I feel sick and sad this morning

Footnote to my story in November called “Why don’t auckland hospitals work smarter rather than harder.” and the previous one The Hospital is the best place to be when you are sick, or is it?

My friend passed away this morning after an agonising battle with cancer. One has to wonder how much easier it would have been for her if she had received the treatment she was entitled to at the times she was turned away due to strikes and staff shortages. I’m sure she would still be with us today if she was able to receive the treatments and surgeries she was scheduled for.

Her husband is one of those nice old school Kiwi guys who listens to what he is told and didn’t want to rock the boat. He refused to fight through the management or the media to get the treatment his wife needed because he felt that was not the way you behave. Now he has lost his wife and soul mate too soon. We had to respect his right to be true to himself, but I’m not sure we have to accept the system that put him in that position.

My advice, if you are in a situation like that, where lives can be saved or prolonged and the bureaucratic penguins and the system is holding stolidly fast to this is where the line starts and if you’re not there anymore when you get to the end of the line, will the next patient shuffle forward, make a noise like someone’s life depends on it, especially if it does. People who go to the media miraculously get the treatment they need and sometimes before its too late.
We Kiwis need to stop being PC and accepting the bs that comes from our health industry. Note its not the wonderful hospital staff, they are put in an invidious position by the administrators, by the beurocrats and by the politicians who sleep sound at night and whose close ones are probably not getting turned away because “a registrar is off sick and the shift couldn’t run”. They are the ones who have to lie to the patients and their families when cost cutting measures, old fashioned systems full of lost paper files and ancient systems, and cost cutting means many people don’t get their surgeries, live or die in pain.

This person’s story is over. We won’t be going to the media or fighting because it is not what her husbands wanted. I respect that and much as it burns me, I will not add to his grief or risk creating feelings of guilt to him to make matters worse. He came from a generation who said yes sir, I know you are doing your best and genuinely trusted that. She may still have died, in fact probably would have, but she might have had a few more years and she certainly wouldn’t have suffered the degrees of agony of that she did over the last 4 months. We don’t do that to animals.

If you find yourself in a situation like this, make a noise, get your loved ones help, let the media know and as a country we have to get our government and administrators to invest in the new technologies that in the long run will cost less and save more lives.

Why don’t Auckland Hospitals Work Smarter Instead of Harder

 

 

On Living Longer

I’ve decided I want to live longer.  I love technology and I love this world of change and the ability to be involved in this technological era. I have things to contribute and I want to be active in ICT, Location Based Services and also as a songwriter. I want to see my children and grandchildren grow up and explore this ever changing world and see what they make of it.

I’m going to have to work longer, that was always expected, but then providing my Maslow and Herzberg needs are met, I enjoy working. I enjoy making a difference, helping people achieve their goals. I enjoy learning, watching what is helping in my spheres of interest, particularly those mentioned above. I enjoy collaborating and networking and am particularly passionate about seeing New Zealand step up to the plate and continuing to innovate and achieve greater success on the world stage.

I reckon a healthy target for me would be 120 given medical advances now and in the future. My greatest risks are probably heart and cancer, with the determining factors being nature and nurture and my general disposition i.e. my attitude and happiness.

One thing that is obvious is that I have to look after my financial well being. If I continue to work, then raising the retirement age isn’t going to be a major for me. If I am enjoying my work, see a future for myself where I can contribute from my experience, passion and knowledge and can continue to grow, I wouldn’t be expecting to retire at 67.

I know I can’t rely on the Government to give me any kind of lifestyle on the retirement pension anyway. Our budget deficit has just been raised to over $15b and despite some significant successes, we still don’t have an infrastructure that really supports innovation. We tend to take credit once people are successful, but most successful innovators tend to be successful in spite of the country’s and their employers contribution rather than because of it.

So my first considerations as I start goal setting and planning will be how I can maintain my lifestyle in the years to come, continue to build an asset base so that when I wind down to a shorter working week I can continue to enjoy a lifestyle and if I should be forced into retirement through poor health (which is not the plan) I can still live comfortably, which no one can in NZ on a pension or benefit. I have a super scheme, I still have a mortgage. I am closing down my rental property LAQC and have sold my rental property. The Government doesn’t want people be able to claim losses from their expenses and without that I can’t afford to own rentals. I’ve invested in public companies before, but unless you are buying and selling daily, this is in my opinion a far greater risk business. Even the biggest companies make mistakes or get caught up in circumstances beyond their control and shareholders unless they are big, have little or no control over their destiny. How many Kiwis lost their life savings in the past by investing in ‘rock solid’ companies?

So I’ll invest in myself. I am studying song writing at Berklee Music on-line, which is costing me a small fortune, but if I can score 1 or 2 hits somewhere along the way, I’ll recoup that investment. I study the industries I’m involved in daily through the media, the occasional conference, networking in person and through social media such as LinkedIn and Twitter and I read a lot.

I have and continue to amass a huge amount of local and international experience in a number of industries, particularly in the application of leading edge technologies to solving business problems. Experience, I have learned takes years and is perhaps something that is least appreciated by younger people who come out of university thinking they know everything and by people who have stuck in one industry or a very small number of companies during their work career.

So to cut a long story short, I need to start planning for my long future. I need to consider a range of aspects, particularly how I want to live those years, what I want to do in them, what I want to contribute, what capital I need, how to maintain my health and fitness. Must be time for some goal setting and dream building.

I’ll leave the last word for now to Anne Brunet (who came via that other little university in Boston (not Berklee Music, but Harvard) and Thomas Rando of Stanford U.

Note the real meat of this video starts around 21 minutes in.

Why don’t Auckland Hospitals Work Smarter Instead of Harder

A friend of mine was prepped for 2 days with nil by mouth a month or 2 ago for urgent cancer surgery. The first day she got bumped and the 2nd day was the start of a radiographers strike. Last night she was prepped for an 8 hour operation and got bumped due to a critical case that suddenly appeared. We thought she was criticial, but obviously that’s not for us to judge.

I’ve asked the question before “Is hospital the best place to be when you are sick?” and pretty  much decided unless it was a private hospital, possibly not. But of course most of us don’t have any choice especially as we get older.

It is nice to see that some things are improving. For example Auckland Health Board has decided to send some patients to private clinics for radiation treatment to reduce waiting times.

I had blogged previously about waiting times at North Shore Hospital based on experiences waiting with family members in A & E and subsequently in corridors in some cases for days, without being assigned to wards. Each time we were told that it was an exceptional case and we were just unlucky. A registrar was sick and therefore his team couldn’t operate was a common excuse. Think about it, an entire team doesn’t operate because one person doesn’t turn up? Maybe they were stretching the truth, being they are short staffed and can’t afford another registrar, and they didn’t turn up because they didn’t exist.

According to the reports, North Shore Hospital is improving and it is now only the 3rd worst in New Zealand. North Shore Hospital supports North Shore and Waitakere with an excess of 400,000 population and rapidly growing. Of course things will change with the new Super City, but the problems won’t go away.

As you can see in previous blogs I’ve written such as ‘76 Deaths, Surgical Mistakes in New Zealand Hospitals‘ I have been pushing for more specialized technology to streamline processes for many years. The technology has been around for a long time, yet we still seem to rely heavily on paper. Tablet and handheld computing has been around for a long time. Most of us use WiFi in the home, in cafe’s, at the airport and understand the power of dealing with information once, accurately and allowing instant access to anyone who needs it in a timely fashion. That’s how we live.

I now see bar codes on patient wrist bands, but I don’t see them being read by a handheld computer to check for allergies, conditions etc at the bedside. This technology could have saved many NZ lives at a tiny fraction of the cost of their lost lives, productivity etc.

When I started promoting this technology, it was with Pocket PC, Palm and Symbol technologies (handheld computers, 3D Bar Code Readers, Portable Printers, Digital Cameras which were being used in many US and European hospitals and that was 20 years ago!

Today there is superior technology such as the Panasonic Mobile Clinical Assistant CF-H1 which runs on Windows 7. The video is pretty corny but it really does illustrate how efficient it is to use mobile technology. Of course this technology has a rugged drop spec, is chemical resistant, lasts 6 hours on a standard battery.

This technology means everyone is in sync and has access to critical data on demand. Paper gets misplaced in hospitals. I had one visit with a daughter that was delayed by 90 minutes simply because someone had misplaced her file. Data can be shared with specialists and medical staff in and out of hospital, including images such as scans, x-rays, photos, test results, charts and graphs. Allergies and condition interactions can be monitored to minimise risk of causing new problems, doses can be confirmed, approvals provided remotely. Pretty much the whole world’s medical knowledge is available online today.

Today’s world should be about harnessing technology to work smarter rather than harder. I suspect the focus is on cost of the technology because our hospitals are run by administrators tasked with saving money. Of course they are largely man aged by politicians. If health is a major election platform every election, why is it that the performance is still so poor?

Next time you are in hospital, have a look at how they use or don’t use technology. Think about how you operate in your business. Think about what’s at stake and ask them why they do things the way they do.

We have national elections next year. They will be talking about improving the health system. Will they be talking about improving the ICT structure and putting information in the hands of the clinicians? Or will they be talking about saving money, improving the monitoring of staff performance and measuring waiting times in A&E?

We have an ageing population and growing population. They are going to need more services and we could increase our throughput, reduce patient risk, significantly improve outcomes by harnessing technology, working smarter rather than harder, expecting great results from staff working double shifts several times a week.

And When I Die

No I’m not talking about my blog, but it is relevant to the podfade. There is so much I want to write about. How thrilled I was about The Hyperfactory achieving their harvest plan and that Derek and Geoffrey are planning on coming back to New Zealand to share their knowledge and help others follow in their successful path. As you know location based services and mobile marketing are amongst my passions.

I would also have liked to talk about the Rex which set foot in New Zealand, just as I was bemoaning the difficulty of Kiwi innovators to capitalise on their ability; again an area that has been of great interest to me. Then of course there is the tentative success of the oil cap on the BP oil well. I have pondered much on Oceanic Dead Zones, whilst the BP accident helps extend them.

Two months ago I was faced with a family crisis. My father in law was told that he had somewhere between 3 days and 2 weeks to live. Life as I know it, pretty much stopped. Our close family was in shock, even though we knew it would come eventually. Before you offer condolences, he is still alive:)

Having developed a taste for tobacco while serving in the air force, 20 years ago he had a laryngectomy as a result of throat cancer. He didn’t take it lying down. He learned to talk again and picked his life up. He became involved with the Lost Chord Club and eventually became President, counselling others through their throat cancer journey. He also visited schools and let children look into his stoma, seeing that he had to breath through a hole in his neck, caused through smoking.

So for most of the last 20 years he was in remission, then the cancer returned and as often is the case 2nd time around, it was not going to be possible to treat it.

So my life and that of my family has changed dramatically for a while and  many of things I have been wanting to do, I haven’t had time for. We spend as much time as we can with him, because once it is over it is totally over.

It strikes me that whilst we all know that from the moment we are born, we can be certain of one thing (I have blogged about people (such as some from Singularity University) are doing everything they can to avoid it) it appears that death is a given for each of us.

So we have been assisting with respite care, trying to help him maintain his dignity as he becomes helpless, and his confusion as to both why he is still alive and what will become of him when he dies. Will there be a place for him in heaven? Is there a heaven? These things worry him. He has never been a religious person, although he was a church choir boy many years back. He worries about his wife and what will become of her after he passes on.

We all worry about each other, how each is going to cope with the end. I wonder how the women of the family cope now, they look after him around 18 hours a day, partly because they want to and partly because there are not many people who understand how to look after someone with a hole in their neck, who can’t talk. If he had a shower and water got into his stoma, he would drown. If his neck valve leaks (and this happens from time to time) when he eats a few spoonfuls of his porridge, the food can leak into his lungs.

Anyway, things aren’t normal right now and no one can tell him what is next tomorrow, let alone for eternity. Two months ago he was told maximum 2 weeks. Two weeks ago we were told “a few days”.  It took us a while to understand what he meant every time he woke up and asked “What’s going on?” We thought he meant Who’s here? or Is someone going to take me to the toilet? But eventually we figured out that he is asking, “Why am I still alive?”

So it seemed appropriate as I wait for my finger nails to toughen up again (for guitar) after washing the bathroom and shower, so I can do my latest Berklee Music assignment and then head back to the rest home after a work out at the gym (down to one a week because I go to the rest home straight from work) that today’s blog be about something more basic than singularity and the latest problems with iPhone 4. Once you break it down, we are just an essence in a body that peaks somewhere between late teens and mid twenties and then starts to die.

Sometimes all that matters is the people that are close to you and can give you comfort, and you them. When you break it down, we are beings in flesh and blood in a temporary home.

76 Deaths, surgical mistakes in New Zealand Hospitals

As one of the old blues songs goes, ‘I laugh just to keep from crying’.  This morning the headlines are out there nationally and internationally. MSN tells the story that in the YEAR ended July 2008, 76 people died out of a total of 258 incidents, that is those that we now about, in New Zealand hospitals.

The story says that the Ministry of Health’s Quality Improvement Committee went on to say that each of these deaths and incidents were avoidable.

The NZ Herald had the story on the front page of the printed edition, but semi buried on the net. They quoted the Health and Disability Commissioner Ron Paterson as saying that it was not a surprise and the story continued to say that ‘Reporting is voluntary and District Health Boards do not know how many incidents are unreported.

Incidents included people’s teeth being accidentally removed, 2 patients being given 10 times the needed dose of medicines, in at least one case, morphine, another patient was booked in, anaesthetised and sent to the operating theatre for an eye surgery they had already had 2 weeks prior. Mistaken identity is another common thread.

Does this come as a surprise to you? It doesn’t to me.

I wrote about these sorts of issues in this blog in February last year. I also presented one of the solutions that has been used in hospitals in the US for many years, at least 15 years ago when Welch Allyn (a well respected technology provider to the health industry) first brought out 2D bar code scanners with the ability to read complex bar codes on patient wrist bands and patient record folders, containing a huge amount of patient information, without requiring access to the hospital’s computer systems. All they would have needed was a number of scanners and a handheld computer such as a Windows CE device (which could also contain a database of things like drug interaction data, i.e. don’t use this drug in combination with that one.

Back in the late 80′s we were already able to come up with a solution that would keep track of patient records folders (which always seem to go missing when you visit the hospital) and are able to identify not only exactly what they are in hospital for, but also things like allergies (especially to drugs such as penicyllin) and any other relevant information such as blood type, currently prescribed drugs (both by their GP and in the hospital and much more.

I presented these concepts and more to Auckland Hospital and the Waitemata DHB. The solution was simple and low cost, but they chose the lower cost option of doing nothing.

So they saved some money and chose to ignore solutions which 20 years ago were strting to be installed in some hospitals in the US. How many lives could have been saved in those years?  I shudder to think. Of course there are also many living victims, who have had to have surgery repeated to remove items accidentally left in their bodies, or many of the other incidents. What about the family of those who died?

So I have a couple of questions:

• When everyone in the industry new these things have always happened in the industry, why was nothing done about it?
• Why is it voluntary to report incidents? Why isn’t it mandatory?
• How many more incidents actually occured that weren’t reported?
• What are they going to do about it?

You can read the damning report for yourself by downloading this pdf.

If you don’t want to, check out a few of these incidents from the report:

• Several mental health patients who committed suicide when they should have been under close supervision, or who were discharged and then killed themselves.
• A patient who died because of confusion over resuscitation status
• A patient who’s tests suggested cancer which was overlooked
• Accidental removal of a breathing tube from a ventilated patient
• Accidental bowel perforation during gallbladder surgery resulting in fatal multi organ failure
• Death of a mother from post partum hemorrhage due to a number of  ‘errors’

The list goes on for 84 pages and these are only those which were voluntarily reported!

So is the hospital the best place to be when you are sick? You decide.

Are there solutions? Yes there are and there have been for many years. I introduced some of them over 15 years ago and my ideas weren’t new, they were already being introduced into US hospitals at the time.

Are they going to do something about it? I hope so. My concepts don’t solve all the problems, but they could have saved several of these poor people and their families. Who is going to take responsiblity for this? I put it to you that the cost of the solutions is far less than the consequences of not using them at least 76 times over.

If you ask me, the government needs to step in now and do something about it. In many cases there are very simple technologies that will if implemented save many lives, but will also introduce sgnificant cost savings through eliminating some of the inefficiencies that waste time and money.

While this blog is starting to get a good following, I would love to get more readers and encouraging me to keep writing. If you feel that my blog is interesting I would be very grateful if you would vote for me in the category of best blog at the NetGuide Web Awards. Note that the form starts each site with www whereas my blog doesn’t and is of course http://luigicappel.wordpress.com.

Thanks so much for your support:)

Why do people still smoke?

With the amount of information about the effects of smoking, it amazes me how many people still want to smoke. My father in-law had a laryngectomy several years ago and speaks through a valve in his neck. After several years of remission he now has tumors in his bladder. My mother in-law has emphysema and cerebrovascular disease, which is similar to Alzheimer’s Disease with similar symptoms. She still smokes.

The cost of smoking increases constantly with taxes and governments have been forcing manufacturers to add more and more horrific images of rotting lungs and other consequences, but to little avail.

It is now known that current smokers have a 50% greater likelihood of getting dementia and are 70% more likely to get Alzheimer’s Disease. It deems this hasn’t had the same publicity as other consequences, perhaps because there is no cure, or operation to help people recover from it.

For people that want the nicotine rush, but want to avoid the tar and other carcinogens that come from tobacco, there are now other alternatives. One is nicotine gum. I used this myself some 20 years ago when I decided it was time to give up. The gum worked for me because I wanted to give up and by continuing the supply of nicotine I was able to get over the psychological urge to smoke.

Now there are E-CIG’s which allow you to continue getting the nictotine rush as well as the need to have something in your hand, to put in your mouth and suck in that deep breath, inhaling a measured shot of nicotine sprayed from an atomiser and then having a nice relaxing exhale. This could one day become quite the vogue for people who want to enjoy smoking, but want to avoid the risks. There are several benefits. You don’t have to be a pariah, standing out in the cold, excluded from enjoying your passion, barred from restaurants and drinking establishments.

There are some ironies in the smoking statistics. In the US, the highest percentage of smokers are those just above the poverty level at 29.9%. Overall around 24% of men and 20% of women in the US smoke tobacco. You often hear of people saying the smoke because they can’t afford many vices and smoking makes them feel better. Off course we all know that those same people also have a lower life expectancy. Some of it might be down to access to medicine, not having medical insurance and so on, but those that can least afford it seem to spend the most money on alcohol, gambling and smoking (to list the legal things).

In New Zealand around 25% of people smoke and a worse statistic is that around 174 to 490 non smokers die from second hand smoke.

There is no end in sight and while in countries like New Zealand it is pretty much illegal to advertise tobacco in any form, hope over to countries like Jamaica and you will see enormous ‘statues’ of packs of cigarettes and billboards of people with big smiles on their faces as they take a big lungfull of tar.

I would love to see support for the E-CIG’s because if people got the same stimulation, even if they don’t have fun curling the smoke from their mouths to their noses, or blowing smoke rings, they would at least live longer. I don’t know how bad the nicotine is as a stimulant.  I did some research on whether nicotine is harmful in itself and there are conflicting opinions and I guess given the commitment of manufacturers to keep making and selling tobacco products, there is potential for bias.

The main thing people say is that nicotine is an addictive substance, but my experience was that nicotine chewing gum made it so much easier for me to give up smoking. The evidence on smoking tobacco is irrefutable and the many court cases the tobacco industry has lost bear testiment to this.

I have a problem with intelligent people using and abusing drugs. Whether it is overuse of prescription drugs, smoking, taking mild or dangerous drugs such as methamphetamines or binge drinking. Many of my friends drink alcohol every day and many can’t open a bottle of wine without finishing it in one sitting. Many are happy drinking a whole bottle on their own, several times a week. I have a friend who works in a prison with methamphetamine addicts and told me that they have inmates who have virtually no brain left. That warden still smokes and drinks to excess.

So here’s a lits of what intelligent people are legally risking with tobacco smoking according to the Mayo Clinic:

• Lung cancer and other lung diseases. Smoking causes nearly nine out 10 of lung cancer cases, as well as other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
• Heart and circulatory system problems. Smoking increases your risk of dying of cardiovascular disease, including heart attack and stroke. Smoking 15 cigarettes a day doubles your heart attack risk. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have cardiovascular illness or heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
• Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and also is related to cancer of the bladder, pancreas, kidney, cervix, stomach, and some leukemias.
• Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
• Infertility and impotence. Smoking increases the risk of infertility in women and the chance of impotence in men.
• Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, decreased birth weight and sudden infant death syndrome (SIDS) in their newborn. Low birth weight babies are more likely to die or have learning and physical problems.
• Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis, than are nonsmokers.
• Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications such as kidney disease.
• Impaired senses. Smoking deadens your senses of taste and smell, so food isn’t as appetizing as it once was.
• Risks to your family. Spouses and partners of smokers have a higher risk of lung cancer and heart disease, compared with people who don’t live with a smoker. If you smoke, your children will be more prone to sudden infant death syndrome, asthma, ear infections and colds.

So I’ll leave the last note to doctor’s of yesteryear:

While this blog is starting to get a good following, I would love to get more readers and encouraging me to keep writing. If you feel that my blog is interesting I would be very grateful if you would vote for me in the category of best blog at the NetGuide Web Awards. Note that the form starts each site with www whereas my blog doesn’t and is of course http://luigicappel.wordpress.com.

Thanks so much for your support:)

Canteen’s Bandanna Week

When I was 8, my best mate died of leukemia, also aged 8. It was hard to comprehend, he had been sick for a long time and his family were very religious and somehow managed to cope. Since then another good friend died aged 20, just when life was going really well for her. Her partner who was totally devoted to her was obviously devastated and spending time with them at home and in hospital during her chemo visits was very difficult. She kept up a very brave face, but it was obvious that she was struggling with fear, dissapointment, frustration, why me, nausea, hair loss, energy loss, anguish for her partner and her family, I could keep going, but you get the picture.

New Zealand is highly regarded when it comes to cancer. When my late grandmother came to New Zealand on holiday, she had a collostomy bag, she had one kidney and had spent a year in hospital with over 50 operations. New Zealand was one of the few countries her doctors were confident about her visiting because of the reputation of care here.

We pay taxes for health care and some of it goes to research, but there are many more services that are essential, and today I have a Canteen bandanna around my neck as a tiny contribution of recognition to some of the services that Canteen facilitates.

One of the most important ones in my book is support. There is noone better to help a young cancer sufferer than someone who has been through it and uderstands what they are experiencing and going through. Noone else can really empathise.

According to a statement on Infonews there are currently 12,500 young people up to the age of 24 living with cancer or a sibling and this grows by hundreds each year.

The $4 donation I gave seems pitiful, but if 4,000,000 of us do it, it might be a different story. There are other opportunities. There are a number of bandannas on Trade Me signed by celebrities. There was supposed to be one signed by Elle McPherson, but I couldn’t find out, so I’ve put a bid on one signed by Donald Trump.

Anyway, Canteen does an awesome job and I hope they raise loads of money for this important cause. Let’s make these young people’s lives mean something and give them a lending hand.

I’m also planning one or more songs about cancer, but you’ll have to keep an eye on my Songwriting blog in the coming weeks to learn more about that.