Domestic staff in London hospitals have begun a week-long strike against private contractor Serco over low pay and job cuts, in what organisers say is the biggest cleaners’ strike in the UK’s history.
Hospitals that are part of Barts Health NHS trust were expected to face serious consequences with more than 700 cleaners, security guards, catering staff and porters employed by Serco walking out on Tuesday. The action came after a ballot resulted in 99% of workers voting to strike.
“We are the people who often get forgotten about but our work is an essential link in the chain of care that makes the NHS,” said Len Hockey, one of the striking workers, who has been a porter for 28 years at Whipps Cross hospital in east London.
Unite members employed by Serco requested a 30p per hour increase in pay last month, which was rejected. “Our claim is a modest claim,” Hockey said. “We don’t want to take industrial action but we have been forced to in order to maintain very basic standards of living.”
Hockey said that since Bart’s trust was taken over by private contractors standards for workers had dropped dramatically. According to Hockey, many workers have suffered real-time pay cuts greater than the 14% cuts experienced by other NHS staff. “Until recently there were some members of staff here on less than the London living wage,” he said.
“Costs of living in London have increased so much recently that many workers have to do two or three jobs just to keep going and many people have become sick as a result.”
Phil Mitchell, the contract director at Serco, insisted the company wanted to pay workers fairly and added that it had agreed to pay the London living wage of £9.75 an hour universally. “We’re determined to ensure that Unite’s action does not impact on patients,” he said in a statement. “We have robust plans in place aimed at ensuring we can continue to support the trust’s hospitals to operate as normal during the planned action.”
However, last week a two-day preliminary strike at Barts hospitals – including the Royal London, St Bartholomew’s and Mile End – caused significant problems, the union said.
By the second day toilets were unclean, beds were left on floors as no porters were available to carry them, and many patients did not receive hot meals due to lack of catering staff.
“Serco feel they can just ride it out,” said Unite’s digital organiser, Matthew Dore-Weeks. “But the two-day strike so far has seen huge effects on the public which will get worse as the strikes continue.”
Last year Serco won the £600m “soft services” contract for Barts trust and made an overall profit of £82m.
Cleaners say the company has increased their workloads to unsustainable levels and many have reported severe hygiene issues in hospitals which have been hotspots for infections such as MRSA and C diff.
“Since Serco came there has been a lot of changes,” said one cleaner at the Royal London. “We never have time for breaks, which has affected my health. Now I have to take other work during weekends, which was my time to see my family and go to church. We are so important to keeping patients healthy but they don’t listen to us – they think domestic staff are invisible. But without us who is going to feed patients or keep the hospitals clean?”
The seven-day stoppage will run until Monday 17 July and will be followed by a 14-day strike starting on 25 July. If no changes are made further strike action will be planned for August and September.
I have never been in a theatre audience like this one – so loving, supportive, involved. Then again, there has probably never been a production quite like this. It is the ultimate verbatim theatre. What’s more, part of the verbatim is happening live, unscripted, in front of us.
Lemn Sissay’s The Report, at the Royal Court in London, is just that: the reading of – and his reaction to – the psychologist’s report about the abuse he suffered over 18 years as a child in the care system. It is a one-off production. This is, by turns, theatre as shock treatment, theatre as therapy, theatre as protest and, perhaps ultimately, theatre as survival. We come away with a microscopically detailed portrait of the poet – and the system that did its best to destroy him. Sissay, now 49, was born to an Ethiopian mother in Wigan. She was a young woman – a girl really – who had come to study in Britain and found herself pregnant. She was placed in a mother and baby unit and, at two months old, Sissay was put in care. His mother was asked to sign adoption papers and refused – she wanted her son back when she could manage better. Social services ignored her wishes, telling his long-term foster parents to treat this as adoption. Sissay was renamed Norman by his social worker, who happened to be called Norman.
His foster family were a white working-class couple who had done well for themselves. He was a teacher, she a nurse. They were strict, but they were loving in their own way. At 12, he became difficult, eating cake without permission and staying out late at night. They said the devil had got into him, they couldn’t cope and returned him to social services. They didn’t want to see him again.
From the ages of 12 to 18, he went from care home to care home, where he was physically, emotionally and racially abused. Sissay was always told his mother had abandoned him. At the age of 16, he bought tiny tins of Airfix paint in gold, red and green, opened the top window, and painted a bit of the roof in the colours of Ethiopia. For this, he was sent to an assessment unit where most of the children were on remand. He had to be accompanied by a guard to the toilet at night and was strip-searched after friends visited.
When Sissay eventually left care, he was given a flat with no bed. The head of social services ordered that he be sent into the world without a penny, to teach him a lesson, although he was never told what that lesson was. At 18, Sissay asked for his files. He had no family, no photos, no letters – his entire history was contained in these files. He was not given the files, but he was given two pieces of paper that revealed his whole life had been a lie. The first said his name was actually Lemn Sissay. (Lemn means “Why” in Amharic, the official language of Ethiopia.) The second was a letter his mother had written to the social worker when Sissay was one, pleading for his return.
Ever since, Sissay has been trying to reclaim his social services files. They alone contain the truth of his life, or something approximating it. In 2010, he made a radio documentary, Child of the State, in which he returned to Wigan to find the files. Initially, he was told they were now held by the data services company Iron Mountain. At the end, he was told sorry, they are lost.
Two years ago, the head of social services got in touch to say his files had finally been found. And this was the start of the process that has resulted in tonight’s performance. In recent years, Britain’s councils have begun to compensate children who were abused in their care. After Sissay was handed his files, he was told that Wigan council wished to apologise to him.
Sissay is an old friend of mine. He is one of the funniest and warmest people I know, extraordinarily animated with a life-affirming laugh. He is also one of the most damaged people I know, suffering paralysing depression that forces him to withdraw into himself and disappear for months at a time, sometimes longer. The public tends to see more of the first Sissay. But not tonight.
Two days before The Report, we meet to discuss it at King’s Cross station. He is on his way to Carlisle for a gig. Sissay is always on the road, travelling light, with nothing but his words. He says he is in a better place than he has been for years, and it is this that has enabled him to make a compensation claim.
It has been two years since he received an apology from the great and good of Wigan council. “They moved the table to the back of the room, put the chairs in a circle. I was like, ‘What the heck is this?’ I said I wanted an apology on five fronts: you stole my family, you changed my name, you gave me to foster parents that were inadequate, you imprisoned me and I suffered constant racism from the get-go. I was spat at, punched, kicked, throughout my time in care. I was dehumanised.
“They said we apologise on all the points and told me I was entitled to make a claim. I said: ‘I’m not going to discuss money with you. I’m not going to barter my experience with you.’ I said: ‘I’d like your lawyer to talk to my lawyer, and then we’ll be fine.’”
His lawyer, an expert in child abuse, made the claim. Sissay tells me, off the record, the amount: nothing outlandish, in the low six figures. Wigan took six months to respond to him and then offered 11 times less. Sissay says he knows of abuse victims who settled for as little as £2,000. “I was in care for 18 years. The care system should be a place where 18 years is a gift because you’ve got all the resources, the best education, the best psychotherapeutic work, and actually it was 18 years of betrayal, secrets, lies, beatings, incarceration.”
This is the genesis of the Royal Court show. To challenge the compensation offered, victims of abuse have to provide a psychologist’s report detailing what they suffered and how it affected them. “You have to justify why everything that has happened to you has happened to you – and how it has played out in your life. Somebody told me the process of doing the psychologist’s report was worse than the abuse she went through. Part of the reason I’m doing this on stage is to show what people have to go through to get redress.”
There is another reason. Sissay has found it too painful to read all his files, let alone the psychologist’s report. He says he will find it easier in the theatre. “I feel good on stage. I feel, in a bizarre way, like I’m with family. This is the best way for me to look at those files. I couldn’t be in a safer place. I feel more comfortable having this out in the open, because they fucked me up when I was on my own.”
Sissay and Julie Hesmondhalgh, who plays the psychologist, take to the stage in a minimalist production (two chairs and a table) directed by John McGrath. The performance lasts two hours – Hesmondhalgh reading the report, Sissay listening and occasionally responding. It is blisteringly powerful: the mix of Sissay’s poetic language (much of the time the psychologist is reading out his words) and the clinical analysis of Sissay’s condition.
Hesmondhalgh is wonderful – particularly when she breaks out of character to ask Sissay if he is all right and if it’s OK for her to go on. We listen to her and watch him: tapping his foot, shaking his head or nodding along, sometimes smiling, occasionally laughing (particularly when the psychologist mentions his “avoidance of even trivial exercise”).
This is theatre at its most raw. Sissay might feel he is in a safe place, but at the same time he could not be more exposed, hearing it all for the first time. So we learn about how his foster family eventually rejected him; how he grew up as the only black boy boy in the village and strangers spat on him from buses; how he was named Chalky White in care and beaten by members of staff.
We find out how he started writing poetry for solace, how he spent more than a decade (and all of his money) crisscrossing the world to track down his family, and how one by one they rejected him. We hear about the achievements – the plays, the books, the MBE, beating Peter Mandelson to the chancellorship of the University of Manchester, the two honorary doctorates. Here, in a rare interruption, Sissay kicks at an imaginary football and shouts: “Goaaaaaal!” The audience laugh – with relief.
At the end, everyone cheers. You sense they would rather just hug Sissay
Most painfully, we learn about the scars on his wrist, the glue he sniffed when he was 12, the way he drank himself into oblivion as an adult (he has been teetotal for three years, apart from one lapse), how he craved intimacy but couldn’t cope with it, the relationships that imploded, his sense of inadequacy, hypersensitivity, extreme shyness, pathological fear of rejection, the birthdays spent alone in tears. We hear the psychologist’s various diagnoses: post-traumatic stress disorder, avoidant personality disorder, alcohol use disorder.
The Report is never more poignant than when the psychologist states: “He meets some of his needs for acceptance and love through the superficial and impersonal relationships he forms through being famous, whereby he interacts with people but at a safe distance.”
The psychologist concludes that Sissay’s “long-term injuries” were caused by his experiences after being taken from his mother and placed in care, and that he is likely to need therapeutic support for the rest of life. The psychologist says the reason it has taken Sissay so long to make a claim is simple – before he received his files and the apology, he did not think he would be believed.
It is a brilliant, draining show. At the end, everybody stands and cheers. You sense they would rather just hug Sissay. Outside, he is having a smoke. His eyes look gone. Audience members tell him that he is a survivor, a hero, a crusader. “Oh dear, I feel as if you all know me now,” he responds. He says he is happy with the report, and glad to have made it public.
Yes, Sissay has done it for himself – but he has also done it for all the victims of the care system who don’t have a public voice. “This is not about me picking the scab. It is about getting redress, navigating my way through this minefield and trying to articulate what was always meant not to be articulated. We were meant to be ashamed of our experiences and not talk about them.”
He mentions a poem he wrote on becoming chancellor of the University of Manchester. Called Inspire and Be Inspired, it contains the lines:
Open all doors. Open all senses. Open all defences. Ask, what were these closed for?
“It’s about opening up all the dark places that have been closed,” says Sissay. “That’s what we’re doing here. We’re digging up the bodies.”
In her letter (29 April), Mary McKeown refers to “hearing” and “audibility”. Certainly, audibility is an essential precursor to comprehension but, on radio and television, a simple remedy is to turn up the volume. It’s careless articulation that constitutes the main problem. Whole words are frequently not articulated with requisite precision. The majority of the applauded weather presenters fall down lamentably on the “test-word”, “occasionally”. The word contains five syllables, yet most of the time one hears “occasion-y” and, at times, “casion-y”. Might the BBC stretch to hiring a speech therapist? Alan Huntington Alderley Edge, Cheshire
• Richard Lee is quite right to suggest (Letters, 29 April) that people have a 50-50 chance of needing hearing aids by middle age. The cause is often the wearing of headphones playing music far too loudly and going to pop concerts where the music is deafening. A drummer colleague was asked by his doctor if he was a deep-sea diver because his eardrums were scarred – but he was only playing in a rock band with loudspeakers beside him. Helen Keating Gatehouse of Fleet, Dumfries and Galloway
•Dame Judi Dench (Get off the sofa and learn your Shakespeare, Dench tells young actors, 28 April) attributes the inaudibility of many actors to their laziness. But surely the fault lies with Rada etc, which no longer seem to teach voice production and projection, and theatre directors who continue to give jobs to mumblers. Nor is the problem confined to the provinces: the National Theatre is also at fault, though it is redeemed by having an excellent system of earphones, which I regularly use. Peter Greaves London
• There are some occasions when opera singers can be forgiven for not being understood (Say it again Carmen: diction coaches to help opera audiences catch every word, 28 April); if the house is huge and the conductor does not restrain the orchestra, no singer will be understandable in louder passages. Occasionally a set or costume will deaden the sound, making it more difficult to hear the details of what is being sung. Sometimes the director places the singer at the very back of the stage or in a very awkward position, or perhaps the vocal writing is so extreme that it makes comprehending the text problematic. In the vast majority of cases, though, the “problem of diction” is not about diction at all, but rather a problem of vocal production, leading to unclear vowel sounds that make it very difficult for the audience to “fill in the blanks” between vowels in the way that all of us do in everyday life. There are so few singing teachers now, including in major conservatoires, that teach singers how to stand and breathe. Too often they concentrate on creating an “operatic” sound, instead of focusing on the core of the singing voice – the breath. A well-supported voice singing “on the breath” will, in almost all circumstances, have little trouble in making itself understood. Many singers sacrifice the text in favour of the “sound” but with correct posture and breathing, leading to clear vowel production, there is no reason that a singer should not be clearly understood. ENO does not need diction coaches, but rather singers who have been properly taught and who stand and breathe properly. Ashley Holland Former ENO company principal, Muthill, Perthshire
• Rolling content screens on digital radios have transformed my Classic FM listening. Turning up the volume, when no one else is in the house, allows me to enjoy the music. But no amount of adjusting the volume or my hearing aids lets me hear the broadcaster giving the title, conductor, etc (Sorry John, Aled, Alan et al). Now the screens allow the “Of course, that’s what it was!” moment. Unfortunately, no one’s managed to radio screen roll John Humphrys or Jenni Murray yet. And no, reading a transcript just isn’t the same. Hilary Grim Oxford
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The British Medical Association has announced a new wave of strikes by junior doctors in England this month – the first since its members rejected the government’s final offer on their new contract.
Junior doctors are to stage five days of strikes with “full withdrawal of labour” between 12 and 16 September, the British Medical Association has announced.
There will be a full withdrawal of labour, including junior doctors working in emergency departments, between 8am and 5pm on the days in question.
The industrial action will further test the NHS, already said by trusts to be at breaking point due to increasing demand for services, staff shortages, and insufficient funding.
There have been five previous walkouts in the dispute, all this year. The longest lasted for two consecutive days, and the first all-out strike – including junior doctors working in emergency departments – was held in April. More than 100,000 operations and outpatient appointments have been cancelled as a result of industrial action to date.
In May a compromise deal was agreed between the BMA and Jeremy Hunt, the health secretary, but last month members of the doctors’ union voted against accepting it by a margin of 58% to 42%. As a result, Hunt is pushing forward with plans to impose the contract on junior doctors – those below the level of consultant – in October.
About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final- and penultimate-year medical students who were eligible to vote, took part in the ballot on the settlement.
Dr Johann Malawana, then chair of the BMA’s junior doctors committee, had recommended the revised terms and conditions as the best deal junior doctors could get, but resigned after the ballot results were announced, and was replaced by Ellen McCourt.
The Department of Health accused the BMA of putting confrontation before cooperation in order to score political points. A spokesman said: “As doctors’ representatives, the BMA should be putting patients first not playing politics in a way that will be immensely damaging for vulnerable patients. What’s more, the BMA must be the first union in history to call for strike action against a deal they themselves negotiated and said was a good one.
“Whilst there are many pressures on the frontline, funding is at record levels, with the highest number of doctors employed in the history of the NHS. Co-operation not confrontation is the way forward to make sure patients get the best treatment and the NHS is there for people whenever they need it.”
Stage 4 Non-Hodgkins lymphoma is not supposed to be this simple to reverse, is it? We make no claims, we’re just reporting what happened, which was confirmed by a family member.
What is shocking is that Non-Hodgkins lymphoma usually only appears in those in their 60s or older. This case occurred in a 34 year old mother of three.
Stage 4 is a designation for a cancer that has metastasized, in this case to all of her lymph nodes, and beyond to an organ or two.
In doing some research on non-Hodgkins lymphoma, we find that immune-suppressive drugs appear first on the list of causes. Did she use them? No, she didn’t (although her chemo drug (Rituxan), interestingly, has an immune-suppressive effect). Why, one wonders, would an immune-suppressive effect be useful in treating a cancer of the immune system?
The Mayo Clinic Website tells us that prior infections with HIV and Epstein-Barr are risk factors, as well as the bacteria Heliobacter pylori, which is often thought to be the cause of ulcers. (These were not a factor in this woman’s case.)
Pesticides and herbicides are believed to play a role in causing Non-Hodgkins lymphoma. Toxic chemicals are poisons and shouldn’t cause any surprise when they are linked to the causation of a cancer of our lymphatic system which is a partner with our immune system that protects and detoxifies poisons we come in contact with.
So, we know what we need to avoid, but — once we get Stage 4 Non-Hodgkins Lymphoma — how might we get rid of it, in a natural way?
Here’s what one woman did:
She did some research on the Internet and talked to a friend who had successfully beat his own cancer.
She stopped the chemo treatments after her second session.
She started a mostly Raw Organic-Only Diet.
Here’s the regimen she used:
“No dairy, no gluten, no eggs, NO Sugar!
Waiting in between meals — no food combining!
1tbs of apple cider vinegar (with the “mother”) twice throughout day
Wake up to 1 ounce of wheatgrass juice followed by raw vegetable juice of choice — either greens, carrots, or beets.
To each juice I added lemons, ginger, turmeric root, and lots more.
2 hours later I’d have Ezekiel bread with avocado, tomatoes, and whatever other veggies you like.
3 hours later I’d blend the juice of young Thai coconut with the meat and add whichever fruits I like. My favorite combo is bananas, dates, cinnamon, almonds, flax powder.
These are the supplements I took: probiotics, Vitamin D, Multi-vitamins, Curcumin (tumeric capsules).
2 to 3 hours later you can have a huge salad of your choice. Then again, 2 hours later, another fresh raw juice — at least 18 ounce or more.
For snacks in between you can eat all kinds of nuts or fruits.
You can make fruits a meal as well.”
Here are some more useful tips this cancer survivor offered, which are good health tips we’ve seen elsewhere…
“No eating 3 hours prior to bed.
You can drink teas with dates if you feel like having something sweet but, No sugars!!!
Ezekiel bread has gluten but I was allowed because it’s mostly grains.
4-6 months of this program is completely raw, depending on each case
Then you can eat cooked foods every other day, such as organic brown rice, quinoa, salmon, soups, brown rice pasta etc… “
After four months of nothing but this diet, there was no sign of the cancer.”
It should also be noted that things happen for a reason and warnings from our body usually precede them, if we are listening. Out of our billions of cells, many are being replaced every moment of the day and night. Some of these might mutate and begin to develop into a cancer tumor. This is usually in response to the presence of some level of toxins in our body or some other stressor.
Fortunately, our body has natural systems to attack and destroy mutated cells before they begin to cause us trouble. Naturopathic doctors tell us that, if we supply our immune system the nutrients it needs to do this important work, it is quite capable of doing the job. The problem is, they say, that our modern food and eating habits are not supplying ALL the nutrients our body is known to need on a daily basis.
As I understand it, when our body reaches its limit of toxicity and stress, cancer begins to take over. The process used here to apparently reverse it is to remove as much of the toxicity that our food choices may be causing and give our cells super nutrients in mega-doses, in a raw, organic form, together with high-ORAC spices like turmeric — and some supplements, for good measure.
Imagine how you would feel if you ate this way all the time!
Author Paul Kemp successfully resisted being pushed into becoming a doctor, but instead has made the study of how to live a long, healthy life without intrusive medical interventions a primary goal. At age 67, he is winning and loving it!
Half and unrelated siblings, this kind of as step, fostered or adopted siblings, used significantly less violence with much less severity, it was uncovered.
In households created up of each blood-connected and unrelated siblings, people surveyed used much more violence in the direction of their relevant – total and half – brothers and sisters, even employing weapons such as heavy objects and knives, the research by Dr Roxanne Khan, Dr Vanlal Thanzami and Jennifer Bowling from University of Central Lancashire concluded.
“This research centered on the ‘Cinderella Effect’ that, according to evolutionary theories, suggests that stepchildren are far more most likely to encounter neglect or abuse than these related by blood. We wished to check out no matter whether this was the case amongst complete, half and unrelated siblings,” Dr Khan mentioned.
“Contrary to what we anticipated, this research did not help the ‘Cinderella Effect’ taking place within siblinghood.
“Sibling relationships are very complex so we assume a variety of other aspects could have influenced our outcomes.
“It could be the case that full siblings count on much less retaliation for using violence towards their blood brothers and sisters, in contrast to the uncertain revenge of half or unrelated siblings, and this could make clear the friction.”
The group asked to 315 brothers and sisters, aged 16 to fifty five, how they fought with their siblings and about the severity of the violence.
Participants supplied data about 456 complete siblings, 123 half siblings and 39 unrelated siblings.
The findings will be presented at the British Psychological Society Division of the Forensic Psychology annual conference in Glasgow on Friday, June 27.
As word spread about Uruguay’s Luis Suarez biting the shoulder of Italy’s Giorgio Chiellini yesterday for the duration of a Planet Cup match, supporters have been surely caught off guard. However, as shocking and disgusting as this behavior was, this became the third episode in four years that Suarez has been accused of biting one more athlete.
Biting in sports activities is certainly not common–we can don’t forget Mike Tyson biting off a chunk of Evander Holyfeld’s ear in 1997–but it reminds us of the animalistic actions that sports activities competition can ilicit in specific men and women who are susceptible to aggression.
Whilst most achieved and elite athletes have the capability to management their emotions in frustrating situations and practice impulse handle, some athletes unfortunately resort to such actions in these substantial-pressure, large-stakes competitions.
Harnessing sheer anger and disappointment in a constructive way is how most athletes can carry their game to a new level. Intense, substantial level competitions this kind of as the Planet Cup and other sporting occasions that convene periodically such as the Olympics create this kind of heights of emotional anxiety that people athletes who are susceptible to aggression-this kind of as Suarez-plainly have problems channeling their anger in this kind of conditions.
Eventually, humans biting other people reminds us of our ancestral connection with primates–and how though evolution and improvement of organized cultures and societal norms–such behavior became unacceptable.
Health-related Implications of Human Bites
Our mouths are host to almost 200 species of bacteria, and so the concern for building a bacterial infection right after a bite is a genuine concern. Staphylococcus and Streptococcus are commonly accountable for infections as properly as other so-called anaerobic bacteria which thrive in reduced oxygen problems. A notably concerning anerobic bacteria in human bites is Eikenella corrodens, which can lead to persistent infection as effectively as abscesses. The significance of thorough wound cleaning, irrigation and debridement is critical to prevent a wound infection. Tetanus immunization need to be up to date as properly.
If the obvious bite is much more consistent with an abrasion–with no violation of the epidermis or any broken skin—prophylactic antibiotics are not vital assuming the damage does not involve the joints, hands or feet or any framework containing cartilage. (the ear). Regional Local wound care with a lot of soap and warm water and antibacterial ointment will suffice.
Specific types of bites are higher risk and prophylactic antibiotics are recommended. These contain bites to the hand as well as those that break by means of the superficial layer of skin–known as the epidermis– along with bites that involve joints and structures which contain cartilage. All Bites to the hand are at large chance for infection and ought to be offered antibiotic prophylaxis. The importance of neighborhood wound care in these circumstances is paramount and a health-related expert must be consulted in these situations.
It is possible to transmit both Hepatitis B and C, as well as Syphilis and TB via human bites. In uncommon cases, it is also attainable to transmit tetanus as nicely. And, even though it is not frequent, studies and situation reviews have documented transmission of HIV by means of human bites.
Although the HIV virus is contained in the saliva of these impacted by the disease, it is existing at significantly decrease amounts in contrast to the blood stream. In addition, there are actually distinct inhibitors in the saliva that make the virus non-transmissible or ineffective in the majority of situations. Therefore, the danger of transmission of HIV by means of human bites is really low.
Comedy in a time of crisis … This Could Hurt a Bit. Photograph: John Haynes
The 12th of July has often produced a feeling of dread in me. I grew up in Ulster, in the seaside town of Bundoran near the border, and I even now remember the influx of holidaymakers we would have on that date – all in search of to escape the north on the biggest marching day of the yr, and the violence it could set off.
This Could Hurt a Bit
Starts 8 April
Right up until twelve April
Box workplace: 0131-228 1404
In 2006, the 12th fell on a Wednesday and marked the beginning of a heatwave in London, exactly where I now dwell. It was also the day my husband, the theatre director Max Stafford-Clark, had a stroke that would change each of our lives for ever. I nonetheless shudder when I recall the knock on the door that evening.
Max had rung me at 6 to say he was on his way house. By seven, there was nevertheless no signal. Half an hour later on, I opened the door to a paralysed and gabbling Max, supported by 4 concerned neighbours who had located him collapsed in the lengthy corridor foremost to our Holloway flat. I mentioned: “Max, you’ve had a stroke. I am calling an ambulance.” He was coherent ample to beg me not to, but was too poorly to take critically. I was all of a sudden overwhelmed by the distinct likelihood that he wouldn’t make it.
My neighbour Justine named 999, whilst I told him I loved him and tried not to fall apart. Despite repeated calls to the ambulance services, it took more than an hour for them to arrive. When I asked the paramedics what had taken them so extended, they mentioned they had ”just acquired the get in touch with”. I discovered out later this possibly meant Max’s case was deprioritised as a lot more urgent calls came by means of.
Ben, the junior physician on call that evening, advised me he wasn’t confident what physical and psychological capacities Max would be left with – if he survived. One of the paramedics held my hand and explained: “Love, you’re going into shock – and you do not want to end up in hospital when you want to be with Max.” I pulled myself collectively, and so started our journey into the subterranean planet of the seriously unwell.
At midnight, Max was moved from A&E to a standard ward that was a vision of purgatory. The cries of “nurse, nurse” went on all through the night. I quickly identified that this persistent entreaty was the song of the ward. The young porter, who up coming morning pushed Max’s bed to the stroke/geriatric ward, mentioned: “So who did he utilised to be?” After six months in hospital, Max returned residence somewhat much better, but disabled and partially blind. Above the previous eight many years, we have met and continue to meet incredible and committed NHS workers. We are deeply grateful for their care and focus.
In 2006, the total state of the NHS had been strengthening, but I was aware of the pressures on some of the hospitals we frequented: a lack of workers tools currently being ancient, broken or each cleanliness on wards leaving one thing to be sought after. The services clearly needed support and consistency – not one more destabilising reorganisation.
This Might Hurt a Bit, my touring play about the NHS, not too long ago opened at the Octagon in Bolton. It arrives at a time when the NHS is dealing with its biggest crisis – the coalition government. I was astonished when they pushed through damaging and unpopular reforms without an electoral mandate following promising, till they had been blue in the encounter, “No more leading-down reorganisation” – therefore producing a reorganisation so vast that, as former NHS chief David Nicholson stated, “It could be seen from outer room.”
Max Stafford-Clark and Stella Feehily final 12 months. Photograph: Dan Wooller/REX
This Could Hurt a Bit is not a play about Max’s time in hospital, even though the truth that we use the NHS frequently does give us insight into what individuals encounter. Early drafts of the play reflected this individual element, but they were soon superseded – right after I interviewed medical professionals, nurses, managers, porters, campaigners and academics, studied materials about healthcare markets and PFIs, and study about the shenanigans of the Conservative, New Labour and coalition governments, who have all experimented with, in their own way, to promote off the greatest remaining public institution in the world.
The play is a comedy drama about a politically divided family members who are drawn with each other when Iris, the 91-12 months-old matriarch, is rushed to her nearby, overstretched hospital with a disturbing neurological dilemma. But it also seems at the wellness and social care bill of 2013 and the harm it brought on. Though This Might Harm a Bit is a political play (since it truly is unattainable to publish about the NHS in any other way), it also depicts the humanity of the institution, and how we require it when we are at our most vulnerable and desperate. The identical medical professionals care for us regardless of whether we are millionaires or penniless – an extraordinary act of social solidarity.
I do not present a ideal NHS due to the fact, as has been nicely-documented, it can offer an uneven services and has allow some folks down terribly. But in spite of the drip-drip of undesirable information, the NHS is not broken, as the coalition would have us feel. In fact, it is a miracle. There are 53 million folks in England – the NHS sees around one particular million folks each and every 36 hours. The vast vast majority of them are getting effectively-served. If we want to keep a overall health support that protects us, we cannot sit back. As Iris says at the close of the perform: “We mustn’t give up, Gina. We need to battle. There is even now time.”
• Michael Billington’s evaluation of This Might Hurt a Bit
Bill Gates believes the globe can and need to step up the fight towards a group of tiny-known and prolonged-neglected tropical diseases, that collectively do as significantly harm as HIV, malaria or tuberculosis.
In an unique interview with the Guardian, the founder and former boss of Microsoft explained the funds has to be discovered, even in the existing difficult economic climate, for very efficient programmes, such as the mass delivery of drugs that can avert diseases such as schistosomiasis and trachoma.
“I think we’ll be capable to increase the funds. It’s variety of like vaccines – you’d really feel awful if you didn’t increase the cash,” he stated. But, “it may take us a couple of many years to get up to where we are carrying out all these mass drug administration programmes at the intensity we’d like to.”
Everyone recognises the damage done by HIV, but few realise the burden of sickness and disability induced by the group of illnesses recognized by the billionaire philanthropist, which are transmitted mainly by parasites, flies and worms. One particular in 6 men and women globally is at threat. And by contrast with the huge 3, significant strides in direction of controlling some of the illnesses are taking location.
“If this was a single illness and the entire burden was attributed to one particular disease, it would be correct up there with the big conditions,” stated Gates. “As a group … the human burden [in terms of disability] is pretty gigantic. I place this entire programme up there with what’s going on with malaria, what’s going on with TB, what’s going on with HIV – it is some thing that folks ought to be quite fired up about the progress which is been made.”
Gates was speaking from Paris, where he was taking portion in a meeting to search at the progress manufactured against ten neglected tropical ailments in the final two years. In January 2012, Gates convened an unprecedented meeting of the CEOs of 13 key drug businesses – usually rivals – as effectively as international wellness organisations and governments in London, who all signed a declaration, pledging to do what they can to control or remove them.
Gates mentioned he was “super-content” with the progress so far. The pharmaceutical organizations have increased their donations of existing medicines that can avoid some of the illnesses and are helping to investigate potential new medicines for diseases exactly where there are inadequate therapies.
“We’re super-pleased with what they’ve carried out on two fronts – the drug donation front, where they’re ramping up the capability and helping with the logistics, to get this things delivered, and the second is on the diagnostic and drug front to search at in which we even now have gaps.
“The best information story we have here is that we have a new diagnostic for sleeping sickness and we have a drug that, though it is in a phase two [trial], seems to be quite promising as an oral treatment for this.”
Sleeping sickness, or African trypanosomiasis, spread by the bite of the tsetse fly, is fatal with no remedy. A quarter of these contaminated are kids. Diagnosis at the moment requires a lumbar puncture, and if the patient is lucky enough to get a single, they will require intravenous medication for days. In some locations, there is nothing at all greater than an arsenic-derivative, which kills 5% of these taken care of. But with the new diagnostic test and probably a pill, the prospects are transformed. Authorities are now for the very first time talking about getting rid of the disease by 2020, rather than just controlling it.
There is a clear elimination purpose for just one of the illnesses – guinea worm, which the Carter Foundation has targeted on for numerous many years. “We’re down I feel to 148 circumstances final year and it truly is in Mali and there were a few cases in Chad and south Sudan. So we’re very close on that. It truly is turned out with the unrest in Mali and South Sudan they are not going to make the unique date for it and so we’re possessing to put much more into that,” stated Gates.
But real eradication is difficult and not usually appropriate. “For most illnesses you never want to try out and do eradications, due to the fact eradications are really difficult and you end up investing a whole lot on the last tiny variety of circumstances and only if you genuinely think you can do well and you are stopping it from coming back, then it gets very worthwhile, as it is in the situation of polio,” explained Gates, who has put substantial money and hard work into the attempt to rid the planet of polio. “So we’re quite mindful about when we get individuals riled up to think correct, true eradication.”
Greater drugs could modify the outlook for young children contaminated by roundworm, hookworm and whipworm – the 3 most widespread of the soil transmitted helminths – and also for onchocerciasis. Current medication only destroy the juvenile type of the worm.
“It signifies you have to maintain coming back and catching the hatched worms again and yet again and once again for a great deal of many years. If you can destroy the grownup worm, which is the human reservoir and it would assist a whole lot,” explained Gates.
There are now R&D agreements with drug firms to investigate. In the meantime, country programmes have in the last couple of many years been created to dose kids and adults with medicines not for a single ailment, but for all people lively in their area. That expenses thirty cents a particular person, said Gates – not thirty cents per man or woman, per disease.
A lot more funds was announced in Paris, like $ 50m (£30m) more from the Bill and Melinda Gates Foundation, $ 50m from the Children’s Investment Fund Foundation and $ 120m from the Planet Financial institution.
The Planet Health Organisation’s director-common, Margaret Chan, explained: “The great progress we have seen in excess of the previous two years is proof of the electrical power of partnerships and the generosity of companies that created commitments below the London Declaration.
“Together with the governments of endemic nations, we are quick approaching the aim of controlling or eliminating numerous of these ancient causes of human misery. This is a professional-bad initiative that is improving the lives of a lot more than a billion folks.”
Nonetheless, Julien Potet, neglected ailments adviser of the Médecins Sans Frontières access campaign, said that whilst they have been glad the campaign was attracting interest to some neglected conditions, others were still forgotten – such as yaws, which can lead to disfigurement and disability, however can be cured with a single dose of the antibiotic azithromycin.
WHO had struggled to get donations from a significant drug firm. Potet stated: “An additional illustration is snake bite, which is listed as quite neglected by WHO. [The drug organization] Sanofi has accomplished a excellent task of donations for sleeping sickness but have told us they have been seeking at stopping production of anti-venom for Africa.”
Donations, in MSF’s view, are not often the greatest way forward, he added, especially as small drug organizations can not often afford to make them.
New suggestions with regards to the use of sentinel lymph node biopsy in patients with early stage breast cancer were issued by The American Society of Clinical Oncology (ASCO) and published in the Journal of Clinical Oncology on March 24.
ASCO organized a group of authorities in medical oncology, pathology, surgical oncology, and radiation oncology to update the 2005 suggestions. Basing its recommendations on overview of available evidence, the committee carried out a systematic assessment of the literature published from February 2004 to January 2013 in Medline.
Published data from current clinical trials–an update from the preliminary guideline in 2005–now supports using the less invasive diagnostic method in a bigger group of individuals. The new guideline supplies far better care for ladies with early stage breast cancer since they can steer clear of the much more invasive axillary lymph node dissection, which caries with it a better threat of issues.
English: Micrograph exhibiting a lymph node invaded by ductal breast carcinoma and with extranodal extension of tumour. The dark purple (center) is lymphocytes (part of a regular lymph node). Surrounding the lymphocytes and extending into the surrounding body fat (leading of image) is ductal breast carcinoma. H&E stain. See also Image:Crc met to node1.jpg – met to a lymph node in colorectal cancer. Image:Lymph node with papillary thyroid carcinoma.jpg – met to a lymph node in papillary thyroid carcinoma. (Photograph credit score: Wikipedia)
“The up to date guideline incorporates new evidence from far more current scientific studies — nine randomized managed trials and 13 cohort research since 2005,” mentioned Armando Giuliano, MD, FACS, co-chair of ASCO’s Specialist Panel that up to date the guideline. “Based on these studies, we’re saying much more patients can securely get sentinel node biopsy with no axillary lymph node dissection. These recommendations assist figure out for whom sentinel node biopsy is proper.”
blue stained sentinel lymph node (axilla) (Photo credit score: Wikipedia)
Axillary lymph node dissection (ALND) requires removing the vast majority of lymph nodes beneath the arm on the very same side as the breast tumor and examining the lymph nodes for indicators of cancer spread. However, the ALND may potentially lead to prolonged-phrase side results including numbness in the arm along with ache and lymphedema, a issue that causes swelling—the consequence of accumulation of lymphatic fluid in the tissues.
Sentinel node biopsy (SNB) has been a important phase towards improving the quality of life of breast cancer sufferers. The lymph node or group of lymph nodes the cancer 1st reaches when it spreads throughout the lymphatic system is referred to as the sentinel node.
In SNB, a portion of the lymph nodes are eliminated and evaluated for evidence of cancer spread. Typically, if sentinel nodes are cost-free of cancer cells, the basic message is that the remaining lymph nodes will not have cancer. Side results can take place with SNB, but they are significantly less common than with ALND.
The guideline updates 3 recommendations primarily based on proof from randomized controlled trials:
one. Women without sentinel lymph node (SLN) metastases need to not receive axillary lymph node dissection (ALND).
2. Most women with 1 to two metastatic SLNs arranging to receive breast conserving surgical procedure with whole breast radiotherapy must not undergo ALND.
three. Women with SLN metastases who will obtain mastectomy might be provided ALND.
The guideline also updates two groups of recommendations based mostly on cohort research and/or informal consensus:
1. Women with operable breast cancer and multicentric tumors, and/or DCIS who will have mastectomy, and/or had prior breast and/or axillary surgical treatment, and/or had preoperative/neoadjuvant systemic therapy may be supplied sentinel lymph node biopsy (SNB).
2. Women who have huge or locally innovative invasive breast cancers (tumor size T3/T4), and/or inflammatory breast cancer, and/or DCIS, when breast-conserving surgery is planned, and/or are pregnant should not acquire SNB.