZOKbyWgD1AejFuiIZo_enZRsKMhyphenhyphenWfoM03tOenHgLeY7aBTw_QGU5lNuwUXN-bzOHaYGwctQWvyU9Y2hq_-rrBC01y_DLA_eR3yKEXBZ4MBRl69NgutIt-JnL7YaViW/s1600/SAM_2402.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div>
<div style="text-align: justify;">
The year that was 2012 is slowly drawing to a close. It's been a busy one. I've been blessed with many opportunities to head east, visiting quite a few countries for the first time. This has included: a parisian New Years celebration with old friends (plus oysters & cigars); navigating a crazy interrail route around Ukraine, Hungary, Poland, Austria and Germany (with a tour of Chernobyl powerplant enroute); enlightening medical teaching trips to Ukraine (twice); summer camps with teaching opportunities in Lithuania and Belarus; short stays in Latvia and Estonia; backpacking around Russia having chance to see St Petersburg, Moscow and Kursk (with fantastic guided tour); and giving a week long series of lectures as part of <a href="http://www.prime-international.org.uk/home.htm" target="_blank">PRIME</a> on 'Whole Person Medicine', 'Stigma in healthcare' and medical communication skills to medical students at the University of Cluj-Napoca, Transylvania (Romania). I've been made incredibly welcome by those I've met and have some great new friends. I'm always amazed at how despite different cultures, the gospel (aka good news and promises of Jesus) unites people all around the world. I have been shown such love, kindness and patience by those I've met and often stayed with over the past year - I cannot be thankful enough! It's also been the year where I've gone from medical newby panicking about taking bloods to scary SHO on-call, being given even scarier responsibilities. I've had some really great wards, inspiring supervisors and a fantastically supportive and caring church family, who've helped me keep my perspectives in check. Furthermore, by grace, Preston now has a <a href="http://www.cmf.org.uk/" target="_blank">Christian Medical Fellowship</a> group.<br />
<br />
</div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
2013 also looks to be another year of challenge and adventure, with potential trips to Czech rep, Austria, Ukraine and Romania on the horizon. Latvia is another contender. God willing, I'm hoping there may also be a trip/holiday to Russia in the pipeline (buh-dum-cha!). This may even be the long awaited year when I embark on the Trans-Siberian railroad and finally reach Vladivostok, the 'Ruler of the East'. If the pace of work continues, 2013 should additionally herald the completion of year one of the Global Health masters (PG cert - woop!) and also potentially the dreaded MRCP part 1 (medical speciality exam). Mega <span class="short_text" id="result_box" lang="ru"><span class="hps">Слава Богу</span></span> if I manage that one!<br />
<br />
Most excitingly however... there is a likely change of scenery ahoy. Whilst adminsitrative formalities are ongoing, I've accepted a clinical position in south-west Germany to start in September 2013 (black dot on map beneath). I can envisage many opportunities and beneficial challenges in working there; I greatly look forward to embracing these! </div>
<br />
So, what have I learnt in 2012?<br />
<br />
1. Trust in God; work hard; things happen.<br />
2. Travel is easy, the mind provides barriers, flexible is key. (Haiku!)<br />
3. Effective time management is never to be underestimated.<br />
4. Necessity is the mother of invention.<br />
5. I have the ability to teach.<br />
6. Stereotypes are limitted in truth, isolation helps reenforce them.<br />
7. Aspirations are not limitted to a particular culture. Neither is self-interest. <br />
8. The Russian language is an enigma slow to unravel. The reward of doing so however is bountiful.<br />
9. God is faithful, even when I am not. Praise be purely to him.<br />
<br />
<div style="text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0khMpb5bdjDCWSZOKbyWgD1AejFuiIZo_enZRsKMhyphenhyphenWfoM03tOenHgLeY7aBTw_QGU5lNuwUXN-bzOHaYGwctQWvyU9Y2hq_-rrBC01y_DLA_eR3yKEXBZ4MBRl69NgutIt-JnL7YaViW/s1600/SAM_2402.JPG" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0khMpb5bdjDCWSZOKbyWgD1AejFuiIZo_enZRsKMhyphenhyphenWfoM03tOenHgLeY7aBTw_QGU5lNuwUXN-bzOHaYGwctQWvyU9Y2hq_-rrBC01y_DLA_eR3yKEXBZ4MBRl69NgutIt-JnL7YaViW/s320/SAM_2402.JPG" width="320" /></a> </div>
<br />
<u><b>Key</b></u><br />
- <span style="color: #444444;"><span style="background-color: yellow;"> Yellow </span></span>: Countries visited previously <br />
- <span style="color: #444444;"><span style="background-color: orange;">Orange</span></span>: Countries visited this year<br />
- <span style="background-color: red;"><span style="color: red;">. </span></span><span style="color: #444444;"><span style="background-color: red;">Red <span style="color: red;">.</span></span></span>: Countries on the hit list for 2013<br />
- <span style="color: #444444;"><span style="background-color: lime;"> Green </span></span>: Germany, planned new home<br />
- <span style="color: white;"><span style="background-color: black;"> Black </span></span>: Location from Sept 2013</div>
Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-21231970149725403132012-11-26T03:33:00.001-08:002012-11-26T03:40:42.764-08:00Corruption in healthcare<div dir="ltr" style="text-align: left;" trbidi="on">
Corruption is a <i><b><u>major</u></b></i> problem in healthcare.<br />
<br />
<br />
<div style="text-align: justify;">
Corruption in healthcare
is a major problem in the nations of the former soviet union. There
are many reasons for this, however none that are insurmountable. My
masters' tutorial group chose the topic of healthcare corruption for our
presentation. Your thoughts on the presentation are most welcome!</div>
<br />
<br />
<b>Corruption in healthcare</b><br />
<br />
<br />
<div class="prezi-player">
<div style="text-align: center;">
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<div class="prezi-player-links">
<a href="http://prezi.com/dtnznuprc1i4/corruption-in-healthcare/" title="Corruption in Healthcare">Corruption in Healthcare</a> on <a href="http://prezi.com/">Prezi</a></div>
</div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<u><b>Why is there corruption?</b></u><br />
No nation is immune to it, however some health systems are unfortunately afflicted by it more than others. Ultimately it boils down to the problem of the human heart - putting perceived personal interests above those of others (and of God). Christians we can be shining lights<!--[if gte mso 9]><xml>
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</div>
<ul style="text-align: left;">
<li><span style="background-color: white;"><span style="color: #0b5394;"><b> Who we are</b></span>:</span></li>
<ul>
<li>Romans 3:23 - all have sinned, all fall short of God's glory.</li>
</ul>
</ul>
<div>
<ul style="text-align: left;">
<li><span style="background-color: white;"><span style="color: #0b5394;"><b> Personal accountability & integrity</b></span>:</span></li>
<ul>
<li>Matthew 7:3-5 - pull the log out of our own eye before others </li>
</ul>
</ul>
<ul style="text-align: left;">
<li><span style="background-color: white;"><b><span style="color: #0b5394;"> Jesus' sacrificial love</span></b>:</span></li>
<ul>
<li>Matthew 22:37-39 - love the Lord your God with all your
heart, soul, mind and strength, love your neighbour as yourself. </li>
</ul>
</ul>
</div>
<div>
<ul style="text-align: left;">
<li><span style="background-color: white;"><span style="color: #0b5394;"><b> We are accountable</b></span>:</span></li>
<ul>
<li>Luke 16:10-13 - God cares about how we live.</li>
<li>“One who is faithful in a very little is also faithful in much, and one
who is dishonest in a very little is also dishonest in much. If then you
have not been faithful in the unrighteous wealth, who will entrust to
you the true riches? And if you have not been faithful in that which is
another's, who will give you that which is your own? No servant can
serve two masters, for either he will hate the one and love the other,
or he will be devoted to the one and despise the other. You cannot serve
God and money.”
</li>
</ul>
</ul>
<br /></div>
</div>
Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com1tag:blogger.com,1999:blog-4830569493099915434.post-83149347592014295612012-11-19T13:38:00.006-08:002012-11-26T03:35:26.980-08:00România - este un loc frumos!<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: justify;">
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<div style="text-align: justify;">
Hmmm, looks like I might be falling in love with another country and her people…<span style="mso-spacerun: yes;"> </span>I’ve just had the great
opportunity of teaching medical students for a week with an organisation called
PRIME (Partnerships in Medical Education).<span style="mso-spacerun: yes;">
</span>The uniting theme was that of ‘whole person medicine’ i.e.
when you value the patient as a person rather than just the condition they
bring with them, you dramatically improve quality of healthcare, diagnosis,
treatment relevance, concordance and compliance.<span style="mso-spacerun: yes;"> </span>The concept is drawn from the foundational biblical principle in love and service of God, we value and
have compassion for our neighbour, regardless of situation.</div>
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<br /></div>
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As a result, I led a diverse range of lectures and seminars on topics
such as:</div>
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<br /></div>
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<li><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Breaking bad news to patients</li>
<li><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Identifying and managing depression</li>
<li><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Stigma in healthcare; including alcohol and
homosexuality</li>
<li><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Evidence based medicine in practice</li>
<li><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span>Corruption and accountability in healthcare</li>
</ul>
<div style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">
These sessions were complemented by further teaching from a colleague
specialising in Breast and Thyroid surgery from the UK.<span style="mso-spacerun: yes;"> </span>The students were engaged and had many
questions from our teaching sessions!<span style="mso-spacerun: yes;"> </span>I
am thankful for this and learnt a great deal from them too.<span style="mso-spacerun: yes;"> </span>I even managed to get a few laughs and at one
point a round of applause – something greatly unexpected.</div>
<div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">
During the afternoons<span style="mso-spacerun: yes;"> </span>I had
chance to learn from a series of sessions aimed at teachers within
the medical school on methods of teaching medical students.<span style="mso-spacerun: yes;"> </span>Again the PRIME principles of ‘whole person
medicine’ were the foundation – whole student teaching?!?!<span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;"></span></span><span style="mso-spacerun: yes;"> </span>I think around 20 different teaching means
and styles were covered, all applied with a mixture of theory, practice and
discussion.<span style="mso-spacerun: yes;"> </span>I again learnt a great deal
from the chance to work with several wise and experienced colleagues from the
UK, being privileged to share in their thoughts, preparations and actions.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">
And as for Romania, her culture and people…<span style="mso-spacerun: yes;"> </span>The warmness of the welcome was pretty
extreme!<span style="mso-spacerun: yes;"> </span>We were very well looked after
and supported.<span style="mso-spacerun: yes;"> </span>I’ve made some good
friends and had chance to experience a culture unlike those I’ve been to before
in Eastern Europe.<span style="mso-spacerun: yes;"> </span>The food is good and
language pleasant to listen to (and sometimes even comprehensible).<span style="mso-spacerun: yes;"> </span>As the name suggests, it’s latin-based –
perhaps you can guess the meanings of: <span class="hps"><span lang="RO" style="mso-ansi-language: RO;">bună seara</span></span>, merci, and adio?</div>
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The last thing to perhaps say, it that Transylvania is not a scary
place (apart from the all-enveloping fog!).<span style="mso-spacerun: yes;">
</span>Give it a try!</div>
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-82997801355189790912012-11-08T06:22:00.002-08:002012-11-08T06:29:30.330-08:00Belarus - the void between ideals?<div dir="ltr" style="text-align: left;" trbidi="on">
Belarus - the void between ideals?<br />
<br />
Belarus (aka white Russia), is a country in Eastern Europe, bordered by the EU to the west (Poland, Latvia, Lithuania) and the Russia/Ukraine to the East. It's boundaries have fluctuated massively over the centuries with its people coming under successive empires and conquests. It lost a quarter of its population during the Second World War, with 90% of its capital city, Minsk destroyed. It became part of the Soviet Union until its dissolution in 1991. Over the past 18 years it has had one leader, Alexander Lukashenko, who has ruled the country through the surrounding economic and political instability of the 1990s and the increasing international isolation of the 2000s. To be frank, western media rarely portrays Belarus in a positive light. The US government called Belarus, "Europe's only remaining 'outpost of tyranny' ". The BBC was recently allowed an interview with the Belarussian leader - a summary can be found <a href="http://www.bbc.co.uk/news/world-europe-20030346" target="_blank">here</a>. When describing Belarus the BBC states:<br />
<br />
<div style="text-align: center;">
Two decades later (after FSU collapse), the sense of national identity is weak, international
isolation continues and the nature of political links with Russia
remains a key issue. </div>
<br />
Thus the stereotypical image of Belarus, is that of a grey, centrally planned ongoing 'soviet-style' dictatorship, lacking in freedom, opportunity and fairness. However, beyond the portrayed stereotype, very little is known by those in the UK of the people of or indeed life in Belarus. I am very grateful for the chance to have had a visa, giving me the opportunity to explore the nation of Belarus and meet the people who live there.<br />
<br />
<br />
<b>Learnings from Belarus</b><br />
<br />
<b>1. Lukashenko (the president) is not unpopular.</b><br />
<b><br /></b>
<b>2. Belarussians view their country as a young country, that is bound to make some mistakes as it develops its own national course.</b><br />
<b><br /></b>
<b>3. The country and its infrastructure are surprisingly modern.</b><br />
<b><br /></b>
<b>4. The countryside is beautiful.</b><br />
<b><br /></b>
<b>5. There seems to be relative freedom in expression, so long as you remain inline with the law (sometimes tricky) and don't organise activities to overtly criticise the ruling party. </b><br />
<b><br /></b>
<b>6. Many Belarussians are confused by the EU's stance of isolation towards their country. Ethnically, historically, culturally and linguistically Belarus has many ties with Russia. It's not a case of choosing to align oneself towards one or the other. Belarus falls under both European and Russian spheres. 'Narrow-mindedness' may in fact come from the West in failing to recognise this.</b><br />
<b><br /></b>
<b>7. Minsk central MacDonalds was recently demolished to build a new library for the university. The other MacDonalds remains on Lenin Street however...! </b><br />
<b><br /></b>
<b>8. The believing church is active, dynamic and growing in Belarus.</b><br />
<b><br /></b>
<b>9. Don't flush toilet paper - it is for the bin next to the toilet.</b><br />
<b><br /></b>
<b>10. The roads in Belarus are really good - the best I've seen in the Soviet Union.</b><br />
<b><br /></b>
<b>11. They value their environment and have quite a few natural parks - 'how were we to survive, if it were not for the blueberries and mushrooms?'</b><br />
<b><br /></b>
<b>12. Hyperinflation means the amount you can take out of an ATM is limited by the width of dispensing slot.</b><br />
<b><br /></b>
<b>13. Belarussians are friendly, inquisitive and full of ingenuity.</b><br />
<br />
<br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-20537863324026781522012-11-06T13:49:00.000-08:002012-11-06T13:49:27.857-08:00From Russia with love...So after flitting my way around Eastern Europe for several years, I've finally made it to Russia. The process has been epic and not something I thought I'd be able to arrange myself. However, by grace it has been achieved and by grace I managed to see some great sights, meet with some great people and learn a huge amount about the fascinating and awe inspiring nation - it makes up a ninth of the world's landmass! Unsurprisingly, I still feel like I've only just scratched the surface.<br />
<br />
So, here are my initial thoughts and perceptions from my trip - things I hope to build on with time!<br />
<br />
<b>1. Russia is huge and is to some extent its own world</b><br />
<br />
<b>2. No smile does not mean no like</b><br />
<br />
<b>3. Russian history is a very complex beast</b><br />
<br />
<b>4. People have the same fundamental yearnings and desires regardless of nationality</b><br />
<br />
<b>5. The concept of an 'ideal' government is not objective</b><br />
<br />
<b>6. Our view of the world is shaped through the lens of the media</b><br />
<br />
<b>7. Night trains are a fun, convenient and comfortable way to travel long distances and meet new people</b><br />
<b><br /></b>
<b>8. The concept of milk with tea is a non-starter. Mixing Smetana with tea causes mass dismay.</b><br />
<b><br /></b>
<b>9. The dress code for Moscow is black. For St Petersburg it's a flat cap.</b><br />
<b><br /></b>
<b>10. Due to depth, the escalator for the Metro can take several minutes. If suspecting imminent nuclear war, head to the metro.</b><br />
<b><br /></b>
<b>11. Always complement the Russians on their fountains</b><br />
<b><br /></b>
<b>12. Saturday is wedding day. Arrive at tourist sites early to avoid the wedding crowds.</b><br />
<br />
<b>13. Russians are very very good hosts!!! </b><br />
<br />
<br />
<div style="text-align: center;">
<span style="font-size: large;">Большое спасибо мый русский друзьями, россия очень красивый стран. мне нравится это очень. Слава богу!</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com3tag:blogger.com,1999:blog-4830569493099915434.post-61995524046462229152012-07-20T14:42:00.000-07:002012-07-20T14:49:56.529-07:00Operation World - Russia<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: justify;">
Browsing through the world section of <a href="http://thegospelcoalition.org/">thegospelcoalition.org</a> blog, I discovered that operation world now has short movie clips on many countries, summarising the situation and listing a few pertinent prayer requests. The one on Russia is quite insightful, showing some of the darkness society faces, the challenges experienced by Christians, and a humble desire for God and his plan to be glorified in their land. Worth a watch.</div>
<br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/nsSUmlWyHBk?feature=player_embedded' frameborder='0'></iframe></div>
</div>Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-41114365144966802452012-07-13T00:24:00.002-07:002012-07-20T14:48:32.510-07:00To be like a Czech<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUF4t4_558c-ll0cDh_Hd21-rBXFeotqGIPziuWbzgQH7eGUTFptSmkVZTVwxG0XvWMChu309JFpCL9eq3HlhKmnRNDOM2bp8xhRErQzF42EmOvwE9AAWzWNsNf26STvrO86c5UuPecFRM/s1600/czech" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUF4t4_558c-ll0cDh_Hd21-rBXFeotqGIPziuWbzgQH7eGUTFptSmkVZTVwxG0XvWMChu309JFpCL9eq3HlhKmnRNDOM2bp8xhRErQzF42EmOvwE9AAWzWNsNf26STvrO86c5UuPecFRM/s320/czech" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUF4t4_558c-ll0cDh_Hd21-rBXFeotqGIPziuWbzgQH7eGUTFptSmkVZTVwxG0XvWMChu309JFpCL9eq3HlhKmnRNDOM2bp8xhRErQzF42EmOvwE9AAWzWNsNf26STvrO86c5UuPecFRM/s1600/czech" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> </a></div>
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According to the BBC's <a href="http://www.bbc.co.uk/news/health-18770328" target="_blank">global fat scale</a>, I'm most like someone from the Czech republic.</div>
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<b>Bring on the <span class="short_text" id="result_box" lang="cs"><span class="hps">klobása</span> <span class="hps">a chléb!</span></span></b></div>
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<span class="short_text" id="result_box" lang="cs"><span class="hps"> </span></span><span class="short_text" id="result_box" lang="cs"><span class="hps"> </span></span></div>
</div>Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-35420673969588010032012-06-16T08:11:00.000-07:002013-02-24T04:57:46.329-08:00Busy times...<div dir="ltr" style="text-align: left;" trbidi="on">
Another busy week at work has sadly put the active study of Russian back a little. Shopping at the Polish supermarket is however widening my culinary knowledge. Plans to attend and potentially teach at Christian ventures for medical students in Lithuania and Belarus are also making encouraging steps forward! Watch this space for further updates... <br />
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In other news, travel to and fro has however given me the chance for more Russian radio! Here is a very gifted Belarussian musician - Sergey Briksa singing <a href="http://www.youtube.com/watch?v=gOZDiw-iL1c" target="_blank"><span class="long-title" dir="ltr" id="eow-title" title="Briksa & Friends LIVE DVD 2012 - Иисуса Эхо">Иисуса Эхо</span></a> (Echoes of Jesus). <br />
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Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-68387158623528803752012-05-31T15:37:00.003-07:002012-06-16T08:12:21.041-07:00Russian Testimony<div dir="ltr" style="text-align: left;" trbidi="on">
So, here it is! I set myself the challenge of writing down how I became a Christian in Russian... It took a while and is somewhat simplified, however the milestone is reached. A friend has kindly corrected some of my endings for me - need to work on my grammar!<br />
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я стал христианином, когда мнe было пятнадцать лет. я должен был xoдить в
церковь, потому что средняя школа былa христианскoй школoй. Нe многиe
студенты верят в Бога. Пo вокресеньям я слушал БиблиЮ
в церкве. на
христианскиx молодежныx группax я видел настоящиx христиан, кoтopыe
верят в Бога. они знали Иисусa. я не знал Иисусa. они говорили о грехе. я yвидeл, что это правда. я Зaхотел yзнaтЬ Иисусa, однако я не верил в
Бога и я не понимал многих вещeй. я молиллcя Богy, что если ты правда,
пожалуста yдaли мое невериe. я не знаю как, однако oн сделал это. я не
понимал многих ответов, однако я знал Oн иcтинa. с тех пор, он научил
меня многих вещeй!<br />
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I recommend copying and pasting to <a href="http://translate.google.co.uk/" target="_blank">Google translate</a> for a rough idea of the English.</div>Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-75541044642040074042012-05-27T14:33:00.000-07:002012-07-20T14:51:22.084-07:00Sounds familiar...<div dir="ltr" style="text-align: left;" trbidi="on">
I was listening to a Russian Christian radio station (<a href="http://www.nlradio.net/" target="_blank">новая жизнь</a> - new life) this evening when a familiar tune started - words were however in Russian. Looks like Delirious, or at least their songs, have made it to Russia!<br />
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<br /></div>Anonymoushttp://www.blogger.com/profile/12819793790440189428noreply@blogger.com0tag:blogger.com,1999:blog-4830569493099915434.post-49312070968535102542012-05-13T09:52:00.001-07:002012-07-20T14:53:16.794-07:00Last letters from Stalingrad<div dir="ltr" style="text-align: left;" trbidi="on">
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This week I've had the pleasure/challenge of reading '<a href="http://www.dramonline.org/albums/elias-tanenbaum-last-letters-from-stalingrad/notes%20">last letters from Stalingrad'</a> (letzte Briefe aus Stalingrad). Being a true sober hearted Brit with a stiff upper lip and non-expressive manner, few things tend to impact me. This book did however, causing me to shead a couple of tears in the process. The book contains a series of letters said to be written by German soldiers towards the end of the second world war. They're writing from frozen Russia, perishing from the cold, poor equipment and lack of supplies. They're surrounded and outnumbered by the Russians. They've realised Hiltler's not going to save them, with any nazi ideology they had rapidly unravelling. They face either lifelong slavery in the Gulags of Siberia or dieing in the coming final standoff. Many prefer, for various reasons, the idea of the latter. The letters are written to families and sweethearts, showing huge outpourings of fear, hopelessness, anger and bitterness, each forming an empassioned final goodbye. The authorities kept and stored all the letters. None of them reached their intended recipients.<br />
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So, what have I taken from these harrowing accounts? Well firstly, no matter how much we make plans or how hard we work, we are ultimately not in control of our destiny. All will die, all have an appointed time. Often it takes a personal crisis to remind us we're not kings of this world, but mere mortals, flourishing only for a time. <br />
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Secondly, in our turbocharged world of individual achievement and output, personal crises are some of the few times that challenge us on what's really important; family, love, freedoms. The make us ask what is life for, is this really all there is, why did it work out like this? This seems not to be bound by culture or time, with German soldiers, modern day Brits and ancient Hebrews all in the same boat.<br />
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God's word has something to say on this in psalm 103. Think, what does it say about man and what does it say about God?<br />
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Psalm 103:13-19<br />
As a father shows compassion to his children, so the LORD shows compassion to those who fear him. For he knows our frame; he remembers that we are dust. As for man, his days are like grass; he flourishes like a flower of the field; for the wind passes over it, and it is gone, and its place knows it no more. But the steadfast love of the LORD is from everlasting to everlasting on those who fear him, and his righteousness to children's children, to those who keep his covenant and remember to do his commandments. The LORD has established his throne in the heavens, and his kingdom rules over all.<br />
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