Last year my pals and I cycled in The Galilee, Northern Israel, to raise money for Nazareth Hospital Paediatric Department. We raised over £50,000 but we could use more! Nazareth is the largest Arab town in Israel; the people are lovely, and the kids are awesome. Nazareth also treats kids in the West Bank of Palestine who have very limited access to healthcare. They need your help! Go to my sponsorship page to find out more and see what you can do! Maybe even join us in 2017..?

11 February 2017

Solving Irish Unity, Scottish Independence & Staying in the EU in one fell swoop

One suggestion from Reddit... 

One nice thing about a total political clusterfeck in the Western World is that it forces us to think a little outside the box. Sure, if we had stability in Northern Ireland, continuation of our membership of the European Union, the far-right in a box and someone with half a brain in the White House in Washington, we might reasonably conclude that the applecart was just grand, and we'll just leave it as it is for now, thanks.

However, times have changed, and you don't need me to point out the woes our little planet faces at this stage. But here are a few facts that are worth pointing out.

  1. Most people in Northern Ireland voted to remain in the EU.
  2. Most people in England and Wales voted to leave the EU.
  3. Most people in Scotland voted to remain in the EU.
  4. Northern Ireland and Scotland stand to lose the most from leaving the EU; England and Wales will likely be fine, eventually, but are unlikely to want to pour treasury funds into NI & Scotland.
  5. A sizeable minority in Scotland voted to leave the UK in the IndyRef. A majority voted to stay.
  6. When Brexit occurs, Scotland will be outside the EU (obviously), and any future independent Scotland would have to negotiate re-accession terms that will probably be far more unfavourable than those it currently enjoys as an EU member as part of the UK.
  7. Although most people in NI want to remain in the UK, for the Unionists at least, the locus of that loyalty lies where many of their ancestors came from - i.e. Scotland. Irish Nationalists also have very strong connections with Scotland, and many also trace their ancestry there. And of course there is our shared "Celtic" culture.
  8. If Scotland's status within the UK were to change, it is inevitable that the attraction for NI of remaining in a Union with just England and Wales would take a massive hit.
  9. A sizeable minority in Northern Ireland want a United Ireland, with a split from UK.
  10. Northern Ireland has a history of violent conflict, and a lot of the benefits we have seen from EU membership and (relative) political stability could be undone if we don't sort out our cultural, economic and political relationships with our nearest neighbours - Scotland and the Irish Republic.
  11. The Republic of Ireland is still in the EU, and is almost certain to remain in the EU; although "Irexit" has been suggested, it has no hope of success (at least at the moment, but who knows).
  12. There are calls in NI for a referendum on a United Ireland (which is doomed to fail) as well as in Scotland for "IndyRef2" (which will probably fail too), but these calls tap into a degree of public feeling that deserves at least some recognition.

Those are a lot of points. Taking all of them together, it seems that we need to get creative and think of alternative solutions that might at least be worthy of consideration. I'm going to propose one here - I am not necessarily advocating it, but I think it deserves some serious scrutiny, given that everything else is up in the air. So here goes - I propose:

The Celtic Union of Scotland and Ireland (CUSI)

Now I'm not the first to suggest this - here's Dorcha Lee's suggestion in the Herald, and it's been touted several times before. The model I would suggest is that we maintain the regional parliaments in Dublin, Edinburgh and Belfast, and work towards a light-touch federal model within the EU. We would need to work on which issues would be devolved and which would be centralised, but in terms of overall powers, it is reasonable to suggest that as much as possible would be left regional.

  • Name of state: Celtic Union of Scotland & Ireland (CUSI)
  • Government: Federal Republic
  • Currency: Euro
  • Flag (do you really want to go there?): Amalgam of St Patrick & St Andrew saltires (although I think someone already has this - maybe something else).
  • Defence: a small army, navy and air force, up-skilled in international relief and peacekeeping - we'll not be needing the nukes.
  • Health: redesign around principles of NHS
  • Economy: aligned with EU best practice, focused on knowledge-based industries and what we already do best. Likely to require a fair bit of EU funding initially
  • Other stuff that I haven't thought of: sure we'll sort all that out. We're good at that.
So what are the advantages for Ireland? Well, we get that United Ireland that people seem to want (or at least some people seem to want), and it avoids all that confusion on the international stage with people not quite knowing what Ireland and Northern Ireland are. Although Ireland already has a significant voice in Europe, joining with another important country at the Atlantic fringe means more negotiating power. Plus bridge funding to set the whole thing up.

Advantages for Northern Ireland? We get to stay in the EU. We maintain (indeed hugely strengthen) our links with our important neighbours in Ireland and Scotland. The distinction between Unionist and Nationalist cultural elements becomes pretty much irrelevant, peace and prosperity break out, and we achieve Nirvana where everyone is happy (realistic? Nah). Major injection of EU funding to manage the transition. 

Advantages for Scotland? Fast-track reaccession to the EU on favourable terms. Strengthening of a link with a major trading partner (although the England-Scotland border is a disadvantage, as would be degradation of access to the English market. Would this be offset by greater access to Europe? Difficult to say).

One thing is for sure - CUSI would be very marketable internationally, particularly in US and Australasia, as a destination for tourism and investment. We would be strategically very important internationally, just given our location. We have a wealth of natural resources in both main islands and our waters. There are opportunities to position ourselves at the forefront of environmental management and renewable energy. We have skills and industries in IT and manufacturing with a surfeit of highly-performing universities.

There are lots of reasons why this could work, and maybe lots of reasons why it might not. So the question is this: is it worth even thinking about, and when/if we do have Scottish IndyRef2 and a referendum on the Irish border, should these be simultaneous, and should CUSI be offered as one of the options?

And at the very least, would it be any worse than the mess we are in right now, and where we're heading?

Comments welcome below!

01 January 2017

Canyons of Mars (lyrics)

Canyons of Mars

We work the red ground here, so far from the earth;
Forsaking the soil of the land of my birth.
"We can't bring you back," they said, leaving no doubt we were true pioneers.
In the dust and the boulders we're staking a plot,
But dreams pull my heart back to one pale blue dot
Lost in the cosmos, whispering echoes of triumph and tears.

But all we can do is step forwards each day,
Because entropy's journey is only one way
From the footprints they left in the Turkana clay,
Walking under the stars I can see from the canyons of Mars.

The next ship from Earth will bring four new recruits -
We'll fit them with visors and helmets and boots,
And we'll set them to work on reactors and rovers and solar arrays.
They'll join the endeavour and never return
To the places and people they loved, and they'll learn
To adjust to their destiny; factor it over the course of their days

But all our psychologists can't tell me yet
If it's best to remember or try to forget
How we stood there in Belfast when the sun had long set,
Gazing out at the stars I now see from the canyons of Mars.

Now Sarah and Ravi have just had their kid;
You followed the pregnancy - the whole of Earth did,
Through broadcast and podcast and media storm -
She's the first of her breed.
We're extending the habitat under the ground,
We'll fill it with air and with colour and sound;
And we'll love them and feed them and keep them all warm -
Is that all that they'll need?

Because her generation's the next link in a chain
Stretching out from a planet of forests and rain,
And the one point of reference that can help us explain
Is: we saw those same stars they can see from the canyons of Mars.

But the frail force of gravity won't hold them here
And they'll look to the heavens with no trace of fear.
And we'll watch them lift off, and then disappear,
As they carry our dreams to the stars from the canyons of Mars.

Canyons of Mars, (c) Shane McKee, 2012

17 December 2016

Photos from our Galilee bike ride

Here are some photos from our epic journey around The Galilee in Northern Israel. Enjoy, and feel free to add your comments.
Bikers gonna bike bike bike bike bike...
(PS. We had an amazing time and are well on our way to raising £50K for the Nazareth Hospital Paediatric Ward Appeal - thanks everyone!)

22 November 2016

Socratic debate, Union Theological College Belfast, 21 Nov 2016

Last night in Belfast we had a debate, as part of the CS Lewis Festival. Just the usual for this part of the world: "This house believes that God is about as real as Narnia". Proposing the motion were Jennifer Sturgeon and me; opposing us were Chris Hudson and David Capener. Our moderator was William Crawley. For the record, here is the text of my opening statement...

CS Lewis was a master story-teller. When he created the Narnia series, he told an engrossing story of interactions between a world somewhat similar to ours and the fantasy world of Narnia.

Many people have pointed out close parallels between the Narnia fantasies and Christianity, and indeed some go so far as to suggest that Lewis consciously created Narnia as a Christian allegory.

The character of Aslan the lion, who dies and resurrects, is a very close parallel to that other fantasy, the risen Christ. And not everyone is a fan of Narnia - there are elements that are pretty questionable on ethical and intellectual grounds. However, we all agree that Narnia, whatever its merits or demerits, reflects the outworking of a human mind, and is not something that “exists” in a real sense.

And that is OK. Because we humans are story telling creatures. We don’t understand things through lists of facts and figures - we use NARRATIVE. Even scientific theories (and the word theory is much misunderstood, especially by creationists, but that’s another narrative) are in essence *stories* that we use to pull the facts and figures and hypotheses together. We create as coherent a narrative as we can muster, and we try to communicate with that.

So if we use stories to help evolved human brains understand reality, what about the story of God? I maintain that we do know enough about the world to answer that question. God is about as real as Narnia.

Now in saying that I am saying two very specific things:
  1. God in general, whether we are talking about the “God of Classical Theism” or a more localised form of god with intentions, emotions, desires etc, is a human construct that does NOT comport with whatever is really out there, and
  2. The Christian story of Jesus Christ as the Son of God is a story that is not “true” in the deep and meaningful sense that many Christians make it out to be. The same applies of course to other religions based on supernatural beings, but since Northern Ireland seems overly fond of Christianity, perhaps we’ll focus there for now.

I’m also making an ancillary point - the notion that the stories in the bible are the Word of God and point unerringly towards a correct understanding of the divine is manifestly NOT TRUE.

The Bible contains many wonderful stories that incorporate errors, contradictions, propaganda, fiction, embellishments, lies, truths, fabrications, fairy tales, history and pseudo-history. The bible is a human product, but whereas Narnia had a single author, the bible - and the religious fantasies woven around it - had many.

I was a believer in the truth of the Christian God story until I was in my 20s. Then I went to spend some time studying in a hospital in Nazareth, Jesus’s home town. I came across people who were Jewish, Muslim, Christian and Druze – all people with different stories about God. But they all experienced the same joys, pains, worries, hopes. Maybe my view was too narrow?

Indeed, maybe Jesus didn’t actually rise from the dead, and like Paul said in the first letter to the Corinthians, my faith was in vain. And when I studied the bible stories, the protestations of the apologists that the resurrection was historically well attested completely fell away. It was a fantasy too.

For example, the story in the Gospel of Matthew has dead people rising from their graves when Jesus is crucified. This is not reported ANYWHERE else in the bible, or by any ANY contemporary source. The author of Matthew (who was certainly not Matthew the disciple) made it up.

When Jesus rode into Jerusalem on a donkey on Palm Sunday, Matthew, who didn’t know Hebrew, misinterpreted a passage in the Old Testament, and fabricated an EXTRA donkey (the foal) in order to fix what he saw as an error in the gospel of Mark (also not written by an eye witness).

When Jesus allegedly rose from the dead we have separate yarns in the gospels and Acts that are completely at odds with each other, indicating that these were MADE UP. It’s now very clear to me that the stories of the risen Jesus are based on visions dreams, false memories and peer pressure, not actual appearances.

It’s an interesting experiment to get four bibles and read the gospels side by side, and I encourage you to do this. It’s like JRR Tolkien and Bertrand Russell were all having a hack at correcting CS Lewis’s mistakes in Narnia, while Arthur C Clarke was off writing something else.

We don’t have four eyewitness perspectives – we have four people telling stories about something they have never seen, except in their imaginations working on what they’ve been told.

The central story of Christianity is a fantasy. Jesus was just a man about whom stories were written, and we should take them with a BIG pinch of salt.

The omniscient omnipresent omnipotent omnibenevolent God that made the universe is likewise just a story. We don’t know exactly how the universe began. We don’t know the fabric of reality. But we do know that surprises are in store, and EVERY time we’ve thought that God has intervened in the history of our universe, we’ve been wrong. The God of classical theism is a philosophical toy God, and frankly we don’t need it - science has given us BETTER stories.

I sometimes identify as a Christian Atheist. Many aspects of the Christian story still appeal to me, because I love stories too. They have helped form my outlook on the world and life.

But we are the product of the laws of physics working in a universe that also produces supernovae, black holes, ice fountains on Enceladus, nitrogen oceans on Pluto, coral atolls on Earth and joy and pain for human beings.

It’s a marvellous Universe, but it doesn’t really care about whether or not we’re here. But WE care, and we invented the gods and God to give us a central place in the cosmos. God is a mirror, not a window.

God is a story, in exactly the same way as the Shire or Hogwarts or Narnia, and it’s a story that gets BETTER – and WE get better - when we realise that it is fantasy.

20 November 2016

Mission Accomplished!

I have been remiss in updating you on my Israel biking adventure - we rolled in to Nazareth on Friday 11 November 2016 after five (well, six) days of incredible biking. A journey together that brought us from the shores of the Mediterranean up to the Upper Galilee, down to the Jordan Valley and the Sea of Galilee and finally to Nazareth itself.

As a group of old friends and new, we explored the terrain, meeting local people and viewing the splendours of the countryside. We passed through villages populated by Jews, Christians, Muslims and Druze, as well as barren hills, verdant valleys, agricultural fields and scented forests.

But the purpose of our journey was its final destination - the crazy paradoxical town of Nazareth, home to the largest Christian population in Israel, and the location of its oldest continually functioning hospital - the Scottish Hospital, established under the EMMS (Edinburgh Medical Missionary Society) in 1861 by the remarkable Dr Pacradooni Kaloost Vartan.

The whole rationale for the bike ride was to raise money for refurbishment of the Paediatric Surgical Unit. We still need to hear how much we actually raised, BUT if you want to give more, you still can! My fundraising page is at http://justgiving.com/shanenaz2016 and  remains open. When we arrived at the hospital we were given a tour of the current facilities (closed while the refurbishment gets kicked off), and I can certainly give my approval to the new plans. I think it will make a big difference to the kids coming in for surgical treatment.

But all of this got me to thinking - why should we in the UK be supporting a hospital in Israel? Surely the Israeli government should be working harder on its own healthcare policies, and properly resourcing its hospitals and clinics? The answer to this one is both complex and simple. The complex answer is that Israeli healthcare planning and funding is a bit of a mess, and healthcare organisations have to sort it out themselves while seeking reimbursement from the national insurer. Capital development is really under pressure.

The simpler answer is that in building better healthcare, and especially in building links between countries and healthcare economies, we not only show that we are citizens of the world (sorry, Theresa May, but that's what we are), but that we want to build links and collaborations with people who are often neglected or disadvantaged. And for those who aren't neglected nor disadvantaged, we still want to work with them, because life is not a zero sum game. My gain is not necessarily someone else's loss. A problem in another country is not something I can just turn up my nose at. It's an opportunity to build links of friendship and healthcare. And healthcare in particular is an effective way of building peace and understanding.

Here, in a small hospital in Israel, there's a part of Scotland (and OK for these purposes I'm going to self-designate as an Ulster Scot!) - a place that's all about looking outwards and bringing people together.

24 October 2016

Nazareth Hospital Paediatrics Ward Appeal 2016

I've been meaning to set out some details of the 2016 Appeal for the Nazareth EMMS Hospital. This appeal is to refurbish and rebuild the Paediatrics Department in Nazareth - an absolutely vital service for the people of the Galilee region. The following information has been supplied by the Nazareth Trust. Don't forget to donate at http://justgiving.com/shanenaz2016 and make sure you spread the word on Facebook and Twitter!


The total population in Nazareth is 74,620. In the past, the majority of the population in Nazareth was Christian, but today the majority is Muslim. Over the years life expectancy has increased which has led to an increase in chronic diseases.


The Nazareth Hospital is licensed and accredited by the Israeli Ministry of Health. It follows and abides by all the regulations and standards of the Ministry of Health. The Nazareth Hospital does not receive regular government subsidies for capital investment in buildings, equipment, and other major improvements. Neither do we have foreign donors who regularly contribute large amounts to our efforts. When it comes to capital development and purchase of equipment, Nazareth Hospital relies totally on gifts and grants from friends around the world.

In October 2011, the Nazareth/EMMS Hospital officially took on the role of a teaching hospital and opened its doors for the first group of medical students from the Galilee Faculty of Medicine affiliated with Bar Ilan University. Seven of the Nazareth Hospital EMMS departments are recognised for the school’s residency programme.

The Paediatrics Service in Nazareth

The Nazareth Hospital provides health services to a catchment area of 264,000 in the North. Over 40% of the target population is under 18 years of age.

The paediatrics department at the Nazareth Hospital was established over 40 years ago by a missionary doctor who recognized the importance of developing and expanding services for children, including community-based health outreach to raise the awareness of mothers regarding child health.

Today the Nazareth hospital runs a very dynamic pediatrics department and a Neonatology department. With 18 hospital beds, a very dedicated team and despite the very limited space, the pediatrics department houses multiple services including general pediatrics, surgery, orthopedics, urology and plastic surgery and often times gynecology services for children.

It is also important to mention that the Nazareth hospital provides unique services in the region including treatment of burn patients and is the only hospital in the region that is certified by the Ministry of Health to treat and provide vaccinations for children who suffer from allergies that could compromise their condition when they are vaccinated for childhood diseases and require special attention and treatment.

The paediatrics staff applies the hospital’s biopsychosocial model, considering every aspect of the children and youth who come to them for care. The social worker and other multidisciplinary teams are available to intervene when needed.

Today, in spite of the department’s crowded physical conditions, patients and their families still prefer to come to the Nazareth Hospital because of the positive and supportive environment provided.

The Nazareth Hospital has the only psychiatry department in the area with Palestinian staff who speak Arabic, making it much easier for Arabic speaking patients to express themselves clearly to health professionals.

In cases where children require psychiatric consultation at the emergency room or paediatrics department they are provided with this service in their first language. In addition, children from the West Bank and Gaza are often referred for treatment to the Nazareth Hospital

The final beneficiaries of this project are the children and youth who will be better provided with immediate care. In 2015, 2,162 patients were admitted for hospitalization spending a total of 3,638 days in hospital. This is in addition to our out-patient and ER clincs.

Through this upgrade of the Pediatrics department, Nazareth Hospital will:
  • Be positioned for accreditation as a paediatric training program to support the hospital in its role as center for Family Medicine residency training. This outcome will be measured by the number of resident doctors in pediatrics, measured against baseline data.
  • Improve access to high-quality paediatric medicine. This will be measured by the number of children treated in the new facility, as counted against baseline values for that statistic.
  • Increase available square footage dedicated to the comfort of patients and their families and caregivers. The new department will have a place where children can do homework, play, and receive family visits with some privacy. This can be measured by square footage gained. Additional emotional and psychological comfort, although qualitative in nature, can be evaluated through patient feedback.
  • Increase the number of its staff with advanced technical skills and relevant professional expertise. This will be measured by tracking the number of staff trained in relevant paediatrics update courses as part of this project.


There is a fairly sizeable pricetag on the plans. The overall total to rebuild the entire Paediatric Unit will be in the region of $3.8M in the long term, which is a LOT, and assistance will be sought from elsewhere to help bring the plan forward. However everything you give will help, and you will know that you are helping the kids of Nazareth to move to a brighter future.

23 October 2016

Transformation powered by technology

On Tuesday the Northern Ireland Health Minister Michelle O'Neill will announce her response to the eagerly-anticipated Bengoa Review into the configuration of Health and Social Care Services in Northern Ireland. This will be a BIG DEAL for those of us working in the HSC, and a BIGGER DEAL for our patients (i.e. everybody).
Minister Michelle O'Neill [photo: BBC]

Before anyone counters that this is yet another review of the HSC and the other reviews haven't had any effect, it's worth injecting a little context. Back in 2014 the then Health Minister Edwin Poots asked Professor Sir Liam Donaldson to report on the state of the NI Health Service. That report was called "The Right Time, The Right Place", and pointed out a number of factors that make health and social care difficult in NI, others that make it excellent, and yet more that provide an opportunity to make it even better. I'm talking things up a little - there are major reasons why the status quo for the NI HSC is not sustainable, and transformation is critically important. Everyone knows this.

The Donaldson report made a number of significant recommendations, the first of which was the establishment of an international expert panel to review the Health Service and recommend a redesign that all political parties would be expected to sign up to in advance. I feel this was a pretty big ask, and therefore when a subsequent Health Minister, Simon Hamilton, took office, he reconfigured this recommendation into a combination of local, national and international experts, chaired by Prof Rafael Bengoa, to carry this recommendation forward. There was no political advance buy-in, but I don't think anyone finds that too surprising. This is Northern Ireland, but even if it hadn't been, politicians don't like signing up in advance to something they haven't had a chance to look at.

The important thing however is that the Bengoa Review exists as a direct consequence of the Donaldson Review, and it would be wrong to see it as "yet another report". I've previously blogged a little bit about this, but in advance of the report itself, it would be wrong to get too bogged down in hoped-for details.

That said, the word on everyone's lips is Transformation. We have to transform the HSC to achieve the so-called "Triple Aim" - better healthcare, better health, lower cost per capita. This means getting patients much more involved in their own care, changing how we deliver services, being much more open in how we share information and resources, centralising some services where appropriate, shifting expensive acute services to a small number of specialist sites, slashing clinical errors, reducing medication harm, taking a rigorous evidence-based approach to management, supporting much more care in community settings, etc.

There are a number of ways we will need to do this, but it seems very likely that the Minister will announce digital technology as a key feature. At least that is what I very much hope. We cannot truly transform our HSC by tinkering at the edges and redesigning a few forms and processes. We need to make sure all staff and patients are on the same page with regard to the data, that we are minimising risk due to miscommunication across care domains, that we are saving time and risk by not requesting and re-entering the same data multiple times into multiple disparate systems. We need our patients to be able to contact and communicate with us using video and audio calls. We need them to be able to access their own data and manage their own conditions insofar as that is appropriate.

This can't be done without the technology, but implementing that is a people process more than a tech process. The next few years are going to be challenging, but the clinical/professional community and our patients/clients are definitely up for it.