Annica’s Diary

Sunday 4th January 2009

HAPPY NEW YEAR

 

I can not believe it is 2009 already. Time does fly. Wishing everyone a very Happy New Year. I got together with Hayley and Amy to bring the New Year in. Unfortunately Pete was working and Delia had a party to go to.

 

Amy treated us to mulled wine, a delicious meal, firworks and even S’mores!!  With a glass of champange we toasted the New Year in style.

 

Over the next few months Lynne Marshall has organised us plenty of presentations to tell the Rotarians in District 1210 about our amazing trip so I’m off to plan what I shall be telling them all.

 

I hope you are all well.

Monday 15th December

One month ago today we flew home – gosh time has gone so quickly. Tonight we all met up for a Christmas get together and it was so lovely to be with the ‘old crowd’ again. Malcolm even wore his cowboy gear! We had Diamond W Ranglers playing in the back ground and chocolate brownies for desert!

 

 

Photos on the gallery!

 

 

Wishing everyone a very

 

 

HAPPY CHRISTMAS and NEW YEAR ! 

 

 

 

 

Visiting America and going over sea

Has helped me learn what is important to me

Family and friends come above high earning

But now I have been hit by the travel bug yearning

 

The burgers and chocolate did taste nice

However so much eating comes at a price

The clothes got tighter and now the gym calls

Heres to hoping the weight quickly falls!

 

The Kansas landscape was certainly flat

The huge crops of corn laid out like a mat

I missed our hills and green green grass

But oh how their wind does blow so fast.

 

Their health care system was mighty fine

Investigations occurred in such a quick time

However I prefer a system that caters for all

From the rich to the poor and the short to the tall.

 

I certainly missed  a good cup of tea

The total lack of kettles did surprise me

The weather was mixed but mostly fine

Most days we had blue sky, the sun did shine

 

The roads were so straight, no bends at all

The leaves on the trees so pretty in fall

The Rotarians were amazing wherever we went

Their accents where great we knew what they ment!

 

I feel my confidence has grown and new friends made

How the time has flown and foundations been laid

What a wonderful experience via GSE

Thank you so much for selecting me!

 

 Sunday 23rd November

This week has been hectic! I think all my patient’s saved up their problems for my return!!!

On Friday 21st we had our welcome home presentation. It was lovely to see so many familar faces of Rotarians that had supported us though the preparation stages of this trip (plus the people who had selected me!)

We had to give a short presentation about the trip and be be honest I just did not know where to start. How can one sum up the experience in just 5 mins? This is impossible. I decided therefore to mention four areas that stood out to me and finish in true ‘Malcolm style’ with a rhyme (although I did not subject the audience to my singing voice – that would have cleared the crowds!!!!)

My four points were:

1) How yummy the food was  (I’m not sure why all the others mentioned how much I eat in their talks too!)

2) The differences in our health care systems

3) Halloween and the wonderful time we had at Steve Wood’s house

4) The American Football game in Guymon - I feel I missed the opportunity to offer my serves as team medic!

I’ve post my rhyme at the top of the page because I did not want it to get lost amongst text.

So that’s it – the trip over, the welcome dinner acomplished. My only question – why oh why did it all have to go so quick?

A big thank you to EVERYONE for this wonderful trip. Words can’t express what it has meant to me.

Sun 16th Nov – Home

Here I am back at home. It all seems like a dream and I can not believe that a month really can go by so quickly. The experience that the GSE Foundation offers people like me really is amazing. I feel I have learnt so much about myself, my profession and the culture of another part of the world.

To be part of such a brilliant and supportive team made the whole experience so much fun and I thank Malcolm, Amy, Hayley, Pete and Delia for that.

My task now for this week is to put pen to papaer to think about how to sum up this trip for our final presentation – this is going to be challenge. I shall copy this onto the blog when done!

A huge big thank you to everyone who has made this trip so special, the time you have all spent with us and for us, the hospitality of welcoming us into your homes and lives has truely made this a wonderful wonderful trip and words can not express how grateful I am for the opportunity – THANK YOU

 Sat 15th Nov

This is a sad day. A big thank you for everyone who met us at the airport to say goodbye. I remember thinking when the American team left the UK 4 weeks ago and cried – I wonder if I will in 4 weeks time. The answer to that question is yes!

Our flight was uneventful except for a sort delay at Chicago. We had lunch at the airport here – my last American burger and all sang Happy Birthday to Delia – which then lead to the waiter bringing her a cake (totally unprompted – that would never ever happen in the UK).

Once boarded on that plane – next stop Manchester and guess what – yes it was raining on our arrival!

Fri 14th Nov – Wichita

This morning I have spent time with my host Dick Gilmartin. Our first stop was the Hospice Unit at Via Christi Hospital here in Wichita. This is the other main hospital in the city which competes with The Wesley Medical Centre I visited yesterday. Via Christi hospital is a ‘not for profit hospital’.

I was lucky to be able to go on the ward rounds with one of the Doctors working on the unit. The most stricking difference to our hospice back in Shrewsbury was that nearly half the patients were not suffering from cancer. There was a gentleman with liver failure (from alcoholism), a gentleman with end stage heart failure and one with end stage COPD (a lung disease). The unit itself was very much like other hospital wings that I have seen before – single rooms (but that is almost standard here in the US). They were a little larger than they average room as each had a sofa bed you could pull out for relatives. The aims of the doctor however were identical to ours – symptom control and if possible aim to get the individual more comfortable and then home with whatever support needed.

Following this we visited the Kansas University Medical School. I was lucky to be able to have a tour and then chat to the Director about training and General Practice. Training to be a doctor involves doing an initial 4 yr science type degree after leaving school at 18 yrs. Then you take a specific entrance exam to get into medical school. It is competitive like in the UK. Medical school is for 4 yrs. Here they do the first 2 yrs science based up in Kansas City – the main university campus and then have the choice whether to say in Kansas city or come to Wichita for the final 2 clinical years. A lot choose to come to Wichita because there are such good facilties here and good hospitals. Exams are taken throughout the four years – both clinical / practical exams and written. In their fourth year they decide which speciality they are going to choose and thus the university help match them to a Residency programme (like our junior doctor rotations). For General Practice this is three years. During these training years post medical school they are earning and pay scales at this point seem very akin to our junior doctors in the UK.

After year one of residency all doctors take a further general exam – regardless of their choosen speciality which they have to pass in order to continue. Exams at the end of 4th year medical school and year one residency at nationalised and thus students/junior doctors have to travel to one of 5 specific areas in the USA to take the exam (they also have to take local university exams too).

Following the residency programme I asked about further exams / assessment. In General Practice the doctors take Board exams every 7 years. This is not compulsory but the majority do as it helps for their insurance costs. This to me seemed a little like the revalidation process that seems to be just around the corner for us GPs back home.

Our next stop on this busy morning was to Derby Rotary Club for our final presentation. I actually felt quite sad when hearing Malcolm do his usual joke about delegation of work in his wood and getting to ride the tractor!!!

In the afternoon Steve Woods kindly took us back to the Western Outfit shop- Sheplers for more shopping and then I also visited Dillons (a supermarket) to pick up ingredients for making S’mores when I get home!

This evening we have had our farewell party in Wichiita. I can not believe that only 4 weeks ago we were all saying farewell to our friends and family in the UK and now this trip is coming to an end. It was smashing to see so many people at The Anchor bar to say goodbye. Thank you so much for travelling up to see us.  I got really quite teary. We had friends from Newton (thank you Steve and David) and Pratt (thank you Donna and Jack) as well as all our brilliant friends from the Wichita area clubs. It was great to have fellow GSE team members Margaret (who came all the way from Ulysses), Jade and Maria there too. In true British style we wore our cowboy hats with pride!!!

This trip has been amazing. I can not express my graditude in words to all the people involved in getting me here (from Tom James and the Darwin Club Shrewsbury and Lynne Marshall for all her organising) to all the hosts and day hosts who have so kindly let me into their homes and shown me the ‘Real America’.

When I get home I shall be updating my blog with my final thoughts so the story does not end here!!

Thurs 13th Nov – Wichita, Vocational Day

Well I have to start by saying Mark Cassell has done a most marvellous job at arranging my vocational day today – thank you so much.

I am sure that I must be boring everyone with all my medical snipets of information but with only 2 days to go I am not going to stop now!! This morning we were taken on a tour of Wesley Medical Centre – one of two community hospitals here in Wichita. Our first port of call was the birthing centre. This was a lovely facility. It caters generally for uncomplicated deliveries. A lady would arrive and her entire stay would be in one room. Each room is large with ensuite facilities and a sofa bed for family members to stay if they wish. The main difference with our maternity units was that family could stay as long as they want and as many members can stay as wished. At Shrewsbury Hospital – after a lady has delivered husbands/birthing partners are sent home at 10pm! Also a lady is moved from the delivery room to a postnatal ward. Here they would stay in their room for their entire stay. Length of stay depends on the Consultant and patient choice.

There is no option for a water birth here - infection control has not allowed this option to develop. Again there were no midwives. Nurses look after the patients and their Obs & Gynae consultant who has provided all the prenatal care delivers the baby. There was theatre for emergency Caesarian Sections if needed.

Across the street (or along a corridor underground) was our next department – the Neonatal Intensive Care Unit. This has 36 beds. I asked re transfer rate if the unit became full – they never do transfer!! The only transfers would be for neonatal cardiac surgery because this facility is not available at Wesley Medical Centre.

Our tour then took us to a Wound Care department and Hyperbaric facility. Patient with wounds that are slow or difficult to heal come here. I mentioned that most of our patients with chronic wounds/diabetic foot ulcers etc require home visits as are house bound. There is apparently a team of specially trained Home Aids that do go to people’s houses but more frequently people attend this outpatient area.

Hyperbaric oxygen treatment is something I was not familiar with – treating troublesome wounds with pressurised oxygen therapy.

We then had a brief walk through their paediatric and adult Emergency Rooms (more about this later) before heading off to Andover to do our penultimate presentation.

Andover is just east of Wichita. After lunch we once again took to the stage and delivered our talk. One of the questions following was about American food. I don’t know why but I was chosen to answer this – is it because of my love for the ice-cream palours and hot fudge sauce??!!

In the afternoon my host Dick Gilmartin took me back to Wesley Medical Centre to spend some time with Dr Mosley – the Emergency Room (ER) Consultant. This was a wonderful experience. I essentially quizzed him about the American Health Care System. Anyone entering the ER will get treated – insurance or no insurance. Approx 6 out of 10 attending ER will NOT have insurance. People with no insurance can not afford to pay their medical costs – non earners, unemployed. The hospital therefore has to write off these bills. My question was how come therefore they are not running into debt? The answer is to put up the cost of treatment – this gets relaid to the insurance companies and thus onto the people who can afford insurance. Insurance costs are therefore forever spiralling.

The person who suffers the most however is “Joe the Plumber” (ring any bells????!!!!) who earns a living but can not afford insurance. He then gets taken ill and as earning will get billed for all his medical expenses (at a high rate to help cover the hospital costs for treating all those without insurance).

So what do you think of this system? I am really rather glad we have the NHS in the UK and certainly would not be changing it. I can not see why/how the US can maintain the system it has and why more people do not complain about the vast cost of health insurance. Essentially to me they talk about a socialised medical system and worry about introducing it as they hear about the long waits in the UK/Canada etc but I feel (and maybe through misunderstanding) that they almost have a socilaised medical system here already because anyone can get treatment at any time, regardless of insurance, by just walking into the ER department.

I also just want to mention some other areas of interest from working in the ER today. One area I am most impressed here is the quality of service patients get and the contentment of staff. I think this does stem from the competitive nature of a privatised health system. In Wichita as I mentioned there are two main hospitals but several other specialist hospitals (e.g. cardiology, orthopaedics etc) and they are all competing for business. Thus to attract patients / get consultants to use that particular hospital depends on facilities – hence they are always striving to have the most advanced imaging techniques, quickest times for investigations, highest nurse/patient ratio etc. This makes for a better experience for both the patients and the staff. Staff turn around in Wesley therefore is incredibly low. People seemed genuienely happy in their work. The competitive nature between the different hospitals certianly seems to improve care because if a hospital is not providing good care then patients will not come and they will go out of business.

I’ve a strong suspicion that this is what our goverment is trying to introduce into the UK?!

The workings of the ER also are different. There is one nurse to three patients, one consultant to 10 patients. Although there were no junior doctors present when I was there today – Wesley is a teaching hospital as thus they do work in the department. My main observation was that the ER Consultant is not part of the trauma team. When a trauma patient is expected a separate team is bleeped down to the department (including trauma nurses) so the ER consultant does not become involved at all. This is in order to allow the main ER department to continue working and be undisturbed by a major trauma so patient waits are not affected. It also helps improve continuity of care so a trauma patient is looked after by the same team when they are moved to the appropriate area of the hospital for further care.  I asked Dr Mosely does he not miss doing trauma / was that not part of his desire to be an ER doctor. His reply was that the system works wonderfully and it makes his job less stressful. He still gets the buzz and excitement from dealing with other critically ill patients such as those having a heart attack /breathing problems / seizures etc.

One final observation for those medics reading this – we have a target time for thrombolysis for heart attack patients – here they have a 60 minute door to cardiac stent time! Wow! Medicaid (the provider of health care for over 65 yr olds) sets specific targets for treatment or it will not pay the bills and it is through this that these targets are generally set. Some are a little like GP QOF points.

Well sorry to write such an essay about the health care system and I apologise to those non medics who have probably now stopped reading my blog or fallen asleep in the process! I have just found it all so interesting and am amazed really about how similar and yet different our systems are but obviously we are all wanting the same outcome – the best health care. I’d love to know the right way to provide it!!!

Believe it or not – following all this I even managed a little more shopping before returning home to have supper with my hosts and a relaxing evening.

At 10pm tonight I have a date with Channel 10 news as today I may have made my debut as a budding TV interviewee! We were followed around this morning by a TV news channel crew and I was asked my opinion on the differences between the National Health Service and facilities here in Wichita. We shall have to see if they give my answer any air time!

(oooo – just seen the news – I made it. Follow the link to see the report!)

http://www.kake.com/home/headlines/34425374.html

Tomorrow is our last day – how did that happen? Where has the month gone? I am thinking of relocating out of Rotary District 1210 in Shropshire/Staffordshire and re-applying to another GSE programme elsewhere with another district! If only I could !!!!!!!! This certainly is the experience of a life time.

Wed 12th November – Wichita

Today has been really interesting! We started off at the Greater Wichita Economic Development Coalition Centre and had wonderful two hour interactive session. Wichita has a population of approx 350 000 and I found it fascinating to see what goes on beneath the scenes to attract businesses to this area in order to promote growth, provide jobs and help this city expand. Kansas is not a ‘cash rich’ state and thus it can be difficult to attract large buisnesses/cooperations to locate in this region as they are limited on incentives they can offer. However a number of specific tax brakes are available.

The largest employers here are involved in the aviation industry and Wichita is known as ‘The Air Capital of the World’. The majority of commercial private jets flown around the whole world are made in this city. Companies based here include Cessna, Learjet, Hawker-Beechcraft and Spirit (a division of Boeing).

During our interactive discussion we chatted about employment issues – we in the UK have so much more holiday than the Americans. Over here they acquire more holiday days the longer they work in an organisation but initially for many years survive on just two weeks a year (plus public holidays). A typical working week is 40 hours. I can not understand how they do not have more ‘burnout’ problems with their work force with having so few holidays! Also maternity allowance – I think we were told 6 weeks paid leave, max time off 12 weeks. What a difference.

We also learnt that although about 70% of young adults attend college/university following school – only about 30% go on to graduate. I feel this is a much higher drop out rate than we have in the UK.

From an economic developement point of view – Wichita is trying to maintain its aircraft links but also apparently is an ‘accent free’ part of the States and thus attracts call centre companies. It was interesting to compare similarities and differences regarding growth and development. One comment made by the Development Centre was that Wichita has often been described as ‘2 yrs behind the American economy’ and thus if there is a down turn it is often unaffected and by the time it hits central Kansas things are on the up again!

For lunch we visited the Rotary Club of East Wichita. Our presentation went well – we seem to have it down to a fine art now!!!  

This afternoon was brilliant – a real insight into a different world! We visited Cessna. This is one of the world’s largest private jet companies. They manufacture aircraft and sell to the rich and famous (Harrison Ford to name a few). We were not allowed cameras in the factory (so no pictures I’m afraid) and we all had to give our social security numbers before being allowed in (top security you know!!!) We intially had a tour around one of their assembly areas and saw several models of the Citation aircraft being built. It was amazing to see these planes being put together and all the work involved. I think the cheapest aircraft we saw was $8 million but if you fancied a more sophisticated model prices did go up to $27 million!!! If I wanted to put an order on one of the fastest jets – I could expect completion by 2018. They have a 10 year wait on some of their jets and all are paid for in advance of being manufactured. It can take two months or more to produce just one aircraft.

Following this we went to the specification unit. Essentially I image it is like buying a Rolls Royce (not that I have ever done that!) - one can choose the interior finish one wants: type of wood, type of leather, colour, bar, microwave, phone system, TV, DVD, toilet etc etc! If you fancied pink fluffy seats – that could be arranged! The whole experience was brilliant and certainly showed me an insight into how the other half live!

To finish the day we then were taken on a little shopping trip (I was fairly restrained!) followed by a lovely chinese meal with my hosts and Hayley’s. Tomorrow is a vocational day seeing the medical facilities so will be good to see what a larger city has to offer in comparison with some of rural areas I have visited thus far.

Tues 11th November

This morning we were taken to a museum just south of Winfield in Arkansas City. It was all about the Cherokee Strip Run. This was a race for land which occured in 1893. Essentially many Americans gathered in Arkansas to order to have the opportunity to acquire new land in an area that was previously occupied by the native Indians. The American government purchased this land (now the Oklahoma panhandle area) and set a date (Sept 16th 1893) in which people could all race to claim a section to call their own.  It was interesting to hear and read about this part of American history that I knew nothing about. Certainly my geophraphy and history of this areas is improving!!

After lunch we were kindly taken up to Wichita by Rotarians from the Winfield club. After a cup of tea at Steve Wood’s house we were met by our final host families. I can not believe this is our last stop – where has this month gone?! I am staying with a smashing couple – Peggy and Dick Gilmartin. Dick is a retired Consultant Paediatric Neurologist. Peggy had read my blog profile and there was a box of chocolates in my bedroom waiting for me!

We have just had a lovely supper and long chat about the exciting things planned for my stay here and general day to day life both in the US and UK. I feel that is what makes this trip so special. Having the opportunity to chat (or visit with – as they say in some more rural areas here) to host families really does give an insight to the American culture, way and pace of life that would never ever be experienced if I was staying in a hotel as a normal tourist. GSE really is a fantastic scheme.

Tomorrow is a busy day of activity so it’s an early night for me!

Monday 10th November  – Vocational morning

Today I have been to my host’s practice in town. I sat in with Treasure for her first few patients. There are 3 doctors in her practice, each work a 4 day week doing clinics and then on their other day – several cover the Emergency Room. Patients are again allocated 15 mins. Treasure can see anywhere between 20-30 patients a day (30 being a bad day!) She covers her on call over night but they have a rota for weekends. She may often have a call in the evening but does not frequently have to go out. She would advise patients to go to the Emergency Room if they needed seeing and if she was needed the doctor there would call her.

They can do Xrays within their practice but all other investigations are referred up to the hospital. One of the main differences I noted was that all patient notes were still on paper – no computors.

Here in Winfield the hospital has 25 beds (6 of these are intensive care). There are 3 Internal Medicine doctors (ie general medicine), one surgeon (who does all surgery from hip replacments to hernia repairs), 3 Obs and Gynae consultants and 24 hr doctor cover in the Emergency Room. Treasure and her practice do not do any antenatal/delivery or post natal care.  Again the GPs look after any patients they decide to admit but if they feel they need further help/second opinion then they will consult with one of the Internal Medicine doctors.

One thing I thought would make our nurses jealous was that there is a ratio in the hospital of one nurse and one health care assitant per 5 patients!

We then had lunch at a Pizza place (for all those people who have missed my references to food – they serve dessert pizza here in Kansas - sounds unpleasant but actually really rather delicious, me and my sweet tooth!!!!!) It was then a trip to Wallmart (Asda equivalent) and they really do know the meaning of the word Superstore. You could buy anything from food to tv’s to car tyres to clothes and obviously chocolate! (No yorkshire puddings though!)

This evening has been our presentation to the Rotary Club of Winfield. It was a great evening, everyone so friendly and we even sang the National Anthem (I have to admit to being a little hazy on the second verse!)

Sunday 9th November

Today I have spent a lovely relaxing morning at the B&B. I had a jog and caught up with my journal. After lunch we were picked up by our Winfield hosts. I am staying with a General Pracitioner called Treasure Wehner with Delia. We had a little walk around the town of Winfield (population approx 14000) and then headed to Laurie and Jim Snyder’s house for a ”cookout” (for the British reading this – a bbq!). So many Rotarians had come to meet us – it was a smashing evening!

Sat 8th Nov

Gosh time is flying and I can not believe we only have one week left. After a sad goodbye to my wonderful hosts Bette and Gary Skaggs in Pratt we were driven to Winfield and met by some of the Rotarians here. The journey took approx 2 hrs. After lunch we arrived at the Bluestem Bed and Breakfast. This is our 24 hour rest stop where we are allowed to unwind and relax until tomorrow. It is just outside the town on Winfield in the countryside. Today there is chilly wind but a lovely clear blue sky and and the sun is shining.

To take advantage of this lovely weather – I spent the afternoon going for jog and then have had an hour long massage - I was in heaven!  Why doesn’t an hour at work go that quickly?! The owner here is qualified in massage and reflexology. We even got Malcolm and Pete having treatments!

Fri 7th Nov Vocational Day

Today I have spent the morning with a fellow General Practitioner who works here in Pratt. I actually sat in with him during his morning clinic which was good. Training to be a GP out here is similar to that in the UK – after medical school they choose their speciality and this takes 3 years in hospital jobs going through various departments. Most GPs working in rural areas deliver babies and do Caesarian Sections and thus they spend about 8 months doing Obs and Gynae in hospital to gain the experience needed.  Again here in Pratt the GPs look after all their inpatients. If a lady is having surgery for example removal of a breast cancer - post operatively the GP will be the doctor that looks after her on the ward.

I asked about night calls and how frequently they expect to be disturbed out of hours. The GP I was with has a list size of approx 1000. He works with 3 other doctors and they cross cover each other’s on calls. He generally might only have one phone call at night. This makes me think that here – because generally people are paying for their health care (most have to pay an excess fee before their insurance covers the cost) they think twice before calling the doctor. Our out of hours calls with the NHS seem much more frequent. Is this because people are not directly paying for the service and thus call for more trivial things?

To study medicine here is expensive and a student can leave medical school with $500 000 debt. Occasionally the state will sponsor a student and cover these costs if they want to be a GP and guarantee to practice in that state on completion of their course.

It was a really interesting morning. Obviously medicine is medicine and thus the same drugs were used, the same common diagnoses made. The GPs make less referrals to specialist care than perhaps we would and I think this is because in a town with a population of 7000 there are not quite the facilities right on the door step. Although a lot of consultants do specialist clinics in Pratt – other services require travelling to Wichita (1 hr away). Also the GPs have access to advanced scans that we do not in primary care (eg MRI and CT).

In the afternoon I visited a local ‘Assisted Living’ (Residential care home) facility – again striking difference is the amount of personal space each resident has. I then was taken to the Hospice. Here in Pratt this is a 12 bedded unit. Current occupency of 5. The facilities were amazing. Each room has an adjoining room where a relative can sleep and a balcony so the bed can be wheeled outside. It differs from our hospices in the fact that people can stay up to 6 months and they try to get people in prior to the terminal phase of illness. It is all self funded by the individual / family. This hospice also caters for terminally ill children.

It has been a fascinating day sitting in, observing and watching the health care system at work here. Essentially I think medicine is the same wherever you go but how the care is provided is what differs. Is our NHS sustainable with an ageing population and forever increasingly expensive medications and technologies? Can America’s health system change from insurance based to provide a more equal system for all? I do not think this trip will answer these questions but sure is making me think about it!

(Also made the front page of the Pratt local newspaper – we are proper celebrities!!!!!)

Thurs 6th Nov

Today it was an early start to visit a rather large ranch – 43 000 acres to be precise!! That is approx 15 miles wide at it largest point! This is owned by a gentleman called Ted Turner (who also happens to own CNN news). He is the largest land owner in USA with over 2 million acres in total over various states. His ranch in Kansas is for buffalo and there are over 3000. We had a guided tour by the ranch managers. The scale of the whole operation really was quite uncomprehensible compared to what we have in the UK. The manager told us it would take 2 days to travel around the perimeter of the land!

Lunch was at a local pizza palour and the in the afternoon by hosts took me to Lemon Park – a lovely parkland with the town of Pratt. In the evening we did our presentation to the local Rotary club and also entertanied them with our ‘Great British Pub Quiz’ !

Wed 5th Nov

This morning I said a sad farewell to my hosts Norman and Gladys Bos and we headed to the Salt Mines just outside of Hutchinson. Here we got to travel 605 feet underground to have a tour of the mine, see how the salt is extracted and how it was discovered. 70% of the salt mined here is used for highways – a vast quantity gets taken up to areas such as Chicago. The empty space made available by the mined salt is apparently a superb storage area as it has a stable temperature and humidity. Housed down here are multiple boxes of documents from various organisations ranging from local businesses to government papers. They also store movies reels and costumes from Hollywood. We saw the original Batman costume that George Clooney wore and Superman!

For lunch we visited a restaurant owned by the local Armish community called Carriage Crossing. This restaurant has a reputation for its desserts – they do an amazing selection of pies (I am in heaven!) A small selection of the choice included: coconut, peanut butter, sour cream raisin, cherry cream, banana cream, snicker bar, lemon cream cheese, honey rhubarb, blueberry, Hershey Almond, Pecan, chocolate peanut butter cream - this list goes on….  We all had a different one and tasted each others – delicious!

In the afternoon we were driven to Pratt which took about an hour. On meeting with our host families we all went our separate ways. I am staying with Gary and Bette Skaggs who own Ace Hardware Store here in the town. After settling in I went for a little jog (had to make room for supper after all those pies!!!) Then it was off out for supper to Hayley’s hosts. Here we had a smashing gathering of all the team and host families. Our programme here in Pratt looks great – so it’s an early night for more adventures tomorrow!

Tuesday 4th Nov Election Day!

Firstly I just wanted to thank everyone for their blog comments which are all published on the bottom of this diary. I had moaned to Mum that I thought no one was reading this so I think she has phoned everyone we know in England and I certainly feel a popular young lady now!!!

Today has been a brilliant day for me vocationally wise. I have had a tour of two clinics here in Hutchinson. This is the first real place that I have been to in size and population that can be compared to Shrewsbury. The first clinic – ‘Hutchinson Clinic’ was built by the hospital.  It is thus next door. This is advantagous because if the facilities are good for doctors to do outpatient clinics etc near by where their ward patients are they are more likely to be attracted to work in this area.

This was a private clinic and to me it closely models what I would call a ‘Polyclinic’ which are trying to be introduced in the UK and are somewhat controversial. About 70 doctors worked in this clinic – renting it from the hospital. This covered specialities from family/general practice, gastroenterology, cardiology, respiratory, orthopaedic, urology, neurology, general surgery, paediatrics, oncology, O&G, an endoscopy unit, a ’same day unit’ and more. Essentially most specialities are covered. This is where all the outpatient clinics are done. The building also had its own cardiopulmonary suit for echos, ecg, lung function, spirometry etc, own radiology (CT, MRI, Xray, USS, nuclear medicine), physiotherapy,  haematology/biochemistry lab and phelbotomists.

Patients attending here have private health insurance or are covered by Medicare (over 65 yrs) or Medicaid (qualify for free health care – strict criteria e.g. disability). Generally speaking they would attend a family physician first (GP) and then if needed would be referred on to a specialist. However if a person wanted to see a specialist immediately they could just ring and make an appointment. Occasionally depending on their insurance package – they may have to see a GP first. All these doctors work out of this one clinic. Blood tests, Xray, Echos can all be done same day. Results within 24 hrs. MRI and CT scans would be done and reported within 5-7 days. A blood test can be done and results available in most cases within 30 mins (and none of these are urgent requests!) They also have 3 radiologists on site to intrepret all the investigations. The GP’s work a similar day to mine but see people in 15 mins slots, sometimes 30 mins. They work from 8.30am to 6pm, no home visits. The system is all computerised. The doctor dictates notes and they are typed up that day.

Having all these facilities under one roof certainly makes it an efficient service. I was most impressed with the lack of waiting times.

I then visited PrairieStar Health Cetre and was shown around by Sally Tesluk. This is a health centre for those with no health insurance, no means of paying and do not qualify for Medicare or Medicaid. They get a grant from the government to help with funding  but this does not cover all the costs. The doctors work for a considerably lower salary than those in the privately funded centres and some speciality consultants occasionally  may do voluntary sessions there. The building was again built by the hospital because it is advantagous to have this clinic as their services stop people attending the Emergency Room where the hospital are duty bound to provide care. The doctors here are all GPs and have a difficult job because they have no speciality opinion at their finger tips because it can not be paid for. Thus the doctors do what they can for patients but can be limited. The patients for example could not get a cardiology or orthopaedic opinion as the patient can not pay for it. Essential tests like chest xray or blood test is covered in the servies provided by the clinic. However a person with diabetes for example would not get regular eye screening or foot checks as there are no facilites for this. Once a month an optomitrist voluntarily comes to screen eyes.  The clinic helps patients obtain drugs more cheaply too. It was all a really interesting insight to how those on the ‘breadline’ obtain health care or not as the case may be.

I could waffle on about this is for ages but I’ll now move on to the election and bore you with medical information when I get home! After lunch we went to the polling stations with some of our hosts. There were no queues at this time for day but apparently people had been queueing first thing. You could vote either on paper or electonically. All paper votes where then scanned into a computor and thus counted automatically. People seem fairly resigned to Obama winning. In the evening we went to the County Hall were all the votes were being collated and verified and we were allowed to watch this process. I then went to a Republican gathering. As well as voting for President this state was also voting for Senate, Congress and multiple county positions (it all got a little confusing!) The people present were relatively somber and we did not stay to the end – but I have to say there was no rejoicing in the streets here like in some of the TV footage I have seen in the cities on the east coast.

I feel remarkably lucky to be here during this election day as it feels a little like history in the making. I shall be sad to leave Hutchinson as I have greatly enjoyed my stay and have had wonderful hosts who I shall greatly miss (thank you Norman and Gladys Bos). 

Monday 3rd Nov Hutchinson

My hosts here in Hutchinson (population 45000) are a lovely couple called Gladys and Norman Bos. He is a retired orthopaedic surgeon so as you can imagine there is a lot of medical chit chat! Today has been an interesting day. It started with a vocational morning at the hospital – a large regional medical centre.  This has approx 190 beds and generally is at full occupancy except for a few beds they keep available for patients coming from rural areas. They have essentially all the major specialities except neonatology and neurosurgery. The hospital managers try to attract all the surrounding rural general practitioners to send patients to them – even from as far away as Ulyssess (a good 5-6 hr drive). They do this by going out to visit the GP’s – essentially advertising their hospital and the facilities. A hospital with good facilities will attract the patients hence making it more lucrative.  The hospital pays it nurses, radiograhers, porters, admin staff etc but does not pay the doctors. Their salaries depend on how many patients they see and operations carried out etc - paid by the insurance companies. To attract high quality physicians means good facilities are required and I can certainly say good facilities are available here. The hospital is the biggest employer in this city (1400 people). 

One striking difference to the UK to note here is that as they are not a teaching hospital – over night there are no doctors on site ( except for the Emergency Room team) at all. If a patient deteriorates then the consultant will be called in to deal with it. For example – there may be a team of 4 respiratory doctors who will cross cover – so one doctor works 3 nights then has several nights off etc whilst another one covers – but therefore it is the consultants who are going in to review patients during the nights/weekends where as in the UK it would be the junior doctors covering this and only calling the Consultant if unsure how to manage a patient.

After a lunch time presentation at the Rotary Club of Hutchinson we were taken to the Comosphere. This is the most amazing museum. It has one of the largest collections in the world of Space travel artifacts and we got to see and touch real astronaut suits, items from the Apollo missions and much much more. It was truely a brillant place to visit. I have to admit I had not really appreciated previously how the development of the rocket and the science behind it had helped with designing missles used during the war. The museum also gave a good history of the Cold War and the race for space supremacy between the former USSR and USA. Did you know that it was a Dr Goddard that developed the initial plans for lanching a rock into space – I wonder if he was a relative??!!

This evening we have spent time with our host families and as it is Norman’s birthday tomorrow we have had a celebration meal tonight. My hosts are so well travelled that I have been hearing all sorts of fascintating tales of thier trips!

Tomorrow is election day – so should be exciting and a real experience to be here! I wonder what the outcomewill be?!

Saturday1st – Sunday 2nd Nov

Rotary District Conference, Broadview Hotel, Wichita

This weekendhas been the district conference for the Rotary District we are staying in.  On the Saturday morning we took part in the flag ceremony andthen later in the morning entertained the delegates withour ‘Great British Pub Quiz’. It was out of 27 with rounds including geography of the British Isles, the Royal Family, British music (inluding Cliff Richard and the Elgar!), current affairs and history. We gave prizes to the top 6 and I think the highest score was 21. 

After a relaxing afternoon here in Wichita walking by the river (a lovely city, population 385000) – we were taken to an area of the city called Cowtownto see a real cowboy band called the W D Ranglers. They were superb and we all bought CDs. The Rotariansfrom Newton all got us Sheriff Badges to wear, so that coupled with our cowgirl hats and boots – we looked like locals!

Today(Sunday) we have had a relaxing morning and then this afternoon we give our presentation, following by the evening banquet. Hutchison Club are picking us up tonight and we head off to stay with them for more adventures!

Friday 31st Oct (Halloween night!)

Today has ben a day of travelling – we left Boise City early this morning to begin the 6 hr drive to Wichita. On route we passed through Greensburgh which was a town totally destroyed by a tornado 2 years ago. To see the scale of the destruction is just awful. Generally people get about 5 mins warning prior to a tornado striking – it is therefore amazing that only 6 people (I think) were killed. There were nearly no buildings left standing at the time. Reconstruction has begun now though and a new water tower is in place thanks to the effort by Rotary.

On arrival in Wichita (which now seems like a huge city!) we checked into our hotel for the District Conference.  Our evening was spent at Steve Wood’s house where we got to sample first hand how Halloween is celebrated here.  It is huge!!! His wife – Kitchel – had got over 700 lolly pops for the children who would called in the evening trick or treating. We took a tour to a near by street where all the houses are decorated and I am not exaggerating when I say that it was like walking down a themed street at Disney Land – it was amazing. The effort people had gone to to decorate their houses was unbelievable and the amount of children out was vast. They have a rule here that no teenagers are allowed out trick or treating – which aims to keep the whole event more save.

Thursday 30th Oct

Another fun day and with the sun shining and blue sky – what more could we ask for. We had my host Terri and Helen showing us around. First stop – Texas! Had to say I’d been! Then on to Autograph rock. This is an area on the Santa Fe trail where the travellers inscribed their names into the rock at one of the resting places near a water source. There were names dating back well into the 1800s. We had a chat with the gentleman who owned the ranch in which Autograph Rock is situated (he owns 15000 acres!)

We then drove onto Black Mesa – an area in Oklahoma that extends 200 miles into New Mexico. This is essentially a lava field from a volcano in New Mexico. It looks like a flat headed mountain that just extends for miles and miles. It is a real landmark on the landscape here as everywhere else is so flat and you can really imagine the Indians attacking the travellers on the Santa Fe trail.

Lunch was at the Black Mesa Bed & Breakfast – a most delicious stew and for pudding – green tomato pie! This seemed to taste like a mix between gooseberry and apple. A big thank you to our host Vicky.

In the afternoon we explored further in this area and reached the border with New Mexico and Colorado (further two states to add to my day!) Got some great photos. We also visited some fossilized trees and some real dinosaur tracks – thought to be from a Tyrannosaurus Rex.

It has been a smashing day – a big thank you to our hosts Terri andHelen for spending their time driving us around all day.

This evening it was homemade hamburgers on the bbqshared with so many people from Boise City – including the Judge, Chief of Boise City Police, a State Trooper and Assistant District Attorney for Cimarron County. This all makes us feel so important!!

Wednesday 29th Oct

Today has been a lovely day. We started with the most amazing breakfast – ‘biscuits’ (which look like scones but more cake like) and the BEST cinnamon rolls ever – just out of the oven! What could improve a start to the day than that! In the morning we have visited the County court and actually got to sit in during 3 court hearings and watch firsthand how the legal system works over here. No wigs or gowns for the Judge or Barristers.

It was then a tour around the local Beef Jerky factory – we saw how this was made and got to taste some. It essentially is strips of beef which are marinated and then dried. People eat it as a snack.

Our lunch was at the local Rotary club – they have 18 members so our smallest club yet but such a pleasure to visit. Everyone in this town knows each other and is so friendly.

After a visit to my host’s Pharmacy shop (run in a very similar fashion to ours) I got to tour the hospital. Here in Boise City (population 1600) there is one full time doctor and guess his age……….. 87 yrs old! I am not joking! Dr Wheeler is an infamous character out here and a truly remarkable man. He is assisted by a PA (our equivalent of a nurse practitioner) and a part time GP 2 days a week. The hospital has 25 beds (never at capacity). Presently only 2 inpatients. There are no nursing home facilities in this town so occasionally they get respite patients. The inpatients and emergency room are all looked after by the GP – ie Dr Wheeler, but staffed 24hrs by nurses. The rural nature of this area means there is no surgery done here, no deliveries, can Xray and ultrasound but no CT, no mammography, no MRI. They do have their own lab to do blood tests etc. Essentially speaking people have to travel for more extensive medical tests and procedures. All very interesting to see. I am interested that so far I have not come across any midwives here in the States – all babies are delivered by doctors. I wonder if this is because of the high litigation rates here. People therefore however to travel a long way for maternity care.

Following this tour we visited a local museum jam packed full of artifacts from Boise City and the county area (Cinnamon County). Very interesting.

A lovely evening was spent at Terri and Jim Weaver’s house (our host) who cooked a super meal for all us team members and the hosts.

Tuesday 28th Oct

So my diary now needs updating with news from Ulysses. On Sunday afternoon my host John took me for a tour around the care home facilities for the town. They have a similar set up to us with the equivalent of warden controlled housing, residential care homes (which they call assisted living) and then nursing homes. In this town they are currently in the middle of building a brand new nursing home. I got taken on a tour of the assisted living home which was amazing. In comparison to our residential homes each resident had their own bedroom, bathroom and living area/kitchenette. Then there were the usual communal rooms for dining, lounge area etc. In the UK in residential homes – generally speaking – the residents only get a bedroom as their own personal space. The building of the new nursing home looks mighty impressive. There will be 4 wings or ‘neighbourhoods’ each with 15 rooms on. One of these will be a dementia unit.

Following this we went to the historical museum and learnt about the Indians and how they lived, the Santa Fe trail and life through the years in Ulysses. Our evening was spent at Margaret’s house (GSEteam member who came over to the UK last month). Here we had a gorgeous bbq, more S’mores and met Jerry Traylor – a gentleman who ran across the USA from coast to coast on crutches. A lovely evening chatting, relaxing and meeting more of the Ulysses Rotarians.

On Monday Larry (our day host) had a jammed packed schedule for us! We visited a grain elevator (this is were all farmers out here either sell or store their crops post harvesting). As you can imagine these elevators (store houses) are just huge because of the size of the farming land out here. Apart from the chilly chilly wind – this was really interesting. Following this we visited a PVC pipe manufacturing plant and the current nursing home before stopping for lunch in the Senior Centre. This is like a community hall where the elderly can come for meals once or twice a day as often as they like. We each gave a little presentation on ourselves and enjoyed a question and answer session.

The afternoon was again jam packed with a visit to the Colombian Carbon black chemical company, BP natural gas extraction plant (built out here because this part of Kansas lies on a natural gas field) andthe Santa Fe dairy. This too was a huge operation with over 6000 cows. As there are no grassy fields out here (land too dry) they are kept in large sheds essentially and it was amazing to see how much their feed is controlled to yield the most amount of milk.

I was then wisked away from the group by my host Judy andtaken to the hospital. We were shown around by the Chief Executive. Essentially a 25 bed unit, very very unusual to be at full capacity. Usually average at 9 beds taken a day. It has an emergency room with an average of 8 patients attending a day. This is staffed 24 hrs by nurses but it is the GPs who are called to see each patient. There are 4-5 GPs here in the town and they do an on call system to cover the Emergency Room. Any admissions that the GP wants for his patient are then cared for by that GP in the hospital. GPs out here will do all deliveries (no midwives), they would do emergency Caesarian Section operations, put their own plaster casts on simple fractures etc. Essentially therefore they use their practical skills much more than we do in the UK. Anything like a heart attack would be stabilised by the GP here and then flown to Wichita or Garden City. The hospital does have an operating theatre and a surgeon comes down three times a week. Other specialists maydo out reach clinics once/twice a month. It was all very interesting. Also to note – all hospital signs in English and Spanish due to the large Hispanic population here (apparently almost 70%).

In the evening we met at the Rotary club and gave our presentation. John and Judy then took me to ‘Sonic’ -an all American drive in where you order your food or drink from the car park and they bring it to you in the car. I had a yummy icecream (thank you!)

Today(Tuesday) we visited a elementary school (ages 6-11yrs). We were shown around by the pupils (5th grade – age 10-11 yrs) and it was great to see and question them about their education. There are class sizes of 20, no more than 25. Each grade has 3 parallel classes. Obviously they learn the main subjects english, maths (or math out here!) but also economics, social studies (which includes history and geography), computing (they are all taught how to touch type), PE (2 half hour sessions a week). Great facilities at the school – very much high technology (smart boards, interactive learning etc.) School daysimilar lengthto ours with after school clubs if parents want.

Following this we visited The Academy which has older students who for some reason may have dropped out of High School and finally a tour of the Senior School.

For lunch we drove to a town called Hugoton where we met our next host from Boise City – Terri Weaver. She drove us all to Boise City in Oklahoma which took about an hour. She bought her trailer too (good job as we are accumulating vast amounts of luggage!!!).

A big thank you to John and Judy for having me to stay and Larry for organising our days.

Terri is hosting myself, Delia and Pete. This pm we have had a chance to catch breath, email and relax. My cup of afternoon tea was delicious!!! The programme here in Boise City looks fantastic. After a relaxing afternoon I am again now ready to crack on!!!!!

Sunday 26th Oct

Well now – I have a lot of updating to do! I shall start with Friday evening and our meal at Elmer’s and Charlotte’s. We had a lovely chicken pasta bake and then pecan pie (I have the receipyto try mum – it was yummy!). After dinner we had a really interesting conversation with all the host families talking about values andsociety today. What I found most informative was that although as a nation we have different healthcare systems, different social security systems etc – we have the same problems with generations of people wanting to claim benefits and being work shy – expectations that the state/country will provide for them, they are “owed it” andsimilar issues with regard to intergration of immigrants.

After supper Charlotte played the piano (she is a very talented lady) and we all sang songs including Frank Sinatra’s ‘My way’. It was a lovely end to an evening.

On Saturday we were taken to GoodwellCollege – the Oklahoma Panhandle State University which specialists in agriculture (a presume a little like our Harper Adams College). Size approx 600 students, with great facilities. To us everything looked new but Elmer told us he considered some of the building old! It was their ‘Homing Coming’ day which is an annual event where by they celebrate the sports teams and parents etc come to view the college. A little like an Open Dayhere. It starts with a Home Coming Parade andwe were lucky enough to take part in this with our own pick up truck as one of the vehicles labelled ‘GSE TEam’. We all sat outside in the back and waved as we went through the town. Other vehicles threw sweets to children (like at our carnivals).

In the afternoon the American football team were playing another uni team and we got to watch from the President’s Box. It was great – I have to admit to still not fully understanding the rules!! If I was a coach my main addition to training would be practising throwing and catching as there seemed to be a lot of ‘incomplete passes”!!!! I think my understadning of the game has a little to be desired! You can have anywere between 35-70 people in a sqaud and upto7-8 coaches – how they coordinate all that many people – I do not know! I believe there are pictures of us with some team members and the cheer leaders in the photo gallery.

After this we were whisked away for horse riding. Again different over here – they hold the reigns much looser and different saddles which you sit back in. In the UK we ride sitting much taller and straighter. Apparently this difference arose because over here there use the horses much more as working horses on the ranches.

Today we have travelled to Ulysses – back into Kansas. We have passed many farms on route and I must just comment of the farming. Obviously one of the main differences is the scale of it all out here – vast. You can’t see hedgerows – just miles and miles of corn/wheat etc. Crops are planted in circles due to their irrigation system. They have sprinklers which may extend for half a mile long and then these rotate around in a circular fashion so can cover a field which would be one mile in diameter.

My new hosts are John and Judy Alig. We are all staying with different families here and are off this afternoon to begin our adventures in this town. Ulysses population is approx 7000 so this is the smallest town we have stayed in so far. It’ll be interesting to see what differences there are.

Friday 24th Oct

This morning I decided to try and shift some of those hamburgers I have eaten and went for a run. It was chilly here last night – down to freezing but this morning the clouds had gone and there was a lovely blue sky. Elmer made us waffles for breakfast (yummy!) and I must also just mention that I had my first ever pumpkin pie last night!

At noon we went to The Rotary Club of Guymon and had a lovely warm reception. After lunch we gave our presentation and had questions and answers session. I was then wisked away by Jim Grochoiski, the Chief Executive Officer of the Guymon Memorial Hospital. He tookthe time to show me around and it was fascinating to learn about the USA health care system and see their facilities. This is a small town of about 12000 people and they have their own CT scanner and MRI scanner etc. The hospital generally always has empty beds, obviously all single or double rooms. So so clean and well maintained. What really did shock me was how few doctors they have and thus these physicians generally cover 24 hours a day. The GP’s look after their patients in hospital and will consult for specialist opinion if needed. They have one internal medicine doctor who also covers ITU if needed, one general surgeon, one orthopaedic surgeon, two paediatricians etc. The doctors all cover their patients, there are no ‘junior doctors’ to do ward work. Also all notes are computorised andcan be accessed anywhere – even interstate. I asked re confidentiality issues regarding this as it is a large problem in the UK with regard to a generalised computer note system. Apparently it has not been considered a problem here at present.

Also I learnt about funding of their health care system and insurance. Gosh I could go on hours about the differences. Learning so much! I was even offered a job out here and it is a tempting offer! Jim (the CEO) reckons he could find me a husband too!!!

This evening Charlotte and Elmer are having us all (GSE team and their hosts) for super andtomorrow more excitement in store with taking part in a home coming parade at the local university in Goodwin and watching an American football game – can’t wait!

Thursday 23rd Oct

Today we have covered over 250 miles from Newton, Kansas to Guymon, Oklahoma. This involved three interesting stops – firstly a typical American ‘truck stop’ for a cup of coffee, then to the Wild West town of Dodge City for lunch and finally to Liberal which is the official home of The Wizard of Oz. We got a tour of the museum andhad photos taken with the Tin Man (my nephew Emil will be very jealous!) I have a photo of Hayley following the yellow brick road which will be added to our photo gallery when I can! A huge big thank you to Steve Johnson – President of Newton Rotary – who drove us all the way here!

The countryside has been very flat but I have been surprised by how wet it is – sitting water in some of the fields. It is very barren in places and I’ve come across tumble weed for the first time! Towns are very small and few and far between the main cities. Roads are very straight andit is very windy! (bitterly so today)

We are in Guymonnow- a smaller town than Newton with a population of approx 12000. Delia andI are staying with a lovely couple – Elmer and Charlotte Nossaman. Elmer has an amazing workshop that my father would be very jealous of and has made all the furniature and finishings to his house himself.

This evening we have had a lovely relaxing time, home cooking and a chance to catch up with journals.

Wednesday 22nd Oct

Last night we did our presentation to the Newton Rotary club. This was a much smaller affair than the Downtown club in Wichita – about 30/40 people. The meeting was very friendly andI was impressed with the quality of the singing of the Rotarians to start and end the meeting!

Today we have visited Eisenhower’s home town of Abilene approx 40 miles north of Newton. We visited a very interesting museum here telling us of his life, role in WWII and presidency.

This pm we visited the Department of Economic Development in Newton and a local county bank.

I have been lucky to stay with Frank Stucky whilst in Newton, he is in real estate and developing/building property. This pm we got to visit some of his new show homes andI have been totally struck with the size of house and property you can buy here compared to UK prices. I think I might sell up and come and live here!!!

All packed now for our move to Guymon – Oklahoma tomorrow. We are stopping off at The Wizard of Oz museum en route!!!

Tuesday 21st OctoberTuesday 21st October

What a jam packed day! This morning we visited Harvey County Court and had talks from various people involved in the criminal justice system here including information on domestic violence and interviewing children who are victims of abuse. It was also interesting to learn about the county’s equivalent to our social services support.

After a gorgeous Mexican lunch (note the multiple references to food in my blog!!!) we visited a relatively new Elderly Care Home which was amazing. Residents are called ‘Elders’ and the facilities andquality of the building was superb. We need more facilities like this in the UK. I have found our newer homes in the UK have more of a hospital feel about them – this one was small but much more like a home environment.

This pm we have visited the Agco factory in which makes tractors and combine harvestors, marketed as Agco, Massey Ferguson and Catepillar – it was HUGE. They make about 5 combines a day – including all the parts. The assembly line and factory buildings we immense. They didn’t trust us to drive a combine though!

Monday 20th October

Today was our first presentation and I have to say I was literally shaking in my shoes! I think it went ok- no horrific mistakes anyway!! This morning we visited Wichita Tourism Office and learnt more about the city and then this afternoon we have come up to Newton. Tonight will be our first experience on a ranch and hopefully we will get to wear our newly acquired cow boy hats!!! Photos to follow!

The food…… oh my goodness, I am in heaven!! This morning we had lemon drizzle cake and streaky bacon at Kitchel and Steve Wood’s house and they even had Earl Grey tea! What more could I ask for (thank you!!!!).

Sunday 19th October

Arrived safely – good flight but disappointed re lack of good films! Stayed at the Hilton for our first night and had a lovely meal with our hosts prior to an early night in order to try and get use to the time difference (we are 6 hrs behind UK time). So excited about all that is planned!

Off for brunch today at Steve Wood’s house (GSE Chair). Weather is lovely here – blue sky and sun!

Wednesday 15th oct

With three days to go before our big adventure I have encountered my first big challenge – how do I fit all my clothes into my tiny suitcase?! Each night after work I have been trying to reduce the amount of belongings I am taking with little success!

Getting very excited now – especially following contact with Mark Cassell in Wichita regarding the opportunities of visiting the hospitals and medical services in Kansas and Oklahoma.

I plan to keep this diary updated during the trip as often as I can so you can read about my activities and adventures!

Thursday 16th Oct

It’s a miracle….. all packed!