| Latest Update (so you know whether you've already read this one): December 18, 2004 |
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Aims: Visit centres within the three main non-UK software-producing countries, spending 3-4 days at each selected centre (dependant on size and travelling required between centres). I will interview (using a proforma to ensure comparability) and observe (to gain additional unstructured information) analyst/programmers at work: their influences, pressures, sources of projects, project methodology, software and hardware tools used. The intention is to do this within a culture that is more task-oriented and more goal-oriented than the UK in order to link outcome to input. In addition, I intend to promote, via a series of presentations, experience and skills present within the NHS to an audience outside of the UK, which will also give something to the hosting centres.
In choosing the three countries to visit, I had in mind not just those that were major players in software authoring, but also those that I felt I could gain contacts in (I found a contact route for India about three weeks before departure but it was too late to add it in).
My original plan was to spend 2-4 days at each centre and then move on. The Churchill Trust dissuaded me of this idea, recommending that a week was the minimum to spend in each place. So I began looking for seven appropriate centres to visit.
My German contact was an ex-pat Medical Physicist I had been in touch with when I had considered emigrating to Heidelberg (beautiful city - didn't get the job). I figured that he would know the Medical Physics field in Germany and be able to put me in touch with the appropriate departments. I wrote to him just as he was preparing to return to the U.K. - dead end number one.
My American contacts were a colleague who has done a lot of work in the U.S.A. and some friends who currently work in a University there. One without a medical school. Dead End number two.
My Japanese contact was another colleague who I knew had undertaken a Churchill Fellowship himself, in Japan. He put me in touch with two of his contacts both of whom replied. Prof. Furukawa went the extra mile, however, organising almost my entire two weeks there.
Undaunted, I decided to make professional contacts and wrote to the chairmen of two professional organisations for Medical Physics in each of the three countries twinned with our own (the Institute of Physics and Engineering in Medicine). Two of these wrote back: an American requesting further details (which I duly sent and never heard from again) and a German, Prof. Wucherer, who suggested three of his colleagues. Two of these were happy to host me for a week each - one put me in touch with a colleague on the same campus who would also be happy so see me.
With Germany and Japan "sorted", I turned my attention to the Americans. And drew blank after blank. Of all the contacts my colleague supplied, only one responded favourably (most didn't respond at all). So I (or rather, Rachel, my wife) turned to the Internet for help. She found many likely and promising places: most of whom didn't write back. Those that did generally were either out of the country themselves during my planned visit time or weren't involved in appropriate work any longer. Finally I drew a friendly e-mail: from Dr. Tonellato, who was visiting Japan at that time and promised to get in touch again once he returned to the U.S.A.
One week left to plan... I had become very interested in Small World Theory by this time and was toying with the idea of visiting a university in New York State and then writing to Prof. Strogatz (one of the founders of the theory) to ask if I could drop in and see him, as I was in the neighbourhood, as it were. In the end, I decided to see if I could spend the whole week there instead: bulls eye (I should have thought of this sooner).
Now to flights and hotels... Flights were easy (thanks to David Scott): a round-the-world ticket, meaning that my journey would be one-way (causing a few jokes) and easier to plan. I decided to fly on Saturdays. Although this meant I'd be leaving places without a day to see any sights I'd been recommended, it did mean I had a day to recover from the longer flights. This all went wrong when it came to Seattle to Osaka as I was crossing the date line the wrong way. Consequently, I would be leaving on Saturday and arriving on Sunday, with no time to recover. I felt this was a bad idea so cut short my visit and flew on Friday (arriving Saturday).
Hotels were mostly done by recommendations from the hosting organisations and booked either by them or over the Internet. The only really difficult one was Ithaca, who had a parents' weekend beginning on the last night of my stay. Once I'd realised why everywhere was booked for the nights I wanted, I changed my search and moved hotel for the last night.
My ability with foreign languages is poor. At school I took the minimum allowed: three (it was a Grammar school): German, Latin & French. In my only year of German, I achieved 27% in the exam and was congratulated by the teacher for doing far better than he’d predicted. I soon dropped German & Latin and concentrated on science. Oh - and I got a grade 9 in my French ‘O’ level (I think that’s about an ‘F’ at GCSE). I’ve normally tried to get by with a few nouns, a lot of gesticulating and a "pardon, monsieur, je suis anglais" - which really confuses the Germans.
I promised myself faithfully that I wouldn’t be packing for seven weeks away at midnight on the night before I left. I kept that promise - it was 1am... I’d had two suitcases on the landing for a week (one for cabin baggage, one for hold) and it took me at least an hour to cut my stuff down to something approaching the weight limits.
At 6:20 (am!) I locked my house and leapt into a taxi taking me to the railway station. It still didn't seem real that I was not going to be unlocking that door again for 51 days. I arrived at Hull station to discover that my train (the 7am to London) had been cancelled. We were advised to catch the 6:40 to Sheffield and change at Doncaster. My plan had been to book a taxi for 6:30, thus allowing it to be 15 minutes late. It arrived at 6:20, thus meaning I was 30 minutes early for the train I meant to catch - but only 5 (once I'd bought a paper and heard the announcement) for the train I now had to catch. Praise the Lord (as we evangelicals tend to say at such times) for taxi drivers who can't sleep.
Back to the table of contents
I've moved the separate visits off to separate pages, as there's a lot of pictures...
Back at Manchester, I located the SAS desk (Scandinavia Airlines - I didn’t think I posed that much of a security risk) and the nice woman there (whose name I have completely forgotten) said she’d see what she could do (she found it & it turned up in Hull a couple of days later). I returned to the lobby and started ‘phoning Nigel Mills (who’d heard of Rachel’s hospitalisation and had offered to collect me instead - he’s been round the world (twice) so he must appreciate what it’s like to be met at airports. Either that or he’s a very nice man. Or both). I’d just found his name in my mobile when his voice said "Hello Mr. Ganney". I had just enough presence of mind to realise that I hadn’t dialled his number yet and turned round to see the man himself striding across the foyer. I was back in England.
But then they presented to me. A silver medallion, by the Duke of Kent, no less. Sadly, apart from a lifetime of wonderful memories, it is all over now.
David Scott at John Good Travel in Hull, for flights and sensible advice.
My referees: Syd Howey and Judith Whitehead, for telling others I could do it.
The Hull & East Yorkshire Hospitals NHS Trust, for letting me have the time to do it.
The Churchill Trust, especially Judith Barber, for helping me do things at short notice (and reminding me of things that had even shorter notice).
Ian Hutty at H&EY Hospitals’ IT for e-mail assistance.
All my contacts and hosting bodies - my overriding impression has been one of being on the receiving end of enormous generosity and friendship, all given to someone they only knew through a few e-mails.
Geoff Howlett and Nigel Mills, for sending me the football results and match reports.
My wife, Rachel, for encouraging me to do it, even when she didn't want me to.
Being surrounded by people who constantly apologise for their poor English is very humbling, especially given my ability with foreign languages. It’s very tempting to go and eat in places that advertise 'we speak English' or in familiar ones such as McDonald’s (someone told me recently of a friend who went to China & ate in McDonald’s all the time, which seemed a major crime at the time but is now very understandable). The only awkwardness would be: is it ‘die BigMac’ or ‘der BigMac’? I decided that if I was to get the most out of this tour, then I’d have to eat local as much as possible. I also decided to start each visit in German (in Germany - that would have confused the Americans too much) and see how far I could get before I was 'rumbled'. Hopefully, I’d get further each time. I still think that the time I spent with a menu and phrasebook trying to decide what to eat probably gave me away, though.
In Germany, it's odd to see so many people smoking and to see dogs in restaurants. It's also odd to see women attendants in the gents lavatories, not to say a little offputting the first time you see one.
Germany is also a lot less "animal rights" than Britain. Medics are open about animal experiments (although all I ever really saw were radiographs of dead mice) and markets have lovely soft scarves which are labelled "Echter Pelz" this isn’t a brand name - it translates as "real fur".
Germany also seems to have a larger expectation that the population are honest and trustworthy: bus passengers with travelcards just board the bus, without showing their cards: there are several doors and only one gives you the opportunity to pay for your journey (the one by the driver). A busy shopping centre I went through had piles of new chart CDs in the centre of an aisle. You browse and then try to find the stallholder in order to pay. However, it is unfair to extend this trust everywhere: the Hospital at Marburg has more locked areas than any other I’ve been in. If you’re with a member of staff who has a key, then you can get anywhere. If you’re not, you may have trouble retrieving your coat from the office you left it in.
America, though, is different. The Rough Guide describes America as "the thrill of the familiar". So much of American culture is well-known through music, film & TV that you wouldn’t expect a culture shock. There are a few things, though that make it apparent that this place is real and not just part of a set design, such as live lobsters in the supermarkets crawling around their tanks and "Hunting is permitted" signs in the woods.
America is also a very "car" society. It took me ages to find a postbox (sorry, mailbox) because I was looking for a large box with an opening on the pavement side, instead of the road side. Mind you, the cars normally yield to pedestrians. After Hull, this took some getting used to.
Perhaps the biggest shock is the one you should be expecting: the language. I was asked if I wanted some sprouts in my salami wrap. Once I’d ascertained that we weren’t talking Brussel Sprouts but something akin to cress, I was fine. Don’t expect your colloquialisms to be understood, either.
On the subject of food, don't expect high cuisine nor anything more indigenous than a burger. Quantity, not quality, is the American diet. Everything is fried, too. Even the salad. (Alright, I made that last bit up - but it certainly seems that way at times).
America is, as has often been noted, very service-oriented. I came across no surly shop assistants (loud ones, weird ones, but no surly ones). When browsing in a record shop (some habits die hard) and someone walks between you and the CDs you’re viewing, they always say "excuse me". Even the teenagers. The thing is, you don't realise it immediately: after all, there are nice people everywhere. It just takes a while before you realise that you could buy a Bay City Rollers CD in Tower Records and not be sneered at. Not that I tried it.
Japan is very westernised, which makes it tempting to think that you understand it - assuming you could understand the writing, that is. It's similar to Germany in that a lot of people smoke (about half the population, according to the Rough Guide) and animal experiments are even more openly discussed (I was even taken to see some goats that had artificial hearts implanted). It's similar to Holland (and, increasingly, the UK) in that cycles share the same paths as pedestrians. It's similar to Gameboy games in that eveything plays pretty tunes at you: pelican crossings and subway trains (it sure beats "beep beep beep", although I've never found myself humming "Mind the gap" for an hour after hearing it).
Japan thrives on service - and expects it. Consequently tipping is very rare, as is acknowledging waitresses, secretaries etc. It didn’t stop me saying “thank you” - some habits are too ingrained.
The Analyst/Programmer in Healthcare is involved in a variety of activities, from design and specification, through coding and on into implementation and maintenance. In all cases, however, one overriding principle has become clear: specialisation.
A successful Analyst/Programmer is specialised, be it in software technology (e.g. web databases), in medical specialty (e.g. Radiotherapy) or in hardware technology (e.g. CT imaging). New knowledge is normally acquired incrementally, by gradually expanding the bounds of the skill set. (However, a well-funded research project may short-cut this approach, mostly because it also provides funds and time for training).
The analyst/programmer has a responsibility to innovate.
The senior programmer should be a senior member of staff, normally a member of the board/management team.
Software engineering in healthcare will never be as financially rewarding as software engineering in industry or finance. The profession must seek to attract graduates by extolling the positives: principally, that the software you write will enhance (maybe even save) lives.
Due to the rarity of analyst/programmers in the NHS, the temptation to do everything and to learn every technique must be resisted. Knowledge that is broad but shallow will quickly find limitations: knowledge that is narrow but deep will survive better, if only by knowing when a project cannot be started because it is out of scope. An acquaintanceship with many medical and scientific disciplines is good, but only if it is in addition to expertise in one or two areas. Most people join the NHS because they wish to be of service (see the previous paragraph) and the temptation to say "Yes" to every project is high, especially if they sound very interesting. However, unless the project is backed up by the time and money to learn the new skills prior to attempting to employ them, incremental expansion of knowledge is to be preferred.
One of the most powerful things that the Department of Health could do, though, is to require registration of all those who write software within Heathcare for the use of others (there is naturally a great difference between the small program that someone writes to assist them in their practice (and consequently is subject to their experienced and critical usage) and software written to implement expertise away from the experts). The registration of professions is seen as a measure that protects patients against poor practice: software is so all-pervasive and can be so powerful, that the effects of poor practice can be far-reaching.
I've been to Germany so many times I thought I could "get by" in German. That was until I went off the tourist trail and needed to find my contact's department. The receptionist spoke no English. I found out how poor my German really is. I bought an English/Deutsche dictionary before I even thought about lunch.
Food is good, plentiful & relatively inexpensive. Eat local if you can, even if you’re not completely sure what it is that you’re ordering. In general, there is enough English spoken to get by (but see caveat in previous paragraph), but it’s far more polite to start a conversation in German and have them answer you in English (and they will, because you really are that obvious). It's far more satisfying, too.
Cash is easy to get hold of (provided you’ve a Visa or Mastercard, of course), but be warned that the majority of eating-houses don’t take plastic. Or if they do, they keep it very quiet. I planned to pay for most evening meals with a card - I soon drew out some extra cash instead.
In general, the Germans seem very happy with the Euro - although there is a feeling that prices rose at its introduction (I recall a similar feeling when Britain went decimal) especially in restaurants - some of whom were accused of just changing the DM sign to a Euro.
Pelican crossings are a little unusual - a green (walking) light doesn’t mean that there is no traffic coming your way, just that you have right of way. A flashing orange light indicates this. This is especially important to know if you’re driving.
Like Germany, a "Walk" sign (for a pedestrian) doesn’t necessarily mean you have the road to yourself.
Watch out for sales tax - it’s not included in the displayed prices and varies from State to State (it can be as low as 0%, apparently). But before you wince at the thought of 12% tax, remember that VAT is 17.5%. But at least it’s included in the displayed price.
Light switches work the other way: up is on.
Shoes: wear slip-ons or tie your laces loosely (not whilst shopping, unless you go to an upmarket restaurant).
Japan is very expensive for some things, incredibly cheap for other. Get used to the exchange rate before you spend £160 on a pair of ornate chopsticks (I kid you not - I had to do the calculation twice to make sure).
Make sure you know who David Beckham is and be prepared to speak appreciatively of him - even if you're a Liverpool fan. It was not unusual for conversations to go:
Them: Where are you from?
Me: England
Them: Ah - David Beckham.
I'm sure my stock rose when I explained that I'd actually seen him play three times.
Japan is very compact. They like to build up (8-floor shopping arcades are not unusual and little shop fronts often extend up, down & back for a fair distance) and down (there are several large shopping arcades underground). It is therefore unwise to estimate how long a window-shopping trip will take, based on land area. Like America, the first floor is on the ground. Also like America, there's a 5% sales tax to add on to most purchases.
Practice using chopsticks before you go - I was often complimented on how well I could use them, even though I don’t think I’m particularly good. I got the impression most westerners call immediately for a knife & fork.
I was often asked what I ate - after realising that this was a "do you have any religious taboos?/are you a vegetarian?" question, I found that a reply of "anything" was the most useful. There was also surprise expressed that I’d eaten rice before.
Sushi is not just raw fish - it’s actually the name of the rice cake that it’s embedded in or on, so sushi can also be vegetable. On the subject of food, it’s worth remembering that most foods in Japan come from one of three basic ingredients: rice, seafood and fresh fruit. So the caramel-looking sauce tastes slightly fishy, the slab of icing is sugared rice cake and the pineapple really is pineapple.
The people really are smaller, as evidenced by the size of tables and chairs (and shoes). They’re also able to sit cross-legged for a lot longer than I could.
Beware the green stuff that looks like Avocado - it’s horse radish!
Practice carrying your luggage up and down stairs (especially up). Airports generally (but not always) have escalators. Railway stations don't (but again, not always).
Have enough stuff in your hand luggage for one night’s stay (remember that your hotel will have certain stuff available so you don’t need it all), as your hold luggage will go AWOL at least once.
Remember customs allowances: you can carry £145 worth of stuff back into England, but you can only post £36 worth to one person.