Conference Review - Medicine at the Margins: Creative Solutions to Healthcare Challenges

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29 June 2016

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The Medical Women’s Federation Spring Conference, 'Medicine at the Margins: Creative Solutions to Healthcare Challenges', took place on Friday 13th May 2016 at the John McIntyre Conference Centre Edinburgh. This is situated within the Pollock Halls of Residence and has a very scenic backdrop with Arthur’s seat very close by.

Our first speaker was Dr Christine Goodall OBE, a senior lecturer and honorary consultant oral surgeon at Glasgow University who founded the charity Medics against Violence (MAV) in 2008. Due to their educational programmes reaching those in primary and secondary schools, youth clubs and prisons, there has been a reduction in homicide and serious assault in Scotland. Behaviours which can lead to what she termed ‘recreational violence’, such as excessive drinking and knife carrying, have also reduced in the younger age group, who have participated in the programme whilst at school. She described other ‘teachable moments’ as being parenting, when assaulted, when arrested and when convicted. MAV also runs the Navigator programme at Glasgow Royal Infirmary which follows up A&E attenders who have presented due to violence, drugs, alcohol, homelessness and domestic or sexual violence. Another programme started in 2010 is Ask, Support, Care (ASC) and trains all health professionals including dentists, vets, fire officers and hairdressers to recognise and respond to signs of domestic abuse. (Non accidental injury to a victim’s pet can be a feature of domestic violence.) Domestic abuse is estimated to affect 1 in 4 women in Scotland and has significant health and social consequences.

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Next, Dr Rosie Hague described her career which led to her becoming the first consultant in paediatric infectious diseases and immunology in Scotland and thus responsible for setting up the service. This began with an elective in Nepal and going in to Paediatrics when she failed to get the Obstetrics job she wanted. The AIDs epidemic in the 1980s sparked her interest in the transmission of the disease from mother to child and her research led her to posts in Newcastle and Denver Colorado before returning to a consultant post in Edinburgh. She told us about the discovery of the methods which have reduced HIV transmission from mother to child from 25% to 1-2% and the testing regime for the baby to reach a diagnosis as early as possible. For those children who are found to be HIV positive, appropriate treatment regimes were devised. There is still stigma around HIV, particularly amongst African women and because breast feeding is almost universal in this group, she feels that many of them continue to breast feed against advice because not to do so leads to an assumption that the mother is HIV positive. As HIV is now a chronic disease the timing of disclosure to the child about their condition is important and as they become teenagers they need counselling about their sexuality. Besides infectious diseases Dr Hague has an interest in primary immune deficiencies and concluded her talk with hope for the future.

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The first abstract was presented by Dr Yesim Karapinar who, having spent precious time trying to locate the equipment she needed to cannulate a patient on a strange ward, came up with the idea of procedure specific trays in treatment rooms. The second abstract from Dr Jacqueline Andrews told us about the Leeds Female Leaders Network set up for women to inspire each other whilst working towards gender equality in the workplace and leadership positions.

Alison Cameron, Leadership Associate at the Kings Fund gave a very personal account of her descent in to loss of career, alcohol abuse and homelessness after a diagnosis of PTSD which followed the deaths of 2 of her colleagues whilst they were working on a project in Russia connected with the Chernobyl disaster. She asked us to think about how we describe ourselves. Is it by the title of our job? What then happens if this is taken away as happened to her? She is a believer in shared decision making in medicine because this empowers the patient not only to make decisions about their own care but to have a wider role in the development of health care policies. Self management was her own starting point to recovery and she now advises health and social care organisations including NHS England on how to work in partnership with those who use the service.

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Miss Elaine Griffiths, Chair of the Medical Royal Colleges Flexible Training Committee presented the results of the recent Parental Leave Survey. The responses highlighted that most trainees were straight back in after returning from a period of parental leave with no shadowing and that departmental changes are not being communicated to those on leave which can lead to difficulties on their return. Facilities for breast feeding mothers were found to be lacking. Many commented that they were not allowed to use the rooms allocated for the use of patients but were expected to express breast milk with little privacy or in the toilet. The survey also highlighted that very few male trainees have taken parental leave.

After lunch we had a choice of three workshops to encourage active participation and discussion. These were
- ‘The Show must go on – Health and the Performing Artists’
- ‘It’s a family disease – living with alcoholism’
- ‘Old Docs, New Tricks? Working Longer’

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Another inspirational talk followed, from Ann Maxwell OBE, Co-founder of the Muir Maxwell Trust which has raised £9m since 2003 to both raise awareness of complex childhood epilepsies, and to give practical support to children and families struggling to cope with epilepsy (such as the provision of night time alarms to detect seizures). She described it as ‘a field that chose me’ as her youngest child Muir has severe epilepsy. She has continued to work towards her goal of seeing better outcomes for the children coming behind her son despite being diagnosed herself with a craniochondrosarcoma in 2006.

Our next speaker was Philippa Whitford, a consultant breast surgeon and since 2014 MP for Central Ayrshire sitting on the Parliamentary Health Select Committee. As well as talking about her experiences as an MP and the usefulness of her mobile phone as a tracking device for her husband to time meals when she is working from home, and FaceTime calls when she is in London, she told us about her 2 trips to Gaza. The blockade has had considerable impact on the treatment and survival of women with breast cancer. Continuous supplies of drugs including chemotherapy are unreliable and at 40% the survival rate is half what it is here. Over treatment with surgery due to poor access to diagnostic services and radiotherapy means many women are left with disabling lymphoedema.

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Prizes were awarded for the abstracts to both presenters. The poster prize was won by Dr Alice Howe, FY1 North Devon District Hospital for ‘Together we can end female genital mutilation; our new statutory obligations under the amended female genital mutilation act 2003 (sections 70-75 of the serious crime act 2015) explained’. The Katherine Branson Essay Prize winners were Helena Fawdry, 3rd year student at Liverpool university, and Karthika Velusamy, 4th year student at Leeds.

We ended the day with the Dame Hilda Rose Memorial Lecture ‘The Importance of Women’ given by Dr Catherine Calderwood, the Chief Medical Officer of Scotland. She reminded us that Dame Hilda Rose remains the only woman to have been President of the Royal College of Obstetrics and Gynaecology. She began by talking about some pioneering women in medicine beginning with Dr James Barrie who graduated from Edinburgh University in 1812 and was an outstanding Army Surgeon. Only on his death from dysentery in 1865 was he found to be a woman, a fact not made public for 100 years. She moved on to talk about women as patients today, their physiological differences from men, unique diseases and the importance of the health of women to that of the next generation. Clinical trials of drugs often exclude women yet the results are extrapolated and fail to account for the gender differences in pathophysiology. This may contribute to poorer outcomes in women. Diseases which only affect women such as endometriosis do not attract the same resources and research as those that affect both sexes but can have a significant effect on families and working days lost. Many adult diseases have their developmental origins in the womb for example cardiovascular disease in the offspring of obese mothers, thus the future health of the whole nation becomes dependent on the health of women of chid bearing age. Perinatal depression, the commonest complication of pregnancy has also been shown to influence the mental health of the child in later life. She concluded by reminding us that maternity leave was not introduced until 1971. In a profession now dominated by women she considered the barriers to positions of leadership and encouraged us to take as example the V formation of flying geese. Different specialties inevitably demand different attributes and some will remain more suited to men, however the opportunities should be equal.

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The meeting was followed by the AGM and then our new President Dr Parveen Kumar gave her Presidential address. Whilst considering the future challenges of the MWF going forward her quote ‘If you educate a man you educate a person, if you educate a woman you educate a whole family’ seemed to reflect on the themes of the day.

On the Thursday evening prior to the conference several members met at ‘Spoon’ for an informal supper. The conference dinner was held at the John McIntyre conference centre and was followed by a ceilidh band which got some of us up and dancing!

Judy Booth 

Junior Doctor Blog - Dr Salma Aslam

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27 May 2016

Wet Beriberi and ShadeSalma

I must be truthful. Ward rounds aren't always my favourite activity. I would rather be taking blood from someone, or doing ABG- mundane tasks to some, but I'm always satisfied doing them- you can't beat the instant gratification. Anyway before I waffle on further, ward rounds aren't always my favourite clinical activity. Ward rounds after a 12 hour acute medicine night shift are definitely not. Bed- side teaching however, I love. Being one to one with a consultant who meets a patient presenting with a condition, they may have written clinical guidelines on, means you are privy to a dissection of a clerking (which may have been yours), and you learn from an expert about how to be the best. Being awake for so many hours is worth it in these cases.

Being the most junior member of the clinical team, I am always learning and I'm always learning from everyone. There aren't many opportunities for me to teach consultants. On one ward round recently whilst I was being taught about wet beriberi, I taught my consultant the word ‘shade’. Those of you reading this may think that you know what shade is. And you do. But perhaps not the definition of shade I was referring to.

I am talking about the slang definition.

This slang term can be understood as someone putting shade on your light. Say for example, you had published an article and someone commented that they had published 5 other articles that were much better. That's shade.

I have had my own experience with this recently. People were talking about my blog, and articles I had written and it really affected me. To the point where I stopped writing. Those internal feelings that can surface at times, associated with the imposter syndrome, re-surfaced for me and I wonder how many other women have felt this? When you do something that is a bit out of the box and instead of being met with encouragement, you hear negative comments and see shade.

Having never experienced much negativity before, I was initially quite ignorant to it. Now I notice it more. "She's a great surgeon but she doesn't have any children" or "she's too driven, she's not very feminine". Why not just say, "she's a great surgeon" or "she's very driven"?

I think that when people see someone doing something that is a bit out of the ordinary or different they get intimidated and out comes the shade. Or maybe it is a reminder of something they would never have the confidence to do themselves.
For me acknowledgement of that was the first part of healing. Then writing came soon after. As did this article.

The truth is, when you're doing well not everyone is going to clap and worse still, you will see the shade. My advice to anyone experiencing this would be to keep going and do what you're doing. Especially if it is something that brings you joy.

Shine brighter and the clouds will go. They only last so long, but your work will remain.

Dr Salma Aslam is an FY1 Junior Doctor in the North of England. She has a personal blog and enjoys writing alongside her work as a doctor.

Equality Watchdog Warns Junior Doctors' Contract Could be Illegal

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28 April 2016

MWF welcomes the news that the European Human Rights Commission are referring the imposed junior doctor contract to the United Nations. MWF has been in communication with the EHRC seeking their view in the period leading up to this decision.

MWF has repeatedly expressed concern to the Secretary of State and the Department of Health about the discriminatory nature of the contract prior to and since publication of the Equality Analysis on 31st of March. The effect on women doctors in training and others with young children, caring responsibility, disability or ill health will be to force them out of acute medical specialties or medicine altogether.

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