Category Archives: Acne

Sierra Leone: teenage girls are dying from unsafe abortions and risky pregnancies

I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.

This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.

From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.

Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.

A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.

During the recent Ebola crisis teen pregnancy rates rose in Sierra Leone by an estimated 50%. This rise could give insights into why the country’s teen pregnancy rate is so high. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection.

What can be done to help these girls? This problem is complex with many driving factors.

The UK is one of Europe’s great success stories with reducing its high teenage pregnancy rate. Improved sex education and access to contraception and changes in social norms are credited with this drop. Can any of the lessons learned be applied in this context?

Improving knowledge of and access to contraception is certainly important. Access to contraception in Sierra Leone is limited; an estimated 16% of women in Sierra Leone use contraception and this figure falls to 7.8% for teenagers. Safe access to abortion for girls who do not want to continue their pregnancy is essential. In Sierra Leone, the country with the world’s worst maternal mortality, abortion is illegal in nearly all circumstances and unsafe abortion is estimated to account for 10% of maternal deaths. This will only be compounded by Trump’s enactment of the “global gag rule” which has a disastrous effect on funding for organisations working for women’s reproductive rights.


The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy in from the men

However, assuming that knowledge about and access to contraception would end this problem is deeply misguided. It puts all of the onus on to the girls not to get pregnant, it assumes they have the option of making a choice. Even when contraception is available many of the girls are not empowered to insist on its use. This approach ignores the wider societal contexts that drive the high teenage pregnancy rate. A recent report by the Secure Livelihoods Research Consortium highlighted some of the inadequacies in current programming.

The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy-in from the men, and a change in attitudes that currently accept the concept of teenage pregnancy. Currently, a lot of work being done on this issue focuses only on the girls. Addressing the attitudes that perpetuate teenage pregnancy is difficult and there are few programmes that do this at the moment. It is easy to pick out and identify the teenage women, but harder to involve the men who could potentially impregnate them.

The high adolescent pregnancy rate, in Sierra Leone and around the world, jeopardises the achievement of the sustainable development goals (SDGs). The SDGs focus specifically on reducing maternal mortality, improving health for all ages and promoting women’s rights. Teenage pregnancy is a threat to the realisation of all those goals and so meaningful efforts to reduce the appalling rate are essential to making any progress.

In the hospital where I work, a teenage pregnancy support group is going on. Girls receive education sessions. Efforts are being made to find them jobs and reintegrate them into the school system. The excitement of the girls is palpable. Many of them have come from situations where they are not shown any respect, but now they are being empowered to take control of this important part of their lives.

This month the UK government hosted Family Planning Summit 2017 to recommit to this global issue, announcing that the UK would increase international development spending on family planning from £180m per year until 2020 to £225m per year until 2022. Governments from countries around the world came together to make commitments to improving women’s access to family planning. In the face of Trump’s regressive change to US policy, putting women’s reproductive rights at the centre of the international community’s agenda is of great importance.

Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a recent Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Terrorism blamed for rise in children seeking mental health support

The number of children and young people seeking help from mental health services has spiked in the wake of recent terror attacks in England, according to the Royal College of Psychiatrists (RCP).

Hospitals across the Manchester region have seen an estimated 10% increase in children seeking help since a bomb ripped through the Manchester Arena on 22 May, killing 22 people, according to the RCP. Mental health experts in Greater Manchester hospitals received hundreds more patients from June to July compared with previous months.

Dr Louise Theodosiou, a consultant child and adolescent psychiatrist at Royal Manchester children’s hospital and a member of the RCP, described the increase as significant and said the terror attack had a “profound impact on the way the children view their city”.

Just a small fraction of those treated had been at the concert; the majority of patients had felt increased anxiety after watching the events on the news. Anxiety and insomnia were the most common complaints, with children worrying about going out or being on public transport after the attacks.

Theodosiou warned the number affected could be significantly greater, with people also seeking support through school or voluntary services and many others yet to come forward for help.

A similar trend has been noticed in London. Dr Jon Goldin, the vice-chair of the child and adolescent psychiatry faculty at RCP, said there had also been anecdotal evidence of “a rise in children seeking mental health services after recent terror attacks”.

“Maybe the rise hasn’t been as much as Manchester [...] but some of those with a predisposition to anxiety have had it heightened by these recent events,” he said.

The increase could be linked to young people’s consumption of media, with children able to access disturbing footage on their smartphones, according to experts. It could also be a positive sign that efforts to reduce the stigma around mental health were having an impact.

Dr Rachel Langley, a clinical psychologist from Southampton children’s hospital’s sleepdisorder service, said: “Technology has a huge amount to answer for in fuelling a rise in children’s sleep problems. It gives young people access to what is going on in the world and also … the blue light of the screens affects melatonin release.”

She added: “There was a 10-year-old boy I saw recently who has anxiety-related insomnia and he has a specific concern about his dad, who works in London, getting caught up in a terror attack.”

In Manchester more young people are expected to seek help in the coming months and years. Theodosiou said: “It has unmasked vulnerabilities that were not there before. It’s fair to say that of the hundreds of children affected only a small fraction would have witnessed the events.”

She added: “If you think of the bomb as being like an influenza epidemic, those most affected by that will be ones with underlying respiratory problems [...] and in the same way the group most affected by the terror attack in the city have been those who are vulnerable to mental health at the beginning.”

Peter Sweeney, another psychiatrist from Royal Manchester children’s hospital, said services needed to plan ahead to manage post-traumatic stress disorder that could hit families and young people.

“We needed to do lots of work for the survivors initially … they got a high level of support at the start. Our concern now is more about young people who may be experiencing anxiety but are not presenting to us, so those who were at the concert but not seriously injured or those who were not at the concert but affected,” he said.

The message to children should be that these attacks should not alter behaviour and that people should get on with their normal lives, said Goldin. “Children should get that message as well as adults. If you have anxious parents saying ‘don’t go to London etc’ then that doesn’t give the most helpful message.

“One message to get across is that it’s important not to feel that, when a child is anxious about a terror attack, they should be taken straight to children’s mental health services. Usually family and a normal support network can really help them. When things are more enduring, for example several weeks after a traumatic experience a child is still struggling with sleep or their mood etc, then you would want CAMHS [child and adolescent mental health services] to get involved.”

  • In the UK, the Samaritans can be contacted on 116 123, and Childline on 0800 1111. 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.

Stressful experiences can age brain ‘by years’, Alzheimer’s experts hear

Stressful life experiences can age the brain by several years, new research suggests. Experts led by a team from Wisconsin University’s school of medicine and public health in the US found that even one major stressful event early in life may have an impact on later brain health.

The team examined data for 1,320 people who reported stressful experiences over their lifetime and underwent tests in areas such as thinking and memory. The subjects’ average age was 58 and included 1,232 white Americans and 82 African Americans. A series of neuropsychological tests examined several areas, including four memory scores (immediate memory, verbal learning and memory, visual learning and memory, and story recall).

Stressful life experiences included things such as losing a job, the death of a child, divorce or growing up with a parent who abused alcohol or drugs. The results showed that a larger number of stressful events was linked to poorer cognitive function in later life.

When looking specifically at African Americans, the team found they experienced 60% more stressful events than white people during their lifetimes. Researchers said that, in African Americans, each stressful experience was equivalent to approximately four years of cognitive ageing.

The study, which has not been published in a peer-reviewed journal, was presented at the Alzheimer’s Association international conference in London.

Dr Maria Carrillo, the chief science officer for the Alzheimer’s Association, said: “The stressful events that the researchers were focusing on were a large variety … the death of a parent, abuse, loss of a job, loss of a home … poverty, living in a disadvantaged neighbourhood, divorce.” She said that even a change of school could be regarded as a stressful life event for some children.

Dr Doug Brown, the director of research at the Alzheimer’s Society, said: “We know that prolonged stress can have an impact on our health, so it’s no surprise that this study indicates stressful life events may also affect our memory and thinking abilities later in life. However, it remains to be established whether these stressful life events can lead to an increased risk of dementia.

“Studying the role of stress is complex. It is hard to separate from other conditions such as anxiety and depression, which are also thought to contribute towards dementia risk.

“However, the findings do indicate that more should be done to support people from disadvantaged communities that are more likely to experience stressful life events. As we improve our understanding of risk factors for dementia, it is increasingly important to establish the role that stress and stressful life events play.”

Other research has suggested there are plausible links between stress and chronic inflammation, which in turn may accelerate the development of dementia. But experts believe that a health lifestyle and a healthy diet can help mitigate this risk, even for those people going through stressful events.

4 Unexpected Ways Summer Heat Is Throwing Your Body Out of Whack  

Summer is finally in full swing—which means cute sandals and sunglasses, beach vacations, and ridiculously scorching weather. If you’re feeling the heat, literally (does it really need to be 85 degrees before nine in the morning, seriously?) you’re not alone.

Hot temperatures can mess with your body in all sorts of sneaky ways, and we don’t just mean the threat of a sunburn or sweating through your outfit on the way to work. Here are four common ways hot, humid weather takes a toll on your health, plus how you can beat heat’s effect on your system.

RELATED: 20 Ways to Stop Allergies

You’re sniffling and sneezing

Flowers bloom in the summer—and so do plants and grasses that produce pollen, says Kim Knowlton, MD, an assistant clinical professor at Columbia University’s Mailman School of Public Health. In response to the warm weather, pollen production goes up, and the presence of pollen in the air can leave even people with mild allergies sneezing, sniffling, and rubbing their itchy eyes through Labor Day.

To reduce these allergy symptoms, pay attention to the daily pollen count and try to stay indoors as much as possible on high-count days. If you can’t give up your outdoor run or yoga class, try to time it (as well as other outside activities) toward the end of the day, when pollen counts go down. And keep windows shut in your house to keep allergens from turning you into a sneezy mess in your own home.

You toss and turn all night

Too hot to sleep—but the air conditioning in your room is making you shiver? Summer makes it tough to find that happy medium. Most people sleep best when the temperature is at 65 to 66 degrees; as the temperature goes up, sleep quality tends to go down, says Chris Winter, MD, neurologist and sleep medicine specialist at Charlottesville Neurology and Sleep Medicine in Virginia. 

The right temperature could also help you stay asleep through the night and score better sleep quality. So if you find yourself waking up fatigued and fuzzy-brained, try adjusting the thermostat. Dr. Winter says many of his patients have reported resting much better when they lower their bedroom temperature, even if they hadn’t noticed sleep problems. Don’t feel guilty for using so much electricity—cranking up the AC to a healthy level is good for you.

Your heart pounds way more than normal 

You do a hard-charging cardio workout three times a week, but your heart rate is suddenly spiking on your walk to work in the morning. What gives? Jonathan Newman MD, MPH, cardiologist at NYU Langone Medical Center in New York City, says higher temps have both direct and indirect effects on your heart.

For starters, if you live in an urban area, you may notice smog or haze fogging up summer skies. Air quality tends to get worse at higher temperatures, and that air pollution itself can take a toll on the heart and vascular system, Dr. Newman says.

Plus, at the most basic physical level, “your heart is working overtime” in the summer, says Kim Knowlton, MD, an assistant clinical professor at Columbia University’s Mailman School of Public Health. “Your heart beats faster in order to pump overly warm blood from your body’s core out to the skin’s surface,” says Dr. Knowlton, which helps cool you down.

Since your faster heartbeat is all part of your body’s way of keeping you cool, there’s not much you can do to prevent it. Taking normal precautions in the heat—drinking lots of water, not exerting yourself too much—are always good ideas. And of course, ”eating a heart-healthy diet, controlling your blood pressure, controlling your cholesterol, and increasing physical activity,” Dr. Newman says, will keep your ticker in good shape so it can handle 90-degree days.

RELATED: Everything You Must Know About Mosquitoes This Summer

You’re racking up lots of mosquito bites

When the weather is warm, you want to spend as much time in the great outdoors as possible. But while you’re embracing nature, dining al fresco, or just enjoying a backyard barbecue, mosquitoes are making you their buffet.

Unfortunately, summer is prime time for mosquitoes. Their prey (in other words, us) are outside more, and the little vampires also mature faster when the sun is out strong. That means skeeters live fast and die young, so the time between the day one hatches and the day it becomes a disease-transmitting adult is shorter. With mosquitoes taking less time to reach this stage, diseases (such as Zika and the West Nile Virus) can spread more quickly, says Aileen Marty, MD, an infectious disease specialist in Washington, D.C. 

What can you do to protect yourself? When you’re hanging outside, skip your signature scent in favor of bug spray, says Debra Jaliman, MD, New York City-based dermatologist and author of Skin Rules. She recommends Ultrathon Insect Repellent. ”It’s creamy and it says on your skin longer,” says Dr. Jaliman. It also has DEET, one of the few ingredients that have been shown to be truly effective in warding off mosquitoes.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

And what you heard as a kid is right—don’t scratch! As itchy as these bites are, scratching them can create an open wound, making you susceptible to infections, especially since there’s plenty of bacteria hiding under your nails, says Dr. Jaliman. 

If you just can’t keep your hands off your bites, Dr. Jaliman has a few suggestions. ”Use ice cubes to stop the itching; over-the-counter hydrocortisone cream or aloe vera gel will also diminish the itch and reduce swelling,” she adds.

 

4 Unexpected Ways Summer Heat Is Throwing Your Body Out of Whack  

Summer is finally in full swing—which means cute sandals and sunglasses, beach vacations, and ridiculously scorching weather. If you’re feeling the heat, literally (does it really need to be 85 degrees before nine in the morning, seriously?) you’re not alone.

Hot temperatures can mess with your body in all sorts of sneaky ways, and we don’t just mean the threat of a sunburn or sweating through your outfit on the way to work. Here are four common ways hot, humid weather takes a toll on your health, plus how you can beat heat’s effect on your system.

RELATED: 20 Ways to Stop Allergies

You’re sniffling and sneezing

Flowers bloom in the summer—and so do plants and grasses that produce pollen, says Kim Knowlton, MD, an assistant clinical professor at Columbia University’s Mailman School of Public Health. In response to the warm weather, pollen production goes up, and the presence of pollen in the air can leave even people with mild allergies sneezing, sniffling, and rubbing their itchy eyes through Labor Day.

To reduce these allergy symptoms, pay attention to the daily pollen count and try to stay indoors as much as possible on high-count days. If you can’t give up your outdoor run or yoga class, try to time it (as well as other outside activities) toward the end of the day, when pollen counts go down. And keep windows shut in your house to keep allergens from turning you into a sneezy mess in your own home.

You toss and turn all night

Too hot to sleep—but the air conditioning in your room is making you shiver? Summer makes it tough to find that happy medium. Most people sleep best when the temperature is at 65 to 66 degrees; as the temperature goes up, sleep quality tends to go down, says Chris Winter, MD, neurologist and sleep medicine specialist at Charlottesville Neurology and Sleep Medicine in Virginia. 

The right temperature could also help you stay asleep through the night and score better sleep quality. So if you find yourself waking up fatigued and fuzzy-brained, try adjusting the thermostat. Dr. Winter says many of his patients have reported resting much better when they lower their bedroom temperature, even if they hadn’t noticed sleep problems. Don’t feel guilty for using so much electricity—cranking up the AC to a healthy level is good for you.

Your heart pounds way more than normal 

You do a hard-charging cardio workout three times a week, but your heart rate is suddenly spiking on your walk to work in the morning. What gives? Jonathan Newman MD, MPH, cardiologist at NYU Langone Medical Center in New York City, says higher temps have both direct and indirect effects on your heart.

For starters, if you live in an urban area, you may notice smog or haze fogging up summer skies. Air quality tends to get worse at higher temperatures, and that air pollution itself can take a toll on the heart and vascular system, Dr. Newman says.

Plus, at the most basic physical level, “your heart is working overtime” in the summer, says Kim Knowlton, MD, an assistant clinical professor at Columbia University’s Mailman School of Public Health. “Your heart beats faster in order to pump overly warm blood from your body’s core out to the skin’s surface,” says Dr. Knowlton, which helps cool you down.

Since your faster heartbeat is all part of your body’s way of keeping you cool, there’s not much you can do to prevent it. Taking normal precautions in the heat—drinking lots of water, not exerting yourself too much—are always good ideas. And of course, ”eating a heart-healthy diet, controlling your blood pressure, controlling your cholesterol, and increasing physical activity,” Dr. Newman says, will keep your ticker in good shape so it can handle 90-degree days.

RELATED: Everything You Must Know About Mosquitoes This Summer

You’re racking up lots of mosquito bites

When the weather is warm, you want to spend as much time in the great outdoors as possible. But while you’re embracing nature, dining al fresco, or just enjoying a backyard barbecue, mosquitoes are making you their buffet.

Unfortunately, summer is prime time for mosquitoes. Their prey (in other words, us) are outside more, and the little vampires also mature faster when the sun is out strong. That means skeeters live fast and die young, so the time between the day one hatches and the day it becomes a disease-transmitting adult is shorter. With mosquitoes taking less time to reach this stage, diseases (such as Zika and the West Nile Virus) can spread more quickly, says Aileen Marty, MD, an infectious disease specialist in Washington, D.C. 

What can you do to protect yourself? When you’re hanging outside, skip your signature scent in favor of bug spray, says Debra Jaliman, MD, New York City-based dermatologist and author of Skin Rules. She recommends Ultrathon Insect Repellent. ”It’s creamy and it says on your skin longer,” says Dr. Jaliman. It also has DEET, one of the few ingredients that have been shown to be truly effective in warding off mosquitoes.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

And what you heard as a kid is right—don’t scratch! As itchy as these bites are, scratching them can create an open wound, making you susceptible to infections, especially since there’s plenty of bacteria hiding under your nails, says Dr. Jaliman. 

If you just can’t keep your hands off your bites, Dr. Jaliman has a few suggestions. ”Use ice cubes to stop the itching; over-the-counter hydrocortisone cream or aloe vera gel will also diminish the itch and reduce swelling,” she adds.

 

Diarrhoea, vomiting, sudden death … cholera’s nasty comeback

Mohammad Shubo is motionless when he is wheeled into the clinic. He had started experiencing diarrhoea and vomiting that morning; by evening, he had no pulse.

In an effort to rehydrate him quickly, the nurses give Shubo an IV of saline solution. His reanimation seems almost uncanny – within half an hour he is able to sit up and speak. He spends the next two days at the hospital to rehydrate and convalesce before returning to his cramped quarters. If Shubo had arrived at the clinic just 10 minutes later he would have died, a nurse says.

For those who have been fortunate enough not to see the effects of cholera first hand, David Sack, a professor of international health at the Johns Hopkins University Bloomberg School of Public Health, says Shubo’s case, which appears on a 2011 Al Jazeera documentary, gives “a good sense of the disease”. Thousands of patients develop the same symptoms as Shubo did, though not all are as lucky. Sack recalls a case from Uganda in which a woman was hospitalised with symptoms of cholera, but the hospital staff didn’t diagnose her properly, even though there was a cholera treatment facility on the hospital grounds. She was not closely monitored and died of dehydration overnight. Cases like this should never happen, Sack says. But clearly they do.

John Snow, the doctor who traced the source of cholera outbreaks in London in 1854.


John Snow, the doctor who traced the source of cholera outbreaks in London in 1854. Photograph: Alamy

In some parts of the world, including Europe and the US, cholera is so rare that it seems to have been eradicated. Some may see it as an “old world” disease, gone the way of the plague and smallpox. But it continues to devastate communities elsewhere, sometimes to pandemic proportions – an outbreak is raging in Yemen, where more than 246,000 cases and 1,500 deaths have been reported.

“Cholera is a brutal infection,” says Jason Harris, an associate professor of pediatrics at Massachusetts General Hospital. “Patients can go from looking healthy to dying quickly with cholera. It’s a scary disease.”

In the mid-1800s, as cholera swept across nearly every continent and killed thousands, scientists rushed to understand the disease. In 1854, a British doctor, John Snow, undertook the first epidemiological study that determined water from a pump on Broad Street was sickening Londoners with cholera (he didn’t discover the true reason why, however – at the time the disease was thought to be spread by miasma, not microbes). Then in 1884, a German researcher, Robert Koch, studied the intestines of deceased cholera patients in Egypt and India, concluding that the comma-shaped bacteria Vibrio cholerae he found there was the cause of the disease.

The Duke of Orleans visits the sick at L’Hotel-Dieu during France’s cholera epidemic in 1832


The Duke of Orleans visits the sick at L’Hotel-Dieu during France’s cholera epidemic in 1832. Photograph: Print Collector/Getty Images

In the years since, scientists have figured out a lot more about the biology of cholera. Snow was correct: Vibrio cholerae is transmitted through contaminated water. Within as little as 12 hours or as long as five days, some people who have ingested the bacteria will start to show symptoms – uncontrollable vomiting and diarrhoea. But 80% of those who ingest the bacteria do not, possibly because of an existing immunity.

The scariest part of the disease, Harris says, is the sheer speed with which a patient can decline. If the condition isn’t treated quickly, people can die of dehydration within hours of showing symptoms.

Dr. Robert Koch (seated) with his assistant Dr. Richard Pfeiffer


German researcher Robert Koch (seated) with his assistant, Richard Pfeiffer. Photograph: Bettmann Archive

“The amount of fluid loss from diarrhoea and vomiting [in patients] is shocking. It’s hard to believe unless you see it,” Harris says. It can be up to a litre per hour. And more people excreting the bacteria into water sources means more get infected, and it’s not hard to see how just a handful of cases could quickly balloon into an outbreak (there have been seven pandemics over the past two centuries), which can last decades.

The last pandemic started in Indonesia in the 1960s and spread across Asia and Africa before coming to Europe in 1973. By 1991, it had spread to Latin America, which had been free of cholera for more than a century. Around 400,000 reported cases and 4,000 deaths were reported in 16 countries of the Americas that year.

These days the disease does not have to be a death sentence. Doctors know how to treat cholera effectively. If a patient can reach a clinic in time, the treatment is fairly straightforward. With a rapid infusion of fluids and antibiotics, they are usually back to normal in a few days. There is also a vaccine, which is taken orally and can prevent infection in about 60% of people.

But this apparent simplicity is deceptive; all this knowledge isn’t the same as stopping the disease. “The map of cholera cases is pretty much a map of poverty,” says Dominique Legros, the team lead of the cholera group at the World Health Organization. “We still have cholera in places like Yemen because people don’t have access to safe water.” People living in poverty may know that drinking polluted water can get them sick, but they don’t have an alternative.

“Because of inequality and a lack of access to safe water and sanitation, more than a billion people are still at risk [of cholera],” Harris says.

So outbreaks continue. In some places, such as Zambia and Uganda, they are predictable, starting every year with the rainy season. But often, outbreaks can’t be anticipated. There are factors that can make an outbreak more likely – natural disasters can scatter infected people to contaminate more water sources and war can close clinics that might have helped citizens receive treatment or inhibit the import of necessary medication.

Engraving by William Heath showing a lady discovering the quality of the Thames water. By the 1820s, public concern was growing at the increasingly polluted water supply


An engraving by William Heath showing a lady discovering the quality of the Thames’s water. By the 1820s, public concern was growing at the increasingly polluted water supply. Photograph: Science & Society Picture Library/Getty Images

But these factors are hardly predictive. After the 2010 earthquake, for example, American epidemiologists concluded that Haiti was at low risk of a cholera outbreak; just a few months later, an epidemic was raging, in part because UN peacekeeping forces accidentally introduced the bacteria.

Years of political turmoil are fuelling the epidemic in Yemen. The situation is dire – the WHO estimates that nearly 250,000 people had been infected by the end of June, almost doubling previous estimates based on academic models. WHO officials are working with other non-profits and what remains of the national healthcare system to bring treatment to rural clinics to help people get treatment more quickly. This week, the International Coordinating Group allocated one million cholera vaccines to be sent to Yemen.

A girl is treated for a suspected cholera infection in Sanaa, Yemen


A girl is treated for a suspected cholera infection in Sanaa, Yemen. Photograph: Hani Mohammed/AP

These strategies, along with education campaigns so people at risk of cholera know how to treat their water (by boiling, or with chlorine tablets), can reduce the incidence of the disease. But these advances don’t address the main problem: a lack of access to clean water. So the solution to eradicating cholera then, doesn’t lie in the health sector. “Yes, you need to treat patients and prevent death,” Legros says. “But the long-term solution is in the development sector – giving people long-term access to sanitation.”

There are some countries in which this may soon be possible. But in others, such as South Sudan and Somalia, the prospect of bringing safe water to the entire population seems remote.

Until the day when everyone has access to clean water and sanitation, researchers will work to answer more questions about the disease. One that remains is how – or if – Vibrio cholerae persists in the environment. “In places like Chad or on the western African coast, we see almost no cholera cases for several years, then there’s a big outbreak. It’s difficult to explain,” Legros says. “Some people say there is a reservoir in the environment that is maintained over years, though we don’t know how, and suddenly it erupts again, though again we don’t know how.” Harris also wonders about how the evolution of Vibrio cholerae may have affected its virulence and ability to cause pandemics.

Women fill jerrycans with water from a well. In Somalia, where cholera outbreaks have killed hundreds of people, the looming famine threatens 6.2 million people, more than half the population


Somalians fill jerrycans with water from a well. In Somalia, where cholera has killed hundreds, the looming famine threatens 6.2 million people, more than half the population. Photograph: NurPhoto via Getty Images

As researchers work to answer these questions, and as nations move slowly towards improved infrastructure, public health officials will have to combat new outbreaks.

“I would hope that people appreciate how significant and serious a threat [cholera] is,” Harris says. “For people who think it’s a historical disease, they should know that it is still an important cause of morbidity and mortality around the world.”

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

Am I pregnant? You asked Google – here’s the answer | Nell Frizzell

Being pregnant, like being awake, seems fairly black and white until you try it yourself. You’re either pregnant, or you’re not. Unprotected sex, a bloodless gusset, tender breasts – you’re pregnant. Except you might not be. Or might not be for long. Or might never be again.

When you get here, being pregnant suddenly becomes a far more delicate, changeable, more abstract state than you’d imagined. You may be pregnant. But then again, you may have endometriosis, so the swelling, the late period and tender breasts aren’t the result of a baby at all. You might be peri-menopausal, so the fatigue, the skipped periods and disrupted sleep are a sign of no more eggs, not a fertilised one. You could be stressed, have disordered eating or a hormone imbalance, causing your periods to halt for a while without you knowing why.

Of course, there is much to pregnancy that will be familiar to many women. As a student, pushed on to the combined contraceptive pill by a family planning system that had all the nuance of a left hook, your breasts may have turned into swollen, bovine sacks, your waist thickened, your mood dropped, your sex drive drained away like water through sand and, if you ran one packet into the next, your periods stopped.

As a 30-year-old, you may still have occasionally skipped periods, felt sick, put on weight at a rate of knots or found yourself lying awake at night, sweating like a boxer in the seventh round. As a 40-year-old, you may have experienced the odd lighter period, have seen your body thicken without warning, your breasts swell, your nipples turn to bullets, your eyelids droop. You may have read that since 2013 the largest percentage increase in conception rates occurred among women aged 35 to 39; that the conception rate for women aged 40 and over has more than doubled since 1990; that in 2014 there were an estimated 871,038 conceptions to women of all ages, but still you assume that your baby-making days are far behind you. Perhaps they are.

Internal view of a human foetus at approximately 10 weeks


Internal view of a human foetus at approximately 10 weeks Photograph: Steve Allen Travel Photography/Alamy

Even 12 weeks in, pregnancy can often feel like nothing more than a murderous hangover, twinned with PMT, car sickness and too many late nights. And, depending on your lifestyle, not to mention your body, you may have experienced all four before, possibly at once. You have been tired, you’ve been nauseous, you’ve felt sick at the smell of a stranger on the bus, you’ve craved pastry, your nipples have felt like raw nerves, you’ve wept without warning, you’ve eaten too much bread and you’ve fallen asleep in the cinema. All this has happened before and you weren’t pregnant then. So you can throw up in a lot of bins and on a lot of car tyres before you start to really believe a baby might be the cause this time.

It took four tests for me to start to believe I might be pregnant. I carried them around in my handbag like piss-soaked amulets – sometimes getting them out on the bus to stare at the blue parallel lines, trying to make it imprint in my head as real. I still have one, in a box-file on a shelf next door to where I’m sitting now, hidden below midwife notes and prescription exemptions and, even, a grainy black and white scan photo of a baby lying across my womb. Sometimes, late at night, when I look down at my unmoving stomach, at this unknowable, invisible, but apparently real baby, I will creep out of bed and look at that pregnancy test again, just to reassure myself that it really happened.

Having something you can neither see, nor feel, nor hear, growing inside your body is an act of imagination as well as biology. All you can do is have faith that it’s alive in there, in the hope that it will remain so. In the second trimester, as the vomiting eases, I often find myself wondering if I really am pregnant at all – or if I’ve just tricked myself (and my partner, and a pair of radiographers) into some desperate fantasy of motherhood. Queen Mary did it – conjured a phantom of hope and hormones and maternal desire into her abdomen – and there are many women living in Britain today with a longing as strong as a Tudor queen.

Pregnant young women at an antenatal exercise class


Pregnant young women at an antenatal exercise class. Photograph: Roger Bamber/Alamy

Just like being awake, being pregnant can also be temporary. According to NHS statistics, among women who know they’re pregnant, it’s estimated one in six of these pregnancies will end in miscarriage. Many more miscarriages occur before a woman is even aware she has become pregnant. While you may, at this moment, be what we deem pregnant, it wouldn’t take much to change all that; for you to become unpregnant. Which seems ever so much worse than being not pregnant. Through no fault of your own, no accident, no abuse, no choice, this pregnancy could end as quietly as it began.

Conception may be a miracle, but miscarriage is a reality. The fear of it will hum away at the bottom of your brain for months – you will swerve prawns, sleep on your left hand side, take folic acid and, sometimes, simply stare at a chart marking your probability, willing the numbers to be on your side.

If you’re asking the internet if you’re pregnant then, the chances are, something is happening to your body that you want to understand. That human curiosity isn’t just natural – it’s probably what’s kept you alive until this point. You want to know what’s happening and you want to know why. Forget about Eve, the apple, the serpent, the bruise – it is always better to know. So do a test. Why not.

At the moment we are lucky enough to still have a National Health Service that will look after you, whatever the cause, and whatever happens. That is a precious and wonderful thing and something we should be fighting for. For our own sake and the sake of our children. If we have them. And even if we don’t.

Theresa May orders contaminated blood scandal inquiry

The government is to establish a full inquiry into how contaminated blood transfusions infected thousands of people with hepatitis C and HIV, bowing to years of pressure from MPs and campaign groups.

The move came hours before Theresa May faced possible defeat in a Commons vote on an emergency motion about the need for an inquiry into the failings and the 2,400 deaths believed to be involved.

Survivors welcomed the announcement, but said the decades-long wait for answers had been far too long. The contamination took place in the 1970s and 80s, and the government started paying those affected more than 25 years ago.

The Labour MP Diana Johnson, a long-time campaigner for those affected by the tainted blood products, had been granted an emergency debate to be held in the Commons on Tuesday.

Without a substantial majority, the prime minister could have lost on the emotive issue and she announced the inquiry – the format of which is still to be decided – to the weekly cabinet meeting on Tuesday morning.

In a subsequent statement, May said the infection of thousands of people, mainly haemophiliacs, was “an appalling tragedy which should simply never have happened”.

“The victims and their families who have suffered so much pain and hardship deserve answers as to how this could possibly have happened,” May said, saying they “have been denied those answers for too long and I want to put that right”.

May said the government would talk to the families about the shape the inquiry should take “so we ensure that it is able to provide the answers and the justice that they want and deserve”.

Asked if she would apologise on behalf of previous governments, she said: “I’m determined that when you see cases like this, where I think people have suffered injustice, that we do deal with them, that we do ensure that people … are given the answers they deserve.”

A recent parliamentary report found around 7,500 patients were infected by imported blood products from commercial organisations in the US, whose paid donors included injecting drug users and prison inmates. More than 2,400 haemophiliacs who received the tainted blood are dead.

Speaking during Johnson’s debate, the junior health minister Philip Dunne said families would be consulted about what type of inquiry would be best.

The two most likely options were a judge-led statutory inquiry, or a Hillsborough-type independent panel, Dunne said, adding that the process would begin “as soon as practical”.

Pressure for an inquiry had grown amid campaigning by Johnson and Andy Burnham, the former Labour MP who is now mayor of Greater Manchester.

In his final speech to the Commons in April, Burnham said he had been contacted by victims and families who believed medical records had been falsified to obscure the scandal, saying there was evidence of “a criminal cover-up on an industrial scale”.

Such allegations were key to the government’s decision, Dunne told MPs. “In light of these concerns and reports of new evidence and allegations of potential criminality, we think it is important to understand the extent of what is claimed, and the wider issues that arise,” he said.

Burnham said in a statement the decision to hold an inquiry was “a vindication of all those people who have campaigned bravely throughout the decades, often in the wilderness”.

He added: “But this day has taken far too long in coming. People have suffered enough through contaminated blood. They have been let down by all political parties and public bodies.”

Liz Carroll, chief executive of the Haemophilia Society, said survivors and families had sough the truth for decades. “Instead, they were told by the government that no mistakes were made while it repeatedly refused to acknowledge evidence of negligence and a subsequent cover-up,” she said. “Finally, they will have the chance to see justice.”

Matt Gregory, a trustee of the Macfarlane Trust, which the government set up in 1988 to support survivors of the blood contamination, says it has been chronically underfunded.

“My main concern is the ongoing difficulties that survivors are going through now, with not having enough money and not being supported properly,” said Gregory, 48, who has lived with HIV and hepatitis C since the age of 14.

“I am grateful for the inquiry. I really want to see some interim support put in for people to the level they deserve.”

Gregory paid tribute to campaigners who died during the fight for justice, such as Haydn Lewis, who was was diagnosed with haemophilia at the age of two, and died of complications caused by HIV and hepatitis C.

In an interview with the Guardian eight years ago following an earlier inquiry into the scandal, Lewis recalled getting access to his medical notes, which revealed that although he had tested positive for HIV in 1984, he was not informed until February 1985 – during which time, he believes, his wife was also infected with the virus.

“How do you deal with that?” he asked. “How do you cope knowing that you have given someone you love something that will kill them?”

Lewis was among those who agreed to an ex gratia payment from the government, described as voluntary so as to not formally admit any official liability for what happened. As with others receiving the money, Lewis signed a waiver in 1990 which stipulated he would seek no further recompense for any further infections.