Wednesday, July 07, 2004

In defence of the NHS
It was a throwaway comment made by someone that knows nothing about my history that got my blood boiling. But then stories like mine are so commonplace, everyday, they don’t make it on to the newsstands.
When I was born I was diagnosed as hydrocephalic. Sometimes called ‘water on the brain’, hydrocephalus is a fairly serious condition:
Hydrocephalus is the abnormal build-up of cerebrospinal fluid in the ventricles of the brain. In most instances, hydrocephalus is a lifelong condition in that the patient is treated rather than "cured". Presently, there is no known way to prevent or cure hydrocephalus and shunts are the primary method to treat hydrocephalus. The one-way calibrated shunt system was introduced in 1952.

I was fitted with a shunt, a valve. As a result of this surgery, I have a two-inch scar on my neck – near my collarbone – and what feels a little bit like a mini spine behind my right ear. The history of how shunts came about is a sad one:
The modern shunting era began with Nulson and Spitz, creating a one-way pressure regulated valve which they placed in the atrium via the jugular vein. John Holter, an engineer, was the father of a hydrocephalic child who worked on the early development of the shunt valve.

Unfortunately, John Holter’s son died before the treatment was perfected. Previously, the standard treatment for hydrocephalus was to tightly bind the patient’s head in the hope that the fluid would be under such a high pressure that it would force its way out through the ventricles – this was not a successful treatment.
The natural history of untreated hydrocephalus was studied in the classic paper by Lawrence and Coates, demonstrating a 46% ten-year survival with intellectual impairment in 62%. The impact of CSF shunting was shown by Foltz and Shurtleff to be significantly improved. Their 10-year survival of shunted children was nearly 95% with intellectual impairment in only 30% of children. Other studies have shown the improved intellectual development associated with a decrease in the ventricular size. Continued problems, however, are related to shunt dependency, which is usually present for the life of the child. These shunt related problems include shunt malfunction, shunt infection, overdrainage and the "slit ventricle syndrome".

It worries me then, when I read this from an American site:
While it is certainly not the most glamorous neurosurgical operation, shunting is one of the basic neurosurgical procedures, and also has the highest failure rate. It has a relatively high complication rate and is probably the most common operation which has to be redone for either malfunction or infection. Shunt operations are often delegated to the most junior and inexperienced member of the neurosurgical team, resulting in suboptimal technique and judgment in the management of shunting. Clearly, one of the best ways of managing shunt problems is avoiding them in the first place. Pediatric shunting should be performed by a pediatric neurosurgeon who is well experienced in the various shunt hardware and techniques, and has experience in thinking through the technical problems of shunt dependency and shunt revisions. These children will require close follow-up to recognize at an early stage some of the complications of shunting, and to pick up on subtle signs of shunt dysfunction. A close working relationship needs to exist between the pediatric neurosurgeon and the families, as well as the child's pediatrician, to provide the best comprehensive evaluation of a shunt problem and recognize at an early stage.

Let me state unequivocally, I received the best possible care from every consultant, doctor and nurse. Mr David Hardy, who was working at the Southampton General at the time, operated to fit my shunt and followed my progress with regular check ups until I was seven. Hardy is currently the President of the Society of British Neurological Surgeons. My GP was excellent – everyone involved ensured that I had the best chance of survival. Let me also add that Southampton General isn’t a specialist hospital like Great Ormond St – this superb standard of care was delivered at a ‘bog standard’ NHS hospital. Also, without the NHS I would not have received treatment – neither my birth mother nor my adoptive parents would have been able to afford it.
At the age of two I was back in hospital to have the drainage tube that leads from the shunt to my heart extended. As a result of this surgery I have a second slightly longer and thinner scar on my neck under the first one. Rude people sometimes ask if I tried to commit suicide.
At the age of seven I was admitted to hospital for a brain scan. The purpose of the scan was to see if I needed another tube extension. Somewhat miraculously, it was discovered that I didn’t need any further surgery. It appeared that the cerebrospinal fluid was finding its own drainage path. It seemed I was cured. I continued to have annual check-ups until I was 12 years old, whereupon I was told it was no longer necessary.
Within a month of my final appointment I was back in hospital. I’d been run over and broken my arm, fractured my skull and ruptured an eardrum. I was in intensive care for 48 hours and then transferred to the children’s ward. Today the only sign remaining is the three-inch scar at the top of my left arm.
Since then I have not needed to stay in hospital. I have, however, had regular appointments with my GP, two visits to consultants (a swollen gland next to my shunt caused panic as did a suspicious-looking lump on my leg). I will never forget that the NHS has saved my life at least three times. Yes, the service could and should be improved. The staff that work for the NHS – from the cleaning contractor to the junior doctor and above – are underpaid and grossly undervalued. They are also human – I can well understand that there have been instances of mismanagement and simple error leading to mistreatment. As they say, nobody’s perfect. But please let us not forget that when you are sick, really seriously ill the NHS offers – free at the point of delivery – lifesaving medicine and oftentimes the doctors and consultants involved are at the top of their profession. In teaching hospitals it is possible to gain access to expertise that money can’t buy.
So next time you want to take a pot shot at our, despite everything, lifesaving health service and the people that sacrifice decent pay and normal hours to work in a highly stressful and difficult environment, where the decisions made really are of life-and-death importance, please remember – there are people walking around today, working in your office, sitting next to you on the tube, people who perhaps bear even fewer scars than me, who wouldn’t be here now if it wasn’t for the NHS. It’s that simple. And if tomorrow, god forbid, something happened to a friend of yours or a family member – the NHS would be there for them.

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