was given today adn steven's sentance has been redused to 10 years.
As I understand it, he should therefore be eligible to apply for probation, and subsequently for deportation.
This is excellant news. Needless to say, steven is over the moon
Friday, February 13, 2009
Wednesday, February 11, 2009
current state of play re steven
Her is the maths. He has served 5yr 2m. He has worked for 3y7m (had a job in the prison for which his time is counted as double). This means he is viewed as haveing served 8y9m.
under nicaraguan law he can apply for parole after serving 2/3 of sentance.
Therefore if the new sentance is anything less that 14 yrs he can apply. This will mean another hearing (probably in a few months time).
Whether or not he is granted parole, he can apply for deportation, either under parole or as still serving his sentance. this process will also take a number of months.
So right now he is hopeful. things for the first time are significantly moving for him
under nicaraguan law he can apply for parole after serving 2/3 of sentance.
Therefore if the new sentance is anything less that 14 yrs he can apply. This will mean another hearing (probably in a few months time).
Whether or not he is granted parole, he can apply for deportation, either under parole or as still serving his sentance. this process will also take a number of months.
So right now he is hopeful. things for the first time are significantly moving for him
Personal reflections
What I'm learning
I've been praying a lot about this. Expecting things to happen. I get disappointed when things don't happen when and how I am expecting.
For instance I'd been expecting this hearing a week ago, took a day off work, and set aside time to pray - then it happens his week at almost zero notice, but I'm able to be there because I'm staying only 4km away from the courts.
I meet the consul to plan how to get steven a new lawyer. Then the next day, his hearing actually happens and his current lawyer, with whom I'd been pretty unimpressed, seems to do a good job. (in that it is his job o get the hearing).
However the consul sends one of his team to the hearing to translate for steven, and to make notes and a report. All seems to work out well
Also I've been reading systematically through a few books of the bible. This landed me this morning on two stories. firstly that of boaz and ruth, and how he is a kinsman redeemer. An ancient jewish custom whereby family members would take care of relatives who are met with hard times, in that case widows. It reminded me strongly of the "coincidence" of finding steven here, a man from my own community, and the bond I feel for him because of that fact. The second was of peter being led out of jail by and angel in acts chapter 12, really reminding me how powerful God can be when it comes to prison related issues. These seemed very apt to be reading as I sat outside the court, eating a breakfast of southern fried chicken and plantain, waiting for the hearing to begin. I spent the hearing praying for the three of them, and for the judge, that she would show mercy, and feeling very confident that God was certainly the most influential person present.
Late in the afternoon, I was granted a "special visit" with steven. We had an hour to sit and chat and discuss things as the sun was setting. It felt very normal, and not like a prison at all.
We talked of the hearing but also of family, friends and of birmingham. We talked about steven's growing fanclub of people in his local church who,though having not met him, still care for him. We talked about the bible and we thanked God for the hearing and prayed for the judge.
and i brought him his weekly groceries.
We had had a really good day together
And he needs dental treatment and he is devouring books (not related).
I've been praying a lot about this. Expecting things to happen. I get disappointed when things don't happen when and how I am expecting.
For instance I'd been expecting this hearing a week ago, took a day off work, and set aside time to pray - then it happens his week at almost zero notice, but I'm able to be there because I'm staying only 4km away from the courts.
I meet the consul to plan how to get steven a new lawyer. Then the next day, his hearing actually happens and his current lawyer, with whom I'd been pretty unimpressed, seems to do a good job. (in that it is his job o get the hearing).
However the consul sends one of his team to the hearing to translate for steven, and to make notes and a report. All seems to work out well
Also I've been reading systematically through a few books of the bible. This landed me this morning on two stories. firstly that of boaz and ruth, and how he is a kinsman redeemer. An ancient jewish custom whereby family members would take care of relatives who are met with hard times, in that case widows. It reminded me strongly of the "coincidence" of finding steven here, a man from my own community, and the bond I feel for him because of that fact. The second was of peter being led out of jail by and angel in acts chapter 12, really reminding me how powerful God can be when it comes to prison related issues. These seemed very apt to be reading as I sat outside the court, eating a breakfast of southern fried chicken and plantain, waiting for the hearing to begin. I spent the hearing praying for the three of them, and for the judge, that she would show mercy, and feeling very confident that God was certainly the most influential person present.
Late in the afternoon, I was granted a "special visit" with steven. We had an hour to sit and chat and discuss things as the sun was setting. It felt very normal, and not like a prison at all.
We talked of the hearing but also of family, friends and of birmingham. We talked about steven's growing fanclub of people in his local church who,though having not met him, still care for him. We talked about the bible and we thanked God for the hearing and prayed for the judge.
and i brought him his weekly groceries.
We had had a really good day together
And he needs dental treatment and he is devouring books (not related).
courtroom drama
Steven has been waiting for a hearing for the last 6months at least.
Today it happened
There was a change in the sentancing law over 6months ago which means that the recommended sentance for steven's crime was reduced to 10-15 yrs (his sentance currently stands as 22yrs)
We have a had a couple of false starts over the last month, due to inaccurate or incomplete paperwork from the prison.
Today however we got the real thing.
One courtroom (whitewashed room with a couple of desks, a working computer and two non-functional typewriters)
One steven
Two other prisoner
One defence lawyer (who I like to call pafilopolis)
One prosecuting lawyer
One judge
One representative from the honourary consul's office - a young lawyer called eduado
One clerk
and me (in my cleanest shirt)
Pafilopolos was first to speak. Very nervous, stumbling over broken sentances (rally not like it is on telly). Has couple of books with him to quote (maybe reminding him what the new laws are..?) He gradually gets up a head of steam and asks tha judge to reduce the sentance to 10 yrs.
Next the prosecuter lawyer, seemed even less competant, wants steven to stay for 15 yrs, not quite sure why.
Then pafilopolos has another go, and actually sounding much more convincing.
The judge, having put up with all this says she'll have 20 minutes to think about it.
Half an hour later we get a message to say she'll call us all back at some point in the next 5 working days
Today it happened
There was a change in the sentancing law over 6months ago which means that the recommended sentance for steven's crime was reduced to 10-15 yrs (his sentance currently stands as 22yrs)
We have a had a couple of false starts over the last month, due to inaccurate or incomplete paperwork from the prison.
Today however we got the real thing.
One courtroom (whitewashed room with a couple of desks, a working computer and two non-functional typewriters)
One steven
Two other prisoner
One defence lawyer (who I like to call pafilopolis)
One prosecuting lawyer
One judge
One representative from the honourary consul's office - a young lawyer called eduado
One clerk
and me (in my cleanest shirt)
Pafilopolos was first to speak. Very nervous, stumbling over broken sentances (rally not like it is on telly). Has couple of books with him to quote (maybe reminding him what the new laws are..?) He gradually gets up a head of steam and asks tha judge to reduce the sentance to 10 yrs.
Next the prosecuter lawyer, seemed even less competant, wants steven to stay for 15 yrs, not quite sure why.
Then pafilopolos has another go, and actually sounding much more convincing.
The judge, having put up with all this says she'll have 20 minutes to think about it.
Half an hour later we get a message to say she'll call us all back at some point in the next 5 working days
Sunday, February 8, 2009
Prison Update
So the plan was to do a weekly clinic in the prison......
Week one:
Brendon, Nestor (our driver) and I are ushered into the heart of the prison with alomost no fuss. We were able to set up in a small room in the medical block. I had a desk to consult from. Bren and Nestor had another table from which to dispense all our medcines. Steven was allowed to come and help us and he brought one of his friends who was able to help me with translation.
We saw 25 or so patients in the morning, msotly things we could treat; musculoskeletal problems, high blood pressure; fungal infections; stomach ulcers.
A few patients had worrysome symptoms that would require investigation outside of the prison. There is a system for this and I was assured it would be arranged. The prisoners assisting witht he clinic seemed less confident.
One patient had epilepsy (I was later told there are 5 men in the prison with epilepsy) The prison pharmacy has no anti-epileptic medication and nor did I.
One patient had a hernia in the scar of a previous operation. He told me he had had appendicitis. His scar however was huge and implied that he hadn't been treated untill his appendix had burst, causing a more serous problem.
One patient told me he had a type of inherited heart problem. He did indeed have an enlarged heart. I wasn't however granted access to the medical files of these patients to see what tests they had had previously.
The prison doctors (4) were very friendly. They were welcoming and seemed keen to work together, though not offering me their files which did limit what I could do.
Treating prisoners was a first for me. Part of me was interested in what crimes they had commited. On reflection I'm glad I didn't know. Not only because I would have been more scared had I known, but more that I wasn't distracted from treating these men with the respect I would try to give every patient. In the respect and value which I tried to show, I hope to have communicated something to these men who live in very hard circumstances.
I left optamistic that I was being welcomed to be a part of a medical team working in a difficult environment with limited resources. I felt I had something to contribute; in bringing some extra medicines; in running some extra clinics and on working on the best treatment plans for patients with chronic illnesses.
Week two: no-one seemed interested in letting me in to do anything. None of the doctors made it out to meet me. I spent the morning in the waiting room.
I went home disappointed; and prayed a bit more, remembering that this had seemed to be the important aspect in the beginning.
Week three: The prison governor met me to ask if I would do the clinic for the guards. I was aware that this man holds all the power in the prison, so I was keen to play ball.
The prison serves 2200 inmates and employs 500 guards. They run regular health clinics for the staff as well.
One of them seemed rather unwell, a man in his 30's having been told previously that he had diabetes, but that day seemed to me to have some sort of liver problem. He was hopefully transferred to hospital. I've not had opportunity to see what kind of care is available in the hospitals here. i can only hope he gets the treatment he needs.
This time I went home happy to have done some medicine, telling myself that even if it wasn't group I had wanted to treat, they were still sick people and that is what I'm there for.
Week four: I'm told this time by the governor that I can no longer enter the prison untill I have a letter of authority from the govenment minister who overseas the prison service. It seemed pointless to try to argue that this seemed a strange thing to bring up now, and it been required of other people I had met who also do volunteer work within the prison.
Fortunately Sandra's husband had worked previously in that government department. He may be able to get my paperwork processed more quickly.
So we shall see. Its frustrating. I'm not the first person to comment that nicaraguan infrastructure seems designed to slow or obstruct progress. I still hope that there is more good to come of this.
Week one:
Brendon, Nestor (our driver) and I are ushered into the heart of the prison with alomost no fuss. We were able to set up in a small room in the medical block. I had a desk to consult from. Bren and Nestor had another table from which to dispense all our medcines. Steven was allowed to come and help us and he brought one of his friends who was able to help me with translation.
We saw 25 or so patients in the morning, msotly things we could treat; musculoskeletal problems, high blood pressure; fungal infections; stomach ulcers.
A few patients had worrysome symptoms that would require investigation outside of the prison. There is a system for this and I was assured it would be arranged. The prisoners assisting witht he clinic seemed less confident.
One patient had epilepsy (I was later told there are 5 men in the prison with epilepsy) The prison pharmacy has no anti-epileptic medication and nor did I.
One patient had a hernia in the scar of a previous operation. He told me he had had appendicitis. His scar however was huge and implied that he hadn't been treated untill his appendix had burst, causing a more serous problem.
One patient told me he had a type of inherited heart problem. He did indeed have an enlarged heart. I wasn't however granted access to the medical files of these patients to see what tests they had had previously.
The prison doctors (4) were very friendly. They were welcoming and seemed keen to work together, though not offering me their files which did limit what I could do.
Treating prisoners was a first for me. Part of me was interested in what crimes they had commited. On reflection I'm glad I didn't know. Not only because I would have been more scared had I known, but more that I wasn't distracted from treating these men with the respect I would try to give every patient. In the respect and value which I tried to show, I hope to have communicated something to these men who live in very hard circumstances.
I left optamistic that I was being welcomed to be a part of a medical team working in a difficult environment with limited resources. I felt I had something to contribute; in bringing some extra medicines; in running some extra clinics and on working on the best treatment plans for patients with chronic illnesses.
Week two: no-one seemed interested in letting me in to do anything. None of the doctors made it out to meet me. I spent the morning in the waiting room.
I went home disappointed; and prayed a bit more, remembering that this had seemed to be the important aspect in the beginning.
Week three: The prison governor met me to ask if I would do the clinic for the guards. I was aware that this man holds all the power in the prison, so I was keen to play ball.
The prison serves 2200 inmates and employs 500 guards. They run regular health clinics for the staff as well.
One of them seemed rather unwell, a man in his 30's having been told previously that he had diabetes, but that day seemed to me to have some sort of liver problem. He was hopefully transferred to hospital. I've not had opportunity to see what kind of care is available in the hospitals here. i can only hope he gets the treatment he needs.
This time I went home happy to have done some medicine, telling myself that even if it wasn't group I had wanted to treat, they were still sick people and that is what I'm there for.
Week four: I'm told this time by the governor that I can no longer enter the prison untill I have a letter of authority from the govenment minister who overseas the prison service. It seemed pointless to try to argue that this seemed a strange thing to bring up now, and it been required of other people I had met who also do volunteer work within the prison.
Fortunately Sandra's husband had worked previously in that government department. He may be able to get my paperwork processed more quickly.
So we shall see. Its frustrating. I'm not the first person to comment that nicaraguan infrastructure seems designed to slow or obstruct progress. I still hope that there is more good to come of this.
Monday, February 2, 2009
2 viewpoints on running a pharmacy
A little context:
The clinics I'm working in are funded by an english charity and a charge for each consultation. They are run by the charity "SIFT" on behalf of the local health authority. As such they are not duplicating other work and are a recognised part of the district's health service
The system seems to work. The two dollar charge is affordable to the majority of the community. The team know which of the patients are unable to pay and can waive the charge. The medicines are all dispensed free of charge.
The clinics funded by the health authority are, by comparison, completely free. They are well resourced with personnel but not with medicines. Many patients therefore have to pay high prices at local pharmacies for the medicines they need.
SO we have a better supply of medicines and cheaper overall for most patients. However there are still a lot commonly used medicines that we do not have, or have so little of that we could only treat a couple of patients for a month or two - not helpful for something like high blood pressure where treatment needs to continue for years. Its a horrible feeling as a doctor to make a diagnosis and not to be able to offer any treatment. We go throught this with cancers that cannot be treated or viruses that need not be treated. It is even harder to make a diagnosis, know that there is a good treatment but not have it available. This is a daily expereince here.
The Joys of being a pharmacist:
Each friday and saturday Dr sandra has a series of representatives from the pharmaceutical agencies visiting her. I like to think of these gentleman as her drug dealers. They have lists of which medicines they have available and what price. Sandra orders what she needs at the lowest prices as they become available, praying the different dealers off against each other.
And then there is the market in town. I like to think of this as the sweetie store. Its in the centre of the capital city's main market. It had to describe if you haven't seen large developing world market. Its one continuous construct of tin shacks built ajoining each other. Covering a couple of square kilometres, one can find absolutely everything. It is the centre of trade for most people in managua. Somewhere in this shopping jungle is a lady with a shack full of medicines. The market is a dangerous place and I was only allowed to some with sandra on the grounds that I brought no money, no valuables, no bag, and said as little as possible as the prices start to go up the more western and rich one looks. So I tagged along a couple of weeks ago.
Imagine being 8yrs old and being taken to a big sweetie store in town. Floor to ceiling with your favourite sweets that you have not seen in any of the corner shops and had almost forgotten what they tasted like. That was what I was feeling as looked round this medicine shack
I never thouhgt I would feel such affection for certain classes of medication. I guess it comes from having to give people a partially effective treatment, or one with many side effects, for want of having the "correct" treatments.
So we bought ourselves a nice little selection of our favourite medicines. I had a selection with which to run a half decent clinic in a certain prison you may have read about - if they would let me in; but that is a seperate story...
The Sadness of being a pharmacist.
The other side of procuring one's own medicines came a few days later.
On the island of ometepe, and in nicaragua generally, there is little in the way of refuse collection. A lot of household waste is therefore burnt instead.
I usually like fires, fascinating to watch and all that. This little fire was different. We'd been sorting through one of the clinic pharmacies, putting medicines in their correct places and checking their use by dates. The fire was made of the medicines we could no longer use because they were out of date. I'm sure every pharmacy in the owrld has to discard out of date medicines but I'd never done it before. It felt a little like burning books - simply wrong.
For those of you asking "why the wastage?", some will be unavoidable; one can never know exactly how much of any particular medicine is going to be needed in any given ammount of time. Some is because western aid agencies think it is useful to give large ammounts of medicines which have a few months to run on their use by dates to the third world. What seems a generous gift will inevitably be a large bonfire. Thirdly a more rigourous inventory of medicines including their use by dates may ensure they are dispensed in a systematic manner; ie those nearest their use by dates dispensed first. This may be a sizable task however.
The clinics I'm working in are funded by an english charity and a charge for each consultation. They are run by the charity "SIFT" on behalf of the local health authority. As such they are not duplicating other work and are a recognised part of the district's health service
The system seems to work. The two dollar charge is affordable to the majority of the community. The team know which of the patients are unable to pay and can waive the charge. The medicines are all dispensed free of charge.
The clinics funded by the health authority are, by comparison, completely free. They are well resourced with personnel but not with medicines. Many patients therefore have to pay high prices at local pharmacies for the medicines they need.
SO we have a better supply of medicines and cheaper overall for most patients. However there are still a lot commonly used medicines that we do not have, or have so little of that we could only treat a couple of patients for a month or two - not helpful for something like high blood pressure where treatment needs to continue for years. Its a horrible feeling as a doctor to make a diagnosis and not to be able to offer any treatment. We go throught this with cancers that cannot be treated or viruses that need not be treated. It is even harder to make a diagnosis, know that there is a good treatment but not have it available. This is a daily expereince here.
The Joys of being a pharmacist:
Each friday and saturday Dr sandra has a series of representatives from the pharmaceutical agencies visiting her. I like to think of these gentleman as her drug dealers. They have lists of which medicines they have available and what price. Sandra orders what she needs at the lowest prices as they become available, praying the different dealers off against each other.
And then there is the market in town. I like to think of this as the sweetie store. Its in the centre of the capital city's main market. It had to describe if you haven't seen large developing world market. Its one continuous construct of tin shacks built ajoining each other. Covering a couple of square kilometres, one can find absolutely everything. It is the centre of trade for most people in managua. Somewhere in this shopping jungle is a lady with a shack full of medicines. The market is a dangerous place and I was only allowed to some with sandra on the grounds that I brought no money, no valuables, no bag, and said as little as possible as the prices start to go up the more western and rich one looks. So I tagged along a couple of weeks ago.
Imagine being 8yrs old and being taken to a big sweetie store in town. Floor to ceiling with your favourite sweets that you have not seen in any of the corner shops and had almost forgotten what they tasted like. That was what I was feeling as looked round this medicine shack
I never thouhgt I would feel such affection for certain classes of medication. I guess it comes from having to give people a partially effective treatment, or one with many side effects, for want of having the "correct" treatments.
So we bought ourselves a nice little selection of our favourite medicines. I had a selection with which to run a half decent clinic in a certain prison you may have read about - if they would let me in; but that is a seperate story...
The Sadness of being a pharmacist.
The other side of procuring one's own medicines came a few days later.
On the island of ometepe, and in nicaragua generally, there is little in the way of refuse collection. A lot of household waste is therefore burnt instead.
I usually like fires, fascinating to watch and all that. This little fire was different. We'd been sorting through one of the clinic pharmacies, putting medicines in their correct places and checking their use by dates. The fire was made of the medicines we could no longer use because they were out of date. I'm sure every pharmacy in the owrld has to discard out of date medicines but I'd never done it before. It felt a little like burning books - simply wrong.
For those of you asking "why the wastage?", some will be unavoidable; one can never know exactly how much of any particular medicine is going to be needed in any given ammount of time. Some is because western aid agencies think it is useful to give large ammounts of medicines which have a few months to run on their use by dates to the third world. What seems a generous gift will inevitably be a large bonfire. Thirdly a more rigourous inventory of medicines including their use by dates may ensure they are dispensed in a systematic manner; ie those nearest their use by dates dispensed first. This may be a sizable task however.
Thursday, January 8, 2009
one for the doctors reading
An 8 yr old boy with an arthritis affecting both elbows and his left ankle. Marked pain swelling and restirction of movement.
symptoms and inflammatory markers settling after a course of herbal medicine and anti-inflamatories.
Bloods: 6/9/08:
CRP: 384 mg/L
ESR: 55
Rheumatoid factor: Positive
30/11/08
CRP: "negative"
ESR: 40
Rheumatoid factor: Negative
WCC: 8.9
I'm not sure how reliable the labs are nor what a constitutes a negative CRP?!
On examination he has marked swelling of a his right elbow and right ankle, only a little warm to the touch and moderately painful on all movements. Just about a ful range of movement at both.
Also He has an ejection systolic murmor radiating to his carotids, with no signs of symptoms of heart failure.
What is the next step: all ideas welcome............... further questions............?
symptoms and inflammatory markers settling after a course of herbal medicine and anti-inflamatories.
Bloods: 6/9/08:
CRP: 384 mg/L
ESR: 55
Rheumatoid factor: Positive
30/11/08
CRP: "negative"
ESR: 40
Rheumatoid factor: Negative
WCC: 8.9
I'm not sure how reliable the labs are nor what a constitutes a negative CRP?!
On examination he has marked swelling of a his right elbow and right ankle, only a little warm to the touch and moderately painful on all movements. Just about a ful range of movement at both.
Also He has an ejection systolic murmor radiating to his carotids, with no signs of symptoms of heart failure.
What is the next step: all ideas welcome............... further questions............?
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