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These Guatemalan women save mothers and babies. Why are they treated so badly?

Juana Cac Perpuac sits on the grass outside the health centre in her town with a look of desperation and disbelief in her eyes. She whispers: “I’m attending to one woman who is eight months pregnant and very thin. I told her to come here to get help, but the staff wouldn’t see her. She’s due soon and I think she’s going to have problems.” Cac Perpuac adds that doctors and nurses often don’t take women like her seriously. She fears the worst for the woman she is looking after.

Cac Perpuac, 78, works as a comadrona in a rural area of Totonicapán, a region in the highlands of Guatemala. Comadronas are hired by families, especially indigenous ones – 41% of the population of Guatemala identifies as indigenous – to guide a woman through pregnancy, labour and the weeks after childbirth. They fulfil a role similar to that of a doula: they help deliver babies, perform massages before and after birth, and use medicinal plants to ease pain and stimulate breast milk.

There are 23,320 comadronas registered with the Guatemalan Ministry of Health and they are often older women. They perform a vital role in hard-to-reach areas, where it can take hours to get to the nearest hospital by truck or foot along dirt tracks – which often comes at great expense – and in communities where Mayan beliefs and practices still play a part in everyday life.

Juana Cac Perpuac and Margarita de León Tamup


Juana Cac Perpuac (left) and Margarita de León Tamup sit outside a health centre. Photograph: Sarah Johnson

In the past they would be the closest person to a doctor women would see during childbirth. Now the situation is changing. In an effort to reduce maternal mortality rates in the country, the Ministry of Health has been working with comadronas to ensure more births happen in designated centres – including hospitals and smaller clinics in the community – with trained healthcare professionals present. But the work of women like Cac Perpuac is still necessary.

The national maternal mortality rate in Guatemala [pdf] is 140 per 100,000 births, compared to nine in the UK. In the departments of Totonicapán and Quetzaltenango, where the Guardian visited, maternal mortality continues to be an issue. According to provisional Ministry of Health figures, in Totonicapán there were 21 maternal deaths in 2017, up from 16 the year before. In Quetzaltenango, there were more in 2017 than two years previously.

Comadronas are now required to register with the Ministry of Health and attend monthly training, where they learn to detect danger signs like whether the baby is in breach position, or if the woman has a fever and abdominal pain. In such cases, they are encouraged to take their patients to the nearest health centre.

Comadronas


Comadronas attend a monthly meeting with Ministry of Health officials. Photograph: Sarah Johnson

Stories like Cac Perpuac’s are still common, however. Comadronas are looked down upon by medical staff, who ignore them when they have concerns and yet tell them off for bringing women to hospital too late. In some cases, they are not allowed to stay with their patient and are forced to wait outside the hospital.

Indigenous women also face discrimination – they are patronised and berated for turning up with dirty feet after walking to hospital and for screaming in pain during childbirth. There have been stories of them being sterilised without informed consent. Dr Juan Efraín Nájera, director of the Quetzaltenango health area, where about 61% of the population is indigenous, says: “The Ministry of Health insists that health services do not discriminate against indigenous people. It is absolutely not allowed.” He admits that it continues, however. “There are still traces, but it doesn’t happen as much.”

Cac Perpuac and other comadronas’ experiences don’t seem to tally with the official line. She says: “It really hurts when we tell our patients they have to come to the health centre, saying that they will receive good care – and when they do come, they are not treated well. They tell us we’re liars.”

Totonicapán, Guatemala


In rural Totonicapán, it can take women hours to get to the nearest hospital. Photograph: Sarah Johnson

Her companion, Margarita de León Tamup, adds: “Most of my patients give birth at home. Once I brought a pregnant girl here. I don’t speak Spanish. When we arrived, staff got angry and didn’t speak to us. Things are a bit better these days, but patients are still ashamed and embarrassed to come here. I would only bring a patient when absolutely necessary – if I can’t do any more, I bring them in order to save their life.”

Hearing these experiences comes as no surprise to Thomas Hart, country director for Health Poverty Action in Guatemala, which works to improve awareness of issues facing indigenous people in health services. He admits: “Three quarters of the people we work with will improve their cultural awareness and change their practice as a result. There will always be a significant minority who won’t.”

Progress on fostering closer working relationships between comadronas and healthcare services may be slow, but there are pockets of hope. In San Carlos Sija, a municipality in Quetzaltenango, Dr Samy Juarez and his psychologist colleague, Ligia Gomez, recognise the benefits that comadronas can bring. Figures for births that happen in the health centre there have increased year on year: in 2015 there were 93, in 2016 that figure rose to 138, and there were 151 in 2017.

Adela Ixcotoyac


Adela Ixcotoyac has worked as a comadrona for 40 years. Photograph: Sarah Johnson

“We work hand in hand with comadronas and we trust them,” says Juarez. “They have a deep knowledge of the patient. They make referrals to us. We ask that they tell us if a doctor or nurse doesn’t tend to them in a culturally appropriate way. We want them to point things out so we can improve the service.”

At the health centre, beds are lined with traditional material, there are special gowns, women have the option of giving birth standing up, common in indigenous communities – and comadronas can be present during labour, important when the mother-to-be speaks K’iche’ for example, and not Spanish.

Meanwhile, in Santa Maria Chiquimula in Totonicapán, Adela Ixcotoyac, 67, a comadrona, acknowledges that the situation has improved. She remembers one occasion five years ago when she attended a patient who lived far away from the health centre. She delivered the baby but it was green and vomiting. The mother was on the verge of losing consciousness. Ixcotoyac knew that both would die without medical attention. She ran to find a doctor but the health centre was closed. The mother’s husband didn’t want his wife and baby to leave the house. Ixcotoyac managed to call the doctor, who came at her request and insisted that mother and baby go to hospital, where both received treatment and survived.

It’s stories like this that have earned Ixcotoyac and her peers hard-won trust and respect. She says: “Forty years ago when I started, it was really hard. They [healthcare professionals and the Ministry of Health] saw us as being useless. It’s changed – but with such struggle.”

Community services are key to the NHS. Why are they still marginalised? | Chris Hopson

The NHS is overstretched, underfunded, and short-staffed. Pressures are growing. The results were there for all to see last winter. Staff run ragged, patient discharges delayed, standards of care slipping. It’s the same story right across health and social care.

The good news is there is a plan to ease these pressures by providing more care closer to home, freeing up much-needed resources for the sickest patients. This plan draws together the right skills from different services so that the care people receive is carefully coordinated and tailored to their needs. It focuses on helping us all to stay well, and live independently. Who would argue with that?

Yet this is not a new plan. It’s actually been around in various guises, under different governments, for many years – most recently in the Five Year Forward View, which underpins a lot of NHS strategy today. The idea is to support and strengthen NHS community services, which currently employ around one-fifth of health service staff and account for 100m patient contacts in England every year. These include community and district nurses, physios, speech and language therapists, school nurses, podiatrists, sexual health services and end-of-life care.

In our new report, NHS community services: taking centre stage, we highlight examples of innovation and good practice which are transforming the way care is delivered, meeting the needs of local people, keeping them well, helping them live independently even with serious, complex conditions – and easing pressures on other services. It can be done.

We also identify the barriers that have prevented schemes such as these from taking root across the country. The harsh reality is that these services are not sufficiently understood or prioritised at a national or local level. In a survey of NHS trust leaders for our report, more than 90% said that community services receive less national attention than other parts of the NHS.

At local level, fewer than 20% said community services were very influential in the current programme to modernise and integrate local health and care services.

While these services continue to be marginalised, they will be underfunded. We see from our survey that more than half of community trusts reported that funding in their area had fallen this year. Nearly a third had reduced staffing levels. And workforce concerns are a particular problem for community services. Since 2010, the community nursing workforce has contracted by 14%. District nurse numbers are down by 44%. It’s clear that the expectation is that workforce pressures will get worse still in the coming year.

All this at a time when demand for community services is going through the roof. This is not just about a growing and ageing population with more complex conditions. Thanks to advances in care and treatment, it is now possible to look after people at home who, 10 or 20 years ago, would have needed to stay in hospital. You only have to look at impact schemes such as the Hospital at Home service in Sussex to see the benefits for patients and staff, and the financial savings for the NHS.

Despite this, our survey showed that more than 90% of trusts thought the gap between funding and the demand for services will grow in the next 12 months.

It is bad news for people who have to wait longer – often lonely, anxious and in pain – for the care they need at home. It means delays for patients who could be discharged from hospital if the right treatment or rehabilitation were available. And it could mean that people are unable to die in the manner and place of their choosing.

No one is suggesting this will be easy to fix. NHS community services come in a range of shapes and sizes, with different approaches in different places. This diversity can be a strength – but the contract and tendering process is complex, and sometimes puts the NHS at a disadvantage. We need to seize the opportunities presented by the push for integrated care and the prime minister’s commitment to increase long-term health and care funding, and bring NHS community services centre stage.

  • Chris Hopson is chief executive of NHS Providers, the association of acute, ambulance, community and mental health services

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

Community services are key to the NHS. Why are they still marginalised? | Chris Hopson

The NHS is overstretched, underfunded, and short-staffed. Pressures are growing. The results were there for all to see last winter. Staff run ragged, patient discharges delayed, standards of care slipping. It’s the same story right across health and social care.

The good news is there is a plan to ease these pressures by providing more care closer to home, freeing up much-needed resources for the sickest patients. This plan draws together the right skills from different services so that the care people receive is carefully coordinated and tailored to their needs. It focuses on helping us all to stay well, and live independently. Who would argue with that?

Yet this is not a new plan. It’s actually been around in various guises, under different governments, for many years – most recently in the Five Year Forward View, which underpins a lot of NHS strategy today. The idea is to support and strengthen NHS community services, which currently employ around one-fifth of health service staff and account for 100m patient contacts in England every year. These include community and district nurses, physios, speech and language therapists, school nurses, podiatrists, sexual health services and end-of-life care.

In our new report, NHS community services: taking centre stage, we highlight examples of innovation and good practice which are transforming the way care is delivered, meeting the needs of local people, keeping them well, helping them live independently even with serious, complex conditions – and easing pressures on other services. It can be done.

We also identify the barriers that have prevented schemes such as these from taking root across the country. The harsh reality is that these services are not sufficiently understood or prioritised at a national or local level. In a survey of NHS trust leaders for our report, more than 90% said that community services receive less national attention than other parts of the NHS.

At local level, fewer than 20% said community services were very influential in the current programme to modernise and integrate local health and care services.

While these services continue to be marginalised, they will be underfunded. We see from our survey that more than half of community trusts reported that funding in their area had fallen this year. Nearly a third had reduced staffing levels. And workforce concerns are a particular problem for community services. Since 2010, the community nursing workforce has contracted by 14%. District nurse numbers are down by 44%. It’s clear that the expectation is that workforce pressures will get worse still in the coming year.

All this at a time when demand for community services is going through the roof. This is not just about a growing and ageing population with more complex conditions. Thanks to advances in care and treatment, it is now possible to look after people at home who, 10 or 20 years ago, would have needed to stay in hospital. You only have to look at impact schemes such as the Hospital at Home service in Sussex to see the benefits for patients and staff, and the financial savings for the NHS.

Despite this, our survey showed that more than 90% of trusts thought the gap between funding and the demand for services will grow in the next 12 months.

It is bad news for people who have to wait longer – often lonely, anxious and in pain – for the care they need at home. It means delays for patients who could be discharged from hospital if the right treatment or rehabilitation were available. And it could mean that people are unable to die in the manner and place of their choosing.

No one is suggesting this will be easy to fix. NHS community services come in a range of shapes and sizes, with different approaches in different places. This diversity can be a strength – but the contract and tendering process is complex, and sometimes puts the NHS at a disadvantage. We need to seize the opportunities presented by the push for integrated care and the prime minister’s commitment to increase long-term health and care funding, and bring NHS community services centre stage.

  • Chris Hopson is chief executive of NHS Providers, the association of acute, ambulance, community and mental health services

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

NHS warns patients they could lose text alerts as GDPR deluge continues

The National Health Service is texting patients to warn they could lose alerts about hospital and doctor appointments, joining the deluge of more than 1bn “GDPR” messages currently hitting personal inboxes to meet an EU deadline this week.

GDPR, which stands for General Data Protection Regulation, has been described as the biggest overhaul of online privacy since the birth of the internet, and comes into force on Friday May 25. It gives all EU citizens the right to know what data is stored on them and to have it deleted, plus protect them from privacy and data breaches. If companies fail to comply, they can be hit with fines of up to €20m (£17.5m) or 4% of global turnover.

Companies and organisations around the world – from giant corporations to charities and church groups – are now anxiously contacting users to check they are happy to carry on receiving their emails and texts.

Q&A

What is GDPR?

The European Union’s new stronger, unified data protection laws, the General Data Protection Regulation (GDPR), will come into force on 25 May 2018, after more than six years in the making.

GDPR will replace the current patchwork of national data protection laws, give data regulators greater powers to fine, make it easier for companies with a “one-stop-shop” for operating across the whole of the EU, and create a new pan-European data regulator called the European Data Protection Board.

The new laws govern the processing and storage of EU citizens’ data, both that given to and observed by companies about people, whether or not the company has operations in the EU. They state that data protection should be both by design and default in any operation.

GDPR will refine and enshrine the “right to be forgotten” laws as the “right to erasure”, and give EU citizens the right to data portability, meaning they can take data from one organisation and give it to another. It will also bolster the requirement for explicit and informed consent before data is processed, and ensure that it can be withdrawn at any time.

To ensure companies comply, GDPR also gives data regulators the power to fine up to €20m or 4% of annual global turnover, which is several orders of magnitude larger than previous possible fines. Data breaches must be reported within 72 hours to a data regulator, and affected individuals must be notified unless the data stolen is unreadable, ie strongly encrypted.

Each person in the UK is understood to have about 100 “data relationships” and with many companies sending out multiple reminders, the total number of GDPR emails is expected to soar above one billion by this Friday.

But with GDPR fatigue setting in, and with many messages heading straight into spam boxes, the figures suggest that few people are responding.

Polling by consultancy Accenture has found that more than half of consumers are not responding to emails from brands, with about a third of people deleting the emails almost as soon as they arrive in their inbox.

Some small businesses are reporting that “reconfirmation” rates are averaging just 10%, meaning they are losing 90% of their marketing email lists.

“Up to the deadline you are going to continue to see some panic and mass communications. Then there will be a lull before it begins again, as this is an ongoing requirement,” said Russell Marsh of Accenture. He is forecasting that some companies will return to direct mail to target customers, as it does not fall under the same GDPR legislation.

Many people are enjoying a once in a lifetime opportunity to clear out their inboxes. But while many can be safely ignored, others – such as from the NHS – will need action.

The NHS message reads: “The law is changing and we must get explicit permissions from patients when using their data. To continue to receive SMS text messages, reply START.”

The messages are being sent from the NHS automated appointment reminder system, used by millions of people across the UK. Data rules mean that the messages are sent by each individual NHS trust rather than centrally from the NHS.

Companies are handling the new rules in different ways, as there is no prescribed format for GDPR approval. If a company has a “legitimate interest” in contacting a customer – such as their principal bank account – then it only needs to let the customer know that privacy details have been updated.

But if the email address had been obtained in other ways – such as a pre-ticked box – then that is not regarded as legitimate, and the company has to contact the consumer and obtain approval for further communications. Some companies are insisting users go through the rigmarole of logging in, which might entail trying to remember a password or setting up a new account.

“It will be their interpretation of what they need to do to be compliant,” said Robert Parker at the UK’s Information Commissioner’s Office.

Companies are resorting to ever more desperate ways to catch the eye of users in inboxes deluged with GDPR emails. Many are in the plaintive “Do you still want to hear from us?” style, others warn that “Time is running out”, while some demand “Urgent action required”. Or as one flower delivery company GDPR email says: “Take it or leaf it”.

Children denied help with mental health unless they attempt suicide

Britain is confronting a mental health crisis because resources for children are so stretched that some only receive help if they seriously self-harm or attempt suicide, Barnardo’s has warned.

Javed Khan, chief executive of Britain’s largest children’s charity, said that young people’s mental health had never been worse in the organisation’s 152-year history. Radical action was needed, he said, because funding cuts had forced charities to abandon vital services.

“It’s never been as bad, and in another five years’ time it’s going to be even more complex,” Khan told the Observer. “This mental health crisis is getting more severe and more difficult by the day. The numbers keep going up. Educational psychologists are pulling their hair out – they haven’t got the resources. They can’t respond as fast as they need to.

“We are going to regret this period if this goes on for too long. We are going to rue the day when we took our eye off the ball.”

Neera Sharma, assistant director of policy at Barnardo’s, said that in some parts of the country the pressure on resources was so severe that only the most extreme cases received help. “The threshold is suicidal in some cases; the child would have had to have attempted suicide or committed serious self-harm to get a response,” Sharma said.

Speaking before Barnardo’s annual lecture this Wednesday, where representatives of Jeremy Hunt, the health secretary, will be among the audience, Khan urged the government to adopt a dramatic new approach.

The lack of resources has forced the charity to walk away from 1,033 contracts during the past year because the money available to local authorities meant it could not offer a sufficient service, Khan said. “They are tightening their belt to a point they cannot tighten it any more. They are asking for more to be delivered for far less resources than ever before, and there is a tipping point where you just can’t deliver a safe, high-quality service,” said Khan, who is also a member of the advisory board for the children’s commissioner for England.

One way the government could save money would be to scrap the traditional tendering process in favour of a more collaborative approach between the state and charities: “I don’t think the tendering model is sustainable – there aren’t enough resources in the system,” said Khan.

The latest on the UK’s mental health problem emerged on Thursday when statistics showed that almost one in five children could be at risk of having mental health issues later in life, according to the study of more than 850,000 seven-to-14-year-olds.

Figures from NHS trusts in England in November revealed that 60% of children and young people referred for specialist care by their GP were not receiving treatment. In December the government published a green paper on mental health problems but Khan said that the plans lacked ambition, falling significantly short of what he felt was required.

“If you analyse it, then three-quarters of children are going to get no support,” he said. “The response is insufficient, it’s not broad enough, there is limited financial detail. It talks about rolling out a number of initiatives in a number of areas but funding is only secured to these areas until 2023. The prime minister has talked about this issue as a burning injustice but we don’t think the action is matching the rhetoric.”

Last month Hunt intervened in the debate to condemn social media companies for “turning a blind eye” to mental health damage suffered by children who have uncontrolled access to their online platform.

Khan said social media was an issue – comparing new technology to “allowing a film crew into the bedroom” – and that they were also liaising directly with companies such as Google and Facebook to limit potential harm to young people.

In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at befrienders.org

Mental health labels can help save people’s lives. But they can also destroy them | Jay Watts

An important Lancet Psychiatry paper has just come out. It is the largest review looking at service user, carer and clinician experiences of mental health diagnosis. For some people, psychiatric diagnosis was helpful, and the problem was that it was not given early enough. For others, a diagnosis was deeply oppressive.

The tensions between these camps frequently threaten to ignite social media. This dynamic, which causes significant distress, is only likely to increase as social media gives a platform to those who have negative experiences of diagnosis at the same time as more and more people identify as having a mental illness as a consequence of changing public ideas around mental health. To drain something of the charge in these inflaming dynamics, it is important to confute the idea that psychiatric diagnosis is a single thing.

Some diagnoses are more useful than others. Diagnoses such as obsessive-compulsive disorder and depression, for example, are more likely to be experienced positively, validating suffering and giving people a platform from which to speak about distress and access help. Yes, there is stigma, but not the rampant sticky, staining discrimination one gets with diagnoses associated with serious mental illness. With the latter, diagnosis can produce what the philosopher Miranda Fricker has called “testimonial injustice” – an inbuilt prejudice that gives less credibility to the diagnosis.

The diagnosis of borderline personality disorder, for example, is experienced commonly as a character slur, a “dustbin” diagnosis that makes many clinicians turn away from people in pain and take communications such as that someone wants to kill themselves less seriously to often deadly cost. The diagnosis of schizophrenia can confer with it a clinical gaze that situates those with the disorder as lacking insight and being delusional. This set of ascriptions has meant psychiatry is only now beginning to hear the devastating experiences of trauma so often core to experiences such as voice-hearing and dissociation. It is difficult to say anything pro or against psychiatric diagnosis per se when different diagnoses have such wildly different effects on one’s capacity to be taken seriously as a speaker.

Second, even within diagnostic categories, some people find diagnosis more useful than others. As the Lancet paper makes clear, the context in which a diagnosis is given is crucial. If a diagnosis is offered carefully, with time for discussion, clear information and hope, it is more likely to be experienced positively. How a psychiatric diagnosis is experienced is also mediated by an individual’s life experience and their cultural identities. For example, someone who identifies as LGBTQ might have good cause for suspicion of diagnosis, given that homosexuality was diagnosed as a mental disorder until the 1970s. Diagnosis is also taken up and put down as an idea depending on the goals of conversations we are in. For example, in family therapy, patients who generally reject their diagnosis often take up this idea as a discursive move if relatives start to attribute cause to their poor parenting skills.

Third, it is difficult to make definitive statements about the scientific worth of diagnostic categories. Classifications often bleed into one another and lack the laboratory-type objective tests one generally finds in other branches of medicine. However, with some diagnoses, there is more evidence that pathological processes are at play than with others. For example, there is good evidence for neurobiological underpinnings to bipolar conditions.

Elsewhere, the difficulties lie with the point at which we start to view experiences that lie on a spectrum as problematic. Here, it is important to critique the pernicious, shaping influence of psychiatric expansionism and big pharma on how we view our inner worlds.

Given diagnosis can be both a structural violence and a life-saving explanatory tool, what to do? A frequent response is that patients should be free to choose. However, it is questionable whether one can make an informed choice about having, say, one’s entire personality invalidated. Or if it is possible to choose freely when diagnosis can be like an overbearing partner, taking up all the discursive space, limiting the possibility of thinking differently, and gaslighting understandable reactions to painful events in a life.

Instead, we need to create space for new ways of speaking about distress that foreground the effects of trauma and the socio-political context on the psyche and body, and that recognises that difference becomes disability at the point that society tries to squeeze people into one-size-fits-all boxes. We must place the power to dictate the thrust of speech firmly with the person of most importance – the person in need. This can only occur if we hold a more tentative relationship to the diagnostic system, binning ways of diagnosing that slur the speaking credibility of certain patient populations, and ensuring access to resources such as benefits are dependent on severity of illness rather than acceptance of diagnosis.

In an era where speech is more and more polarised and combative, with devastating effects on our mental health, open dialogue is key. Far from being an “everybody has won and all must have prizes” response to the diagnosis wars that have plagued psychiatry since its inception, such an approach demands a radical rethink of power relations in psychiatry to place patients’ voices where they belong – centre stage.

  • Jay Watts is a clinical psychologist, psychotherapist and senior lecturer working in London

Students on how they are getting a raw deal | Letters

I am an MA student on the journalism course at Birkbeck, University of London, fighting for compensation for lectures lost due to the staff strike. We paid £3,000 last term for services that were not provided. I wrote to the master of the university, David Latchman, about this and received no reply. I then wrote to the registrar and got this back: “Your tuition fees contribute towards your entire learning experience and are not directly linked to specific contact or teaching hours. Your tuition fees also cover infrastructure such as buildings, library and IT.” How can it possibly be stated that my entire learning experience is not diminished by a lack of lectures?

The university have taken my money and banked what they have not paid the lecturers, it seems. We have been told that the strike may affect lectures for the first two weeks of next term and could be ongoing. I have just been asked to pay my fees for the summer term. I don’t intend to throw more money at the university unless I get a promise of compensation if the strike is ongoing. I wonder if I’ll be thrown off the course?
Katrina Allen
London

As a student of English at the University of Southampton, I have been affected by the recent decision by the UCU that called for all of my lecturers to strike with the aim of retaining a favourable pension deal. At the end of my four-year course, I will have racked up debts in excess of £54,000, a sum that will increase at a rate of interest of approximately 6% (why didn’t I ask the banks for a loan instead?). I understand that lecturers are feeling frustrated about their pension cut, especially when the pay of the vice-chancellor of my university is £433,000. This is a perfectly legitimate concern. But without trying to mount a pedestal of moral authority, I would not be going on strike were I a lecturer. The work that goes into the six hours of lectures and seminars that I am entitled to each week is admirable. Oh, and the one hour per week during which I am able to arrange a 10-minute meeting with my tutor to discuss my progress.

If this was back in the days of free tuition, I might even have joined the staff on the picket lines. But unfortunately, I wasn’t born in the same decade as my baby-boomer parents, and I am paying £9,250 per annum for tuition alone. I hope that the lecturers don’t win this battle.

If vice-chancellors were to now bend and snap against their principles (however much I might disagree with whatever they are), it would set a dangerous precedent that students are legitimate pawns to take advantage of in industrial disputes. And we are not.
Ben Dolbear
Southampton

I am about to sit my GCSEs. I am surrounded by many bright young women every day, some who excel in examinations and others who do not. However, one thing we all have in common is our strong feelings towards standardised testing. Every year thousands of 15/16-year-olds are forced to sit GCSEs. What education ministers do not realise is the harm this pressure causes young people. It leads to high stress levels, a loss of interest in education and, in many cases, mental health problems: approximately one in 10 children have them.

I have seen the harmful effects of this robotic exam system which leaves no room for creativity. We need students to feel that there is more to life than exam grades. This can be achieved by encouraging universities to look at the whole person rather than just grades, and to value experiences and extracurriculars, like the US education system. The most successful people did not get straight A*s.

The exams should also lend themselves to all kinds of students, not simply those with the ability to memorise, testing true intelligence rather than artificial intelligence. We are growing up in an age of robots; surely we should be raising humans who can do what robots cannot do: be creative. The government should scrap GCSEs and focus on A-levels – maybe if the school system did not burn so many people out, then people would stay on. At least ministers should realise that, as Einstein (the cleverest of them all) said: “Everyone is a genius. But if you judge a fish on its ability to climb a tree, it will live its whole life believing it is stupid.”
Romy McCarthy
London

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

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

Students on how they are getting a raw deal | Letters

I am an MA student on the journalism course at Birkbeck, University of London, fighting for compensation for lectures lost due to the staff strike. We paid £3,000 last term for services that were not provided. I wrote to the master of the university, David Latchman, about this and received no reply. I then wrote to the registrar and got this back: “Your tuition fees contribute towards your entire learning experience and are not directly linked to specific contact or teaching hours. Your tuition fees also cover infrastructure such as buildings, library and IT.” How can it possibly be stated that my entire learning experience is not diminished by a lack of lectures?

The university have taken my money and banked what they have not paid the lecturers, it seems. We have been told that the strike may affect lectures for the first two weeks of next term and could be ongoing. I have just been asked to pay my fees for the summer term. I don’t intend to throw more money at the university unless I get a promise of compensation if the strike is ongoing. I wonder if I’ll be thrown off the course?
Katrina Allen
London

As a student of English at the University of Southampton, I have been affected by the recent decision by the UCU that called for all of my lecturers to strike with the aim of retaining a favourable pension deal. At the end of my four-year course, I will have racked up debts in excess of £54,000, a sum that will increase at a rate of interest of approximately 6% (why didn’t I ask the banks for a loan instead?). I understand that lecturers are feeling frustrated about their pension cut, especially when the pay of the vice-chancellor of my university is £433,000. This is a perfectly legitimate concern. But without trying to mount a pedestal of moral authority, I would not be going on strike were I a lecturer. The work that goes into the six hours of lectures and seminars that I am entitled to each week is admirable. Oh, and the one hour per week during which I am able to arrange a 10-minute meeting with my tutor to discuss my progress.

If this was back in the days of free tuition, I might even have joined the staff on the picket lines. But unfortunately, I wasn’t born in the same decade as my baby-boomer parents, and I am paying £9,250 per annum for tuition alone. I hope that the lecturers don’t win this battle.

If vice-chancellors were to now bend and snap against their principles (however much I might disagree with whatever they are), it would set a dangerous precedent that students are legitimate pawns to take advantage of in industrial disputes. And we are not.
Ben Dolbear
Southampton

I am about to sit my GCSEs. I am surrounded by many bright young women every day, some who excel in examinations and others who do not. However, one thing we all have in common is our strong feelings towards standardised testing. Every year thousands of 15/16-year-olds are forced to sit GCSEs. What education ministers do not realise is the harm this pressure causes young people. It leads to high stress levels, a loss of interest in education and, in many cases, mental health problems: approximately one in 10 children have them.

I have seen the harmful effects of this robotic exam system which leaves no room for creativity. We need students to feel that there is more to life than exam grades. This can be achieved by encouraging universities to look at the whole person rather than just grades, and to value experiences and extracurriculars, like the US education system. The most successful people did not get straight A*s.

The exams should also lend themselves to all kinds of students, not simply those with the ability to memorise, testing true intelligence rather than artificial intelligence. We are growing up in an age of robots; surely we should be raising humans who can do what robots cannot do: be creative. The government should scrap GCSEs and focus on A-levels – maybe if the school system did not burn so many people out, then people would stay on. At least ministers should realise that, as Einstein (the cleverest of them all) said: “Everyone is a genius. But if you judge a fish on its ability to climb a tree, it will live its whole life believing it is stupid.”
Romy McCarthy
London

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Students on how they are getting a raw deal | Letters

I am an MA student on the journalism course at Birkbeck, University of London, fighting for compensation for lectures lost due to the staff strike. We paid £3,000 last term for services that were not provided. I wrote to the master of the university, David Latchman, about this and received no reply. I then wrote to the registrar and got this back: “Your tuition fees contribute towards your entire learning experience and are not directly linked to specific contact or teaching hours. Your tuition fees also cover infrastructure such as buildings, library and IT.” How can it possibly be stated that my entire learning experience is not diminished by a lack of lectures?

The university have taken my money and banked what they have not paid the lecturers, it seems. We have been told that the strike may affect lectures for the first two weeks of next term and could be ongoing. I have just been asked to pay my fees for the summer term. I don’t intend to throw more money at the university unless I get a promise of compensation if the strike is ongoing. I wonder if I’ll be thrown off the course?
Katrina Allen
London

As a student of English at the University of Southampton, I have been affected by the recent decision by the UCU that called for all of my lecturers to strike with the aim of retaining a favourable pension deal. At the end of my four-year course, I will have racked up debts in excess of £54,000, a sum that will increase at a rate of interest of approximately 6% (why didn’t I ask the banks for a loan instead?). I understand that lecturers are feeling frustrated about their pension cut, especially when the pay of the vice-chancellor of my university is £433,000. This is a perfectly legitimate concern. But without trying to mount a pedestal of moral authority, I would not be going on strike were I a lecturer. The work that goes into the six hours of lectures and seminars that I am entitled to each week is admirable. Oh, and the one hour per week during which I am able to arrange a 10-minute meeting with my tutor to discuss my progress.

If this was back in the days of free tuition, I might even have joined the staff on the picket lines. But unfortunately, I wasn’t born in the same decade as my baby-boomer parents, and I am paying £9,250 per annum for tuition alone. I hope that the lecturers don’t win this battle.

If vice-chancellors were to now bend and snap against their principles (however much I might disagree with whatever they are), it would set a dangerous precedent that students are legitimate pawns to take advantage of in industrial disputes. And we are not.
Ben Dolbear
Southampton

I am about to sit my GCSEs. I am surrounded by many bright young women every day, some who excel in examinations and others who do not. However, one thing we all have in common is our strong feelings towards standardised testing. Every year thousands of 15/16-year-olds are forced to sit GCSEs. What education ministers do not realise is the harm this pressure causes young people. It leads to high stress levels, a loss of interest in education and, in many cases, mental health problems: approximately one in 10 children have them.

I have seen the harmful effects of this robotic exam system which leaves no room for creativity. We need students to feel that there is more to life than exam grades. This can be achieved by encouraging universities to look at the whole person rather than just grades, and to value experiences and extracurriculars, like the US education system. The most successful people did not get straight A*s.

The exams should also lend themselves to all kinds of students, not simply those with the ability to memorise, testing true intelligence rather than artificial intelligence. We are growing up in an age of robots; surely we should be raising humans who can do what robots cannot do: be creative. The government should scrap GCSEs and focus on A-levels – maybe if the school system did not burn so many people out, then people would stay on. At least ministers should realise that, as Einstein (the cleverest of them all) said: “Everyone is a genius. But if you judge a fish on its ability to climb a tree, it will live its whole life believing it is stupid.”
Romy McCarthy
London

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

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

Students on how they are getting a raw deal | Letters

I am an MA student on the journalism course at Birkbeck, University of London, fighting for compensation for lectures lost due to the staff strike. We paid £3,000 last term for services that were not provided. I wrote to the master of the university, David Latchman, about this and received no reply. I then wrote to the registrar and got this back: “Your tuition fees contribute towards your entire learning experience and are not directly linked to specific contact or teaching hours. Your tuition fees also cover infrastructure such as buildings, library and IT.” How can it possibly be stated that my entire learning experience is not diminished by a lack of lectures?

The university have taken my money and banked what they have not paid the lecturers, it seems. We have been told that the strike may affect lectures for the first two weeks of next term and could be ongoing. I have just been asked to pay my fees for the summer term. I don’t intend to throw more money at the university unless I get a promise of compensation if the strike is ongoing. I wonder if I’ll be thrown off the course?
Katrina Allen
London

As a student of English at the University of Southampton, I have been affected by the recent decision by the UCU that called for all of my lecturers to strike with the aim of retaining a favourable pension deal. At the end of my four-year course, I will have racked up debts in excess of £54,000, a sum that will increase at a rate of interest of approximately 6% (why didn’t I ask the banks for a loan instead?). I understand that lecturers are feeling frustrated about their pension cut, especially when the pay of the vice-chancellor of my university is £433,000. This is a perfectly legitimate concern. But without trying to mount a pedestal of moral authority, I would not be going on strike were I a lecturer. The work that goes into the six hours of lectures and seminars that I am entitled to each week is admirable. Oh, and the one hour per week during which I am able to arrange a 10-minute meeting with my tutor to discuss my progress.

If this was back in the days of free tuition, I might even have joined the staff on the picket lines. But unfortunately, I wasn’t born in the same decade as my baby-boomer parents, and I am paying £9,250 per annum for tuition alone. I hope that the lecturers don’t win this battle.

If vice-chancellors were to now bend and snap against their principles (however much I might disagree with whatever they are), it would set a dangerous precedent that students are legitimate pawns to take advantage of in industrial disputes. And we are not.
Ben Dolbear
Southampton

I am about to sit my GCSEs. I am surrounded by many bright young women every day, some who excel in examinations and others who do not. However, one thing we all have in common is our strong feelings towards standardised testing. Every year thousands of 15/16-year-olds are forced to sit GCSEs. What education ministers do not realise is the harm this pressure causes young people. It leads to high stress levels, a loss of interest in education and, in many cases, mental health problems: approximately one in 10 children have them.

I have seen the harmful effects of this robotic exam system which leaves no room for creativity. We need students to feel that there is more to life than exam grades. This can be achieved by encouraging universities to look at the whole person rather than just grades, and to value experiences and extracurriculars, like the US education system. The most successful people did not get straight A*s.

The exams should also lend themselves to all kinds of students, not simply those with the ability to memorise, testing true intelligence rather than artificial intelligence. We are growing up in an age of robots; surely we should be raising humans who can do what robots cannot do: be creative. The government should scrap GCSEs and focus on A-levels – maybe if the school system did not burn so many people out, then people would stay on. At least ministers should realise that, as Einstein (the cleverest of them all) said: “Everyone is a genius. But if you judge a fish on its ability to climb a tree, it will live its whole life believing it is stupid.”
Romy McCarthy
London

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

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