Drugs and Alcohol

In October, Club Hopeland had the pleasure of welcoming Mr Da’oud Rosa, coming to Algeria from Hartford, Connecticut, USA and Australia’s Gold Coast for a talk in English on Drug and Alcohol counselling.

He began by highlighting the fact that tackling Australia’s drug problem is an ongoing fight.
Heroin from Thailand and cocaine from South America coupled with the country’s own perfect cannabis-growing climate and universally easy-to-make amphetamines means high availability of a variety of drugs. In fact, approximately, 85% of inmates in American and Australian prisons are there for drug-related crimes.

Why do people become addicts?
A couple of possibilities were discussed but the idea of an ‘addictive personality’ was refuted by Da’oud. He favoured the work of Alice Miller, a psychotherapist, who suggests that families are the main cause of substance abuse through engaging in child-rearing techniques which result in emotional, physical or sexual abuse of the child.
This abuse affects the self-esteem of the individual causing denial and for some, this denial manifests itself in an addictive process which is a dangerous combination.

The result of this combination may show itself in a variety of ways depending on the person’s personality type. Some individuals may develop obsessive compulsive behaviours and become all-consumed in work or a passion of theirs such as music, art or sports and may indeed excel in their field. Others may turn to drugs or self-harm.
However, neither is healthy as they both keep the individual from facing the truth about themselves.

As Da’oud believes that humans have an inbuilt need to seek the truth, drug addicts will always be restless and reliant on their drug until they deal with the denial.

He also suggested that some nations have been drinking alcohol for centuries and therefore their people have genetically adapted to it but that for some nations who are only recently being exposed to it, such as the indigenous Aborigines and the Black African Americans, it can cause real problems.

How are drug addicts rehabilitated?
In general, rehabilitation has two main steps:
1. Medically detoxify the patient – a controlled gradual reduction of the drug they usually take or synthetic replacement to enable the body to adapt to the withdrawal process to a point where they are drug-free.
2. Outpatient or residential programmes – these are aimed at removing the individual from the addiction long enough to help them identify the underlying issue and its effects and help develop strategies to deal with that issue.
There are a number of ways that friends and family can also help.
Da’oud highlighted the importance of telling addicts the truth by using expressions such as, ‘I hate seeing you deteriorate in this way’. This should be coupled with action. Relatives and friends often act as a ‘prop’ to their loved ones, bailing them out of jail, giving them money and trying to reduce the harm they cause themselves. However, it was suggested that the following, ‘ABC’ method should be used to help break the cycle:
A = Antecedent
B = Behaviour
C = Consequence
By experiencing the consequence, the addict can see the result of their behaviour and this in turn may prompt them to seek out the cause.

What Next?
One of the difficulties following rehabilitation is being discharged back into an environment which encourages the previous behaviour which is often the case in developed countries where enjoying yourself, by definition, involves taking one form of drug or another.
People work very hard with high stress levels and are looking for a quick way to relax. Alcohol and cigarettes had, in the past, been widely advertised on TV and at sporting events and the fact that they were legal helped them become a social norm amongst a majority of the population.
Interesting, in the UK, the smoking ban in public places (brought in to reduce the huge costs spent by the government each year through the NHS on the treatment of smoking related diseases), has made smokers feel like social lepers. However, alcohol remains an acceptable social lubricant for all occasions despite its position on Da’oud’s ‘Addictive drugs harmful effects’ ladder.
This may be why the term ‘drugs and alcohol’ is slowly being replaced by the term ‘alcohol and other drugs’ as a reminder as to its addictive nature.

Da’oud’s ‘Harmful effects of addictive drugs’ ladder:

Barbituates
Alcohol
Amphetamines These stimulate the nervous system making the user feel energetic and reducing the need for sleep or food.
Nicotine Smoking related diseases are the most common cause of death in some countries.
Cocaine
Cannabis Long term use can cause psychosis, occasionally irreversible.
Methadone Used to ween addicts off of Heroin but potentially more harmful as a product.
Heroin Chemically closely resembles our own body’s endorphins (which provide pain relief). The body then stops producing its own endorphins so withdrawal from Heroin can be both an emotionally and physically painful
process.
Caffeine

It may surprise readers to see Heroin so low down on this list where Barbituates are the most harmful and caffeine the least but the majority of deaths from Heroin are from a lack of regulation causing the drug on the street to be mixed with unknown additives and no guarantee of its strength.
The American Government made it a condition of joining the United Nations that Heroin should be illegal although the reason for this is unknown. Some believe that if it were made legal then deaths from its use would reduce.

It should be remembered that a majority of these drugs have the potential to trigger an underlying predisposition to psychiatric diseases and that sometimes, during withdrawal, a patient’s disease may become worse due to the fact that the drug was propping up that condition.

Healthcare: Algeria v the USA

On the 28th August, Club Hopeland had the pleasure of welcoming Mrs Jenny Henry, an American health care professional and English teacher, all the way from Nashville, Tennessee (currently living in Blida) to give a talk in English entitled: ‘Healthcare: Algeria v the USA’.

Just before her talk some of my medical English students (pictured below), joined English speaking expats for a meal with an eclectic range of International cuisine!

Jenny started with an introduction of herself, a nurse for 30 years in the USA but now living in Blida, teaching English. She gave us a feel for her home town of Nashville, the music capital of the world which started with country music but is now home to every possible genre of music. A local newspaper is dedicated to providing the music lover with a timetable of where and when to go depending on their ‘musical mood’!

Nashville is situated in the ‘Bible belt’ of Southern America where a church can be found on every corner although these days, houses of worship for all denominations can be found. The weather can be similar to Algeria occasionally seeing 4 seasons in one day and despite Jenny remembering it as a small town; it has now grown into the 25th largest populated city in America.

Nursing
Jenny loved nursing, describing it as a good field, but over the years, the changes have made it harder to enjoy the job.
She started by speaking about the risk of litigation health care professionals find themselves faced with on a daily basis and the paperwork required to manage that risk. She reminded us of a well known saying in nursing both in the USA and the UK:
‘If it’s not written down, it didn’t happen’
So if the patient goes to the toilet, you have to write it down, if you speak to the relatives, you have to write it down, if you educate a patient about something.... you guessed it!
This fear is also compounded by each health professional being accountable for his or her own actions and therefore the doctor saying, ‘The nurse did it!’ is not unheard of!
This fear of making a simple mistake and finding you have no support and at risk of losing everything has prompted nurses in the USA to take out medical malpractice insurance and while this is not yet the case in the UK, is likely to be the case in the not so distant future.
Jenny would love to be a nurse in Algeria but is limited by the language barriers.

Healthcare
In the USA less than 60% of the population are medically insured and a majority of those who are, have been given it by the companies they work for, however, fewer companies are doing it these days due to the expense.
Many Americans have no health insurance which means that they may receive very basic emergency care but no further treatment will be given until they can produce their insurance card.
The reason for this is the cost............... approximately 500 $ per month.....just in case you are ill!
You might consider this worth the money when you consider that a single ride in an ambulance and a 3 hour stay in the emergency department can cost a staggering 6000 $ and a simple operation followed by a 24 hour stay can set you back 80,000 $.
The Head teacher of the school told the group that even as an American citizen on holiday in her own country, she is not entitled to health care unless she has travel insurance.
A further shock was that the doctor may think that you require an operation but the insurance company can override this decision!!!!!

If this wasn’t enough, those with money are buying health insurance for their pets!

Medication
Medication in the USA is very expensive and most insurance policies don’t cover it. As a nurse, Jenny recalled increasing scenarios where families have to decide between important medicines and food and heartbreaking stories of parents unable to afford medicines for their children.
Whilst there is minimal care for the elderly (Medicare) and some social security, it is not enough to live on and therefore in no way covers the costs of medication.

These high costs have made health care a major USA electoral issue.

Jenny then recounted the story of her daughter in the USA who doesn’t have health insurance on account of her being a college student but who has a recurrent respiratory tract problem. In the USA, she has to see a doctor to prescribe the medication she needs at a cost of 100 $ and then it costs 25 $ for the treatment, treatment which can be bought over the counter in Algeria without seeing a doctor and costing a fraction of the cost.

She admits that some medication is unavailable in Algeria but is amazed at those which are available without prescription. She has an Algerian pharmacist friend who she engages in ‘drug’ talk but is starting to worry that they are beginning to think she takes them all!!!!

Choice
In Algeria, when you want to see a doctor, you go directly to a specialist of your choosing. In the USA, you will see a general practitioner, not of your choosing, who may or may not decide to embark on the bureaucracy to get a specialist opinion.
If you have a basic universal insurance then it is likely that the doctor you see will be newly or not very well qualified (HMO).

Jenny finished by saying that the best thing about Algeria was the Algerians and although the main health concerns seem to be too much sugar and smoking, in general, the Algerian lifestyle was healthier than the ‘everything deep fat fried’ diet of the Southern Americans. She praised the doctors in Blida following personal experience of their care and reminded us all to reflect on whether the health care system in Algeria really was that bad after all!!!!

The event was attended by approximately 25 Hopeland ‘General’ and ‘Medical’ English students and teachers and was followed by a drinks and sweets reception in the garden as an opportunity for our students to speak freely with the native speakers present. A wonderful time was had by all and our thanks go to Jenny for her enlightening talk.
We look forward to receiving the next guest speaker at Club Hopeland after Ramadan.

Where did the time go?

I was quite taken by surprise that my last blog was indeed in April!!!! I have no excuses other than the obvious but rather predictable, 'I've been so busy!' so I won't try and make up anything less plausible.
These 4 months have seen the first course of Medical English through to completion although the students still have some classes to redeem due to on-call and conference commitments before they can take their final tests in order to assimilate all the results to see if they have passed.

We have had to move classrooms due to an increase in students from an initial 3, (thank you to them for having faith in the course) to 8 currently and 2 due to start this week.

We have doctors from Ain Nadja, Bab El Oued, Zeralda, Beni Messous, and Bainem Hospitals aswell as biology and medical students and have had interest from 1er Mai, Bainem and Kouba Hospitals with a view to holding classes on site. Unfortunately, uptake at this time of year is slow due to Summer holidays and Ramadhan but Insha'Allah things will pick up in October.

A recent trip to the UK enabled me to bring back more medical realia and resources for students to further enhance the learning experience.

I have to say that personally, I have thoroughly enjoyed teaching this course. I have learned more about teaching and medicine, the Algerian healthcare system and those who work within it.
Although it was my intention to post more regularly, I somewhat failed in my objective, however, I will make every effort to redeem myself now that the 2nd course has started and I have a little more time to myself!!!

So for anyone in Algeria interested in Medical English, please scroll down to the bottom of this blog homepage for more details of the courses offered.

English Medical Articles in French Journals

At the same conference detailed in my last post, I was introduced to a medical journal called 'Prescrire'. In each edition, one of the articles has been translated into English. This would make an excellent reading exercise with the translation readily available should you have any difficulties. I suggest you check it out!

If you want to publish your work in English in this, or any other significant journal, please contact us and we will do our best to help you. Good Luck!

English Medical Books

Whilst attending the 4th GP conference at Hamma this week, I took the opportunity to look around the library. I was surprised to see so many English books but sad that there were so few medical books to loan, pharmacology, first aid, nursing and tests in medical english were among the 5 books on the shelf. There is, however, a reference section where I was shown modern medical reference books in excellent condition:

• Anatomy and Physiology
• Pathology
• Physical Examination
• The Respiratory System
• Medical Dictionaries

You need to be a member of the library (800-1500 dinars) and then you can sign up to the American corner for free. I have added the link to the library in the 'useful links' section for more details.

It is envisaged that Hopeland will be able to provide access to medical books in the future, however, until this is possible, I recommend the library as an alternative.

This is what the American Embassy has to say about this resource:

American Corner
In February 2005, the U.S. Embassy in Algiers and the National Library of Algeria forged a partnership to open the first American Corner in North Africa. Centrally located in the El Hamma district of Algiers, the American Corner offers the Algerian public a resource of information on the United States. The American Corner has documentaries and films, books, and CD-ROMs on a wealth of topics. Spanning American culture and history to politics, economics, and law, the American Corner’s collection includes hundreds of titles in English, French, and Arabic on these and other subjects. A key component of its holdings is its large English language section that provides learning materials for students of all levels as well as teaching manuals and reference books for instructors.
Additionally, the American Corner serves as a gathering point for seminars, lectures, and activities. The Public Affairs Section organizes a program of events during the academic year from September to June held in the National Library. To view the current schedule, click here.
The Embassy is committed to expanding the American Corner Program and hopes to open new corners in Algerian cities in the coming years.
The American Corner is open to the general public during regular library hours. For more information, visit the National Library of Algeria’s website.

You made your bed, now you lie in it!

"Random House Dictionary of Popular Proverbs and Sayings" by Gregory Y. Titelman says the above phrase 'you made your bed, now you lie in it', has been traced back to about 1590 and is related to the fifteenth century French proverb 'Comme on fait son lit, on le treuve' (As one makes one's bed, so one finds it). It was included in George Herbert's collection of proverbs in 1640 and in James Kelly's collection in 1721. It was first attested in the United States in 'Cy Whittaker's Place' (1908) by J.S. Lincoln, and is found in varying forms..." however, today I use it in an ironic form.

This week has had an infection control feel. It started whilst undertaking written tests of doctors English levels in a local hospital where I witnessed a patient argueing with a doctor. As my Algerian is still at elementary level, I asked a nurse in French what it was all about and she explained that the patient was insisting on using their own linen despite the hospital policy prohibiting this.
I was confused but pleased to hear that the hospital had such a policy as last year, a family member had been asked by a different hospital to bring their own linen with them as the hospital had run out.
My confusion and a well-timed lesson entitled 'patients expectations' enabled me to explore this further in my weekly Medical English class.

The doctors told me that patient's bring their own linen, and sometimes even their own mattress, as they do not trust the hospital linen to be clean. The lack of a regular water supply was partly blamed for the hospital's inability to provide a reliable quality service.
This is certainly something I'd be interested in investigating further and as luck would have it, I was fortunate enough to meet a Professor specialising in Infection Control just a few days later.
Unfortunately, we did not have time to discuss this particular matter on this occasion although I will try to remember next time we meet and add any insights to the blog later.

Instead, we discussed the system which her hospital has introduced where a 'link-person' for infection control has been identified in each department. This person is responsible for attending meetings to discuss any changes and then disseminating the information to their colleagues to ensure the message reaches as many staff as possible. This is a method of communicating important information with which I am familiar from the UK where it has been used to effectively update staff on universal issues such as diabetes, latex allergy and infection control amongst others.
I was also interested in her current work looking into the benefits of screening certain patients for MRSA prior to surgery following a high incidence on recent random screening, again a well-established practice in the UK following front page headlines of the infection's 'superbug' status.
At first, I was shocked to see that well recognised methods of infection prevention are only just being considered in Algeria but then I marvelled at the motivation of the Algerian doctors who, despite the difficulties they face, continue to strive to improve the conditions for their patients.
I was invited to the 1st Hospital Hygiene and Fight Against Nomocomial Infections Study Day being organised by her department and I am very much looking forward to attending, learning more about the Algerian health service and working with the inspiring people who work in it.

Never Lose Sight of Your Dreams

Hi to all,
I mentionned my dream in a previous blog entry but don't worry, I haven't lost sight of it already.
It's just that I met a doctor yesterday with a very interesting proposition.
Obviously far more realistic than I, he suggested that future conferences could start to have one session / poster/ symposium etc in English to start with, which had escaped me despite it being a very sensible and logical idea!
So.......today I start my quest to find willing volunteers who may like to present in English at the conference of their choice. I can then help them to organise their slides and give presentation skills classes before approaching the organisers with an abstract.
If you feel you'd like to give this a go, let me know and we'll do all we can to make it a reality.
As always, I look forward to hearing from you.

How Much Should A Patient Be Told?

On Thursday, we had the second full day of teaching Medical English at Hopeland Institute. It gave me great pleasure to be involved in engaging discussions about ethical decisions we, as healthcare workers, make every day and learn more about how the resources and culture in Algeria affect the decisions made.



We debated how much, when and even if a patient should be told about their condition, irrespective of the condition, and whether it was ethically acceptable to tell the relatives of the patient before the patient themselves. Views exchanged by the Algerian doctors in the class included comments such as:

• Patients are only told what is hapening to them depending on their educational level, some patients don't need to know


• It depends on the situation as I wouldn't tell a person with cardiac failure that he could suffer from sudden death at any time as it would be too stressful for him


• People in the Western world are independent and need to look after themselves so it is different for them, but Algerians are cared for by their families and therefore their families may be told things that the patient is not


• Doctors in Algeria haven't had the training to talk to patients honestly about end stage disease


• There isn't the support for the patient in the community once they have been told


• We wouldn't talk to a patient about their prognosis as they may live longer or less time than we have told them


• What about a patient who has a secret wish to do something before they die such as go to Mecca or get their affairs in order? Surely they have a right to know their prognosis as early as possible so they can fulfill their dreams before they are too sick to do so?


• When families are told about someone's condition, it is usually the males in the family who are told as it can be too emotional for the women.

This discussion opened my eyes to a new perspective, one which I look forward to discovering more about.

If you would like to send comments on the discussion above or anything else, please send them to me. I will post them on the blog unless you tell me that you wish them not to be.

I look forward to hearing from you!

Algerian Medical Websites

Well I've had quite a productive week this week! I found out that despite not finding a great deal of information on 'health issues' in Algeria when performing a Google search, there is, in fact, a wealth of information and things going on if you know where to look!

I had the good fortune to meet Professor Abid at Bainem Hospital on Wednesday and he introduced me to a number of very informative websites which he is involved in, giving me endless hours of fun, not least for having to read everything in French, a real challenge for me I can tell you! I'm sure that you already know these sites but will include them here for those who may not: www.santemaghreb.com and www.sante-dz.com

Welcome!!

Hi to all you English speaking medical people here in Algeria!
Let me introduce myself. My name is Louise and I'm an English teacher based in Algeria.
I have 17 years experience in the Health Service in the United Kingdom as a Gastrointestinal Nurse Specialist, trained to perform endoscopies independently and responsible for the training of doctors and nurses within my field.

Following a course in Teaching English as a Foreign Language, I am now living in Algeria with my Algerian husband, where I have been teaching Business English and English Conversation.
Then, Alhamdullah, I met Laura and Bachir Dib, an inspirational couple, who, through their American English school in Cheraga, gave me the opportunity to use my experience to design a Medical English course. As medicine has been my lifelong passion, I took the challenge, designed a course, and this week started teaching the first group of doctors.

It is my dream that over time, we can help medical personnel in Algeria develop the necessary English skills to access all the latest research and to benefit from the many International Conferences held in English throughout the world. My ultimate goal would be to organise a Medical Conference in English, here in Algeria, but I keep being reminded 'bshweeya bshweeya!!!'

I would love to hear your experiences, thoughts and hopes for the future and insh'Allah we can use this blog as a think tank where we can share ideas and support each other. I look forward to hearing from you.