Tag Archives: about

I’m registered blind. That doesn’t mean you can assume things about me | Alex Lee

I’m standing in line waiting to get into a nightclub, bumping shoulders with people who are already having a good time. As I reach the front, a bouncer looks me up and down. Without a word, he places his hand on my shoulder and pushes me forward. I’m pinballed from security guard to security guard, fully expecting to be led directly into the club. Instead, I’m guided out of the queue, confused as to why I now find myself standing behind the metal barriers.

“What’s going on?” I mean, I’ve had a few drinks but I’m certainly not drunk.

He asks me to blow into a breathalyser, and we wait a few moments. All clear.

“Are you OK?” he asks me plainly.

“Yes?”

Why wouldn’t I be? And then the penny drops. The first bouncer must have thought I was off-my-face drunk, simply because my eyes weren’t looking in one particular direction.

The thing is, I’m visually impaired, but I don’t necessarily need a cane. What follows is my desperate vomit of different terms for blindness, trying to prove my innocence.

“I’m visually impaired? Legally blind? I’m registered blind … Jesus! I can’t see properly!”

But it is all too late. A fun night out had been soured by one tiny assumption and a judge and jury who had decided to put me on trial because I didn’t look them in the eye.

This isn’t the first time this has happened and it certainly won’t be the last. But given that today is World Sight Day, I thought I’d shine a light on what people with vision impairments go through on a daily basis.

Blindness and visual impairments are severely misunderstood. What people presume is that if you’re blind, you can’t see anything and you’re either going to be relying on a dog or swinging a stick about. If you’ve got neither … then hey, you’re not blind.

This is entirely incorrect. People who are registered blind are statistically more likely to be partially sighted than completely blind. In reality, only a very small portion of people have no sight at all. Despite this, awareness regarding legal blindness is practically non-existent. Two million people are registered blind or partially sighted in the UK and, shocking as it is, we are actually able to participate in society.

According to a report by the Royal National Institute for the Blind (RNIB) almost half of blind and partially sighted people feel moderately or completely cut off from people or things around them, leading to a marked rise in the risk of depression among people with sight loss. That’s why the ignorance surrounding vision impairments needs to be addressed. If a night out is a way for a visually impaired person to enjoy themselves, shutting them out because they don’t carry a stick is a sure way to keep us cut off from society.

There often seems to be a misconception that the only thing blind people do is … be blind. We don’t just sit at home decked out in our blind garb, hovelled up in our pyjamas and dropping curry down our shirts. It’s detrimental to our overall identity to assume that if a vision-impaired person says that they’re going to work, they must be going to the RNIB. People with varying capabilities of sight are able to lead lives that don’t revolve around blindness. Yes, we might have keen interests in issues surrounding blindness or want to rally around in support, but that doesn’t mean we don’t want to get out to a nightclub now and again. It’s not only able-bodied people who can have fun.

I can appreciate that it’s difficult to really know a person’s situation, but making face-value assumptions, whether they’re a product of society or not, isn’t going to help anyone. We do exist in the outside world, even if we aren’t holding a cane. Like most things, blindness exists on a scale and what you know about one blind person certainly isn’t going to apply to another.

Alex Lee is a freelance writer

Weight Watchers’ new boss: ‘It’s about health, not weighing yourself’

Every time Mindy Grossman looks in the mirror, she is reminded that “you are skinny, you are fabulous, you are clever”. It is not some magic talking looking glass, but an engraved compact-sized mirror designed by a friend and stuck to the back of her smartphone. Two of the three mantras are wearing away, leaving only “you are clever”.

“It’s the most important one, anyway,” says the businesswoman tasked with reinventing Weight Watchers for the digital age, where weight loss apps and Insta-fuelled phenomenons like clean eating are in the ascendancy.

“My first Weight Watchers meeting was when I was 14 years old on Long Island, and I went there with my mother,” says Grossman, who has returned 46 years later to run the company. “I’d gained that adolescent weight and wanted to try out for cheerleading … I lost the weight, tried out and made the cheerleading team.”

Grossman’s business credentials (she appeared in the Forbes list of the world’s 100 most powerful women after turning around the Home Shopping Network cable channel) and her immaculate blonde coiffure resulted in the New York Times billing her as the second coming of Jean Nidetch, the Brooklyn-born entrepreneur who founded Weight Watchers in the early 1960s. When we meet, Grossman looks more like a cast member of Sex and the City, with a leopardskin jacket and purple bejewelled Louboutins.

Oprah Winfrey pictured in September 2017 during the Emmys in Los Angeles.


Oprah Winfrey, who owns 10% of Weight Watchers, at the Emmy awards in Los Angeles last month. Photograph: Buckner/Variety/REX/Shutterstock

Grossman arrived at Weight Watchers in July, picking up the baton from Oprah Winfrey, whose purchase of a 10% stake in 2015 triggered a dramatic reappraisal of the brand at a time when it was losing thousands of members. Before Winfrey’s involvement, the writing looked to be on the wall for the 54-year-old brand, with shares changing hands for less than $ 4 (£3), down from $ 86 in 2011.

But Winfrey’s patronage is helping the company bounce back, with nearly two years of sales growth now under its belt. In its most recent quarterly sales update, subscriber numbers had surged by 20% to 3.5 million, with the firm growing in both the US and the UK, which account for 70% of its sales.

“She’s human,” says Grossman of Winfrey’s much-publicised battle with her own weight. And she argues that the fortunes of the company are not tied to the billionaire’s waistline. “Oprah’s involvement is not just about losing weight … she is a visionary businesswoman. She has had an influence globally on how people are thinking about the brand.”

Thanks largely to Winfrey, Weight Watchers shares have regained more than half the value they had lost, making the company worth $ 2.9bn. But Grossman is tasked with a bigger reinvention as the diet business morphs into the “health and wellness” industry.

“The term ‘dieting’ has some negative associations with consumers, because for some people it reminds them of unsuccessful attempts to lose weight,” says Emma Gubisch, an analyst at Leatherhead Food Research. “It also has the connotation that it is something you do for a short time until you’ve achieved your aim, and then you stop or go back to your old lifestyle.”

Weight Watchers had been losing members for years as people turned to calorie-counting apps and fitness trackers. The brand, whose recent UK faces have included the actor Patsy Kensit and MasterChef’s Gregg Wallace, had begun to feel dated as new stars emerged, such as Joe Wicks, whose Lean in 15 books are now the biggest-selling diet titles of all time.

Grossman says Weight Watchers failed to invest enough in marketing and technology, but insists its holistic package of food plans, advice and community remains powerful in a crowded market where the latest trends include intermittent fasting and the diet drink Skinny Sprinkles.

“[Weight Watchers] have been in people’s lives for a long time, so you are not the new shiny penny out there, but you really are the one that works,” says Grossman of the notoriously faddy diet industry. “When people want to lose weight, they get to a point where they are desperate and looking for the new thing that is going to work miracles. But at the end of the day, there is no such thing.”

With health and wellness now firmly in vogue, Weight Watchers does not want to be seen as a short-term fix – rather, it is positioning itself as a credo to live by, with its app something users check as frequently as Facebook or Twitter. “We’re looking at the future of experiences and how you personalise it,” says Grossman. “We can inspire people to have healthy habits … that’s not just about losing 10lbs, but creating a structure you can live within.”

The first Weight Watchers cruise, which sailed in May, offers a taste of where the company is headed. The Caribbean trip was a bootcamp designed to shift the pounds, but it took a “wellness” theme, with holidaymakers offered tailored fitness workouts, cooking demonstrations and seminars from experts.

“I’ve been 35lbs heavier than I am now and 25lbs thinner than I am now, and both of those times were probably the most miserable times of my life,” says Grossman. “I’m happier now, because it is about being healthy, not weighing yourself.”

But the big question is: how is Oprah doing? “She looks great,” reports Grossman. “She was at the Emmys wearing a white jumpsuit – and you have to be confident to do that.”

Women have the right to know about injuries of vaginal birth beforehand | Sascha Callaghan and Amy Corderoy

It’s not just the constant pain. After a while, you learn to adjust to that new normal. It’s the feeling that you weren’t warned; that you never gave your consent for the risks you were exposed to.

That is the message coming out of the Senate inquiry into the use of vaginal mesh products to treat women who have vaginal prolapses.

The submissions are heartbreaking. Many are handwritten, intimate portraits of lives interrupted by constant infections and pain, of relationships disrupted.

One woman writes how she never had an orgasm again after her surgery.

Another describes a procedure performed on her: “It was the most painful experience and I screamed very loud and was crying. [The doctor] scolded me and told me I had scared the patients in the waiting room”.

Many say they were never warned of the risks of the mesh, never understood the treatment they were about to undertake.

Despite the clear importance of these stories finally being heard, there is concern in some quarters that speaking out loud about injuries after a vaginal birth is a dangerous thing. In their submission to the senate enquiry, the Australian College of Midwives’ submission warns that coverage of the issue “has increased fear around childbirth”.

“It is important that the issues surrounding the transvaginal mesh implants are separated from the issues surrounding vaginal birth,” they write.

The truth is however, that these injuries and others, such as prolapse, scarring, incontinence, chronic pain, and fistula are all risks of vaginal birth – particularly where complications necessitate the use of instruments such as forceps. The risk of these complications increases with the age of the mother, her BMI, and the size of the baby relative to the mother’s pelvis.

We expect women to be strong enough to run these risks when they give birth, but many clinicians and natural birth advocates seem to imagine that telling women about them beforehand might be too scary for them to handle.

This rhetoric is now so entrenched in health services that official birth policy in NSW emphasises that only one type of birth – vaginal birth – is “normal”. The policy states that “all pregnant women [should be informed] about the benefits of normal birth”, but does not specify that patients must be informed of risks of vaginal births. Many hospitals now aggressively pursue vaginal births, encouraging vaginal births after caesarean section, discouraging the use of effective epidural pain relief and aiming to use alternative interventions such as forceps to ensure babies can be delivered vaginally. All without fully informing patients of the known risks associated with that approach. Clinicians now actively promote the role for forceps in childbirth, even if they do note in their academic research the “trade-offs between risks of maternal and neonatal trauma”. These “trade-offs” include a four-times greater risk of stress incontinence and an eight-times greater risk of prolapse compared to no use of instruments, and a five-times greater risk of facial injury for the baby (compared to the use of a vacuum device). Yet all this is in aid of producing a “normal” birth, so there is apparently no need to ensure informed consent on the woman’s part.

This increasing trend towards paternalism in childbirth is not only disturbing, but it can also be unlawful. In a 2015 UK case, obstetrician Dina McLellan was found to have negligently harmed Nadine Montgomery and her baby because of a failure to inform Montgomery about a substantial risk that her large baby would become stuck in her pelvis during an attempt at vaginal birth. This was despite the fact that Montgomery, who had diabetes, had repeatedly asked about these risks and said she would have elected to have caesarean had she had been properly informed. The obstetrician gave evidence that she did not spend a lot of time, or indeed any time at all, discussing these risks with her patients. This is despite the fact that should a baby become trapped in the mother’s pelvis due to a complication known as shoulder dystocia, highly invasive manipulations are required to free the baby. In this case, this included pressing down on the mother’s pubis with clenched fists, while two midwives forced her legs back; pushing the baby’s head back up into the uterus, so as to be able to perform an emergency caesarean section, forceps, and an attempted symphysiotomy. This is a surgical procedure that involves breaking the pelvis to free the baby.

Despite these known risks, Dr McLellan took the view that if such “small” risks were mentioned “most women will actually say, ‘I’d rather have a caesarean section’”. Dr McLellan felt this was undesirable because “it’s not in the maternal interests for women to have caesarean sections”. For this reason she did not discuss the risks with her patient.

In this case, there were terrible outcomes for mother and baby. But even in the normal run of things, the law is designed to protect a patient’s right to autonomy – the freedom to decide what can be done to their bodies in a medical setting. Healthcare professionals must not only give patients enough information to get consent to a procedure, but enough to ensure that the patient’s right of autonomy, and control over their bodies, is protected. That includes giving information about the risks of having no procedure, as in the case of an attempt at vaginal birth, where known risk factors are present.

Much important work was done by our feminist foremothers in fighting for women to have the right to make choices about their births, to take control of their labours with active, natural births if they want them, and to be free of unnecessary interventions. This shift has been welcomed by many women, and is in line with international trends.

But we cannot lose sight of the fact that the goal of these shifts in practice has been to empower women, and in order to achieve that aim we cannot throw the baby out with the bathwater – so to speak – by deciding that all women have the same priorities and that it is acceptable to hinder informed decision-making in the cause of achieving those priorities.

The fact is that in modern medical practice, we have long let go of keeping the “awful truth” from patients. We let patients decide what is best for them – by informing them of risks as well as benefits, and allowing women to choose which set of risks they are more comfortable taking. Two perfectly well informed, intelligent women may have totally differing opinions about the type of intervention they are comfortable with. One might feel that a vaginal birth is an experience they value highly, and that the surgery involved in a caesarean section (with its associated recovery time, potential for complications, and increasing risk with each additional pregnancy) is something they would like to avoid at almost any cost. Another women may feel her personal circumstances make vaginal delivery unappealing, and believe that if such a delivery needed forceps then it is a risk that she would not be willing to take. Many more will fall somewhere between these two views.

Either way, the days of medical paternalism are over.

Midwives and doctors must ensure women are fully informed, and their wishes known, before the labour, so that they can inform clinical decision-making during it. There is no easy way to give birth to a baby, and most first-time mothers are apprehensive about labour and aware that once it begins you simply cannot have full control over what happens next.

Ensuring women are fully informed should not scare them off vaginal birth, but it will ensure that if something does go wrong they will not feel betrayed by the healthcare system itself.

  • Sascha Callaghan is a lecturer in health law and bioethics at the University of Sydney. Amy Corderoy is a freelance medical journalist

I’m lucky. I can afford private mental health treatment. What about those who can’t? | Deborah Orr

Almost one in 10 14-year-old boys have symptoms of anxiety and depression. Which is awful. But almost a quarter of 14-year-old girls have such symptoms. That is such a sad and miserable statistic that one barely knows where to start. The worst thing of all is that it isn’t really surprising. There is so much in this world of ours for a teenage girl to feel worried and hopeless about – not least that the advertising of such sensitivity can easily attract the sneering epithet “snowflake”.

Twas ever thus, though. Bullies find sensitive people like wasps find jam. It’s easy to get carried away with the idea that such statistics are the creation of modernity, thereby assuming that 14-year-old girls were less anxious and depressed back in the old days when rape wasn’t legally possible in marriage, domestic violence was not a term there was any call for, reliable contraception didn’t exist, and many people thought childbirth was the extremely dangerous reason for female existence. Back then, anxious women were called “hysterical”, depressed women were called “sullen”, and childless women were called “barren” or “spinsters”. Good times.

In fact, there is even a positive light in which to view this baleful news of teenage suffering. The interior lives of 14-year-old girls are nowadays acknowledged and considered. It’s been a long time coming, but it’s progress. The difficulty now is in finding a way to address the problem. Or, as is so often the case, finding a way to recruit and retain the army of skilled professionals needed to address it. A paradox of the current era is that our understanding of how to help people with mental health difficulties has never been greater, while the infrastructure that ought to be providing such services has never been more stretched.

I’ve been sorting out my own mental health issues over the past year and a half, as long-suffering readers will know, after I was diagnosed last year with CPTSD – complex post-traumatic stress disorder. I’m lucky. I can afford – just about – high-quality psychotherapy in the private sector. Christ, I wish I’d had it at the age 14. It took me 50 years to realise that being duped and robbed of my gold christening bracelet the first time I ever left my home alone, at the age of three, was traumatic. Of that 50 years, only about 40 minutes was spent discussing the incident and taking part in the eye movement desensitisation therapy (EMDR) – a treatment aimed at expressing traumatic memories and turning them into ordinary ones – that finally allowed my ancient trauma to bugger off out of my brain’s amygdala.

The incident is a bad memory now, not a jumble of repressed feelings that fire up my fight-or-flight reaction every time they get a chance. And I count myself lucky. Early traumas can develop into pervasive personality disorders, some of them serious – such as narcissistic or antisocial personality disorder. Or a combination of both, which pretty much makes a person function as a psychopath.

Not long ago, when CPTSD hadn’t been recognised, sufferers sometimes used to be told they had borderline personality disorder (which is diagnosed far more frequently in women than in men). It’s not hard to understand why. Trauma, left untreated, tends to start colouring every emotion, encouraging hyperarousal at every turn. What’s more, you tend to keep on re-enacting early traumas in all sorts of situations, trying to replay the scene and get a better result. Which never happens. Instead, again and again, you hand over the metaphorical bracelet, along with another little bit of your selfhood. For me, a lifetime with a dodgy fight-or-flight mechanism meant a tin ear for danger and risk, leading, of course, to further trauma. EMDR continues, as and when. There’s still a big, messy pile of stuff to tidy up, and just sifting through it is a large task.

Early research suggests that EMDR is particularly effective in treating children. This makes sense, because you don’t really have to understand the context of your feelings too much to get them corralled off into a more sensible part of your mind. The case for timely intervention when trauma has been suffered is unanswerable, and EMDR should most certainly be part of the lexicon of possible treatments. On the NHS, however, I wouldn’t have got near EMDR, or even heard of it, and I doubt that many 14-year-olds would either. It’s very hard to get beyond your GP, for mental health issues. I know. I’ve tried. I’ve written about that before as well.

Having asked my GP to refer me to a psychiatrist, after a couple of new doses of trauma earlier this year, I was eventually seen by a social worker doing triage. He later arranged for a GP I’d never met to prescribe citalopram, an SSRI – selective serotonin reuptake inhibitor – with which I was entirely unfamiliar. I wrote about how powerfully my symptoms intensified in the first few days, and how unprepared I’d been for this, even though I’d read the instructions carefully and looked the drug up on the internet. I’m glad to say that in time the drug settled down quite nicely – as far as I know. Obviously, I didn’t keep a control copy of myself not taking citalopram, so who can say how I’d be doing now without it? I certainly don’t feel better now than I did before May, when I toppled so hard off the trauma-recovery bandwagon.

I am sure, however, that I feel entirely on my own with this drug, because I am, pretty much. The GP who referred me to the mental health team has moved on, so I have a new GP now. I still haven’t ever met or spoken to the GP who prescribed the pills. The mental health social worker did one follow-up call, said I didn’t reach the threshold for a psychiatric consultation and, with a passive-aggressive “Do you agree with us that this is the right thing to do?”, signed me off.

I said that I accepted, rather than agreed: not being privy to the full spectrum of other cases that my own was being weighed against. Because that’s the thing: the knowledge that there are so many people out there in need so much greater than mine, with resources so much less plentiful. I hope very much that I was stood down in favour of a 14-year-old girl, who is even now beginning to thrive.

Deborah Orr is a Guardian columnist

Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

Medicine treats women as entirely passive – being ‘told’ about HRT is par for the course

Buck up, ladies of a certain vintage! There is marvellous news. “Women told hormone replacement therapy does not lead to early death,” reads the headline in the Times. That’s women “told”, you see. I do not know why any women were worried about the increased risk of breast cancer, heart disease and stroke except that, well, we were told to be. Now scientists more or less agree that the benefits – protection against fracture for lower bone-density, against diabetes and endometrial cancer – cancel out the risks. So pump it up, if that’s your bag.

When I got to the age where I was offered HRT I was completely mystified by the conversations around it. It’s terrible! It’s wonderful! It saves your life and your skin. Suddenly, there was a world of women handing round the names of private doctors like dealers; doctors who offered bioidenticals said to be better than the bog-standard HRT on the NHS.

It wasn’t for me, though now I wonder. What bothered me at the time was the idea that ageing is an illness that must be treated; that our depleted oestrogen has to be restored in order for us to function properly as feminine. Clearly I did not suffer in the way I have seen some women suffer. The insomnia was bad but I quite liked feeling angry all the time, alongside the sense of dropping out of the part of life where one’s drive is seen as inherently about mating.

I wondered what I was becoming, for menopause is a form of transition, an everyday one. Still it’s embarrassing to talk about it all, because age is embarrassing and women’s bodies are frankly weird. We live in a culture where the highest compliments are not “Well done on that Nobel prize”, but, “You’ve lost weight”, and, “You don’t look your age”. This is an unfortunate thing for the middle-aged bon viveur.

But that women’s lives may be put at risk – or that as individuals we may assess those risks, while a medical establishment addresses us as entirely passive – is par for the course. It starts in puberty when girls go to the doctors and are told that the solution to their pain (cysts, fibroids, endometriosis) is either pregnancy or the pill. Thus begins a life on a combination of artificial hormones. Pills for ever until you hit the HRT jackpot.

Along the way, women who do not feel OK may be going to doctors for years complaining of pain before being diagnosed. The new advice on endometriosis is: “Listen to women”. Yes, really. And if you do listen to women you will hear story after story of women not getting the right treatment for years and then women beating themselves up for not giving birth the right way or not finding breast-feeding easy and feeling both that their bodies were all wrong but that nobody was listening to them.

I used to think one of the successes of feminism was in encouraging women to make active choices around contraception and childbirth. My mother, after all, was sterilised against her will while under general anaesthetic, the permission given by her then-husband. He was very much “then” after that, I can tell you.

By the time I had my first child, more than 30 years ago, I still had to fight not to have labour induced, but I had a sense that my generation would demand that the rights of individual women be taken into consideration.

This was because the body was firmly at the centre of feminist debate and many women benefitted from that debate whether they considered themselves feminist or not. The proverbial birthplan did not come about by accident.

But what has gone on in the meantime? Sure, progress has been made, but I do not know a woman who hasn’t been patronised by a doctor or been made to feel that she should not complain.

At the same time I was being offered HRT or antidepressants, I was in A&E with one of my daughters, then 19 and in terrible pain. My entire reproductive life flashed before me as she was having an internal scan and the consultant said: “Mummy, come behind the curtain and see your daughter’s lovely eggs. Don’t worry, you will be a grandma after all.” Yes, my daughter gave me permission to tell you this story as we were both mortified by it. Her value was that she could reproduce; mine was that I had done so.

This is still the way much of the medical establishment addresses us; the reality of having a female body with its periods and malfunctions and fluctuating hormones, its hair and its blood and its pain.

From young women brushed off in doctors’ surgeries to women in their 50s being “told” whether we can have HRT or not, it never stops. Listen to women: such a simple thing to do. I can’t wait for it to start.

As an NHS boss, there is little I can do to reassure EU staff about Brexit

“Should we be worried about Brexit?” As a chief executive of west London mental health NHS trust, I make a point of getting out into our diverse and geographically dispersed services as often as I can. Not for the first time, staff are asking about what Brexit means for them, especially, of course, if they come from another EU country.

We need to deal with the practicalities and ramifications of major political issues like the future of our EU staff post-Brexit. It is also important for me to be as open and honest as I possibly can with our staff. Staff who are used to dealing with complex mental disorders are not easily fooled by a glib throwaway line, well-crafted though it may be.

So, yes, we should be worried, I answer. We have lots of staff from the EU and we need to be focusing on retaining as many as possible. We can’t influence the political discussion, but we want to do everything we can to support our colleagues from the EU.

Currently we have 332 staff from the EU – about 10% of our workforce. They are nurses, consultant psychiatrists, senior doctors, managers, domestic staff, porters, occupational therapists, psychologists and much more besides. Their contribution to our work is as valuable as anyone else’s, and we are clear that we will fight tooth and nail to make sure that they can continue to provide the very best care for our patients and their carers.

This tells me that caring knows no borders. Every single day I see that being caring and acting with professionalism are inherent qualities of dedicated healthcare staff, wherever you are from. The “national” in our name means we are all one service together. As we have seen when responding to the modern challenges we face, divided we fail our patients, together we succeed.

But we cannot (nor should we) pretend that this isn’t a worrying time. If you put yourself in the shoes of our EU staff, a lack of clarity and reassurance suggests there aren’t many who could honestly say they aren’t making plans for their future. Their fate and that of their families, many of whom have settled here and made London their home, hangs in the balance.

The discussion about residency rights is all about who can and who can’t remain after April 2019. It is hardly a warm way to discuss the hugely valuable contribution these staff members of EU origin make.

We need to reframe this conversation to one of why NHS staff from the EU should stay in the UK and continue their tremendous work. We know that skilled professionals are in high demand in other countries. The only way we are going to stop valued colleagues leaving is by strongly making the case for them to stay.

That means thinking innovatively about accommodation in high-cost areas like London, and it means being able to tell staff what their career might look like in 10 or 20 years’ time. This may be difficult to do as we can’t even confirm they will be allowed to stay in the country. As a trust we are doing everything we can to support our staff from the EU, including HR support and passing on practical information, and this is at a time when recruiting and retaining qualified clinical staff is a challenge, for us and for other trusts, in its own right.

But there is precious little we can do to reassure staff about the longer term and we urgently need some clarity from those closest to the ongoing negotiations. If it doesn’t come soon, I fear that staff will begin to take matters into their own hands and leave the service – leaving the NHS and mental health altogether poorer and diminished by the loss of their expertise, skills and care.

If you would like to write a blogpost for Views from the NHS frontline, 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.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I imagined myself pregnant, felt tiny fingers in mine, I dreamed about babies | Sally-Ann Rowland

I ran into attempted motherhood like a wall and it grew to become the worst period of my life. Eventually, a garden of possibility broke through the mound of crap and enabled me to like the unexpected life I am now living.

I was 35 and charmingly, newly in love. With this shiny affair returned my dreams of parenthood. The sword of Damocles of my 40th birthday was just far enough away for me to build an idyllic mental castle: there was me, together with my new beau, and two beautiful children, with the various accoutrements of a comfortable life, including a nice home, close friendships, lots of sex and laughs, satisfying employment, enough money, rah rah rah.

My boyfriend quickly jumped on the baby wagon. After some months of finger-tingling doctors’ visits and loaded up with vitamins and my first armful of facts to increase the probability of having a healthy baby, we went at it pretty joyfully.

Trying to get pregnant is initially pretty hot. The first time we had sex with no contraception was great. So exciting, so hammered full of possibility, the very profundity of life itself and the weight of the decision to dive in and go on this crazy ride with an incredible person I loved so much. That experience is a little fainter the second time, a bit more the third, and from there on in seems to evaporate, leaving “trying to conceive” a really good way to kill a sex life.


Everyone seemed to be pregnant everywhere.

With time passing and no conception, I can now see my boyfriend’s growing reticence over the whole thing. His career had got shaky, his income was small and falling, he was dissatisfied with the city where we lived and ultimately wanted to change countries. While his desire waned, mine grew. My longing coated everything I saw. Pregnancy is such a heady and romantic state, so alluring and filled with the potential for fulfilment, no wonder it’s the harbinger of tremendous desire. The fecund girl, her swollen breasts and belly bursting with life, simultaneously a symbol, vessel and identity with life itself.

I imagined myself pregnant, felt tiny fingers in mine, I dreamt about babies, felt ill with jealousy when I saw pregnant women on the street, on TV and films. When my unknowing acquaintances and work mates would happily share their pregnancy news with me it was a slamming kick in the stomach. Everyone seemed to be pregnant everywhere.

As I sank more and more money into doctors my life became the menstrual cycle. Days one through five, the period. After the initial crushing trauma of bleeding that couldn’t be rationalised away as “implantation bleeding”, I’d proceed to count off the days until the 10th. Then the fertility drug Clomid. There followed alternate days of doctor-recommended missionary sex with a pillow under my butt.

Days 10, 12, 14 and 16 passed like this, compulsory sex following the most thinly-veiled seduction. Then the awful rise of hope, a hyper awareness of my body, I would fill with anticipation as I got closer to day 28 and the nasty biological trick that early pregnancy and premenstrual symptoms are the same. My boobs would get big and swollen, sometimes day 29 or 30 would pass and I would be positively giddy, only to be hurled back down the hill to push my expectations up again next month, Sisyphus-style.

My boyfriend seemed OK with how things were. He was verbally sympathetic but he’d produce little reasons to delay. At first he suggested we wait a bit so I’d qualify for maternity leave; then, my sister’s cat had stayed with us – best have another toxoplasmosis test; then, I might have chicken pox – best not have baby sex for a while; then, I had a miscarriage – he was too upset to try again for months (even though he wasn’t the one who’d had the period with bits in it – oh to experience reproduction from the bleachers). Finally, he insisted we move interstate – best wait till we’re settled before finding a gynaecologist. I dragged along this suitcase with jammed wheels to age 38 when, after following him to a new city on the other side of the country, I went into a full state of emergency.

We were confirmed as medically infertile (not due to my age) which left IVF the only way we could have a child together. This is, of course, massively expensive.


I poured my broken heart into reviewing the masses of material on donor IVF.

What began as a joint project had morphed into “my” project. I was left with the bills and the organisation, justified in the topsy-turvy universe of our interaction on the basis that I was the only one working. At the time I took this as his general laziness rather than dare think that he didn’t want a child … although the evidence of this was mounting. He lost his sperm test form and took weeks to get another; he wanted genetic testing to reduce the risk of disease, adding $ 6,000 to my bill. He wanted to live in another country, a project I’d shoved to secondary status after the baby; he lamented what sex with us used to be like and mourned the origin of his child in a specimen jar.

“We used to have fun,” he said, “Now all we have are big scary problems.” He didn’t attend the last counselling session required for us to start treatment on the basis that he wanted to move overseas and did not believe I would facilitate his dream once I had a child.

This brought me to my knees and I moved out, aged 39 and six months, to go ahead on my own through the single woman IVF program. My eggs were rotting in my ovaries at this point. I poured my broken heart into reviewing the masses of material on donor IVF.

Although I’d converted my application to single status, attended more compulsory counselling, read books on explaining donor conception to children, I stalled at the last minute – much like my boyfriend. Instead, I turned 40, spent my IVF savings on two overseas trips and pulled the pencil out the closing door of reproduction. At least now I could change jobs, I thought. I’d gone down to part-time work after telling my boss I was undergoing IVF. I hadn’t been able to admit the break up for fear of being returned to full-time work in a stressful job with which I could barely cope. The fictitious boyfriend thing had become absurd.

At this time, my younger sister got pregnant. It was the first pregnancy I could not run away from because we are too close. Instead, it forced me to put my face into the centre of the thing that caused me so much pain. When my niece was born, something miraculous happened. I realised that with her I’d got the baby I so desperately wanted.

At the other end of a short plane ride, I could hug this tiny thing and touch her soft skin, listen to her sounds and gurgles, buy her gifts and take her into my life to make us important to each other. This was the way a baby fitted into my life. I didn’t have to have my own.

I was too crushed from the end of my relationship and years of infertility to start motherhood by myself. I had no financial resources, I’d moved to a city where I had few friends and no family to join the boyfriend who was now my ex. The pieces wouldn’t fit regardless of how I shuffled them. My staunchest supporter, a close friend who had a child with a husband but without money, who’d encouraged me to go for it, back peddled.

The kicker was it costing at least $ 10,000 to get pregnant. Most people do that bit for free. When I looked at motherhood on my own I saw a really hard road, with crummy clothes and no money, lugging strollers up flights of stairs with a sore back, a stream of penny pinching, labour and loneliness that would take 20 years of my life. I wasn’t sure anymore that I wanted to become a mum under any circumstance.

I’ve often heard it said that having children is the most profound experience in a person’s life. The love for a child is complete and without experiencing the self displacement of raising children, this love remains inaccessible and incomprehensible. After coming out the other end of attempted reproduction I can say that not having children has been the most profound experience in my own life. The soul-crushing pain of it all has placed me on the other side of a river where I can see life as less of a string of acquisitions (husband, children, real estate, career accolades, objects) and find contentment and satisfaction in what I have. I learnt to live without getting what I wanted. I am so grateful for that.

  • Sally-Ann Rowland is an artist and a lawyer

I imagined myself pregnant, felt tiny fingers in mine, I dreamed about babies | Sally-Ann Rowland

I ran into attempted motherhood like a wall and it grew to become the worst period of my life. Eventually, a garden of possibility broke through the mound of crap and enabled me to like the unexpected life I am now living.

I was 35 and charmingly, newly in love. With this shiny affair returned my dreams of parenthood. The sword of Damocles of my 40th birthday was just far enough away for me to build an idyllic mental castle: there was me, together with my new beau, and two beautiful children, with the various accoutrements of a comfortable life, including a nice home, close friendships, lots of sex and laughs, satisfying employment, enough money, rah rah rah.

My boyfriend quickly jumped on the baby wagon. After some months of finger-tingling doctors’ visits and loaded up with vitamins and my first armful of facts to increase the probability of having a healthy baby, we went at it pretty joyfully.

Trying to get pregnant is initially pretty hot. The first time we had sex with no contraception was great. So exciting, so hammered full of possibility, the very profundity of life itself and the weight of the decision to dive in and go on this crazy ride with an incredible person I loved so much. That experience is a little fainter the second time, a bit more the third, and from there on in seems to evaporate, leaving “trying to conceive” a really good way to kill a sex life.


Everyone seemed to be pregnant everywhere.

With time passing and no conception, I can now see my boyfriend’s growing reticence over the whole thing. His career had got shaky, his income was small and falling, he was dissatisfied with the city where we lived and ultimately wanted to change countries. While his desire waned, mine grew. My longing coated everything I saw. Pregnancy is such a heady and romantic state, so alluring and filled with the potential for fulfilment, no wonder it’s the harbinger of tremendous desire. The fecund girl, her swollen breasts and belly bursting with life, simultaneously a symbol, vessel and identity with life itself.

I imagined myself pregnant, felt tiny fingers in mine, I dreamt about babies, felt ill with jealousy when I saw pregnant women on the street, on TV and films. When my unknowing acquaintances and work mates would happily share their pregnancy news with me it was a slamming kick in the stomach. Everyone seemed to be pregnant everywhere.

As I sank more and more money into doctors my life became the menstrual cycle. Days one through five, the period. After the initial crushing trauma of bleeding that couldn’t be rationalised away as “implantation bleeding”, I’d proceed to count off the days until the 10th. Then the fertility drug Clomid. There followed alternate days of doctor-recommended missionary sex with a pillow under my butt.

Days 10, 12, 14 and 16 passed like this, compulsory sex following the most thinly-veiled seduction. Then the awful rise of hope, a hyper awareness of my body, I would fill with anticipation as I got closer to day 28 and the nasty biological trick that early pregnancy and premenstrual symptoms are the same. My boobs would get big and swollen, sometimes day 29 or 30 would pass and I would be positively giddy, only to be hurled back down the hill to push my expectations up again next month, Sisyphus-style.

My boyfriend seemed OK with how things were. He was verbally sympathetic but he’d produce little reasons to delay. At first he suggested we wait a bit so I’d qualify for maternity leave; then, my sister’s cat had stayed with us – best have another toxoplasmosis test; then, I might have chicken pox – best not have baby sex for a while; then, I had a miscarriage – he was too upset to try again for months (even though he wasn’t the one who’d had the period with bits in it – oh to experience reproduction from the bleachers). Finally, he insisted we move interstate – best wait till we’re settled before finding a gynaecologist. I dragged along this suitcase with jammed wheels to age 38 when, after following him to a new city on the other side of the country, I went into a full state of emergency.

We were confirmed as medically infertile (not due to my age) which left IVF the only way we could have a child together. This is, of course, massively expensive.


I poured my broken heart into reviewing the masses of material on donor IVF.

What began as a joint project had morphed into “my” project. I was left with the bills and the organisation, justified in the topsy-turvy universe of our interaction on the basis that I was the only one working. At the time I took this as his general laziness rather than dare think that he didn’t want a child … although the evidence of this was mounting. He lost his sperm test form and took weeks to get another; he wanted genetic testing to reduce the risk of disease, adding $ 6,000 to my bill. He wanted to live in another country, a project I’d shoved to secondary status after the baby; he lamented what sex with us used to be like and mourned the origin of his child in a specimen jar.

“We used to have fun,” he said, “Now all we have are big scary problems.” He didn’t attend the last counselling session required for us to start treatment on the basis that he wanted to move overseas and did not believe I would facilitate his dream once I had a child.

This brought me to my knees and I moved out, aged 39 and six months, to go ahead on my own through the single woman IVF program. My eggs were rotting in my ovaries at this point. I poured my broken heart into reviewing the masses of material on donor IVF.

Although I’d converted my application to single status, attended more compulsory counselling, read books on explaining donor conception to children, I stalled at the last minute – much like my boyfriend. Instead, I turned 40, spent my IVF savings on two overseas trips and pulled the pencil out the closing door of reproduction. At least now I could change jobs, I thought. I’d gone down to part-time work after telling my boss I was undergoing IVF. I hadn’t been able to admit the break up for fear of being returned to full-time work in a stressful job with which I could barely cope. The fictitious boyfriend thing had become absurd.

At this time, my younger sister got pregnant. It was the first pregnancy I could not run away from because we are too close. Instead, it forced me to put my face into the centre of the thing that caused me so much pain. When my niece was born, something miraculous happened. I realised that with her I’d got the baby I so desperately wanted.

At the other end of a short plane ride, I could hug this tiny thing and touch her soft skin, listen to her sounds and gurgles, buy her gifts and take her into my life to make us important to each other. This was the way a baby fitted into my life. I didn’t have to have my own.

I was too crushed from the end of my relationship and years of infertility to start motherhood by myself. I had no financial resources, I’d moved to a city where I had few friends and no family to join the boyfriend who was now my ex. The pieces wouldn’t fit regardless of how I shuffled them. My staunchest supporter, a close friend who had a child with a husband but without money, who’d encouraged me to go for it, back peddled.

The kicker was it costing at least $ 10,000 to get pregnant. Most people do that bit for free. When I looked at motherhood on my own I saw a really hard road, with crummy clothes and no money, lugging strollers up flights of stairs with a sore back, a stream of penny pinching, labour and loneliness that would take 20 years of my life. I wasn’t sure anymore that I wanted to become a mum under any circumstance.

I’ve often heard it said that having children is the most profound experience in a person’s life. The love for a child is complete and without experiencing the self displacement of raising children, this love remains inaccessible and incomprehensible. After coming out the other end of attempted reproduction I can say that not having children has been the most profound experience in my own life. The soul-crushing pain of it all has placed me on the other side of a river where I can see life as less of a string of acquisitions (husband, children, real estate, career accolades, objects) and find contentment and satisfaction in what I have. I learnt to live without getting what I wanted. I am so grateful for that.

  • Sally-Ann Rowland is an artist and a lawyer

Jeremy Hunt says Stephen Hawking is wrong about weekend NHS deaths

Jeremy Hunt has been criticised for claiming Stephen Hawking is wrong in the row about the government’s seven-day NHS plan.

Hunt was responding to criticism from the renowned 75-year-old physicist and author of A Brief History of Time ahead of a speech at the Royal Society of Medicine on Saturday.

In the speech, Hawking will accuse the health secretary of “cherrypicking” favourable evidence while suppressing contradictory research to suit his argument.

Hunt tweeted: “Stephen Hawking is brilliant physicist but wrong on lack of evidence 4 weekend effect.”

Jeremy Hunt (@Jeremy_Hunt)

Stephen Hawking is brilliant physicist but wrong on lack of evidence 4 weekend effect.2015 Fremantle study most comprehensive ever 1/2

August 18, 2017

Jeremy Hunt (@Jeremy_Hunt)

And whatever entrenched opposition,no responsible health sec could ignore it if you want NHS 2 be safest health service in world as I do 2/2

August 18, 2017

The shadow health minister, Justin Madders, weighed in on the row: “It doesn’t take a genius to work out the Tories are wrecking the NHS.

“Professor Hawking has given us answers to many of the universe’s most challenging questions, and even he can’t work out why Jeremy Hunt is still in his job.”

The former Liberal Democrat leader Tim Farron said: “A renowned scientist such as Stephen Hawking questioning your evidence might normally be cause to think again, but sadly it looks as though Jeremy Hunt has joined the chorus of those who have had enough of experts.

Stephen Hawking will say that cherrypicking evidence for political ends ‘debases scientific culture’.


Stephen Hawking will say that cherrypicking evidence for political ends ‘debases scientific culture’. Photograph: Philip Toscano/PA

“It’s easy to accept evidence when it supports your ideological view of how a service should be provided, but we see this government ignoring the evidence time and time again when it suits them, be it on the NHS, our school system or leaving the single market.”

Social media users, including many doctors and scientists, mocked Hunt for taking on the “world’s most famous scientist”.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, responded directly to Hunt, citing studies and articles that contradicted his argument.

McKee, who said he has been writing on the subject of hospital mortality for 22 years, added: “I’d appeal to those commenting not to personalise this with attacks on Hunt – let’s stick to evidence – it’s strong enough on its own.”

Trisha Greenhalgh, professor of primary care health sciences at Oxford University, said: “Awake to tweet from Jeremy Hunt telling Stephen Hawking he doesn’t know how to interpret evidence. Replies are good.”

In his speech, Hawking will single out Hunt, who claimed that 11,000 patients a year died because of understaffing of hospitals at weekends. He will say that four of the eight studies cited by the health secretary were not peer-reviewed and that he ignored 13 papers that contradicted his statements.

“Speaking as a scientist, cherrypicking evidence is unacceptable. When public figures abuse scientific argument, citing some studies but suppressing others, to justify policies that they want to implement for other reasons, it debases scientific culture,” Hawking will say.

Dr Lauren Gavaghan, a consultant psychiatrist‏ whose speech about the junior doctors dispute on James O’Brien’s LBC radio show last year went viral, told the Guardian that Hunt “purposefully misinterpreted statistics from a faulty paper around NHS weekend deaths, when the authors explicitly said that to use the figures would be ‘rash and misleading’. As a consequence of this, sick people did not seek medical help at weekends.

“Subsequent research has shown his ‘analysis’ to be wrong, yet the harm has unfortunately already been done. For Jeremy Hunt to now have the audacity to dispute Professor Stephen Hawking, arguably the world’s most brilliant mind and a man who has dedicated his life to the complex analysis of data, on the interpretation of these academic papers is quite simply laughable.”

Gavaghan called for Hunt to debate with Hawking on live television. “Given also that Jeremy Hunt enjoys presenting himself as a patient advocate, it would seem that he has an opportunity at humility here, to perhaps learn something from an experienced patient – for Professor Hawking has of course himself been a lifelong patient of the NHS.

“He has much to say about the rapid privatisation of the NHS that is taking place currently, and fears this will lead to an unequal, unfair two-tier health service. I wonder if Jeremy Hunt might take up my offer,” she said.