DOG BLOG

May I introduce you to Professor Edward T. Creagan. 

Professor Creagan is Professor of Oncology at New York Medical College and a Fellow in Internal Medicine at the Mayo Clinic Graduate School of Medicine

His recent publications include:

Phase II Study of Temozolomide (TMZ) and Everolimus (RAD001) Therapy for Metastatic Melanoma: A North Central Cancer Treatment Group Study, N0675.

Dronca RS, Allred JB, Perez DG, Nevala WK, Lieser EA, Thompson M, Maples WJ, Creagan ET, Pockaj BA, Kaur JS, Moore TD, Marchello BT, Markovic SN.

Am J Clin Oncol. 2013 Jan 24. [Epub ahead of print]

Is Age ≥ 70 Years an Important Predictor of Adverse Events Among Patients Enrolled in Metastatic Melanoma Trials? Findings from Pooled Analyses of Therapeutic Trials.

Jatoi A, Allred JB, Suman VJ, Creagan ET, Croghan GA, Amatruda T, Markovic SN.

J Geriatr Oncol. 2012 Oct 1;3(4):307-311. Epub 2012 May 7.

He also wrote a BLOG recently on Pet therapy: How animals help us heal.

Dr Creagan believes in the healing power of pets. He talks of his life changing experience several years ago when a patient he thought he would lose was inspired to fight on by his overwhelming desire to return home to Max, his German Shepherd.

The Mayo Clinic takes the healing power of pets seriously. It has Jack; or to give him his correct title, Dr Jack. He is a 10 year old miniature pinscher. Dr Jack sees around ten patients a day. He is one of the thousands of canine healthcare ‘professionals’ known as ‘assistance dogs’. ‘Sometimes they help a healthcare provider with treatment and sometimes they just spend time with patients. The Health benefits are diverse’ writes Karen Ravn in the Los Angeles Times.

Mayo is world renowned for its scientific rigour and clinical excellence. There is something like 250 areas of research and numerous research projects being undertaken in each research area at any one time. Yet Mayo has Dr Jack. Mayo published a children’s book recently to explain the history of Mayo and what it does. They chose Jack as the vehicle to do this because they believe he exemplifies the Mayo model of care. The book is called ’Dr Jack: The Helping Dog’.

Another book published recently on the subject is ‘Dogs that Changed the World’. It tells the story of Daisy and Tangle, dogs able to sniff out cancer cells, and Delta, a German Shepherd who can sense changes in the blood sugar levels of her young master. And at the Sensory Research Institute at Florida State University in Tallahassee, scientists have trained dogs to detect the odour of skin melanomas and prostate cancer. Researchers are now training dogs to sniff out ovarian cancer.

 ISQua Staff Dogs:  Mr Johnny Angel, Maxie, McGrath, Scamp, Muhtar and Sasha  

Our pets are always therapeutic for us. But there are also the professional therapy dogs with which you will be familiar. I well remember visiting my Father in his Nursing Home where ‘Annie’ the therapy Golden Retriever used to bring so much joy to what might otherwise have been quite empty lives. In addition to providing companionship, researchers are now finding that these dogs are legitimately therapeutic. They have been found to reduce blood pressure and levels of stress hormones in heart failure patients and to have improved the focus and memory of patients with Alzheimer’s.

More and more clinicians, like Dr Creagan are embracing ‘pet therapy’ which surely would have been dismissed as nonsense even as recently as few years ago – if the notion was even seriously entertained at all. Certainly it works at the edges as an adjunct and a complementary application to the scientific method which will always prevail. But why not incorporate something that brings benefits if all it takes is ‘getting a dog in your life’.

Peter Carter

Chief Executive Officer

ISQua
August 29 2013 

Keep on Keeping on

Building 101 in Taipei city was once the tallest building in the world. It has been forced into second place by the recently completed Burj Khalifa building in Dubai.

The President of ISQua and I were delighted to be the guests of Dr Chiu-liu Lin, the Deputy EO of the Taiwan Joint Commission on Hospital Accreditation and Dr Wui-Chiang Lee, President of the Asian Society for Quality in Health Care at a dinner for speakers at the recent Asian countries accreditation meeting on the 85^th floor of this building. Our delight was somewhat tempered however by typhoon Soulik which was rolling towards us and we were of course perfectly positioned to watch, with growing trepidation, its advance.

‘Typhoon Soulik battered Taiwan with torrential rain and powerful winds on Saturday that left two people dead and at least 100 injured.’ (Press report)

With a little speeding up of the courses we made our escape to the waiting bus and back to our hotel before the full force of Soulik hit in the early hours of the next morning.

I have worked on various projects in Asia for over 20 years but every time I return I am amazed and impressed by the work I see going on and in particular by the range and diversity of healthcare quality. In 1990, when CEO of the Royal Australasian College of Surgeons I visited a surgeon working in a hospital in Pokhara, Nepal where waste from the operating room was washed into an open drain running alongside the wall of the room. Elsewhere I have seen the crispest and cleanest of bed linen in the wards but open windows with pigeons on the sills of the operating room and open drums of alcohol for scrubbing up before theatre. Yet Hong Kong, Malaysia, Singapore, and other Asian countries are an exemplar of what one might strive to achieve in healthcare quality.

Asia is not unique in this regard. And not only are the extremes inter country – they are also intra country. One sees the best and the worst of healthcare quality in Europe and the best and the worst in the United States; and it is the same the world over.

I have written before in this BLOG about the inequities in healthcare quality suffered by minority groups and this remains a problem and a concern. In some parts of the world however we see the reverse of this with a privileged few enjoying high quality healthcare while the majority try to get by.

I editorialised once in another magazine under the heading ‘Never Enough’ and I have spoken in this BLOG about our ‘…almost insatiable demand for healthcare services’. But while we all seek out healthcare services as and when we need them, some of us must wait longer for our consultation or procedure and, when the system is finally ready to take us, some of us will have to settle for whatever we can access and whatever we can afford rather than what we would prefer.

Have universal healthcare insurance schemes such as ‘Medicare’ in Australia, the NHS in the UK, schemes in Japan, New Zealand and a group of Nordic countries for example made a difference? Yes, in my view, but they have not produced anything like the health utopia their protagonists may have promised and they have not penetrated society to the extent that the especially needy and vulnerable such as the minorities to whom I so often refer have particularly benefitted. In a 2010 WHO report it was commented that:

 ‘Universal health care is not a one-size-fits-all concept; nor does it imply coverage for all people for everything. Universal health care can be determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered.^[1]

Along with education, free speech and a number of other fundamental rights, timely access to safe quality healthcare should be unqualified.

So many of us, ISQua included, will ‘keep on keeping on’ in this quest.

And having survived Soulik to be able to write this BLOG today I look forward to my visit to Dubai where I expect to experience a sand storm on the 101^st floor of Burj Khalifa and be inspired to write my next BLOG.

Peter Carter

Chief Executive Officer

August 01 2013

^1.                  ^ ^a b World Health Organization (November 22, 2010). "The world health report: health systems financing: the path to universal coverage". Geneva: World Health Organization. ISBN 978-92-4-156402-1.

Plan or Perish……….

More often than not, business ventures founder on the shoals of poor or altogether absent planning.

Those that succeed initially but subsequently come to grief often do so because they fail to recognise that planning is continuous process not just a one-off up- front exercise.

In another life I designed a university management programme aimed at training managers for the surf industry. Don’t laugh! While this might sound like a frivolous exercise it was anything but. The surf industry in Australia alone is a $9 billion industry and I was working with the likes of Billabong, Quiksilver and Rip Curl to train the next generation of managers to take over from the baby boomer founders of these companies.

Surf companies had read the market beautifully and were on the crest of a wave of success. They were also skilled at monitoring and regularly interrogating the market place and knew that the brave new second generation world they were about to enter required a new approach and a new skill set.  Not to gear up for that would certainly see their demise. In the event one of the companies was too slow to adjust and has seen a dramatic fall in sales and a halving of its share price. A takeover is mooted.

Things are no different in other endeavours – including health care management training. Three things that strike me in the generation of new training programs are:

·         The amount of work that is undertaken with limited market research having been done;

·         The, perhaps related, fact that courses, and good courses at that, are introduced and experience limited uptake; and

·         That a process of evaluation and market monitoring is not built into programs from the outset ie as part of the planning process.

When I raise these issues in discussion I am usually told that the programme is in its infancy and that the questions of evaluation and market monitoring will be introduced at a later stage.

I am of the school that believes that the way in which you intend to determine the success and on-going relevance of a programme or project is built in at the outset, lest part way through your journey you find you are travelling in the wrong direction or, worse still, you complete your journey only to find you have arrived at the wrong place.

For me this applies whether you are selling surfboards, training surf industry managers or introducing a management programme for health care executives.

I can tell you that in the year of its introduction the Diploma of Sport Management (Surfing Studies) was voted the ‘sexiest’ course of the year by one of the high circulation media outlets. I have no idea how that was measured but this award drove the marketing for the course for the next couple of years.

I doubt that a health care executive managers course is likely to be the next to be honoured in this way.

GROWING OLDER………and older………….and older……….

GROWING OLDER………and older………….and older……….

At her Dublin concert last week Emmy Lou Harris spoke of her greatest regret about getting older, which was losing friends. Then sang her haunting tribute to her dear friend singer Kate McGarrigle who died last year.

Today I received an email from a uni mate to say a mutual friend had died and was being farewelled this week; sadly such emails are more frequent these days.

These events come on the back of a recent fascinating conference presentation by Benedict Clements of the IMF and a discussion with the ISQua President, Tracey Cooper both of which highlighted the ticking time bomb of our aging world population.

The OECD graph below provided by Dr Cooper is striking in two ways, the first being the sheer increase in the ‘over 80s’ over the next few decades, and the second being the increasing separation of the life expectancy lines – representing countries - on the graph.

The pressure this will place on healthcare services and, of course costs and quality is but one of a number of issues that will confront those who have to make the world work in the future, some others being the need for increased food and fuel production and the negative impact a growing population will inevitably have on air and water quality and other environmental considerations such as the welfare of non-human animals and of the plant world as they compete with human animals for all the things needed to sustain life on the planet.

Benedict Clements presented data on current life expectancy in various countries graphed against health expenditure in those countries. This was of particular interest in that it showed:

·         a cluster of developed countries such as Japan, some Scandinavian countries and Australia where life expectancy was amongst the highest yet health expenditure is comparatively modest, which is, on the face of it, a curious combination;

·         many developing countries and some countries with struggling economies where health care expenditure is low and so is life expectancy, which is not unexpected; and

·         some countries, notably the USA, where expenditure is high yet life expectancy falls somewhere between the two groups of countries just mentioned. It does have to be acknowledged however that unfortunate complexities and anomalies in the US health care ‘system’ has a lot to do with how this country fares.

  

The IMF has reported elsewhere on the impact of an aging population in recent times as follows:

The International Monetary Fund has warned that life expectancy may rise faster than governments and financial institutions are forecasting, posing a risk to financial stability.

Underestimate the elderly at your peril is the warning from the International Monetary Fund. Statisticians and economists may be downplaying the lengthening of the human lifespan. If they’re doing so by the same three years as in recent decades, the IMF reckons the cost of pensions and healthcare will be 50 percent higher than estimated. Something, almost certainly the age of retirement, will have to give.

More distress is on the way, however, unless more permanent solutions are found. Tying the retirement age - and benefits - to the escalating life expectancy is the simplest step. A few pioneers, like Denmark and Sweden, have already moved in this direction. Other nations would be wise to follow suit quickly. Delaying will only make the final reckoning more painful.

It would appear the Danes and Swedes are saying, in effect, that either you support your own retirement or you work longer because the state cannot afford to support more and more people in retirement.

One might hope that the funds released as a result of such an approach will be directed towards addressing some of the problems referred to above that an aging population will create. If introduced globally this might alleviate the problem – but GOOD LUCK, recent riots in a number of European countries against various austerity measures, including raising the retirement age, suggest such a move would be a challenge to say the least.

In the meantime, while by no means encouraging complacency, let us age gracefully. My wife is doing so as she has accepted that in her audition for a part in Dublin’s Shakespeare in the Park production of A Midsummer Night’s Dream this summer she should really try out for the part of Puck or even Bottom rather than Titania.

POSTSCRIPT:

The ISQua Special Interest Group on Social Care for Older Persons will be holding a pre-conference session at the 2013 ISQua International Conference in Edinburgh on October 13 and will have sessions in the conference proper on the ensuing days. Contact Eadin for more information (emurphy@isqua.org).

How to Achieve a Tenfold Return

Conformity is the jailer of freedom and the enemy of growth - John F. Kennedy  

I once had an Archivist working for me, let’s call him Arthur, who used to arrive at work at anywhere between 9.15 and 10.00; work till around 2.00 then roll out his ‘swag *’ on the floor of his office and catch 40 minutes shut eye; go back to work and then head home anytime between 17.00 and 20.00.

ISQua staff members here in the Dublin Office arrive at work anytime between 7.00 and 9.30 and leave between 16.00 and 18.00. Over the course of a week average hours worked by staff is more than is normally expected and it varies very little for each member and from member to member.

In Arthur’s case, one day I was approached by a delegation of other staff who asked me how it was that I tolerated his behaviour. My reply was in the form of a question being ‘Does he do what is expected of him?’ to which the answer was ‘Yes – and more’. The realization on the part of the other staff that productivity rather than adherence to specific start and finish times is the more relevant measure of worth had a transformational effect on that workplace (in hindsight it would have been better had I made this clearer to all staff at the outset – but I excuse myself on the grounds that I was a young CEO who was still discovering these things myself!)

In the case of ISQua staff, the productivity individually and collectively is higher than I have known in the many other workplaces with which I have been associated – both public sector and private sector.

Perhaps the more subtle lesson in this is that the benefit of a staff member to an organisation is inextricably tied to how the organisation benefits the staff member.

It is the benefiting of the individual for her or his own sake, because that is a good thing to do, AND because inevitably it benefits the organisation, which drives the philosophy that the Deputy CEO and I try to bring to the ISQua workplace. One way of doing this is to understand what motivates each person and to work with that. Another is the active professional development programme we pursue and in which the staff are pleased to participate. And adding CPD to the end of a working day is not always easy. After a full and busy day at work it can be difficult to get motivated by the thought of three hours of ‘college’ work which might mean ultimately arriving home at midnight knowing an early start is required the next morning for another day at work (so – why not come in at 10.00!). This is especially unappealing if it happens to be one of Dublin’s less than pleasant winter evenings and you are relying on public transport.

All these things, the flexibility, the CPD, the recognition that at the end of the day a staff member’s family is the most important part of his or her life (so, yes take time off to meet a family need), all these things are a way of saying to staff that we respect you, we trust you, we believe in you and we are prepared to invest in you. An organisation’s efforts to do this will be rewarded tenfold. 

However, swags are not about to become standard issue to ISQua staff!

Peter Carter

April 11 2013

* In Australia and New Zealand, a swag is a portable sleeping mat or blanket sometimes with other possessions rolled up in it.

Minorities: How they are created and how they are neglected

The world's oldest continent is a product of the Dreamtime when the ancients known as the First Peoples travelled across the great southern land of Bandaiyan, creating and naming as they went. The Dreaming, as it is known, is the origin of spiritual values and reverence for country (kuntri).      

There were many different Indigenous groups in Australia, perhaps 600 of them, each with its own individual culture, beliefs and language. These cultures overlapped and evolved over time.

The Rainbow Serpent   (known as Ngalyod by the Gunwinggu and Borlung by the Miali) is a major Ancestral being for Aboriginal people across Australia.  The Ancestral beings formed the song lines that cross the continent from north to south and east to west.

One version of the Dreaming story is:

The whole world was asleep. Everything was quiet, nothing moved, nothing grew. The animals slept under the earth. One day the rainbow snake woke up and crawled to the surface of the earth. She pushed everything aside that was in her way. She wandered through the whole country and when she was tired she coiled up and slept. So she left her tracks. After she had been everywhere she went back and called the frogs. When they came out their tubby stomachs were full of water. The rainbow snake tickled them and the frogs laughed. The water poured out of their mouths and filled the tracks of the rainbow snake. That's how rivers and lakes were created. Then grass and trees began to grow and the earth filled with life.

The respective relationships with the land of Indigenous and non-Indigenous Australians are epitomized in a line from a Paul Kelly song (those of you who can remember back as far as my first BLOG will remember him) in which the non-Indigenous line is ‘this land is mine’ and the Indigenous line is ‘this land is me’.

The complex and diverse Indigenous cultures of Australia are the oldest living cultural history in the world,  going back at least 50,000 years, perhaps 65,000 years (by comparison Ireland has been populated for just 9,000 years). At the time of first European contact, it is estimated that around 750,000 people lived in Australia.

You can imagine what the introduction of British colonists – and them being sailors and convicts - did to this ancient, rich, beautiful and fragile pattern!

 The ‘First Fleet’, comprising eleven ships, sailed into Botany Bay and Sydney bringing with them around 780 British convicts. This was on January 26, 1788, now celebrated as Australia Day, but labeled ‘Invasion Day’ by Indigenous colleagues with whom I have worked who see this landing as no cause for celebration. Two more convict fleets arrived shortly after. 

This settlement brought with it all manner of destruction for the Indigenous peoples not least of which was a wave of Old World epidemic diseases. Smallpox alone quickly killed more than 50% of the Aboriginal population, who lacked immunity. Then followed the appropriation of native land and water resources.  The combination of disease, loss of land, social and cultural disruption and violence reduced the Aboriginal population by an estimated 90% within 12 years of white settlement.

This story is replicated elsewhere in the world.

Mythology also told how the lands and lives of the Arctic Inuit were created and nurtured. The environment and animals of the Arctic and the adventures of the hunt created visions of spirits and fantastic creatures and the aurora borealis, or northern lights, might conjure images of family and friends visiting from the hereafter.  Alternatively the Lights might be invisible giants or the souls of animals.

The Inuit practiced a form of shamanism based on animist principles. They believed that all things had a form of spirit, including humans, and that to some extent these spirits could be influenced by supernatural entities that could be appeased when one required some animal or inanimate thing to act in a certain way. 

European arrival in Inuit lands shattered this delicate system of beliefs so closely in tune with nature and caused widespread death through new diseases introduced by whalers and explorers, and enormous social disruptions.

The imposition of western laws, in Canada for example through the RCMC, and a moral code decreed by missionaries wore down the culture and social fabric leaving the traditional supports in tatters.

European colonization of North America also had a devastating effect on the native populations through loss of land, disease, enforced laws which violated their culture and through the introduction of guns, alcohol and horses.  Suddenly the balance between man and nature, tribe and tribe was upset forever. Increased mobility alone meant more tribal trespass and the ease now of killing prey upset a symbiosis which had evolved over centuries.

European religions were introduced and conversion to them forced interfering with the traditional ancestral worship breaking down cultural understandings. Then, of course the Native Peoples’ lands were appropriated – and this appropriation resisted.

You can see the pattern here, and these are but a few examples of what has been repeated over thousands of years; our actions cause the emergence of minority groups who then inevitably become disadvantaged in numerous respects.

These ignominious beginnings have had a sustaining legacy.

As a group, Indigenous Australians have one of the lowest life expectancy rates in the nation. Today that life expectancy is on average 10 years less than for non-Indigenous Australians. A large part of this is due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease. Many of these have common risk factors, including smoking, poor nutrition and lack of exercise. On returning from a visit to ‘outback’ Indigenous communities in the 1990s the then president of the College of Surgeons and I, as CEO, reported to a College Council meeting that whilst our developing countries outreach programme was leading to improvements in healthcare quality in those countries we had largely ignored an almost identical problem amongst  our own Indigenous peoples.   

Life expectancy figures for the Inuit population are complicated by the spread of Inuit peoples across a number of Arctic countries. However studies of life expectancy of Canadian Inuit peoples suggest it is 10 to 15 years less than for non-Inuit Canadians.

Native Americans’ life expectancy ranges from 66 to 81 depending on whether you happen to live in South Dakota or California (which itself raises questions) and, while averaging is fraught, if one averages, American Indians spend four years less on this planet than do other Americans.

Isolated and minority groups, whether indigenous minorities or ethnic minorities or economic minorities or social minorities are almost without exception worse off when it comes to quality of life and quality of health care. For instance, in the USA, the Agency for Healthcare Research and Quality (AHRQ) reports that:

·    African Americans received worse care than White Americans for about 40% of measures.

·    Asians received worse care than White Americans for about 20% of measures.

·    Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.

·    Poor people received worse care than high income people for about 80% of core measures.

In Ireland a particular unequal minority of concern are ‘the Travelling People’ (an lucht siúil or Pavee). Very little is known about the origin of the travellers. They may be descendants of people in Irish history who had been evicted from their lands; they may be descendants of travelling tradesmen, such as tinsmiths; or are they may be descendants of travelling bards.

 What is known is that there are concerns for this small minority of Irish (0.5% of the overall population). One is health. Life expectancy among the travellers is low and infant mortality high compared to the general population. A second is education. Because of their lifestyle, only half of the school-aged children are in school and many of the adults are illiterate. 

That minority groups are with us and always will be is inescapable; but that the quality of healthcare that many of these groups receive is poorer than the rest of the population should not be an inevitability.

ISQua has a clearly articulated set of objectives to enhance health care safety and quality in low and middle income countries. We believe this will have the effect of improving outcomes for the populations, including minorities, in those countries. ISQua’s overall mission will also lead to benefits for minorities as the effect of improvements filter through societies in general. ISQua has also made its intentions clear in focussing on minority groups in particular as one of its recent conference tracks directed to this theme attests. As we build our interest in this problem and search for possible solutions we would be assisted by your input and invite you to offer it.

_____________________________________________________________________________________________________

The following sources where used in compiling this document.

Australian Museum Online: www.dreamtime.net.au

Australian Government Culture and Recreation Portal: www.culture.gov.au

www.en.wikipedia.org

Webster Online: www.webster.com

National Museum of Australia: www.nma.gov.au

www.funsocialstudies.learninghaven.com/articles/natives2.htm

Publication No. AHRQ 11-0005-3-EF April 2011

 www.abs.gov.au/ausstats/abs@nsf 

Statistics Canada Health Reports

www.irish-societhedgemaster-archives-2/groups-organizations/the-traveling-peopley.org/home/

kullilaart.com.au

My Country: Our World

My Country: Our World

‘We are in a tiny town on Tasmania's east coast, Coles Bay, about 3 o'clock from Launceston on the Freycinet Penninsula.

There is only one road in and out. We are surrounded by National Park. The road was closed, and the fires were being driven by a very strong NE wind. They got to about 5kms away, so you can imagine the smoke. Everything was tinder dry after no rain for six weeks, a big build-up of fuel after a wet spring, a 40 degree Celsius day and zero humidity.

As a fire can move quickly, even 25 km per hour we were very close to disaster.  We were on one hour evacuation standby, with the only exit by boat. Fortunately the fire was contained by back burning.

I did say goodbye to the house, but, miraculously no loss of life or property here. South and east of Hobart was a different story, and then it cooled off and the Australian danger moved to Victoria and NSW. You will of course be aware of Coonabarraban.’

I received this email from a friend as I arrived back from a hot and dry Australian Christmas to a wet and cold day in Dublin having flown over the pleasant and serene emerald fields of Ireland. And in the week since my return, floods have once more risen over much of the east coast Australia and huge seas have swept beaches away.

In her iconic poem, My Country, Australian poet, Dorothea McKellar  describes such contrasting environments as follows:

The love of field and coppice,
Of green and shaded lanes,
Of ordered woods and gardens
Is running in your veins.
Strong love of grey-blue distance,
Brown streams and soft, dim skies –
I know but cannot share it,
My love is otherwise.

I love a sunburnt country,
A land of sweeping plains,
Of ragged mountain ranges,
Of droughts and flooding rains.
I love her far horizons,
I love her jewel-sea,
Her beauty and her terror –
The wide brown land for me!

McKellar spoke in the same poem of Australia’s: flood and fire and famine.

And it is true. I have fought a bushfire, had one threaten my home to the point of evacuation, like my friend who describes his plight above, and I have had floodwaters through my home.

Nature throws up different joys and different challenges wherever we choose to live in the world. However, the resilience we show as a people, wherever we are and whatever the challenges, is the same the world over.

And, as the world becomes more ‘connected’, or global, if you like, we are increasingly learning from one another and commonly and often collaboratively, addressing the various challenges that face us'.

The global financial crisis could not have occurred in years past; economies weren’t so connected and interdependent. It used to be the investment mantra that one hedged one’s investments by holding a range of investments in a range of economies around the world. This doesn’t work so well anymore. It used to be that disease could be more or less contained within a region, contained by isolation, geography, lack of movement by populations. Today disease is increasingly global.

Accordingly, global solutions are needed to what are becoming global problems.

With 70 countries represented in our membership and some 8000 individuals and organisations with whom we interact ISQua has a ‘box seat’ when it comes to observing the global safety and quality healthcare scene. We are able to bring this international perspective to bear on all we do to enhance quality and improve safety. ISQua is holding a regional meeting in Ghana this month along with URC and WHO with delegates from some 12 African countries in attendance. Our delegation will bring experts from Europe and North America to share their knowledge with and to learn from these African nations. In April we are meeting with Chinese healthcare leaders where a similar exchange will occur.

So, while nature might still differentiate, giving us the ‘droughts and flooding rains’ of Australia and the cold wet climes of Ireland, for good or for evil and whether we like it or not, otherwise the world now shares pretty much everything.