Three generations of surgeons, born in the wilderness by @fanusdreyer


Olifantshoek is a small town in the south-east corner of the Kalahari desert, in a “poort” where a seasonal river flows through. Seasons here are measured in years or decades, not months, but there is enough water so that the town dam only occasionally runs dry. In the Northern Cape and southern Namibia children regularly get to school age without ever having seen rain. In the 1920’s my grandfather was the Dutch Reformed minister in Olifantshoek.

One day in 1922 granddad travelled to Bloemfontein for the church synod. He was a bit of a technophile so he was one of the first in the region to own a car, although he did his parish visits on horseback due to the roughness of the terrain. After the synod he gave a lift home to a Rev Brink from Danielskuil, another small town on the edge of the Kalahari. They got to Danielskuil late afternoon, granddad was treated to an evening meal (the Brinks have always been superb cooks) and offered a bed for the night. He declined as his wife was nearing the end of her pregnancy and he wanted to get home that night. Rev Brink knew of a shortcut along farm roads but this had lots of gates to be opened and closed. He then offered that his six year old son could accompany Rev Dreyer, show him the shortcut and open and close the gates for him. Granddad gladly accepted and they got home by 1 am. And so it was that my future father-in-law helped my grandfather get home to my grandmother, who was expecting my father’s birth any day.


Dad grew up during severe drought and the Runderpest in the 1920’s Great Depression; the only animals still alive in Olifantshoek were donkeys. It was so dry that grandma had to send a bottle round the streets; everyone who had a little bit of donkey milk to spare would put it in the bottle so she would have just enough to feed a future ground-breaking surgeon.

In the 1950s Dad helped to develop potassium cardioplegia for open-heart surgery while working with Sir Ian Aird, got married to Mum in Edinburgh with Dr Davidson (of the internal medicine textbook) as best man, then went back to Cape Town where in 1958 he did the first technical successful heart transplant in the laboratory by swapping two dogs’ hearts; they lived three days until rejection set in. He was invited to join Dr Willem Kolff (who had built the first dialysis machine) in Cleveland, Ohio, to work on the first artificial heart programme. On his return to Cape Town he went back to general surgery because he thought heart surgery was too boring.


First patient, and a decision

It was 1975, somewhere in Southern Angola. I had decided to go for national service because I was not sure what to study. We were pions in a West-East imperialist war for future control of Angola’s riches. We drove into the ambush at dusk and James took a bullet through the ankle. Mark, James and I were lying under the same truck we were in 4 hours earlier. Angolan rain was no joke. We got his boot off; his ankle was getting bigger by the minute, and blue. We had no idea what to do, so gave him 4 Codis tablets and wrapped the ankle so we wouldn’t see the dark blood seeping through, but it looked like toilet paper on a stick. If only we had a proper medic.

The codeine-aspirin combination did not help much for James’ pain, but it made him talk. There was nothing more we could do, but lie next to him to keep him warm. And whisper. The sergeant was on the radio, trying to get an air evac. We knew the chopper pilots would not fly tonight, maybe drunk again. They’re sending an ambulance which will take hours, the road is mined.

At first light the ambulance arrives. James’ leg looks like it will fall off any moment. “Thanks boys” he says, “you’re good to sleep with”. “See you” we said.

We never saw him again but heard that the army doctors saved his leg. “Good outcome” they said. A stiff ankle gets you an honourable discharge for medical reasons. Not a good outcome for a champion 800m athlete. On an Eastern Cape farm you can ride a horse or pick-up truck; there’s no need to run.

The next week I got a message to Dad: “Please confirm that place in medical school, forget engineering”. It took me another 20 years to understand that often we can do nothing for patients except offer them comfort.


Malawi boy

It is 1985. Every time I looked at her, she seemed more uncomfortable. Her legs were more swollen every day. Pre-eclampsia is not easy in the tropics but maybe it’s not easy anywhere. It was too late to fly her out to South Africa. After the scare with premature labour at 32 weeks she was not flying anywhere anyway. She was now 38 weeks, “so we made it” we thought. Our baby was going to arrive in a small mission hospital in Nkhoma in the Malawian bush. “Time for an induction”, I said, without thinking much of informed consent. Working amongst so much extreme poverty did not give time for reflection.

With the senior midwife we started her on Pitocin on the Saturday. No contractions followed and the cervix was not yet ready. Should we rupture the membranes or wait? We decided to wait 48 hours.

We tried again Monday morning. By now the blood pressure was borderline high and there was 1+ proteinuria. If the induction fails today she would need a C-section. “Who will do the Caesar”, the midwife asks. “I will” I say, “after all, the others ask me if they have a problem case”. This time she responds well to Pitocin. Within an hour she has good contractions and the membranes rupture spontaneously. I feel for a cord but there is none. Four hours later she is fully dilated. She has a lot of pain. I’m too brusque, so focused on being a doctor that I forget to be a husband and expectant father. She has a boy, 3460g, Apgar score 10/10. I suture the episiotomy; she’s embarrassed. “Don’t worry” I say, “nobody will do this better”.

That night we all slept in the same hospital room, our new son with his mother, our two year old daughter and I on a mattress on the floor. We shared a bathroom with an AIDS patient with resistant malaria, the first HIV positive patient diagnosed in our small hospital.

Today he is 30, has taught in Africa with me, and recently we shared working together in Dumfries. A few weeks before he was born I went to an East Africa surgeons’ meeting and heard Dr Imre Loeffler speak, a Hungarian-Austrian surgeon who gave his whole life to surgery in Africa. He said that a first class surgeon could operate in a hammock slung between two palm trees on a beach and have better outcomes than a second class surgeon working in the most modern theatre. A few months later, when in South Africa to show the new boy to the family, I went to see the prof to get a training post. I started one year later.


Full circle

Before starting surgical practice in 1992 in Upington, the main town of the Kalahari, I went to see GPs in the region, and that took me to dr Jan Meyer in Olifantshoek. He promised to support me. After our meeting I thought to try and find the old Dutch Reformed manse where Dad had been born 70 years before. Dad’s brother had told me that the building commission drew the house plan in the dust with a stick, and according to that the building started. Now there was a new church and manse, and I opened the gate with the “Pastorie” sign, rang the doorbell and asked the young inhabitants if they knew where the old manse was. Nobody knew. I walked dejectedly to my car and, as I started the engine, an old man walked past; he looked part-Tswana, part-San. I rolled down the window and asked him if he maybe knew where the old NG Kerk Pastorie was. “Oh I know exactly where it is”, he said, “it is the house with a wind pump in the back garden”. I asked him to take me there and he got in, moving very slowly because of rheumatism. It was two blocks down, around the corner in a dusty street, a small little square house, still with a wind pump in the back garden, watering all sorts of vegetables and maize patches. I got out to take a picture. The owner came out and asked what I was doing. When I said my father had been born in the house he showed me round. Afterwards I drove my guide to his house in the old African township and I asked him how he knew the house. “When I was a schoolboy, I used to work there on Saturdays for a Reverend Dreyer”, he said; “He paid my school fees. If it was not for him I would not have been able to read and write”. I stopped the car and we both shed a tear for this generous and humble man whose names I wear with pride.

Jan Meyer kept his promise. The first patient I operated on after setting up practice in Upington was an elderly diabetic from Olifantshoek. His father was the lead elder when my grandfather was appointed minister. Granddad did his catechism and I took out his gallbladder; it was beginning to become gangrenous, typical of a diabetic.


My father and my son have surgical dispositions, much more than I could ever have. When the boy was working in Dumfries, staff kept telling me how he was becoming more like me. That was only half the truth as I was also learning from him. It is when the son not only emulates the father but the father subconsciously starts to emulate the boy that the relationship becomes complete, like my 93 year old father has become dependent on our conversations as much as I once needed his advice. And so we live and learn, love and one day die, in sync and at peace.


“Dear Ward 7” by Jackie Shrimpton

Dear Ward 7,

I would like to take the opportunity, afforded to me by this blog, to thank all of you on ward 7 for the care I received during my 14 day stay in June of this year. I have worked for 40 years in the NHS and all of them spent in DGRI so the thought of being an inpatient was not a terribly nice one. However there was something so special about the way I was cared for, the personal touches, the kindness, that I felt I had to put my gratitude into writing.

I became ill some years ago although at this time I did not know the severity of my illness. I had a painful right shoulder which nothing seemed to help. This got progressively worse and then about a year ago I had a brief stay in hospital with a DVT. Subsequent investigations revealed that I had breast cancer and that it had spread to my lungs and shoulder. I was devastated. Treatment commenced with radiotherapy and medications but I knew this was all ‘Palliative’. Earlier this year I became increasingly dizzy and sick and eventually had a brain scan which revealed the cancer had spread to my brain. It was now that I was admitted to ward 7.

From the moment I was admitted to ward 7 I realised I was somewhere special. The nursing staff seemed to go out of their way to make me feel comfortable, even when they were clearly busy. I have heard it said before but it can’t be said enough: at times like this it is the small things that really matter. Combing my hair to make me look nice for my family, knowing the right thing to say to cheer me up when I was down, a simple wee word here and there made all the difference. To feel that someone genuinely wants to help, to see joy in their faces when they know they have helped, means so much. One nurse said that helping me to the shower and making me feel better in myself helped her because she was not coming to me to inject something or do something to me.

I am particularly indebted to Dr Finlay. She was obviously busy and had many patients to care for but never made me feel this way. I was made to feel important and all decisions that had to be made were made with me, not for me. She went above and beyond and I viewed her as a person rather than a doctor. I didn’t feel silly when I struggled to understand, especially when my head was in a fug due to steroids. This was such a huge thing to me at the time. Thank you Dr Finlay.

It is sometimes easy to forget how being an inpatient with an illness like mine can affect your family. My two children and other family were clearly concerned but all said that seeing me in ward 7, speaking to the nurses looking after me, filled them with confidence and made the situation easier for them. My daughter said that she was overwhelmed with gratitude as she wasn’t spending time at work worrying that I wasn’t being cared for. This meant a lot to them and a lot to me.

To all the nurses, auxiliaries, therapists, domestics, doctors, porters, pharmacists, everyone on ward 7……Thank You. I am very proud to know you and have worked in the same hospital as you.



J Shrimpton

Top of the Pops (My Top Ten) by @gbhaining

Gladys H 1This blog is to celebrate the fact that after twenty seven years I have taken the life changing decision to retire from NHS Dumfries and Galloway. I have had the honour and privilege of being the Alzheimer Scotland Dementia Nurse Consultant for the past two and a half years.

This is an effort to describe some of the work undertaken during my time as nurse consultant and I had an idea that I’d try to link it to popular songs thus the rather dated Top of the Pops theme.

I must say that I’ve gone with the titles in the hope that some of the lyrics reflect my comments.

So let’s begin. 

  1. Another Brick in the Wall (Pink Floyd). I was delighted to be appointed as Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway in December 2012. This was a new post and with the support of others I pretty much developed and evolved the post in keeping with the national standards, strategies and drivers. I believe I have built the foundations required to take this agenda forward.


  1. We are the Champions (Queen). In the past two and a half years I have had the absolute privilege of leading and supporting Dumfries and Galloway’s Dementia Champions. I have to say they work extremely hard advocating the best care for people with dementia when they have to be admitted to our acute and community hospitals. This is one of the pieces of work that I am extremely proud of and I want to thank each and every one of them for being so motivated, enthusiastic and most of all for engaging with me.


  1. Long and Winding Road (The Beatles).This journey has been challenging however I have built up some excellent professional relationships. I have flown the flag for dementia and I truly believe there is a far greater understanding of the needs of this group of people. I believe we have turned some of the corners and I’m sure as an organisation we will continue to do so.


  1. Feeling Good (Nina Simone).I think that there is a great willingness to work together to make services person centred and to deliver care at the right time and in the right place. This fills me with pride and optimism.

 Gladys H 2

  1. Funny How Time Slips Away (Willie Nelson).Personally it feels like yesterday I was starting my nurse training and trying to figure out how to put my nurses’ hat together! I’ve had a fantastic career and learnt so much over the years. I’ve worked with some fantastic people who’ve encouraged, nurtured and seen my potential. That’s something I will be eternally grateful for. We all need to do this and help people develop and reach their maximum potential.


  1. 9-5 (Dolly Parton). Although it should read 8.30am – 5pm there will be no more “Working 9-5” for me!


  1. 40 Hour Week (Alabama). Time now to rest, relax and enjoy my family life, catch up with friends and find time for all those things I’ve always put off.


  1. It’s Five o’clock somewhere (Alan Jackson and Jimmy Buffet). Self explanatory I think!


  1. When All Is Said and Done (ABBA).I hope that I have left the beginnings of a legacy for people living with dementia, their families and carers and that they will recognise a change as this work continues. We never know the time when we, our families and friends will require services and I’m sure we will continue to strive to deliver the best standards of care for all our citizens.



  1. So Long, Farewell (Rogers and Hammerstein – The Sound of Music).I officially retire on the 28th August. I wish all my colleagues and friends well and want to say thank you so much for everything!!

Gladys H 3Gladys Haining is an Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway.






Mental Health Change Programme by Ian Hancock

Government policy, changing demographics, epidemiology, health inequalities and increasing public expectations services, requires NHS Scotland to flex and bend to meet healthcare needs of the Scottish public.

Ian Cock 1The challenges faced by NHS Dumfries and Galloway Mental Health Service Directorate are no different from the national perspective, and have required innovative thinking which have seen the development of better ways of working.

The demographic changes facing Scotland are well documented, with the number of people in Scotland aged over 65 projected to increase by 22% by 2020, and by 63% by 2035. The over 75 population is predicted to increase by 23% and 82% over the same period and the over 85 population will increase by 39% by 2020 and 147% by 2035. Our current service will need to adapt to meet the healthcare needs of this growing population

Ian Cock 2We all recognise the benefits of keeping people at home, or within a homely setting, as close to their family, friends and local community. The Mental Health Service works closely with patients, carers, statutory and third sector colleagues to provide services that, wherever possible, prevent unnecessary hospital admission. There are, however, times when admission to a hospital is necessary and with this in mind, we have been developing our services over a number of years, and have seen a huge shift from hospital based care to community settings. We need to capitalise on our previous successes and have identified ways in which we plan to move ahead over the coming years.

Ian Cock 4The Mental Health Service Directorate comprises of four large component service teams (Mental Health, Learning Disability, Substance Misuse and Psychology) and within these teams there are a range of individuals from different professional backgrounds (nurses, AHPs, administrative staff, HCSW, Medical Staff, Psychology, and workforce business partners from Workforce Directorate, Finance). We have 2 in patient units based in Midpark, and in Darataigh in Stranraer, and have numerous community bases across all 4 localities

Ian Cock 6Over the next few years, the Mental Health Directorate will continue to strive to provide care that aligns with contemporary healthcare policy and legislation, and do this in a collaborative way with our stakeholders. In order for us to ensure appropriate services are being delivered, and that will meet the health needs of the general public of Dumfries and Galloway, we will continue to focus on a number of specific areas.

We will consider ways in which our inpatient beds are configured and consider opportunities to improve individual’s experience of in patient care, whilst developing inpatient services in line with our changing demographics. Services will be based on patient need rather than age.

We will support and evaluate the current 24/7Crisis Assessment and Treatment Pilot Service (CATS), based in the Out of Hours/Accident and Emergency Unit

We will develop our IDEAS (Interventions for Dementia, Education, Assessment & Support ) Service, a team designed to enhance skills in statutory and non statutory services specifically for individuals with a diagnosis of dementia.

We will develop a model of care that takes into account the challenges associated with our more remote and rural areas.

We will develop services which provide early interventions for people with memory problems, and develop Health Care Support Workers to work with families living with dementia.

This is an exciting time with significant challenges to face. We think, however, that we can offer a modern and effective service, within budget, but that such successes will inevitably rely on continuing to build strong working relationships with our service users, carers, and families, colleagues from all health and social care settings, and third sector partners.

Ian Hancock is the General Manager for the Mental Health, Learning Disability, Substance Misuse and Psychological Services Directorate