Category Archives: healthcare

the devious commercialisation of public health

I have been quite surprised before, but now I’m pregnant again, it struck me once more: what is it with Bounty, a ‘parenting club’, and the NHS?

The folders and information you are given when you are pregnant by the midwives and in the hospital are from Bounty, and I remember well how when r. was born the bounty lady just came in my room with the authority  of a midwife or doctor and gave me a bag full of stuff such as samples of disposable nappies, laundry powder, wipes, but also important documents related to getting child tax credits. I found this collusion quite perplexing, and the intrusion of this woman uncomfortable. She offered to take pictures of r., and did it, but it was all a bit strange for me, I did not really understand if it was a public or private thing …especially because I am not from the UK, and those first few days after birth, with the worry and anxiety of those first days as r. was born tiny and I could not manage to breastfeed, my milk was coming in and hormones were flowing in turmoil, and sleep deprivation made everything more hazy.

Now, again  I faced this quite tight weaving of comercial interests with public healthcare. Again the dutiful Bounty folder, and on my first scan, I was given a Bounty bag full of stuff and was told by the receptionist of the hospital that I had to fill a form. I looked and looked and the only form I could find was the Bounty form to give my details to Bounty, and thus, to different companies. I looked at the contents of the bag and found disposable nappies, laundry powder, etc – luckily not formula milk!- but these were things I did not want. So I went and asked the receptionist which form did she meant, thinking it would be something official, since I ‘had’ to fill it in. No, she explained, it was the Bounty form. When I said I did not want to fill it in, she looked at me sourly and told me curtly to give back the bag then. I found this outrageous, why did they make you think it was an official ‘public’ form, why did I HAVE to sign it? She got her bag back.

Recently, this article in The Guardian shows that I am not the only one worried about this, and gives more details of what is involved, which sure enough is, guess what? money. As this article states

The Independent today reports the National Childbirth Trust’s (NCT) findings that “parenting club” companies are paying maternity units £5,000 for the right to access their wards, approach their patients and sell their wares. These generally constitute sets of pictures of your newborn for around £20 a print, and in some cases – notably by the largest of these companies, Bounty – the right to distribute “new mother” packs, which contain free samples of baby-related commercial brands, along with promotional literature and some discount vouchers.’

The article concludes with the following:

‘That maternity units are struggling and need all the money they can get is a major cause for concern, but by allowing them to be subsidised in this way the NHS is colluding with private companies exploiting people at their most vulnerable.’ 

I think this sums  up nicely what I felt then, but more so now, as I understand the system better… I’m glad someone is digging into this. The NCT is looking to ban this practice, and I, as the author of the article also states, would gladly add my name to that petition.

Lucila

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Carta a un medico

Estimado Doctor Huesos,

Le escribo para darle algunas sugerencias para su practica. No se si se acuerda de mi, yo soy la que lleve a mi hija porque tenia el pulgar trabado, lo que me entere que se llama dedo gatillo, y para ver si estaba todo bien con sus pies y postura. Si, si, la que lloro con su hija, claro. De eso le queria hablar, porque en el momento no soy muy articulada con mis pensamientos, pero ahora tuve tiempo para refelxionar sobre esta experiencia, y esto es lo que me parece.

Mi primer consejo es que antes de hacer nada que le vaya a causar dolor, incluso aunque cure a un/a paciente, usted haga la explicacion racional, el dibujito y todas esas cosas que hizo despues mientras mi hija lloraba desconsoldamente ANTES, y para los cuidadores tanto como para el/la paciente, no importa su edad. Que le explique a la madre/padre/cuidador cual es el problema, y que es lo que va a pasar, y no que – aunque se que usted se tiene plena confianza- haga las cosas de sorpresa. Y que cuando intente explicar el dibujito, yo le preste mi atencion dividida, dado que tengo que consolar a mi hija, no se sorprenda. Aunque parte de no mirarlo era un poco el odio que me genera que me traten con paternalismo. Si ya se, usted penso que era que estaba yo desconsolada por mi hija. Si, un poco y un poco. Y de paso le digo, no es necesario explicar algo simple cincuenta  veces. A pesar de ser madre y que me angustie el estado de mi hija – porque no tengo idea de lo que paso- soy un ser medianamente inteligente. Si, ya se, usted me dijo que el llanto no tenia correlacion con el dolor – pero sabe que, si mi hija llora es porque le dolio, si, estaba cansada que no ayuda, pero creo que mas que todo, porque se lo hizo sin avisarle, y por eso fue que tambien vomito. Mi hija solo vomito unas pocas veces cuando llora, y casualmente dos de tres fueron con medicos que no la respetaron lo suficiente como para explicarle lo que se venia.

El proximo punto es que el consejo que usted me dio acerca de mi practica de madre, es sabio, si se usa en un buen contexto. Usted me dijo que a menos que me calme, ella no se iba a calmar. Seria mucho mas facil calmarme si supiese lo que esta pasando, eso es seguro, por lo que lo llevo al punto anterior. Segundo, le pido que aunque usted este lleno de confianza y consejos, se los meta un poco en el culo. Si, como ve, aprecio su conocimiento de mi forma de ser madre a los veinte minutos de encuentro. Y seguramente, usted apreciara estos consejos como yo los suyos.

En fin, espero que su practica mejore con estos consejos, con sus futuros clientes, entre los cuales, desafortunadamente – aunque no dudo de sus capacidades como medico- no contara.

Desde ya, lo saluda atentamente,

Lucila

Motherhood and nurturing in the age of obesity

Keenan, Julia and Stapleton, Helen, 2010,  Bonny babies? Motherhood and nurturing in the age of obesity, Health, Risk and Society, Vol. 12, No. 4, 369-383

 This article grabbed my attention as I am very interested in issues of feeding and nurturing as core activities of motherhood practice, as well as in body image issues. In this article, Keenan and Stapleton draw on women’s accounts of their interactions with health professional and families to see how the prevalent and powerful biomedical discourse around obesity plays out in practice. The authors describe the importance of this discourse for this study as involving the medicalisation and moralisation of large bodies in pregnancy as ‘obese’ and thus the creation of subjects ‘at risk’ to themselves and their foetus/infant.

This paper is based on findings from a qualitative research project, conducted from 2006-2008 in a city in the north of England, and this paper draws mainly on accounts and experiences told by  participants with large bodies.

First they discuss the World Health Organisation’s definition of obesity as ‘excessive fat accumulation that may impair health’. This definition is operationalised many times through the use of Body Mass Index (BMI), based on a height to weight relationship, which is a simple and cheap tool. A BMI of over 30 is most commonly seen as obese. For children, categories are based on the percentile position on ‘normal’ growth scales. Obese children are considered those which surpass the 95th or 98th percentile.

The authors discuss the different problems that the use of BMI to figure out risks brings, and show how critical studies of obesity question the link between BMI and health, which often are translated into policy in oversimplified ways that create definitions of certain bodies as fat and problematic.

The authors show how biomedical research links appropriate pre-pregnancy weight, weigh gain and nutrition in pregnancy with satisfactory foetal outcomes, and more and more with infant health over the life-course.

In the biomedical literature, a BMI over 30 is linked with

‘increased risks of miscarriage, gestational diabetes,  high blood pressure and pre-eclampsia,  blood clots, haemorrhage following birth, increased risk of induction and instrumental delivery, post-caesarean wound infection, genital and urine infections, giving birth to an infant with an abnormally high birth weight and problems with breastfeeding; obesity is significantly implicated in maternal deaths (CEMACH 2007). Babies born to ‘obese’ mothers are at increased risk from premature birth, still birth and birth abnormalities and are more susceptible to health problems, including obesity and diabetes in later life.’

However, as the authors point out, there is still debate about how much of an increased risk obesity brings, and these risks are not exclusive to women with BMI over 30. And there are contestations to the notion that adult health is predetermined by infant body size.

But this discourse comes strongly through social and cultural norms concerning the right way to prepare for pregnancy, and is framed in the media in this terms. This authors point out how health has increasingly moral connotations, and how being obese, this ‘risky’ bodily state is seen as an individual and moral failure.

However, given this atmosphere, the authors were surprised to find that women in antenatal interviews reported that health workers did not discuss ‘obesity’ with them. Very few were under consultant care due to their weight, and most of them were not aware of any of the risks listed above, apart from those few who were self-informed. In the UK, maternal weight in pregnancy is not monitored. So apart from a one-off measurement of weight and height at the beginning, weight is only informally monitored by midwives.  Women with a family history of diabetes, or with a BMI over 30, where tested for gestational diabetes, and monitored if the results were positive.

The authors argue that it is understandable that health workers were reluctant to broach the subject, as despite the urgency of the obesity debates, there are still no clear policy guidelines, support or resources, and health workers do not want to make women feel guilty, uncomfortable, or encourage them into weight regulation. Although the authors do not go into this in detail, they highlight that negative comments were always given by family, their social circle or the media.

In this way, weight was not made an issue during pregnancy by health workers, and while attempts at discussing this issue by participants were met with reassurance, some women found this helpful, while others found it frustrating, as they would have liked some support and discussion. This was especially the case for women in terms of birth plans. Most of them were led to believe that they could just plan whatever birth they wanted, but they were unaware of the regulations that prohibit certain options for women with BMI over 30, and they felt that, at the last minute, they were snatched of their choices.

Furthermore, the lack of dialogue about the risks for women and their babies meant that when health professionals, especially higher rank ones, mentioned weight as the cause of ‘poor outcomes’, these were dismissed by women. The approaches that higher ranking health professionals used were crude, induced blame and were insensitive, and did not work in terms of the goals of these professionals – raising awareness about the risk of excess adiposity – but made women, quite rightly, discredit their comments.

In terms of infant size, the authors note that across their data as a whole, underweight or premature babies generated much more anxiety around their weight than a baby deemed to be ‘big’. The authors show that the much like the more traditional understandings of ‘bonny’ babies, bigness and a good appetite were seen positively, and not as a problem. The only exception to this unproblematised view of weight gain was done by women who managed diabetes through pregnancy.

The authors end up concluding that while they do not want to contest the studies that relate excess adiposity with increased risks for women and infants, they want to identify the problems that using a measure such as BMI can bring in terms of policy, or in its translation in the treatment of individual women to improve birth outcomes and health. This article shows the disparity between discourses and practices. At the moment, health workers do not encourage women to manage biomedical risks, within pregnancy, but there are many policy and guidelines in the pipeline that are probably going to change this. Moreover, this article underlines how it is not possible to understand the medicalisation and moralisation through the work of one type of actor, such as health workers, but other social actors need to be included.

I liked this article because it tackles a sticky issue: how to understand in a measured way the risks that ‘obesity’ might bring, while problematising deterministic studies and the individualisation and moralisation of this problem. At least I find it tricky. I am worried about what these studies are showing, and scared, frankly, but at the same time, am wary about how this might be translated. If I had to bet, I would say it will probably end up in blaming the mum, and not only for a difficult pregnancy and or birth, but for the health of their children now and forever. Which is not the outcome I would like to see, but it is one that is taking shape in the media for instance. But just because it is sticky does not mean we can ignore it, or act as if nothing happened….It is the same with women’s bodies and fat shaming. We don’t need more of that, and we do not need more women who are not happy in their bodies. In this case, how could there be support for women, without it being medicalising, moralising and individualising the problem? As I say, tricky.

Lucila

Health for children not a priority in the UK

I was talking to Natalia the other day about our experiences with the NHS care for children, and we both felt that our GPs did not have much of a clue about children’s health, that they were not properly looked at (clinically), and that most of the times, our concerns were dismissed, or not heard.

First, let me say, that I love the NHS, I think it is amazing that there is such good public care, and I understand that because this is the case, many times we don’t have access to other ‘luxuries’ I could get in Argentina, like for instance, being able to call my paediatrician by mobile phone when I have a query. Because in Argentina I pay for this very expensive, private, care. And this means that you get what you can pay, which I think it is an awful way of thinking about something as basic as health care.  This, however, does not mean that I don’t feel that there are many problems, inconsistencies, and disorganisation within the NHS, which now that I have a daughter, sometimes scares me.

Today, I read an article in the Guardian online, which underlined some of these problems, which are probably bound to be made worse with the cuts and changes that this government is planning. Reading the confirmation of our fear is not a nice way to start the morning, I can tell you.

This article shows how a study by the Royal College of Paediatrics and Child Health (RCPCH), has flagged up a very serious shortage of consultants, and a need to better organise children’s units to deliver safe care. Scarily, data from the college shows that  

‘a third of the 220 children’s units in the UK are not compliant with the EU working time directive. Doctors are forced to work longer than 48 hours, trainees – albeit senior trainees working to become consultants – are left in charge, locums are having to be employed and consultants end up having to stay overnight unexpectedly in the hospital because there is no one else.’

One of the reasons for these problems is, guess what? under-investment.

‘Under-investment in children’s services is partly to blame. The number of children arriving in accident and emergency has gone up by 12% since 2009 – now almost 4 million children a year, a quarter of all visits – possibly because GPs no longer routinely do their own out-of-hours cover. And a surprisingly low proportion – 37% – of GPs has done any training at all in paediatrics. In many other countries children are not taken to a GP but to a paediatrician.’

The problems, however, are not only in emergency care, but also in routine care, and it shows how diabetes is not well controlled, and cancer symptoms are not picked up soon enough, which means there is less possibility of chidlren  surviving.

I find the fact that the majority of GPs have not had any training in paedriatric shocking in one way, but on the other it unfortunately resonates with my experience.

Children, as Prof Sir Ian Kennedy is quoted saying, are not a priority within the health service.

Depressing. Sorry.

Something you can do: http://www.38degrees.org.uk/page/s/Protect_our_NHS_Petition#petition

Lucila