Sunday, 31 October 2010

South West weekend

Sky, houses, boats and the river Avon
Mr A and I have had a short holiday, which has refreshed and invigorated us. We went to Devon to visit friends, and then Bristol, which is a city I know of old and where I would be happy to live if I had to. I think I would also be happy in Edinburgh or Cambridge, but Bristol is likely to be generally warmer than either of these two other options.

Before we left, back on Thursday, I received notification that I'd be doing my third clinical placement in a northern location much too far for commuting. This will be for 12 weeks from February to May 2011, so I'll be trying to arrange accommodation for weekdays and most probably coming home at weekends. I've already had a look at the options for weekday badminton up there.

On Friday morning I went to the drop-in session of the local Society for the Blind where I recruited my research volunteers, took a cake to share, and stayed for a while to chat. Then Mr A and I set off for the South-West, and reached our friends in Devon in time for dinner.

We had a lovely evening, and next morning was fun for me too, as I was awake first. I thought I'd just sit in the lounge with a book, but was joined by their two lovely daughters, and we had a sing-along to the DVD of Annie. Thirty-six hours later I have very nearly stopped humming 'Tomorrow, tomorrow, we love ya, tomorrow' which has to be one of the stickiest tunes in the world.

Looking up the mast to the crow's nestWe went to Bristol because as I mentioned before, The Boy has moved there. He wasn't answering his phone at the beginning of the day, though, so we wandered about the town looking in the art gallery, museum, and trying to find our way to the SS Great Britain.

He joined us for coffee later on, and I now understand a bit more about his music, which is a blend of Dubstep, Jungle, Drum 'n Bass and Glitch Hop plus a few other styles I can't remember. So now you know. We stayed in an area called Cotham, which is very nice, and has about thirty restaurants of all sorts next to one another in one or two nearby streets. We chose an informal Thai noodle place where Mr A chose one of the best seafood soups I've ever tasted.

Over the past few days I have also been wildly, unfeasibly, unreasonably excited about our snowboarding holiday in January, in between exams and vivas and the start of my placement. We have a few location options which we are debating between ourselves and a couple of friends whom we hope will come too, and we are gearing up to book some lessons before we go. I am already much too excited about this.

Thursday, 28 October 2010

Social Marketing

We had a different sort of test this week, where we had to write an essay in near-exam conditions, the difference being that we'd been given details of all that was required in advance. Which meant researching and essentially writing the essay in advance, and then regurgitating it in a classroom for 90 minutes. In previous years, we might have been expected to write the whole thing in our own time and hand it in to a deadline. Having considered this alternative, I think I prefer this 'seen test' method - the other sort would have needed a great deal more research and a ton of references.

The subject, Social Marketing, started being considered in earnest in the UK for health in 2004, although the idea had been around since the 1970's. It arose from the realisation that telling people what was good for them was not achieving a great deal, and resistance to change, habit and convenience was enough to keep people not exercising, smoking and eating too much. Even though goodness knows enough information had been provided and they should know better.

Those concerned with improving public health turned to this idea of social marketing, which simply means selling a behaviour in the same way as cigarettes or hamburger-and-fries. Not only by providing information, but also by making the behaviour attractive and desirable, considering the competition, and addressing the true price of change in terms of abandoning one activity and/or adopting another.

The change in the way that smoking cessation was approached is a good example: a whole mix of other things was added to the simple message that smoking is bad for you. Taxation and legislation banning smoking almost everywhere raised the financial and behavioural cost of smoking; prominent smoking cessation clinics, prescribable nicotine patches and fake therapeutic cigarettes lowered the 'cost' of giving up. Adverts that showed how smoking isn't cool by rubbing the contents of an ashtray into an attractive model's hair made smoking less desirable. Addressing individual behaviour, environmental factors and social norms together is a much more powerful 'product' combination than a sentence on a packet of cigarettes and the absence of sponsorship in sport.

This is the approach that will need to be taken in addressing obesity. Telling people not to eat so much will never work on its own because eating is a much more addictive behaviour than smoking, and unlike cigarettes we can't cut it out completely. Eating too much, or eating the less healthy kinds of food needs to become something we simply don't want to do, but this is an incredibly difficult proposition, because no food is inherently bad as long as it forms part of a healthy balanced diet. Chocolate should never become as socially unacceptable as cigarettes, but it should be easier to find something healthy, tasty and reasonably priced to eat at a motorway service station. The approach taken with smoking appears to me to be hugely encouraging, and time will tell if it is successful. Perhaps the next big campaign in a similar style will be weight management.

Anyway, the particular example of Social Marketing that I wrote about in my essay was a small project in a district council office in Norfolk in 2007-8, where they tried to address the issue of employees eating no fruit and veg at work, and eating lunch at their desks.

I've worked in various places, some of which had a strong 'lunch away from your desk' ethos, and others where there simply wasn't anywhere to go. When I worked in Coventry the whole team took a break and sat together around a proper table for lunch. At my clinical placement over the summer, the dietitians had nowhere in the building to sit other than their desks, or there was the hospital canteen 10 minutes walk away, and only 30 minutes allowed for lunch.

Honesty Fruit BowlIn Norfolk they provided one-to-one consultations with a dietitian, refurbished the staff eating area, invited a chef to provide taster sessions and advice at a launch event, and worked with local businesses to provide an 'Honesty Fruit Bowl' and a 'Healthy Lunch Pack'. Evaluation after a year showed modest improvement, with more people rating their lunch as 'healthy', more fruit and veg being eaten at work, and fewer people eating at their desk.

There isn't any more recent information about the project, and I'd be very interested to know whether the eating area has been maintained or allowed to deteriorate, and whether the fruit bowl and lunch packs are still going. Until I'd had the experience of eating away from my desk at work, I didn't realise what a difference it made. Of course, it helped that I liked nearly all the people in that office, but even so, if I'd been a permanent member of staff instead of on a 12-week placement, I would have looked into ways of improving my lunchtime in that dietetic department.

Monday, 25 October 2010

Bits and pieces

Lattice patterns formed by the metalwork of the side of the bandstand
There have been several events of note, none worthy of a headline. At uni, apart from the odd lecture and my research, I attended an optional talk given by dietitians working for Nestle Nutrition - yes, the same company that makes Quality Street also makes prescribable nutritional products for people in hospital.

In the real, not academic world, Mr A has bought another bike in anticipation of a mammoth odyssey that he is planning - riding to Volgograd (formerly Stalingrad) and back, with a friend, next summer. His bike of preference up until now is a fairly esoteric make (Cagiva Elefant) which isn't suited to this type of journey, so he has bought a Honda Pan European. It's the first time I've ever viewed one of his bikes and thought "I wouldn't mind riding pillion on that one". Up until now, pillion seats have been razor thin and I've needed a ladder to get up there - this one's like an armchair in comparison. Not that I'm likely to be riding anywhere with him, but you never know.

We have also been visited by The Boy, who is now marketing himself as a freelance web designer while attempting to 'make it' in the world of young people's music (but I couldn't tell you exactly how the music is produced). He imparted some valuable insight into his life: he has moved to Bristol where the music scene is a bit more accessible, he is not romantically attached to any one female, he hopes to set up a tour of Europe and/or America in which he will be paid for gigs. He is good company and he seems to be doing OK, so that's fine.

Decorator adding finishing touches to the bathroom paintI haven't mentioned the bathroom for a while, but it was finished at the same time as the exterior painting. It is now a vivid shade of blue-green-turquoise that still surprises me as I come up the stairs. It now needs pictures, to tone it down a little.

I have played in two more badminton matches with a new partner who is very tall and can smash rather well. We have won one or two of our games each time, but overall our team always loses. My previous partner had a foot ligament problem, which he ignored until he was accepted as a special policeman, and now I believe he's getting it treated. Either that, or he hasn't got time for badminton any more. If I am posted in some distant backwater for my next clinical placement, I will have to give up my local badminton - I will need to find a replacement club for those three months.

Lastly, I had an 'incident' in the car on the way home from school last Thursday, when a car pulled out into my lane and hit the back of my car. Not very hard and not much damage was done, but annoying because now there's quite a lot of admin to do. I spent 45 minutes on the phone to the insurance company at 5p a minute, and will definitely find a cheaper way to communicate next time.

Friday, 22 October 2010

Researching food choices

Trees in their autumn colours
On Tuesday I went into uni to start transcribing the interviews I've recorded for my research. It was one of those mornings when nothing went to plan.

I arrived at my usual time, around 8.30 a.m., knowing that the office doesn't open until 9.30, but I spent the time checking my mail and blogs and doing a little bit of research into Social Marketing. At 9.30 I went down to the office, but a sign on the door said it would be closed until 10.30, so I went back and did some more research into Social Marketing.

At 10.30 I picked up the transcription machine, which allows you to play the recording through headphones and control the speed and playback using a foot pedal. Except that the software it needed wasn't installed on the computer, and I didn't have administrator rights so I couldn't install it myself.

I had a backup plan, which was to install it on my own laptop, but that would be breaking the terms of my agreement with the Medical Ethics Committee who approved the research, because data security and confidentiality are key features of this programme of research. So I went in search of technical assistance, which couldn't be supplied until about 11.30, so my next thought was to find one of my student colleagues who wanted some help with referencing software. But she didn't answer her phone.

Because mobile reception is pretty poor in most places on campus I actually headed out to see if she was in the library, and found two of her friends, who said she was probably in the shower and called her again. So I met her eventually, and went through the referencing software, and then realised I hadn't taken my student card with me so I couldn't get back into the main building. Eventually I found someone passing to let me in, and the transcription software installation was just finishing up. I got started on the transcription, but I had previously arranged to meet a friend for lunch, so I had to break off again pretty soon.

The interviews are between 25 and 35 minutes long, but each is taking about 4 hours work to transcribe - half a day each. It's not mentally demanding, and my touch typing is definitely improving in its accuracy rate, so at the moment it's fairly relaxing in comparison with all the coursework that is clamouring for attention: an essay about Social Marketing, a research proposal about something I saw on my placement, a plan for a nutritional intervention in a community of my choosing, and a poster and short presentation about the role of Dietetic Assistants.

I did the final two interviews today, and the next job (after transcribing them) is to examine the transcripts for 'themes', and thoroughly analysing what people have said. There's a software tool to help with this, and I shall be getting an introduction to that in a couple of weeks together with other students who will be doing the same sort of analysis.

I really enjoy interviewing. The first two volunteers were in Birmingham, and I knew one of them quite well from when I used to work there. The other five interviews have been at drop-in sessions run by the local Society for the Blind, and it has been an absolute pleasure to work with them. All my volunteers have been interesting, warm, pleasant people, with amazing life stories to tell.

I've been asking them about any difficulties they have had due to their visual impairment when shopping, cooking or eating out. I've also asked them about the history of their sight loss, and a description of what they might eat in a typical day. Sometimes it has been a little tricky to focus the conversation on these topics, and I've heard about all sorts of other things too.

Transcribing the interviews has been very revealing too, in terms of the manner in which I ask the questions, and the extent to which I have been listening to the answers. It ties in nicely with my particular interest in carrying out effective consultations, and with the research I took part in a few weeks ago, when I was a simulated patient with type 2 diabetes. The complexity of communication between clinicians and patients cannot be overestimated; it is extraordinarily difficult.

Wednesday, 20 October 2010

What I've been reading

Image of the book cover
The Scarlet Pimpernel
by Baroness Orczy

narrated by B. J. Harrison
"Perhaps the most famous alias of all time, 'The Scarlet Pimpernel' hides the identity of a British nobleman who, masked by various disguises, leads a band of young men to undermine the Reign of Terror after the French Revolution. As he makes daring raid after daring raid into the heart of France to save aristocrats condemned to the guillotine, at each rescue he leaves his calling card, with its image of a small, blood-red flower."
This is actually a podcast download in several episodes from iTunes, and further stories become available weekly, all narrated by the same chap. He's American, narrating a story written by a Hungarian about an English nobleman operating in France, and his command of accents is not great, let alone his pronunciation of French. I think I have worked out that 'sarn-seer' is his version of 'Sancerre' but without the text, I can't be sure. Similarly, 'imp-ass-ay' is probably 'impasse'. But apart from this, it's not a bad reading, and the story's a good one, and it's free, so why am I being so picky? I've enjoyed it.

Image of the book cover
Dreams from my father
by Barack Obama

"The son of a black African father and a white American mother, Obama details the dramatic journey that constituted his parents’ life, before his own trip to Kenya to confront the sobering realities of his father’s life."
This is so well-written and insightful that I was able to grasp some of the identity issues of this black American raised in Hawaii and Indonesia by his white mother and grandparents, among others. His early career felt very familiar too - he was a 'Community Organizer', confronting entrenched attitudes and values to try to improve life for people, mainly but not exclusively black people, in Chicago. The quality of his writing, his demonstrable intelligence, and the early desire to make the world a better place for all are in stark contrast with the previous President's capabilities and ambitions.

Image of the book cover
Wolf Hall
by Hilary Mantel

narrated by Simon Slater
"Tudor England. Henry VIII is on the throne, but has no heir. Cardinal Wolsey is charged with securing his divorce. Into this atmosphere of distrust comes Thomas Cromwell - a man as ruthlessly ambitious in his wider politics as he is for himself. His reforming agenda is carried out in the grip of a self-interested parliament and a king who fluctuates between romantic passions and murderous rages."
I bought this in print for Mr A, who read and recommended it in audio form. It's a long, hard slog, written in a style that doesn't always allow the listener to be certain who's speaking, and without the ability to flick back to earlier passages. I liked the immersive experience in the 16th century, experiencing the all-pervasive nature of religion, the separate lives of men and women, the uncertainty of disease and the contrast between power and helplessness. But I've no idea why it's called Wolf Hall, which is the Seymour family residence and is only mentioned occasionally throughout the book, including in the very last sentence.

Saturday, 16 October 2010

Health services in the 21st century

Bird perched on the head of a statue of a man holding a book
Our lectures on Thursday were all about management within the NHS, including the description of a real tendering exercise that took place in Doncaster last year. The Strategic Health Authority (SHA), acting on government priorities, had decided that an obesity management service was required in the area. This imperative was passed to the Primary Care Trusts (PCTs), which are the bodies that currently commission health services (although this is due to change any day now).

The PCTs consulted practitioners and others to determine what obesity management services should look like. Then they invited tenders for three contracts: adult, adolescent and child obesity management services in 'Tier 2', which is for people already overweight but not automatically eligible for bariatric surgery.

The dietetic department in the area had been part of the group that defined the services, and also decided to bid for the three contracts. You may be able to imagine the paperwork and bureaucracy that is involved in bidding for a public sector contract, but the process also included the requirement to produce a short film summarising the bid, as well as the paper documentation. All this for each of the three contracts.

Two of the contracts, for child and adolescent services, were won by the 'Carnegie' weight management program, based in Leeds Metropolitan University - not a health service provider at all. The dietitians won just one of the contracts, for adult services. They had put in a bid for new services not currently being provided, so dietitians and others were recruited and equipment bought so that they could start delivering and measuring outcomes.

The issue of outcomes is also very interesting. The SHA and PCT are not health practitioners, but they make the ultimate decision about how success or performance will be measured or indicated, through Key Performance Indicators (KPIs). Of course they are guided by clinicians, including dietitians, but they also have strategic targets to meet, set nationally in the UK and by the World Health Organisation. The amount of weight loss within the period of the intervention, and the longer term targets for weight maintenance are both outcome measures within the contracts, and notoriously unachievable.

I suspect that the younger students would have found the whole talk tedious in the extreme - I would have in their place. The only reason I was engaged was the amount of soul-destroying bidding/tendering that I've had to endure through my past career. A few things stood out:
  • The cost of putting in the three bids (and winning just one) was £40,000;
  • The contract has been awarded for just 3 years, at which point the whole tendering/bidding thing happens again;
  • The 'success' of the service depends on outcomes, some of which are probably not achievable.
The NHS has improved a great deal over the past few years from the point of view of transparency, accountability and best practice. I don't know the full intimate details of either case, but if we compare the seemingly measured decision to stop paediatric heart surgery in Oxford with the scandal in Bristol over a similar issue, I think the progress in monitoring the quality of care is clear.

A ton of money has been poured in, and some of it has been wasted, but I don't agree with Sir Philip Green that a public service can be run like a retail store. I am glad that some attention is being paid to the bottom line, and some level of greater fiscal responsibility may ensue, but the burden on health practitioners is high - it is clinicians, not managers who have to lead on these bids, because they are the ones who understand the service being tendered, and ultimately whose jobs are at risk if the bid fails.

If in three years the contract for adult obesity services moves to another provider, then equipment bought for the service and staff employed to run it will be surplus to requirements. Maybe they will transfer to the new provider, but probably not. While I welcome the principle and clarity of a well-written contract to deliver a specific service with defined indicators of performance, the devil, as ever, is in the detail.

Other than lectures, the only two activities allowed to me are university work and housework, neither of which is provoking much interest. I took the car for a service, interviewed three more of my research subjects, bought some vegetables and came home yesterday. Then I thought a lot about the different bits of coursework I have to start, but didn't actually start anything. I have spent most of today in my pyjamas. It's a tough life.

Wednesday, 13 October 2010

Starting to research

decorative bargeboard and old-fashioned lamppost
I have embarked upon the interview phase of my research project. This is all about finding out about how real people who have vision impairments make choices about their diet, and what the difficulties might be, in order to inform the dietetic profession and perhaps contribute to the sum of human knowledge.

I am down to three organisations for my subjects, since my contact at the Guide Dogs for the Blind Association had changed jobs and wasn't terribly encouraging about the options for interviewing guide dog owners. To be honest, it would have been difficult to meet the requirements of the Medical Ethics Committee who gave me permission to carry out the work, because I would have had to meet my volunteers in unfamiliar places and out of work hours.

The main source of my subjects is therefore the Warwickshire Association for the Blind, and I went along to one of their drop-in sessions last week to canvass for volunteers. Out of the five members present, one lives in a residential home and so is limited in his food choices by that environment, and one has a sight impairment but isn't registered as blind or partially sighted, so can't be included. I have lined up the three others for interviews, and may be able to recruit one or even two more next time I visit.

I have actually carried out two interviews already, using my other two organisations to provide volunteers. It was a very new experience and there's room for improvement in my interviewing. It's a difficult balance trying not to ask leading questions, but still prompting when the subject isn't sure what my questions mean. I'm not familiar with the dictaphone recorder that's been loaned by the university, and despite practice I worry that I've erased something by mistake, or it hasn't recorded, or the sound hasn't been picked up properly. Next I have to locate the transcription equipment that the university owns, to help me transcribe the interviews word for word. Getting my hands on the gear may be more difficult than it sounds.

Another lecture has gone by in the Community Nutrition module. It was an all-day exercise in groups, where we were given the task of devising a food-based intervention for an imaginary population of lone parents at risk of heart disease, living on a council estate. What makes this noteworthy is that I actually enjoyed myself. It was down to the group I was in, who made me laugh all day, often due to their inability to concentrate on the task in hand for more than about 30 seconds.

It might have been irritating if it had been an assessed exercise, or if I had been intent on squeezing the most possible benefit out of the day's teaching, but instead it was just fun. A chance remark about fried chicken led to a story about a trip to KFC in Loughborough. Fruit on the desk prompted discussion of russet apples looking like pears. There was talk of whether it is bad to lie to someone about the kind of car one drives, what type of robes university graduates wear, what photos people carry in their wallets, whether one should fancy boys who look like your brother, which of the three marker pens we'd been given smells the nicest, how one's husband has been coping with revising for an exam for the first time in about 30 years (oops, that was me), and no end of other spurious chat.

Yes, Mr A has taken his first exam for his Open University course, on some sort of computing topic. He has the same ambition as I do about doing as well as possible, and he has been revising hard for at least a week. I believe it went quite well, and going through the process has given him much food for thought on how he will adapt his approaches to learning for the remaining modules of his course.

I have now made my choices for the C placement, of which two are too far distant to commute. We should be notified of the outcomes before Christmas. Of course I may get allocated to somewhere else, but I'm ready to face the probability that I won't be living at home for those 12 weeks.

Sunday, 10 October 2010


Shabby house before work starts
I have been blogging from the sofa, which feels quite decadent. I brought the computer over because if I do not finalise my choice of car insurance in the next 24 hours, the car will be uninsured and when I run over a person I will be ruined forever. As will the person that I run over. However, I am disinclined to spend my evening on a chore as unpleasant as investigating car insurance, so I thought I would write about our house instead.

Front door with cricket bat and ball motif aboveMr A reckons (from desultory research) that our house was built around 1850, and was a pub that catered for the local cricket pitch and archery field. It still retains a cricket bat and ball motif above the front door, a cellar underneath the room nearest the street, and a very large doorway between this room and the living room, but we don't really know much about the pub layout.

We have a mortgage deed that shows that it was still a pub in 1874, it transferred to its current location next door sometime after this, and has been remodelled since with the removal of some of the floor area at the back and the addition of the garage and shower room. More houses were built on the cricket pitch and archery field, but the park (which still hosts local cricket) and the bowling greens remain.

Ladders from the roof of the van to the top of the gableWe moved here at the start of 2002, and undertook a few major jobs early on: removing the wall between two small bedrooms to make Mr A's office, installing an I-beam to support the sagging purlins of the roof, insulating the loft space and decorating Mr A's office and our bedroom. We used several different workmen: builders and decorators recommended to us, who all turned out to be fairly unreliable, either in their standard of work or willingness to complete the job required.

Then there was a gap, when we did very little, except on an emergency basis, and always due to water. If we lived in a hot, dry location, I'm sure we wouldn't need all this remedial work. Perhaps we'd have to deal with termites, or fires, or air conditioning units instead.

Painting the front of the houseAnyway, Alf has been different. He came to us by recommendation, like the others, and the first job we gave him was replacing some lead on the roof to prevent water coming into the hall. That went well, and the next job was bigger: replacing the flat roof over the kitchen. He's rendered the external wall of the shower, rebuilt our bathroom, repaired the hole in the living room ceiling, replaced the parquet, the doorframe and the broken sill between the living room and kitchen, repaired and painted the front door and side door, and now is renewing the whole of the outside of the house, this time with the help of his two sons, occasionally accompanied by their dogs.

Alf painting at the backThey have replaced the decayed brickwork over the front door and the garage, and repointed the bits that needed repointing. The gable ends of our house have ornate bargeboards, which are matched exactly in the house built opposite across the road. At the highest point in the centre and at the two lowest points of the roof are decorative posts - at least there used to be posts, until they rotted through. Only one remained, in the centre of the gable at the back. But they were still present on the house over the road, and Alf has copied the design, so we now have our posts back. I love the character it gives the house.

Then there's the colour. Previously the house was painted a yellowy cream colour (the matching house opposite remains unpainted brick, and how much less effort that would be). We have chosen a pale violet, which sometimes looks pink and sometimes blue, depending on the light quality and time of day, and the lintels and sills are picked out in white. It looks brilliant. The weather, however, has deteriorated significantly, so the photo is a bit dull. But we love it.

Front view of the house after painting

Thursday, 7 October 2010

First weeks of the fourth year

Broth with leaves
You need another post about what I'm doing at school. Term started two weeks ago, and what have you had? A whinge about how ill I am, how busy I am, a heavy hint of a future post about house-painting, and a camping holiday. It's not very 'dietetic' at the moment, is it?

Well, the truth is that this term seems a bit odd so far. After 12 weeks of 'work' over the summer, including 2 weeks of very nearly doing the job for real, it is very strange to re-enter the world of university, especially when the modules are so different from previous years. I have to admit that I don't feel terribly motivated about this semester's academic focus, especially with the hodge-podge of introductions to the two taught modules (Nutrition in the Community, and Advanced Dietetics and Professional Issues). First lectures have been:
  • An introduction to key policies in Public Health Nutrition, both nationally and internationally
  • A long, long lecture entirely about UK statistics, surveys and data relating to diet and health (Health Informatics), given by an Analyst from the East Midlands Public Health Observatory
  • One morning on complex diabetes cases (which wasn't actually all that advanced) from a specialist Diabetes Dietitian
  • A forum for feedback on our B placements, as well as looking forward to our C placements and beyond to job applications and employment
  • A professional development session about behaviour change and motivational interviewing, plus a tutor-led half-day session on advanced communications skills
  • Prevalence and treatment of childhood obesity, led by a Public Health Dietitian.
The lectures don't seem to have much of a theme running through them, other than "these are things that you ought to know more about but we haven't had the time or opportunity to tell you in previous years." One of the modules even has two completely different subjects in its title. The coursework is similarly varied - I haven't really settled down to look at it properly yet, but I am expecting it to be more challenging than in previous years. I need to take a look at past exams, to see whether I've missed something, and there really is something examinable in the lectures so far.

I've also had a long meeting with my research project tutor, a short meeting with my B placement supervisor (who is also the Course Manager), and a very short meeting with my personal tutor. Today I sold three textbooks that I won't need any longer, or if I do need, I can find very easily in any hospital library. The other things I have been doing are to get started on my research project, and to interrogate other students about what their B placement was like, and where they are likely to want to go for their C placement.

As in previous years, we have to express a first, second and third preference for our next placement, due to start in February 2011. People in circumstances that restrict their choices (with children, dependent family etc.) can apply for priority status, and they are allocated first. New this year is a second category of priority, for people who didn't get any of their three preferred choices last time. The rest of us are picked in a random order, and if none of our choices is available, then we get whatever's left.

I have two simple criteria for my preferences: inclusion of the services that I wasn't exposed to in my B placement (dietetics in the community rather than in hospital, diabetes, and weight management), and distance from home. There are only three choices within commutable distance, and one of them was my B placement, so I can't choose that one. The second is part of the same countywide service as my B placement, but I'm not sure if it can offer me the right opportunities. The third is commutable from Nottingham, so many of the other students are including it within their choices, which seriously reduces the odds of me being placed there.

I am resigned to the idea of living away from home during the week, as long as I don't have to live in on-site nursing accommodation, and if I can find a cheap method for long telephone calls to friends and family (e.g. Skype). My plan at the moment is that I'll look at the clinical picture first, and then try to pick the far-flung places that are likely to be unpopular with the other students, most of whom would like to be able to commute from their homes in Nottingham.

The very good news is that I have been enquiring into exactly how things work in terms of dates for exams and placements, and have established that there is a window of about two weeks in January when the exam period will definitely have finished, but placements will not have started. Combined with the two facts that dad had some treasure to sell which he generously wished to divide between his grateful offspring, and that my brother-in-law is an ebay wizard, and bingo! A snow-related activity holiday for me and Mr A is now being planned.

[The house is looking lovely, but there is an all-pervasive smell of paint hanging around. Pictures to follow, honest.]

Monday, 4 October 2010

Another camping break

Swanage seafront at dusk
These posts don't write themselves, more's the pity. Hand-crafted quality like this takes time and effort. I'm feeling quite short of time, despite having no scheduled teaching today - going camping on Friday morning and coming back on Sunday morning has taken up the time that's usually needed for organising my life.

Lola II standing proudly outside the perfectly pitched tentThe weather wasn't quite as bad as it might have been, and Saturday was quite a pleasant day. I collected Lola II on the way down south on Friday, but I was half an hour late because of being disorganised (spot the theme here). We drove down to the accompaniment of DJ Lola II choosing tracks from our ipods that are particularly suited to singing. It was wet but not raining when we arrived at the campsite and pitched the tent.

No point hanging around the campsite when there's food to be bought and fun to be had in the local town. We drove down to Swanage, and Lola II was disappointed to realise that we've been there before. I don't mind that much - it's a nice place and I was happy to visit again. We went to the cinema this time, before driving back to the campsite for a late supper, prepared inside the wonderful porch of the tent. Over to Lola II:
One of my favourite parts of camping, apart from Lola's company of course, is the cooking. Lola has all the kit, and night-time cooking is the best. I think it's probably because sunset limits our options and it makes the tent warm too. Always a winner for me. The useful tent porch comes into its own. Table and chairs? Check. Headtorches in position? Check. On the right way around so the light is shining down, not up? It is now. Check. Ok, soldier, light that gas!

Cooking soupIt was quite cold overnight, but dry, and Saturday breakfast was an outdoor affair: hotdogs made from frankfurters and Dairylea cheese slices in brioche rolls. I'd never go near food like that at home, but this is camping! I insisted on having some cucumber and tomato with it, because it is against the law to have a meal without vegetables.

Saturday was spent in Dorchester, initially in camping shops where I found a splendid wind-up camping light, and Lola II ingratiated herself with the staff in the shop to the extent that they let her use a staff cupboard to try out a headtorch (and the wind-up light). I encouraged them to lock her in there, but they insisted on letting her out.

We explored a little bit of Dorchester's history on foot, including a statue of Thomas Hardy and an excavated Roman villa. We would have liked to stay a little longer, but we headed back as it started to rain, and after a short nap we spent the evening on a pub crawl in Langton Matravers. There are only two pubs, but we had a drink in each, read the newspaper in one and played Trivial Pursuit in the other.

The rain continued on and off through the night, occasionally coming down hard enough to wake me up, and the wind was pretty strong too. There was a lot of noisy flapping - only a little bit of the tent had fallen down; the guy ropes holding the porch came off, but no damage done and nothing was too wet in the morning. But we didn't feel like breakfast, and saved ourselves for a slap-up lunch in a pub on the way home. Lovely weekend with Lola II, as usual.

Today I've been busy with little things, like trying to sort out car insurance, booking a car service, washing dishes and clothes and drying out all the camping things in the garden, while Alf and his sons continue mending and painting our house. I really must get down to some school work soon, or I'll be in trouble.

Lola II complete with head torch and supper