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Monthly Archives: July 2014

Fight loneliness and improve your health

I have been well aware for many years that many people who attend surgery regularly are lonely. Some of our frequent attenders or callers are clearly lonely and I have often heard a receptionist state,”I think she or he calls because they are lonely.” I am aware that it can cause illness or be as a result of illness and therefore affect recovery.
Loneliness is not feeling part of the world. You might be surrounded by loads of people but… you are [still] lonely.

Our practise nurse who recently broke her leg tells me that “she couldn’t be without her friends” and I am sure their dutiful visits will aid her recovery as much as physiotherapy and medication.
image

Not only can loneliness lead to mental-health issues but studies proved that it can also be more dangerous than obesity and smoking.

A study has found that chronic loneliness has been shown to increase the chance of dying early by 14 per cent, which is as bad as being overweight and almost as bad as poverty in undermining a person’s long-term wellbeing. It is linked with higher levels of the stress hormone cortisol in the morning, which raises the risk of heart attacks and strokes.
Loneliness is also linked with higher blood pressure and a weakening of the immune system.

Earlier this year, researchers at the University of Chicago aimed to quantify the effect that loneliness had on the elderly’s wellbeing. Led by Professor John Cacioppo, their report, entitled Rewarding Social Connections Promote Successful Ageing, discovered that feeling lonely increased the risk of heart attacks, dementia, depression, and could disrupt sleep, raise blood pressure and lower the immune system. In short, loneliness is as bad for the health as that nasty 15-a-day Marlboro Light habit.
One possible explanation for its link with ill-health is that loneliness seems to make people sleep less deeply. Lonely people tend to suffer from brief “microawakenings” in the night, which may reflect a nervousness about being alone at night, he said.
Research found that your body’s inflammatory response to illness can be affected by loneliness.

Last week, a survey by the Office for National Statistics found that Britain is the loneliest country in Europe in that people are less likely to have strong friendships or know their neighbours than inhabitants of any other country in the EU.

Loneliness is a massive issue for people in later life in the UK. Half of all people aged 75 and over live alone, and 1 in 10 people aged 65 or over say they are always or often feel lonely – that’s just over a million people.

Shockingly, half of all older people consider the television their main form of company.

Eyeore

 

HOW FEELINGS OF LONELINESS CAN BE OVERCOME

We can all help if we make the effort to acknowledge people around us. On the French TGV trains there are signs which suggest that passengers should help others with luggage of ask if someone if they want a drink from the buffet car.
TGV
I find it sad that it has to be advertised rather than be something that people did without prompting.
I am sure many of us will have helped lonely, vulnerable people simply being a good neighbour and carrying out small tasks. Even just passing the time of day can be very meaningful to someone who lives alone.
When the medical students are assigned to the practise I often introduce them to patients who live alone and encourage the students to sit and listen to what these patients have to say. There have been many magical moments when I have watched the older person suddenly ‘come to life’ as they relate tales of their earlier life. Moreover, I have observed the fascination of the young student as they listen. On one occasion after a patient was telling the student how she worked as a maid in a country house the student retorted “So the life in ‘Downton Abbey’ really did happen!”

Age ukAge UK’s befriending services
Befriending

To tackle the problem of loneliness among older people, Age UK has developed befriending services. The service works by assigning each older person a befriender, who provides friendly conversation and companionship on a regular basis over a long period of time.

Many local Age UKs provide befriending services, some by telephone and some where a volunteer visits the older person at their home. This vital service provides a link to the outside world and often acts as a gateway for other services and valuable support.
To volunteer as a befriender, call 0800 169 6565 or contact your nearest Age UK to find out what befriending services they offer.
http://www.ageuk.org.uk/about-us/

Every once in a while an idea comes along with the potential to truly make the world a better place.

Suspended coffeeSuspended Coffee is one of those ideas.
*First, it’s simple. You walk into a coffee shop and instead of buying just one cup of coffee, you buy two, or more. You buy one for yourself and one for someone in need.
*Second, it’s direct. You do not need to worry if your money is going to actually help someone or just to take care of a charity organization and its overhead and expenses. You also do not need to worry whether or not your recipient will use your gift to buy alcohol or drugs. You can directly control which food or beverage you would like to donate.
*Third, it’s win-win. You not only support a person in need, you also support your local business and all its employees. Your money does not go to another state, country or continent. It stays right in the neighborhood where it was spent.
*Lastly, it can be used for more than just coffee. You could buy a hot bowl of nourishing soup, a filling sandwich, water, fruit, bread, or a full meal. Suspended coffee’s simplicity makes it easy to duplicate with other food items.

The history of suspended coffees
We entered a little coffeehouse with a friend of mine and gave our order. While we were approaching our table two people came in and went the counter. “Five coffees, please. Two of them for us and three suspended.” They paid for their order, took the two and left. I asked my friend: “What are those ‘suspended coffees?’” “Wait for it and you will see” he answered. Some more people entered. The next order was for seven coffees and it was made by three lawyers – three for them and four “suspended”. While I still wondered what’s the deal with those “suspended” coffees I enjoyed the summer weather and the beautiful view towards the square in front of the café. Suddenly a man dressed in shabby clothes who looked like a beggar came in through the door and kindly asked “Do you have a suspended coffee?” He got a coffee for free – no charge – he sat down and took a sip and a smile ran through his face. It’s simple – people pay in advance for a coffee meant for someone who cannot afford a warm beverage. The tradition with the suspended coffees started in Naples, but it has spread all over the world and in some places you can order not only a suspended coffee, but also a sandwich or a whole meal.
Suspended coffees

After reading about the above story, John Sweeney created the Facebook page Suspended Coffees. Soon after that something amazing happened. People loved the page and the simple but amazing gesture of a suspended coffee. Over 260,000 people have joined the page since March 27, 2013.
The nearest participating café to the surgery is:-
CAFE OAK TREE
Acton Central Railway Station, Churchfield
Road, Acton, London England

Either find your local participating cafe on the website or suggest that your local café participates.
To learn more about this now worldwide idea click on the link below:-
http://www.suspendedcoffees.com

What difference can one person make?
Starfish
“While wandering a deserted beach at dawn, stagnant in my work, I saw a man in the distance bending and throwing as he walked the endless stretch toward me. As he came near, I could see that he was throwing starfish, abandoned on the sand by the tide, back into the sea. When he was close enough I asked him why he was working so hard at this strange task. He said that the sun would dry the starfish and they would die. I said to him that I thought he was foolish. There were thousands of starfish on miles and miles of beach. One man alone could never make a difference. He smiled as he picked up the next starfish. Hurling it far into the sea he said, “It makes a difference for this one.” I abandoned my writing and spent the morning throwing starfish.”


For many people, overcoming loneliness is about increasing the level of social contact that they have with other people and there are different ways to do this.

However,it is possible to overcome loneliness becoming a problem by finding ways of meeting other people with common interests.

A new patient I saw recently told me about ‘Meetup’ helped move her life forward following her recent divorce after 30 yrs of marriage. It gave her chance to get her life back on track and overcome the feelings of rejection and isolation.
Meetup

Meetup is an online social networking portal that facilitates offline group meetings in various localities around the world. Meetup allows members to find and join groups unified by a common interest, such as politics, books, games, movies, health, pets, careers or hobbies.

There are also many Meetup groups which are neighbours getting together to learn something, do something, share something…
You don’t need to be an expert to organize an awesome Meetup. You just need something you care about and a desire to bring people together.
They will help you find the right people to make it happen. Most Meetups start getting members within the first few days. Plans are free for 3 months.
http://www.meetup.com

Another organisation which is very active in Ealing particularly for retired and semi- retired people is:-

U3AThe University of the Third Age (U3A)

This movement is an unique and exciting organisation which provides, through its U3As, life-enhancing and life-changing opportunities. Retired and semi-retired people come together and learn together, not for qualifications but for its own reward: the sheer joy of discovery!

Members share their skills and life experiences: the learners teach and the teachers learn, and there is no distinction between them.

A Brief History of the University of the Third Age (U3A)
U3A was founded in 1981 by three friends, all distinguished in their own field and embarking on the “third age” of their lives. Peter Lazlett, Eric Midwinter and Michael Young. They met in Cambridge to discuss the intellectual and cultural prospects for older people. France had already set up in 1972 their Universités du Troisieme Age and some Cambridge academics saw this as their model. Peter Lazlett made a visit to the continent and on his return pronounced the organisation admirable in its way but too elitist – Second Agers, mostly men, deciding what Third Agers should learn. The three friends knew that older people were perfectly capable of teaching each other. It is this mutual learning principle, forming a learning cooperative, which marks our organisation in the UK from other U3As around the world. The three set about getting the organisation off the ground.

The U3A movement is supported by its national organisation, the Third Age Trust.

Interest Groups are the heart of the U3A movement. Groups meet mainly in each other’s homes. Someone with particular expertise and knowledge takes on the role of teacher, leading each session. Alternatively, a member acts as secretary and helper with group members taking it in turn to lead a meeting. Groups generally meet fortnightly or monthly and everyone pays 20 pence a meeting to cover tea and coffee. If a class is full we have a waiting list and start a new group as soon as possible.

To join a group, telephone the contact name on the programme sheet or approach them or a committee member at a Thursday meeting. If you cannot attend Thursday lectures you can still join a group, but must pay the membership subscription. Ealing U3A is always looking for new interest groups. If you would like to lead or suggest a group please contact a member of the committee.

U3A is a worldwide movement which seeks to encourage older people to take part in educational and cultural activities and help them to teach and learn from each other in friendly and informal settings. U3A is also keen to include the housebound and the disabled in its educational and cultural activities. No qualifications are required to join – and no qualifications or degrees awarded. Members are encouraged to see the value and take pleasure in learning for its own sake.

EALING U3A – a co-operative of older people sharing educational, creative and leisure activities. The motives for joining are a desire to improve and share your knowledge and experience, to keep your mind active, to enjoy leisure pursuits and to socialize with like-minded people. No qualifications are needed and none is given. You share learning and leisure experiences across a wide range of activities through a network of self-managed groups. Members have access to our weekly talks on a wide range of topics, for example science, history, politics, literature, music and many more.
Meetings are held weekly, on Thursday mornings in Ealing Town Hall

You should aim to arrive at 10.05a.m. The venue is indicated on the Town Hall entrance noticeboard. It is usually in the LIZ CANTELL room.

Meetings begin with announcements and in-house business. This is followed by the speaker’s presentation during which there is usually a break of approx. 15mins. The proceedings finish at 11.45-12.00.

They can participate in the various interest groups, in leisure activities such as rambles and visits to interesting places as well as in the occasional short courses. Learn about all of these by searching

http://u3asites.org.uk/code/u3asite.php?site=523&page=25796

TELEPHONE CONTACT FOR THE ELDERLY
TelephoneLast year, the Campaign to End Loneliness estimated that more than a million people in the UKfeel trapped in their homes and around five million older people consider television their main form of company.

So many people feel bereft and lonely when they lose a partner or become ill and frail and are confined to their home. In November 2013 funded by a £5 grant from the Big Lottery a free 24-hour dedicated helpline for older people across the UK was launched by Esther Rantzen.
She said,
“We will signpost them to the services in their community, and by showing them we value them and care about them we will restore their confidence and feelings of self-worth. It is tragic that older people are so undervalued and isolated that they believe life is not worth living and that they are no longer part of the human race.”

Silverline

Modern technology is now proving a great help for people to be in contact with relatives throughout the World using Skype and emails but it is not a total substitute for personal contact.
Several years ago I remember a dear lady who came to surgery with great discomfort in her neck and arm. I asked her if she had been doing too much polishing or sleeping in the chair. ” No doctor, I am afraid I have a confession to make!” she claimed. I sat curiously awaiting some deep revelation.  ” Well it was my 90th birthday and I treated myself ( 90yr olds don’t buy luxury gifts for themselves) to a laptop and I have been spending hours getting to grips with it!”  In more recent years I have noticed that some of the more senior patients have acquired laptops or tablets which they can use to contact their friends and relatives locally and throughout the World by Skype or email.
Pet
Many people also find that having a pet, such as a dog or a cat, can also help reduce feelings of loneliness. If you know an older person living alone and struggling to find motivation to get out, It may be very beneficial for them to visit with your pet. Ask them to pet-sit for you or see if they’d be interested in fostering a homeless pet. The more people interact with pets, the more likely they are to interact with other humans and shrug off depression. I’ve seen more than one case of a pet literally saving their owner’s life, just by being there. Not infrequently I have started a consultation by asking about a patient’s pet usually by name and found that their whole demeanour changes. In one case a patient confided that it was his pet Guinea pig that saved him and even arrived with photos for me! Many people need a reason to get up in the morning, go for a walk, and visit the shop. Without a purpose, many older people fall into harmful patterns of behaviour that ultimately lead to depression, illness, or worse. Many times the best prescription for healthier living comes with four legs and fur.

 

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Posted by on July 11, 2014 in Training and Advice

 

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100 days of coughing after a 100 years

Eight months ago I wrote my 100th blog about a lady who had become a centenarian and how we had celebrated her birthday and since then she has followed my blogs and I have even introduced her to TED talks which she finds most interesting!

The telephone went yesterday to inform me that she was in hospital with what in some countries is known as
the 100 days’ cough or cough of 100 days.

The red dots are Bordatella pertussis bacteria, the cause of whooping cough.

We know it as whooping cough, or Pertussis..It is a highly contagious bacterial disease caused by Bordetella pertussis.

Although, in isolation and distressed by the severe coughing fits, which often produce the namesake high-pitched “whoop” sound when air is inhaled after coughing she has been in good spirits and no doubt full of questions due to her interminable curiosity.

What causes whooping cough

The bacterium infects the lining of the airways, mainly the windpipe (trachea) and the two airways that branch off from it to the lungs (the bronchi).
When the Bordetella pertussis bacterium comes into contact with the lining of these airways, it multiplies and causes a build-up of thick mucus. It is the mucus that causes the intense bouts of coughing as your body tries to expel it.
The bacterium also causes the airways to swell up, making them narrower than usual. As a result, breathing is made difficult, which causes the ‘whoop’ sound as you gasp for breath after a bout of coughing.

How whooping cough spreads

People with whooping cough are infectious from six days after exposure to the bacterium to three weeks after the ‘whooping’ cough begins.
The Bordetella pertussis bacterium is carried in droplets of moisture in the air. When someone with whooping cough sneezes or coughs, they propel hundreds of infected droplets into the air. If the droplets are breathed in by someone else, the bacterium will infect their airways.
This is why it is highly contagious. I remember in 1979 I was working as a paediatric doctor and there had been a whooping cough vaccination scare resulting in a sharp increase in cases. It was pitiful to see the numerous admissions of babies and young children with distressing bouts of coughing. It is clear how when a vaccination is introduced how the incidence of the disease falls so rapidly but rises again if vaccination uptake declines.
Whooping cough.

Treatment
If whooping cough is diagnosed during the first three weeks (21 days) of infection, a course of antibiotics may be prescribed. This is to prevent the infection being passed on to others.
It is important to take steps to avoid spreading the infection to others, particularly babies under six months of age.
Children with whooping cough should be kept away from school or nursery for five days from the time they start taking a prescribed course of antibiotics. The same advice applies to adults returning to work.
As a precaution, household members of someone with whooping cough may also be given antibiotics and a booster shot of the vaccine.
Antibiotics will not usually be prescribed in cases where whooping cough is not diagnosed until the later stages of infection (2-3 weeks after the onset of symptoms).
By this time, the Bordetella pertussis bacterium will have gone so you will no longer be infectious. It is also very unlikely that antibiotics will improve your symptoms at this stage.
Immunisation

Children are vaccinated against whooping cough with the 5-in-1 vaccine at two, three and four months of age, and again with the 4-in-1 pre-school booster before starting school at the age of about three years and four months.

Vaccination in pregnancy
In the UK, all pregnant women are offered vaccination against whooping cough when they are 28-38 weeks pregnant. Getting vaccinated while you’re pregnant could help to protect your baby from developing whooping cough in its first few weeks of life.

The immunity you get from the vaccine will pass to your baby through the placenta and provide passive protection for them until they are old enough to be routinely vaccinated against whooping cough at two months old.

Is the whooping cough vaccine safe in pregnancy?
It’s understandable that you might have concerns about the safety of having a vaccine during pregnancy, but there’s no evidence to suggest that the whooping cough vaccine is unsafe for you or your unborn baby.

Pertussis-containing vaccine has been used routinely in pregnant women since October 2012 and its safety has been carefully monitored by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MHRA’s study of nearly 20,000 vaccinated women found no evidence of risks to pregnancy or babies.
To date, 50-60% of eligible pregnant women (over half a million) have received the whooping cough vaccine with no safety concerns being identified in the baby or mother.
Vaccination against whooping cough in pregnancy is also routinely recommended in the US and New Zealand.
The pregnancy vaccination programme has been very effective in protecting babies until they can have their first vaccine when they are two months old.
During 2012, 14 babies died from whooping cough, all of whom were born before the vaccination in pregnancy programme was introduced, and developed whooping cough before they could be vaccinated themselves. The number of infant deaths from whooping cough fell to three in 2013 – all three babies were too young to have been vaccinated themselves and none of their mothers had been vaccinated in pregnancy.

Further questions can be answered using the following link:-

http://www.nhs.uk/Conditions/Whooping-cough/Pages/Prevention.aspx

 
 

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WHAT MEDICAL STUDENTS CAN TEACH US – HAND HYGEINE

This week I had an email from one of 3rd year medical students requesting topics that her student and her partner would like to concentrate on during the next teaching session. I was a bit surprised when she requested this but apparently she had failed this in a previous examination.

Handwashing
The main medical purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. As a general rule, handwashing protects people ill or not at all from droplet and airborne diseases, such as measles, chickenpox, influenza, and tuberculosis. It protects best against diseases transmitted through fecal-oral routes (such as many forms of diarrhoea and vomiting) and direct physical contact (such as impetigo). When visiting hospitals there is also the need to wash hands is to prevent the spread of the ‘super bug’ MRSA and Clostridium Difficile a bacteria responsible for severe diarrhoea which is life threatening particularly in the elderly.

“It is well documented that one of the most important measures for preventing the spread of infectious disease is effective hand washing.”

Handwashing
With the students I then went through the procedure very carefully as it has been established that doctors are probably culpable for the spread of infection in hospitals. We certainly were not taught hand washing formally let alone as part of our examinations and it is only in recent years probably since the swine flu epidemic has there been the stress on prevention of the spread of infection and emphasis of handwashing and using hand rub.

Hand-washing:
• Use warm running water
• Wet the hands before applying soap
• Ensure you create a good lather
• Follow the correct hand washing technique to ensure all areas are covered as shown below.
• Hand washing should take at least 15 seconds, but no longer than 3 minutesAll hand basins in surgeries and hospitals have instructions of how to wash hands correctly as below.
• Rinse well with the hands uppermost so that the water runs off the elbow
• Use a ‘hands-free’ (e.g. elbows) technique to turn off taps. Where ‘hands free’ tap
systems are not in place, dry the hands first with paper towels and use these to turn off
the taps
• Dry each part of the hands properly and dispose of paper towels in the appropriate waste
bin without re-contaminating your hands (e.g. use the foot pedal). Do not touch the bin lids

Drying
Effective drying of the hands is an essential part of the hand hygiene process, but there is some debate over the most effective form of drying in washrooms. A growing volume of research suggests paper towels are much more hygienic than the electric hand dryers found in many washrooms.

hand washing

Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water.The main action of soaps and detergents is to reduce barriers to solution, and increase solubility. Water is an inefficient skin cleanser because fats and proteins, which are components of organic soil, are not readily dissolved in water. Cleansing is, however, aided by a reasonable flow of water.

Water temperature
Hot water that is comfortable for washing hands is not hot enough to kill bacteria. Bacteria grows much faster at body temperature (37 C). However, warm, soapy water is more effective than cold, soapy water at removing the natural oils on your hands which hold soils and bacteria. Contrary to popular belief however, scientific studies have shown that using warm water has no effect on reducing the microbial load on hands.

Solid soap
Solid soap, because of its reusable nature, may hold bacteria acquired from previous uses. Yet, it is unlikely that any bacteria are transferred to users of the soap, as the bacteria are rinsed off with the foam.

Antibacterial soap
Antibacterial soaps have been heavily promoted to a health-conscious public. To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature. However, antibacterial soaps contain common antibacterial agents such as Triclosan, which has an extensive list of resistant strains of organisms. So, even if antibiotic resistant strains aren’t selected for by antibacterial soaps, they might not be as effective as they are marketed to be.

Besides this on entering a hospital and individual wards and now in GP surgeries there are facilities to use hand antiseptic and this also must be carried out on entry.

Hand antiseptic
A hand sanitizer or hand antiseptic is a non-water-based hand hygiene agent. In the late 1990s and early part of the 21st century, alcohol rub non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity.
Handwashing

Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to decrease the drying effect of the alcohol.

Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza,and hepatitis) and fungus. Alcohol rub sanitizers containing 70% alcohol kill 99.97% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% of the bacteria on hands 1 minute after application.
Handwashing

Hand sanitizers are most effective against bacteria and less effective against some viruses. Alcohol-based hand sanitizers are almost entirely ineffective against norovirus or Norwalk type viruses, the most common cause of contagious gastroenteritis.
Handwashing

 
 

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TELEDERMATOLOGY ARRIVES IN EALING

Every surgery there will be several patients who will attend with a skin problem. It is not surprising as the skin is the biggest organ in the human body. Also, there are frequent visits of someone who is worried about a skin lesion, usually a mole which they fear may be skin cancer. We are fortunate that we can refer to an excellent service in Hammersmith hospital with the longstanding walkin skin clinic every Monday morning.

Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and tumours of the skin) over a distance using audio, visual and data communication. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuous) education. The dermatologists Perednia and Brown were the first to coin the term “teledermatology” in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
The Ealing CCG has purchased a Dermascope which can examine the skin using skin surface microscopy. It is also sometimes called ‘epiluminoscopy’ and ‘epiluminescent microscopy’. Dermoscopy is mainly used to evaluate pigmented lesions in order to distinguish malignant skin lesions, such as melanoma and pigmented basal cell carcinoma, from benign melanocytic naevi and seborrhoeic keratoses. Hence,with specialists trained in dermoscopy, there is considerable improvement in the sensitivity (detection of melanomas) as well as specificity (percentage of non-melanomas correctly diagnosed as benign), compared with naked eye examination. Astudy showed that the accuracy by dermatoscopy was increased up to 20% in the case of sensitivity and up to 10% in the case of specificity, compared with naked eye examination. By using dermatoscopy the specificity is thereby increased, reducing the frequency of unnecessary surgical excisions of benign lesions.

Dermoscope

We will now be referring patients to a community nurse-led clinic to perform Dermoscopy and then the photos of the images will be sent by email to be read by a Dermatologists in the same way X-rays are read by Radiologists.

Figure 5. Milky-red globules/areas (circle) in an invasive melanoma (A) and crown vessels (asterisks) in a sebaceous hyperplasia (B) (original magnification ×10).

Figure 5.
Milky-red globules/areas (circle) in an invasive melanoma (A) and crown vessels (asterisks) in a sebaceous hyperplasia (B) (original magnification ×10).

As you can see the details are amazing and can be closely evaluated and a diagnostic language is evolving.
image
With modern phone technology a Dermoscope has been developed by attaching the magnifier to an iPhone and in the future this will probably be part of a Gp’s equipment alongside the stethoscope and ophthalmoscopeDermatocope

 
 

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30 YEARS TO CELEBRATE

HestiaWhen I had an invitation to a 30 year party at our local hostel for homeless mentally ill. I was too quick to accept as I didn’t realise I had then laid myself open into having to give a speech. I thought, ” That’s not too bad as I know the staff and residents well”.Then it was revealed that ‘by the way’ the Mayor, the MP and Ealing Gazette and ….. would be there!
When I arrived I was relieved to see the familiar faces of the staff and patients- initially not immediately recognised as they had dressed up for the occasion and I was pleased I had appropriately attired.
I nervously gave the initial speech after introduction from the director of Hestia and then we had ‘the tree planting ceremony’ by the Mayor – an apple tree.
Hestia

This was followed by an entertaining speech from Steve Pound who couldn’t resist relating the story of the circus elephant that was buried on Castlebar Hill many years ago when it died whilst walking from Hanwell acknowledging the elephant as being universal symbol of strength, loyalty, divinity and good luck appropriate for the siting of this important residence.
He then cut the cake!
Hestia

Many of you will recognise this house which is on Castlebar Hill, Ealing and has always been known as Dame Gertrude Young House, although no-one knows exactly who she was.
The only information available is that in 1933 Princess Louise, Duchess of Argyll, opened the Dame Gertrude Young Memorial Convalescent Home. The building, with 4 acres of gardens, had been bequeathed to the Central London Throat and Ear Hospital by the Hospital’s Vice-President and a friend of Florence Nightingale, Col. Sir John Smith Young, on the proviso that it be used as a convalescent home for the Hospital. A liberal endowment fund was also bequeathed for its maintenance. The Home had accommodation for 26 patients – 8 males, 10 females and 8 children.

During WW2 the gardens provided vegetables for patients in the Home and its parent Hospital.

By 1964 the building had become a geriatric hospital for the North West Metropolitan Regional Hospital Board, with 19 beds.

By 1967 it had 12 beds.

In 1976 it became a hostel for patients awaiting operation. It finally closed in 1977.

As we know it today The Dame Gertrude Young House opened in 1984. Hestia also liaise closely with Ealing council.
imageIt is run by the St Mungo Community Trust (Hestia) and has accommodation for 20 vulnerable homeless men.
What is the St Mungo Trust ( Hestia)
In 1970 Jim Horne, a man who had personal experience of homelessness, started a soup run to help people living rough around the old Covent Garden Market.

Later that year he founded the St Mungo Community Trust, and obtained the use of run-down houses at token rents, from the Greater London Council and local authorities, to provide shelter for men and women living on the streets. For nearly a decade the Trust pioneered work in this area, running the old Marmite factory in Vauxhall, the old Charing Cross hospital and other properties to provide as many as 800 people a night with accommodation. It was the dedication of the members of the Trust and of those who supported them which kept them going in conditions which would seem almost impossible today.

When I arrived in 1997 I was warned that we should not register residents permanently and they should be always accompanied on their visits to the surgery and seen at separate times after surgery hours. I was horrified at the idea as I was committed to the ethos of the National Health which serves all people without discrimination and insisted from the outset that they should registered, given a new patient check in the same way as other patients and attend surgery with everyone else. I have to say with the sensitivity and support of the surgery staff there have been no significant problems. Admittedly on occasions when receptionists have noticed that one of them has been agitated or unwell they have gently lured them away , given them a cup of tea and discretely called one of us out if surgery to attend to them, which has sometimes alerted an observant waiting patient to become disgruntled at the thought of someone being taken out of turn. Although there was one occasion when I had been warned that one resident tended to get inpatient and ready to call him in without waiting for very long but when I went to call him in he exclaimed, “We are playing I-spy and it’s my turn”.
For those that don’t know this game it is ideal to play as a family especially whilst waiting. (I-spy is a guessing game. One player chooses an object that is visible to all the players and says, “I spy with my little eye something beginning with …”, naming the letter the chosen object starts with (e.g. “I spy with my little eye something beginning with C” if the chosen object is a car). Other players have to guess the chosen object.)
All of these patients have suffered serious mental illness, often rejected by their families and friends and as a consequence become homeless and subsequently are taken from the streets and often end up having long stay hospital admissions in some cases up to a year.

As the years have gone by we have formed a more positive relationship with these residents and my feedback from the warden in charge is that they appreciate coming to the surgery and looking after them has become an important part of my work as GP. Over the years I have watched many of them ‘turn around’ to lbe rehabilitated back into the community. The staff have an amazing gift of being able to patiently motivate them and guide them into feeling a part of a community and in some cases even helping them find employment and become independent. Working alongside these dedicated staff I have learnt so many different ways of getting alongside these men who can be challenging. The ‘knock on’ effect is that I have used these skills to communicate and understand patients and their families who could be potentially as vulnerable.
It is only in the past 3 years that it has been recognised that people with severe mental health have a life expectancy
10-15 years less than the rest of the population In a study looking at 30,000 patients they found that many were dying early from heart attack, stroke and cancer rather than suicide or violence. Is was stated in the press that
‘Mental health groups say vulnerable people need to be offered better care to prevent premature deaths.’
Now the government have recommended that patients with severe mental illness should have general medical checks!

More recently I have begun giving the residents talks on health issues and have taken medical students who have then chatted to them in small groups. The atmosphere has been positive and the questions interesting and they have asked me to give more talks which I hope to do in the coming months. Along with the staff we are encouraging healthy living particularly eating habits as many have living on fast food and living a poor lifestyle.
The Round Table bought a greenhouse for them and they have started growing vegetables and I am hoping that any gardeners in Ealing will be able to donate plants or gardening items to encourage this venture.
Hestia

Thank you Sandra for letting me share this special occasion and to be associated with this wonderful organisation.

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Because I Am A a Girl………….

Last week I had an MMS message and when I logged in this is what I viewed:-

FGM

When I came to work in Ealing in 1997 I soon became aware that this was a common practise for many young Somali girls to have endured. It accounted for why they were reluctant to come for their cervical smear screening and in some cases why they were childless. It was not long before some of them approached me to be referred for corrective surgery. At that time Central Middlesex Hospital was in the throes of forming a team including the Gynaecologist Mr Harry Gordon and Mala Morjaria, specialist midwife practitioner to address this problem.

I was also aware of one of our patients a local solicitor was very passionately involved in campaigning for making it illegal and it is sad when I see her that I can’t share with her the more recent activity of abolishing this practise as she now has Alzheimer’s Dementia.

The precise origins of FGM are unknown, but the practice of FGM dates back 200 B.C although in many parts of West Africa, the practice began in the 19th or 20th century. Some scholars claim that it originated in the Nile Valley during the Pharaonic era and dates back to 400 years.

Recently when I spoke openly to a young Somalian patient about FGM to update me on how common it is today in our Somalian community. She was well informed and recognised that it was something her mother had come to realise was not an acceptable practise. However, she told me that her mother and her elder sister had had this done as it was considered an important ritual and a mother in Somali would be scorned upon if she did not arrange for it to be done and the girl would be derided by her peers. She was able to explain the different types of cutting and also was very cynical as to how it could be policed and people prosecuted for allowing it to be done.

However, it was good to hear how she was not only well informed, not afraid to speak out about it and adamant it should be a practise to be abandoned. It is educated girls like this with determined personalities we rely upon to educate future generations and drive to abolish FGM.

FGM is deeply embedded in local traditional belief systems for various reasons (Koso-Thomas 1987):

FGM

• Faithfulness: to ensure that women are virgins at marriage and remain faithful to their husbands .

• Chastity: to suppress female sexuality and to ensure chaste or monogamous behaviour (predominantly type 3, see below).

• Amongst those who travel in herds as a protection against rape

• Health: belief that it promotes cleanliness, improves fertility, and prevents both infant and maternal mortality.

• Religion: some practicing communities believe that FGM is a religious obligation, but there is no doctrinal basis for FGM . It is not stated in the Koran or Bible.

It is generally performed on girls aged between 4 and 12, although in some cultures it is practiced as early as a few days after birth; as late as just prior to marriage; during pregnancy or after the first birth. Girls may be cut alone, or with a group of peers from their community or village. The excisor can be a traditional birth attendant, a traditional practitioner or a health professional; typically, traditional elders (male barbers or female excisors) carry out the procedure, sometimes for pay. In some cases, it is not the remuneration but the prestige and power of the position that compels practitioners to continue. The practitioner may or may not have had health training, use anaesthesia, or sterilize the cutting instruments. Instruments used for the procedure include razor blades, glass, kitchen knives, sharp rocks, scissors, and scalpels.

fGM

Female Genital Mutilation (FGM) – also known as Female Circumcision (FC) or Female Genital Cutting (FGC) – involves the cutting or alteration of the female genitalia for social, rather than medical, reasons ac defined by the World Health Organisation. The term FC was widely used for many years to describe the practice; however, it has been largely abandoned as it implies a false analogy with male circumcision though various communities still use the term as a literal translation of their own languages.

FGM ‘comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female organs, whether for cultural or other non therapeutic reasons’.

The practice ranges from a symbolic cut, to the removal of all or part of a girl’s clitoris, to infibulation (sewing up the labia). Female Genital Mutilation or Cutting is therefore far more damaging and invasive than male circumcision.

Furthermore, while male circumcision is seen as affirming manhood, FGM is often perceived primarily as a means to curtail premarital sex and preserve virginity.

Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue.

Long term complications include:-

*recurrent bladder and urinary tract infections;

*cysts;

*infertility;

*an increased risk of childbirth complications and newborn deaths;

*the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated both immediate and long-term risks.

There are an estimated 30 countries where FGM is traditional practice, and members of communities from those countries that have emigrated practice it in their new homelands. The practice is common in many parts of Africa (in at least 28 African countries), as well as in some Asian and Arab Countries. Certain immigrant communities in Europe, Australia, Canada and the United States also engage in it. Countries have tried to ban the practice, with mixed success:-

Unicef estimates that more than 125 million girls and women have undergone the practice and that 30 million girls are at risk of it over the coming decade. In addition to Egypt, where 91 percent of women 15 to 49 have undergone the practice, countries with the highest percentages of women who have been cut include Somalia, at 98 percent; Guinea, at 96 percent; Djibouti, at 93 percent; Eritrea and Mali, at 89 percent; and Sierra Leone and Sudan, at 88 percent. Almost one in five young girls in sub-Saharan Africa are forced to endure FGM.

20,000 girls in the UK are at risk of FGM every year

Although the practise of FGM remains persistent in several countries in Africa and the Middle East teenage girls are now less likely to have been cut than older women in more than half of the 29 countries in Africa and the Middle East where the practice is concentrated. In Egypt, for example, where more women have been cut than in any other nation, survey data showed that 81 percent of 15- to 19-year-olds had undergone the practice, compared with 96 percent of women in their late 40s. Only a third of teenage Egyptian girls who were surveyed thought it should continue, compared with almost two-thirds of older women. Thankfully the practice is more widespread than it is popular, giving some hope that it will decline even more in the future;

FGM

A simple MMS message alerted Dr Livingston and myself to be more sensitive about this condition and to be proactive in understanding those women who have had FGM and to be vigilant if we suspect this is being carried out. If you want to support this campaign and read more about it by clicking the following link:-

FGM

http://m.plan-uk.org/because-i-am-a-girl/about-because-i-am-a-girl/violence-against-girls/female-genital-mutilation-fgm/

Prohibition of Female Circumcision Act 1985 made genital mutilation illegal in the U.K although it allowed girls to be taken abroad and circumcised. A Private Members Bill was introduced by Ann Clwyd MP in 2003, and came into force in March 2004. (Mohammad 2005)

The Female Genital Mutilation Act 2003 makes it an offence for UK national or permanent UK resident to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice may be legal. It also increases the maximum penalty for performing and procuring FGM from 5 to 14 years imprisonment.(Gordon 2005)

The Children’s Act (1989) states that every professional has a duty and responsibility to protect children, and that the welfare of children is PARAMOUNT.

WorriedWhat to do if you have concerns regarding possible or actual FGM:

As with any other suspected child abuse anyone can inform local Social Services or consult a health care professional for advise.

If you are worried that you or someone you know might be taken abroad for FGM, please call the police or local children’s services immediately. You can also ask a trusted adult such as a teacher or school nurse for advice first.
You can also obtain support from your Local Safeguarding Children Board
(LSCB). The NSPCC provides a list of LSCBs on their website.
Non-urgent advice for British nationals abroad can be obtained from the Foreign Office helpline on 020 7008 1500.
Other organisations that can help are:
Childline
Helpline: 0800 1111
Website: http://www.childline.org.uk
NSPCC
FGM helpline: 0808 028 3550
Website: http://www.nspcc.org.uk
Metropolitan Police (Project Azure – FGM)
Helpline: 0207 161 2888
Crimestoppers
Helpline: 0800 555 111
Website: https://secure.crimestoppers-uk.org/ams.form.anonymous.asp

 
 

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