$tockholm - economics of a city

Stockholm is where tall, beautiful Swedes will tell you, sorry, no, you can't pay for that 15 Krone cinnamon bun with Swedish Krone. You will look on, aghast, wondering if their famously impeccable English language skills are all a lie. No, they're not. 

Sweden is moving on much quicker than the UK when it comes to the technology in the financial sector. They are swiftly moving away from hard cash and into the realm of cards-only paying. Granted, being an unsuspecting tourist, this did work to our advantage in some ways. We tried to get on a bus only to be told the no cash rule. We muttered about international card charges and got a free bus ride. That cinnamon bun debacle? The nice shop man paid for our cakes himself, in return for us giving him a handful of cash shrapnel.

Fair enough, you think. Cash is overrated, and card is seemingly much safer. A survey from last April revealed that cash comprises only £18.33 of every £100 spent in the UK.* But surely there are some downfalls to a card-only economy? Tourists struggle and face large credit card charges. The homeless face even more of a challenge, as there is less spare change around - and less places to spend that spare change. When we paid by cash for our train tickets in a local Pressbyrån, they were more expensive than if we had purchased from the card-only ticket machine. It almost seemed that, in the Swedes seeming financial progression, they had actually digressed to a financial situation that discriminates against those who need the discrimination the least.

Views at the Royal Palace - no money issues here

*http://www.cityam.com/213547/death-cash-brits-pay-card-and-mobile-instead

How We Live Now

About a year ago, I wrote a post detailing my angst for post-graduation life and specifying that as long as I was writing and surrounded by friends, I would be alright.

One semester into my MSc in English Literature at Edinburgh, I managed to wangle my situation into almost fitting those specifications. I am writing a lot (and reading even more), and am surrounded by a fair majority of my friends (although those who left Edinburgh last year, I'm still awaiting your swift return).

A TICKET!

What I have most notably salvaged from fourth year, is that worrying about the future does nothing. Neither does comparing yourself to other people and the amount of work experience they have (this is my new hobby; it's actually quite stressful). Neither does doing something because you think you should be doing it. This is the most pertinent lesson I can take from my final year of undergrad. Last year, I applied for an awful lot of things that I wouldn't actually have enjoyed, because I thought it's what you do when you're in final year. It took up a lot of brain space and also real time.

So actually, I wouldn't like to say I predicted the future, but I kindof did. There's lots of people (let's call them nay-sayers, for the sake of this post), who, whatever you life decision is, will scowl upon it. My message is this: follow your heart. After you've stopped cringing, I recommend you go to a workshop like the one I grumbled about last year (or recreate it at home - I mean, all you need to do is draw a spider diagram and think about yourself), and work out what you like. Work out your priorities, and follow others' advice with a pinch of salt. Post-graduation life will be alright, in the end.

Doctors Strike – And Here’s Why It’s Not Surprising

Today, the BMA (British Medical Association) announced that junior doctors will be striking on three dates across January and February. Negotiations with the Department of Health ended this evening; the government having failed to resolve what BMA sources term “absolute areas of disagreement”.

The first strike for 40 years will take place from 8am 12^th January to 8am 13^th January, with only emergency care provided. Under this model, junior doctors will only provide cover that they did on Christmas Day, with consultants having to step in to cover any unfilled positions. A second emergency care strike will occur from 8am 26^th January to 8am 28^th January, and for the first time in history, a full withdrawal of labour will take place between 8am and 5pm on 10 February.

The BMA emphasise that they cannot agree to changes which will have a negative impact on patient care and junior doctors’ working conditions. Johann Malawana, leader of the BMA’s junior doctor’s committee (JDC), said this afternoon that he was “sorry we have not been able to find a way forward and get the government to see the genuine concerns that junior doctors have and our continuing desire to have a safe and fair contract”.

Although Jeremy Hunt said it was “extremely disappointing” that doctors are striking, he also said they were unable to solve problems concerning weekend pay and has asked Acas to reconvene negotiations.

On 30^th November last year, the BMA called off strikes after Hunt agreed to re-enter negotiations with the BMA at the 11^th hour.

In an update to junior doctors this weekend, Malawana emphasised that they would not agree to a contract harmful to the NHS: “We hope that the government is able to come back with a greater understanding of how important junior doctors feel about the future of the NHS they work in.”

One fourth-year student doctor said: “Doctors do not want to strike, they want to do their jobs and look after patients. They have been forced into this position by the current secretary of health Jeremy Hunt who is threatening to impose a contract which is unfair and unsafe without negotiation. It leaves doctors with no other option and this is unequivocally demonstrated by a 98% approval for industrial action when BMA members were balloted”.

Although the contract will only affect England at the moment, trainee doctors are worried there will be a ripple effect on other parts of the UK. One student doctor studying in Edinburgh voiced concerns: “Scotland isn't devolved enough to resist the movement of the English NHS. If this is indeed a move towards privatisation - which I suspect it is - then if England goes, so does Scotland. So effectively it does impact Scottish healthcare just as much down the line”.

Should Hunt’s proposed contract be successful, junior doctors will be paid less for working the same amount of hours. Under the current contract, doctors are paid a basic rate for any hours worked between 7am-7pm Monday-Friday, with an additional supplement to recognise the unsocial nature of any hours worked outside of this framework. Planned contract changes will add in 27 extra hours of “standard time”, extending these hours to 10pm every weekday evening and to incorporate Saturday 7am-7pm.

Additionally, junior doctors currently receive an annual pay progression to recognise the increasing responsibility and competence they gain year-on-year. However, this is to be replaced with just a handful of increments. This has led to a myriad of concerns including claims that this will have a detrimental impact to those who wish to take time out to undertake research, or for those wishing to take maternity leave.

Whilst the government say that only the doctors working outside of legal limits would see their pay actively cut and 75% receiving a pay rise, a student doctor stated: “This is simply government spin. In order to prevent doctors suffering a pay cut, there has been the introduction of ‘pay protection’, based on the salary earnt in October 2015. This is only to last until 2019 and would not apply to newly qualified doctors. If salaries weren’t being cut there would be no need for this payment, and it is simply an attempt to get current doctors to sell their future colleagues down the river.” 

The second main issue with the contract is the removal of safeguards that prevent doctors working for dangerously long periods of time. The current contract financially penalises any hospital trust for over-working their junior doctors. However, these penalties would be removed. This has led to fears that despite the legal number of hours that can be worked weekly being reduced from 91 to 72, the lack of penalties would result in this frequently being broken.

Under the agreement made on 30^th November, if the government did not alter the contract in line with the JDC’s concerns, it was clear industrial action would be re-instated. During these talks, the government has failed to address these problems  - leaving doctors with no other available course of action.

Kindness in Kenya

Once the transformation from day to night passes, we normally stay inside the hostel, eating western food and perusing the view of Lake Victoria from the rooftop.  Tonight though, we throw caution to the wind, and venture out into the streets of Kisumu to a recommended restaurant. It takes ages to find, and I become panicky as we snake through streets, empty save for the security guards, who stand outside the shops the whole night long, shotguns upright.

Kisumu is Kenya’s third-largest city and certainly the most up-and-coming. In the daytime, students tumble out of university buildings, while cars and school buses are driven into Lake Victoria for a wash. As night falls, however, the markets are packed away and shutters are pulled down on the previously bustling main road.

Sunset over Lake Victoria

Eventually, our Italian-style eatery is found, and we settle into wicker chairs, surrounded by leafy ferns and paintings of safari in the Masai Mara. I drink something deliciously non-alcoholic, called ‘Fresh and Cool’, and my angst about the streets dissipates.

But we soon have to set off back to our lodgings. As we approach the first roundabout on our way home, a flock of street-children spies us, those rich tourists from a foreign land. Expectant of sweets or money, I think, as they rush up to us.  We are alone on the street against the group. I bolt. But the moment of successful bolting is delayed as my ankle gives way, and I end up on my knees in the road. My vision is fuzzy and pain courses all the way up my ankle. Concerned about the encroaching mob, I attempt to get back to my feet. But the world is still a lot fuzzier than it ought to be, my ankle unable to withstand my weight. ‘I’m going to faint’, I say.

Just a giraffe in the lake

My travelling partner likes to think he is an experienced medic: ‘Lie down! Lie back down if you are going to faint’. Vulnerable in front of the watching children, who have now gathered in a circle around us, I reluctantly return to my position in the middle of the highway. But instead of pouncing on my money belt, which is haphazardly slung around my stomach, one of the older children offers some condolence.

‘Sorry for falling’, he says, and then looks at my white t-shirt. ‘You are now dirty’.

He bends down and tries to rub away the mud from my shoulder. The children behind him take his cue, as if he knows the correct protocol for fallen-down tourists, and then they all join him in the bending down and the patting, trying to brush the dirt off my top in different places. One of the children runs for a tuk-tuk. I lie there in the middle of the tarmac, surrounded by twenty street children who are all concerned about my clothes, until our transport is flagged down to take us to the hospital, and we are whisked away from our assailants – and our rescuers. 

No NHS Abroad: Part II

We've gone to Nepal, so let's take a step back and sojourn to Jaipur, India, and my very first experience of illness in Asia.

Jaipur before the ordeal. 

It was June 2013, and we were about one week into our travels. Having escaped the chaos and filth of Mumbai, we had unintentionally found ourselves on a 24-hour bus journey with only a packet of crisps for sustenance. We had taken the road less travelled with a detour to Ellora caves (I recommend highly, by the way, but that's a tale for another day), and were now righting our way back to the official Land of Tourists: Rajasthan. Rajasthan is famous for its palaces and forts, and queen of all palaces and forts is the city of Jaipur and the most prestigious castle of all: The Amber Fort.

Not knowing how to prioritise, we made a list of all the things we wanted to do in Jaipur. And then we started from the bottom. Let me tell you now that you should never save the best to last in India. There will be obstacles. There is such a thing as Indian Time, and this will contribute avidly to your obstacles. But in our case, there was illness.

It came on quite suddenly. I woke up, and my travelling pal was no longer there. Immediate panic. When I found him throwing up, I was a little relieved. At least he was where I could see him.

But when the morning came, it seemed that a clean-up operation was in order. There was lots of sick, particularly on our shared mosquito net. Jolly good, I thought, this will be excellent training if I ever want to become a midwife, as I rinsed the net in the shower (at one point I did want to be a midwife, so please refrain from calling this irrelevant). My second tip for India, and any travels really, is that if you have a sickness bug, go immediately to the doctors. In a foreign country, it won't 'clear up' like it might in the UK. Oh no. I fall for the 'it will just heal itself' trick every time, and this has resulted in many infected blisters and more unfortunately, the acceptance of Rennies as treatment for diarrhoea. No, my friends, your foreign illness will not go away by itself.

Anyway, we thought it would, so asked for a room change and some tea to settle my pal's tum. I went down for breakfast. When I came back up to our new room, however, the innocent boy who had been sent to deliver tea was standing intrepidly in the door way, as my friend lay on the cold hotel floor, stark-naked, and quietly moaning. I ushered terrified boy away. When my companion asked for more tea later on in the day, I reminded him of the no-towel incident.

Jaipur, after the incident, at the Amber Fort.
Just before this picture, an elephant had sneezed on us.

It was this incident that sent us to breaking point. We should go to the doctors, we decided. On arrival, however, the doctor was not there. We were disappointed. We had felt so brave in making a decision. Anyway, Indian Time came and went, and the doctor finally arrived. He nodded knowingly. He had seen this before. Sticking a drip in the arm, a needle in the bum and some colourful tablets down the throat, he wrote out a payment slip and told us to call him in a week to confirm we were still alive. Fortunately for all involved, we were.

LOTF

We all know Lord of the Flies, our first encounters being in a haze of hot secondary school classrooms and the 'naughty boys' saying how boring it is. But after my initial misgivings, Golding's text turned out to be one of the most formative texts of my school years. Looking through the 60th anniversary ebook, it looks like it was for a lot of other people, too.

Find my contribution on page 31, here.

What happens when you get ill and the NHS is nowhere in sight

Part 1: Nepal

After summers of travelling and a year spent in Germany, my friends and I have given the health services in other countries a bit of a try-out. For Sam and I, our experiences in Nepal were the most exciting by far, so I thought I would start with the land of Mountains and of dahl before heading on to less turbulent territories.

Post-illness storms

The route of both our illnesses was in India. Feeling flu-ey for days, I put it down to over-exhaustion and hid away in my room in the holy city of Varanasi, sending Sam out to find Western food (he failed). In Kathmandu I felt even worse, and Sam secretly googled the symptoms of malaria, despite us regularly taking our tablets. Throughout these days, he was doing an excellent job of being my fake doctor, providing me with sick bags on a six-hour ride through the Himalayas in search of a cleaner town than Kathmandu to aid my recovery, and buying polos for the journey in which we ran over a dog in our rickety minibus. Which is why, when Sam sat up in bed, exclaiming 'I need to go to the hospital', late one night, I was rather surprised. How dare he try to reprehend me of my mantel of illness. It was mine. 

But our hotel owner duly drove us to 'the best hospital in town', where I was hurried off to buy things like needles and sheets of paper with medical terms on. The pharmacist explained, mostly with hand gestures, that, before they could begin treatment, I had to buy everything. This took place in a little counter outside of the hospital. It happened several times during the long night, where I was directed off to purchase more antibiotics or drips or pee pots. Although this was a strange system, it seemed to make sense, under the premise that you can only receive treatment if you can afford it. We were fortunate enough that we could, but it led me to think of the thousands living in Nepal who couldn't - or the millions that could only just afford treatment, if it meant their family sacrificing food and other life essentials.

The night was a long one. An elderly man was visited by his family before having an ECG scan under the bedsheets, right in front of us. He was white and frail, and looking at him made my heart hurt.

We slept in a room which might have been the reception if the hospital wasn't so full. Sam was hooked up to various drips and was decorated with cannulas, diagnosed with dysentry. I felt bad that I hadn't believed him before, as he narrowed his eyes and told me he could have been dead in a week, describing how the disease could make its merry way up to the brain. In an attempt to apologise, I accompanied him to the bathrooms and tried to be helpful by holding his drip. The bathrooms were by far the worst thing about our visit. There were drains in the floor, and there were buckets. Neither of these were especially effective for the poorly people in the hospital.

I tried further to be helpful, but on buying ice-cold water from the hospital shop, I was reprimanded by the hotel owner who had come to check on us the next morning. 'Warm water only', he scowled, before feeding Sam boiled potatoes and suggesting I return to the hotel with him on his motorbike. On moving over to be closer to the patient, I tripped over his cannula tube  - and pulled it out. He winced, the nurse came over to tell me off, I cried. It was all okay though - the nurse gave it a quick wipe and popped it back in: perfectly clean.