Sunday, 9 August 2020
Friday, 7 August 2020
Snakebite experience in Uganda: Antivenom ineffective but a few days of mechanical ventilation gives good outcomes
Background.
Antivenom is rarely available for the management of snakebites in rural sub-Saharan Africa(sSA). Objective. To report clinical management and outcomes of 174 snakebite victims treated with basic intensive-care interventions in a rural sSA hospital. Methods. This cohort study was designed as a retrospective analysis of a database of patients admitted to the intensive care unit (ICU) of St. Mary’s Hospital Lacor in Gulu, Uganda (January 2006 - November 2017). No exclusion criteria were applied. Results. Of the 174 patients admitted to the ICU for snakebite envenomation, 60 (36.5%) developed respiratory failure requiring mechanical ventilation (16.7% mortality). Results suggest that neurotoxic envenomation was likely the most common cause of respiratory failure among patients requiring mechanical ventilation. Antivenom (at probably inadequate doses) was administered to 22 of the 174 patients (12.6%). The median (and associated interquartile range) length of ICU stay was 3 (2 - 5) days, with an overall mortality rate of 8%. Of the total number of patients, 67 (38.5%) were younger than 18 years.
Conclusion. Results suggest that basic intensive care, including mechanical ventilation, is a feasible management option for snakebite victims presenting with respiratory failure in a rural sSA hospital, resulting in a low mortality rate, even without adequate antivenom being available. International strategies which include preventive measures as well as the strengthening of context-adapted treatment of critically ill patients at different levels of referral pathways, in order to reduce deaths and disability associated with snakebites in sSA are needed. Provision of efficient antivenoms should be integrated in clinical care of snakebite victims in peripheral healthcare facilities. Snakebite management protocols and preventive measures need to consider specific requirements of children. Keywords. Africa, essential emergency and critical care, ICU management, mechanical ventilation, snakebite.
S Afr J Crit Care 2020;36(1):39-45. https://doi.org/10.7196/SAJCC.2020.v36i1.404
Tuesday, 4 June 2019
Sunday, 14 April 2019
Sarah Hipperson who died in 2018 is most importantly remembered as arguably one of the most committed Greenham Common women peace activists who from 1983 to 2000 lived at Greenham Common Yellow Gate and watched its transformation from an RAF military base to an American nuclear cruise missile base to an open common for the public with a commemerative peace garden. She was born in 1927 in Glasgow and her early life was disrupted by the separation of her parents when she and her sisters were sent into care under the supervision of the Sisters of Charity in Glasgow. She recalls her time under the Catholic nuns’ supervision with affection and her First Communion day with special joy. There is no doubt that from an early time her faith was a most important force in her life and which gave her a sense of identity and value which was to be an important part of her self confidence in all the struggles that were to follow.
Her formal education was limited and when she applied to join the nursing school in Eastern District Hospital Duke Street Glasgow the matron initially refused her entry on the grounds that she had not completed the necessary educational requirements. Not to be put off by such obstruction from authority even at that early age she argued her case with the matron saying that she should be given a chance and was finally accepted. She repaid the matron’s trust by winning the anatomy and physiology prize in her first year. She went on to qualify as a nurse midwife and to work in some of the poorest parts of Glasgow after further training as a district nurse. She had a great respect for how her very materially deprived patients coped with the harsh conditions of life in Glasgow during this time but her desire to travel and to see more of the world led her to apply to become a nurse in the army. She was however refused entry to the army on the grounds that she failed the medical having what was to prove to be an insignificant heart murmur. One can only wonder how her life might have evolved if she had been then accepted into the army.
Her continual desire to travel led her to emigrate to Canada where she married and had five children. She returned to London in 1969 where to all appearances she had a materially secure middleclass life and was even appointed a magistrate. Her experience on the magistrates’ bench proved to be a strain as her discordant voice in support for the often poor and poorly represented defendants made her unpopular among her fellow justices of the peace. She finally resigned from the bench sensing that her presence was giving the legal process a legitimacy she could not support.
In the 80s as a parishioner of Our Lady of Lourdes Wanstead she became active in the Justice and Peace group and motivated by the Dr.Helen Caldecott film, Critical Mass, on the dangers of nuclear war she organised invitations to the local churches to a viewing of the film hoping to start discussions and social action. She noted that in fact the usual response was horror and awareness followed by social paralysis. In 1982 she noticed an invitation by Dan Martin who was then the Justice and Peace worker for the Roman Catholic Diocese of Southwark to meet in the forecourt of Westminster Cathedral to discern a Catholic response to nuclear war preparations. This was to form the beginning of Catholic Peace Action and her first introduction to non-violent antinuclear protests deemed by the authorities as illegal.
At that time the Catholic Church’s teaching on nuclear deterrence was at the least ambiguous. The then Pope John Paul II’s address to the General Assembly of the United Nations in June 1982 gave a moral acceptance to nuclear deterrence as a step towards nuclear disarmament. To many in the Church this was taken as an endorsement of the policy or as was often termed loosely the “doctrine” of nuclear deterrence. Others in the Church saw this doctrine as a kind of heresy and saw no indication of genuine nuclear disarmament. This was a time when the cold war was at its height. Mrs.Thatcher’s government dominated the political scene in the UK with her ally Mr.Reagan in the USA. Mr.Heseltine the secretary of State for Defence was telling Parliament that protesters ran the risk of being shot if they trespassed onto military bases and to be a peace activist often meant regular visits to court and sometimes jail. Greenham Common was designated to be the place where 96 nuclear cruise missiles, each with a capacity of 15 times that of the bomb at Hiroshima, would be stationed to counter the Soviet SS20 missiles threat in the East. There was a general sense of uncertainty, the cold war rhetoric was fierce and the introduction of these intermediate-range nuclear weapons made nuclear war more likely. The debate and division within the Catholic Church at this time was heated but respectful. Senior well known Catholic lay people and senior religious leaders took opposing views in public. While some developed a theology of nuclear deterrence others not only voiced and debated opposite views but advocated and took part in non-violent antinuclear protests with trespass and cutting of the fences at military bases, and obstruction to the cruise missile convoys. To sustain people through the legal process and often jail time affinity groups which could be described as base communities were set up among which Catholic Peace Action was one in London and which Sarah became a founder member, see this link to a film where she speaks to camera (CPA). Her first arrestable nonviolent antinuclear protest was carried out with this group at the Ministry of Defence London and she described it as crossing an invisible line which marked out her commitment to no longer being a bystander.
In 1983 she moved to live at Greenham Common though continuing her discerning with and support for Catholic Peace Action and their support for her. She attended their regular meetings and while she focused her actions at Greenham Common the other members focused on non-violent protests at the Ministry of Defence London which often led to court cases and prison sentences.
The Imperial War Museum has recorded an extensive oral history of Sarah’s story, see this link, (oral history) where she describes the harsh conditions of living in the mud of Greenham Common, the brutality of some of the bailiffs and police, her over 20 imprisonments, her numerous court appearances, her fasting which on one occasion lasted 31 days in Holloway Prison when she lost over 2 stone in weight. She records the moving experience of attending Mass on Sundays in Holloway Prison with the marginalised women whose faith was an inspiration.
She describes the grassroots non-violent spirituality of the Greenham women and her confidence in the ultimate removal of the cruise missiles. She relates the women at Greenham were neither saints nor sinners but were described by the authorities as “bloody women”. Sarah was proud of that description and that they were rooted in non-violence whatever faith tradition or none they claimed. She never hid her own Christian faith and roots at Greenham and the unifying spirituality among them was the women’s non-violence and their anti-nuclear position and willingness to cross that line of protest that put them at risk of arrest and jail. Sarah’s legal struggles with the state are well documented in her book, Greenham non-violent Women-v-The Crown Prerogative a copy of which is in the Pax Christi library and also a digital copy at this link here.
Often peace activists like Sarah never see the results of their struggle and it may be another generation or even more generations that reap the benefit but in the case of the Greenham Common women history gives them a visible legacy. In 1987 the Intermediate-Range Nuclear Forces Treaty was signed by Mr.Reagan and Mr. Gorbachev and soon after the cruise missiles were removed as were the SS20s from the East. The Ash Wednesday annual Pax Christi demonstration at the Ministry of Defence against nuclear weapons is a legacy that Sarah was happy to see in her lifetime and the Catholic Church is now no longer ambiguous about any “theology” of nuclear deterrence. The very possession of nuclear weapons is condemned with clarity at the highest level. Sarah was very aware that her prayer for a nuclear free world remained unanswered in her time, we still have much to do but considering one “bloody woman’s” contribution to the cause of non-violent peace building she will be to all who knew her an inspiration and a challenge.
Tuesday, 28 August 2018
Franz Jagerstatter Service 9 August 2018
1
Reflection
given by Dr Ray Towey at the Franz Jägerstätter Commemoration Service,
Westminster
Cathedral Crypt, London. 9 August 2018
Gospel reading: Luke 10: 1-6,17-21
The story is simple, a peasant farmer in Austria is conscripted to fight for Hitler,
refuses claiming being a Catholic and being a soldier in Hitler’s army is
incompatible so they kill him to preserve military morale. In 1943 German
military morale was in serious jeopardy. The battle of Stalingrad had been lost.
The
German state needed men at the eastern front. Franz was isolated in the Church,
in the village, in his country. To his knowledge then no-one had taken a stand
like this. I use the word peasant
farmer purposefully, not so often used now about Franz, to us it has negative
connotations but the Gospel writer is clear about what is a negative:
I
thank you Father Lord of heaven and earth because you have hidden these things
from the wise and learned and have revealed them to children. (Luke ch10: 21)
This Gospel passage is uneasy reading because ever
since I entered formal education I have strived to be someone who is both wise
and learned. To the Gospel writer that comfortable
self-image or illusion was an obstacle that Franz did not have.
In 1982 I returned from 2 years in a mission
hospital in Nigeria. The overwhelming experience of working as a doctor in
Africa is watching helplessly the premature death of scores from diseases
easily preventable by a little money or curable by modest means.
This remains the global injustice of our time, so the
injustice of the Falklands invasion at that
time was minor in comparison and I could see no need for further human
sacrifice. There was enough premature death in the world, more than enough in
Africa alone.
And so, the armada travelled to the South Atlantic
to right the wrong bringing with it a military hospital well equipped and I
thought why not just make a small detour and share a few drugs from the
pharmacy, a few bottles from the blood bank, Nigeria is close by to the east.
We won’t delay you long, but don’t forget Sierra Leone, Ghana, we have friends
there too, and what harm if we do delay you long?
Even a child could see the need but the wise and
learned had other plans.
There was worse to come. The cruise missiles in
Greenham Common were an essential counter to the SS20s of the Soviets and the
Pershing 2s in Europe would give us the superiority we needed to keep our
Christian culture safe and the Church at the highest level then was ambiguous.
What was this doctrine of nuclear deterrence, a necessary
modern moral relativism for the Church or a new heresy, is that too strong a
word and who was for the burning? everyone? and so we asked, where do we stand
and we made a stand and not like Franz, alone,
but we were few. Like Dorothy Day, without seeking permission, we had the nerve
to call ourselves Catholic and thereby Catholic Peace Action. We
were non-violent but did not keep the law and counted jail time as a duty or
was it a spiritual pride in the new indulgences? Were we the orthodox or the
heterodox? Time would tell.
We added our small voice to others in and out of the
Church. We shared with a few of our own bishops but at the time like Franz were
not affirmed and learnt how to be strangers in our communities, our Church and
country which we loved. But let me not forget Bishop Gumbleton from Detroit and
Pax Christi who wrote us a good character witness letter for our bad
disobedient behaviour which we copied for the court, usually to no avail, so
unlike Franz we were not alone but
we were few.
Fr. Daniel Berrigan has a reflection on Franz written
some years before Franz’s beatification:
“As
for Franz he will not go away, he will not go away from the Church that sent
him on his way alone.
His
way, which should have been the way of the Church.
So
he lingers half unwelcome……..”
After the war Franz’s name was added to the memorial
in his parish cemetery of those who had died for Austria but it was secretly
erased. For some in his village his name was most unwelcome.
In his own diocese of Linz 40 priests were sent to
concentration camps and 11 died. In the Archdiocese of Vienna which was twice
the size of Linz 9 priests were sent to concentration camps and 1 died. There
was resistance in the Church to the Nazi regime but it was thin and patchy. One
of his parish priests had been banned from the parish by the regime for
delivering an anti-Nazi sermon and even he advised him accept the conscription,
he saw his bishop who advised the same.
When the wise and learned advised him to fight for Hitler
was he choosing the way of suicide?
This was his terrible deep spiritual anguish.
When he was
transferred to the Berlin prison he met with the prison chaplain who related to
him the case of an Austrian priest Fr.Reinisch who had refused to take the oath
to Hitler and was executed a year before. Fr.Reinisch had been conscripted to the
medical corps but still refused the oath stating that he opposed the Nazi world
view which had resulted in murder, the elimination of the mentally disabled, forced
sterilisation, the illegal annexation of Austria. The chaplain relates that
Franz breathed a sigh of relief and was greatly encouraged and said, “I can’t
be on the wrong path after all, if even a priest has decided the same and has
gone to his death for it then it’s all right for me to do it too”
I think this was the first time he had heard of
anyone refusing conscription for Christian reasons and it suggests that even at
this late stage he was still in need of more support that his stand was correct
and not a suicide.
After the war the search for justice began but there
were to be dispensations, if you had the secrets of the V1 and V2 rockets there
was an amnesty. The learned and the wise needed you, and a new and comfortable life
in the West or the East guaranteed. These wonderous Nazi indiscriminate weapons
of terror had their uses. The V1 became cruise missiles and the V2 ballistic
missiles, just add a nuclear warhead when required.
And so… Coventry, Hamburg, Dresden, Hiroshima,
Nagasaki….we know who won the battles but who won the values?
In 1941 while doing his military service after his
second call up Franz writes, “Ybbs is a beautiful town.. there’s quite a large
mental asylum here, which used to be full of patients but now probably even the
mad have become sane, because there are no longer very many of them in the
asylum. My dear wife there must be some truth in what you told me once about
what’s happening to these people.”
In May 1943 Franziska writes to Franz of the sudden
death of a disabled child who had been put in a home for the disabled. Hundreds
of thousands of disabled children, psychiatric patients, mentally disabled
adults, Downs syndrome children were killed during the war. Bishop von Galen of
Munster was a vociferous opponent of this Action T4 euthanasia programme and was
placed under virtual house arrest in 1941.
In Europe these days Downs syndrome is becoming a rarity.
For them we have developed our own final solution.
And what of us? The state may not need us in uniform
but it still needs our obedience or is it just our silence?
But now it will never be so hard because we have
Franz. Thank you Franz from the bottom of my heart for making my small journey
clearer, less lonely, more loyal, more forgiving and with no place for
bitterness.
Sunday, 6 May 2018
Election
Communication
Christian Peoples Alliance Party
respects the individual PERSON
use your
vote on Thursday
3 May 2018
 |
Vote for Ray Towey
Christian values work
raytowey1992@gmail.com
Published and promoted by:
Ray Towey 11 Ruskin Court 4 Champion Hill London SE5 8AH Printed by: Solopress 9 Stock Road
Southend-on-Sea SS2 5QF
I have worked in the past as both a junior and senior
medical doctor in the NHS at Guy’s and St Thomas’ Hospital for 15 years. In
recent years I have worked as a doctor doing volunteer humanitarian work in
Tanzania and Uganda. My national and international experience has given me a
profound respect for our National Health Service and all who work in the health
and social care sectors. The current politicians of all major parties have
failed us. The unjust and immoral national austerity has divided society and put
a severe strain on how to integrate both hospital care and our social care.
Local government is now faced with making difficult choices. The Christian
Peoples Alliance will put the sick and the poor the top priority and make those
difficult decisions wisely.
The housing market in London is
broken. Social housing is being sold off, the young cannot get mortgages and
the so-called affordable housing isn’t affordable. The numbers of rough sleepers
in London and throughout the UK rises year by year. This is a growing scandal
to any civilised society let alone one of the richest cities in the world. The Council
should work with local charities to prioritise help for rough sleepers.
In the cold weather the broken road drains cause pools
of water resulting in dangerous ice rinks on our pavements. From personal
experience in Champion Hill I know this is a dangerous hazard. I would put pedestrian
safety a high priority.
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