what you get here

This is not a blog which expresses instant opinions on current events. It rather uses incidents, books (old and new), links and papers as jumping-off points for some reflections about our social endeavours.
So old posts are as good as new! And lots of useful links!

Saturday, November 19, 2011

mainline medical experience

So many books and paintings accumulated in 7 months in Sofia - that moving flats (back to the warmer one I had 3 years ago) proved more strenuous than I had imagined. Perhaps that’s why my big toe decided to swell – and led to more contact with the medical systems here in Sofia. The local medical centre decided after only a brief conversation that this was not for them and directed me to the Military Hospital nearby. It must be one of the largest buildings in the city – only a couple of bus-stops from the new flat off Hristo Botev Bvd. A friendly receptionist and passerby had me at a doctor in a few minutes who decided I needed to see a dermatologist. It was 13.50 when I reached the relevant corridor – and became an early part of a queue which steadily built up over the next 45 minutes with no sign of life inside the door a notice on which told us that consultations started at 14.00. Eventually a couple of women arrived – and, after 10 minutes, started to take people. I was told that I needed to have a blood test and to return with the result at 14.00 next day. A note was duly written specifying the checks which were needed after which I asked about payment. I was told that the charge was 15 euros and that I would have to go the 18th floor to make the payment – if, that is, I wanted a receipt. As I didn’t, the payment was made on the spot. I have to wonder hpw many others do the same thing. It depends presumably on whether the cash is subsequently reimbursed. The doctor gave me her business card and indicated her mobile number.
The “army laboratory” was closed by the time I reached it. At 08.30 the next day, I therefore joined another queue which moved quickly and paid another 15 euros to a receptionist who duly typed up the specification. After a 5 minute wait, I was admitted to the surgery – and asked for the doctor’s name (which was clearly not on the note she had written). Any statistics will therefore show the amount of blood tests given – but will be unable to attribute the source of demand.

At 11.00 I returned, as requested, for the result; and at 14.00 presented myself at the doctor’s cabinet clutching said results. I was alone – and again no sign of life. Another friendly doctor checked and told me the doctor had left the hospital for the day - it transpired that her daughter was ill and she had forgotten about the appointment. I have to return at 08.30 Monday – although I was duly warned that the people I am dealing with are diagnosticians only and that I will need to be referred elsewhere for treatment.

This compartmentalization is what I find so difficult about the medical systems everywhere – in Scotland I had a MRI scan for my weak knees a few years back and all the guy could tell me was that I had no physical debility. No advice on other options to pursue. I have had to assume that it is arthritic. Not surprising that I have lost confidence in medics. Either they are generalists – or diagnosticians – who merely refer. Or specialists who are trained only to identify and deal with their own specialism. As the old truism has it – “if all you have is a hammer, everything looks like a nail”! Apparently we owe this saying to Maslow – of self-actualisation fame

Not much time for thinking or reading about weightier matters – but a couple of posts which seem to me to go to the essence of the Euro crisis and also here.

The Western interventions of the past 15 years have seen a lot of political and academic rationalisations and protests; and few considered analyses. A recent, short book by a couple of people with very extensive personal experience promises to right the balance. It’s “Can Intervention Work?” A New York Times article had this to say about it -
Rory Stewart castigates the international community for its irrelevant data sets, flow charts and attempts to define “best practices.” He worries that “a culture of country experts has been replaced by a culture of consultants” who travel everywhere with jargon: “Lofty abstractions such as ‘ungoverned space,’ ‘the rule of law’ and ‘the legitimate monopoly on the use of violence’ are so difficult to apply to an Afghan village that it was almost impossible to know when they were failing.” At Harvard, where he directed a human rights center, Stewart struggled to convince his congenitally optimistic American students of his stark conclusion: “The international community necessarily lacked the knowledge, the power and the legitimacy to engage with politics at a local provincial level.” If we are to intervene at all, we must do so with modest expectations and a sure sense that “less is often more” and that “we had no moral obligation to do what we could not do.” In a companion essay, Stewart’s former Harvard colleague Gerald Knaus defends the West’s intervention in Bosnia while arguing for an ethic of “principled incrementalism.” While “there is encouraging evidence that limited missions in support of peace agreements and with sufficient resources can produce a good result,” he concludes, the prospects for “nation-building under fire” are much worse
.Finally two sets of wonderful paintings - by Scottish and Russian women of more than a century ago.

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