Tasks and Tickboxes: a broken care system.
Last year was a roller coaster of a year and it made me reflect on how i can be more intentional with what i consume all round and not just food but also digitally. I focused alot on my health, getting relevant checks and follow- ups as well as my mental health. As someone with a long term health condition and getting on in age, i needed to stay on top of things. My cholesterol levels have been high for awhile but not of much concern as my good cholesterol was higher than the bad, so that bought me sometime in terms of cardiovascular disease risk.
This has been the healthiest eating combined with fasting that i have done in a long while. I was also conscious of how perimenopause was playing havoc with my body and hormones and no matter what i did, i could not shake the belly fat and the creeping weight gain. Anyhow, i ploughed on and even got joking with the family about how my Doctor will tell me my cholesterol levels have gone up despite all my healthy habits! Come the new year, i had my half yearly check and bloods and was very confident that even though my weight was still on the high side, my cholesterol levels would at best decrease or at worst stay the same.
I get the call from my consultant and everything is fine except the bloody cholesterol and the levels mean that a recommendation will be made to my GP to consider starting me on statins after having a discussion. I am not a fan of statins or regular medication especially if other options are available, so while i waited for an appointment from my GP to discuss my options,as had been suggested by my consultant, i drew up a list of questions and concerns i had.
A week and a half later i get a call from the GP surgery and it is the pharmacist calling to discuss my high cholesterol levels, if the hospital had given me any statins and if not then which ones she could prescribe. she then asked a series of questions about my activity levels and diet with the offer to send me a link to healthy eating. She checked which pharmacy i collect my medication from, informed me that i would experience some side effects when i started the prescribed statins but not to worry. I was then to have repeat blood tests in 6-8 weeks and did i have any questions? To say i was stunned into silence would be an understatement.
I was mad and disappointed, not at her but at the system that is broken and has been reduced to a task based and tickbox service where the whole sum of the person and their circumstances and views are not taken into account or made space for, when their care is being decided. I know the days of having a meaningful face to face conversation with your GP who had all your records at hand and had known you for years are over, but i had at least expected to have a face to face appointment to discuss this life changing event and explore other options available. That i would be given the chance to make an informed decision instead of the decision being made for me.
So for now i have a prescription waiting for me that i am not keen on picking up any time soon. Meanwhile i am intent on pursuing those alternative methods like exercise and diet and see what results i get when i next have my blood test. What is it they say? You are more likely to look after your health if you are involved in the decisions about it and are invested in it. Please talk to and with patients and not at them. When patients feel they have a say in their health and care they are more likely to be receptive to suggestions made and not balk at them.
Why you should take part in Our Future Health Research Programme.
‘I’m taking part because I want Black Women to be represented in health research’
I was recently featured on Our Future Health’s website as part of their Volunteer Stories, which is about why i chose to take part in the study. You can read the full story here: https://ourfuturehealth.org.uk/news/im-taking-part-because-i-want-black-women-to-be-represented-in-health-research/ and hopefully you will be inspired to take part yourself.
H. pylori: The Hidden Culprit Behind Gastric Woes.
Helicobacter pylori, commonly known as H. pylori, is a bacterium that finds its way into the stomach lining, causing a range of gastrointestinal issues. Discovered in the 1980s, this tiny but mighty bacterium is one of the most prevalent global infections. H. pylori has been linked to various conditions, including gastritis, peptic ulcers, and even stomach cancer. Its ability to thrive in the acidic environment of the stomach makes it a formidable opponent. The infection often goes undetected, as symptoms can be subtle or mistaken for other digestive ailments. However, with advancements in medical research and diagnostics, accurate detection and effective treatment of H. pylori have become increasingly attainable, offering hope for those suffering from its adverse effects.
When it comes to the prevalence of H. pylori infection in different populations, including black people, it is important to consider both genetic and socio-economic factors. Studies have shown that black individuals may have a slightly higher prevalence of H. pylori infection compared to other racial and ethnic groups. However, it is crucial to note that this difference is likely multifactorial, resulting from a combination of cultural practices, and disparities in healthcare access and quality. Some studies have also shown that obesity/ having a high BMI is assosiated with an increased incidence of H. Pylori infection. It is essential for healthcare providers to be aware of these factors and provide adequate screening and treatment options for all individuals, including black patients, in order to effectively manage H. pylori infection and its complications.
Diagnosis
Diagnosis of H. pylori infection typically involves a combination of tests. One of the most common methods is the breath test, where the patient ingests a substance that is broken down by H. pylori, leading to the release of a specific gas. The amount of this gas is then measured in the patient's breath, indicating the presence of the bacteria. Another diagnostic method is a blood test, which identifies the presence of specific antibodies produced by the immune system to fight H. pylori. Your G.P will mostly request a stool test, where a sample is collected and analyzed for the presence of H. pylori antigens or genetic material. Endoscopy may be required in certain cases, where a thin, flexible tube with a camera is inserted through the mouth to directly visualize the stomach lining and take biopsies for laboratory analysis. Accurate diagnosis of H. pylori infection is crucial in order to initiate targeted treatment and reduce the risk of complications.
Signs and Symptoms
This infection can cause several signs and symptoms, ranging from mild to severe. Many individuals with H. pylori do not experience any symptoms, but when they do occur, they may include persistent abdominal pain, particularly in the upper abdomen, bloating, nausea, and vomiting. In some cases, individuals may also experience a loss of appetite, unintentional weight loss, and a feeling of fullness after eating small amounts of food. Additionally, H. pylori infection can lead to the development of peptic ulcers, resulting in symptoms such as burning or gnawing pain in the stomach, indigestion, and dark, tarry stools.
Treatment
Fortunately, there are effective treatments available for H. pylori infection. The most common approach involves a combination therapy known as triple therapy. This treatment consists of a proton pump inhibitor (PPI) and two different antibiotics, taken together for a period of one to two weeks. The PPI reduces the stomach acid, creating a favorable environment for the antibiotics to work and eradicate the bacteria. In some cases, if the first-line therapy fails or the infection becomes resistant, doctors may recommend quadruple therapy, which adds a bismuth salt to the PPI and antibiotics. H. pylori treatment is essential to alleviate symptoms and prevent complications such as peptic ulcers or stomach cancer. Consulting a healthcare professional is crucial to determine the most suitable treatment plan based on individual circumstances.
Please remember…….
So next time you experience stomach discomfort, indigestion or even bloating that you cannot explain, it might be worth visiting your GP for a check up. At best it could be nothing, or could be an infection of H.Pylori or at worst it could be Stomach or Bowel Cancer. Know your normal and get checked if anything feels out of the ordinary. Do Not Delay.
The Wandering Nurse X !
ARE YOU GETTING YOUR VITAMIN D?
Did you know that the likelihood of you being deficient in Vitamin D is high if you are Black/Dark-Skinned, cover most of your skin when outdoors and live in the U.K?
Vitamin D is an essential nutrient for maintaining overall health and well-being. Its importance lies in its role in various bodily functions, such as maintaining strong bones and teeth, regulating the immune system, and promoting healthy cell growth and development. One of its most crucial functions is facilitating the absorption of calcium, a mineral vital for bone health. Without adequate levels of vitamin D, the body struggles to absorb calcium efficiently, leading to weakened bones and an increased risk of fractures and osteoporosis. Additionally, this sunshine vitamin plays a significant role in supporting a robust immune system, helping the body fight off infections and reducing the risk of chronic diseases. Given that natural sunlight is the primary source of vitamin D, ensuring sufficient levels of this nutrient is particularly crucial in regions with limited sunlight or during winter months when exposure to sunlight is reduced. Supplementing with vitamin D or consuming foods rich in this nutrient becomes essential in maintaining optimal health and preventing potential deficiencies.
Vitamin deficiency is a concern among people of all races and backgrounds, including Black individuals. Due to various factors, Black people may be more prone to certain vitamin deficiencies. For instance, melanin, the pigment that gives darker skin its color, can act as a barrier to absorbing sunlight, which is essential for the production of vitamin D. Consequently, Black individuals may be at a higher risk of vitamin D deficiency compared to their lighter-skinned counterparts. Additionally, certain cultural dietary preferences or restrictions may contribute to inadequate intake of vitamins such as vitamin B12 or iron. However, it is important to note that each individual is unique, and while there may be trends within racial groups, it is essential to consider individual variations and consult with healthcare professionals to address specific vitamin deficiencies in Black people.
Signs and Symptoms of Vitamin D Deficiency.
Did you know excessive sweating could be a sign of Vitamin D deficiency?
Vitamin D plays a crucial role in maintaining our overall health and well-being. However, vitamin D deficiency is becoming increasingly common, especially in areas with limited sunlight exposure. The signs and symptoms of this deficiency can vary from mild to severe. Fatigue, muscle weakness, and bone pain are common early indicators. People with low vitamin D levels may experience frequent infections and a weakened immune system. Additionally, depression, mood swings, and low mood can be attributed to inadequate vitamin D levels. In more severe cases, individuals may suffer from impaired wound healing, hair loss, and a higher risk of fractures. Recognizing these signs and symptoms is essential in order to promptly address and manage vitamin D deficiency.
Diagnosis.
Vitamin D deficiency is diagnosed through a combination of clinical examination, medical history assessment, and laboratory tests. During a clinical examination, healthcare professionals observe symptoms such as fatigue, muscle weakness, and bone pain, which may indicate a lack of vitamin D. They also take into account risk factors like limited sunlight exposure, obesity, or certain medical conditions. To confirm the diagnosis, blood tests are conducted to measure the levels of 25-hydroxyvitamin D, the active form of vitamin D, in the blood. These tests are considered the gold standard for diagnosing deficiency. Additionally, imaging tests such as X-rays or bone density scans like a Dexa Scan, may be performed to assess bone health and potential complications associated with vitamin D deficiency. The combination of thorough clinical evaluation, medical history review, and laboratory tests ensures an accurate diagnosis of vitamin D deficiency. The early detection of this deficiency plays a crucial role in initiating timely treatment and preventing long-term complications.
Prevention and Treatment.
Vitamin D deficiency is a common health issue that can lead to various complications if left untreated. To treat this deficiency, it is crucial to increase your exposure to sunlight, as sunlight is the primary source of vitamin D synthesis in the body. Spending around 10 to 15 minutes in the sun ( apply sunscreen after if you plan to stay longer and also avoid the sun between 11am to 3pm when it is at it’s strongest) at least two to three times a week can significantly assist in replenishing vitamin D levels. Additionally, incorporating foods that are naturally rich in vitamin D into your diet can be beneficial. These include fatty fish like salmon and mackerel, egg yolks, fortified dairy products, and certain mushrooms. In some cases, vitamin D supplements may be necessary, especially when sunlight exposure or dietary changes are not sufficient. However, it is important to consult with a healthcare professional before starting any supplementation to ensure appropriate dosages and monitor your progress.
So make sure you get enough Vitamin D, now that you know how vital it is to your health and well-being and talk to your doctor if you think you may have a deficiency.
Self-Swabbing Vs In-Person Smear Test: What's your choice?
Gynaecological cancers refer to the cancers that affect the female reproductive system such as the ovaries, uterus, cervix, fallopian tubes, vulva, and vagina. According to Eve Appeal, which is the U.K’s Gynaecological Cancer Research Charity, that raises awareness and funds research into the five common gynaecological cancers: Womb, Ovarian, Cervical, Vulval and Vaginal, there are over twenty two thousand new cases of gynaecological cancer every year in the U.K. Symptoms of gynaecological cancers may include pelvic and abdominal pain, bloating, abnormal vaginal bleeding, and changes in bowel habits. Early detection and treatment are crucial for the successful management of these cancers. Regular gynaecological screenings, including Pap tests and pelvic exams, can help detect these cancers in the early stages. Understanding the risks and symptoms associated with gynaecological cancers is important for all women to help prevent and manage these potentially life-threatening conditions.
Cervical screening, also known as a smear test, is an important preventative healthcare measure for women. The test involves taking a small sample of cells from the cervix to check for any abnormalities that could lead to cervical cancer. It is recommended that women aged between 25 and 64 years old should have a cervical screening every three to five years, depending on previous results, and those who are living with HIV should have one every year. Early detection of abnormal cells can lead to prompt treatment and a higher chance of successful outcomes. It is a simple and relatively quick procedure that can help to save lives, so it is important for all eligible women to participate in regular cervical screening.
Women in a park
There are two main types of cervical screening tests: the Pap test and the HPV test. The traditional Pap test involves collecting cells from the cervix and examining them under a microscope for any abnormal cells. This test can detect early signs of cervical cancer and is typically recommended for women aged 21 to 65. On the other hand, the HPV test checks for the presence of the human papillomavirus (HPV), which is the main cause of cervical cancer. This test can be done alone or in conjunction with a Pap test and is typically recommended for women aged 30 or older. It's important for women to discuss with their healthcare provider which type of screening is best for them and how often they should be screened.
Self swabbing tests have recently been introduced to allow women who would otherwise be uncomfortable with in-person tests or do not have time to attend in-person screening appointments. The self swabbing smear test is a much more convenient way to get checked for cervical cancer. Going for an in person smear test can be a daunting experience for some women. However, the self swabbing test can be done comfortably at home by following the instructions carefully. It also saves time and eliminates the need to visit a healthcare facility. On the other hand, an in person smear test is still necessary for some women, particularly those who may require additional medical attention or have difficulty performing the self swabbing test. Despite the slightly invasive nature of in person tests, they remain an essential part of women's health care, and they should never be ignored.
While i am all in favour of Self Swabbing for all the reasons listed above plus that it provides some sort of screening for those women who would have fallen through the cracks, i am still a firm believer in in-person smear tests because of the extra level of safety net it provides. Let me explain!
Woman sitting on couch
When i attend my smear test appointment ( which takes weeks of me psyching myself up), the nurse has a general conversation with me about how i am doing and if there have been any changes since my last smear test. Once i am lying down and in position and comfortable, she checks my vulva area for any changes, then feels for any swollen glands and once she is satisfied that everything looks healthy and alright, she inserts the speculum and continues with the smear test. Once all is done, i leave the appointment reassured that whilst i wait for my results, i am relaxed in the knowledge that my pelvic exam was otherwise normal and that i have no signs or symptoms of vulval cancer. But while in-person smear testing is my preferred choice of testing, i will leave you with the Pro and Cons of both, so that you can decide which one you would prefer, if not both.
Pros and Cons of Self-Swabbing Smear Test
Self-swabbing smear test is becoming more common as an alternative to the traditional method. There are pros and cons to consider when deciding whether to go for self-swabbing or not.
# Pros:
1. Less invasive - Self-swabbing test is less invasive because women do not require insertion of the speculum. This makes the procedure more comfortable for some women.
2. More privacy - Self-swabbing smear test allows women to perform the test in the privacy of their own homes. This enables women who find the traditional smear test embarrassing to have the test without feeling embarrassed.
3. Convenient - Women do not need to book an appointment or visit a clinic for a self-swabbing smear test. The self-swab can be done at home at a convenient time.
4. Cost-effective - Self-swabbing smear tests are usually cheaper than the traditional smear tests performed by medical professionals. This makes it a more affordable option for women who may not be able to afford the regular smear test fees.
# Cons:
1. Potential for inaccurate results - Self-swabbing may not be as accurate as the traditional smear test because the sample could be contaminated or insufficient,
Pros and Cons of In-person Smear Test
# Pros
Accuracy: In-person smear tests are generally more accurate than at-home tests.
Thoroughness: A healthcare professional can perform a more thorough exam during an in-person smear test.
Immediate Results: Depending on the facility, results can be available immediately after the test is performed.
Availability of Follow-up Care: If any abnormalities are detected, the healthcare professional can offer follow-up care or referrals for treatment.
Experienced Medical Professionals: The healthcare professional performing the test has undergone training and has experience in performing smear tests.
# Cons
Discomfort and Pain: For some individuals, smear tests can be uncomfortable or even painful.
Embarrassment or Shame: There may be cultural or personal barriers that make the test cumbersome or shameful to undergo.
Time and Effort: An in-person smear test requires scheduling an appointment and taking time out of one's day to travel to the facility.
So whichever method you choose, just remember that early detection saves lives and it is important to have your screening done when invited to have one.
Is that Decongestant killing you?
It has been a rough couple of weeks, maybe months since the start of winter. it seems everywhere you turn, it is all coughs and colds and sniffles and if you have not come down with it then you must be very lucky. Now as winter comes to an end and you think the sniffles are all behind you, you remember that spring is on the way and hello Hayfever!
The one thing we can always count on are the cold and flu medication and nasal sprays to help clear up our sinuses so that we can breath better. It is always the assumption that if you can buy it over the counter, without a prescription then it should be safe, so we rarely read the patient leaflets that come with the remedies we take. So it would surprise you to know that while that medicine might be helping you to breathe better, the decongestant it contains, might be trying to kill you!
Most cold and flu remedies like Lemsip or Sudafed or own store brands, contain decongestants like ,pseudoephedrine, ephedrine, phenylephrine, naphazoline and oxymetazoline, that are a type of medicine that provide short-term relief to a stuffy or blocked nose, by narrowing blood vessels and reducing swelling inside the nose, which in turn leads to opening of your airways. This can also cause other blood vessels to narrow which in turn could raise your blood pressure which would be dangerous if you already suffer from high blood pressure.
So while decongestants can safely be taken, you should be cautious and most probably avoid them or seek medical advice before taking any medicines that contain them if you suffer from:
Diabetes
Kidney problems
Heart, Liver and circulatory problems
Enlarged prostate
High Blood Pressure
Hyperthyroidism
Glaucoma
All is not lost, as there are cold and flu remedies out there that do not contain decongestants and can be safely taken by those who suffer with high blood pressure, plus saline nasal sprays are also great at flushing your sinuses.
Stay safe and always read the label/patient leaflet before buying or taking any over the counter medication.
The Wandering Nurse. x
Useful Links:
https://www.nhs.uk/conditions/decongestants/
https://www.health.harvard.edu/heart-health/dont-let-decongestants-squeeze-your-heart
Pulse Oximeters and the issue of Skin Colour: A PATIENT SAFETY ISSUE!
It is 2023 and years after the issue of bias in readings when it comes pulse oximeters and Black Skin was first raised, it has still not been fixed, leading to harm being caused to Black patients due to incorrect readings that lead to delayed or improper treatment.
“Since the start of the pandemic, the popular medical device has been indispensable for measuring oxygen in the blood, but dangerously inaccurate in patients with darker skin. Now the FDA is in the hot seat and Black researchers are working on a cure”.- Forbes
According to a recent article in Forbes by Amy Feldman , in one year alone, 11 hospitals in and around Baltimore had sent home 1,012 Black patients who had dangerously low, life threatening, low oxygen levels despite having normal readings on Pulse Oximeters! That alone should send shivers down our spines if you look at the numbers globally, since these devices are used worldwide.
This is even more shocking given that during the pandemic ( which is still ongoing, with long lasting effects), people were encouraged to buy pulse oximeters and keep them at home, as a safety measure, because it was found that one indication of deteriorating health, despite one feeling well, was a low oxygen saturation level. But we have since found out that, they give false readings when it comes to those of us with darker skin!
Although the article focuses on the American population and their own regulatory bodies i.e the FDA, this has far reaching implications for patients everywhere, even here in the U.K, given that these devices are used in every hospital and around peoples homes and also the fact that the UK government is moving healthcare to the home via ‘Virtual Wards’ , which rely on data produced by these devices and others linked to phones or smart watches. If the bias in reading is not fixed, then i fear that more harm will be caused to a population that is already bearing the brunt of medical racism! We have not even touched on Clinical Research Trials!
While some manufactures are tweaking their devices to correct this huge, life threatening anomaly, there is still a danger posed by pulse oximeters that are manufactured abroad and sold online on sites like Amazon and online stores with the danger being that they have not passed rigorous testing and approval by regulatory bodies like the FDA in America and the Medicines and Healthcare products Regulatory Agency (MHRA) here in the UK.
I hope that the MHRA will follow their American counterparts in holding the manufactures of these devices to account and also protect the public from defective, life threatening pulse oximeters that are sold online and in stores, by allowing only tested, regulated and licensed pulse Oximeters, to be used in all clinical settings ( Research Included), as well as in our homes( with regards to those purchased online).
We should not be harmed or worse still, die because of the Colour of our SKIN!
Research and US: Changing the narrative!
Using Research to Advocate for your Healthcare and Treatment.
Thanks to research, we now know that Black men, women and children and other people of colour are disproportionately affected by diseases such as cancer, high blood pressure, diabetes and women’s health just to name a few in comparison to their white counterparts. Research has laid bare the stark health inequalities that plague our communities, raising much needed awareness and prompting questions as to how these inequalities came about and how the gaps could be bridged if not closed!
For some reason, these pieces and articles of research are wielded out and about by the government and doctors surgeries when there are relevant campaigns that suit their current agendas at that particular time, like a window dressing of sorts or a way to gaslight the already disadvantaged that it is up to them, they need to take more care of their health so as not to end up as part of the statistics that are quoted in the research articles. “Get screened, recognise the signs and symptoms, tell your doctor if you feel that there is something wrong”- we have all had the above and the powers that be, are aware of these statistics and disparities, then why is it still so damned hard to get the treatment that one deserves, especially as a woman, a Black woman?
Let’s use uterine fibroids as an example, according to the NHS website (link at the end), fibroids develop more frequently in women of African-Caribbean descent, but it can takes years for them to access treatment with symptoms that include but are not limited to: heavy and or painful periods, abdominal pain, lower back pain, pain and or discomfort during sex, the increased urge to urinate and constipation. Black women, myself included, who have presented with the above list of symptoms at the G.P are more than often ignored or fobbed off despite research pointing to the high prevalence of uterine fibriods amongst Black women and this has led to prolonged unnecessary suffering with detrimental effects on Black women’s health and wellbeing.
Using knowledge and research to advocate for one's health and treatment is definitely a form of self-care, i have come to realise. It may mean that you get labelled as a ‘problem patient’ because of how hard to may have to fight to get the treatment you deserve( we are hopeful that somewhere down the long line, this fighting for appropriate treatment, will no longer be necessary, but until then, be battle ready!).
So gather as well as note down:
all your symptoms, start dates, what makes them worse or better
how many times if any you have sort medical advice and what was said/recommended, what remedies, medication you have tried/used
any family history/ family member who has or had same symptoms
What information/research is out there as pertains to your symptoms especially as a Black man/woman or child
what treatment/management plans are out there/recommended and which ones are specifically/ proven or shown to work for or on Black people
G.P appointments are notoriously short and the planning above helps make those allocated ten minutes count. Take someone with you if you can and most important of all, always ask for a differential diagnosis and management plan, that way you start a conversation around ‘if it is not what i know it is then what else do you think it could be and how do we( you and the doctor) tackle it’?
It is great that there are a lot of articles both research and lived experiences about health inequalities in relation to Black and other minorities as well as specifically ones on Black Women and while much still needs to be done, like increasing diversity in terms of more Black people and women in research trials, we can still use what we currently have to help advocate for our health and treatment and in the process keep the focus on reducing and eventually eliminating all forms of health inequalities.
Further Reading:
NHS Website: https://www.nhs.uk/conditions/fibroids/
Huffington Post: https://www.huffingtonpost.co.uk/entry/what-are-fibroids-black-women-diagnosis_uk_618d0ec8e4b0b1aee92199ea
Refinery29: https://www.refinery29.com/en-gb/fibroids-symptoms-causes-treatment
Kings Fund Organisation: https://www.kingsfund.org.uk/publications/what-are-health-inequalities
How do you want to DIE?
Death, be it our own or a loved ones is something that causes a profound sense of loss to those that are close to us and can raise lots of questions and evoke emotions like guilt: How did they die? did they plan their death? Did we respect their wishes? How do i want my death to be?
As a society, and here i mean the British society, we tend to shy away from talking about death and dying.
We have compiled some information from two great Doctors about death and dying to get the conversation going and to make talking about death and dying less of a taboo but a part of normal life conversation.
Dr Kathryn Mannix is a Retired palliative care doctor. Writer: 'With the End in Mind', 'Listen.' Wants us to understanding dying more, fear it less, listen better.
Below is a powerful piece by her where she talks about dying and why we need to talk about death and dying.
Dr Linda Dykes also talks about the importance of having that conversation about CPR and how it is you want to die?
“CPR is not a treatment for #ordinarydying. Every instance of futile CPR - which is what will happen if nobody has sorted out the protection of a DNACPR for someone whose life is coming to an end - is a tragedy. Please, doctors, nurses, patients, families - #havetheconversation.”
Finally it is Spring 💃🏾! It is also HAYFEVER season 🤧 😫 😭!
I for one, am looking forward to Spring, sunshine and not having to turn on the heating while constantly staring at the gas meter wondering how i am going to afford to pay for it all! The only problem i have is that i suffer from bad hayfever and spring really is not my friend. The crusty eyes, constant sneezing are a pain and having to use my nasal spray, eye drops and antihistamine tablets are just some of the ways to survive pollen season, which seems to start earlier and earlier every year!
A sunny spring day.
Seasonal allergic rhinitis commonly known as hay-fever, can be disruptive to ones quality of life and if you are one who finds this time of the year miserable with a huge negative effect on you life, limiting what you are able to do, then you can be reassured that help is at hand.
Your GP/Doctor can refer you to an allergy specialist who will take a thorough history from you about(not an exhaustive list):
Your symptoms and when to they start/get worse/better?
How long you have had the symptoms for?
any medication you take/use to relieve the symptoms?
any other illnesses you may have?
any other relevant history?
A comprehensive history helps to narrow down what are the likely causes of your allergies and is used alongside Skin Prick Testing to the specific allergens to confirm or rule out the Doctors suspicions.
Aeroallergens are commonly tested for and these could include and are not limited to:
Timothy Grass
Silver Birch
House dust mite
Aspergillus
6 Grasses
3 Trees
Skin Prick Testing Allergen Solutions.
Once your clinician has decided what tests need to be done, an appointment is then made to come to clinic. You would normally be advised to stop taking any antihistamines at least 5 days before you Skin Prick Test appointment. This is because, antihistamines can mask your reactions to the allergens being tested and hence the results would be skewed. It is also important to note that allergy testing is NEVER 100% conclusive. You may also have a blood test to look for sensitization to the suspected allergens.
A sample of a skin prick test request form.
The testing procedure involves using a drop of allergen solutions applied to your skin in a grid like fashion and then using a lancet to prick your skin lightly do introduce the solution into your skin and illicit a reaction which is then observed and interpreted after 15 minutes. A negative solution( saline) and positive solution(histamine) are used a controls.
Skin prick test allergen solutions laid out with lancets ready for testing.
Below is a sample test i conducted on myself and you can see from the wheals and redness which allergens are responsible for my hayfever! It also shows how the test and subsequent reactions show on dark skin as most images around are of white skin.
Your clinician would then collate and review all your results and advise as to which i the best course of action treatment wise for you. Available treatments depending on the severity of your symptoms and recommendation from your clinician could be:
Higher dose of antihistamines or changing the antihistamines you currently use.
Steroid Nasal sprays.
Immunotherapy.
So, you don’t have to suffer, help is out there. If you are currently using a nasal spray, please see below on how to use one correctly to help gain maximum benefits.
Correct Nasal Spray Technique.
The 5 Moments for Hand Hygiene.
Hand Hygiene practice is the simplest and most effective way of preventing infections.
The 5 moments for Hand Hygiene at the point of patient care, as adapted from the WHO Alliance for Patient Safety 2006 are:
1- Before patient contact
2- Before a clean/aseptic procedure
3- After body fluid exposure risk
4- After patient contact
5- After contact with patient surroundings
As a patient, you are well within your rights to question your Healthcare provider/ carer about hand hygiene.
Advocating for your Health.
Tips on how to be your own health advocate.
“Health is wealth”, as the saying goes and when your health is not right, you are not feeling yourself, you look to the experts to help you make sense of what is wrong and how they can help you get better. More often than not, it takes several attempts/ appointments for you to even be listened to, let alone get the treatment you need. This is a scenario that Black people, especially Black Women are familiar with and can make an already worrying and anxious situation even more frustrating.
We are going to share some tips below on how you can advocate for your own health and in some way help you take charge of your health/treatment.
Health Advocates take control of their health care experience. You and your doctors make decisions as a team. You speak up with your questions, needs, concerns, and preferences. Webmed.
1) Keep a Symptom Diary.
If you are anything like me, by the time you rock up to a doctors surgery or pick up the phone to call your GP, you have suffered for awhile and have tried all sorts to get better but you have now reached a stage where you have now acknowledged that something is indeed wrong and that none of your self treatment options are working and you need help! Problem is your Doctor/ healthcare provider doesn’t know that and will base their opinions or treatment options on whatever you are most likely presenting with at the appointment, which always happens to fall when you are relatively well and symptom free! To help your doctor/healthcare provider make sense of what is happening, it helps to have a clear picture of sorts, hence a symptom diary would be of help to them and you as well. It shows a pattern.
How did it start?
possible triggers
what makes it better or worse?
what treatments have you had self and prescribed?
It would also be a good idea to know your medical/ surgical history if any and any allergies you might have as this is not always recorded correctly or might be missing from your medical notes. In short: KNOW YOUR BODY.
2) Research.
Are your symptoms unique to you or is there a family history of the same? Ask family members, they may tell you about an aunt or grandmother etc who had the same complaints as you. Some illness are hereditary/genetic and knowing your family history can be of great help, including treatment options that they had if any and at what age(s) their symptoms/illness started and outcomes. This can help speed up treatment options/ referrals.
Treatment options that are out there/ available on the NHS and which ones you prefer, also who are the specialists and where they are located because some illness are rare and not all hospitals have a specialist or a dedicated treatment center. It also helps to know what help in terms of support is out there in the community, like support groups, charities and how you can access them if you need to. They can help you navigate timelines by providing more information like how long it takes to see a doctor , get a referral and test times and what is involved.
3) Ask Questions.
Don’t be afraid to ask questions, for example: about your illness, treatment options, if you do not understand what is being said, during your appointment. If you think you might be overwhelmed and not remember what you need to ask, you can write them done prior to your appointment or take a trusted family member or friend who can ask on your behalf or remind you. If English is not your first language and you need the information in your native language, let the doctor/healthcare provider know.
4) Keep Records.
While we may have one healthcare system, The NHS, the various parts of the system rarely talk to each other, let alone use one central system. Which means your hospital records and what is contained in them varies from one part of the hospital/ specialty to different NHS Trusts and are completely separate to your G.P records. This can be very confusing and frustrating when you finding yourself having to explain, recall and recount your medical history, tests and referrals each time from memory. Keeping a record of all your hospital appointments, times, specialist names, tests, results, basically anything and everything will help ensure that nothing is missed and that you have a clear timeline and record that you can refer to each time.
5) Know when you need a second opinion.
Get a second opinion when you feel like your concerns are not being listened to or that you are not being taken seriously and are being fobbed off. You will know when the doctor or healthcare provider does not seem interested in what you are saying or your experiences and tries to hurry you along or not allow you to ask questions or seems to dismiss your questions. You may not be a medical expert but you are an expert on your own body and if something doesn’t feel right then it probably isn’t.
The medical community has a long way to go when it comes to believing women about their health - Meredith Fineman.
Here is a link to an interesting article and we hope the tips above help. Let us know in the comments.
https://www.shondaland.com/live/body/a19878029/how-to-advocate-for-your-health/
Black and Menopause
Talking about being Black and Menopausal
Karen Authur on World Menopause Day
Today is World menopause day and we would like to bring you the brilliant work done by Karen Authur on raising issues around black menopause experience. She has a podcast where she talks all things black menopause with useful resources. You can follow her on her social media pages- Instagram: @menopausewhilstblack
And also link up to her linktr.ee:
https://linktr.ee/menopausewhilstblack
@thekarenarthur
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Happy #WorldMenopauseDay
Image first posted two years ago. I was sick of not seeing diversity in the Menopause space. Plus I was tired of the same old 'Menopause is the end of life woe is me head in hands BS' tbh. Yes it can be shit. But that's often because we're not ready or prepared . We're not talking across generations. The medical profession are woefully under educated and society is constantly trying to silence older women. Don't get me started on what the world does to black women.
Anyway we're not having that any more are we loves?
We're two years on and much has changed culturally including new podcasts like mine @menopausewhilstblack with 2 seasons of honest knowledge centring the black British experience, new pod @blkmenobeyond and spaces like @mamm20_20 @blackwomeninmenopause and more.
Plus @davinamccall honesty in @muirka #SexMythsAndTheMenopause which blew viewing expectations out of the water, @themenocharity launched AND #CarolynHarrisMP will be speaking on dropping UK prescription charges for HRT (hormone replacement therapy) as well as mandatory menopause education for schools and colleges and workplace policies. There's a rally on the 29th October at 11.30am in Parliament Square, Londonium. If you can, come!
I'm thrilled to say that the UK seems to be leading the charge when it comes to discussion around menopause. But we still have a LOT to do.
This is an exciting time to be alive and kicking ass! I'm proud to be part of the generation to finally #MakeMenopauseMatter
Join us!
@dianedanzebrink Petition link is in my stories. Read more there. Then Sign it if you haven't and Share it with EVERYONE. Menopause is a GLOBAL, DIVERSE conversation!
I dun.
Peace xx
[Image description; Happy carefree older black woman laughs. White ombre text reads 'October 18th.World Menopause Day .Embrace the Change! "]
#MenopauseWhilstBlack
#MakeMenopauseDiverse
#BlackWomenInMenopause
Black Women and Breast Cancer: raising awareness through patient stories
Black women are twice as likely to be diagnosed with advanced breast cancer in comparison to white women.
NHS England and NHS Improvement feature Leicia’s story about breast cancer. Click on the link below to read more about it from their instagram page.
'Black women are twice as likely to be diagnosed with advanced breast cancer in comparison to white women. This #BreastCancerAwarenessMonth and #BlackHistoryMonth, I want to share my story to help raise awareness.' Read Leicia's story in full. https://instagram.com/p/CU7Fyn0jfUo/
Is a lack of trust and faith in the healthcare system killing your patient?
A Case Study:
Patient A died at the age of 46 from pneumonia which was as a result of complications brought on by diabetes. By the time she presented to hospital and was diagnosed with type 2 diabetes, she was in a coma and major organ damage had ensued.
Her medical history, sparse as it was, made no mention of diabetes and there was no family history of diabetes. She had been to see a doctor about aches and pains in her limbs which she had put down to arthritis but this had not been professionally diagnosed by a doctor. It was also noted that she wore spectacles , citing old age for lack of 20/20 vision. So how was it that at 46 she was dead as a result of diabetic complications? A disease she did not have as per her medical history! Had she been aware that she had type 2 diabetes? if she did, why had she not sort treatment earlier? To answer some these questions we have to go back a couple of years.
At the age of 41, patient A, a mother of 6 had left her abusive marriage after years of domestic violence that often ended up in broken bones and various bumps and bruises. She tried various business ventures to make ends meet and eventually, two years before her death she worked for her sister managing her sisters chemist. She would complain of joint pains and would often be prescribed Indomethacin ( Indocid ), a non steroidal anti-inflammatory by her doctor to help with the pains which she often referred to as arthritis. Working in a chemist gave her access to medicines and also one of her other sisters worked at a major chemist in town and would supply medicine to their sisters chemist as well. She would alternate her indocid with prednisolone and because she was not on any prescribed regime for prednisolone, her dosage depended on how much pain and discomfort she was experiencing at one given time with no formal medical over site or supervision.
It wasn’t long before she started having problems with her vision, which she put down to old age and resulted in her sister getting her a pair of spectacles from the local mission hospital. Then came the feeling of pins and needles in her legs which would result in her screaming with pain especially when she was soaking her legs after a full day of standing up at work. This was also put down to arthritis. She started experiencing what looked like restless leg syndrome which then progressed to full fits which ended in urine incontinence. The seriousness of this latest incident was what landed her in hospital attached to a drip of intravenous glucose which made her go unconscious and had to be rushed to intensive care unit where upon tests being done it was found that her blood glucose was very high and she was in a diabetic coma. It turns out she had developed steroid induced type 2 diabetes with extensive organ damage. Although she came out of the coma, she died two weeks later.
According to diabetes.org.uk, type 2 diabetes is still a silent killer as most people( a whooping 56%) are not aware they have the disease let alone know the symptoms and that most have been diagnosed by accident when they were being treated for other conditions or undergoing certain tests. Late diagnosis leaves patients open to developing serious complications like blindness, amputations, strokes, kidney disease and heart disease.
People of Black African ethnicity are three times more likely to develop type 2 diabetes than people of White European Ethnicity. It would be interesting to know out of those diagnosed, what factors were in play that lead to the diagnosis? The above scenario is an extreme example of what can happen when patients self medicate without medical supervision and ignore health symptoms. while it did not occur in the U.K, that is not to say that such can not happen here in the U.K. That is because while we have a free healthcare system, the NHS, most black people do not engage with services and are more reluctant to seek their doctors/ healthcare professionals or medical help due to previous bad experiences that they may have had or heard about. The issue of racism and two tier system within the NHS is a very real and ongoing issue that has put off black people from engaging meaningfully with any healthcare services especially screening services. As i have mentioned in earlier blog posts, most Black Africans would rather seek medical advice and treatment from their country of origin. One because they trust their own people and also you can buy almost any medication over the counter making it easier to stock up just in case you need medication to treat an ailment that would require you to navigate the healthcare system as a black person in the U.K which has been established as a barrier in itself.
Coming from Kenya I have personally experienced the worry and terror of family members and friends who stock up on all sorts of medication so that they can be ready to treat themselves before the NHS kills them! Stories of people suffering in side rooms and even dying from malaria because it was not diagnosed quickly enough as they were thought to be contagious have been doing the rounds for years not to mention the time and effort it takes to even get an appointment to be seen by a doctor only for your concerns to be fobbed off and not taken seriously, have led to a lot of mistrust of the healthcare system as a whole because as i have explained before in previous posts, going to see a doctor or even admitting that you need professional help is a big thing in African culture, it is an indication that things are serious and that all their tried and tested methods have failed.
It would be interesting to find out how many Black patients are registered with G.Ps and how many actually engage with their G.P practices? Of those who have been diagnosed with type 2 diabetes, high blood pressure or any other serious illness, how many were found accidentally during routine check up or were as a result of referrals after ending up in A&E? There is a lot that needs to be done to earn the trust and faith of Black patients and before that happens we might just end up with a scenario( if we have not already) like the one in the case study above!
While we wait for the the system to be changed and until we as black people trust, have faith and feel safe within the healthcare system, we can take steps to continue looking after our health in a safe way and using our voices and stories to highlight the health inequalities and disparities that exist in our communities, So what is steroid induced diabetes?
Long-term use of steroids like predisolone can cause diabetes but it is treatable and usually goes away once course of steroids is completed but sometimes it can lead to type 2 diabetes especially if the use of steroids has been long-term. This is because steroids can increase your blood sugar levels by:
causing the liver to release more glucose.
reduce your bodies sensitivity to insulin.
stop the absorption of glucose from the body by muscle and fat cells.
You are more at risk of developing steroid induced diabetes if:
you are of African- Caribbean, Black African or South Asian descent. and are over 25 years of age.
Have a close family member with type 2 diabetes
have high blood pressure
are living with obesity.
Self medicating with steroids is dangerous and should be avoided as you just might be killing yourself! Instead:
Only use steroids as and when prescribed and always inform your doctor or healthcare professional of any other medication you might be taking.
Do not ignore any health concern no matter how small. Make use of walk in centres and pharmacies especially when they offer free blood pressure checks and free blood glucose checks.
It is a good idea to get regular eye checks especially as we are on screens most of the time. an eye check can reveal a lot about your health status.
Check out diabetes.org.uk for more information about diabetes, especially type 2 diabetes. you can also find information on the nhs website at: https://www.nhs.uk/conditions/type-2-diabetes/
SOURCES:
www.diabetes.org.uk
www.nhs.uk
www.lupus.org
September is Gynaecological Awareness Month!
Raising awareness of Gynaecological Cancer.
According to a civil service blog on Gov.uk, there are more inequalities in Cancer morbidity and mortality amongst black women, despite equal access to the National health Service(NHS) .
Cervical cancer remains the commonest cancer amongst women under the age of 35 and posses a greater risk of death in Black Women over the age of 65 despite being preventable by upto 80% via screening according to studies done by Dr Ekechi, a London based Obstetrician and Gynaecologist, one on behalf of the Jo Cervical Cancer Trust. She also highlights the fact that deaths from endometrial cancer are highest in Black Women, a statistic also backed by a study by the in the American Journal of Obstetrics and Gynaecology who suggest that this is the case because Black Women are less likely than White Women to receive an early diagnosis!
So why are Black Women more likely to die from cancer? according to a study done by the Department of Obstetrics and Gynaecology at University of Washington, some of the reasons are:
the inability to get an early diagnosis
Doctors are more likely to view black patients as medically uncooperative and that diagnosis and treatment decisions are influenced by race.
Lack of confidence by Black Women in the healthcare system due to difficult episodes and not being believed when they present with symptoms
Below are links to articles and organisations like The Eve Appeal that aim to address these issues and raise awareness about cancer and the black woman.
1)BAME women are let down by the health system – nowhere more so than in gynaecological health: https://www.google.com/amp/s/inews.co.uk/opinion/comment/bame-women-are-let-down-by-the-health-system-nowhere-more-so-than-in-gynaecological-health-288985/amp
2) Breaking Down the Taboos: Lifting the Lid off Cancer in BAME Communities: https://civilservice.blog.gov.uk/2020/10/19/breaking-down-the-taboos-lifting-the-lid-off-cancer-in-bame-communities/
3) Ciara’s Mega Mission: Stopping Cervical Cancer In Black Women: https://www.forbes.com/sites/lipiroy/2021/07/02/ciaras-mega-mission-stopping-cervical-cancer-in-black-women/
4) Gynaecological Cancers: https://eveappeal.org.uk/gynaecological-cancers/
5) One Type of Cancer is Killing Black Women at Record-High Rates: https://obgyn.uw.edu/news/one-type-cancer-killing-black-women-record-high-rates
Racial Profiling and Preconceived Notions in Healthcare in relation to Patient Care and Safety.
Racial profiling in hospitals is a patient safety issue.
Television programmes be they soaps or american medical shows, have always played a part in highlighting topical issues that are occurring in society in a more relatable way to the general public. We have seen EastEnders tackle issues around cancer, sexual consent and rape culture, schizophrenia, New Amsterdam and the opioid crisis, just to mention a few. Medical firsts have also been premiered in television medical shows and later we have been made aware of real life stories of those who have undergone these pioneering procedures.
The issue of race and its influence on healthcare provision and access is now coming to the forefront, especially after the Black Lives Matter protests and the healthcare disparities that have been laid bare by the Covid19 pandemic. This has come as no surprise to most BME patients and healthcare workers who have long known about these issues, raised concerns about them only to have nothing done to address them with business carrying on as usual.
The Good Doctor is an american television medical show, that in one of their recent episodes( season 4, episode 9), dealt with the issue of racial profiling in current medicine practice as well as forcing one of their resident doctors to take a hard look inwardly and confront their own preconceived notions. Claire, the doctor in question had been called to the emergency room to attend to a patient who happened to be a black woman who had experienced a cardiac event. Zara, the patient was on anti-hypertensive medication and was insistent that she was taking them as prescribed and had even brought them along with her, only in the confusion, she couldn't find which pocket she had placed them in. Claire on the other hand considered Zara ‘loud and messy’ and did not believe that she was compliant with taking her medication(which Zara did find eventually).Instead she used a pattern- processing technique that she had learnt in medical school which supported her case that ‘loud and messy’ black people always lied about their compliance and went ahead and administered an ACE inhibitor to try bring down Zara’s blood pressure which in turn led to complications with Zara needing open heart surgery as a result! Zara later learns of Claire’s assumptions based on racial profiling, requests that she is taken of her case and later confronts Claire , who feels afronted that she would be considered racist! You see, Claire was a black doctor, who had based her assumptions on her own experiences of being racially profiled and constantly having to prove herself to get to where she was and ‘loud and messy’ Zara was everything she was trying not to be so as to fit in a predominantly white environment. This was also the experience of a fellow non white doctor. Basically, they had to check their blackness at the door. How many times as a black nurse or patient have you been required to or felt the need to “check your blackness at the door” for you to get where you need to be or treatment. I know i have and this episode got me reflecting on instances during my work where racial profiling and or preconceived notions has been at play and where it has been framed as ‘the problem patient’ and my role if any in those scenarios.
Working on an acute medical ward, especially if it is a short stay one, you get to see familiar faces often in terms of patients and at times predictions can be made as to when they are likely to come back. These predictions could be based on certain trends illnesses take based on weather patterns and seasons and others are based on compliance and social issues. This is common amongst patients living with long term conditions, who more often than not have borne the brunt of cuts in services, speciality ward closures which in turn means they are in hospital more times than they would like.
Working on one such ward, we often had patients who had come in after a flare up of their conditions and subsequently admitted to the short stay unit. One such group of patients were those who suffered from sickle cell disease, a young demographic, who were trying to live their lives the best way they knew how. Somehow these patients had been labelled as problem patients, so much so that as soon as you walked through the door on your way to handover, you would be briefed on how many had been admitted or were on their way to the unit. One particular patient, got double the warnings and lookout calls from management. All this was because of pain management , what the doctors and nurses thought was best for the patients( little or no opiods) and what the patients rightly so argued was not working for them( lack of opiods or hostility towards them when opiods are requested). The scene as usual was set, the nurses and doctors caring for these patients already on the defensive and on the lookout, tensions palpable waiting for the so called problem patients. The patients on the other hand are also on the defensive and know that they have to fight again to get the pain relief and care that they deserved. This was a constant, ongoing scenario and we were more often than not so caught up in the battle of wits that we forgot to see the patient, the person behind the label. Yes we doled out care and medicines as prescribed, ticked the required boxes, freed up beds as fast as they were needed, often under very stressful and pressurised conditions not to mention short staffed. Care became automated, assembly line like.
Several studies have now shown that there is a great racial bias in pain assessment and management when it comes to black patients. Black patients, like these sickle cell patients are systematically under-treated for pain, especially when it comes to getting an opiod prescription. This was compounded by the fact that almost all speciality wards had been axed and closed across NHS trusts, where they would have received specialised care from a team that understood their disease process. Instead they were sent into a system that although provided care, it was care that was conditional and didn't meet their needs at best and was combatative at worst.
Years later, working within a specialist clinic, I had the chance to interact with one of the patients who had been labelled as doubly problematic when I was on the wards, from management to staff on the ground. The difference this time was that the management I worked under were aware and against the bad reputation this particular patient had been given all over the hospital and always made a point of mentioning the fact that, the patient was a young person, who was living their life despite their long term condition and the many complications( medically and socially) that came with it. In other words he made sure we saw the person behind the condition and focused on the person. He re-framed the equation from ‘problem patient’ to a person dealing with a ‘problem condition’. This re-framing made a whole world of difference. You saw the young person who throughout their life has had to live and learn to cope with their disease. They have had to advocate and mostly fight to get heard and get the care they deserve. Often they have been dismissed and inorder to prove their case have had to question and record each and every aspect of their care in the midst of being labelled ‘probelematic’. They were just trying to survive, live and not to be consumed nor defined by their illness, colour of their skin or their socio-economic status.
The system is not perfect, no system ever is but we can strive to make it fair. If we are aware of our own and others preconceived notions and challenge them instead of buying into them because it is easier and or helps us fit in, be part of the gang then we are one step closer to creating a fairer system, if not an almost perfect one.
The Unofficial Guide to Nursing while BLACK: An Ebook.
Racism in the NHS and other organisations is still an ongoing issue that has been highlighted by the recent black lives matter movement as well as the COVID19 pandemic. It is also great that more and more people are coming out and being vocal about it and calling for change which in my opinion is way overdue. I am also encouraged by the younger generation who are coming up the ranks and calling out incidences of racism and inappropriate behaviour. While all this is good and looks like we are heading in the right direction with regards to stamping out racism within and without the NHS, we must not lose sight of the fact that there are colleagues who are living this sad reality at this moment any given day up and down the country with serious consequences for their lives, livelihoods, health and family life and it can be a very lonely and frustrating place to be in.
The COVID19 pandemic and the Black Lives Matter movement have highlighted the issue of continued racism within the NHS and the wider work community. A number of recent studies have shown that black people still face alot of racism and job discrimination in the United Kingdom(U.K). Indeed a disproportionate number of Black, Asian and Minority Ethnic(BAME) nurses and midwives get referred to the Nursing and Midwifery Council (NMC) by their employers as opposed to their White counterparts, this is according to findings published by the NMC of their - Equality, Diversity and Inclusion research⁴ with the NMC not faring any better in dealing with racism within its organisation and in how it deals with the findings that a disproportionate amount of BAME nurses are referred to them under fitness to practice. It is disheartening and plainly unbelievable that in 2021 we are still talking about race and racism and that as a black nurse, indeed a black worker anywhere, i have to put in three times the effort, triple check my work and be in constant awareness of systems and regulations that in some instances sorely exist to trip me up. It is frankly exhausting but until change comes and I would like to believe that it will come, we still have to be on our guard, double up and prove ourselves over and over again. In this unofficial guide, I aim to pass on some of the gems I have learned and have been passed on over the years in what I call the extreme sport of nursing while black, in the hope that it will help my fellow Black Nurses navigate their workplaces, maybe even the playing field a little bit while we wait for changes to take place within and without our workplaces.
There are brilliant people out there who are voicing their concerns and shaking up the status quo. Silence is no longer an option. We must make our voices heard. Dr Maya Angelou sums it up beautifully in this quote below.
“When you know you are of worth - not asking it but knowing it - you walk into a room with a particular power” - Dr Maya Angelou.
World Elder Abuse Awareness Day
Raising awareness this World Elder Abuse Awareness Day.
Help raise awareness and stop Elder Abuse this World Elder Abuse Awareness Day. To mark the Day, The World Health Organisation ( WHO ) has produced some handy information to help raise awareness. Find out more at:
https://www.who.int/en/news-room/fact-sheets/detail/elder-abuse
Racism and Inherent Bias in Health: A Patient Safety Issue? Navigating healthcare while Black: Part 2
Snap shot of racism issues raised in the last few weeks.
Growing up, going to hospital was a very serious affair. It often meant that one was very sick or that something was very wrong. You would often get people going to visit relatives or friends to check on them because they heard they had gone to hospital. I have often joked that we Africans only seek medical help or go to hospital when we are dying ie when things are serious! Other times we relied on herbal medicines and remedies or over the counter medication and just got on with life. I had not realised that this ideology was deeply rooted in myself, why go to hospital when a paracetamol here, an ibuprofen there, a little Vix/Rob could help ease the pain, plus there are more sick people in the world and so long as the pain was bearable, life went on. In fact I took pride in the fact that i was not a frequent visitor to the GP and surely that alone must have earned me brownie points and that if I finally came in for a consult they would look at my records and see that I had not been in to see them for near on 11 years and that for me to have come in, means things were serious- the dying African analogy thing! I mean my work sickness records matched my not visiting GP records, if that earned you brownie points at work surely it applied to my GP as well? How deluded i was! But before i explain my delusion and crash to earth moment, i need to highlight another issue that in my opinion is a huge determinant in the quality of healthcare we receive as Black and marginalised communities. These are my observations and experiences through the years and by sharing them i hope i start a conversation where we as individuals can look within ourselves and check our biases and maybe we can understand that sometimes the system is stacked against certain individuals making them invisible and that by the time they become visible, it is not because they were neglectful with their own health or that they did not try hard enough, it just got too exhausting trying to get the help they needed and finally they gave up and that those racist views and practices at the top that we constantly deal with at work, school, in life, have a knock on effect that then affects society as a whole.
Before moving to Birmingham in 2005, we lived i a quiet mainly white neighbourhood within a small town. The GP practice was a small family practice with a handful of doctors and a lovely pair of receptionists who even while talking to you in person or over the phone, getting more information before sign posting you to the right service, did it with kindness and patience more often than not. You always felt welcome, never rushed and every concern was dealt with in house or via referral. Slowly the town started to grow, the independent shops were knocked down, a huge Tesco was built and new apartment blocks started springing up and the GP surgery got busy. The town was growing and changing, a natural progress. The area we moved to in Birmingham and indeed Birmingham as whole was much quieter and laid back than London, the traffic was almost none existent, it seemed like by 12 midday, especially on weekends everything just died, it was way to quiet but on the up side we could afford a bigger house with garden and the neighbours seemed nice. We registered with the local GP surgery, which was almost like the one we had left in London, despite the incident with the practice nurse or occasional gaffe by one of the GP partners who upon seeing the children during a consult said: “ what fat children! Very different from the ones I have been seeing in South Africa this last month” ( She had just come from a volunteering programme in South Africa), overall you felt heard and more importantly you saw your named doctor and the continuity of care was there. The receptionists were kind and you could walk in to make an appointment . The streets were clean, we knew the local street cleaner and would stop for a chat once in awhile. A year in we started to notice for sale signs cropping up, the white folk in the neighbourhood were moving out. Not long after, the local street cleaner left, said he was retiring and for a week a two we had a replacement and then nothing and they would be cleaned as and when. The area started to look neglected and derelict. Various take away shops started to crop up. Our corner part of town was changing and growing and not for the better it looked and the GP surgery was not spared this growth. We were getting an upgrade, a bigger and better service, it looked like but looks can be deceiving and not all change is good, especially when an area is changing and becoming more derelict and unkempt and phrases like ‘ deprived area ‘ start being banded around. When an area is now mostly inhabited by marginalised communities and it looks like the local council has all but given up and services such as litter picking, rubbish collection, housing and the community surroundings as a whole take a back foot, you start to realise how all this connects to healthcare provision, schooling, policing and life in general. A two tier system comes into play.
A year after my life altering surgery, i was back at work navigating the pitfall that is the extreme sport of nursing while black, especially in a new town, environment and work culture and all the changes going on withing the neighbourhood largely went unnoticed or took awhile to notice as most of my time was spent at work and the only time i went to the GP surgery was to take the children for their immunisations etc. I had been told at my hospital outpatient follow up after the surgery that i would experience some lower abdominal pain which was normal due to scaring and so i managed my pain when it became unbearable by taking paracetamol and ibuprofen and occasionally buscopan. My local pharmacy was great and between myself and the pharmacist we always managed to puzzle stuff out which meant i was helping the GP service as well as the hospital service by not using up time that can be used by more urgent cases. Years went on and the pain slowly got worse but i put it down to scaring and work/ family pressures. More and more people were coming into hospital and complaining about their GP’s and access to services, from rude receptionists, seeing different doctors if you were lucky to be granted an audience and no continuity of care, it was easier to come into A&E. One chap had been to his GP ( one of those mega practices) several times complaining of chest and joint pains and each time his was given pain killers, then stronger ones which were eventually on repeat prescription! After a year of frustration and increasing pain and breathlessness he turned up in A&E and was diagnosed with TB. Another elderly chap had to go into A&E at the request of his GP’s receptionist at the frustration of the A&E doctors. His old GP had retired ( White Exodus) and the surgery had been taken over by another GP ( South Asian ) who only operated on a Thursday and worked the other days at his brothers practice in Solihull. This meant that his patients could only book appointments to see him on the Thursdays otherwise if they fell sick outside of that given day, then A&E was their only choice! He finally had to change GP’s to a bigger practice, when it took almost 4 months to fix a medication error with his diabetic medication, where he was previously on a combined tablet of Metformin 850mg/ pioglitazone 15mg but later changed to standalone tablets but with Pioglitazone at 30mg, when this error was later highlighted to the surgery( taking months to sort out) , the only explanation was that the standalone tablets were cheaper than the combined tablets! No recognition of the drug error/ potential harm caused to patient nor an apology. This is what care in a so called ‘deprived’ area had come down to!
After more than 11 years since my major surgery and managing the related pain on my own, it got to a point where the pain was massively affecting my quality of life. So i decided to seek the services of my GP to help find out why the pain was getting worse and also why it was mainly on the left side and not the right where the Fallopian tube had been taken off, also why i was needing to empty my bladder more often. My GP practice had under gone a huge change and had become one of those major practices with around 8-10 doctors. It was a mission getting an appointment and i was informed that i would see a duty doctor as opposed to my named GP as that would take weeks of waiting. So i turned up for my appointment with my husband ( he was not letting me go to hospital alone ever , since i almost never came back last time he did) , the doctor asked why wanted to see him, i told him i had given all that history to the receptionist but i could tell him again, so went to explain why i was there to his completely disinterested self. He then asked what is it i wanted him to do? and that i had been dealing with it for 11 years, so what did i expect him to do? I was stunned into silence, i tried to explain that yes i had been dealing with the pain for that long but i had come in for help because it was getting worse and affecting my quality of life and my work as well and that something didn’t feel right and that if he looked at my records he would see that i was not a frequent visitor to the surgery and that the fact that i had come in meant that i was not coping and needed help. He casually googled the medical term for ovulation pain, then proceeded to tell me that i was suffering from that and that i should would write me a prescription for Ibuprofen which i should try and that would sort out my pain and that i can not expect him to help me when i have no records and do not seek help and that if i need help i should fight for it and bang the door more and then i would be taken seriously as they would then wonder why i was frequenting the surgery and was not getting help/relief from interventions prescribed and so would take matters further. in other words, i had to be a problem patient to be taken seriously! I was gobsmacked and just sat there starring and not believing what i was hearing. I could see that if i stayed and continued arguing my point the situation would escalate into something serious, so we left. I don’t know who was more livid between myself and my husband.
I could tell you how after weeks of banging on proverbial doors I finally got an ultrasound and MRI scan, which showed fibroid growth and bulging disks, further banging led to useless misogynistic gynaecological referral and a most eye opening Orthopaedic appointment where I was being warned to look out for signs of Cauda Equina and to get myself a female gynaecologist. At this point I was just tired 😫. Not that the story ends there nor does my experience of bad healthcare even after changing Gp's ( still same area with super surgery ) and i’m sure mine is not the only story of struggle in getting proper healthcare as a black person not to mention as a woman ( indeed the black practice nurse at my new surgery was leaving due to racism at the surgery! Not to mention that a serious drug error almost occurred because my records had zilch on them, no one had bothered to populate my online GP records! Being a nurse saved the day.)
Historical and all through colonialism with attitudes that still extend to this day, Black people have always been at the bottom of any hierarchical structure, our value and worth was and is still considered below that of the Whites and South Asian and these biases exist in everyday lived lives of Black People no matter your standing in life. How many black Owned and led GP services are out there? I am yet to see a black doctor at a gp surgery! Maybe if there were it would at least be a start in evening out the playing field of healthcare navigation for black patients? Just a thought. All I know is that i’m tired of constantly fighting to live while Black, be at work, I'm school/University, access to healthcare not just bare minimum healthcare and tired of being blamed as a whole for health outcomes while the system is verily rigged and stacked to the rafters against any positive outcomes.
Meanwhile, when you see me at the hospital looking alot worse for wear with conditions that could have been treated had they been caught earlier, please don’t fall into that judgmental trap of “ why are these people so neglectful with their health while it’s free” ! Try to listen and get their story, you maybe the only one who cares enough at that point!
Independent Patient Safety Organisations:
Plan4ZERO- Patient Safety Movement: https://patientsafetymovement.org/product/plan4zero-pin-magnet/
Patient Safety Learning Hub ( U.K based ) : https://www.patientsafetylearning.org/the-hub
Courtesy of the Lansing Injury Law News ( available on the Patient Safety Learning Hub.