“Indeed,” George Washington wrote in his diary in 1785, “some kind of fly, or bug, had begun to eat the leaves before I left home.” But the father of America was not the father of bug. When Washington wrote that, Englishmen had been referring to insects as bugs for more than a century, and Americans had already created lightning-bug(萤火虫). But the English were soon to stop using the bugs in their language, leaving it to the Americans to call a bug a bug in the nineteenth and twentieth centuries.

    The American bug could also be a person, referring to someone who was crazy about a particular activity. Although fan became the usual term, sports fans used to be called racing bugs, baseball bugs, and the like.

    Or the bug could be a small machine or object, for example, a bug-shaped car. The bug could also be a burglar alarm, from which comes the expression to bug, that is, “to install (安装) an alarm”. Now it means a small piece of equipment that people use for listening secretly to others' conversation. Since the 1840s, to bug has long meant “to cheat”, and since the 1940s it has been annoying.

    We also know the bug as aflawin a computer program or other design. That meaning dates back to the time of Thomas Edison. In 1878 he explained bugs as “little problems and difficulties” that required months of study and labor to overcome in developing a successful product. In 1889 it was recorded that Edison “had been up the two previous nights discovering ‘a bug' in his invented record player.”

Noticeboard

    The summer I turned 16, my father gave me his car — a gift wasted on me at that age. The important thing was that Hannah and I could drive around.

    Hannah was my best friend, a year younger but much taller, almost five foot ten. "Hannah's a knockout, "my mother always said. And that summer she signed with a modeling agency. She was already doing runway work.

    A month after my birthday, Hannah and I went to the movies. On the way home, we stopped at the McDonald's drive-through, putting the fries on the seat between us to share. "Let's ride around a while, "I said. It was a clear night, full moon slung(悬挂)low over the desert. Taking a turning too fast, I plowed (撞)through a neighbor's wall and drove into a full-grown tree.

    We were taken in separate ambulances. I'd cracked(使裂开)my cheek bone; Hannah's forehead had split wide open. End of her modeling career. What would I say to her?

    When her mother, Sharon, came into my hospital room, I started to cry. She sat beside me and took my hand. "I rear-ended(追尾) my best friend when I was your age, "she said. "I totaled her car and mine."

    "I'm so sorry," I said.

    "You're both alive," she said." The rest is window dressing. I forgive you. Hannah will too."

    Sharon's forgiveness allowed Hannah and me to stay friends throughout high school and college, to be at each other's weddings … The scars are so faded no one else would notice, but in the sunlight I can still see it just below her hairline — for me, a mark of grace(优雅).

Unhealthy health care bills, long emergency-room waits and inability to find a primary care physician just scratch the surface of the problems that patients face daily.

Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and costs. The U.S. takes the opposite approach by emphasizing the specialists rather than the primary care physician.

A recent study analyzed the providers who treat Medicare Beneficiaries(老年医保受惠人). The startling finding was that the average Medicare patient saw a total of seven doctors — two primary care physicians and five specialists — in a given year. Contrary to popular belief, the more physicians taking care of you don't guarantee better care. Actually increasing breakup of care results in a corresponding rise in costs and medical errors.

How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed (返还费用). Moreover, the amount of a physician receives leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's disease. Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.

Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.

Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.

How do we fix this problem?

It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally managing their diseases and practicing evidence-based medicine. Make primary care more attractive food to medical students by forgiving students loans for those who choose primary care as a career and harmonizing the marked difference between specialist and primary care physician salaries.

We're at the point where primary care is needed more than ever. Within a few years, the first wave of 76 million Baby Boomers will become qualified for Medicare. Patients older than 85, who need chronic care most, will rise by 50% this decade.

Who will be there to treat  them？

SHARK CONSERVATION IN SOUTH AFRICA

Take a two-week trip that you will never forget as a volunteer with sharks on a beautiful stretch of South Africa's coastline. Head out to sea to witness one of the world's most powerful (and most misunderstood) creatures on this inspiring project, enjoying watching them from both above and below water.

The DAY-BY-DAY schedule

Day 1: Arrive in Cape Town on a Sunday. You will be collected from the airport and spend your first night in a guest house in the city centre.

Day 2: You will be collected bright and early from the guest house and taken down to the project. The drive takes about 90 minutes. You will receive a welcome and head out to sea to witness your first sharks!

Day 3: Most days you will be out on the boat with the sharks, depending on weather. Help out with the full range of tasks on the boats, and in conservation initiatives on land too.

Last day: On the final day of your project you will be taken back to Cape Town for your onward travel.

The price is £ 829, including the voluntary work programme with accommodations, airport transfers, one night in a guest house in Cape Town, breakfasts daily and lunches when on the boats. Your trip can be extended at a cost of £ 375 per week.

It is an amazing experience! Some volunteers planned to stay for 4 weeks, extended to 6 weeks and still didn't want to come home. If you'd like to chat about this holiday or need help, we're very happy to help.

Call us at 01273 823 700.

Email us at rosy@responsibletravel.com.