I walk and cycle to work because I’m lazy by Rhian Davies

It’s true, I’m lazy. If I didn’t travel on foot or by bike to work, the shops, the pub, I’d need to find the time, inclination and means to exercise. So I walk and cycle because it:

  • Gets me there

Walking is the oldest form of transport. In fact we’ve evolved to do it – having been walking around for about 1.9million years. Cycling has been a means of getting from A to B for nearly 200 years.

  • Gets me there quickly

No searching for car keys, waiting in traffic and finding parking spaces. A journey by bike in Dumfries takes about the same time as a journey by car. Walking or cycling on traffic free and quiet routes means I don’t get held up by queues and stay clear of road works.

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  • Saves time

No need to find time to get to the gym or go for a run as travel is my exercise. Most people say they would exercise more if they had the time. As I’m travelling anyway, that time is put to use as exercise time too.

  • Is enjoyable

Rhian 2The main thing for me is the fresh air, being outside and enjoying the wildflowers and wildlife that I see and hear, especially at this time of year. Winter has an upside too – no need to get up early to see a beautiful sunrise and the moonrises can be pretty spectacular too. I’ve also seen shooting stars on my way home from work. And despite what it feels like, it doesn’t rain that much! In fact, there’s a 95% chance of NOT getting rained on, on your way to work.

  • Is sociable

I often see people I know on the way and enjoy having a chat with them. Waving to the lollipop lady on the way to work or chatting with the nice man who walks his spaniel adds a little happiness to my day.

  • Is safe

The most recent figures from the Department of Transport show the fatality rate for pedestrians and cyclists is the same, with one death per 29 million miles walked or cycled. Looking at how many people were killed or seriously injured, it works out at one person for every 1 million miles cycled and one person for every 2 million miles walked.

  • Keeps me fit

The main difference compared to driving is that whenever you walk or cycle your health benefits, whereas remaining seated in a car does nothing to improve it. Typically I cycle to work, a 20 minute journey each way, which easily meets the guidelines for 150 minutes of moderate exercise a week.

  • Benefits people and planet

You only have to look at the news and you’ll see an almost daily report on worsening air pollution and the effect this is having on people and the environment. Walking and cycling isn’t the only way to tackle this problem but it is a difference we can make every day to the people and place we live.

  • Is easy to get parked

Rhian 3In my role as Active Travel Officer, I’m here to help anyone who is thinking of travelling by foot or by bike. I’m working with staff at DGRI, the new hospital, Crichton Hall and The Willows.

Over summer I’m running events including basic bike maintenance workshops, Essential Cycling Skills, information stalls on route finding and guidance on buying a tax free bike through Cyclescheme. Upcoming events are posted online and advertised in the core briefing and posters around DGRI, Crichton Hall and The Willows.

So if you’re feeling inspired come along to:

Bike Maintenance for beginners

Drop in session – not sure how to change an inner tube? Need to know how to check your bike is safe to ride? Find out how and have a go.
Monday 22 May and Friday 26 May: 12noon – 2pm and 4pm – 6pm

Venue: Garage 26, the hospital residences

Cyclescheme information stall

Come along to find information on applying for a tax free bike

Crichton Hall Canteen on Tuesday 23 May: 12 – 2pm

Essential Cycling Skills (Beginner)

Can’t remember the last time you’ve ridden, or feeling wobbly when you ride? This is the course for you. Please book here.
Part 1 Wednesday 24 May: 11.30am – 1pm, Part 2 Thursday 25 May: 11.30am – 1pm

Part 1 Monday 5 June: 5pm – 6:30 pm, Part 2 Tuesday 6 June: 5pm – 6:30pm

Meeting point: Garage 26, the hospital residences 

Essential Cycling Skills (Intermediate)

Are you happy cycling on quiet roads but not sure how to navigate roundabouts or junctions confidently? Then this is the course for you. Please book here.
Part 1 Wednesday 24 May: 5:30pm –7pm, Part 2 Thursday 25 May: 5:30pm –7pm

Part 1 Wednesday 7 June: 11am – 12:30pm, Part 2 Thursday 8 June: 11am – 12:30pm

Meeting point: Garage 26, the hospital residences 

Bike Security Marking

Thursday 1 June: 12 – 2pm and 4pm – 6pm

Meeting point: Garage 26, the hospital residences 

I also want to hear from you about what would help you get out and about on two feet or two wheels. Are there facilities or infrastructure improvements that would allow you to walk and cycle? Have you heard about electric bikes but never had a go on one? Just let me know!

Contact me on:

rhian.davies@sustrans.org.uk

Mob: 07788336211

Tel:  01387 246246 EXT: 36821

 

Rhian Davies is an Active Travel Officer for NHS D&G

Lochar North

Crichton Hall

Bankend Road

Dumfries

DG1 4TG

 

 

 

 

 

Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

Preparation of a typhoid shot in the medical clinicThe advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

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In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

 
From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.

 

Why do we need OPAT?

 
In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

 
Main aims of OPAT.

 
Clinical
To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
Patient.
image3Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Organisational.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

 
We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.

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Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.

Be Prepared ….Have the Power by Graham Abrines

I think all of us would agree that making informed decisions for ourselves or others is one of the most responsible and indeed worthwhile things we do on a regular basis. It’s something we largely take for granted.

It’s only when matters begin to stray from the norm that we question our or others ability to make informed decisions. How many of us have parents, aunt’s uncle’s, partners even whose steady decline is becoming increasingly evident? Bring that same question into the professional arena; it will be more relevant for some than others, watching patients who you may have known for some time or perhaps only just met who are just struggling to make informed decisions.

Having conversations with people, whatever the context, about their wishes around how they want to be supported when they are not in a position to make informed decisions is important. It’s important for a whole raft of reason. The primary one for me; knowing how that person wants to be treated, cared for and supported  when they are unable to make informed decisions for themselves!

That’s why we all need to be better prepared

The message is quite simple if you have family members, patients or even yourself, who haven’t yet thought about how they would like to be supported if they lose the ability to make informed decisions for themselves then now is a good time to consider doing something about it.

Power of Attorney (POA) allows people, whilst they still have full decision making capacity, to state how they want to be treated and who and it can be more than one person, should be making decisions on their behalf when they are no longer able to do so. Quite simply it takes away many of the dilemmas that families and on occasion clinicians find themselves in when deciding what or what not to do in supporting the person.

There are some patients across our hospital settings, who with no POA  in place, require  an application by a family member or the local authority  for a Guardianship Order which is required to be heard in the Sheriff Court  to establish who should be making those informed decisions on their behalf. Take a moment; if that was you, or somebody you knew how does that make you feel? Particularly if you know there was an easier alternative where the person’s wishes were fully known?

POA is a legal process and the POA documents need to be very clear and detail the powers the adult proposes to grant to the prospective attorney/s.  As it’s a legal process involving a solicitor at an early point may be useful and most local solicitors should be able to assist in the drafting of a POA and can provide legal advice on this matter. A solicitor will charge a fee for this service.

Over the next number of weeks the Health & Social Care Partnership, via work within the Delayed Discharge Partnership, Local Authority Communications Unit & Local Authority legal services will be running a media campaign on local radio & TV supported via other methods, buses, bus shelters, flyers & local newspapers to encourage people to think about Power of Attorney.

Many of the local solicitors across our whole region, who are fully supportive of this approach will give a 10% discount to anyone wanting to progress with a POA until the end of June.

If you require further information, please contact Phyllis Wright, Regional  Statutory Mental Health Team Manager  on 03033333001 or Phyllis.wright@dumggal.gov.uk .  The Office of the Public Guardian in Scotland registers continuing and/or welfare powers of attorney under the terms of the Adults with Incapacity (Scotland) Act 2000, and their website offers full information on the POA process. www.publicguardian-scotland.gov.uk/power-of-attorney/power-of-attorney/the-power

So please, for everyone’s benefit   …. Be prepared and Have the Power of Attorney in place.

Graham Abrines is Interim General Manager Community Health and Social Care

Life in the NHS – A Personal View by Robert Allan

I have an admission to make.  Although a non executive member of NHS Dumfries and Galloway, I have never worked in the NHS at the coal face.   However, the NHS was involved at the start of my life, and I suspect the same will be true for the end.

The NHS was five years old when I was born in an NHS maternity home in Ayrshire. Within three days I was operated on for an intestinal problem, and when my mother got me home and I made my first visit to our GP, he detected a heart murmur.   So began my life and my NHS journey.

Frequent visits to Kilmarnock Infirmary and various Glasgow Hospitals became part of the pattern of my childhood.  Some appointments lasted an hour, some necessitated week long stays in hospital for more complicated tests.

In 1965 I had open heart surgery to repair an ASD (hole in the heart) and leaking mitral valve.  I made steady if slow recovery, and by the age of 17 was told I was as good as new and went off to live life.

There followed the healthiest twenty years of my life.  I got a career, I married and we started a family.  In 1984 we moved to London.

I‘d had a minor episode with a stone in the kidney in 1978, but in 1988 this returned with more serious consequences.  It dogged the next eleven years, with frequent visits and admissions to Northwick Park Hospital, and eventually successful removal of the stone in 1999 at West Middlesex Hospital.

Now that all was well, we moved back to Scotland although I continued to work in London.   Then in 2002, out of the blue, my heart problems came back to bite me.   I was hospitalised at Northwick Park, and back in Scotland sought out the expertise of the Arrythmia Team at Glasgow Royal Infirmary.   Unfortunately, after numerous tests and a third failed cardioversion, I realised I had to live with my new condition and carve out the best quality of life possible in the circumstances.  Over the next few years I collected several more LTC’s

So a lot of my time now is devoted to medical appointments and proactively managing my conditions.   It is a bit boring, but the rewards are a quality of life denied to many suffering from the same or similar LTC’s.

My journey so far has taught me many lessons, and I have seen the best and the worst of the NHS.   Here are some of the lessons.

The patient is not always right, but has the right to be wrong.   It is their life.

Only the patient experiences the patient journey from beginning to end.

No one cares more about my health than I do.

No hospital maintains the same quality throughout.  One hospital I attended had its maternity unit put into special measures and several other wards were a disgrace.   But End of Life Care and Cardiology were outstanding.   Another, an old crumbling Victorian edifice with poor facilities, gave some wonderful nursing and clinical care through dedicated teams. It has now been demolished and a new hospital built on the site.

Patient empowerment and patient self management see much better outcomes than leaving it all to the doctor. Taking responsibility for your health is a great way of ensuring the best quality of life possible, and the best from the NHS. Managing our health should be a partnership between patient and clinicians.

I now have multiple Long Term Conditions and mobility issues, but still maintain the best quality of life possible through self managing my health and proactively seeking information on my lifestyle and health conditions.

I became an elected non executive member of NHSDG in 2012 knowing that making even the slightest difference for the better was important. Drive for continuous improvement maintains my sense of purpose.  I bring to the table experience gained from a life in the NHS, and a career in public service spanning over 40 years.    In 2014 I was appointed as a non executive member..

I know the NHS is not perfect, and never will be, but it is a fine organisation staffed by many dedicated and highly skilled people who every day do their best.

The NHS today faces many challenges.  Staff will experience frequent changes and difficulties, but so will patients.   Both need to embrace change and accept that we must do things differently if the NHS is to face the future fit for purpose.  And key is for us the patients to take responsibility for managing our own health, and clinicians and health professionals empowering us to do so.

The future should be bright for the NHS, but success will require hard work, tough decisions, and the support of patients and staff alike.

I am looking forward to many more years of life in the NHS.

Robert Allan is a Non Executive Member of the NHS Dumfries and Galloway Health Board.

Speaking Up (or keep your head down and say nothing) by Alice Wilson and Graham Stewart

“Whistleblowing” :-

Alice W 1

is the act of drawing public attention, or the attention of an authority figure, to perceived wrongdoing, misconduct, unethical activity within public, private or third-sector organisations. Corruption, fraud, bullying, health and safety violation, cover-ups and discrimination are common activities highlighted by whistleblowers.”

Whistleblowing has some negative connotations but what does it really mean: how safe would you feel to raise concerns or speak out about issues that worried you?

Why would you want to speak up? We’ve all seen the headlines about Whistleblowers feeling they have been treated badly by employers for speaking up about concerns or heard others suggesting it’s easier and better to keep your head down and not get involved.

What if you do that – keep your head down and not get involved? What would you say if something happened that you think or know could have been avoided – would you just say “I could have told you that was going to happen?”

If you could tell something was going to happen, why don’t you?

Alice W 2Don’t we all have a responsibility to get involved in the NHS to ensure patient safety and high quality care ?

There are reasons why people don’t speak up, mainly because they don’t feel safe to do it. NHS Dumfries and Galloway’s job is to make it safe… not just talk about it being safe but genuinely to make it ok, to make people feel glad they had the courage to speak and to hear and act on the message.

First of all it’s important to understand when a concern becomes Whistleblowing or – to use the legal speak a “qualifying disclosure”. Put simply a qualifying disclosure is a concern raised by a member of staff where they have a genuine and reasonable belief of wrongdoing in one the following categories:

  • A criminal offence
  • A miscarriage of justice
  • An act creating risk to health and safety
  • An act causing damage to the environment
  • A breach of any other legal obligation or
  • Concealment of any of the above

We have all heard examples of where things have gone badly wrong in health and social care, resulting in serious injury or death.

Whistleblowing is a means to reduce the chances of something like this going undetected.

In many cases staff knew there was a problem or had a concern about safety, however the culture of their organisation meant they didn’t speak up.

Whistleblowing provides a mechanism to allow individuals to speak up about something they know is wrong or dangerous

Alice W 3By having two independent whistleblowing “champions” at hand staff can be assured that they can raise their concerns in private (which can be over a cup of coffee and ‘off-site’) whilst knowing their anonymity is fully protected.

 It doesn’t happen everyday.

Whistleblowing issues are not a daily occurrence; often staff concerns can be raised with their manager and resolved however you can also speak to your trade union or professional organisation for advice.

Whisltblowing is not an avenue to take simply because you disagree with your manager or feel you haven’t been listened to (there are other formal HR policies that apply in these situations). Whislteblowing is there to allow staff to raise concerns as highlighted above in a confidential manner so that issues around safety and security can be looked at to assess whether there are real concerns.

NHS Dumfries & Galloway also has two members of staff who you can go to for advice, that’s us and our contact details are:

 

Graham Stewart                                                                               Alice Wilson

graham.stewart@nhs.net                                                               alice.wilson@nhs.net

01387 244033                                                                                  01387 272789

What would make it safe for you?

If you feel safe to speak up that is really positive; in the last staff survey 57% of the staff who responded said they felt safe to raise concerns but that leaves 43% of the staff who responded who didn’t say they felt safe (Staff Survey return rate for the Board was 41%)

Tell us:

  • What makes speaking up safe?
  • What prevents you from speaking up

We’d like to hear from you, either directly or through someone else, if there are things we could do to help staff speak up

Alice Wilson is Deputy Nurse Director and Graham Stewart is Deputy Director of Finance at NHS Dumfries and Galloway

The QI Hub by Wendy Chambers

 

 Wendy C 1

 

Wednesday 19th of April – Marks the official launch of The Quality Improvement Hub for Dumfries and Galloway

Our vision: To support health and social care staff to design and deliver services that better meet the changing needs and aspirations of people, families and communities that access care.

The purpose: Quality is everyone’s responsibility. We aim to build a culture where continuous improvement is the norm and develop a network to share resources, learn and work together, to make it easier to do the right thing at the right time, every time.

Wendy C 2The QI Hub is a creative space where you can connect with others throughout health & social care, people with a passion to make a difference. Thinking space, away from the hustle & bustle that is daily life!! Come and find a supportive network of colleagues, share experiences and learning. Choose from a library of resources and practical tools to help structure your improvement projects and explore development and coaching opportunities.

Wendy C 3Building capability and capacity to lead improvement is vital, it empowers people and teams to own change; one resource available is a locally delivered Scottish Improvement Skills Programme. To illustrate how this is already having impact Wendy Chambers, who has recently graduated from Cohort 1, shares her reflections.

3 lessons from Scottish Improvement Skills (SIS) in D&G

Having recently completed cohort 1 of the SIS course in Dumfries, with a project that hasn’t gone quite according to plan, I thought I’d share 3 things I’ve learned along the way.

Lesson 1 – I’m not alone

I’ve always been comfortable questioning my own clinical practice; to be honest I ask “why” and “how” about most things in life; it drives my other half, and now as a parent I can appreciate must have driven my parents, mad! For me though questioning things is a reason why I get out of bed in the morning and keeps my job interesting and challenging. But in my 20 plus years of clinical practice, in many different settings, I’m acutely aware that not everyone thinks as I do…. then came SIS.

I walked into a room, filled with 30 other people, on the first day of the course and I felt like I had arrived, I’d come home! These were my people, this was my tribe – we spoke the same language, had the same fire in our bellies and were comfortable with the “what if …” questions!

Wendy C 4Being surrounded by similar and like minded people; learning from each other, sharing ideas, both the things that go well and the things that fail – I’ve come to appreciate that this support is essential to the process of implementing and testing change ideas. Because when I go back out into the real world, with all its pressures and realities, the natives won’t necessarily be as welcoming or receptive to my “bright ideas” and things won’t feel as cosy.  So now I won’t be alone, I’ve found my tribe, I’ve found support.

Lesson 2 – “Whose project is it anyway?”

The SIS course has given me an opportunity to consider and reflect on the process of implementing a change idea from conception through, in theory, to completion. And one of the fundamental pieces of learning for me has been – it’s all about the relationships; the people who I need to work with and who need to work together cohesively, in order to try things out.

None of us like, or take kindly, to being told what to do, regardless of how much positive evidence there may be that it’s the right thing to do. We all like to feel and be in control of our own destiny and decisions, try things out and discover for ourselves – and I’m no different from anyone else, in fact I’m possibly worse!

A change project idea that one person has come up with is exactly that – it’s their idea, their project.  It doesn’t, at that point, belong to the team for whom it is intended will be the “willing” guinea pigs to trial and develop the ideas. At that point it is “my project, not yours” and “your project, not mine”.

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I’ve had the opportunity to reflect on my current and also previous projects, consider and question when I’ve done this well and a team has taken on board an idea and really owned it and made it their own and when it has most definitely remained my idea and no one else has bought in.
And my reflections go back to the relationships and the time that I have spent in this part of the process as a whole. And I realise that the time spent in the planning, alongside and with the others who will be involved and affected by the change idea is essential to the process, not the icing on the cake.

This isn’t new, or rocket science, any leadership book or workshop will include this – but we rarely have the luxury of “thinking space” to reflect on our learning.  And having a space, such as the SIS course, where failure is seen as valuable a part of learning as success has been enlightening, reassuring – it feels like home.

Lesson 3 – Skills

Apart from the thinking and reflection space the SIS course has also given me an opportunity to learn some real, practical skills and to relearn some old ones. I feel as if I now have a working toolbox of things which I can use and try out next time around, and every time around, when my next bright idea pops up.  I also have access to a whole tribe of people who can help me when I get stuck – which I will.

Wendy C 6

Old dogs, New tricks, nothing new under the sun.

But in the current health and social care climate things have never felt so uncertain, it’s all about change and innovation. We are all being expected to get comfortable in a world which is full of discomfort and will be constantly shifting. In this world my learning and reflection would be – get skilled, take time building relationships, find your tribe!

 Wendy C 7

Wendy Chambers is  a Mental Health Occupational Therapist and AHP Practice Education Lead at NHS Dumfries and Galloway

The QI Hub is for you and your team and you’re invited to actively contribute. Your ideas, knowledge and experiences are crucial to ensure the hub provides what you want!

Join us on Wednesday 19th April 2017, Conference Room, Crichton Hall. Programme and registration available by contacting Stevie.johnstone@nhs.net

QI Hub Development Team

An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology