November 2016 - I am cycling in The Galilee, Northern Israel, to raise money for Nazareth Hospital Paediatric Department. Nazareth is the largest Arab town in Israel; the people are lovely, and the kids are awesome. They need your help! Go to my sponsorship page to find out more and see what you can to do help!

19 September 2016

Building a new Paediatrics Unit for Nazareth

Shane is cycling the Galilee, 6-10 November 2016

Previously we helped build this modern operating theatre.


I will join friends from the UK and Middle East to raise money for the Nazareth Hospital Paediatric Department by cycling round the north of Israel. This post contains some information about me and my ride – feel free to share and to get in touch. Most important of all, I would love you to donate to our appeal – your support is greatly appreciated, and will help us achieve our dream of a modernised Paeds Unit in this amazing little city!

Who am I?

I’m Dr Shane McKee, a consultant in Genetic Medicine at Belfast City Hospital. My job involves the diagnosis and management of children and adults with rare genetic disorders. Some of the work is very hi-tech, involving the latest DNA techniques and computational analysis, but the most satisfying bit of being a Genetics doctor comes down to listening to patients and their families, putting together the pieces of the puzzle, and applying that knowledge to make life better. Children are disproportionately affected by rare genetic disorders, and when kids are ill, they need the best care, with their families around them.

What is the Nazareth Hospital?

Back in 1861 a young Armenian doctor named Dr P.K. Vartan from Constantinople, capital of the Ottoman Empire, arrived in the Palestinian town of Nazareth. He established the only clinic between Beirut and Jerusalem, catering for people from all around the Galilee and beyond. Although well known as the boyhood home of Jesus, Nazareth in the 1860s was a fairly small town. Over the decades, and through considerable turmoil in the region, the hospital expanded and modernised as best it could, supported by the Edinburgh Medical Missionary Society, the organisation that had originally trained Dr Vartan and which had sent him to Palestine.

Today the Nazareth Hospital (known locally as the English Hospital as well as the Scottish Hospital) is a modern facility, acting as the District General Hospital for the region of the Galilee. Although established by a Christian charity, and drawing many of its staff from the local Christian Arab population, the Hospital also has many Muslim and Jewish staff (and others), and treats patients of all backgrounds. It is a beacon for unity and peace in a region that has been marred by conflict for many years. However, several areas of the hospital are in serious need of upgrading, particularly the Paediatric Department, and that is the focus of the latest appeal by the Nazareth Trust.

What is my connection with Nazareth?

During our training as medical students, we were encouraged to travel from Northern Ireland to another country, somewhere unfamiliar, to see how medicine is practiced in conditions very different to back in Belfast. This was in 1993; I chose Nazareth, since a doctor from my home town of Dungannon, Dr Stephen Crooks, was working out there. I have always been fascinated by the Middle East, and this was an excellent opportunity to get to know a small part of it at first hand. I spent six weeks training in Nazareth itself, and fell in love with this little city and its wonderful inhabitants. Although I was only there for a short time, it now feels like a second home to me.

The local Arab Israeli population are warm generous people with a great sense of humour. They graciously welcomed me into their town and their homes, and that experience has shaped my entire medical career as well as my outlook on the world. As I met these people in the Emergency Department, the wards, the operating theatres, the clinics and maternity unit, I learnt a great deal about the practice of medicine, about cross-cultural communication, and about myself. I am forever in their debt. When I returned to Northern Ireland after my elective was over, I longed to return.

In 2009 I joined a sponsored bike ride along the Jordan Valley, from the Dead Sea up to Nazareth. About twenty of us cycled 250 miles through Jordanian and Israeli territory, seeing the sights and feeling the burn of climbing over 1500 metres up from the valley floor to the Jordanian plateau. The proceeds of our ride went to maintaining and developing the hospital, including the new operating theatres which were a massive improvement on the very old-fashioned theatres I worked in as a student. And of course I made a lot of new friends, all of whom share my love of Nazareth.

The Nazareth Hospital celebrated its 150th Anniversary with a conference in 2012 – this was a chance to catch up with old friends and to see how things have changed. Many of the kids whom I met on my first trip now have children of their own, and the Paediatric Unit does amazing work with very limited resources.

What will I be doing?

From 6-10 November 2016 I am joining another intrepid group of cyclists from the UK and The Galilee (and possibly a few from elsewhere). We will start in Haifa, and over the next five days we will cycle over 200 miles around Northern Israel, before crossing the Sea of Galilee by boat, and then making our way up through the hills to Nazareth Hospital. There are some challenging climbs, scary descents and bumpy tracks, as well as a couple of on-foot sections, and we’ll be overnighting in local kibbutzim at each of our stops. It won’t be easy, but it will be unforgettable (there may still be a few spaces available if anyone wants to join us!). Our objective is to raise as much money as possible to help refurbish the Paediatric Unit in the Hospital.

How can people help?

I have set a fund-raising goal of £3000, but I hope to raise as much as I can. I have set up a Justgiving web page at http://justgiving.com/shanenaz2016 . Using Justgiving significantly reduces the administration costs for the charity (The Nazareth Trust) meaning that more money goes directly to the project. I am really grateful for any donations, no matter how small (or how big!) - they all go to making the Paediatric Unit fit for the kids of the 21st Century, and hopefully building peace for the next generation. I am of course also grateful for any publicity on FaceBook, Twitter, Instagram, media or even good old-fashioned sharing – anything to help raise as much as possible for the Hospital, and to raise awareness what we are trying to do for the children of Nazareth.
Nazareth is a popular quick destination for tourists visiting Israel, but most people pass through very quickly on a whistle-stop tour. I would strongly recommend staying a bit longer, perhaps in one of the fantastic local guest houses in the Old City, exploring the town, and talking to the modern Nazarenes. It’s a complex, fascinating, full-on experience – oh, and the Palestinian food is amazing. Nazareth is famous for the best cooking in Israel, if not the entire Middle East.

- Shane McKee

Twitter: @shanemuk hashtag: #shanenaz

10 September 2016

Belfast in CardBoardCamera Virtual Reality

OK, by now you know I like the Google CardboardCamera app. It turns any Joe Soap with a smartphone into a VR 3D photographer, and as such you can in principle use it to experience 3D VR content from many sources and places. There are two main reasons why it is brilliant:

  1. It is actually stereoscopic. Most YouTube VR movies are actually 2D spherical projections - you don't get a real sensation of depth. CardboardCamera is pretty smart, and stitches together its panoramas to give you separate left and right eye images. Nice. 
  2. It overlays an audio track. Sound really boosts the immersiveness of the experience. It's not just looking at a boring image - even though it's still, there is still something going on. The soundtrack helps to locate you within the scene.
So with all that in mind, here is a small collection of CardboardCamera images I shot in Belfast. I hope you come and visit our great wee city, and have as much fun visiting these places in reality as I did shooting them for VR!

Download the panoramas - right-click, "Save link as", and copy the resultant file into your \DCIM\CardboardCamera folder on your Android phone. Then view in the CardboardCamera app.

Belfast City Hall is a masterpiece of art and architecture, dating from the very early years of the 20th Century. It's well worth a visit, with regular tours of the interior.

This fountain commemorates Daniel Joseph Jaffe, one of the leading members of Belfast's small but influential and illustrious Jewish community at the turn of the 20th Century. It sits in the historic heart of the city, close to the modern Victoria Square shopping centre.

HMS Caroline is the last survivor from the Battle of Jutland in World War One, the largest naval engagement in history. The ship has been restored to tell the story of the battle and life at sea in the early 20th Century. It's absolutely fascinating.

This is where I did my first house jobs as a junior doctor, although it's a lot quieter now than back then! The main action in the RVH takes place in the new sections. This Victorian corridor is a listed building, and contains many memories.

Belfast's flagship conference and concert venue in the evening light, as the traffic rushes by on Oxford Street. The Belfast Bikes are a great way of getting around the city.

Well, every city has its not-so-pretty major arterial routes, yes?


03 September 2016

The first Presbyterian Church in Ireland - #VirtualReality

Google Cardboard Camera Virtual Reality panorama of Templecorran, the ruined church in Ballycarry Co Antrim. It's a fascinating place, and now you can visit in VR. [CLICK HERE for the link]

INSTRUCTIONS: Download the .vr.jpg file and put it in the \DCIM\CardboardCamera folder on your Android device. It should show up automatically when you launch the Cardboard Camera app, and you can view it with your Cardboard Virtual Reality viewer. Have fun!

Virtual Reality: Dalway's Bawn

Here's a Google Cardboard Camera VR pic of Dalway's Bawn, a historical Plantation cattle fortress from the early 17th Century. It can be found just outside Ballycarry, near Carrickfergus Co Antrim. The towers and frontage are spectacularly well preserved, yet this amazing piece of history is hardly known outside the immediate area of Ballycarry and Bellahill.


Some more information on Dalway's Bawn:

INSTRUCTIONS: Download the .vr.jpg file and put it in the \DCIM\CardboardCamera folder on your Android device. It should show up automatically when you launch the Cardboard Camera app, and you can view it with your Cardboard Virtual Reality viewer. Have fun!

21 August 2016

Training for #shanenaz2016: GLENARM

You already know that I'm heading to Nazareth, the largest Arab town in Israel, in November. I'll be joining a fine group of folks cycling to raise money for the Paediatric Unit in Nazareth Hospital.

So today (21/8/2016) I did a training ride up to Glenarm in Co Antrim. The Antrim coastline is one of the most scenic in on the planet, and very accessible. Today's ride was up to Glenarm, the southernmost of the famous Nine Glens of Antrim, with its historic castle and harbour.

Here are a few Virtual Reality images from my trip - same as before - download them to your phone or tablet, and view with Google Cardboard. I think they came out pretty well - what do you think? A truly immersive Antrim Coast experience!

FILE 1: BALLYGALLY VIEW. Yes, Northern Ireland has some pretty variable weather, but it's precisely because of that weather that we can enjoy views like this!

FILE 2: GLENARM HARBOUR. A view over the foot bridge towards the harbour.


FILE 3. GLENARM MARINA 1. Little boats rocking in the gentle breeze.

FILE 4. GLENARM MARINA 2. They're still there and they're still rocking.

Please leave me a comment in the box below - I'd love to know how these make you feel.

Here's the Strava map for my journey - this is a lovely ride - do try it out.

And please sponsor my bike ride for Nazareth! Thanks :-)

17 August 2016

How the Clinical Note has to change

How not to do it.
Everything is wrong about this image of clinical noting in the digital age. White coats are an infection hazard. He's not bare below the elbow, presumably in a clinical area. The device is a big clunky useless piece of crap that's a pain to type on using this stylus. Why is he typing anyway?

So here is the problem. When Electronic Health Records were first designed, their job was to replace and carefully emulate what we had been doing with paper records. The concept was that the paper record was something of a Gold Standard, and our objective was to leverage the benefits of electronic onto this gold standard.

However, as Larry Weed pointed out FORTY FIVE YEARS AGO, there is a deep problem with the way we structure clinical records, and I'll be honest here - in my journeys around hospitals and clinics, and even in my own note-taking (even? Good grief!), our notes are not fit for purpose.

Here's a typical example of a note on a baby on day 3 in the Neonatal Unit (I've made this up, but if anything it's better than most): "Thanks for referral; Hx noted. D3. b38/40 twin 1. Other twin OK. bwt 3.21kg. Meconium at delivery, req resus. Resp now OK; off vent. NG feeds. Dysm features: hypertelorism, small mouth, crumpled ears, clinodactyly V, abn palmar creases, hypospadias. Suggestive of genetic syndrome. DNA for array. Will RV. Pls get clinical images & skel surv."

Now in the context of a busy NICU that's going to get buried in loads more clinical notes very quickly. If do that in an electronic system it's going to take me longer to type in (I could have scribbled that in half the time it took me to type it, even with the abbrevs), BUT again it's going to be lost in the load of other observations, consultations and notes that get added in.

As if that wasn't bad enough, just look at it - there's little structure to it. A computer is going to have to be pretty smart to parse even that highly lucid (in my opinion) text into something it can analyse or search on. It's free text. Furthermore there's a load of duplication there - much of that info is recorded elsewhere, similarly in free text. Maybe I've just jotted it down to persuade some lawyer some day that I've actually read the record (not necessarily understood the clinical case - those are different concepts).

So let's say we ditch the paper (YES!) and go digital - how do we change our practice and train doctors, nurses and AHPs to bring the clinical note up to date?

It's not an impossible task. For one thing, if we can crack the login/ID problem it should become easy to see who has made a note, and when (yes, we're supposed to sign and date/time all notes, but that is often missed, or people miss their IDs eg GMC number). It should also become easy to contact that individual through the secure EHR system. So in that area the clinical note is a good "stamp" to focus at least some clinical care around.

We surely don't need to repeat the basics - that should all be in a summary box every time we open that patient's EHR. But who curates that? How do we turn the mass of data that we generate into a coherent story that outlines the scenario relating to that patient, and that all the professionals AND the patient/family can group around and agree? Moreover, how do we turn that summary into something we can perhaps share with tertiary or supra-regional professionals outside our local (or in Northern Ireland's case, we hope) regional EHR?

And (critically) how do we ensure that electronic notes actually bring benefit, not just to the patient, but to the staff using the system? We need it to free up time. We need it to be a pleasure to use. But I feel that our approach to noting has shackled us to the past in such a way that we have lost sight of the purpose and function of The Clinical Record.

In the digital era we need to actually enter things manually to a computer as LITTLE AS POSSIBLE. Voice recognition is still pretty damn basic, but it's making headway. But my clinical note should be short and to the point. If I need to enter something quantitative I should be able to do that, but I'm not writing a legal document here. I want to construct a digital record that is dynamic and positively contributes to good clinical management and outcomes for my patient.

So like clunky tabs and white coats, perhaps the clinical note itself needs a major overhaul before we start replicating in electronic form the mistakes that Larry Weed pointed out to us all those years ago, but nevertheless persist in our training and practice.

12 August 2016

Virtual Northern Ireland

Have you ever wanted to visit Northern Ireland, but haven't got around to it yet? Now you can get a feel for it in #VR prior to booking your trip(s).

VR panorama: Waterfront Hall & Law Courts, Oxford St, Belfast. *Doesn't lead to Oxford.

I've been playing with Google CardboardCamera - an app that allows you to take 3D Virtual Reality pictures on your smartphone and view them with a Google Cardboard Viewer.

Anyway, the lovely people at VisitBelfast gave me one of their special viewers, produced for the new Belfast Go Explore VR app (check it out on Google Play or Apple Store), so in honour of the occasion, here are some of my own VR shots of Northern Ireland for your Virtual pleasure!

Simply download the file from the link (these are DropBox) - you should get a file ending in .vr.jpg - then add the file into a folder on your Android device called /DCIM/CardboardCamera and then launch the CardboardCamera app. It should automatically detect the files, and if you have a VR viewer such as the one above, you can be magically transported to a mystical world of wonder (i.e. Northern Ireland). Enjoy!

Let me know in the comments what you think of these, and don't forget to sponsor my cycle ride to Nazareth for the Paeds Department in Nazareth Hospital! Spread the word - thanks!

30 July 2016

Sponsor me to Cycle the Galilee for Nazareth Hospital

Stubborn to the last. Jordan Valley, 2009.


Nazareth is the largest Arab town in Israel, and home to its largest Christian community. Its hospital is the oldest in the country, founded by the remarkable Dr P.K. Vartan from Constantinople in the days of Ottoman Palestine. I became an honorary Nazarene when I did my elective there as a medical student back in 1993, and saw at first hand the great work being done, using healthcare to build bridges between people.

The Nazareth Trust is raising money to provide much-needed refurbishment for the Paediatric Department, and a group of us are cycling through the ancient terrain of the Galilee in November 2016. Christians, Atheists, Muslims, Jews and others - all are welcome. So please go over to my Justgiving page and sponsor me! Also share on Facebook and Twitter: #shanenaz2016 - and thanks so much for your support!