#shanenaz2016

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!
http://justgiving.com/shanenaz2016

22 November 2016

Socratic debate, Union Theological College Belfast, 21 Nov 2016

Last night in Belfast we had a debate, as part of the CS Lewis Festival. Just the usual for this part of the world: "This house believes that God is about as real as Narnia". Proposing the motion were Jennifer Sturgeon and me; opposing us were Chris Hudson and David Capener. Our moderator was William Crawley. For the record, here is the text of my opening statement...

CS Lewis was a master story-teller. When he created the Narnia series, he told an engrossing story of interactions between a world somewhat similar to ours and the fantasy world of Narnia.

Many people have pointed out close parallels between the Narnia fantasies and Christianity, and indeed some go so far as to suggest that Lewis consciously created Narnia as a Christian allegory.

The character of Aslan the lion, who dies and resurrects, is a very close parallel to that other fantasy, the risen Christ. And not everyone is a fan of Narnia - there are elements that are pretty questionable on ethical and intellectual grounds. However, we all agree that Narnia, whatever its merits or demerits, reflects the outworking of a human mind, and is not something that “exists” in a real sense.

And that is OK. Because we humans are story telling creatures. We don’t understand things through lists of facts and figures - we use NARRATIVE. Even scientific theories (and the word theory is much misunderstood, especially by creationists, but that’s another narrative) are in essence *stories* that we use to pull the facts and figures and hypotheses together. We create as coherent a narrative as we can muster, and we try to communicate with that.

So if we use stories to help evolved human brains understand reality, what about the story of God? I maintain that we do know enough about the world to answer that question. God is about as real as Narnia.

Now in saying that I am saying two very specific things:
  1. God in general, whether we are talking about the “God of Classical Theism” or a more localised form of god with intentions, emotions, desires etc, is a human construct that does NOT comport with whatever is really out there, and
  2. The Christian story of Jesus Christ as the Son of God is a story that is not “true” in the deep and meaningful sense that many Christians make it out to be. The same applies of course to other religions based on supernatural beings, but since Northern Ireland seems overly fond of Christianity, perhaps we’ll focus there for now.

I’m also making an ancillary point - the notion that the stories in the bible are the Word of God and point unerringly towards a correct understanding of the divine is manifestly NOT TRUE.

The Bible contains many wonderful stories that incorporate errors, contradictions, propaganda, fiction, embellishments, lies, truths, fabrications, fairy tales, history and pseudo-history. The bible is a human product, but whereas Narnia had a single author, the bible - and the religious fantasies woven around it - had many.

I was a believer in the truth of the Christian God story until I was in my 20s. Then I went to spend some time studying in a hospital in Nazareth, Jesus’s home town. I came across people who were Jewish, Muslim, Christian and Druze – all people with different stories about God. But they all experienced the same joys, pains, worries, hopes. Maybe my view was too narrow?

Indeed, maybe Jesus didn’t actually rise from the dead, and like Paul said in the first letter to the Corinthians, my faith was in vain. And when I studied the bible stories, the protestations of the apologists that the resurrection was historically well attested completely fell away. It was a fantasy too.

For example, the story in the Gospel of Matthew has dead people rising from their graves when Jesus is crucified. This is not reported ANYWHERE else in the bible, or by any ANY contemporary source. The author of Matthew (who was certainly not Matthew the disciple) made it up.

When Jesus rode into Jerusalem on a donkey on Palm Sunday, Matthew, who didn’t know Hebrew, misinterpreted a passage in the Old Testament, and fabricated an EXTRA donkey (the foal) in order to fix what he saw as an error in the gospel of Mark (also not written by an eye witness).

When Jesus allegedly rose from the dead we have separate yarns in the gospels and Acts that are completely at odds with each other, indicating that these were MADE UP. It’s now very clear to me that the stories of the risen Jesus are based on visions dreams, false memories and peer pressure, not actual appearances.

It’s an interesting experiment to get four bibles and read the gospels side by side, and I encourage you to do this. It’s like JRR Tolkien and Bertrand Russell were all having a hack at correcting CS Lewis’s mistakes in Narnia, while Arthur C Clarke was off writing something else.

We don’t have four eyewitness perspectives – we have four people telling stories about something they have never seen, except in their imaginations working on what they’ve been told.

The central story of Christianity is a fantasy. Jesus was just a man about whom stories were written, and we should take them with a BIG pinch of salt.

The omniscient omnipresent omnipotent omnibenevolent God that made the universe is likewise just a story. We don’t know exactly how the universe began. We don’t know the fabric of reality. But we do know that surprises are in store, and EVERY time we’ve thought that God has intervened in the history of our universe, we’ve been wrong. The God of classical theism is a philosophical toy God, and frankly we don’t need it - science has given us BETTER stories.

I sometimes identify as a Christian Atheist. Many aspects of the Christian story still appeal to me, because I love stories too. They have helped form my outlook on the world and life.

But we are the product of the laws of physics working in a universe that also produces supernovae, black holes, ice fountains on Enceladus, nitrogen oceans on Pluto, coral atolls on Earth and joy and pain for human beings.

It’s a marvellous Universe, but it doesn’t really care about whether or not we’re here. But WE care, and we invented the gods and God to give us a central place in the cosmos. God is a mirror, not a window.


God is a story, in exactly the same way as the Shire or Hogwarts or Narnia, and it’s a story that gets BETTER – and WE get better - when we realise that it is fantasy.

20 November 2016

Mission Accomplished!

I have been remiss in updating you on my Israel biking adventure - we rolled in to Nazareth on Friday 11 November 2016 after five (well, six) days of incredible biking. A journey together that brought us from the shores of the Mediterranean up to the Upper Galilee, down to the Jordan Valley and the Sea of Galilee and finally to Nazareth itself.

As a group of old friends and new, we explored the terrain, meeting local people and viewing the splendours of the countryside. We passed through villages populated by Jews, Christians, Muslims and Druze, as well as barren hills, verdant valleys, agricultural fields and scented forests.

But the purpose of our journey was its final destination - the crazy paradoxical town of Nazareth, home to the largest Christian population in Israel, and the location of its oldest continually functioning hospital - the Scottish Hospital, established under the EMMS (Edinburgh Medical Missionary Society) in 1861 by the remarkable Dr Pacradooni Kaloost Vartan.

The whole rationale for the bike ride was to raise money for refurbishment of the Paediatric Surgical Unit. We still need to hear how much we actually raised, BUT if you want to give more, you still can! My fundraising page is at http://justgiving.com/shanenaz2016 and  remains open. When we arrived at the hospital we were given a tour of the current facilities (closed while the refurbishment gets kicked off), and I can certainly give my approval to the new plans. I think it will make a big difference to the kids coming in for surgical treatment.

But all of this got me to thinking - why should we in the UK be supporting a hospital in Israel? Surely the Israeli government should be working harder on its own healthcare policies, and properly resourcing its hospitals and clinics? The answer to this one is both complex and simple. The complex answer is that Israeli healthcare planning and funding is a bit of a mess, and healthcare organisations have to sort it out themselves while seeking reimbursement from the national insurer. Capital development is really under pressure.

The simpler answer is that in building better healthcare, and especially in building links between countries and healthcare economies, we not only show that we are citizens of the world (sorry, Theresa May, but that's what we are), but that we want to build links and collaborations with people who are often neglected or disadvantaged. And for those who aren't neglected nor disadvantaged, we still want to work with them, because life is not a zero sum game. My gain is not necessarily someone else's loss. A problem in another country is not something I can just turn up my nose at. It's an opportunity to build links of friendship and healthcare. And healthcare in particular is an effective way of building peace and understanding.

Here, in a small hospital in Israel, there's a part of Scotland (and OK for these purposes I'm going to self-designate as an Ulster Scot!) - a place that's all about looking outwards and bringing people together.

24 October 2016

Nazareth Hospital Paediatrics Ward Appeal 2016

I've been meaning to set out some details of the 2016 Appeal for the Nazareth EMMS Hospital. This appeal is to refurbish and rebuild the Paediatrics Department in Nazareth - an absolutely vital service for the people of the Galilee region. The following information has been supplied by the Nazareth Trust. Don't forget to donate at http://justgiving.com/shanenaz2016 and make sure you spread the word on Facebook and Twitter!

Demographics

The total population in Nazareth is 74,620. In the past, the majority of the population in Nazareth was Christian, but today the majority is Muslim. Over the years life expectancy has increased which has led to an increase in chronic diseases.

History

The Nazareth Hospital is licensed and accredited by the Israeli Ministry of Health. It follows and abides by all the regulations and standards of the Ministry of Health. The Nazareth Hospital does not receive regular government subsidies for capital investment in buildings, equipment, and other major improvements. Neither do we have foreign donors who regularly contribute large amounts to our efforts. When it comes to capital development and purchase of equipment, Nazareth Hospital relies totally on gifts and grants from friends around the world.

In October 2011, the Nazareth/EMMS Hospital officially took on the role of a teaching hospital and opened its doors for the first group of medical students from the Galilee Faculty of Medicine affiliated with Bar Ilan University. Seven of the Nazareth Hospital EMMS departments are recognised for the school’s residency programme.

The Paediatrics Service in Nazareth

The Nazareth Hospital provides health services to a catchment area of 264,000 in the North. Over 40% of the target population is under 18 years of age.

The paediatrics department at the Nazareth Hospital was established over 40 years ago by a missionary doctor who recognized the importance of developing and expanding services for children, including community-based health outreach to raise the awareness of mothers regarding child health.

Today the Nazareth hospital runs a very dynamic pediatrics department and a Neonatology department. With 18 hospital beds, a very dedicated team and despite the very limited space, the pediatrics department houses multiple services including general pediatrics, surgery, orthopedics, urology and plastic surgery and often times gynecology services for children.

It is also important to mention that the Nazareth hospital provides unique services in the region including treatment of burn patients and is the only hospital in the region that is certified by the Ministry of Health to treat and provide vaccinations for children who suffer from allergies that could compromise their condition when they are vaccinated for childhood diseases and require special attention and treatment.

The paediatrics staff applies the hospital’s biopsychosocial model, considering every aspect of the children and youth who come to them for care. The social worker and other multidisciplinary teams are available to intervene when needed.

Today, in spite of the department’s crowded physical conditions, patients and their families still prefer to come to the Nazareth Hospital because of the positive and supportive environment provided.

The Nazareth Hospital has the only psychiatry department in the area with Palestinian staff who speak Arabic, making it much easier for Arabic speaking patients to express themselves clearly to health professionals.

In cases where children require psychiatric consultation at the emergency room or paediatrics department they are provided with this service in their first language. In addition, children from the West Bank and Gaza are often referred for treatment to the Nazareth Hospital

The final beneficiaries of this project are the children and youth who will be better provided with immediate care. In 2015, 2,162 patients were admitted for hospitalization spending a total of 3,638 days in hospital. This is in addition to our out-patient and ER clincs.

Through this upgrade of the Pediatrics department, Nazareth Hospital will:
  • Be positioned for accreditation as a paediatric training program to support the hospital in its role as center for Family Medicine residency training. This outcome will be measured by the number of resident doctors in pediatrics, measured against baseline data.
  • Improve access to high-quality paediatric medicine. This will be measured by the number of children treated in the new facility, as counted against baseline values for that statistic.
  • Increase available square footage dedicated to the comfort of patients and their families and caregivers. The new department will have a place where children can do homework, play, and receive family visits with some privacy. This can be measured by square footage gained. Additional emotional and psychological comfort, although qualitative in nature, can be evaluated through patient feedback.
  • Increase the number of its staff with advanced technical skills and relevant professional expertise. This will be measured by tracking the number of staff trained in relevant paediatrics update courses as part of this project.

Budget

There is a fairly sizeable pricetag on the plans. The overall total to rebuild the entire Paediatric Unit will be in the region of $3.8M in the long term, which is a LOT, and assistance will be sought from elsewhere to help bring the plan forward. However everything you give will help, and you will know that you are helping the kids of Nazareth to move to a brighter future.

23 October 2016

Transformation powered by technology

On Tuesday the Northern Ireland Health Minister Michelle O'Neill will announce her response to the eagerly-anticipated Bengoa Review into the configuration of Health and Social Care Services in Northern Ireland. This will be a BIG DEAL for those of us working in the HSC, and a BIGGER DEAL for our patients (i.e. everybody).
Minister Michelle O'Neill [photo: BBC]

Before anyone counters that this is yet another review of the HSC and the other reviews haven't had any effect, it's worth injecting a little context. Back in 2014 the then Health Minister Edwin Poots asked Professor Sir Liam Donaldson to report on the state of the NI Health Service. That report was called "The Right Time, The Right Place", and pointed out a number of factors that make health and social care difficult in NI, others that make it excellent, and yet more that provide an opportunity to make it even better. I'm talking things up a little - there are major reasons why the status quo for the NI HSC is not sustainable, and transformation is critically important. Everyone knows this.

The Donaldson report made a number of significant recommendations, the first of which was the establishment of an international expert panel to review the Health Service and recommend a redesign that all political parties would be expected to sign up to in advance. I feel this was a pretty big ask, and therefore when a subsequent Health Minister, Simon Hamilton, took office, he reconfigured this recommendation into a combination of local, national and international experts, chaired by Prof Rafael Bengoa, to carry this recommendation forward. There was no political advance buy-in, but I don't think anyone finds that too surprising. This is Northern Ireland, but even if it hadn't been, politicians don't like signing up in advance to something they haven't had a chance to look at.

The important thing however is that the Bengoa Review exists as a direct consequence of the Donaldson Review, and it would be wrong to see it as "yet another report". I've previously blogged a little bit about this, but in advance of the report itself, it would be wrong to get too bogged down in hoped-for details.

That said, the word on everyone's lips is Transformation. We have to transform the HSC to achieve the so-called "Triple Aim" - better healthcare, better health, lower cost per capita. This means getting patients much more involved in their own care, changing how we deliver services, being much more open in how we share information and resources, centralising some services where appropriate, shifting expensive acute services to a small number of specialist sites, slashing clinical errors, reducing medication harm, taking a rigorous evidence-based approach to management, supporting much more care in community settings, etc.

There are a number of ways we will need to do this, but it seems very likely that the Minister will announce digital technology as a key feature. At least that is what I very much hope. We cannot truly transform our HSC by tinkering at the edges and redesigning a few forms and processes. We need to make sure all staff and patients are on the same page with regard to the data, that we are minimising risk due to miscommunication across care domains, that we are saving time and risk by not requesting and re-entering the same data multiple times into multiple disparate systems. We need our patients to be able to contact and communicate with us using video and audio calls. We need them to be able to access their own data and manage their own conditions insofar as that is appropriate.

This can't be done without the technology, but implementing that is a people process more than a tech process. The next few years are going to be challenging, but the clinical/professional community and our patients/clients are definitely up for it.



27 September 2016

Trump outdone by Clinton

Photo source: NYT
The Free World outside America is wondering how long this can go on. A less presidential candidate for President is pretty hard to imagine - we have a reality TV "personality" pretending he can run a country, but it's hard to imagine any country currently run by a less suitable person. His voice croaking with what might be exhaustion - who knows? - he accused Hillary Clinton of lacking the stamina to be President. This has gone beyond farce and is now a train wreck. Beat it, Donald - go somewhere. You're the loser here, and frankly the USA will be better and greater without your sexism, racism, ignorance and rapaciousness even in it.

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?

Enjoy!