In this article, we learn about the gynecological healthcare experiences of Black women in the United Kingdom. We also speak with Dr. Christine Ekechi, who is a co-chair of the Race Equality Taskforce that the Royal College of Obstetricians and Gynaecologists (RCOG) recently formed to tackle racial bias and disparities in women’s healthcare.“I can’t breathe” were the words that George Floyd repeated more than 20 times while a white Minneapolis police officer unjustly murdered him.The resonance of these words not only triggered a global outcry against violence inflicted on Black communities; it also propagated recollections of similar experiences of oppression within Black communities. In a similar vein, this article shares the experiences of six Black women and their ongoing battle with painful reproductive conditions. They all reveal a similar story: that Black women’s “cries” for help are routinely unheard, unseen, and misunderstood. As a result of this, these women are disproportionately suffering in healthcare.This is a reminder that Black Lives Matter (BLM) is an expansive and inclusive movement that brings all Black lives to the forefront of the ongoing fight against systemic racism. In contrast, the “All Lives Matter” counterprotest is supposedly intended to establish solidarity and common ground in support of the BLM movement. However, it parallels the “colorblind” ideology, according to which “we all bleed the same color.” In a healthcare context, the latter violates the concept of triage in medical ethics, which demands that life endangering issues be dealt with first.These stories are also a reminder of the fact that Black women do not have medical conditions simply because they are Black. So, using “Blackness” as a proxy may never help us understand how their experiences inform the disparities in their healthcare outcomes.It is the harsh reality that exposes the vulnerability of Black people in U.K. healthcare systems, where implicit bias permeates the healthcare workforce and, in some cases, puts “Black lives at risk” in comparison with other ethnicity groups.This is apparent in the 2019 MBRRACE-UK report, which confirms that Black women are five times more likely than white women to die as a result of complications in their pregnancy. Reproductive health research also reports that Black women have a higher risk of miscarriage with both spontaneous and in vitro fertilization (IVF) pregnancy. For full-term pregnancies, stillbirth is also twice as likely to occur in Black women compared with white women.Reproductive conditions such as fibroids are three times more likely to occur in Black women than white women. Similarly, endometriosis is traditionally associated with being a “white woman’s disease,” which may consequently lead to misdiagnosis and delays in appropriate treatment for Black women. Dr. Christine Ekechi — who is also a consultant obstetrician and gynecologist at Imperial Healthcare in London, U.K. — recently announced that a multi-focused approach and collaborative effort between doctors and the government, implemented by the newly established Race Equality Taskforce, “[will] ensure that no woman or her family suffers unnecessarily, and that [it should hopefully] address racial inequality, where it exists.”Medical News Today reached out to six Black women from the U.K. All the women keenly responded to our request for them to talk about the difficulties they had experienced in getting a diagnosis and treatment for reproductive and gynecological conditions such as endometriosis and fibroids. What was pertinent in the conversations was their appreciation that “someone cared” and was “holding a safe space” to listen to their concerns and, at last, take them seriously. In the sections below, we summarize their unique yet broadly similar experiences by including key quotes from each case study. The quotes reflect the women’s collective experiences, and, more importantly, they are thematically consistent with the reported drivers that may contribute to implicit bias and racism in healthcare.Most significantly, Dr. Ekechi endorsed MNT’s decision to include personal case studies for this article. Her interview responses reveal that she places particular emphasis on “listening to the experiences of individual women and clinicians” as a way to best improve the Race Equality Taskforce’s understanding of the causes of the inequalities in Black women’s healthcare.Self-advocacySelf-advocacy in healthcare refers to a person’s ability to ask for what they need and want and to tell doctors about their thoughts and feelings.MNT first spoke with 32-year-old Latoya, who talked about dealing with 20-plus years of pain and being “fobbed off” with prescriptions for birth control pills and mefenamic acid, a type of nonsteroidal anti-inflammatory drug, for pain management. After requesting a female doctor multiple times, Latoya explained that “it took me having to cry helplessly in front of my GP [general practitioner] to be taken seriously, which finally led to my referral to a specialist.” After a series of investigations, a healthcare professional discovered numerous fibroids in her uterus. They removed them in two separate laparoscopic surgeries — one of which removed two tennis ball-sized fibroids.Latoya continues to manage her flare-ups by eating a healthful, balanced diet at the recommendation of a female doctor, who said to her [paraphrased]: “I’m not supposed to tell you this, but eat more fruit[s] and vegetables. Although I’m meant to prescribe medication, following a health[ful] diet will limit the growth of your fibroids.”Latoya’s tenacity to learn about fibroids led her to start her own online platform called Wombbae, which she uses to continue advocating for other women with fibroids. We also spoke with Paige, 24, who experienced such unbearable pain at times that she had no choice but to defer her university studies due to multiple hospital admissions. Each time she left, a healthcare provider prescribed a stronger combination of pain relievers.Paige’s reliance on pain relief medication started to affect her mental health. So, after researching alternative ways to manage her pain, she found that her symptoms were consistent with endometriosis and pushed to be referred for an MRI scan. The MRI scan confirmed the presence of fibroids. After a healthcare provider offered Paige birth control pills to manage the pain — which, like Latoya, she refused — a female doctor encouraged her to push for a laparoscopy.Around 6 months later, Paige underwent laparoscopic surgery. It revealed no evidence of endometriosis. She explained to us that a male doctor left her feeling humiliated when, soon after she awoke from surgery, he said, “[W]hat you have done [supposedly wasting their time] is serious, and you need to consider if you have psychological problems.” Paige has lost trust in the National Health Service (NHS). She is now focusing on educating herself on how she can manage her pain using holistic therapies.The negative feedback cycle and ‘stereotype threat’ We also spoke to Mel and Sarah, both 30 years old, who experienced years of debilitating pain that doctors eventually diagnosed as severe endometriosis. One similarity in both stories is the constant dismissal of their reported pain, despite the fact that the severity of the condition (unknown at the time) was causing extreme symptoms that they feel should have warranted specialist investigation.Both women spoke about the pain being so unbearable that it would cause vomiting and fainting. The inconvenience and sense of embarrassment associated with trying to navigate extremely heavy periods while working also affected their mental health. There were also a few occasions where they both questioned the validity of their own concerns as a result of the lack of healthcare-related empathy in their cases.In the earlier stages of investigation, Mel asked her GP if they had considered endometriosis or fibroids as the cause of her pain. To this, her doctor replied, “Hmmm, maybe, as it’s common in ‘BAME’ [Black, Asian, and minority ethnic] people.” The doctor still prescribed birth control pills to manage the pain, despite later finding out that she also had a case of fibroids. Sarah also spoke about a time when she had a doctor’s appointment, and a doctor discussed her case in a nonconfidential patient waiting area. She explained that this particular situation made her feel “worthless” and showed the “lack of care in maintaining her dignity.”Both experiences highlight negative medical interactions through a loss of patient-centeredness and the removal of patient autonomy. This, in turn, breeds “stereotype threat” and hinders interactions between the patient and the doctor. Mel continues to research lifestyle changes and natural remedies that will help her manage her pain flare-ups. Sarah underwent three surgeries to manage the pain and is now pregnant with her first baby. Self-funding We also spoke with Liz, 33, and Hafiza, 30. They both waited approximately 10 years to receive a diagnosis of stage 4 endometriosis. Healthcare providers left both women “to their own devices,” meaning that they needed to self-fund their specialist investigations and treatment. This is because they faced significant delays in investigating their long history of pain cycles and had to manage with prescriptions of the birth control pill. In Liz’s case, the severity of the endometriosis affected her bowel and bladder. It also compromised her fertility, as the condition caused scarring and blockages, leading to the removal of both of her fallopian tubes. Liz is now undergoing IVF treatment.Similarly, Hafiza underwent surgery to remove two parts of her bowel, remove her appendix, resection her bladder, and place a stoma bag. Despite all the difficulties she faced, she now has two young children.Lessons learned One thing that each of these eye-opening accounts highlights is the need for early intervention in gynecological and reproductive health investigations and self-advocacy to “follow one’s gut” when something feels wrong.The case studies we heard have shown how desperation can cause a person to take matters into their own hands. However, the implications rest on the intersectional difficulties that Black women may face regarding their class and socioeconomic background, where a lower status can hinder a person’s access to private healthcare. This, in turn, has detrimental effects on their health outcomes. We started our discussion with Dr. Ekechi by summarizing the case studies we heard. Dr. Ekechi, in part, reaffirmed and contributed her own explanation as to how and why these experiences and differential outcomes occur. She also explains how the Race Equality Taskforce plans to tackle these issues. We have edited the interview below for clarity. MNT: The RCOG are committed to working with various stakeholders, including the government, to eradicate racial bias. What will this involve?Dr. Ekechi: Well, there is a data gap that pertains to women outside of maternity outcomes. We [RCOG] are not aware of the depth of the problem, so firstly, we need to plug the data gap where it exists.Secondly, it’s important that we understand the prevalence, so we need to be asking ourselves, “How many Black women have fibroids?” and “How does it affect their lives?” These kinds of questions delve deeper and help us understand the actual problem.We also need to put the patient voice as a priority to gain [a] further understanding of the issues, but we can only understand this if we work with the women and clinicians on the front line of our services who have a better awareness and understanding of the issues at hand.MNT: Can you provide further explanation of the multidimensional factors that may contribute to poorer patient outcomes for Black women specifically?Dr. Ekechi: Black women are more likely to have conditions such as obesity, high blood pressure, [and] diabetes that put them at risk of having poorer outcomes in gynecological health and subsequent outcomes.Language barriers can also be a factor, so research is being done to figure out how services can communicate effectively with patients to improve delivery of information. I also push back against a simple answer that “it’s all racism” — that’s too simplistic. Racism is a very complicated web of deeper and underlying issues that will be looked into and addressed.MNT: What role can medical research play in addressing the disparities in outcomes for ethnic minority groups, and specifically Black women?Dr. Ekechi: We always have to know the extent of the problem, so we can start with quantitative research questions, such as: Is there a geographical variation? Is the issue changing over time? How many women does this truly affect? And also, what we really need to look at is not just the fact that somebody is Black, white, or Asian, but what is their social group? [Social] class plays a huge role in this, too.Also, how significant is a preexisting medical condition? For all the women who have died, did they have a preexisting condition that contributed to the cause of their death? [T]hen there’s also qualitative data, which is more about how people feel and behave — [t]heir belief patterns. For example, […] for a lot of ethnic groups, they don’t believe that the NHS is “for them.”MNT: [In response to Dr. Ekechi’s comment about belief patterns] Yes, many of the women we spoke to in our case studies felt they needed to pay for private healthcare in order to feel like they were being taken seriously.Dr. Ekechi: It’s important for us to know this because if we are working toward effective interventions, it won’t make sense if we “stand” next to groups who we can’t target or won’t come forward [for treatment]. I think, for me, it’s about thinking about ways to rebuild the trust that we really don’t have.MNT: Is this the approach you will take in your project workstreams? Dr. Ekechi: 100%.MNT: How do you plan to combat this within your specific project workstream (which is focused on tackling racial bias)?At first hand, it’s important to say that racism is a very difficult thing to address, and there will be no easy or quick solutions. We have to understand very clearly the linkage between poorer outcomes for certain ethnic groups and the lack of diversity in the health profession that serves these ethnic groups.[S]o it’s important that we address the differential outcomes, and in tandem [make] sure that our workforce also has equal opportunities. [H]aving a workforce that is homogenous and not as diverse as the population that it serves, but also has a lot of persistent and inherent biases within it, means we would never improve the terrible statistics that we see today […]. MNT: Can you tell us a bit more about how you plan to start tackling these wider issues beyond maternal mortality?Dr. Ekechi: Yes. The stream that I’m heading is specifically looking at women’s health outcomes, which includes maternal mortality but also the other health outcomes. Part of the reason why I’m excited to be chairing this stream [is] because I want to move out of this narrow focus of maternal mortality and […] start to look at [adolescent] health because we are the RCOG, and so we look at the health of girls and young women. [I]’m also excited to be working closely with other colleagues in the community, because we […] want to promote preventative health before people start getting these illnesses.This work looks at working within the community to inform, […] and also finding innovative ways to disseminate information. So, for example, doing a lot more podcasts and Instagram takeovers, any which way that we can reach out to all the different groups that we serve, but most importantly the younger generation, so they can have this information at hand and seek help early if they have any concerns.MNT: As this is the last question, would you like to talk about anything else that we may not have covered that is important for our readers to know? Dr. Ekechi: I understand that this is for the long haul, and so at the end of the day, [this taskforce] will be in place be for as long as it needs, which is forever, unfortunately. We always have to make sure that we are continually reviewing our work and the outcomes.[T]he results will not be instantaneous, and we will make mistakes, but as long as everyone is committed to the outcomes, [we should start to] see a gradual positive change in the statistics.[We, as a community,] need to bear in mind that the issues at hand are very complex, and therefore results will not be seen immediately. So we need to focus on staying committed to the outcomes and involving all the necessary people at the start.
Lax gun laws in neighboring states may increase firearm deaths
A US study suggests strong gun control regulations reduce a state’s firearm deaths, but having neighbors with more lenient laws undermines their effect.Share on PinterestNew research suggests that one state’s lax gun laws could undo the effects of its neighbor’s stricter firearm regulations.In 2017, 39,773 people died from gun-related injuries in the United States, according…
A US study suggests strong gun control regulations reduce a state’s firearm deaths, but having neighbors with more lenient laws undermines their effect.Share on PinterestNew research suggests that one state’s lax gun laws could undo the effects of its neighbor’s stricter firearm regulations.In 2017, 39,773 people died from gun-related injuries in the United States, according to the National Center for Injury Prevention and Control.Overall, research indicates that stronger state laws governing the sale and ownership of firearms reduce firearm-related deaths. However, some states have relatively high rates of gun deaths despite strict regulations. To investigate why this might be the case, scientists at the University of Alabama at Birmingham, and the Boston University School of Public Health at Boston, MA, looked into the effects of firearm laws in neighboring states.They used the Web-based Injury Statistics Query and Reporting System to obtain figures for firearm-related deaths in the 48 adjacent U.S. states from 2000 to 2017. There were 578,022 firearm deaths in total, including homicides and suicides, but excluding deaths due to shootings by police or other law enforcement agents. The scientists also searched the State Firearm Laws Database for laws in each state regarding:background checksgun dealer regulationsbuyer regulationsgun-trafficking lawsThe team used the number of these laws as a proxy for gun control strength in each state.If you would like to check your registration status or register to vote, we have added some useful links at the bottom of this article.Overall, stronger state gun laws were associated with reduced firearm deaths, but having a neighboring state with more permissive laws undermined this protective effect.Larger policy differences across state borders were associated with increased gun-related deaths, suicides, and homicides, though the results were statistically stronger for suicide than homicide.The authors conclude:“This study adds to the growing literature emphasizing the role played by neighboring states’ firearm regulations in addition to own-state firearm regulations in firearm deaths. Failing to account for neighboring states with weaker laws, in some instances, can make a state’s own regulations appear less effective in reducing firearm deaths.”The scientists calculate that, on average, failure to account for weaker firearm laws in neighboring states make it appear as though a state’s laws were about 20% less effective at reducing deaths than they really were.They report their findings in the American Journal of Preventive Medicine.The researchers write that higher prices and strong marketing regulations can lead consumers to purchase firearms in adjacent, relatively unregulated markets. They say these are a frequent source of the guns used in crimes.They believe their work supports the case for more cooperative legislation between neighboring states and at the federal level.“I think the main message of this study is that to solve a nationwide problem we need to think of a nationwide or at least a regional-level (i.e. multistate) approach, like we may also need for the COVID-19 pandemic,” says Dr. Ye Liu, who is a doctoral student in the Department of Health Care Organization and Policy at the University of Alabama and the first author of the study. “An ‘each state on its own’ approach is ultimately inadequate to address one of the biggest public health challenges in this country,” Dr. Liu adds.The authors acknowledge the number of gun-control laws may not perfectly reflect the strictness of a state’s regulations. In addition, they note states may vary in how diligently they enforce these laws.They call for further studies that might use alternative measures of regulatory strength, focus on specific categories of law, or explore the effects of regulations in more distant states. To check your voter registration status, click here to visit VoteAmerica, a nonprofit, nonpartisan organization dedicated to increasing voter turnout. They can also help you register to vote, vote by mail, request an absentee ballot, or find your polling place.
COVID-19 will eventually become seasonal, researchers predict
A new study argues that COVID-19 is likely to become a seasonal disease similar to influenza — but not before a vaccine and greater herd immunity are achieved.Share on PinterestResearchers warn that COVID-19 outbreaks may become a seasonal occurrence.New research published in the journal Frontiers in Public Health suggests that SARS-CoV-2 is likely to be…
A new study argues that COVID-19 is likely to become a seasonal disease similar to influenza — but not before a vaccine and greater herd immunity are achieved.Share on PinterestResearchers warn that COVID-19 outbreaks may become a seasonal occurrence.New research published in the journal Frontiers in Public Health suggests that SARS-CoV-2 is likely to be affected by the changing seasons in a way similar to other human coronaviruses and influenza.In temperate regions, this would mean reduced infections in the summer and peaks in the winter. However, this seasonality is only likely to occur once a vaccine is developed and greater herd immunity is achieved.Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.The sudden emergence and rapid spread of SARS-CoV-2 and the disease it causes, COVID-19, have left scientists urgently attempting to develop vaccines to combat the virus and treatments for its disease.Another key area of research is how the virus is transmitted from one person to another.Understanding how the virus spreads is crucial, as it allows governments to enact policies that effectively limit viral transmission.While policies have varied from country to country, they have generally involved maintaining social distance, washing the hands regularly, and wearing face masks.This is because the virus can be transmitted on surfaces, through direct human contact, and via droplets expelled when a person sneezes, coughs, or talks.In addition to transmitting through droplets from the respiratory tract, the virus may also spread through aerosols: very small droplets that are expelled alongside larger ones or that form when larger droplets evaporate.Determining precisely how the virus transmits requires time and research. However, given the lethality of COVID-19, policy decisions need to be made urgently, based on the best evidence currently available. Making the best suggestions requires scientists to analyze emerging research on COVID-19 and past studies that have looked at similar viruses.Doing so may also allow researchers to better predict how the virus will react in the future.In the present study, the team pooled the latest research on COVID-19 and compared it with information about other viruses that affect the respiratory tract. They did this to predict whether the novel coronavirus is likely to become seasonal — particularly severe in the winter in temperate regions — or whether it will circulate throughout the year.The researchers noted that many other human coronaviruses are more prevalent in winter than in summer, as is the influenza virus thought to react to temperature similarly to SARS-CoV-2.They argue that this seasonal pattern will likely develop in SARS-CoV-2, due to the effects of the climate on the virus and on humans.First, the researchers point out, the climate can affect the stability of the virus. Previous research has suggested that enveloped viruses, including SARS-CoV-2, become more stable in cold weather. This means that they are able to survive for longer periods between hosts.Cold weather may also allow the virus to travel through the air more easily, while higher levels of ultraviolet radiation in the summer may be more likely to kill the virus.Second, cold weather may affect our physiology, making it easier for the virus to infect us. People also generally get less vitamin D in the winter, when sunlight is less intense, which has been linked to a weakened immune response to respiratory infections. In addition, people are more likely to stay indoors during the winter months, increasing the risk of viral transmission at home, work, and school, for example.While cold weather may increase the rate of transmission of SARS-CoV-2, the prevalence of the virus in countries with significant heat and high levels of moisture suggest that climatic conditions alone are not enough to make the virus seasonal.Instead, the researchers argue that seasonality is only likely once an effective vaccine has been developed and deployed, and once a greater level of herd immunity comes about as more people develop the infection.That means that, in the meantime, emergency measures remain crucial for limiting the spread of the virus — no matter the time of year.As study co-author Hadi Yassine, an assistant professor of infectious diseases at Qatar University, in Doha, notes: “The highest global COVID-19 infection rate per capita was recorded in the Gulf states, regardless of the hot summer season. Although this is majorly attributed to the rapid virus spread in closed communities, it affirms the need for rigorous control measures to limit virus spread until herd immunity is achieved.”As senior study author Hassan Zaraket, an assistant professor of virology at the American University of Beirut, in Lebanon, observes, “COVID-19 is here to stay, and it will continue to cause outbreaks year-round until herd immunity is achieved.”“Therefore, the public will need to learn to live with it and continue practicing the best prevention measures, including wearing of masks, physical distancing, hand hygiene, and avoidance of gatherings,” he adds.The authors stress that their study is a “best guess” at how SARS-CoV-2 may react to changing weather conditions. Although it can behave similarly to previous viruses, the new virus is unique and may react in unexpected ways.“This remains a novel virus, and despite the fast-growing body of science about it, there are still things that are unknown. Whether our predictions hold true or not remains to be seen in the future. But we think it’s highly likely, given what we know so far, [that] COVID-19 will eventually become seasonal, like other coronaviruses.”– Hassan Zaraket, Ph.D.For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.
COVID-19: Antibody fragment could prevent infection
Research suggests that an antibody fragment, or “nanobody,” can neutralize SARS-CoV-2. The authors also say that it is possible to produce the nanobody cheaply and at scale, making it a promising candidate for the widespread prevention of COVID-19.As cases of COVID-19 continue to rise, the search for an effective vaccine against the disease continues. A…
Research suggests that an antibody fragment, or “nanobody,” can neutralize SARS-CoV-2. The authors also say that it is possible to produce the nanobody cheaply and at scale, making it a promising candidate for the widespread prevention of COVID-19.As cases of COVID-19 continue to rise, the search for an effective vaccine against the disease continues. A recent report provides encouraging results for a vaccine candidate under development in Russia, but there are still no data showing that any vaccine can prevent COVID-19. It could be months, if not years, before a vaccine reaches the general population.In the meantime, however, scientists are busy looking for an effective treatment to mitigate symptoms or, even better, to prevent infection from occurring in the first place.Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.In a new study in the journal Nature Communications, a group of researchers from Karolinska Institutet in Sweden describe one such treatment.They outline the production of an antibody fragment that binds strongly to the SARS-CoV-2 spike protein to neutralize the virus. They also say that it is possible to produce the fragment cheaply and at scale, and that it has good potential as an antiviral agent against the new coronavirus.A nanobody, which is a fragment of an antibody, is less than one-tenth of the size of a normal antibody. Although much smaller, nanobodies are just as specific and effective as regular antibodies.Camelids — the family of animals including camels, llamas, and alpacas — naturally produce nanobodies. In this study, the nanobody came from an alpaca.To obtain the nanobody, the scientists injected the alpaca with the spike protein of the new coronavirus back in February. The virus uses the spike protein to enter cells, but by itself, it is harmless.After 60 days, the researchers took blood samples from the alpaca. The blood samples revealed that its immune system had responded to the spike protein by generating several nanobodies. The researchers then analyzed the sequences of these nanobodies to see if any had the potential to become a treatment option.They found one nanobody in particular, called Ty1, that binds strongly to the part of the spike protein that usually binds to its receptor, ACE2.Cells in the body express ACE2, and the virus uses it to access and infect cells. Stopping the interaction between the spike protein and the ACE2 receptor, as this nanobody does, can effectively prevent infection.“Using cryo-electron microscopy, we were able to see how the nanobody binds to the viral spike at an epitope [that] overlaps with the cellular receptor ACE2-binding site, providing a structural understanding for the potent neutralization activity,” explains first study author Dr. Leo Hanke.The scientists suggest that, if further development is successful, it may be possible to use the nanobody to prevent infection in those with the highest risk of COVID-19.It could also be usable on a bigger scale to allow larger sections of the population to safely return to work, school, and other currently restricted activities. The authors claim that such widespread use of the nanobody is viable because manufacturers can produce it cheaply and on a large scale. This is because nanobodies are smaller and easier to manufacture than regular antibodies and because bacteria can express them in large quantities. Scientists can also make the nanobodies safe for use in humans by using existing methods. Indeed, previous research has suggested that they can help prevent respiratory infections.The team is currently exploring strategies to improve the potency of the nanobody and planning preclinical studies in animals to assess whether or not the treatment can help prevent COVID-19. The researchers have also made the nanobody sequence freely available online to facilitate collaborative research efforts and enable rapid production.“We hope our findings can contribute to the amelioration of the COVID-19 pandemic by encouraging further examination of this nanobody as a therapeutic candidate against this viral infection.”– Senior study author Prof. Gerald McInerneyFor live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.