Hodges' Model: Welcome to the QUAD: November 2019

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Saturday, November 30, 2019

iii RCGP’s 7th Health and Justice Summit ...

Returning to Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’

In February this year the Independent Advisory Panel on Deaths in Custody (IAP) and the national newspaper for people in prison, Inside Time, began a ground-breaking collaboration - Keeping Safe - to help keep people in prison safe. Supported by the Samaritans and Prison Radio, the IAP called on Inside Time readers to say how best to prevent suicide and self-harm. Prisoners’ recommendations in this Inside Time special report reflect evidence from, and recommendations made repeatedly by, amongst others, the Prisons and Probation Ombudsman, HM Chief Inspector of Prisons, the Chief Coroner and the National Audit Office.
Ms Lyon spoke of the clinical context, hope and time:

What was done in the  ::   Being in Prison  ::    What might be done in the
Past                        Now                             Future

Mention was made of a 'Keeping Safe' event in February 2020. If I learn more, I will add details.

Mark Langridge took us through some technology developments in healthcare as Care UK National Lead Pharmacist:

Socrates (with reference to 5-domains of well-being)

There was discussion of "Opt-out" in respect to population screening for antibody positive screening tests and how the question is framed:

"Want your bloods done, luv?"

"We test everyone because    ...
is that OK with you?"

On day 2 Suzy Diamond-White, Governor at HMP Eastwood Park shared management experiences and the quest for change in ‘Delivering Health and Wellbeing in a Women’s Prison’
A look at how health services are delivered within the operational demands of daily life at Eastwood Park given its complex population and wide geographical catchment area. How we keep wellbeing on the agenda to support our contracted health teams. What is so specific about a women’s prison? What needs to be overcome to ensure equivalent service to the community.
Gender was obviously fundamental here, the fit and appropriateness of P.E. kits, the procurement and supply of sanitary towels and incontinence pads. What is 'hygiene' being accounted for through a 'cleaning' budget and other historical legacies to be challenged. The geographical range of Eastwood Park across nine counties and all the consequences for family and children. Talk of prison as a punishment and the public's view was echoed a few times at the summit.

Elizabeth Moody, Deputy Ombudsman at Prisons and Probation Ombudsman provided more reflection on deaths in custody, stressing the families affected by and need for action and lessons to be learned. High profile cases were mentioned in several presentations. The talk gave me a sense on one hand of what families must go through, especially when circumstances suddenly engulfs an individual in the criminal justice system. The work that independent agencies do behind the headlines and sometimes in the midst of them

Chantal Edge, NIHR Clinical Doctoral Research Fellow for Department of Epidemiology and Public Health described research on “Systems barriers to telemedicine in prisons”.
Experiences of systems barriers (prison and hospital/community) encountered in England whilst attempting to operationalise a local prison-hospital telemedicine model, alongside broader evidence on prison telemedicine implementation barriers drawn from a systematic qualitative literature review of published prison telemedicine evidence.
I was late arriving to this session. As per my thoughts concerning Dr Matthew Langley's presentation the potential socio-technical studies might provide some insights?

Although it is also a commercial vehicle, Raconteur published with The Times had a special report on 5G in June. In a similar way to my references to the 5-Care-Domains of Hodges' model, many people talk of 5G and its speed, without fully understanding the change and opportunities this can bring. The report's summary:
"5G is so much more than faster 4G, but the extraordinary hype surrounding it has left many confused over what it will actually do for them. The 5G special report, published in The Times aims to shine light on this, exploring how 5G can transform healthcare and make smart roads a reality ahead of autonomous cars. It covers how to address public concerns over the health impacts of 5G and examines whether the rush to be first in the 5G race is a fool’s errand, with comment on how it might be better to deploy 5G best, rather than deploy it first. Also featured is an infographic measuring the true impact of 5G and looking at the sectors which stand to benefit the most ..."
Page 3 is enlightening.

Chantal provided some copies of an associated paper:

Edge, C., Black, G., King, E., George, J., Patel, S., & Hayward, A. (2019). Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X19869131

Rachel Gibbs "Equalizing Spaces"
Rachel Gibbs, Assistant Director for Prison Healthcare Services for Northern Ireland shared a travel fellowship “Equalising Spaces”.
Rachel Gibbs was awarded a Winston Churchill Memorial Trust Fellowship in 2019. She will share learning from her visits to Prison Healthcare services/Transitions clinics/Harm reduction rooms in California, North Dakota, New York, Barcelona, Geneva and Stockholm over an eight week period in order to being back innovative ideas to the UK. She will share some of the user involvement work happening in Northern Ireland.

Churchill Fellowship

The title of this session including 'spaces' had my immediate attention and did not disappoint. Rachel's Gibbs also provided help in making me feel a little less guilty in the future. Rachel highlighted and reminded me of the value of travel in the exchange, transfusion and diffusion of ideas, a difficult equation to resolve in these flight-shaming days.

Rachel Gibbs - findings
I do wonder what a global consensus would be on models of care, nursing theory and what other continents have to say (if anything?) on this topic that might inform my study of Hodges' model. Rachel recounted her travels and learning not just from her peers but from prisoners and ex-prisoners. Existing awareness of international health and justice provision was used to focus countries to visit.

Rachel shared her time with:

Transitions Clinic Network (TCN), USA.

One Day at a time
Empowering youth to lead positive lives

Hodges' model repeatedly 'takes' me to spaces of all kinds and also transitions:

Life course - infant - child - teens - adult - older adult - end of life
Life course - infant - child - teens - adult - older adult - end of life :: Diagnosis X (Rare?)
Health - Social Care
Critical information giving :: Pre - Post
Adult service - Older Adult Services
Looked after Children - Adult
Younger Adult, Adult, Older Adult :: Early Onset Dementia
Home care - Day care - Respite care - Residential Care
Continuing Health Care
Justice and Health
Veteran - Civilian
Formative education - Lifelong learning
Health - Trauma - Intensive Treatment - Return Home
and other Transitions (Prevention!) ...

We often think of tools and the need for them to be ready to hand, as in organising your workspace. Increasingly as the list above suggests there is a need for tools to help keep things 'close to mind' also.

Professor Graeme Henderson (School of Physiology, Pharmacology and Neuroscience for The University of Bristol) gave a serious and yet entertaining talk on“Why are fentanyls so deadly?”
Fentanyls are highly potent opioid agonists. Only small quantities are required to produce their effects and this may make them attractive drugs for smuggling into prisons. fentanyls have pharmacological properties that make them more likely to lead to overdose than other opioids – in addition to their high potency and rapid onset of action these drugs induce respiratory muscle stiffness making it difficult to breath, are less sensitive than heroin to naloxone reversal and may show reduced cross tolerance to other opioids.
Prof Henderson provided statistics that had you paying notice, supporting the first answers to the title:
  • High potency
  • Faster rate of onset of respiratory depression
  • Muscle stiffness (wooden chest) making it harder to breathe
  • Lower cross tolerance between heroin and fentanyl
  • Resistance to naloxone reversal
The Chairs for the summit had quite rightly drew delegates attention to the exhibitors, so I was a bit late again here. The photo is not very good, but brings home the potency of fentanyl. (That is Prof Henderson in the biohazard suit.)

... (still) to be completed - part iv to follow ...

Thursday, November 28, 2019

ii RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Before moving to day 2 ...

- the keynote by Cllr Asher Craig Deputy Mayor (Communities, Equalities & Public Health) at St George West Ward and Bristol City Council provided a city-wide perspective on public health, public mental health, the lived experience of child poverty and with it adverse childhood experiences, the impact of institutional racism and deaths in custody. I've taken more notice locally of community initiatives and sadly note speaking to what was once a local authority day care centre is now a social enterprise with uncertainty about its future. Cllr Craig spoke of Bristol's One City Approach and Learning Circles.

I attended Dr James Matheson's workshop, a GP at Hill Top Surgery and three medical students at Manchester Medical School - “Resources for primary care support to people in contact with the criminal justice system and their equally-affected others”

"Whilst the GP workforce is short, never have we had so many GPs in training. Is general training enough without extra specialist skills training on top? How then do we create and deliver a curriculum to inspire and prepare the next generation adequately for the challenges they will face?"
With posts to follow reviewing Kinchin's book the care environment presented by prison health  seems to encourage a network approach to learning, not merely linear - procedural - chain like approaches. As air safety methods demonstrate (outside of recent design?) checklists have their vital place as a heuristic and decision-making algorithm, but prison immediately challenges a student's attitudes, their expectations of themselves and others. Meeting prisoners crystalises a focus on self-awareness, what is subjective, objective, verbal and non-verbal communication. As per the synopsis the enthusiasm and feedback of the students to their learning was great to hear.

In addition to the student's contributions Dr Matheson highlighted inequality and referenced the "Deaths of Despair" that we have reached.

Another by Dr Matthew Langley, Consultant Forensic Psychiatrist for Rampton Hospital addressed:
“Remote vital signs and activity monitoring”.

"Early experiences with remote vital signs monitoring technology in High Secure (Women’s) Coral Ward (NHSHSW) is trialling Oxehealth’s remote vital signs and activity monitoring system. This is an innovative solution to support our staff but also presents challenges to integrate effectively. This presentation will discuss initial feedback from staff and patients and investigate our experience as a service with this new technology."
This project was already underway when Dr Langley returned to work at Rampton. Apparently the technology is very effective, Dr Langley trying it himself. Risk is a cost-rationaliser and here the risk is acute. Generally in health care professionals will need to weigh the ethical pressures in adopting technology. Technology will be a factor in making health care (and universal health care) sustainable, but as with electronic health records and their benefits the latter need to be assured. Does a technology 'solution' really free senior staff to focus on more 'complex' work?

I did not ask in session Dr Langley about his awareness of work on socio-technical approaches and Enid Mumford's work. At coffee we had a chat and will follow up with some information. I am very much an advocate for technology - students expect no less, the public look at what we do, the way we work and rightly wonder: wither the technology?

Another concern, however, is the word 'recognition'. Facial recognition is already politically and ethically loaded. States are deploying this technology with 'emotional recognition', so careful consideration and critique is needed (imho).

Sarah Bromley, National Medical Director Health in Justice at Care UK, covered:
“Patient Safety and Quality in Prisons”
"Deaths in Custody are still rising and the PPO have identified repeat recommendations that continue to contribute to deaths. How do we learn lessons and implement change and how do we know when we have been successful. Dr Sarah Bromley will discuss the challenges faced, the Care UK PROTECT programme and quality assurance measures in use."
Sarah appealed to my 'information-oriented' focus, as it was noted how teams can still reach a point with a new referral / patient ' client and question:

"Have we got more information"?
"Oh, right."

They then elect to carry on without this (acute - in contrast to the uncertainty it represents?) need being pursued and fulfilled. A useful distinction was made by Sarah between training for staff - Wellbeing approach, ASSIST training 2-days on self-harm and suicidality, TRIM training; and support for staff who experience extreme trauma, clinical supervision and clinical forums.

There are subjects that need regular update and so I was very grateful for:

Dr Iain Brew, Deputy National Medical Director of Health in Justice Medicines Safety and
“Hepatitis C – developments and outcomes”.

This was very helpful personally as a nurse, and in the national and global objectives that have been set. With Hodges' model incorporating an individual -- group (population) axis and a Political care domain two further talks were greatly appreciated:

Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’ Ms Lyon explained feedback from prisoners on how "... you get the odd officer who really takes care and really wants to do something but there should be an officer on every landing who spends at least twenty minutes with one prisoner at a time through the time he is there and understand him and get to know him rather him just being a number ...".

A comment Ms Lyon made concerned the training of prison officers. The time is limited. I spoke briefly to Ms Lyon as there is a resource that imho should be a part of all course 101's and again I will reach for the email. This resource might help many prisoners too. One of the needs identified was prevention, improving prisoner - officer relationships and preparation for release. It must surely help in all of these if prisoners themselves were better equipped to reflect and have a better relationship with themselves? Self-esteem counts for a great deal and whether inside or out it seems many prisoner's self-esteem is challenged, even if sufficiently coherent and emotionally mature?

A quote also struck a chord: "All my life just got the better of me since aged 13" and a self-harmer.

And, Dr Brad Hillier, Consultant Forensic Psychiatrist at Heathrow Immigration and Removal Centres on “Mental Health and Substance Misuse in the Immigration Estate”. A topic that is clinically remote to me and yet conceptually 'visible'. Visible through geopsychiatry, the impacts of conflict, enforced migration.

Dr Hillier outlined the history of immigration removal in the UK from "Immigration Act Prisoners"
1970 - small detention unit in Harmondsworth, similar units in Dover and Gatwick.
Most IAPs held in prisons (180 in 1982).
1993 - Campsfield House converted from prison to IRC
Current system dates from around 2001-6
Home Office Policy to detain and deport developed
Detention Centre Rules (2001 - statutory instrument)
Immigration Detainees

More background on 'Routes into Detention'; the impact of detention on mental health (Von Werthem et al. 2018; Adult at Risk and Rule 35 - consideration for release on medical/professional evidence that there is a history/evidence of
  • Torture/trauma
  • self-harm
  • Health condition (mental and physical) ...;
and Issues on removal / release.

This insight was new for me.

Although the programme is primarily divided between plenary sessions and workshops, the workshops - at least those I attended are essentially presentations. The room layouts reflected this. A workshop for me should have an audience work.

More to follow ...

Wednesday, November 27, 2019

i RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Day one of my second Health & Justice Summit was very enjoyable and informative. The title even had me wondering whether I have inadvertantly referred online, or in conversation to the conference as 'Justice & Health'. This one, like January's in Liverpool demonstrates the balancing act that is: health (care) and justice.

Sometimes given the all-encompassing nature of Hodges' model you might think nothing stood out on day one. There is key learning here for me as on Monday I take on a ready-made caseload with an 'Adult' Community Mental Health Team. The team / service designations (Adult / Older Adult) are not mine (but, yes I am part of this 'system') and within teams due attention is given to ageism and 'where' patients are best suited whatever their age. While not specifically prison health, the new part-time role includes references to substance misuse, self-harm, history of violence, personality disorder and post-traumatic stress disorder. (The current political context was also acknowledged and applied on several occasions.)

As I start to write this (25th Nov) PM on BBC Radio 4 is deliberating on violent incidents and the need to toughen up on sentences, the glamourising of certain lifestyles and expectations for life chances, employment, police numbers, youth services, political manifestos, social media and understanding 'all this'. Amid what is a complex background the event's agenda was context packed, but for me several sessions stood out.

Suicide and Self-Harm across the Criminal Justice Pathway with Dr Louise Robinson
Suicide and Self-Harm across the Criminal Justice Pathway
with Dr Louise Robinson

Prison health is a challenging context. The prison health community are not just asking hard questions, they are clearly researching them, as in 'Suicide and Self-Harm across the Criminal Justice Pathway' with Dr Louise Robinson. The research pathway was outlined. Interventions discussed included 'skin camouflage' for self-harm; and Psychodynamic Interpersonal Therapy [PIT].

The development of the study from feasibility to WORSHIP I & "Women Offenders Self Harm Intervention Pilot I":

Walker, T., Shaw, J., Turpin, C., Reid, C., & Abel, K. (2017) The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm, The Journal of Forensic Psychiatry & Psychology, 28:2, 158-171, DOI: 10.1080/14789949.2017.1301529

- through to the latest WORSHIP III. It must be marvellous to be part of evidence-based thought and practice development and with future plans delineated: Complete WORSHIP III, COVER RCT; Cell-Soothe and PrisScope.

Miranda Davies of the Nuffield Trust reported work on "Prisoners' use of hospital services in 2017/18. Many were shocked hearing that 31% prisoners miss out-patient appointments, in contrast to a general did-not-attend - DNA rate of 8.6%. Was this due to the 'patient', or prison reasons? With frequent talk of the need for increased productivity and its neighbours of efficiency and effectiveness: this is painful. Miranda Davies also questioned the limits of hospital data: what (and how) healthcare is provided in prisons; wider aspects of the prison environment; whether researchers are capturing all the activity associated with prisoners from post code alone and coding quality.

Defining trauma

Emma Facer-Irwin explained “The role of trauma and PTSD on negative behaviours among male prisoners: Toward a model of Trauma-Informed Correctional Care in the UK”. When revising and updating - definitions are always welcome.

This definition is useful as on twitter and elsewhere you cannot fail to notice an addition to the debate, critique and vitriol on PTSD with the companion of Complex PTSD.

Differentiating between PTSD and Complex PTSD
This slide 'gave' me the lead for this blog post. It stresses the 'self' and interpersonal difficulties which can create humanistic chaos, by undermining relationships old and new 'in' the Sociological domain. The intra-personal and reflexive aspect is found in the re-experiencing centred on the inter-interpersonal domain as memory, emotional response, dreams (nightmares) and avoidance behaviours that can also affect other people.

In another session the bias, stigma and damage associated with the diagnosis of personality disorder as a 'bin' was noted. This was very positive to hear and later ('elsewhere') on twitter, negative responses in cases of self-harm in casualty by nurses were also called out. I remember this being highlighted in the late 1990s - early 2000s, a surprise that such negative attitudes from mental health professionals can still be expressed and felt.

Here in a tweet are organisers, supporters and sponsors who made the event possible:

More to follow ...

Friday, November 22, 2019

G.D.P. Capitalism pp. A.M. Holistic ...

One pivot-point or several?

HUMANISTIC -------------------------------------------------- MECHANISTIC

"A more holistic approach to
'growth' needs to evolve ...

Growth mania -

Demographics: Population Growth

 GDP per capita - new measures?

"nominal GDP growth, supported by
population growth,

... looking to capture societal and
environmental benefits and costs".

"borrowing from the future while destroying the environment".

socio -
[and profit] growth"

Gross Domestic Product [GDP]


- economics

This week there has been a major focus on Self  Care Week.

Lars Münter brought to my attention the need for an 'Economy of Wellbeing'. 

Jenkins's item in the FT refers to Milton Friedman, shareholders and stakeholders. The latter seems to be an over-used term in healthcare and health services, but there is learning in comparing and contrasting the two.

The climate emergency will change capitalism. 

Perhaps, what we need is not just an:

'Economy of Wellbeing'
as 'Economies of Wellbeing'

The presiding orientation of which must be circular.

See also:
The Friedman Doctrine, or Shareholder Theory; and Stakeholder Theory. 

My source:
Patrick Jenkins, Fund chiefs call for shift in capitalism, FT Weekend, 16-17 November 2019, p.4.

Thursday, November 21, 2019

World Philosophy Day: "Why do we need evidence of mechanisms?"

December 17th 2019, 14h30-16h00

Bordeaux Pellegrin Hospital, Rheumatology Service, 12th floor

Phyllis Illari (University College London, UK)

"Why do we need evidence of mechanisms?" A PhilInBioMed seminar

Open to all

Phyllis Illari is a Senior Lecturer at University College London (Dept of Science & Technology Studies; Faculty of Maths & Physical Sciences) in the UK. She works in the philosophy of science, with particular expertise in causality, mechanisms and information.


I will present a view of evidence of mechanisms as evidence of the activities, entities, their organization, and the phenomena they explain, using the idea of ‘minimal mechanism’ (Glennan and Illari, 2018). I will argue that this view allows us to theoretically organize an incredibly diverse array of forms of evidence and empirical practices. I will then home in on a specific way in which evidence of mechanism is crucial, arguing that it is important even for solid evidence of correlation. Any clinical study, even a well-conducted RCT, which is still one of our best methods of establishing a reliable correlation, needs decent answers to two questions: (i) what are the variables for disease, treatment and outcome? and (ii) how and when are they measured and why?

I will use the case of ‘vitamin D deficiency’ to show how important these questions are, even when they are not explicitly addressed in published results, because they are regarded as sufficiently standardised to be unimportant. Until recently, vitamin D deficiency was regarded as well-understood, reliably measurable in standardised ways, and linked to diseases such as rickets by well understood mechanisms. However, recent research has linked vitamin D deficiency to other diseases, in ways that expose the fact that different measuring techniques measure slightly different forms of Vitamin D. Those differences are now relevant.

Considering the case shows how deeply integrative our evidential pluralism needs to be, and therefore how complex our practices of reasoning about evidence are. Philosophical accounts need to be responsive to this.

For more information click here.

Best regards,

Wiebke Bretting
Dr. Wiebke Bretting
Project Manager ERC IDEM
ImmunoConcEpT, UMR5164
Université de Bordeaux
146 rue Léo Saignat
33076 Bordeaux

My source:
Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/

Wednesday, November 20, 2019

A key to Health & Art...?

HUMANISTIC -------------------------------------------------- MECHANISTIC

"When you have no power, no rights, no privacy, and no control - when your humanity is denied and your liberty revoked - creativity can still save you. That is the radical message message of The Pencil is a Key, a potent and timely exhibition at the Drawing Center in New York. ...
As Milton declared, "the mind is its own place, and in itself / Can make a Heaven of Hell, a Hell of Heaven". The pencil can be a tool in this act of self-creation. Drawing unlocks the brain's shackles, empowering the passive prisoner with private forms of dignity and escape." p.15.



Chester Brost, Devon Daniels, Joseph Dole, Francisco “Paco” Estrada, Darrell W. Fair, R Dot Nandez,
 Damon Locks, C. McLaurin, Flynard “Fly 1” Miller, Andrés Reyes, Sarah Ross,
 B.R. Shaw, Bring, Johnny Taylor. The Long Term, 2017–2018.
Video animation, 13:05 minutes. Courtesy of the artists.
Image courtesy of C. McLaurin.




My source:
Ariella Budick, The mind unlocked, Life&Arts, FT Weekend, 2-3 November 2019, p.15.

... and looking forward next week to:

RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation
Bristol, 25-26 November 2019

- on which more to follow ...

Tuesday, November 19, 2019

South Sudan Medical Journal - November 2019

South Sudan Medical Journal

The November 2019 issue is now online here and includes items on Diabetes management, FGM and perineal injuries, Nutrition surveys, Gestational choriocarcinoma, Laryngeal trauma, Tympanic membrane perforation, Acute malnutrition and Overuse of antibiotics.  See details below.

Please send us your feedback on this issue, submit your manuscripts (which we can help you prepare), encourage colleagues to join the mailing list here, follow us on twitter @SSMedJournal and our Facebook Group, and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).

  • Bringing diabetes mellitus into focus on World Diabetes Day Edward Eremugo Kenyi
  • The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania Janeth Dickson Sichone, Athanase Lilungulu, Secilia K. Ngwashemi and Agatha Ngowi
  • Analysis of trends in SMART Nutrition Survey data from South Sudan between 2004 and 2016 Ciara Hogan, Kate Golden, Regine Kopplow and Elaine Ferguson
  • Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania Zephania Saitabau Abraham, Aveline Aloyce Kahinga, Kassim Babu Mapondella, Enica Richard Massawe, Emmanuel Ole Lengine and Daudi Ntunaguzi
  • Nurses’ knowledge of the management of diabetic patients at Juba Teaching Hospital Abuk Mayen Deng, Lucia Buyanza and Fekadu M. Alemu
  • Abstracts from the Juba College of Nursing and Midwifery: Management of 3rd stage of labour Deborah Akon Akech; Danger signs of obstetric complications Kiden Harriet Oliver
  • Gestational choriocarcinoma at Juba Medical Complex and Juba Teaching Hospital: five case reports Kizza Paul, Kuma Chuol Biel, Anthony Lupai, Changkel Banak, Mirghany Abdallah and Paula Nuer
  • Laryngeal trauma at Juba Teaching Hospital, South Sudan Justin Rubena Lumaya, Jino David and Natali Tong
  • South Sudanese recipients of grants from the Gordon Memorial College Trust Fund (GMCTF) in 2019
  • Continuum of care for acute malnutrition in South Sudan
  • Public health resources

Kind regards
The SSMJ team

Copyright © 2019 Southern Sudan Medical Journal, All rights reserved.

Sunday, November 17, 2019

Patient-centred + Treatment = Self Care Week

This week 18-24th November is Self Care Week


Hodges' model might tend to have us equate 'self care' with the humanistic half of the model. As Self Care Week begins I could not help but suggest on twitter that what self care means to me is 4-fold care (or 5-fold taking in the spiritual also).

Then, continuing to read Kinchin more on threshold concepts, care and caring:
"In the case of 'caring' within the clinical sciences (e.g. Clouder, 2005), the concept may link the salient points of the personal perspective (patient-centred discourse) with the biomedical (treatment) discourse (Figure 32).

Here 'care' is seen to occupy the space that links caring as a therapeutic intervention (to the left) and caring as the nurse-patient interpersonal relationship (to the right), as described by Morse et al. (1990). This positioning enables the carer and the patient to be active partners in linking the chains of clinical practice with the networks of understanding that relate to the patient's wider needs. The key factor within this model is the 'care' that includes consultation with the patient and carer that allows them to relate the two halves of the model - something that is required for learner agency (Kinchin & Wilkinson, 2016)." p.90.

The halves referred to in Figure 32 are those within Hodges' model, merely switched left-right. I will add a photograph soon.

Self care must encompass ALL of Hodges' model.

HUMANISTIC -------------------------------------------------- MECHANISTIC

The patient (questions)
Capacity, Motivation, Ability -
Knowledge and Skills to Self Care

Medical science
Clinical medicine


Choices, Engagement

Clouder, L. (2005) Caring as a ‘threshold concept’: transforming students in higher education into health(care) professionals, Teaching in Higher Education, 10:4,505-517,DOI: 10.1080/13562510500239141

Kinchin, I. M., & Wilkinson, I. (2016) A single-case study of carer agency. Journal of Nursing Education and Practice, 6, 34–45.

Morse, J.M., Solberg, S.M., Neander, W.L., Bottorff, J.L., Johnson, J.L. (1990) Concepts of caring and caring as a concept. Advances in Nursing Science. Sep;13(1):1-14.

Kinchin, I.M. (2016) Visualising Powerful Knowledge to Develop the Expert Student: A Knowledge Structures Perspective on Teaching and Learning at University, Rotterdam: Sense Publishing. p.90.

Saturday, November 16, 2019

Take Two Concepts, One Life, 114,000 Lives Saved, 204 Lost*

HUMANISTIC -------------------------------------------------- MECHANISTIC

Le Mesurier

See also:

John Le Mesurier, The Independent


* and counting ...

Friday, November 15, 2019

Science can see around corners: What about Health & Social Care?

As stressed here before, records are crucial in many work situations. In healthcare acutely so, for safety, accountability, professionalism, legal and other reasons. Even before we reach the point of creating the (comprehensive) record (paper or electronic) clinicians are focussed upon the data and information provided (the referral: does it qualify as a referral and other gate-keeping / triage stages?). The search then begins, often described idiomatically as shedding some light on the problem.*

This is the purpose of Hodges' model.

The starting point is what can we 'see'?
In other words, what do we know?

These initial facts are the first pieces of the jig-saw. A jig-saw that will always be incomplete unless we take into account the four domains and the overall spiritual situation. Having visited the four domains captured the key concepts, drawn out the relationships and meanings with the patient / carer when possible, we can then integrate as needed. This as needed, then influences the way and what is defined as the context which we must capture, assure and preserve for subsequent evaluation (and dynamic update).

While technology can enable us to look through walls, around corners, in health and social care there are many limits. We must access and assess all the domains.

Otherwise - forget all talk of the big picture.

Reflection and critical thinking can facilitate effective reasoning and decision making and (multiple) points of view, whatever 'room' we initially find ourselves in:

HUMANISTIC -------------------------------------------------- MECHANISTIC


Light in
the Shadows
New Scientist, 6 November 2019

In taking into account all the domains and the spiritual it may be that there is nothing of marked relevance (salience) in one or more. It is checking, asking the question that counts, being conscious of what is happening 'next door'.

My source:

Seeing around corners: How to decipher shadows to see the invisible
Read more: https://www.newscientist.com/article/mg24432550-800-seeing-around-corners-how-to-decipher-shadows-to-see-the-invisible/#ixzz65ISAh2QS
New Scientist, 6 November 2019.

Image source: https://twitter.com/Adjuvancy/status/1193628284170522624?s=20

*Patients, clients are never a problem, but one-day I will be an absolute pain-in-the-neck.

Wednesday, November 13, 2019

||||| Still |||| Too |||||| Many |||| Walls |||||||||||

c/o and Photographs © John Davies

"Working in West Berlin in 1984, the British photographer John Davies became fascinated by the Wall as a symbol of the cruelty of the cold war. When he returned this year to shoot the same locations, he found a city healed and changed beyond recognition." p. 25.

HUMANISTIC -------------------------------------------------- MECHANISTIC

"There was a horror about 
the Wall. It was shocking for 
me at the time - an affront." p.27.

See also:

John Davies

Callahan, William A.(2018) The politics of walls: barriers, flows, and the sublime. Review of International Studies. pp. 1-26. ISSN 0260-2105 DOI:10.1017/S0260210517000638

My source:
Guy Chazan, The Freedom of Berlin, FT Magazine, November 2-3, 2019, pp.24-29.

With thanks to John Davies, Guy Chazan and FT.

Monday, November 11, 2019

Book: Visualising Powerful Knowledge to Develop the Expert Student

A Knowledge Structures Perspective on Teaching and Learning at University

Following Professor Friel's book on Climate Change and the People's Health, I've another to review with just 33 pages left to read.

Another short book at 134 pages it has been read by-and-large whilst in casualty (3 times in 6 days), waiting and shifting between ambulance triage, X-Ray, Zones 1-3 to being warded, or not (warded now); with a family member. This probably accounts for the fact that while reading I've noticed some word errors, but not pencilled the margin. I think there are 3-4 thus far. (Usually) Proof-reader-Pete, I'll watch and record any others. This is not a major problem from a gift of book, that was brought to my attention on the Threshold Concepts Discussion list. Blogging over the years, I've probably referred to many 'gifts' granted through academia, books, journals and study in ideas and influences that can further Hodges' model. Here is another and as the book covers below reveal - what is the first book in a trilogy.

Constructionism clearly has a role to play in studying Hodges' model. Professor Kinchin from the outset prompts me to see limitations. Limitations not in Hodges' model, far from it; but the limitation and challenge of time to really focus on the model and where, how and why it 'fits' and 'sits' within theory, practice, discourse and research. I am sure it does in a way beyond the rendering of 2x2 tables on W2tQ. I've been aware of CMap and other software for many years - decades even. As my source indicates, threshold concepts figure here. I look forward to writing this review in the next few weeks, including ramifications for my study of Hodges' model and the impact upon future teaching I might pursue as a tutor.


Kinchin, I., 2016. Visualising powerful knowledge to develop the expert student. Rotterdam: Sense Publishers.

See also:

Review One






Thanks to Brill for my review copy.

Sunday, November 10, 2019

Psyche: Amid the Mind and Stars

HUMANISTIC -------------------------------------------------- MECHANISTIC
"The Greek origin of the word psyche (breath) is well known but psyche also referred to life as action or as soul, some special force or spirit which entered living creatures. ... It was natural that when psychology and and medical psychology became established with institutions, they would wish for armorial bearings and it was logical that some representation of psyche should be incorporated. ... Some psychiatrists would consider mind to be an epiphenomenon of brain function, many of whose mysteries will eventually yield to scientific and clinical investigation and most would consider the emergent subjective experiences as important in determining behaviour. The current motto "Let Wisdom Guide" is certainly suitable whatever interpretation or meaning is given to Psyche and whatever direction psychiatry may take in the future." p.429,431.

James, F.E. (July 1991). "Psyche". Psychiatric Bulletin. 15 (7): 429–31. doi:10.1192/pb.15.7.429

Artist's concept of the asteroid 16 Psyche
which is thought to be a stripped planetary core.
Image credit: Maxar/ASU/P. Rubin/NASA/JPL-Caltech

Psyche Revived by Cupid’s Kiss
 Antonio CANOVA (1757 – 1822)
Marble - H. 1.55 m; L. 1.68 m; D. 1.01 mMR 1777
Paris, Musée du Louvre

© 2010 Musée du Louvre / Raphaël Chipault
Political mythology:
Government pronouncements on psyche?

Saturday, November 09, 2019

Mercury: Care in Transit or Transformation?

HUMANISTIC -------------------------------------------------- MECHANISTIC
Hermes (Mercury) - the messenger
Mercury Abducting Psyche
© Musée du Louvre/P Philibert.

Public understanding of Science
Social Media (or Political)?
Patient engagement
in clinical records

Data, Information, Knowledge
Data, Information Law & Regulation
Information Governance & Accountability

How to Safely Observe the Sun (Infographic)

See also:


Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Thursday, November 07, 2019

Book: Narrative Economics - "Happy Care-day to me!"

"Stories matter. It's a truism for journalists, but not much for economists. Robert Shiller, the Yale professor and Nobel laureate who predicted the housing crisis and also put behavioural economics on the map, aims to change that in a book dedicated to the thriving field of narrative economics."
Narrative Economics:
How Stories Go Viral and Drive Major Economic Events

HUMANISTIC -------------------------------------------------- MECHANISTIC
(My) mental health

(My) narrative

(My) physical health

"While many economists are still busy creating mathematical formulas to decode and contextualise our supposedly "rational" behaviour -

... people's actions are more often based on human interest stories than hard data."


(Who owns your story?)


"Novelty often catches on - Shiller explains how the "Happy birthday" song, which used the same tune as an earlier piece of music, was much more successful because it allows us to place our own name in the lyrics."
Just imagine if there was a tool in health care, social care, education - formative, professional and lifelong learning, that was generic and suited to personalisation whatever the context - whatever the name and story?

My life chances - my health career ...

Rana Foroohar, Stories of value, FT Weekend. Life&Arts, 2-3 November 2019, p.10.

Wednesday, November 06, 2019

So, Hodges' model is all about Vision ...?

... It depends how you define 'vision'
and even then,
Hodges' model is about so much more ...

Inclusion, Holistic bandwidth, Holistic care ...

This is what we should all aspire to
especially as children -
to realise our person-al potential.

HUMANISTIC -------------------------------------------------- MECHANISTIC

Knowledge / Learning
Communication / Liaison
Palliative Medicine
Holistic Care

Alexandra Elaine
0% - 5%
Negotiation / Navigation Physical
Physical examination
Vital signs
 Patient assessment
Total:  DeafBlind?


Negotiation - Acceptance
"A DeafBlind Doctor?"
 Patient Reactions
Colleagues - Reactions

‘A doctor said,
what are you doing with
a patient’s cane?’


Human Rights Law
Employment Law
Equality, Equity
Political Accessibility
'Tick Boxes'
Activism: TEDMED

BBC and Andrew Gregory, Healing touch of the deaf and blind doctor-to-be, The Sunday Times, September 29, 2019, p.3.

This post is a reminder for me about the accessibility of this blog...

Monday, November 04, 2019

Ancient of Days: A Newtonian Compass [?]

HUMANISTIC -------------------------------------------------- MECHANISTIC

William Blake Ancient of Days
Europe a Prophecy Copy B (Printed 1794)

William Blake, Newton



See also and image sources:



[ Visited last month 1830-2200 ]

Saturday, November 02, 2019

Healthcare & Nursing: A select sport

Ed Smith: ‘We can’t risk stars’ mental health by playing too much’

Gruelling summer proved to England selector that player welfare is critical

Apparently, cricket is a late arrival to team building around a strong core and leader and then using a selection strategy. According to Wilde (below*), cricket is playing catch up with baseball (1880) football (1990) and rugby in 2010s. Even with a squad and substitution some players can play too much with physical and mental impacts. Delivery of healthcare is no 'game' even though certain aspects are open to gamification. Everyone understands the need to stay 'fresh' and avoid injury (burnout too). Nurses are not the only professionals and team players to experience the paradox of a break. On the one hand it's like you've never been away; on the other it is great to pick up the threads of cases, caseloads, referrals old and new. Key here too is the cover provided by colleagues while you were temporarily 'off the field'.
"Eddie Jones was asked after England's quarter-final
win over Australia if he felt vindicated in his decision
 to drop George Ford. He said, we didn't drop him, we
changed his role - welcome to modern rugby."
In health, the appliance of sport's 'win ratio' is not in dispute. We can test this! What is the satisfaction rating of the patient and family? But, let's broaden things to include the tax-payer and the patient's recovering, staying that way and becoming self-caring as far as possible. What has to be considered is the context, for example, palliative, end-of-life care and the aims of care.

Nurses have no choice but to 'play'. Sometimes an astute manager will recognise that a specific staff member is best suited to deal with a specific referral, or re-referral even.

As you guessed it, 'selection' does not end there. 

If Hodges' model is the compound field of play, then the selection of care concepts is the vital strategy to assure -
  • person-centredness;
  • integrated care;
  • parity of esteem;
  • reflective practice;
  • critical thinking;
  • a learning encounter;
    • preventive approaches
    • addressing health and other literacies ?
  • teamwork ...

Yes, care assessment, evaluation can be a team effort. The significant care concepts (social determinants ... ), associations and priorities, risks and opportunities can be identified by an individual practitioner and also as a collective effort (group case discussion) and always with the patient / carer - guardian.

So, let Play commence  - and congratulations South Africa!

HUMANISTIC -------------------------------------------------- MECHANISTIC

Simon Wilde, Cricket correspondent, The Big Interview. ‘We can’t risk stars’ mental health by playing too much’. The Sunday Times. October 27 2019. p.9.

Friday, November 01, 2019

Here is the News: another "Brilliant Map"

Or, to be more precise -

"Brilliant Maps"

An Atlas for Curious Minds – 100 New Ways to See the World

A new book released 5 November 2019:
Brilliant Maps - Book
"Which nations have North Korean embassies? How many countries have bigger economies than California? Who drives on the “wrong” side of the road? And where can you find lions in the wild?
In Brilliant Maps for Curious Minds, you’ll learn all this and much more. One hundred visually arresting maps strike a balance between sobering analysis (number of executions by state) and whimsical insight (the countries of the world where there aren’t any McDonald’s).
Thought-provoking and flat-out fun, this one-of-a-kind atlas—compiled by the editor of the popular Brilliant Maps website—makes surprising connections that illuminate the contours of culture, history, and politics. Brilliant Maps for Curious Minds will change the way you see the world—and your place in it".

See also:


My source:
Wright, I. The World as you've Never Seen It, The Sunday Times Magazine, 27 October 2019, pp.26-31.