Category Archives: healthcare

Physician Heal Thyself

Yet another doctor has committed suicide recently. The 3rd in the past year in the UK that I know about. There are probably more. It is so sad. On the face of it, many people might think what do doctors have to be so depressed about? The public still imagine that being a doctor comes with a good job, good income and the respect of the population in general. Those of us in the profession and our loved ones know better. For most doctors, the work is relentless. The NHS is no longer fit for purpose. There are too many patients with less resources to care for them. There is more and more paperwork borne out of the NHS having too many ‘managers’ who analyse medical errors and harm and feel that creating another form to fill in will prevent future incidents. They fail to realise that what is needed is more funding to employ enough staff for the numbers of patients we treat. They fail to realise that they need to invest in their staff and make them feel appreciated and valued for their hard work and for doing more than they are contracted to do. They need to examine the levels of sickness and absenteeism and realise that burnout is real and so is depression. Above all, they need to realise that without preventative measures, doctors will continue to work themselves until they simply can’t.

Although the UK rates highly in a lot of economic and living standards indices, being a rich developed 1st world nation, it doesn’t do so well with mental illness. The positive news is that the UK had made it into the top 20 of the world’s happiest countries in 2017 (it was previously 23rd and is now 19th) for the first time since 2012 when the world happiness report started being published annually.

In March 2017, the Mental Health Foundation commissioned a survey to look into prevalence of mental health in the UK and to identify the factors about individual that make them vulnerable to suffering from a mental illness. It found that 7 out of 10 women, those aged 18-34 and those living alone had a mental illness. Only 1 in 10 of the whole population are happy most of the time. Women are 3 times as likely as men to suffer a mental illness. Stress is a growing problem. Majority of people suffer from either a generalised anxiety disorder, depression or phobia. Self-harm and suicide are not classed as mental disorders but are a response to mental distress usually cause by mental illness that has not been recognised and treated.

With these statistics in mind, it is easy to see why young female doctors are at risk of mental illness. Couple that with the fact that medicine attracts people with a type A personality who are high achievers and do not like to admit they have a ‘weakness’ or that they need help. I have already described working conditions in today’s NHS. No wonder so many young female doctors are struggling and every year, we lose a few to suicide. What I find particularly difficult with this is that when colleagues pay tribute to those who have died, there is always a huge sense of shock. Unfortunately, these women hide their illness so well that often even their closest confidants have no idea how much despair they are in. Their friends often describe them as ‘superwoman’, someone who ‘has it all’, always helping others, taking on incredible amounts and managing to ‘juggle it all’ somehow. They give so much to others that they forget to give their selves.

Caring. Freedom. Generosity. Honesty. Health. Income. Good governance. These are the things that increase happiness and promote mental well-being according to the Mental Health Organisation. I would sum it up as friendship. I think human beings are social creatures (yes, even the introverts) and need to have at least one good nurturing relationship. This is intrinsically linked to self-worth. Many people who have attempted suicide and lived to tell their story say that depression and anxiety eroded their self-worth to such an extent that they felt useless and that the world would be better without them in it. Depression interferes with rational ordered thinking. When it is severe, it is like being in a deep dark hole, full of doubts and lacking in any hope. Far from being selfish, I believe people who contemplate suicide are (in their warped thinking) being selfless and believe in that moment that they are un-burdening those around them.

So is there anything we can do to turn the tide? Most experts agree that by the time a person has planned to commit suicide, it is probably too late to do anything. The depression has taken over and has them fully in its grasp. Where we can make a difference is at a much earlier stage. We need to prevent people with low mood going on to develop depression. We need to be that friend who validates their self-worth. The one who lets them know in words and action that their presence is very much appreciated in your life. We need to talk about mental health more so that someone at the early stages of depression feels able to confide in someone and seek help. If mental illness is so prevalent, why do we not talk about it more? Why are we ashamed to say, ‘I am depressed, I need time off work to get treatment/rest to get better’? Would any of us feel ashamed to call in sick at work if we developed appendicitis, had to have surgery and needed a few days to recover? Just because mental illness is invisible doesn’t make it less valid. I think this ultimately is what will turn the tide. Talking about it, admitting we have a problem and asking for help early, taking time out now to prevent getting to the point where all hope is lost and we feel like we have no other option other than suicide.

If you are reading this post and can identify with the desperation that mental illness can induce, please reach out to somebody. Ask for help and support. If you are in the UK, there are some very good resources. Your GP should be your first port of call. If you are feeling suicidal, call the Samaritans on the free phone 116 123. Mind has help pages online that can be accessed at https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/helping-yourself-now/#.WX8lFojyvIU as does Turn2Me at https://turn2me.org/?gclid=EAIaIQobChMIvKCtr8Sz1QIVT5PtCh2D7QnCEAAYAiAAEgKyyPD_BwE. The Mental Health Foundation has some great guides for promoting mental wellbeing which can be accessed on https://www.mentalhealth.org.uk/your-mental-health . The app Headspace comes very well recommended for dealing with stress, anxiety and depression.

If you are a medic, there is a wonderful Facebook group called Tea & Empathy for peer support for all those working in healthcare. It was founded after we lost another one of our young doctor colleagues a couple of years ago and is a brilliant space full of supportive caring people. The Wales Deanery has published a booklet specifically aimed at helping medics cope with the stress of the job. You can access it here: https://www.walesdeanery.org/sites/default/files/bakers_dozen_toolkit.pdf.

Finally, I want to say to you all: You matter. You are loved. You are not alone. Be kind to yourself x

 

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Baby Now What?

I wrote about the day I gave birth (blog entry called Childbirth) and described the physical process. Harder to put into words is the emotional process that day and the next few days as my baby and I started on our journey together. I’ll start at the beginning. When I woke up bleeding that day, I knew Savannah (that’s my baby’s name) would soon be here. I was scared. That labour would be painful, more painful than anything I had ever been through. I was scared that when it came to it, I wouldn’t be able to physically push her out and might end up needing a caesarean section. I was scared that Savannah might run into trouble and have complications. I was scared that I was going to be a mother and I didn’t know if I’d be any good at it. The main feeling that morning was fear and anticipation. I could not wait for the scary bits to be over, to hold my baby in my arms, to be a mother.

I had a scan printout from 28 weeks of pregnancy which captured her face. The shape of her face was clearly outlined and you could make out where her eyes and mouth were. I must have built up an image of Savannah in my head although when I thought about it consciously in the days leading up to her birth, I couldn’t quite see a clear picture. It was a bit of a shock when she finally popped out and the midwife bundled her into my arms. I looked at her and I couldn’t quite compute what she looked like. Not like my subconscious imagined because every time I looked away and back, I felt a dart of surprise that this was Savannah. The face I was looking at was the face belonging to the baby who was moving about inside of me just a few hours earlier. She looked like her dad and she had lots of curly hair.

I handed her back to her dad as I delivered the placenta and was examined for tears (thankfully none!) and given a little clean. When she came back to me, she was rooting about so I got into position and stuck her to my still-normal-feeling breast. Lo and behold, she opened her mouth and started to suckle. That almost blew my mind. It was the reality check I needed. My brain was starting to connect the dots. I had a baby. For real. Trying to get milk out of my boobies.

So, did I fall madly in love at first sight as people often describe it? Not quite. Naturally I loved her but it wasn’t a sudden flood of emotion. Perhaps it was the exhaustion of the day but it was all a little muted. I was dirty, exhausted and hungry. At my midwife’s suggestion, I mustered up all the energy I had left and shuffled to the bathroom, half hanging onto my husband as my mother held her granddaughter. As I stood under the hot shower (which annoyingly kept stopping whenever I stood still), I started to feel less drained. When I was washed, and dressed and smelling of the lovely shower gel I’d used, I had tea and toast (inhaled it more accurately) then I sat half asleep on the comfy armchair and watched my mama hold Savannah.

3 hours after her birth, the wheelchair was brought in to transfer me up to the ward where I was to spend the night. I sat in it and was handed Savannah. This was when I felt an almost overwhelming feeling of protectiveness. She felt so small, so fragile as I held her close. I pressed my face into the side of her face and felt the warmth seeping into my soul. Up on the ward, my husband and mother settled me in and said goodnight. With the curtains pulled around my bed, it was the first time I was alone with Savannah. As she lay in the cot, I lay down and closed my eyes, my hand resting on her cot. I found it difficult to sleep. Every fibre of my being was attuned to her and I was listening for the tiniest sounds from her. I didn’t sleep much that night (or any night for the next few months). When we were discharged, I sat in the backseat next to her and watched her carefully as her dad drove us home. This watching continued for the next few days until I got used to her face.

So, in the first few days, I felt warmth, protectiveness, love and fear. The falling in love bit came later. The first time I felt that exciting, blood surging, butterflies in the stomach love for her was weeks later when she started smiling socially. Every time she smiles, I feel a surge of in-loveness that makes my knees a little weak. When she smiles deep into my eyes, especially first thing in the morning, I fall in love all over again. She looks at me the way my mother looks at me. With an unconditional deep love that is incredibly humbling. When she reaches out her chubby fingers to touch my face or grabs me when I go past her highchair, I fall more in love. When she laughs with pure unadulterated joy as I tickle her or throw her up in the air, it’s love like no other. Now many months in, as Savannah learns to express herself and her personality is starting to take shape, I feel love for her like I never imagined I would love. I thought the love I had for my mother was unmatchable but it is. It is the same yet so different. Every day, I fall more in love with this innocent, beautiful child. Every day, I feel her essence seep into my very core and wrap itself around all that I am. I know that this love is the forever kind. The I’d take a bullet for her kind. The I am all in and so vulnerable to be hurt kind. The best kind of love. I am in love with her. Totally, madly, deeply.

Childbirth

I did it! Au naturel thanks you very much! I was so worried that my android pelvis would not be able to naturally deliver a baby, especially a baby who wasn’t small. Of course, had I been incapable of pushing the baby out, a caesarean section would have been okay by me but I really wanted to do it the ‘normal way’ so that I could get on with bonding with my baby and be back on my feet as soon as I could. The day before I had the baby, I had a scheduled scan to make sure the baby’s growth was on track. Everything looked great and her estimated weight was not a small baby. Worse, looking at the growth charts, if she carried on growing at the rate she was, she would be a large baby by the time I got to 40 weeks. I said prayers and I spoke to the bump for the rest of the day, urging her to come on out as soon as she could. Anytime now. I was 38 weeks pregnant. I felt huge and ungainly. I was getting breathless with minimal exertion. I wasn’t sleeping well. Mentally, I was geared up for labour. I had completed my antenatal classes and I knew what to expect including the ‘ring of fire’. I just wanted to have my baby in my arms. That night, just before midnight, I had the strongest craving for an ice lolly. Of course, there was none at home so I roused my hubby and we went to the nearest 24 hour shop.

I woke up in the wee hours of her birthday, bleeding lightly. I had lower back ache that had been there for days but otherwise I felt fine. Baby was moving about as usual. I called the delivery suite and was asked to come in. I had to tell the hubby a few times to get a move on, get ready and drive me to the hospital. I think he was completely unprepared for me to have the baby that day. My mother on the other hand only needed telling once. She was dressed and downstairs. The waiting hospital bag was placed in the boot and off we went.

In Triage, the baby was monitored and she was absolutely fine. I was examined and my cervix was 3cm dilated and thin – the official landmark marking the start of active labour. I got a room and settled in. 3 hours later, my cervix remained at 3cm and the obstetricians were twitchy because of the bleeding so I was induced and then placed on a drip to help the labour along. As the drip was cranked up, the contractions intensified. At first, I was comfortable enough sitting up in bed, doing controlled breathing. 2 hours in, I started to walk about and that helped too. Another examination and I was 6cm dilated. Progress. Another hour and I needed the gas and air. I think it helped but to be honest, the light-headedness was all I could process. I kept feeling like I would fall so I had to stand by my bed and hold onto the headrest. I ended up kneeling on the bed, grabbing the headrest for balance. As a side note to those of you who are going to have babies after reading this, the pain of my contractions was 10x worse whenever I lay on my back to be examined. My advice is, being upright either standing if you can or kneeling on the bed. It honestly made a huge difference in the experience of pain.

5 hours after the drip was started, the pain changed from a rhythmic contracting vice-like pressure to a feeling I can’t describe. I felt an uncontrollable restlessness come over me, like I needed to ‘do something’ other than just breath and bear the pain. This was the urge to push. I told my midwife who tried to keep my mind off the feeling as she was expecting it to be another hour before I was fully dilated. I could keep still and I said again, I think I am going to start pushing. She examined me this time and in a surprised voice, she said ‘You are ready to start pushing.’

My first few pushes were ineffective. I felt like I was pushing but I was directing my energy wrong. When I finally bore down and pushed into my bottom, praise came from my midwife. She wanted more of the same. With my husband’s arm to hold onto, I remained kneeling and I pushed with everything I had with every crushing contraction I got. About 15 minutes in, I suddenly thought ‘what if I can’t do this despite my best efforts?’ I watched the midwife examine me and asked if I was making progress. She was all smiles. ‘Oh yes’ she said. ‘ Do you want to feel the head? It is full of hair!’ I declined to release my hold on my hubby. I was still woozy from the gas and air but I was given a new lease of life by that news. ‘Ok baby,’ I whispered to the bump. ‘We can do this.’ I was sweaty and dizzy but I was also very excited. It was nearly over. I pushed and pushed until every muscle in my body was trembling from the effort.

Then came the ‘ring of fire’. This is the bit where the head comes out and your pelvis is at maximal stretch plus your perineum (the skin) is stretched to tearing point. It feels like you are on fire down there. Luckily though, this is when you don’t have to push any more. You just ‘pant. Breath, breath.’ The fire subsided somewhat as the head came out then it felt like everything paused for long moments then more stretching (baby rotates, shoulders born, one at a time). Then a hug gush as the rest of the baby and fluid pops out. She cried as she hit the mattress and I felt the biggest lift. All the worry and stress was gone. We had come through labour. The relief was a little premature. The placenta came a few minutes later. Then the midwife had to examine my insides and perineum for tears. Now that hurt. Like I was being stabbed by a thousand sharp knives. Despite the gas and air the midwife made me have before. Good Lord! I was prepared up to the point. That pain is the only pain I remember with clarity today. The contractions, the pushing, the ring of fire have all faded away mentally but I am scarred by the post-delivery inspection.

As I stood on shaky legs in the shower under a warm spray, watching the blood wash away, I could not believe that I was now a mother. This morning, I had a large bump. Now, I had a jelly-like bump and a baby to hold. Back in bed, I drank tea and ate buttered toast. Never had a simple breakfast tasted so delicious as I stared at the bundle my mother held. ‘This,’ I thought to myself in amazement, ‘Is the first day of the rest of my life.’

Here We Go Again

lilywhite

The past few month has seen a lot of talk about racism in the media. Particularly in relation to the Oscars. With it, a lot of eye rolling and people saying they are fed up of black people going on about discrimination and playing the race card. What about the Muslims, the gays, the transgender, the browns, the women, the poor? It is a constant source of irritation and sadness for me when these discussions kick off and people start shouting at each other. My first issue is no one wants to listen. This is why racism and the many other forms of discrimination continue to thrive in our societies. Societies that are ashamed to admit a lack of progress and would rather hide what they consider dirty laundry out of view. As if out of sight is really out of mind. Well, it is humanity’s shame and face it we must. Because if we don’t face it then we won’t ever fix it.

On the Oscar issue: yes, it is inherently racist. Why? Because up until recently, majority (94% according to many internet sources) of those who are eligible to nominate and vote for the winners are white and ¾ of those are men. Human nature, and this is evidence-based, is such that if a selection of talented actors/actresses/directors is presented to a person, the voter will look for common traits to identify with the nominees. The easiest trait to identify: skin colour, gender and other physical attributes. So stands to reason that if 94% are white, they are more likely to nominate and vote for white people. There was a blog by a young black woman who works in the entertainment industry published on mumsnet. The reaction was one that had my gnashing my teeth. Many (white, brown and black) suggested that it was not the correct forum for such a discussion. I was dismayed. If mothers are not the people who need to be educated about the ills of discrimination and who need to be encouraged to socialise their children into seeing beyond colour, then who exactly is going to be the catalyst for change?

mother and child

I cannot for the life of me see which other group yields more influence when it comes to such a fundamental change. As a soon to be mother, I see it as absolutely my job to teach my child to see the inner qualities of every person they interact with and judge them based on their actions and words and not the things over which they have no control over.

queue jump

In Nigeria, there is blatant racism still. The fairer your skin is, the more socially desirable you are in many circles. The more foreign your English accent, the more educated you are perceived to be. Being resident in Europe or America or Asia elevates your self-worth. Doesn’t matter if you do the most menial of jobs abroad or have very little education over there. I was born in Nigeria, left as a teenager and I have now officially spent more of my life outside of Nigeria then in it. I see the discrimination clearly. Sure I am a highly educated and successful professional but most of the strangers I interact with don’t know this. To many it is all superficial. I get asked my opinion on things that are well outside my area of expertise and even when I am confessing to having little knowledge, my opinion carries weight. I get better customer service because of the way I speak. I get less abuse from those who like to abuse their positions of power – the police, road safety, customs and immigration officers. When I go into shops run by foreigners, I watch how they treat ordinary Nigerians with barely disguised rudeness or contempt and how those Nigerians do not complain about it. I speak up sometimes to the surprise of those Nigerians and I get told I am ‘feisty or fiery or outspoken’ with amusement or admiration depending on the age of the Nigerian I am defending. I have been in situations where a non-black person has walked into the place, seen the queue of Nigerians waiting to be served and decided that their time was more valuable that the locals and cut to the front. I wait to see if the officials say anything, rarely will they ask for the person to do the right thing. If nothing is said, I am never afraid to tell the person that there is a queue and we were all in it.

The other manifestation is through skin bleaching. It is so prevalent in Nigeria and indeed many other societies. People, mostly women, spend a lot of money on creams and lotions containing dangerous toxins which ‘whiten’ their skin. Some of the more expensive products do a good job and give them fairer skin that looks natural and healthy. Most do not. It is so ugly to see the patchwork that results from some of these products. You see women prancing around with their face and neck a Caucasian skin tone, their arms brown and their joints black as nature intended. It is so unnatural that it sometimes looks like a comedic caricature. Sadly, for those who do it, they look in the mirror and think they look more beautiful. Heart breaking to me because some of the most superficially beautiful people on the planet are all shades of brown and black. There is nothing more beautiful to me than flawless golden or deeper brown skin. I see photos every day and wonder how those who bleach are unable to see the beauty in brown skin. Of course this is all about superficial beauty. Maybe that is where we fail. We are too preoccupied by the outer image and fail to see the beauty within. I truly believe that for a person to be truly beautiful, their soul, their heart and their mind must have a positive nature. That is why I find beauty in the eyes – a person whose eyes glow with love, happiness, kindness and warmth is a person I naturally gravitate towards.  That is why there is nothing more beautiful to me than a baby (human or other mammals). That luminosity that is unspoilt by life and its many hardships, that bright light.

name spelling

Here in England, racism is everywhere. I have a surname that has 3 syllables. Pronounced exactly as it is written yet many won’t even attempt to pronounce my surname. If I can get my head around Siobhan actually being pronounced as shee-von and Yvonne pronounced as Ee-von, then I do not see how it can be hard to say a name as easy as Ab-dal-lah or Jo-da or Di-ya. Working as a doctor on the wards, I have had patients say to me with surprise ‘you speak good English’ and I turn around and say to them ‘why wouldn’t I? English is one of 3 languages I was brought up speaking’. I overhear staff talking to non-native English speakers (those with foreign accents or limited English) very loudly, as if the issue is with hearing loss. I hear comments about those non-indigenous Brits being ungrateful for asking for what is routinely offered to their white British fellow patients. I see the relief in black and Asian patients when I say that I will be their doctor and I will look after them. I empathise with them even as I feel sad that I make them feel better not because of my medical skills but because of the colour of my skin and how they perceive that I can relate to them better or will treat them with more dignity.

I will never forget the first time I was racially discriminated against. I was in my 3rd year of medical school on my first hospital placement in an inner city English hospital working with a medical team. On the first on-call I did with them (on-call means being responsible for the new patients coming in off the streets as emergencies), I was seeing patients who were then reviewed by the qualified doctors. Of course, there is a triage system so medical students never saw patients who needed urgent care for things like an on-going  stroke, heart attack or acute asthma that needed immediate treatment before information gathering. Anyway, I was allocated an elderly Asian gentleman to see. I walked into the cubicle and introduced myself, clearly explaining that I would see the patient then get one of the doctors on my team to review. The patient did not protest but his 2 sons were affronted. They, in their high-powered suits, did not think it was appropriate for their father to be seen by me. They wanted someone else. I got my registrar and told him what they had said. He, being Asian like them, was angrier than I was. He marched me back to the patient and his family, informed them that I was part of the team and as this was the NHS, they would be seen by the first available medic. Their choice was me or going private. How awkward for me and the patient! They apologised and I got through the consultation. This happened 10 years ago and happens to this day. I applaud my registrar for his stance and anecdotally, it is happening less and less because people like that registrar were calling people out for their attitudes.

random search

I spoke in another post about the attitude the police have when they stop you as a black person. The approach is usually quite different – the black person is more likely to be treated as guilty of some wrong-doing until proven otherwise even where you are the victim reporting a crime whereas the white person is more likely to be treated as innocent until proven otherwise. Same as when you go into a shop, a security man (or woman) is more likely to follow around a non-white person than a white person. Same as ‘random’ extra security stop searches in the airports. Once, I got stopped for a random search twice in 10 minutes in Birmingham International Airport less than 100m apart. I was irritated and the lady was apologetic and wouldn’t meet my eyes. I pointed out to her that her colleague had just stopped me randomly too and in fact he was only a stone’s throw away. What was it she thought would have changed in the distance to her? It is a random search ma’am. Randomly because I am black you mean. She flushed and muttered an apology as I gathered my bags and carried on. Random. Racial profiling is reality.

So whilst I know that majority of white people are not actively racist, just as I know that majority of Muslims are not extremists, it is clear that as a black woman, I have more obstacles to contend with. Life is just that little bit harder because I was born with the colour of my skin. I ask for no special treatment. I just want to be treated the same as my non-black friends are. I want to be treated with respect and given my dues. I want people to judge me for what I have said and done (which I have control over) and not the genetics I have inherited. I want my talents to be recognised for what they are and not the physical package they come with. I want the same rights afforded to me by virtue of being a human being. I want justice. I want acceptance. I want to freedom to be me.

The Power of Dreams

My aunty forwarded one of those inspiring videos about life and happiness. One particular message struck me. It said something about having a dream then making it happen. Of course, it is easier said than done. It is not quite that easy to turn a dream into reality but those people who are the happiest are those who had a dream then put their all into making it a reality. I have many dreams. Through hard work and luck, many of my dreams are already a reality. I got into medical school, I graduated. I applied and got into speciality training and I am gaining experience as a paediatrician. I met a man with a big heart, fell in love and married him. We bought our lovely first home, a permanent abode after my many years of moving from flat to flat.  I fell pregnant when we were in good place and the baby has been growing well with the easiest pregnancy. I am getting ready to realise one of my biggest dreams – giving birth and being a mother. So yes, my bucket is overflowing.

This is about my professional dream.  I used to think I would be happy to graduate, specialise as a paediatrician, get a consultant post and settle down to a routine. With the recent political shenanigans and the more I work in the NHS, the more I realise I want more. I want more out of my life and I also want to contribute more than the daily grind. Don’t get me wrong, I know in my current role I do make a difference to lives. There is nothing more satisfying that when I have done a good job and I know that parent or child’s life has been changed for the better, no matter how small that change is. However, many days I look back after a busy day and think was that worth it? Those days which are all about paperwork and administrative tick-boxing exercises that contribute nothing except to some faceless manager’s satisfaction.

The part of the world where my life started (Yola) is lovely in a lot of ways but there is a significant poverty. In terms of economics but also in healthcare terms. Nigeria as a whole fails to cater to the healthcare needs of its population unless you have lots of money to go private. The North-East of Nigeria is one of the poorest when you look at health outcomes. In particular, looking at childhood. The statistics (where there are any) are shocking. Nigeria, for all its wealth, regularly features at the bottom of tables for health outcomes. We are in the bottom 5 for most outcomes including maternal and under 5 morbidity and mortality. For the non-medics reading this, morbidity refers to how much ill-health and disease (sickness there is) there is and mortality refers to how many are dying.

Mothers naturally should come in a low-risk group. Most should be healthy young women doing what is most natural – getting pregnant, growing a baby and then delivering the baby. Young children, although fragile because they are not mature yet biologically are despite all of that resilient on the whole and have bodies that are full of strong healthy organs with endless potential for healing. What we are failing to provide is basic care. Basic antenatal care, trained birthing assistants, hospitals to assist in difficult deliveries and facilities for emergency caesarean sections (surgery) for those women who cannot do it naturally. Infections, on the whole preventable and most totally treatable, cause a lot of the morbidity and mortality in Nigeria. Many of the other things we provide here in the NHS is simple supportive care, allowing patients own bodies to heal themselves in a secure environment.

So here is my dream. I would like to set up a women’s and children’s health centre. Big dream I hear you say. Yes, I am aware. It will be a huge task. I worked at the FMC in Yola for 4 months in 2012. I saw how much need there was and the things that were missing. I know a lot of the patients we couldn’t help were those who lived far away from town and did not come to us until their disease was too advanced for us to be able to do anything. Mothers died in childbirth because they did not have adequate antenatal care so predictable problems were not discovered until it was too late. Preterm babies died because they were born out of hospital in environments not hygienic enough and did not get simple breathing and feeding support and early treatment with antibiotics. Term babies were born too small because their mothers were undernourished and unwell with treatable conditions during pregnancy but were not diagnosed and treated. Very few of the patients we couldn’t help needed fancy expensive medicines or surgery. It was simply too little too late.

On the positive side, those that did come to us in time had better outcomes than those suggested by the statistics I read about on WHO and the likes. Those preterm babies born at FMC Yola thrived and majority survived until discharge. Sure, their progress was slower than here in the NHS because of a lack of basic equipment and provisions like oxygen and breathing support, working incubators, labs, fluid pumps, parenteral nutrition for those too young to feed by mouth or through the stomach. But survive they did because they are little fighters.

So what I dream is to provide all those basic things to the mothers, babies and children free of charge if I can manage to raise funds or at the very least at the smallest prices possible to give those with little the chance to quality healthcare. To go with that, I would like to provide an outreach service to those isolated villages. Run clinics, provide immunisations, antenatal vitamins and nutritional support, teach about prevention of infections and when it is vital to seek early medical help. Central to that idea is to train some of the villagers to provide safe simple birthing assistance, supportive care for new-borns and how to diagnose and treat the most common infections and provide first aid. All little things but added up should cut the numbers of mothers and children suffering unnecessarily and prevent the many preventable deaths.

My grandfather listened to me talking about my dream and was (rather unexpectedly) downbeat about it. He pointed out that it wasn’t as easy as I was making out. Actually, I know it will be difficult to do and as I have never done this before, it is a monumental task. There is so much to do to get this off the ground. However, here is my plan. I will start small and do this project in stages. I will deal with the complications as I get to them. A journey of a thousand miles has to start with that first step. I have taken my first step. I have dared to dream and I have written down my dream in black and white. Now onwards and upwards. Watch this space.

The Cycle of Life Part 3

I could write and write about the many lives I knew that were cut short in their prime but I will complete the cycle with this last blog about one of my oldest friends. His name was Nabil. We probably met as babies but the first meeting I remember was when I was 15 years old. We had moved to London the summer before and were getting settled in still. My mama came home one day and announced we had been invited to have dinner the Ibrahim’s on Saturday. Who were they? I asked. She explained that they were old family friends. The parents were my grandparents’ friends and although their children were younger than my mother and siblings, they knew them well as children. I am told one of the kids had even stayed periodically with my grandparents in Lagos when they were going to school there. She told me that the oldest daughter had 2 sons, one my age and I was going to meet them.

Although we both lived in North London, it was quite a trek as there was no direct tube route and we had to go on 2 (or was it 3?) buses. By the time we got there, my nose, fingers and toes were frozen and all I wanted to do was curl up into a ball and sleep by a fire. I needn’t have worried. As soon as we stepped into their house, I felt my frozen cells begin to stir. It was always tropical in that house. Mum and Baba (the grandparents) like it very warm so there was never any danger of being cold once you got in there. I was introduced to the many adults, face after smiling face. It was like a mini-Northern Nigeria. All the warmth, the noise, everyone speaking Hausa. The boys were called down, Nabil and his little brother. They were instructed to take me upstairs until it was time for dinner. Although Nabil was friendly, he was definitely the quiet one. His little brother made up for it. He was very chatty, still pre-adolescent and full of excitement about life. Back then, he was quite small too. Very cute!

Nabil played us some music and told me about how they had only been in London for a year so were new to town too. He explained who was who in the family and we made general chitchat with his little brother telling us his fantastical half made up tales. We were in the same year of school and I was older by 2 months. By the time we got called down to dinner, we were friends. Over the delicious dinner cooked by Mum (his grandmother) and his mum, we talked some more. We exchanged numbers when I left. We stayed good friends over the years. We went to visit every so often and they made the trip across North London a few times too. We text occasionally in between visits. The next year, we talked about finishing year 11 and applying for colleges. I told him I was doing all the sciences and Maths because I would be applying to do Medicine. He said he wasn’t sure yet what he wanted to be so he was still thinking about which subjects to choose. We talked about where to go and I must have been convincing because I suggested for him to join me in Barnet College and he promised to consider it. He wrote down his address on a teddy bear notepad I had so I could sent him information when I had a confirmed place.

Common sense prevailed and he went to a college more local whilst I went to Barnet College. We went to see movies together and we even ate out at this stage, being all grown up at the ripe old age of 17 and 18 years. Every time we went out, he would insist on paying for everything and I would argue him down so we went halves. His little brother had grown into pre-adolescence by then and would irritate Nabil endlessly. His patience was great and he would repeatedly ask him to butt out of our conversations. I didn’t mind. I had a sister too and as the younger sister, I knew what it was like to be the little one. When we applied through UCAS for universities, he finally had a plan. He was going to study Maths. I was shocked. I mean, I was a straight A student and I got my A in Mathematics, an A* even in AS. I was no slouch when it came to it but to do a whole degree in Maths? I was agog! Why would anyone in their right minds do such a thing? He took my teasing in his stride. He said he didn’t have a profession in mind like I did and he knew he could use his generic Maths degree to do a wide range of things. I accepted this but I still thought him mad. He gave me that calm smile of his. ‘You’ll see’, he said.

As is the norm, we saw each other less when we went off to different universities. I went to Birmingham and he stayed in London. We probably saw each other once a year but when we did, it was like no time had passed at all. Ours was a very easy friendship. He would tell me about his ‘crazy’ Maths course. He seemed happy. I would tell him about Medicine and how much of it there was. How I realised more and more that what I knew was only a small fraction of how much I needed to know. He was openly impressed by how well I coped with it. His support and belief in my abilities were unwavering. Just like his friendship. I knew he was there somewhere should I ever need a friend. We text and Facebooked more than we spoke face to face. I can count the number of times we spoke on the phone in all the years.

Over the years, I would tease him gently about his girlfriend, or lack of. As the Fulani girl, I should have been more embarrassed to talk about such things but he was so shy about it. It became part of our friendships. I would needle him about ‘her’ and he would counter by asking me about my many boyfriends. I wasn’t shy about it. I had very little in the way of boyfriends but I told him of every encounter and how I preferred not having a boyfriend. He never admitted to any love interests but his brother was a more open book and I know there was somebody special at some point. He graduated and started an online sales platform. Next thing, he was talking about going back to Nigeria for his NYSC (mandatory youth service). He settled in Lagos. I happened to go the Lagos route once in his time there so I got to see him. He looked way too skinny and I was worried. As a newly-qualified doctor, I saw ill-health everywhere and was concerned he wasn’t sharing. He reassured me that he was fine. I didn’t need to doctor him. I believed him because youth corpers do tend to look the worse for wear during their year’s tenure.

The last time I saw Nabil was in Life Camp, Abuja in 2011. He happened to be visiting Abuja whilst I was there on a 10-day holiday. He was staying with a friend who brought him over. Again, I thought he was too skinny and he laughed it off. ‘Maybe I was always meant to be skinny like you’, he said. We chatted for an hour and he had to go. As we hugged goodbye, I felt how bony he had become. Life in Lagos was a hard one for a young man trying to start a business. My parting words were ‘You need to eat more. You should look after yourself better.’ His reply was a laugh and a ‘Yes doc!’ I stood at the door and waved until the car was out of sight. Not for a second did I imagine I was saying goodbye for the last time. The fuel subsidy crisis in Nigeria was the last thing we ever chatted online about. He became very involved in the demonstrations. I worried about his safety and he sent photos of himself and his friends at Lagos marches, looking happy and less skinny. He had found a cause to believe in. I was proud he was making a stand for a cause.

News that he was ill came out of the blue. I was in Yola, having taken a year out from working in the NHS to see the world. My mama got a call from one of his relatives saying that he was in hospital with a bleeding illness, cause still unknown. It was pretty serious and they were considering transferring him abroad as the healthcare available in Lagos was deemed inadequate. When my mother related the facts, I wanted to know more. What sort of bleeding? Was it related to a fever? Was Lassa fever the suspected cause? When my spoke to them again later, she was given more details. He had woken up that morning and told the friend he was living with that he wasn’t feeling too well. I think there was mention of a headache. He had been well the night before going to bed. His friend had gone with him to hospital and he either vomited or peed blood. The exact sequence is hazy but the gist of the story was that he had become sick rather quickly and what started out as an isolated bleed was now bleeding from multiple sources. He had been given a transfusion, we were told. He was conscious but seemed to be deteriorating.

When my mama related all of that news, I immediately thought the worst. When I burst into tears, she was alarmed. ‘He is alive,’ she said to me. ‘Don’t write him off.’ I tried to explain what I was thinking. I didn’t want to be a pessimist but unexplained severe generalised bleeding had a poor prognosis even with the best medical care. And he was not getting that. Not yet anyway. I had 2 professional experiences to draw on, both rather negative. My first experience of a patient with uncontrollable bleeding was in Malaysia on my medical elective in the 4th year of medical school. He was brought in by his heavily pregnant wife and a male relative to the A&E where I was working. He was very quickly diagnosed with Dengue Haemorrhagic fever. However, before any real treatment could be commenced, he went into cardiac arrest. With the medical students and his wife watching, the doctors performed CPR. It was horrific. He began to bleed from every orifice imaginable. His ears, nostrils, mouth. The blood was coming up the tube he had inserted into his lungs to ventilate him. The only part visible with no blood streaming out of it were his closed eyes. It was over as quickly as it began. It was obvious to everyone that he was far too ill to be saved. His wife was led away with the news.

The second experience was indirect. I was working in FMC Yola (Federal Medical Centre) and although Yola was ‘free’ from Lassa fever at the time, there were new cases being reported further south of the country. In fact, about 6 months before I had started working at FMC, there had been a patient with Lassa fever there and 2 of the doctors had contracted it from him. Unfortunately, 1 had died and the second had got to the Lassa Centre down south in time to be treated. He was one of the registrars on the paediatric team I was working with. So although he was okay, it seemed that mortality was quite high and only those who were diagnosed early and treated before they started actively started to haemorrhage (to bleed) were salvageable. Nabil’s story didn’t quite fit the bill because he had not complained of a fever and indeed had no fever in hospital. But it was my best guess with the facts I had and I feared the worst.

I pulled myself together eventually and prayed and waited with my mama. Next time we got an update, it was to say he was worse still, I suspect barely conscious at this stage. He was still bleeding despite all efforts and his parents were with him (they don’t live in Lagos). An air ambulance had been organised and he would be transferred abroad as soon as possible. We even heard he was being placed in the ambulance and I thought maybe there is some hope after all. That hope was short-lived. We got a call a few hours later to say that although his parents were in a flight to London, his air ambulance had never taken off. There were complications and unfortunately, he had not made it. I was so upset! All I could think is how his parents had no idea he had died and how they would have to make the return trip with that news weighing on them. To be honest, I have not asked them what happened exactly but it could only have been a terrible day.

I think the initial reaction of tears had taken the edge of my grief. I had started my grieving process before he was gone. I sat around in disbelief as my mama asked if I would be okay. As we made arrangements to go and visit his family, I could not stop thinking about how final death was. That was it for him, in this life anyway. I have no brothers so I whilst growing up, I found a handful of boys/young men to be my shining examples of decency in the male sex, my torch bearers when I felt dark about men in general. Nabil was one of them. Here was a gentle, calm, positive young man who believed in doing what was right, what was decent. He was respectful of God, his parents and our culture. He was a great friend and it was clear from the few times that I spent with him in the company of his family and friends that he was an all-round good guy. Losing Nabil was losing a little of the light in the darkness that sometimes surround men for me. Nabil was a good guy. Now he is no more. It took just over 2 days for a healthy young man in his mid-20s to sicken and die. Muslims would say it was time to go. I accept that but did it have to be such a horrible death? What did he ever do to deserve such an end? Why him?

The Cycle of Life Part 2

Mamie, my late grandmother, was from Mubi and Ribadu. Mubi is a large town in Adamawa State, even in the old days a thriving commercial town with good links to many other towns (that is until Boko Haram decided to move in). I understand that Mamie’s father was one of the successful merchants there and her home in Michika only came about long after her father died because Grannie, her mother was from Michika. Anyway, through one of her parents, she is partly from Ribadu too. My memory of Ribadu is of a little diversion on the road to nowhere, little more than a collection of huts that we got to by using dusty dirt roads off the main highways. Most Nigerians will recognise the name though because of the famous Nuhu Ribadu, arguable Ribadu’s most successful son. He was EFCC’s first executive chairman – Nigeria’s anti-corruption agency and suffice it to say, he went about his business fearlessly, bringing those previously seen as untouchable to account. He was loved by the masses and detested by the ‘elite’ who had enjoyed incredible daylight lootery for so long in Nigeria. He had to go on exile when he left office because of fears for his life. I digress, Nuhu Ribadu is a relative. Of course he is I hear the Nigerians cry. Everyone in Ribadu is related so therefore, he is definitely a cousin of some sort. My point is that before Nuhu Ribadu, Ribadu would have been a name no one except its indigenes noticed on the map of Nigeria. Now it is one of the household names in the country and no Nigerian should wonder about its origins.

The girl I want to write about was called Aishatu Mohammadu Ribadu. We called her A’i for short (pronounced Ah-ee). I don’t know how the arrangement came about but I remember vividly when she moved in with us. She was about to start secondary school. I suspect my mother offered to bring her cousin to Yola where there were more education opportunities. She was the oldest girl and named after Mamie so who better? She was as you would expect a little village girl to be at first. Timid and as quiet as a mouse. Pretty Fulani girl with her long curly natural hair. She was soon enrolled into GGSS Yola (Girls Government Secondary School) and on the first day, we lugged all the usual paraphernalia to the boarding school to check her in. I remember us walking around the dorms trying to find her allocated one. We did and when we had her things moved in, we said our goodbyes and left. I was in primary school then so it didn’t occur to me how hard it would have been for her. Not only to leave the shelter of her little village and move in with us but to then go straight into boarding school with girls from all corners of the State. She never complained about it.

She remained quiet for the first year or so and then by JS2, she came into herself. She joined the cultural club in JS3 or SS1 and flourished more with it. She came back after the first term of being part of the group and started to sing us their songs in her lovely voice. One chorus went:

Sai mu ‘yan Hausa cultural,

Daga makarantar Geeeee Geeeee (GG).

Mun zo ne muyi maku wasa,

Wasan mu ta Hausa.

Mun zo ne muyi maku wasa,

Wasan mu ta Hausa.’

(Translates roughly into: We are the Hausa cultural girls from the school of GG. We are here to entertain you, in the Hausa cultural way).

We particularly loved the bit where they introduced themselves and when she got to Aisha Mohammed (the Hausa-nised version of her actual name), we would grin out loud. Over the next year or 2, we learnt many of her songs (some by Sa’adu Bori, very X-rated for our age but who knew?). In the evenings when there was no electricity, we would lie on mats out under the stars and moon. She’d tell us stories about boarding school and we’d sing her songs. Her love for music grew and the first album she absolutely loved was Brandy’s Never Say Never in 1998. We all loved it to be fair but she learnt the words to the songs ‘Never Say Never’ and ‘Have You Ever’ early and would sing those songs so hauntingly that I can’t hear now even today without thinking about A’i. Just hearing someone utter the words ‘never say never’ evokes memories of A’i to me. I suspect looking back she was going through puberty and probably was in love for the first time. Being a shy Fulani girl, we never heard or saw the object of her affections. In fact, in all of her time, I only knew of one ‘boyfriend’ before she met the man who would be her husband. I cannot for the life of me remember him but I know she suddenly relaxed her hair, started to wear makeup and took extra care when getting dressed to go out.

When she graduated, she met Hamma Z (his nickname) and we all knew this was different. She would light up when his name was mentioned and although she was shy about it, she never hid that she liked him. I barely knew him then because I was in boarding school in Lagos myself and he wasn’t resident in Yola but visited periodically. I heard she was getting married shortly before the event and as it was the middle of school term and we had moved to London then, I could not be there. I spoke to her though and she told me how excited she was. She sounded it. After the wedding, they moved to Ashaka where her husband worked. It is a little removed so it wasn’t on the road to anywhere we would normally go when we visited. I never made it to her marital home (this I am still sad about). One summer holiday, I contacted her to say I was coming. She promised we would see each other as she was planning a visit to Yola and Ribadu in that summer.

One day, there she was. I think this was in 2002. She looked beautiful. She was always pretty but she was glowing that visit. When she spoke of her marriage and her new home, her eyes shone. I was very happy. I wondered if she was pregnant and asked her the question. A little bit of the light dimmed. She clearly wanted a baby and it had been over a year. She was worried. I remember telling her not to worry. ‘These things are written,’ I said. Her baby would come when it was meant. She smiled and said ‘You are so grown up Diya’ in Fulani. I hugged her and we sat by the car parking bays at home in Yola, sharing a private moment. Once again, the two Aishas reunited under the stars and moonlight. Before she left, she told me about how quiet it was in Ashaka but that she had made a few friends. She told me about her small business venture and how she was now making some money for herself and her plans to make it more than a hobby. She told me about her husband and how he was kind and worked very hard for them. When she left, I promised when I came next time, I would make the trip to Ashaka especially.

That next visit never came. I saw her when she came for Mamie’s death. Then I got a call from A’i a few months later excitedly telling me that she was pregnant and to tell my mother. Her voice was exuberant and I was ecstatic for her. We rejoiced briefly before she had to go. Call charges to the UK in those days were astronomical but she clearly wanted us to know because she was over the moon. It was very un-Fulani of her to call and talk about her pregnancy so early. Traditionally, Fulani girls would normally never say a word until their pregnancy was obvious to everyone. I guess she knew with us being abroad, we had to be told to know. It was the last time we ever spoke on the phone. We texted from time to time and she let me know everything was progressing fine. She said she had never been happier.

One morning, I got a call from my mama who had moved back to Yola. She said ‘A’i has a son’. Her voice sounded sombre so I immediately asked ‘and how is A’i?’ Mamie had died the year before and since then, we had lost a few other people. I suspected the worst as soon as my mama began to speak. She said Hamma Z had been informed that A’i was taking a little longer than expected to recover from her general anaesthetic. You see, she had had complications which meant they had taken her into an emergency caesarean section. Although my heart was still heavy, I was a little relieved. I was a medical student then so I looked it all up and was a little reassured. Chances of dying from a general anaesthetic are slim in a healthy young woman. Looking back, I think she had pre-eclampsia or something like that but as usual, in the Nigerian healthcare system, information is restricted so all we heard was that she hadn’t quite woken up. My mama promised to call when there was news.

I sat by my phone and waited. When the call came, it was what I didn’t want to hear. She had died. We found out later that actually she had died pretty much straight after the baby was born but that was kept from her family. In a panic, they pretended she was still alive but unconscious. I was in the UK and she was buried according to Islamic rites so I never got to see her. My mama went for the ‘funeral’ and reported Hamma Z was devastated but their son was healthy and beautiful. When the next summer came, I went to Yola and asked to be taken to him. He was living with his grandmother then and was nearly 18 months I think. He was beautiful, like my mama had told me. Quiet like A’i was at first. His aunties and cousins told me how he didn’t talk much or take to strangers. He came to me and sat by my side all visit, leaning into me when I wrapped one arm around him, despite not saying a word to me. They looked at me in wonder and said ‘he must know his blood’. I smiled and agreed. Yes, he must. I felt an intense love for him at that moment and I wanted to steal him away. I also wanted to burst into tears. I knew how proud his mum would have been of her little boy and was devastated she never got to meet him.

His father remarried after many years and A’i’s son was reunited with his father for good. Although I have only seen him a few times over the years because they do not live where I go on my short visits to Nigeria, his father and I keep in touch and I am told he is happy. He is an adolescent now and he is so much his mother’s son. I looked at the most recent picture of him I have and saw his smile. A’i’s smile. He has her eyes, her nose and her mouth. His colouring and demeanour is very reminiscent of her. I still well up at the thought he will never know her just as she never got to meet him but I am comforted by the fact that she lives on in him. If I ever get a chance when he is older, I will tell him his mother wanted nothing more than to bring him into this world. That I have never seen her so happy than when she was with his father. Nor heard her so excited than when she announced he was in the making. That he would have been the centre of her world. That she would have done anything for him. That he would have been the most loved little boy, the apple of her eye. I hope I get the chance to tell him all that. Life!

The Taboo of Domestic Violence

One of the great privileges of being a paediatric doctor is the frontline seat we have on humanity. Of course we only see this great variety of human life and get to share in their stories because the NHS is still at the point of need free. We get to see how the very poor live their lives and also how the more affluent live theirs. Stereotypes abound within medicine and on the whole they ring true but we doctors and other frontline staff are constantly amazed and shocked by the unexpected. Life is certainly unpredictable as a doctor in the NHS. This is one of the reasons why I love the NHS so.

One of the greatest sorrows I have faced is when I come across a mother and or child who is being abused by the man who is supposed to love her and protect her from the rest of the world. One of our babies has been taken into foster care recently because the mother is being abused and has chosen that option for herself and her baby. I wanted to weep (still do) because I cannot imagine the horror that the mother has gone through and must be going through to carry a baby to term, labour to deliver her beautiful baby and then feel she must give that baby up. Heart breaking! In this case, the abuse is on-going and the father of the child not only threatened the mother with further abuse, he has threatened to kill the baby if she takes it home. Isn’t there something we can do for her I hear you ask? Of course there are ways in which we can help her. We have offered her every viable option including the one she has taken: giving up her child for fostering or adoption. She weighed up her options and came to a decision to give up the baby. Some of us are worried this is not a rational decision but unfortunately, within the law as she is an adult without any mental illness to cloud her judgement, we have to accept her decision whether it appears rational or wise or not.

Unfortunately, this case is not unique. In my 4 years of paediatrics, I have seen far too many cases of domestic violence and its many victims. 1 is too many but there have been dozens in my short time in the NHS. Bearing in mind that I have only worked in 7 NHS Hospitals and have seen but a tiny snippet of what is going on out there, this is a massive problem that is rarely talked about. Even within paediatrics and obstetrics where this is a major concern, we only talk about it when we get a case. Then it gets filed in the back of our minds until the next unfortunate case. Today I want to highlight the evil that is domestic violence and in my little way encourage anyone directly or indirectly affected to do something about it. What we need is more awareness and everyone who can do something to do a little bit so we can get some change happening.

As you may know, my mother is a feminist so I have always been aware of domestic violence in its many guises and how ugly it can get. As a young feminist, it was always one of those issues I was passionate about and I even wrote a radio drama aged 14 on the topic which got aired in Lagos in 2000. From a very early age, my mother taught me to have zero tolerance to domestic violence. I have always said that the minute a man raises his hand to hit me, unless it is in retaliation after I hit him first, that relationship is done and dusted. Some of you may think this is extreme but if you knew what I know, you would understand that zero tolerance is the best way to go about snuffing out domestic violence.

In medical school (here in Birmingham), I opted to do a module on Domestic Violence in my 4th year of study. It was a short module but the quality of teaching delivered voluntarily by the staff from the local Women’s Aid was fantastic. It was sobering to realise that the knowledge I had from what was happening in my hometown in Yola was mirrored in Britain. Britain may proclaim how forward thinking it is but just the same with Yola in Nigeria, their response to domestic violence is still inadequate and there is very little actual protection for the victims. Majority of the work is done by the voluntary sector trying to safeguard those who seek for help. By the very nature of this service provision, victims do not have access to help and unfortunately, many will continue to be victims until they end up in intensive care or even worse in early graves.

Here are some facts and statistics from Women’s Aid (http://www.womensaid.org.uk/domestic_violence_topic.asp?section=0001000100220041&sectionTitle=Domestic+violence+%28general%29) by way of introduction:

  • Domestic violence is any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. It is not just physical violence. It can be verbal, sexual or neglect. It can be against a partner, a child or an older relative.
  • The vast majority of the victims of domestic violence are women and children, and women are also considerably more likely to experience repeated and severe forms of violence, and sexual abuse.
  • Women may experience domestic violence regardless of ethnicity, religion, class, age, sexuality, disability or lifestyle.  Domestic violence can also occur in a range of relationships including heterosexual, gay, lesbian, bisexual and transgender relationships, and also within extended families.
  • The majority of abusers are men, but in other respects, they vary: abusers come from all walks of life, from any ethnic group, religion, class or neighbourhood, and of any age.
  • Abusers choose to behave violently to get what they want and gain control. Their behaviour may originate from a sense of entitlement which is often supported by sexist, racist, homophobic and other discriminatory attitudes.
  • The estimated total cost of domestic violence to society in monetary terms is £23 billion per annum. This figure includes an estimated £3.1 billion as the cost to the state and £1.3 billion as the cost to employers and human suffering cost of £17 billion.
  • The first incident of domestic violence occurred after one year or more for 51% of the women surveyed and between three months and one year for 30%.
  • Amongst a group of pregnant women attending primary care in East London, 15% reported violence during their pregnancy. Nearly 40% reported that violence started whilst they were pregnant, whilst 30% who reported violence during pregnancy also reported they had at some time suffered a miscarriage as a result (Coid, 2000).

The commonest question people who have not been victims ask is ‘why doesn’t she leave?’ To understand the answer, you have to try to understand how they become victims in the first place. The typical victim starts out as a happy vivacious young woman, often pretty with very social personalities. They meet and fall in love with a man who at first glance is perfect. Often these men are older, more experienced who charm the girl with their confidence and assertiveness. Once the young woman/girl is ‘in love’ and moves in with the abuser, he (often he but not always) will begin to isolate the girl from her friends and family. It often starts innocently but becomes more pervasive. Often the man will complain about some character flaw in one friend and systematically will find a way of making her cut ties with majority if not all of her social support network. He will often start with small acts of violence like physical restraint if she wants to go out and he doesn’t approve, seizing her shoes so cannot leave the house or calling her ugly when she dresses in a way that she would normally and in the way he would have previously approved. Then once he starts to isolate her, he will chip away at her confidence and withhold praise so that she begins to modify her behaviour to please him and to get approval. To please him, she often has to isolate herself from her friends and family and cater to his every whim. Despite that, he will find fault with all she does and he will start by criticising her. Eventually, he will physically punish her for not doing what she should. Mentally, because of the slow insidious way of grooming her into becoming a victim, she starts to believe that whenever he abuses her verbally or physically it is because she has failed to do something.

Eventually, she is truly a victim and she stops to see herself as a victim and him as an abuser. She begins to blame herself for everything that befalls her and see him as her saviour. Most will come to believe their abuse is an act of love. What it often takes for her to begin to see her thinking is faulty is either when she ends up in hospital because he has lost control and beaten her so badly that he ‘allows’ her to seek medical help or she has children or other family members she feels responsible for and they get harmed. Even then, these victims will often go back time and time again. Sadly, some will go back one too many time and end up dead. Or their child will end up dead or permanently damaged. Here are some statistics to back that fact:

  • Women are at greatest risk of homicide at the point of separation or after leaving a violent partner. (Lees, 2000)
  • 60% of the women in one study left the abuser because they feared that they would be killed if they stayed. A further 54% of women left the abuser because they said that they could see that the abuse was affecting their children and 25% of the women said that they feared for their children’s lives. (Humphreys & Thiara, 2002).
  • The British Crime Survey found that, while for the majority of women leaving the violent partner stopped the violence, 37% said it did not. 18% of those that had left their partner were further victimised by stalkingand other forms of harassment. 7% who left said that the worst incident of domestic violence took place after they had stopped living with their partner. (Walby & Allen, 2004).
  • 76% of separated women reported suffering post-separation violence (Humphreys & Thiara, 2002). Of these women:

– 76% were subjected to continued verbal and emotional abuse.

– 41% were subjected to serious threats towards themselves or their children.

– 23% were subjected to physical violence.

– 6% were subjected to sexual violence.

– 36% stated that this violence was ongoing.

Lest I forget, I will mention the even more invisible group: male victims of domestic violence. I was heartened to see a poster the other day in a public toilet (female) offering male victims some help. This is just as important because we know that many perpetrators of (domestic) violence were once victims their selves. The man might be the victim in some cases. Learn to expect the unexpected.

So what do I suggest? For anyone who reads this, please share so that we can raise some awareness. If you suspect anyone you know might be a victim, please talk to them and point them towards the Women’s Aid website for help. Do not allow your friend or sister or mother to isolate herself. If you feel you are being pushed away and this is out of character for your friend, please persevere and remain friends with them even if it is only from a distance. Do not cut all ties as you may be tempted to do. Lastly, be watchful. Personally and for everyone you love. If you suspect something is amiss, draw them closer and be there so that if they need help, you might be that link that keeps them real and potentially saves their lives. If you are with a partner who is exhibiting some of the behaviours above, talk to someone you trust about it and ask for help. This help could come from Women’s Aid or even a trusted friend. If you are in a place where Women’s Aid or similar do not exist, turn to friends and family and seek for help early. No man is worth losing your dignity, sanity, health or life for.

Champion the Truth

If you don’t live in the UK, you may have missed the junior doctor contract row that has been brewing for a few years but has escalated over the last couple of months. If you live in the UK and rely on major media outlets to keep you informed, you may think the dispute is about junior doctors asking for more money. I would suggest you turn to social media for more accurate information from doctors, other NHS staff and more importantly their families. Long and short of it is that the dispute is about our Government deciding we junior doctors need to work longer hours whilst our pay is cut and refusing to do the simple arithmetic that would show that if you want more junior doctors working around the clock, you need to recruit more of them because we are already working long hours and we absolutely will not do me as it would put our lives and the lives of patients that we hold so importantly at risk. I mean, how is it fair that the Government has voted to pay its MPs more and they can still claim vast amounts on expenses yet the very same Government says we have no money in the coffers to pay for more junior doctors? Isn’t that ridiculous???

I digress, please read up on Facebook, twitter and blogs writing on the issue. Plenty of truth out there is you care. The baseline is that at least half of the junior doctors who have voiced their opinions have stated either that they have made up their minds to quit the NHS or are at the very least, looking into alternate careers or going abroad. The simple truth is we as a group of junior doctors think the bottom line is that the Tories have vested interest to tear down the NHS and privatise our healthcare and hence line their pockets. There is also strong evidence out there that the current fool we call our Health Secretary has been a champion of NHS privatisation for many years and probably owns share in private health insurance conglomerates like Virgin Health.

This blog is actually about the one good thing that has come from this attack on junior doctors. We now have an online Facebook forum called Junior Doctors Forum which is by invitation only. It has 63,000 members and counting. Not all of them are junior doctors. We have consultants, medical students, nurses, midwives, paramedics and other allied healthcare professionals plus a few lawyers, journalists and even politicians about the forum. What I want to do is big up the passion of those on the forum and champion them sticking to their guns and being honest about how they feel and what this is doing to us as a group. Never has there been so much unity within the profession. Medicine is a very hierarchical and competitive profession and although we all start as one, we generally sub-divide as we become more senior and choose specialisation programmes. Our world then shrinks even further so all we know is related to the one field eventually. Our only contact with the outside specialities is if they are part of the multi-disciplinary team that we need to make sure each patient’s care is optimal with the inclusion of all relevant expertise.

So it is all good news though? No. Unfortunately when you get 63,000 opinionated voices with the top 1% in terms of IQ and ability to rationalise, debate and analyse, you get varying opinions. I am all for freedom of speech and embracing our differences. However, as with all other aspects of life, some are excessively worried about how other people interpret our opinions. An article was published based around a discussion we had on the forum and people are getting all uppity about all coming across professional and un-emotional. Why? If this was about professionalism only, we would all continue our stony silence whilst we get attacked as we give our all for the greater good. This time, we have stood up and shouted NO because not only have they attacked us (we have thick skin because of the nature of being medics who take enormous responsibilities day in, day out) but they are threatening the very fabric of the health of our nation. Their proposals are not only ensuring that many of us want to leave because we choose life and living than putting ourselves in danger from physical and mental exhaustion, they are also meaning that we are now less willing to carry on doing extra unpaid hours for no thanks.

The NHS has been running on the goodwill of its junior doctors for a very long time and things have been in a steady decline for the past decade yet this is the first year that doctors have threatened to strike. We love the NHS and have been carrying its weight to the detriment of our mental, physical and psychosocial health for far too long. This is the straw that will break the camel’s veritable back. It is because we are passionate that we are fighting the proposed changes which may start with junior doctors but we all know will extend to the rest of the hardworking staff the NHS is lucky to have as its employees. How then can anyone ask that we lie about how angry and betrayed we feel? How upset we are that we are being made to reconsider our futures? Whether we can afford to have children and continue to be there for our patients? How the lies of Hunt et al are demoralising us? How we don’t feel it is worth it anymore to carry on in the NHS when all we get for breaking our backs for a pittance (£11/hr 6 years after graduating for me compared to a plumber who can earn up to £50/hr) is abuse and an Etonian ignoramus vilifying us for caring.

Well, I am here to say that no. I will not be unemotional. If I didn’t care for the NHS, I would have quit after my first foundation year when I became a fully licenced medical practitioner. If all I care for was the money, I would be abroad today with a private clinic, dictating my hours and pay. If I didn’t care, I would not be attending protests and spending what little I have left over after my living expenses and medicolegal expenses on supportive merchandise. I care and I am not afraid to show it.

Hunt is only the face of the Tory campaign to break the NHS and leave privatisation as its only viable option. The Tory Government is libellous, dishonest, spineless and un-democratic. If the general public continues to buy the bullshit the Government is peddling, it will be the British public who will pay the price in the next few years. So unless you are all dying with something that will kill you with certainty in the next couple of years, wake up and realise facts. Fact is the NHS as we know it will be no more unless the whole of the British public fights this. Just google how much it’d cost you to pay for your health insurance in the US and imagine the UK going the same. Doctors are in hot demand the world over. We can and will be forced to leave the UK and the NHS is this horror continues and we will be fine. I assure you. So the fact that I am getting emotional is not because I am a greedy lazy overpaid privileged posh kid as Hunt and co would have you believe. It is because I care and I am not afraid to show it. Fact!

Open Letter to David Cameron – Our Silent PM

This was written by the father of a UK doctor. He lives in Sweden but is speaking out to save our NHS. If you share his sentiments. Reblog or share my link. Please.

Sir,
Your silence in the matter of the NHS and Junior doctors is conspicuous and indicates your silent approval of the Health Secretary and his policies.

This is not a matter only between Mr. Jeremy Hunt, the NHS, and junior doctors. In fact, this concerns everyone, from a child yet to be born to the elderly person counting the last breath and every one in between. Therefore your intervention is of vital importance to the national interest.

It is also very painful to see how ruthlessly and insensitively you treat the elite youth of your society. The youth who have chosen to indulge in the service of people of your nation, day and night, ignoring their own comfort and social life. They are the foundation of health and wellbeing of your nation of which, I am sure, you are proud of.

I have seen the plight of junior doctors. They are working day and night, have no control over their week-ends or holidays, when on call they have to be available for up to 48 hours. They cannot think of taking leave irrespective of personal urgency. In spite of all this they are single-mindedly devoted to their duties and responsibilities and have never asked for a pay rise. They are just short of being slave driven. To add ridicule and insult to their calibre, Mr. Jeremy Hunt wants to reduce their pay and increase their working hours (while informing the public he is doing the opposite). All the while he has been projecting them as greedy and an unwilling work-force. You are watching all this silently.

The fact is that junior doctors are tired, fatigued, exhausted, demoralised and yet they stand erect and defend the health system of your nation.

I will spare myself the energy and assume that you know more than I can ever explain. You will be well versed on the internal workings of your own government, therefore, I will draw your attention to a few things which might have escaped your attention. I do not think that this has escaped the attention of Jeremy Hunt because it appears his is a well calculated mission.

First, all signs suggest that you want to privatize the NHS. If that is so, you should come out boldly and declare to the public that you want to do so. Firing the gun from the shoulders of the junior doctors and blaming them is not graceful nor is it worthy of a strong Government. The public who have placed you in the high office have the right to know your plans rather than manipulations. If your Government succeeds, cutting the pay of junior doctors and increasing their working hours, junior doctors will survive in one way or another. However, the entire population of your country will suffer. I do not think that they will forget nor forgive. Therefore, before you dismantle the NHS, it is imperative that you rethink your plans because the health and wellbeing of your country depends on it, and for this, you are directly answerable – even in the future.

Second, the Health Secretary has succeeded in downgrading and vilifying the medical profession as much as possible. Once again, you are a silent witness to this. He has taken away all the motivation and incentive from bright and elite students of your schools and colleges to choose the medical profession. If he is allowed to succeed further, you might find medical colleges left wanting for students. That would create an enormous shortage of qualified and quality doctors in the long run and an ever increasing burden on the health service.

Thirdly, if you and Mr. Jeremy Hunt succeed in privatising the NHS – I can see how this could be the interest of Mr. Jeremy Hunt. Your previous health secretary Mr. Lansley, has recently take a role in a company who is promoting privatisation of The NHS.

If The NHS is short of funds (and we know it is, through systematic underfunding by the government), it is not the fault of junior doctors. On the contrary they have to work even harder without adequate machines, equipment and staff. It is a simple case of mismanagement of finances and mismanagement of administration. Instead of pointing the gun toward the junior doctors – who are the weakest link in the chain of NHS hierarchy – aim your guns at cleaning and pruning the financial management of NHS. Look deeply into it as to why The NHS is in this position.

There are 53000 junior doctors. They are working for at least double that number. Each doctor is giving you output for at least two doctors. Instead of motivating them, patting them on the back, and incentivising them, you want to pull the carpet from under their feet so that all of them tumble down. More worryingly, you are willing to do this on the whims of a few people who may not think beyond their own interests at the cost of the health of your entire nation.

Your junior doctors are dedicated, hardworking and responsible. They are the future specialists, researchers and innovators. They are the backbone of the health system of your country. Give them the respect they deserve. Give them the motivation and sense of worth. Applaud them for having chosen the medical profession.

I have seen them working with dedication and without complaining in spite of all the hardships they face as my son is one of 53000 junior doctors.

This letter is the voice of 106000 parents who are proud of their children and their devotion to the service of people.

Best regards,
Anil Bhatnagar