Category Archives: Acne

The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The US healthcare system – and with it the health and welfare of millions – is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Office’s (CBO) dismal “scoring” of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire America’s healthcare prospects are under Trump’s administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill – narrowly passed by the House on 4 May – is less a piece of healthcare “reform” than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesday’s CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of “essential healthcare benefits”, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, “over time, less healthy individuals … would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all”. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered – say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $ 800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

It’s worth noting here that Trump’s budget – released Tuesday – proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $ 1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget – best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes – would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and – more than anything – a big fat payout to Trump’s bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress – and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death – quite possible given the headwinds it faces in the Senate – we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with “high-deductible health plans” rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill – the “Expanded & Improved Medicare For All Act” – had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bill’s history.

This bill – like other single-payer proposals – is the precise antithesis of Paul Ryan’s AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The US healthcare system – and with it the health and welfare of millions – is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Office’s (CBO) dismal “scoring” of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire America’s healthcare prospects are under Trump’s administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill – narrowly passed by the House on 4 May – is less a piece of healthcare “reform” than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesday’s CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of “essential healthcare benefits”, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, “over time, less healthy individuals … would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all”. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered – say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $ 800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

It’s worth noting here that Trump’s budget – released Tuesday – proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $ 1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget – best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes – would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and – more than anything – a big fat payout to Trump’s bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress – and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death – quite possible given the headwinds it faces in the Senate – we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with “high-deductible health plans” rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill – the “Expanded & Improved Medicare For All Act” – had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bill’s history.

This bill – like other single-payer proposals – is the precise antithesis of Paul Ryan’s AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

I worried about working in psychiatry but one patient taught me how to listen

In medicine, psychiatry isn’t seen as glamorous. As a student and while training, you fight with your colleagues for the sexy jobs in cardiology, intensive care or on the frontline. When the crash call goes off, it’s dramatic; chest compressions, ventilation, trying to be the hero you see depicted on television. A job in psychiatry wasn’t my first choice, if there was a crisis, what would I do? Come running with my pen and notebook? Not exactly Oscar-winning stuff.

I had my reservations as I was about to embark on 91 days as a doctor in an adult inpatient psychiatric unit.

My first patient was a middle-aged woman with chronic depression and schizophrenia. Sandra* greeted me with a look of suspicion. Abused as a child, she had lived on the streets for most of her adult life, during which time she’d been through harrowing experiences. My first task was to take bloods from her. With every attempt over the next four months, I was met with the resistance of a combat warrior.

In my interactions with patients I wondered whether I was talking a different language. I had never been rejected by so many patients so much – the common answer to most of my questions being met with a firm “No!”.

After weeks of failing at any kind of meaningful interaction with patients, I decided to change tack. I stopped being the doctor in the white coat and softened my somewhat rigid attitude. Rather than judging their resistance towards me I decided to dig beneath their exterior. Connecting with my patients on an even playing field was going to be my biggest asset – but more importantly it was going to change my understanding. With Sandra, meanwhile, I had to earn her trust. Slowly, over the weeks, I learned more about what made her the person she was and the experiences that had shaped her life. She was letting me into her world, and with time she would give me her arm to take those bloods.

At first I was perhaps too naïve. I soon began to realise that if a patient was suffering from a manic episode and running around the ward naked, it wasn’t funny, but undignified. Psychotic symptoms were no longer just a list I had memorised for my medical finals exams, but instead a detachment from reality which gave patients the powers to feel like a God – indestructible. They would jump out of a window because they believed they were a superhero. I was fighting to keep them alive and protect them from the dangers of the outside world – imaginary wings will not make you fly. They will bring you crashing down to earth, hard and fast.

I started to see beyond patients’ bizarre delusions, wild disinhibition and somewhat entertaining personalities. Instead what I saw in front of me were people whose lives were consumed by the cruel fate of mental health problems. I was seeing how such a distressing illness could leave them as an empty shadow of their former self. Disabled by these crippling illnesses, their vulnerability and risk put their lives in my hands more than ever.

One day on the ward, my bleep (or, technically, in this setting, a personal protection alarm) began sounding like a siren to draw my attention to an urgent incident. Sandra lay slumped with blood pouring out from her wrists. Self harm and suicide is talked about almost too readily in the news. Seeing it in front of you is a whole different ball game.

A lone junior medic in a psychiatric hospital, I was the most senior (year two out of medical school) and experienced medical doctor. I longed for a team to come running to my aid – as is the norm in a hospital when those alarms sound. With little equipment and assistance we were able to stabilise her and wait for the bleeding to stop. Although Sandra’s wounds in time would heal, her psychological scars remained etched even deeper.

People like Sandra have taught me a lot about myself. I’m walking out with invaluable experience.

In its own right, psychiatry is a complex integration of theories and experience. No physical test will give you an explanation for the patient in front of you. Maybe that’s why the rest of the medical profession remains baffled – as a cohort we like to work with numbers and hard evidence. Instead, with mental health you must talk, listen and observe – skills that take years to acquire.

*Not her real name and some details have been changed

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

UEA course cut a blow for mental health work | Letters

All the parties in the general election have adopted mental health as a key issue. But this enthusiasm is not reflected on the ground and the electorate should not be fooled. We are students and former students on the internationally renowned counselling programme at the University of East Anglia. We trained to be counsellors, or “shrinks”, to quote Prince Harry in his recent interview. But now the university has closed the course and even made it impossible for some students to complete their professional qualification. As part of this draconian process, in which consultation was at a minimum, responsibility to students, staff and the wider local community has been completely deprioritised. This is exactly the opposite of what the princes, applauded by the government, were calling for.

The impact is not only on the course itself, but also on those therapy organisations where students have for many years worked as volunteers on placement and beyond, and on the availability of the kind of in-depth listening relationship – described as so crucial by the princes – in the university’s own counselling service. The management-speak reason given by the university for this closure is “a need for greater alignment of courses and a more coherent portfolio of activity centred on the teaching of education theory and practice”. What is the point of accenting mental health if there won’t be any counsellors to deliver it?
Sara Bradly, Dr Rachel Freeth, Bridget Garrard, Nikki Rowntree
Norwich

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Are you a doctor in Australia struggling with mental health issues?

The issue of mental health among Australia’s doctors and medical students has been in the headlines. Four junior doctors from one cohort have taken their lives within six months. Last week, Australian gastroenterologist Andrew Bryant died in his office after battling depression.

The National Mental Health Survey of Doctors and Medical Students shows that the profession experiences higher rates of mental illness than the general community. Though doctors report that talking about it is taboo within the high-performing culture of medicine.

Dr Ranjana Srivastava writing for the Guardian said: “When it comes to mental illness, we hear a lot from the experts but not enough from the sufferers. Nothing would be more welcome than the insights of doctors who have endured mental suffering and worse, been on the brink of suicide. What healed them and who helped them? What could their colleagues have said or done differently at the time? What workplace adjustments would have meant the most? These stories are clearly among us – hearing them could illuminate the dark corners of our understanding and help link theory and practice.”

Share your experiences

We’d like to hear from doctors who have experienced mental health issues. What helped you through it? What could your colleagues have done differently at the time? You can share your experiences, anonymously if you prefer, by filling in the encrypted form below. We will do our best to keep your information secure. We will not publish any responses without contacting you first.

In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255

Scanxiety: why private baby scans are on the rise

Anxiety may be the scourge of our times, but it now appears we have “scanxiety”, too. According to a study of 2,000 women, the phenomenon of pregnant women paying for extra private scans is on the rise. Almost a third paid for scans during pregnancy, with 36% citing anxiety as a reason. The NHS offers routine scans at 12 and 20 weeks, although more may be given for medical reasons.

“For the last 20 years, it’s been quite common for women to access private facilities for scans,” says Dr Christoph Lees, a consultant in foetal and maternal medicine and obstetrics and a spokesman for the Royal College of Obstetricians and Gynaecologists. “Sometimes it’s simply for reassurance, or because they don’t feel they’re getting sufficient scans on the NHS. Sometimes they’re accessing a service that isn’t routinely provided, such as 3D and 4D scans. Many are what you might call souvenir scans.”

For Lauren McGlynn, who has two boys aged four and nine months, anxiety was the main reason for paying for private scans. “Before my first son, I had two miscarriages,” she says. “I just couldn’t deal with waiting until 12 weeks. I had a private scan at seven weeks, which is the earliest they will let you do it.” Did she speak to her midwife or doctor about her worries and ask for an early scan on the NHS? “I didn’t say anything,” she says. “I just assumed the NHS wouldn’t be able to give an extra scan to every woman who had a miscarriage.”

Mandy Forrester of the Royal College of Midwives believes the rise may be partly explained by the shortage of 3,500 midwives in England (Lees also points to the national shortage of sonographers). “Midwives are pressurised during antenatal appointments and continuity of care is an issue,” she says. “If a woman is seeing the same midwife, it’s more likely they will build a good relationship. It may be that women are not getting the reassurance they need.”

There is also the issue of the small, unconfirmed risk to the foetus associated with ultrasound, which is why multiple scans without sufficient medical reason are not recommended. “And it’s difficult to know the quality of the service,” Lees adds. “While there are many private providers that are extremely good, there are pop-up services where the person doing the scan doesn’t have any training in ultrasound. You don’t need to have a licence to do an ultrasound scan privately.” Does he often see women who have had private scans that have worried them? “I do see women who come back to me with a private scan report,” he replies. “Quite often we have to repeat the scan and sometimes the advice is not correct. [Private scans] can cause concerns that are not necessarily merited, which rather negates their point.”

A moment that changed me: realising, aged 16, that I couldn’t handle alcohol | Lou Sanders

I was 16, on holiday in Alicante on my own – my Aunty Sue was due to join me the next day. So in preparation for her arrival, I drank almost a litre of vodka, hit the town and passed out. A Spanish stranger called an ambulance and the local hospital kindly pumped my stomach. “Olé! Olé!” as they say (translation: Oi! Oi!).

I was in a foreign place, didn’t speak the language, and had no idea where my hostel was. I thought I was streetwise but I was a street idiot. Like many people my age, I was a turbulent sea of emotions: a mix of hormones, some unprocessed family happenings, and a classic case of a broken heart. Because of this emotional maelstrom, the male nurse thought he could drop me back to my hostel via his place and have sex with me, since I was too low on self-esteem, and way too out of it, to put up any sort of counter-argument. Turns out he was right. Muchas gracias, maaate!

I’d like to say that this was the moment that changed me, but I still needed another 117 occasions just as murky to decide that maybe drinking wasn’t for me and that, rather than saving me from my problems, it might have actually been causing quite a few of them, or certainly giving them some fertile ground in which to blossom.

A year later, when I was 17, I was working as a bartender in one of the roughest pubs in Margate. To give you some idea, a lot of the clientele had the latest jewellery in electronic tags, and some of the customers were working as local concubines. It was run by a couple called Pam and Bob and they, as you can imagine, had seen all sorts.

The establishment let you accept drinks as tips while you worked. Big mistake, Pam and Bob, big mistake. I’d had some super-strength lager on the bus over, so the double whiskies really topped off the trouble. By 10pm, I had burnt the arm of my jumper, I had one foot stuck in the bounteous fag bin, and I had smashed a whole dishwasher tray full of drinks into a wall. I was not winning any bar-staff awards that night and, of course, got asked to leave. Later on I found out that I was so drunk my bosses thought that I couldn’t have just been intoxicated – I must have been on drugs. I was not on drugs – well, not that night anyhow.

Around this time, I was also arrested for drink-driving. I was driving at 5mph, so as not to arouse suspicion. Then when I realised the police were tailing me, I thought I could trick them by indicating left, and, you guessed it, turned right. They saw through my plan and pulled me over, but drunk me had another scheme; I downed a bottle of lemon grass aromatherapy oil and told them I was “in a rush, so must be getting on”. Needless to say I was prosecuted, and quite right too.

I have lost count of the incidents through the years and the number of times I gave up drinking. But I did get better at controlling it. When I was younger I used to wet myself and pass out, and I’d often come to with a “friend” who had decided that he would try to remove my clothes and insert his penis in me. It’s a shame judges sometimes blame the women in these scenarios, because if a woman was passed out drunk and someone started punching her in the head (another physical violation) would they say – “to be fair she was drunk, so she was asking for it”? She was only asking for “it”, if “it” is a fully clothed snooze, thank you. Or indeed a nudey-snooze if she so fancies.

Anyway, I cleaned up my side of the street and bit by bit became stronger and started working on the trauma and shame. I do believe that if you are lucky and meet the right people, some horrific situations can be an opportunity to grow stronger, and every single person has a spectrum of events happen to them, which don’t have to define them. I’ve forgiven all the people who used me and abused me when I was drunk because, really, they were just as unconscious as me – just in a different way.


There was no knowing when the beast would be unleashed. But, at some point, the beast was always unleashed

I thank them for all the lessons they brought with them – through their “teachings”, as they all helped me to reach that well-documented rock-bottom, so that all I could do was build upwards. And year on year, slowly but surely, I built a rock-solid foundation. I’ve also forgiven myself for everything in the past (I think), and I hope that all the people who I’ve inflicted my pain on have forgiven me too.

Giving up drinking was a slow and gradual thing. In my late 20s, I drank a fair bit, and was for the most part a big, fun drunk without incident. But there was no knowing when the beast would be unleashed. And, at some point, the beast was always unleashed. I had so much shame and guilt that I drank to forget it. Which is a bit like saying you crave exercise so much that you cut off your legs.

Now, finally, I love not drinking. I love the clarity and simplicity of it, but it’s taken a long time to get here, via many, many mistakes. I used to think I was missing out, so inevitably I would always, slowly, creep back to the wine. Then, through a combination of being in the right place at the right time, meeting the right people and finally being ready – I gave up for good. I also read a great book called The Easy Way to Stop Drinking, by Allen Carr (not that one). It somehow made me realise that I wasn’t missing out; in fact, I would only be missing out if I started drinking again.

The word sober sounds so serious. I still love dancing till 2am and talking shit. I still love all the enjoyable things I did drunk, but there’s choice and power in my decisions now. And I’ve also given up drinking lemongrass aromatherapy oil; that was the big one for me.

For information on all of Lou’s upcoming projects please visit lousanders.com

Number of strokes in UK predicted to rise by 44% in next 20 years

The number of strokes in the UK is expected to increase by almost half over the next 20 years owing to the ageing population, according to a study.

Over the same period, the number of stroke survivors is predicted to rise by a third, raising questions about how the already stretched NHS and social care services will cope.

King’s College London analysed data from 35 European countries, finding that the number of strokes across the continent is likely to rise by a third (34%) by 2035. But the increase in the UK is expected to be more pronounced at 44%, owing to the rate at which the country’s population is ageing relative to many other European countries.

By 2035 the number of UK stroke cases is expected to increase by 44% to about 62,000 a year

Alexis Wieroniey, deputy director of policy and influencing at the Stroke Association, said: “The predicted rise in the burden of stroke is largely due to our ageing population, as the risk of having a stroke increases as you get older. It is a worrying forecast, but it is not inevitable.

“Most strokes are preventable and everyone can take steps to lower their risk of stroke as they get older. Obesity can increase your risk of stroke by at least 64%. However, simple lifestyle changes like eating healthier meals, taking regular exercise and stopping smoking, along with checking your blood pressure regularly, can greatly reduce your risk.”

According to the Stroke Association, an estimated 1.2 million people are currently living with the effects of stroke. It says there are more than 100,000 strokes each year.

Spending on stroke patients

The King’s College London analysis is published on the same day as the British Medical Association warns that the UK is facing a health time bomb owing to a failure in addressing the burden placed on the NHS by obesity, smoking and alcohol consumption.

The BMA points to figures showing that nearly one in six adults still smoke, 7.8 million adults binge drink and obesity rates remain stubbornly high. It says there has been a failure to publish a new tobacco control plan and a lack of recognition of the need for a new alcohol strategy. It also describes the childhood obesity strategy as “watered-down”.

In its manifesto, A Vote for Health, the BMA says whichever party wins the general election should reverse the £400m of public health cuts taking place between 2015-16 and 2020-21.

Dr Mark Porter, chair of the BMA council, said: “In England, successive governments have failed to deliver a long-term plan to improve public health, and too often evidence-based public health measures have been kicked into the long grass. We need tighter regulation of the food and soft drinks industry, a minimum unit price on alcohol and support for people to quit smoking.”

The Stroke Association says a plan to tackle strokes is also essential given the projected rise in the number of cases. The current stroke strategy for England is scheduled to end this year, leaving it as the only UK nation without such a plan.

A Conservative party spokeswoman said: “We are committed to improving the health of the nation. Smoking rates are now the lowest in our history, with cancer survival the highest, and we’ve put in place a childhood obesity plan Public Health England calls the most ambitious in the world.

“But the truth is that this all depends on a strong economy – we spent £3.4bn on public health programmes last year – which Jeremy Corbyn would risk with his nonsensical economic ideas.”

Your 12 Worst Allergy Mistakes

You’ve got clutter

Stuffed animals are cute, cuddly, and unfortunately, major magnets for dust, a common allergy trigger.

If your child has piles of fluffy friends, and he or she—or anyone in the household—has allergies, you’re better off storing or giving them away. (Many charities collect stuffed animals to give to needy kids, or even as puppy play toys.)

It’s best to limit youngsters to a select few, which can be occasionally washed, rather than a whole collection, Dr. Rosenstreich says.

Nigeria battles to beat polio and Boko Haram

The man sporting a giant purple bottom adorned with a swinging horse tail is chanting to the beat of the drummers, his blue-painted face sweating copiously. Children delightedly race around the colourful clown. All except Ismail, 13, who watches from the ground, twisting his head to follow the dance. A man with a megaphone is yelling something, but it can’t be heard in the melee. Then a group of blue-caped women emerge from the crowd, clutching cheap market stall lunchboxes, to begin the real business of the day.

This is the “flag-off” in Ungogo, Kano state. The party marks the first of four days of intense work by an army of volunteers, mostly young mothers, who will go door to door across Nigeria. Some will pass through thousands of twisting warrens of slums fanning out into the red-orange, mud-built hamlets and reed-thatched huts. Others will visit the crumbling concrete city blocks, slipping drops of polio vaccine into as many of the 30 million Nigerian children under five as they can find.

Their capes bear the slogan: “Lafiyar al’ummarmu hakkin kowa da kowa ne” – “The health of the child is the responsibilty of all.” The lunchboxes are filled with ice and polio vaccine. They have marker pens to dab on the finger of each treated child and chalk to mark every house wall they visit, marking which child was vaccinated and when. No one is to be missed out.

Ismail has mixed feelings as he watches, his useless legs tucked under him in the dust. He contracted polio aged two. “I blame my parents,” he says, “for not having me vaccinated, it makes me angry with them. I don’t feel so glad to see this today, I feel sad.”

Polio is a plague on the poor, a paralysing, disabling brute of a virus, it deforms the limbs and wastes the muscles. Children under five are most at risk and places with poor sanitation are favoured feeding grounds for the virus, which spreads through infected faeces. For every one person paralysed by polio, another 200 will be contagious.

Even in countries like the UK, where it has long been wiped out, sewers are regularly tested to ensure that polio does not sneak back into the population. Only three host countries remain: Nigeria, Afghanistan and Pakistan. Nigeria was on track to be declared polio-free in 2017. But just as it was ready to celebrate, the disease returned.

Binta Siddique, left, and Hanza Absulane await anti-polio vaccinations for their babies.


Binta Siddique, left, and Hanza Absulane await anti-polio vaccinations for their babies. Photograph: Tracy McVeigh for the Observer

The stumbling block here is not a lack of effort. The drive to vaccinate by Nigeria, with help from Unicef, which has been behind this mass mobilisation, has been heroic. The problem is Boko Haram.

This fearsome insurgency group holds a great swath of territory in north-east Nigeria, where it attempts to impose an extreme form of Islamic law and a hatred of the west. Violent and insular, Boko Haram also tries to seal people in its territory and keep vaccination teams, seen as a western influence, out. It is to this area that polio has returned, and the fear is that those fleeing their violence could bring the virus back into the wider country. The two polio cases discovered in August were children displaced from Maiduguri, capital of Boko Haram’s stronghold, Borno state.

Boko Haram is now weaker, but the poverty, propaganda and fear that brought them into being remain strong. The memory of the murder of two Kano vaccination teams four years ago is still fresh. “I was soaked in blood,” said Abbas Ibrahim Musa, in the village of Kauyen Alu. “It was a Friday, at 8.30am. I was preparing the vaccines. I heard a gunshot and raised my head and saw a man in the door holding a gun. I fell to the floor and heard ‘bang, bang’. Then ‘shoot them, shoot them’. There was the smell of petrol and they started to burn the place. I had bodies on top of me. Providence decreed I didn’t die that day. Three people died and three were injured. One had just finished her studies, one a bus conductor with one child and a pregnant wife. One sold vegetables.”

Meanwhile, in a nearby village, other gunmen were slaughtering eight women, another team of volunteers. Three days before, a radio show had run an item in which an imam repeated allegations that the polio vaccine was a western plot to sterilise Muslims.

“I can say this,” said Musa. “Without Boko Haram polio would be a thing of the past. Some say health is not the problem; security is. They are linked. If we hear one child in Maiduguri has polio, then that means there are 200. So what if there are 10 children there? And very many children are coming out of the conflict zone. We don’t know, so we have to work harder. We persuade people by educating them. You make them understand. We have reduced the non-compliance rate here now to almost zero. I tell our workers ‘your names are written in gold’.”

But with some religious leaders sharing the distrust, what should have been a celebration of a disease eradicated is now a renewed struggle to finish a job that should have been over. Since the outbreak in Boko Haram-controlled territory, northern Nigeria has been in emergency mode. Teams of vaccinators are out almost constantly. “I almost cried,” said Rhoda Samson, “but not to finish the job is not acceptable.”

‘Disabled in the body, not the mind or heart’: surviving polio in Nigeria

A supervisor in the mobilisation teams, Samson is thorough, checking every move her teams make. They visit a woman whose five-day-old baby still has no name. The chalk on the wall outside shows a list of visits here. “Seven times they have said no,” said Samson as her team coo over the baby. “Bamaso,” said the mother, Amina Ali. “We don’t want. My husband says vaccine is not food, why do the government not give us food? He refused and has not offended God.”

At this her husband, Ali Zaki, returns home, angry at the invasion of his house: “I believe God will provide; this is what we are taught.” But he is no match for Samson: “You think God doesn’t make the medicines? You want your children to have polio? To never play? Does Allah want that? What kind of man are you?”

When Zaki grudgingly agrees, the vaccine is quickly slipped into the baby’s mouth and the women clatter off, congratulating the couple. “They’ve a lot of reasons for refusing. We have some who don’t want drugs at all, some who say they won’t because they want something in return, some hear the stories,” said Samson. “The security situation is a problem. People are suspicious, they hear vaccinations make infertility. But we are bringing the numbers of non-compliants down; we will not stop.”

And they are not just fighting polio – they are creating a network and collecting data in a way never before done in Nigeria. A network of trained, community-based health workers, it’s a structure already being used to deliver other healthcare.

Senior state and government officials have recognised the value of this, gracing the polio flag-offs. In their elegant robes and themed hats, and long, often less elegant political speeches, their presence stresses to everyone in the fidgeting crowds of locals that something important is happening here. It is the kind of message that could reverse the damage done by Boko Haram, says Dr Kabiru Ibrahim Getso, Kano’s health commissioner. “Kano used to be a hub of polio cases, now it’s best practice. The last case was 2014 and this did not happen by accident. The teams are headed by the governor himself, it’s high profile This is how we do it. We go into the field every day, every day the volunteers are out there. Then we can use these structures to develop an entire primary healthcare system.”

Displaced people are especially targeted in this campaign. Abule Abdullah has hosted seven families – seven mothers and 33 children – in her home in Katsina state. One of her current guests is Aisha Idris, 40, recently arrived from Maiduguri.

“Boko Haram forced us to come here. The insurgency has stopped everything, the hospitals, the schools, everything is shut down,” she said. “My husband was killed at his Islamic reading group by a stray bullet from the fighting. My child was sick and so I came here with my children. I have to live with no roof over our heads but they have all been vaccinated now.” At the bus stations, and the state and national border crossings, the lunchbox-toting teams are there. Peering into cars, lifting the cloaks of women perched on motorbikes to find the babies strapped to their fronts and backs. Squeezing in the little vials of vaccine.

“If they say no, then we tell them they can go back,” said superintendent of immigration, Charles Tashllani, imposing order on Nigeria’s border with Niger in Katsina. Here, late in the evening, the Polio Emergency Operations committee reviews the campaign’s first day, which has seen 3,661 teams immunise 28,882 underfives. The detail is such that eight missing marker pens are on the agenda, as is the sacking of two town announcers who did not inform people about the programme.

“We look at every single child, everyone counts to us. I’m dealing with human beings. But we do have the iceberg phenomenon: many inaccessible, remote areas where we do not always know what is going on.

“People not feeling that polio is a threat to them, that is a big worry for a resurgence. But the biggest threat to health is Boko Haram. When we learned we had Borno refugees here in Katsina we were worried; they melt into the communities. It is potentially dangerous.”

The legacy of polio can be seen everywhere in Nigeria. Aminu Ahmen el-Wada lives with Hadza, his wife of 28 years, and those of their nine children who still live at home. One of life’s cheerful souls, he is enormously proud of the length of their marriage. “The trick is when I am the problem, I say sorry, when she is the problem, she says sorry,” says Wada.

The couple both skim along the floor using wooden handles Wada designed and carved to protect their hands – when your legs are withered from polio and are folded tiny and useless below your torso, your arms are the limbs that propel you. “I went to school until I became too heavy for my parents to carry me there,” said Wada. “So I taught myself to make hand-operated cycles, first for myself, then for others.” He now employs 20 people, 15 polio survivors. “Otherwise we would be beggars. This is because in Africa nobody can help you if you are disabled. But my father told me: ‘Disabled is in the body, not in the mind or in the heart,’ and this is what I believe.”

His smile falters only when he introduces Ummar, 14. His son contracted polio during a hiatus in the immunisation programme. “It was horrible. But the place behind our house is where people defecate. This is what happens.”

Wada began the Polio Survivors Group, which supports the vaccination drives. “I tell people: ‘Look at me. Do you want your child to end up like this? To never play football?’” Although he acknowledges the irony in that he also coaches a polio survivors’ para-football team. “But they would rather play for Arsenal,” he grins.

In his open-air workshop by the side of a main road in Fagge, the air smells poisonous as the men who would otherwise be beggars weld, cut and paint, making the three-wheeled, arm-operated cycles that give a certain freedom of movement. “This is the small size, for age five, then they can move up, age teenage, age adult,” he says. “One day I would like it that we make no more because polio is eradicated. Then we will make playground equipment instead, slides for happier children.”

He fires up his beaming smile: “Years ago in Nigeria we had leprosy, smallpox. We chased them all away. Now the last one is polio.”