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Monthly Archives: June 2014

Prescription for disaster

When I was handed this book by Candace Lafleur I wasn’t quite sure what to expect. We are so used to hearing the negative aspects of the NHS that as doctors we dread to hear let alone read comments from patients. But as I read this book I laughed and I cried but was moved by her gratitude to the NHS. As an NHS doctor I recognised so many of the scenarios and it is patients like Candace that inspire us, humble us and help us to cope with the sadness and despair it can sometimes bring.
Thank you, Candace for this ‘good read’

This is not a book about a disease itself, nor does it have any ‘woe is me’ or forced epiphanies on the meaning of life and health. It’s a book about sobbing student nurses wielding sharp needles, falling hospital elevators, having to be surgically removed from your own sweater for an X-ray and support group brawls. About getting my whole family pulled off into a cement bunker at British customs for being more radioactive than a truck full of Russian nails. It’s about sneaking nachos into the hospital at seven in the morning and making sweet, sweet love to the back of a parked taxi while having a stroke. This is a book about laughing and joyfully embracing the bizarre and the truly funny side of being ridiculously, incurably diseased. So sit back, take a hit of your oxygen tank and get ready to laugh at the funny side of falling apart. At the very least you’ll never look at a bed pan or an IV pole the same way again.

She writes as a patient suffering from a rare disease called Sarcoidosis (pronounced SAR-COY-DOE-SIS) is an inflammatory disease that can affect almost any organ in the body. This causes an increase in immunity. It causes a persons immune system to overreact when fighting an infection, (or imaginary infection). This then creates inflammation which then results in it damaging the persons own body tissue.

The classic feature of Sarcoidosis is the formation of Granulomas. These are microscopic clumps of inflammatory cells that group together. When too many of them form in a body organ they can interfere with how that organ functions on a day to day basis..
Little is known about who is susceptible to this disease and what causes it.
To read more about this condition refer to
http://www.sa-uk.org/What%20is%20Sarcoidosis.htm
or
http://www.stopsarcoidosis.org

Candace is part of an international forum which she highly recommends and finds it supportive, informative and can even share her humour with other people with Sarcoidosis. To join click on the following link
https://www.inspire.com/groups/stop-sarcoidosis/

 

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FLEDGLINGS ARE ALMOST READY TO FLEE THE NEST IN THE JUG

For the past 2 weeks everyday I have had a peep in the jug to watch the progress of these tiny creatures and from a distance observe the dutifully parents flying back and forth with food.


Even their ‘cheep,cheep’ sounds different!

 

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VENEZ DONNER VOTRE SANG!

When I arrived in Paris on Saturday after a slow miserable journey of several hours and standing for most of the journey due to widespread industrial action I saw modern rickshaw transport waiting outside the station marked with a sign saying “come, give your blood! I thought this was a French idea of a joke! The smiling student drivers were there to transport passing, customers to donate blood. Blood donation Unbeknown to me it was World Blood Donor day and every year, on 14 June, countries around the world celebrate World Blood Donor Day. The event serves to raise awareness of the need for safe blood and blood products and to thank voluntary unpaid blood donors for their life-saving gifts of blood. These rickshaws had been organised by the EFS( French Blood Service – Etablissement Français du Sang)

Transfusion of blood and blood products helps save millions of lives every year. It can help patients suffering from life-threatening conditions live longer and with higher quality of life, and supports complex medical and surgical procedures. It also has an essential, life-saving role in maternal and perinatal care.

However, in many countries, there is not an adequate supply of safe blood, and blood services face the challenge of making sufficient blood available, while also ensuring its quality and safety. An adequate supply can only be assured through regular donations by voluntary unpaid blood donors. WHO’s goal is for all countries to obtain all their blood supplies from voluntary unpaid donors by 2020. Today, in just 60 countries, national blood supplies are based on close to 100% voluntary unpaid blood donations, with 40 countries still dependent on family donors and even paid donors.

Blood donationThe focus of this year’s World Blood Donor Day campaign is “Safe blood for saving mothers”. Every day, about 800 women die from pregnancy or childbirth-related complications. Severe bleeding during delivery and after childbirth is a major cause of mortality, morbidity and long-term disability. Severe bleeding is the cause of 34% of maternal deaths in Africa, 31% in Asia and 21% in Latin America and the Caribbean. The goal of the campaign is to increase awareness about why timely access to safe blood and blood products is essential for all countries as part of a comprehensive approach to prevent maternal deaths.

How and where you can donate blood
Both my parents donated blood for many years- I grew up thinking that was what every parent did every few months on a Sunday afternoon!
Give bloodWe regular post details of blood donor sessions in surgery but you can find out your nearest centre by clicking into the following website and inserting your postcode. https://my.blood.co.uk

The next nearest centre to the surgery is
Ealing, Ealing Town Hall New Broadway, Ealing, London., W5 2BY Distance 0.79 mile
Next session in 2 days 16/06/2014
Choose date Mon 16th Jun, 2014 13:00-15:00 / 16:30-19:30
Available to walk in
Appointments can be made

Find places in many other countries:-

Other places in the World

For those readers in USA use the following website http://www.redcrossblood.org/make-donation-v6

EFSOù donner votre sang ?
http://m.dondusang.net/tablette/#
Other European countries – find your country
http://ec.europa.eu/health/blood_tissues_organs/blood/become_blood_donor/index_en.htm

To mark World Blood Donor Day 2014, thousands of volunteers have turned up at a centre in Colombo, Sri Lanka to donate blood in what is being claimed as South Asia’s largest blood drive.

Sri Lankans attach special importance to the act of blood donation. “Because most Sri Lankans follow Buddhism, blood donation is religiously and culturally accepted and very much a valued concept,” says Dr Namal Bandara, Senior Registrar of the National Blood Transfusion Service (NBTS).
Details on other countries and blood safety on the World Health Organisation website http://who.int/mediacentre/factsheets/fs279/en/

 
 

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FINDING PEACE WITH YOGA

This week my attention was drawn to an article on bbc.com about the increase of Yoga in Sierra Leone. I had been aware of this country with long, atrocious civil war between 1991 and 2002 and a country with one of the worst records of human rights this was not the place I thought this would be happening.
Yoga
I recalled years ago one of the patient’s, a Head-teacher coming into surgery having had a difficult Ofsted inspection – not an unusual when trying to manage a multicultural, challenging school in London. She certainly wasn’t the first and won’t be the last. I particularly remember her talking about a group of new children that had entered the school: they were children that had come from Sierra Leone and had been used as child soldiers. For her it finding a way to integrate them into the school was in itself a challenge as for these 8-9 year olds who had had no childhood all they knew was war and fighting. They had been deprived of a childhood and found it difficult to just play and have fun in a childlike way.
Despite peace the aftermath of this wretched war has left indelible scars and the World Health Organisation estimate that about one sixth of the almost 6 million population have mental disorders. Albeit, they only have one psychiatrist and care of these people is poor.

Tamba Fayia taking a yoga class

Tamba Fayia taking a yoga class

Tamba Fayia, once a child soldier in Sierra Leone’s civil war, who in 2012 became the country’s first qualified yoga teacher says yoga transformed his life. He set up Yoga Strength which focuses on taking yoga to the people that need it. “I work on the streets, in the slums, in the schools” says Mr Fayia. He has even held a class on a remote river island in the jungle.
He teaches at Sierra Leone’s only mental hospital in the east of Freetown, and therapists say the classes have led to clear psychological improvements in some patients. “It makes me feel light,” one patient said
He teaches at Sierra Leone’s only mental hospital in the east of Freetown, and therapists say the classes have led to clear psychological improvements in some patients. “It makes me feel light,” said one patient.
http://www.bbc.com/news/world-africa-27704543

 
 

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CAN YOU LIVE A NORMAL LIFE WITH DIABETES ?

imageWhen I first stated at 102 The Avenue I tested every single person’s urine for glucose and after 6 months I had picked up 19 new diabetics.

Those of you who have read one of my previous blogs may remember Sam, an 18yr old boy who came in nervously with his sister as he had been complaining of genital irritation which turned out to be thrush, which is a known presentation of diabetes especially in men.
https://102theavenue.wordpress.com/2013/08/13/how-to-prevent-or-delay-the-onset-of-diabetes/

He had no other symptoms but his urine contained glucose. When I told Sam he had diabetes his reply was, ” Am I going to die?” My reply was “I hope not as that means I am not a very good doctor. However, I suggest that you must not smoke and night’s out with the lads heavy drinking is not for you!” He replied,”Oh that’s good I don’t smoke and I am not fond of drinking I only drink an occasional lager”

I arranged for him to attend the diabetic clinic to be initiated on insulin as he was clearly a Type 1 diabetic.
Sam remains well still in the same job, although thinking of joining the fire service, married with 2 children, fit as a fiddle. Diabetes does not dominate his life, he has never been in hospital,continues taking insulin and sees his doctor every 6 months for regular check ups. That how the majority of diabetics live – they can have a lager or a bar of chocolate occasionally and can become organ donors and he will be assessed on his ability to be a firefighter and will not be turned down because he has diabetes.
Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.

Who typically gets Type 1 diabetes?
Type 1 diabetes accounts for about 10 per cent of all adults with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially y in childhood. It is the most common type of diabetes found in childhood. Type 1 diabetes can’t be prevented. The body’s immune system destroys the insulin-producing cells, and nobody quite understands why.
The vast majority of children with diabetes have Type 1 diabetes, but an increasing number are now developing Type 2 diabetes.

Notwithstanding, there are those for one reason or another develop complications but for the most part the majority of people like Sam lead a normal life.

 

Diabetes

The rest of those patients who I picked up with glucose in the urine were older.
I particularly remember Diane, who was a 55yr old teacher very overweight, and admitted she did very little exercise. She had come to surgery feeling tired and stressed but a routine urine showed glucose. I tried to suggest that she lost weight and even suggested Bariatric surgery but she was very negative, claiming she had tried every diet and didn’t have time for exercise. As time went by she was treated for hypertension and needed to have several types of diabetic medication and the diabetes was still not satisfactorily controlled and she was not only was her weight increasing but she was developing angina. Probably dreading hearing the same old advice – diet and exercise and the suggestion of insulin she started not turning up for her appointments. At the beginning or each year we audit our patients to review those that have not been checked and her name appeared and we then ask the receptionists or nurse to phone them to make an appointment. She did make an appointment and her blood tests showed her blood glucose was running very high. When I saw her she said that her job was now becoming so stressful that she was considering early retirement and that she was now prepared to have Bariatric surgery and look seriously at her health. I was thrilled it was worth waiting for that moment. She went on to have surgery and with the support of the multidisciplinary team of dietitian, psychologist and surgeon she became motivated to eat a healthier diet, exercise and gradually as the weeks went by she stopped one medication after another. She was transformed she looked more attractive, she was happier, free from both her diabetic and blood pressure medication and the angina settled. She was now retired and set to enjoy life outside London and as she came to say goodbye she said, “Why hadn’t I done this earlier?”
Diabetes
Who typically gets Type 2 diabetes?
Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required.
In Type 2 diabetes there is not enough insulin (or the insulin isn’t working properly), so the cells are only partially unlocked and glucose builds up in the blood.
In today’s press:-
More than one in three adults in England are on the cusp of developing type-2 diabetes, new research suggests.
If nothing is done to stop the trend, there will be a steep surge in this form of diabetes within the next few years, the authors of a report published in the British Medical Journal Open said.
People are classed as having borderline diabetes, also known as pre-diabetes, when they have blood glucose levels at the very high end of the ‘normal’ range. Those with the condition are at high risk of developing diabetes and its associated complications.
Their study found that in 2011, the number of people diagnosed with pre-diabetes tripled from 11.6 per cent in 2003 to 35.3 per cent.
We now regularly screen patients not just for urine glucose but for blood glucose in an attempt to prevent the onset of diabetes.

It is now reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone

As I reflected it made me realise the enormous strides that have been made in medicine since I have been qualified regarding diabetes, firstly being able to diagnose it so easily with a simple dipstick and more accurate blood tests to recognise pre-diabetes as well as having the proven knowledge that leading a healthy lifestyle can prevent the onset. However, sadly many people don’t take heed of this and don’t eat healthily and live a life of a couch potato running a great risk of developing Type 2 diabetes.

 

I remember my first job as a surgical house officer there were always some patients on the ward with chronic leg ulcers, and those who had poor lower limb circulation both as a result of diabetes and who were on the surgical ward and inevitably ended up having an amputation. Many of these patients also had poor eyesight due to cataracts or diabetic retinal damage, others had had heart attacks or strokes and it was a concern whether they would able to cope with anaesthetic and had to have the surgery with a spinal block. Most of these diabetics went on to develop kidney failure but were considered unsuitable candidates for renal dialysis because of there array of other complications. They had to have peritoneal dialysis – a cumbersome way of ridding the body of liquid waste. It involved pouring large volumes of fluid into the abdomen and then flushing the fluid out. When I was a GP visiting these patients, who were discharged home for it to be carried out by the District nurse on a regular basis, sometimes daily, I remember having to squeeze past these piled up boxes in the hallway. There prognosis was poor and they often developed severe infections or went into end-stage kidney failure and died at in there 50’s. Hence, it is not surprising that many people fear this condition and feel it will alter their life.
Diets at that time consisted of large amounts of fat and sugar: the day started with a greasy cooked breakfast, puddings were a must and afternoon tea was accompanied by a selection of home-made cakes. Although exercise was part of a daily routine the television began to limit how much people did and more people bought cars, public transport improved but everyone continued with the same diet.
Diet and exercise
In 2001 Diabetes Prevention Program (DPP),a large trial was carried which was scheduled to last 4years comparing a group of people who were supervised strictly to adhere to exercise and a healthy diet and a group who were not educated but the trial had to be abandoned after 3 years because it was so clear that a highly significant number were developing diabetes in the non-educated group and it was considered non-ethical not to educate everybody.
Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5-7 percent of their body weight.

It is reported that 80% of Type 2 diabetes can be prevented by diet and exercise alone

You can check your risk of developing diabetes by clicking on the link below:-
http://riskscore.diabetes.org.uk/type2risk/

It is possible to delay the onset of Type 2 diabetes by lifestyle intervention.
Before you develop symptoms:-
Diabetes

 
 

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Video

NEXT FAMILY OF JUG FLEDGLINGS GROWING FAST AT 9 DAYS OLD

These second clutch of birds rare growing fast -feathers just appearing. Hungry mouths wait their mother to arrive with food. A slight tap on the jug and they prepare themselves to be fed by there parents.

 

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I THOUGHT THE JUG WAS FREE BUT NEW ARRIVALS!!

I THOUGHT THE JUG WAS FREE BUT NEW ARRIVALS!!

 

COULD CAMELLIA BE YOUR CUP OF TEA?

It took me many years to appreciate the connection between Camellias and tea.

Tea

When my children were small an ideal afternoon trip was to the Isabella Plantation in Richmond Park. It also impressed my mother-in-law even if she considered me an irresponsible mother as three,explorative dear little children ran up the tiny streams in their Wellington boots, played hide and seek under bushes, climbed precariously on cut down trees and expended enough energy to be awarded with an ice-cream that I think grandma was more grateful for than them. Visits can be all the year around in fact as soon as the snowdrops appear, a welcome assurance that the brighter days of spring are on their way. Camellias, magnolias, as well as daffodils and bluebells are soon to follow.
Bluebells

From late April, the mind blowing beautiful display azaleas and rhododendrons storm into flower reaching their peak in May.
Azaleas
– See more at: http://www.royalparks.org.uk/parks/richmond-park/richmond-park-attractions/isabella-plantation#sthash.XSIa3H8A.dpuf

Strangely it was the dramatic colourful splendour of azaleas and rhododendrons that drew my attention to the Camellias as they heralded the onset of this display.
I was soon to learn that the first recorded camellia in this country was grown by Lord Petre at Thorndon Hall in Essex in the 1730s, and we know it was thriving and flowering by 1745.
The first named varieties to attract public interest were C. japonica ‘Alba Plena’ and ‘Variegata’, both of which were brought to England in 1792 on an East India Company ship.
Although many gardens planted Camellias it was probably not until the 1990’s that they were planted in Richmond Park.

Many years later I was fortunate enough to take a Medical trip to Kerala,South India not only to have lectures in Western Medicine but also Ayurvedic medicine (also called Ayurveda) which is one of the world’s oldest medical systems. It originated in India more than 3,000 years ago and remains one of the country’s traditional health care systems. Its concepts about health and disease promote the use of herbal compounds, special diets, and other unique health practices.
TeaDuring this trip I visited the TaTa tea plantation and the picture on the packet of PG tips came alive. These acres of plants were Camellia senensis Tearelated to those plants I had admired in The Isabella Plantation and the Asian lady on the packet represented a workforce of women who delicately plucked those tender leaves to be dried and fermented to make tea.
Tea
As doctors because they assumed we could be trusted not to touch the exposed machinery we were privileged to be shown around the factory. I certainly hope health and safety standards have now improved. During this visit I was made aware of the chemical contents of tea
which contains xanthine derivatives such as caffeine, theophylline, and theobromine, and the glutamide derivative theanine. These substances have well-known stimulant properties, and have also been reported to have beneficial effects on memory and on the immune system. Tea also contains many nutritional components, such as vitamin E, vitamin C, fluoride, and potassium.
This made me appreciate why tea breaks were introduced in factories in order to calm the workers with theanine at the same time stimulating them with caffeine. Tea is thought to differ from coffee in that coffee simply stimulates without the calming effect and it was found that workers drinking tea carried on for long rather than in a short, sharp spurt. It also made sense of something I have heard on countless occasions when breaking bad news or after a sad or significant event, “shall I make a cup of tea?”
Before soldiers departed on a mission they would often have “a mug of tea” no doubt to calm them before setting off.
Tea
In another context when I worked with miners who had chronic chest problems they often told me how they couldn’t get going in the morning before they had their first cup of tea ” I like it strong, doctor so that the spoon stands up in it!” What they were really saying was they wanted a good dose of theophylline ( a bronchodilator) to improve their breathing. Nowadays, there is appropriate medication in the form of inhalers but these were not available.

Caffeine has been the most popular medical subject for people to read about in 2014 especially with regards to anti-ageing.
Now, new research suggests that a dose of caffeine after a learning session may help to boost long-term memory. This is according to a study published in the journal Nature Neuroscience.
This is my introduction to the fascination subject of tea!

 
 

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DENGUE FEVER AND THE WORLD CUP

imageDengue is widespread in Brazil, which many travellers will visit this year for the football World Cup and in 2016 for the Olympic Games.Dengue fever

Dengue is a flavivirus infection transmitted by the bites of female mosquitoes, mainly of the species Aedes aegypti and Aedes albopictus, which are daytime biters. It is only the female mosquito that feeds off blood to provide protein for the eggs;the males feed off plant nectar.

Map dengue fever

From its origins in south-east Asia, it has spread to many parts of the tropical and sub-tropical world. Aedes mosqitoes are capable of breeding in small quantities of water, such as accumulated rainwater in oil drums and old tyres, as a consequence of which,
dengue often occurs in urban areas.

What are the main symptoms?

The incubation period is usually between two and five days, but may occasionally be longer. This is followed by fever, which may abate after a day or two, only to rise again. This is known as saddleback fever.

Common symptoms are severe arthralgia and myalgia, giving rise to the name breakbone fever, and headache.

Up to 50% of patients develop a maculopapular rash and there may be widespread lymphadenopathy. Recovery may be accompanied by prolonged fatigue and/or depression.

About 2% of patients may develop severe complications
of dengue such as haemorrhagic fever (DHF) or dengue shock
syndrome (DSS).
Warning signs for the rare dengue haemorrhagic fever include:
tiny bloods spots or large patches of blood under your skin, bleeding from the gums or nose, persistent vomiting and severe abdominal pain, vomiting blood or black, tarry stools. If you have any of these symptoms, you must seek immediate medical assistance.

Dengue fever

To establish if the rash is haemorrhagic use the glass or tumbler test as used in meningitis:-
Glass test

Can it be diagnosed by blood test?

Dengue fever can be diagnosed by isolating the virus in the blood during first five days. Also, on examining the blood there can be low white cell count and platelets and a raised alanine amino transferase (a liver enzyme) but this is not specific to Dengue Fever.
IgM antibodies may persist in the blood for two to three months
and a positive test may indicate recent or previous dengue
infection. If a traveller has had no previous exposure to dengue, a positive test is likely to be due to recent infection, but there is also cross-reactivity with other flaviviruses,

Is there a vaccine?
There is no vaccine

How can Dengue Fever be prevented?
It is a viral infection transmitted by mosquitos that bite in the day. It is important to wear clothing that covers as much of the skin as possible and use effective insect repellents such as diethyltoluamide (DEET) from dawn until dusk (in contrast to malaria prevention throughout the night from dusk until dawn)

How can it be treated?

There is no specific treatment for dengue. In most people symptoms can be managed by taking paracetamol (you should avoid aspirin, ibuprofen or other similar drugs), drinking plenty of fluids and resting.
Most people will recover within one to two weeks.

Before travelling it is advisable to attend a travel centre to obtain appropriate immunisations and advice.
Most immunisations can be given by our practise nurse or at one of the local travel clinics
http://www.globetrotterstravelclinics.com/
Travel advice for Brazil
http://www.mims.co.uk/TravelTables/882631/Brazil/

Having said this I had an amazing trip to Brazil several years ago to see my daughter who was studying there and absolutely loved Rio de Janeira, swimming on Copacabana beach, sky-diving on to the beach, dancing Salsa and even visited a Favela under escort. Then going on to explore the incredible Amazon river and Amazonian jungle and fortunately remained very well.
Rio

 

 
 

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MERS – Health Alert to those travelling to the Middle East and returning from theMiddle East

Middle East Respiratory Syndrome Coronavirus (MERS- CoV)
MERS
This week Saudi Arabia reported significantly more deaths from the MERS virus
About five weeks ago, Saudi Arabia was reporting 339 known cases of MERS-CoV, 102 of which had resulted in deaths.
This is out of 688 total cases in the Arab nation; 353 patients have recovered and 53 are still receiving treatment
Last week, the World Health Organization reported it was aware of 636 “laboratory-confirmed cases” of MERS infections, which had led to 193 deaths. It is not immediately clear how Saudi Arabia’s latest figures affect those numbers. There are documented cases of the virus around the world.

Doctors believe they have found the first evidence that a new deadly virus has been transmitted from a camel to people.

Camel

A study published in the New England Journal of Medicine has found “identical” Mers viruses in camels and their owner.
An analysis of viral samples taken from both the camels and the patient showed that “the full genome sequence from the two isolates was identical”, the report said.
It added: “These data suggest that this fatal case of human Middle East respiratory syndrome coronavirus infection was transmitted through close contact with an infected camel.”
“However, as with other studies recently published, the camels were sampled after the human patient was diagnosed, making direction of infection difficult to prove.

“To be definitive, camel herds will need to be prospectively followed and showed to be infected with Middle East respiratory syndrome coronavirus and infectious prior to a documented transmission event to a human.”

As a coronavirus, MERS is in the same group of illnesses as the common cold
But it is much more lethal: The U.S. Centers for Disease Control and Prevention notes that about 30% of those infected have died.
There is no vaccine or special treatment
Public Health England has released the following posters, which will be displayed at all airports and airlines.
MERS
image

 
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Posted by on June 5, 2014 in Training and Advice

 

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