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

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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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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.

MWF Attends Screening of Suffragette

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The Medical Women's Federation were lucky enough to be invited along to an exclusive screening of the upcoming film, Suffragette, starring Carey Mulligan, Helena Bonham-Carter and Meryl Streep. We invited two MWF members to give us their take on the film. 


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Dr Sangeeta Rana

Earlier this month, a group of us were fortunate to be brought together by MWF for a fun and thought-provoking preview of the new Suffragette movie (starring Carey Mulligan, Helena Bonham Carter, and Meryl Streep). It’s been almost a century since British women won the right to vote, yet the lessons—and experiences—of the suffragettes still stand. We left the theatre shocked by the extent of the antagonism against the suffragettes, and inspired by (and thankful for) for their persistence. Nor is their job fully completed; I was personally taken aback by hearing that women were only granted the right to vote in Switzerland in the 1970s, and that Saudi Arabia is planning to grant women the vote just this year. Overall, the movie was inspiring and a stirring reminder that there are still battles to be won.

These battles continue. In our own field, we’ve all been hearing in the news and on social media about the new junior doctor contracts that have been proposed. The changes could have a disparate impact on women, with de facto financial penalties for maternity leave and changing careers. And as we know, women are still in the minority across the government in decision-making, both in parliament and local councils. Across the pond in the U.S., where I grew up, the right of women to free contraceptive care, and the legality of some forms of such care, are being challenged, again by a national government with a small minority of female representation.

..All in all, a reminder to keep speaking out, and coming together with MWF friends and colleagues for more fun and inspiring events!

Miss Angel Mthunzi

Set in early 20th century Britain, Suffragette is an extraordinary film depicting the very real and intensely emotive story of the brave and determined women of Britain fighting for suffrage.

The film begins at a laundry facility where Maud Watts (a fictional character portrayed by Carey Mulligan) has worked since the very young age of 7. Now, in her early 20s, Maud is still working in the same laundry, washing and ironing sheets. Believing that working in a laundry is all she can do to support her young son and husband, Maud continues to toil in the laundry despite the sexual abuse she suffers from her boss. Her husband, Sonny, who also works at the laundry, dares not say anything about the abuse of his wife but valiantly salutes a portrait of the King every evening before bed. It is no surprise that Maud’s face is worn from endless strife- she is poor, a woman, a young mother and a wife who has always done what she’s told. Does she have it in her to rebel?

Skilful work by the director, Sarah Gavron, and an understated yet compelling performance by Carey Mulligan come together brilliantly to convey the outwardly soft but inwardly impassioned spirit that is Maud. What would the vote mean to Maud? When she casts a stone into a shop window, Maud unwittingly becomes drawn into a movement that will cost her everything she holds dear. Over the next hour of the film, we see Maud Watts blossom into a suffragette and grass roots activist. “We break windows, we burn things, ‘cause war’s the only language men listen to”, Maud declares in rebellion. In this moment, we see her determination and willingness to fight for the vote. It is through her eyes that the audience experiences the heart-breaking losses that suffragettes suffered whilst fighting for justices that today we perhaps take for granted. Her bleak and poverty stricken life galvanizes the film bringing the immediacy of the suffragette struggle to life while the rest of the cast play excellent supporting roles; portraying real suffragettes.

Ann Marie Duff plays Violet Miller, a gobby but formidable woman who is also a worker at the laundry house and central in recruiting Maud to the suffragette movement. Meryl Streep makes a short cameo as Emmeline Pankhurst, one of the two sisters who pioneered the use of militant tactics by the Suffragettes. In an interesting twist of history, Helena Bonham Carter, great-grand daughter of Herbert Asquith (the prime minister at the time), plays Edith Ellyn, a fiercely loyal suffragette and self-proclaimed “soldier” who will stop at nothing to get the vote. Throughout the film we see the heart breaking and tragic losses these women faced including domestic abuse, rape and slander. Perhaps the most heart breaking is the death of Emily Davison (Natalie Press), the real life activist who died under King George V’s horse after she stepped out onto the Derby racecourse to draw attention to the suffragette cause. Her duly dramatized and tragic death makes headlines across the world and the film ends here with real life scenes from the funeral of Emily Davison.

Abi Morgan (scriptwriter) does extremely well to depict defining moments of the suffragette struggle. Packed full of emotion and emotionally rousing (bring a box of tissues), “Suffragette” rounds up one part of the struggle for women’s suffrage. Is it a classic? Critics may argue that the film is somewhat sentimentalised. Indeed some aspects of the suffrage movement are only alluded to, or ignored altogether. Everyone that disagrees with women’s suffrage is basically cast as an ignorant or sexist pig, invoking eye rolling from the audience. The divide between those supporting militant tactics and those in disagreement is not mentioned and the impact that the militant action had on the suffrage cause is cast in a largely positive light. The possibility that it may have damaged the cause is not really entertained. Nevertheless, it is important to note that in their struggle, the suffragettes never intended anyone to come to any harm. Moreover, the scenes depicting disagreement between suffragettes and women who are not interested in suffrage allude to the difficulties faced by those (women and men) fighting, peacefully or aggressively, for women’s suffrage.

While it may not be historically perfect, Suffragette is a compelling account of the fight for a basic human right.

Suffragette is out on nationwide UK release on October 12th 2015

Blog Post - Dr Clarissa Fabre

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One of the UN's Millenium Development Goals was the reduction of maternal mortality, and in many countries very important advances have been made. However there is still a long way to go. Dr Fabre has been MWIA’s representative to the WHO since 2012, and has become involved in promoting the worldwide use of the Safe Childbirth Checklist. This is a tool developed by the Harvard School of Public Health and the WHO for reducing maternal mortality. She was delighted that an MWIA member from the African region was part of a very successful pilot of the checklist. One of her aims is to spread its use worldwide via the MWIA network.

She has been closely involved in the MWIA Clinical handbook on Violence against Women and Girls, focusing particularly on prevention and the involvement of men and boys. She spoke recently at MWIA’s parallel event at the UN’s Commission on the Status of Women in New York on the subject. Her aim now is to develop a national strategy for the UK looking at the role of doctors in addressing violence against women and girls.

MWIA can be a powerful voice and a strong force in advancing the cause of women’s rights and women’s welfare, as well as improving the lives of women doctors. If successful, she would aim to harness the energy and enthusiasm of key women in every region, and support and coordinate these forces for practical advances in every part of the world.

Dr Clarissa Fabre, Past President of MWF (2010-2012) is standing for President-elect of MWIA in July this year at MWIA’s 30th International Congress in Vienna. To see the full list of candidates standing for election please click here.

Click here to book now for the conference in Vienna.


Challenging the Stereotype of a Surgeon

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The social media campaign #ilooklikeasurgeon highlighted just how many women surgeons there are working in the UK and around the world. Posting photos of themselves with the caption, ‘I look like a surgeon’, these women were challenging outdated stereotypes, so often associated with our profession. They were sending a very powerful message to young women doctors and medical students who might not otherwise picture themselves as future surgeons; as well of course, to the wider public.

There is evidence which suggests that people who don’t perceive that they 'fit in' are more likely to opt out. In 2008, The Royal College of Surgeons (RCS) commissioned the University of Exeter to carry out some research which found a similar phenomenon in some female surgical trainees.
Our mental image of what a surgeon looks like reflects the era when that potential role model got through training when the culture was very different. Surgeons like me (still just under 50!) trained in the 1990s when the hours were very long, you had to be up operating all night (before National Confidential Enquiry into Patient Outcome and Death stopped that) and then work the next day.
You were dependent on your boss’s reference, supervision was variable and the training system was less clear. There are fewer women surgeons now in their 50s and 60s when surgeons trained in a very different era, when absolute dedication to the job was expected, 168 hours per week, and when society expected the man to be the main breadwinner in a relationship. Generations coming through now and in the future will be very different.

The last two decades have seen a shift in attitudes and an acknowledgement that surgical training coincides with the peak time for starting a family; and that it is possible to combine pregnancy and child-rearing with surgical training and work. Reduced junior doctors’ hours also allow at least some time off. But the lack of women surgeons is not all about historical attempts to balance or reject family vs. career.

The human brain puts things into patterns. For example, people may unconsciously think that you have to act or look a certain way to do a certain job, particularly if that is all they have seen. But you don’t. The skills needed to do a job can be taught and learnt. Surgeons are already highly intelligent, skilful and adaptable. Each one of us is a role model – some good, some bad.
The key hurdles for future surgeons, at exam, selection and progression do not discriminate against women. So why is surgery still different for women? Many women medical students want to do surgery. Our research (published in the RCS Bulletin in February 2012) showed that 30% of applicants to core surgical training are women, but far fewer women than men continue and apply to Higher specialist surgical training.

Women and men’s behaviour tends to be perceived differently (eg strident/bitchy vs charismatic). Some psychological studies have found that women will not ask to do an operation until they are sure they can do it and that other people (including other NHS staff) can be more forgiving of a man’s learning curve. More diverse teams cope better with change. And losing this talent is wasteful and unfair. So what can we do about it?
On a general basis, everyone should see themselves as a role model, men and women. We should engage with people if they say unacceptable things and challenge them. We should also identify which individuals might need more support.

On an individual basis, aspiring surgeons would benefit from a mentor to help with their long-term view. This is especially true now there are fewer Foundation posts in surgery and now that the later retirement age means that women will have several decades of working after having children, but this phase of working life has fewer role models for the current generation. Mentoring and support might also help the NHS with succession planning, so people can picture themselves in future roles, building up their skills and rising up the ranks in their career.

The RCS is trying to change the profession from within through its Women in Surgery (WinS) group. This offers networking opportunities and events for female surgeons at all stages of their career. We want to break the historic cycle of there being too few female surgeons by providing strong female role models and encouraging female surgeons to take on high profile roles. Although only 10% of consultant surgeons are women, the workforce is changing: 30% of surgical trainees are women. We now need to encourage all medical students to believe they too look like and can act like a surgeon.
Visit the Women in Surgery (WinS) website.

Mrs Scarlett McNally is a Consultant Orthopaedic Surgeon & Council member at the RCS England.This blog was originally written for, and published, on the Royal College of Surgeons's website.

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