Learned helplessness

If you seperate a predatory fish from some prey fish with some clear perspex the fish will initially keep knocking into the perspex to try to get to the food, after a while it will give up trying and just swim around and ignore them. The interesting part is that if you remove the perspex the predatory fish will continue to ignore the prey and will not make further attempts to catch them, this effect is so extreme that the predatory fish will actually die of starvation before it tries again to catch the prey again- hence the fish has learned helplessness.

Life in the Transkei can sometimes feel like the life of the predatory fish. For example I've developed learned helplessness towards accessing various tests for my patients. I have tried hard to access CT scans through the government hospital but have had virtually no success and had essentially given up.

What I've learned is that just as in the fish story it is a dangerous mindset to slip into because you just never know when the perspex has been lifted. It often takes the fresh approach of a new member of staff to spur you into action and in my experience you can get some great results when this happens. For example, I've recently learned by chance of a new approach to the CT scan problem that may well work and it has spurred me on to revisit some other obstacles that I had previously abandoned.

Bumblebees

I remember learning that while most animals behave to get as much done for a given amount of energy expenditure (maximise benefit/energy cost) this isn't true of bumblebees. They behave in such a way as to get the most done per unit time (maximise benefit/time cost). This is because after a determined length of time they essentially 'wear-out' and die. I've noticed something similar in human resource poor medicine which I wanted to share.

In high human resource settings doctors are generally encouraged to make decisions based on health cost vs benefits. Prescribe a certain drug to enough patients and the adverse side-effects will be out-weighed by the improved quality and quantity of life (health benefits > health costs). When human resources become limited the doctor is often faced with a different question. Is it worth me spending a certain amount of time on an intervention for a given benefit to the patients (maximise health benefit / unit of doctor time). There are a whole bunch of initiatives I would like to start including aspects of preventative medicine and intensive care of the critically ill. The question is not whether there is a cost vs benefit advantage to the patients but given that time is very limited, which of these interventions should I choose to do at the expense of the others. Basically you need to have a much greater understanding of how much something works and not just that it works at all. Financial resources must be considered in both settings but where I'm working financial cost comes into it less than you might think.

I have something else in common with the bumblebee because the only other thing I remember learning about bumblebees is that according to the laws of aerodynamics it is impossible for them to fly!

The similarities

It is easy to get caught up in all the differences and oddities you are likely to encounter when you move to a new culture. What I hadn't given a thought to were all the similarities that I would find. Steven Pinker talks about the fact that in all cultures people tell stories, recite peotry, sing, dance, decorate surfaces and perform rituals but isn't it the differences in the stories and the rituals that people generally find interesting in other cultures?

What I'm talking about are the things that appear to be all but identical. I'm not surprised that young men love football and drink as much beer as they can afford but it's easy to forget, when people appear engrossed in a daily struggle to survive and bring up children, that there is always time for gossip for example. The old women standing beside the road may have no shoes and smoke long wooden pipes but if you eavesdropped I'm absolutely sure you would hear the same conversation that could be heard the world over about who doesn't keep their house clean and who's husband has run off with a younger model.

The way women look after their children also seems so similar to me. The absolute amount of money floating around might be different but children still nag for a few cents for sweets and mothers still seem to resist for a while but eventually give way for 'a bit of peace and quiet'. Flirting is another thing. A bit of harmless flirting with slightly older nurses seems to get you just as far on the wards here as it does in the UK.