Brain Awareness Week by Alison McKean, Tammie Gottschlich, Jenny Graham & Wendy Chambers

Brain Awareness Week is 13 – 19^th March 2023 and is a good time to think about and talk about our brains.  We wanted to take the opportunity to share some updates and resources with you. 

NHS Dumfries & Galloway are working in partnership with Brain Health Scotland on an exciting global project on healthcare system preparedness for the early detection of Alzheimer’s Disease.  Scotland is one of six countries selected as a flagship site for this Davos Alzheimer’s Collaborative (DAC) program, working alongside sites in Brazil, Japan, Jamaica, Mexico, and the USA.    The program funds new approaches that measurably increase rates of cognitive screening, early detection, and accurate diagnosis of Alzheimer’s Disease. 

The project offers the opportunity to use a next generation digital cognitive assessment which includes a Brain Health Action Plan (Linus Health’s Core Cognitive Evaluation) and an innovative blood-based biomarker (C2N’s PrecivityAD™).  The learning from NHS Dumfries & Galloway will contribute globally along with the learning from the other flagship sites.  This will help to understand how equipped healthcare systems are to implement early detection of Alzheimer’s and what might be needed to enable this further.  Best practice will be shared in order to speed and scale future innovations and developments in order to reach the people who need it most.

Tammie Gottschlich, Team Leader and Jenny Graham, Mental Health Nurse said:

“The CMHNT in Annandale & Eskdale and have been involved with DAC program over the past few months as part of an improvement project. The team have embraced the opportunity to be involved in such an exciting project working towards early detection and dementia diagnosis.  There has been a positive response from participants to date with the reduced cognitive screening time during initial assessments and recommendations identified from completion of the brain health questionnaire.

Earlier detection and diagnosis make it possible for individuals and their family to take steps to improve brain health, manage symptoms and capture their care preferences through a lifestyle questionnaire.  We are looking forward to the blood biomarker phase of the project starting.  Feedback has been positive, however as with new projects there has been some teething problems, however we are endeavouring to resolve these and learning as we go!”

Wendy Chambers, NHS Dumfries & Galloway Alzheimer Scotland Dementia Consultant said:

“The opportunity to be involved in this work, testing NHS Scotland system readiness, to adopt tools which may shape how we diagnose dementia in Scotland is really exciting.  I was delighted that during very challenging times our busy clinical teams and GP practices have been able to embrace this work.   They have signed up and positioned themselves at the forefront of clinical services improvement work, driving forward and paving the way for future, new ways of working at an earlier stage in the dementia pathway.  Hopeful steps such as these move us all in the direction were options for prevention, care and cure for dementia become more of a reality.”

Further information on Davos Alzheimer’s Collaborative can be found here:  https://www.davosalzheimerscollaborative.org/

There is a growing understanding about what can impact brain health. While some factors cannot be changed (such as family history and genetics), it is now known that there are many lifestyle factors where positive changes can make an impact on brain health.  Brain Health Scotland has been established to inspire and empower people to protect their brain health and reduce the risk of diseases that can lead to dementia, working with people of all ages, across the whole of Scotland. Here are links to some of the resources available:

Lifestyle factors

Learn more about key lifestyle factors and use this to help you make your own personal brain health pledge.

https://www.brainhealth.scot/understanding-brain-health

My Amazing Brain

Aims to inspire and empower young people to learn about the things they can do to keep their brains healthy so they can set up good habits early in life. 

https://www.brainhealth.scot/amazingbrain

Brain Health Quiz

Get inspiration and personalised top tips by completing an online quiz.

https://brainhealthplan.brainhealth.scot/start

We hope that this blog has inspired you to spend some time thinking about the health of your brain this week and beyond.  Sign up to the Brain Health Scotland newsletter or visit the website to keep up to date:  https://www.brainhealth.scot/

Alison McKean, DAC Project Lead, Brain Health Scotland, @AliAHPDem

Tammie Gottschlich, Team Leader and Jenny Graham, Mental Health Nurse, Annandale and Eskdale CMHT

Wendy Chambers, Alzheimer Scotland Dementia Consultant, @wendyAHPDem

I am not my diagnosis by Hannah Green

Noun: A diagnosis is the identification of the nature of an illness or other problem by examination of the symptoms.

I’ve always had the mentality of “that won’t happen to me”.

I wouldn’t describe myself as being part of the “snowflake generation” (I’m also not that young), but I naively thought that I would never receive a life changing diagnosis. 

That was until 2022, then everything changed.

A chronic illness?

A bias comment but surely that only happens to old, unhealthy, unfit, immobile people?!

I’m only 33 years old, I regularly go to the gym, I lead a healthy lifestyle and day to day I feel okay – surely you must have me mixed up with another patient?!

It was only seeing the outline of my face on the computer screen from the image of my MRI that made me believe.

I had to see it with my own eyes.

(Image below is not my brain scan)

Image | Radiopaedia.org

There they were

• lesions
• plaques
• abnormalities
• dark spots
• damaged tissue.

However you describe them, their connotations were not good, and they were not welcome in my life.

No one likes a mystery, after all the synonym of diagnosis is to investigate / analyse.

Everyone likes to get to the bottom of a problem, especially those in clinical positions. 

The MRI and lumbar puncture made a firm diagnosis for me but why have I developed this condition?

Let’s pause for a moment and talk about health anxiety.  Have you ever had it?

It’s an intense fixation on your health, literally every sensation has you on Dr Google, and you always jump to the worst case scenario.  A lot of the time it’s only the worst outcomes that are published.

It can be triggering by talking about health (something that we as a society tend to do a lot, a bit like the weather). It’s exhausting – especially for those of us out there who are over thinkers at the best of times!

However bad my health anxiety is, I’ve always tried to trust my body.  Instinct plays a huge part in our health journey.  I’m not clinically trained, but I know my body (even if I always jump to the worst case scenario….best to be prepared!)

As sad as it was to hear “you have Multiple Sclerosis”, it was also a relief.

Relief that I didn’t imagine my symptoms

Relief that I finally had an answer

Relief that I’d been listened to

Relief that I had a Consultant and a Specialist Nurse available to listen to my anxieties and questions

There is also a sad side to receiving a diagnosis

The mourning of what you can no longer do

The loss of a part of you

The fear of what will change about you

The worry and guilt of how it will affect your loved ones

The thought that life is going to be different forever

The hurt when it feels like your body has betrayed you

I may look the same, but I don’t feel like I used to

A diagnosis is an answer, but it doesn’t always mean that there is a solution.  Sometimes a diagnosis will lead to many heartbreaking times.  Getting diagnosed makes you evaluate everything in your life.

Buckle up – you’re going to be in for a bumpy ride – but can you find anyone whose life is plain sailing and problem free?!  I now have a new routine of MRIs, routine bloods, and medical consultations.

There are many diseases and in turn many specialities to support you. 

I would like to applaud the skills of those who provide a diagnosis, and are available to offer advice and support, especially when I had already diagnosed myself 10 times over with many possible ailments.

Rather than thinking, I have something wrong with me and then a full stop, how about adding a semi colon; this isn’t all that I am. 

Every situation is unique.

Every person is unique.

There are many other challenges that come with a diagnosis. 

Sometimes people hear I have MS and go ‘so what?!’

Other people say ‘you don’t look ill’ – so what is the definition of a sick person? 

You can still be fully functioning and have a condition.  

We need to stop invalidating people’s illnesses.

I always go on the basis of being kind to others and what might not be awful to me might be dreadful to them.  Someone out there will always be in a worse off position, it’s how we react to news and how we support others that matters.  You don’t have to understand someone’s disability or diagnosis, you just have to respect and value the person enough to do it.

Ironically, multiple sclerosis is sometimes referred to as the ‘snowflake disease’.  This is because, like snowflakes, no two people’s journey with MS are the exact same. 

Personally my diagnosis has made me braver.  I now have the mentality of “I need to do it today”, because tomorrow isn’t guaranteed to be a good day. 

During those ‘brain fog’ days, I just make sure I have a thesaurus to hand and I know it’ll be all right.

I can sound like I’ve got this, but I’m struggling as I write this.

Not all days are rosy

Not all days are happy

Not all days I am accepting of this diagnosis

But then I remember that I am not MS.

I just happen to have MS.  I know my limits (even if I don’t always pay attention to them)

I’m constantly torn between “I can’t let MS ruin my life” and “I have to listen to my body and rest”.

I’ll treat this diagnosis as a friend, as it’s something that will be with me for the rest of my life. 

I’m accepting that there may be more lesions at my next MRI. 

I’ll welcome them into the family – I might even give them names as they are my battle scars.

If you ever receive a diagnosis please don’t let it define who you are.

You are still you.  Keep s’myelin! (a little MS joke)

I am Hannah and I AM

An over thinking queen

A loving and kind individual

A true and loyal friend

A mother to three amazing kids

A wife, sister, daughter and a woman!

That is who I am

Spare a moment & Spread the word: Women, Equity & Justice! by Sonia Cherian

We stand on the shoulders of giants.

8th March 2023 (Wednesday) is International Women’s Day (IWD) officially recognised by the United Nations in 1977. The day came into being inspired by the universal female suffrage movement.

The usual focus of the day being ‘women’s achievements on the backdrop of challenges’, the day is important to every human being who believes in a diverse, equitable and inclusive world. The Pandemic and world events have caused setbacks to progress.

Gender equity is the progressive concept that has been built on the achievements of historical women’s movements that campaigned for rights of women to work, vote, receive education, get fair wages, hold public offices, equal rights within marriages, equal property rights, maternity leave etc. We have come a long way since women were allowed to vote in 1928 (Equal Franchise Act).

We should now be able to visualise a world free of gender bias, stereotypes and discrimination!

The campaign theme for this year’s IWD is #EmbraceEquity. The words ‘equality’ and ‘equity’ are often used interchangeably but have a distinct difference in the context of social justice.

Image credit: Tony Ruth for Design in Tech Report

Equality implies that everyone should be treated in the same way with equal access to opportunities irrespective of their unique circumstances or challenges. This implies that everyone has a level playing field with evenly distributed tools in order to succeed. However, this concept is fair provided the starting point and unique challenges are similar for everyone.

Equity, on the other hand, looks at fairness. It acknowledges that not everyone has a favourable starting point nor the resources to achieve equal success despite being provided evenly distributed tools. Hence resources need to be provided to individuals based on their unique needs so that they can overcome their specific challenges. The related concept beyond equity is justice. In reference to gender fairness, there are social inequalities within our society that reflects in our workplace culture and practices. If gender justice is our ultimate goal, then the bent apple tree images depicts this appropriately. Justice implies fixing the unfairness in the system (bent apple tree) so that there is equal access to both tools (ladders at same height) and opportunities (equal apples on both sides of the tree).

In the journal Human Rights Quarterly (HRQ), Charlotte Bunch highlighted that our approach to human rights would be incomplete without addressing issues concerning women’s rights. Women form 51% of Scotland’s population and is a resourceful pool of talent to generate economic activity. Scotland’s gender equality index (2020) depicts gender equality at 73% indicating that more effort is needed in achieving full gender equality.

There are multiple reasons for women not achieving gender equality at work. I have described some of the important aspects that need consideration:

Participation in work:

Women have disproportionate caring responsibilities and have been restricted from obtaining paid employment due to their traditional roles as carers and mothers. As a society we have to acknowledge these unpaid caring roles and provide flexible and secure job opportunities to enable women to achieve economic independence. Job security can help increase a woman’s quality of life, wellbeing and offer a potential opportunity to own a home. Technology can help with flexible remote working. The United Nations theme for IWD 2023 is “DigitALL: Innovation and technology for gender equality”. Technological and digital education for women needs improvement alongside addressing ‘technology facilitated gender-based violence’ online.

 

Segregation:

Segregation in the workplace refers to the unequal concentration of men and women in different kinds of jobs (horizontal segregation) and at different levels in the hierarchy (vertical segregation). Gender stereotyping, inflexible working patterns and undervaluation of job roles that are usually considered ‘women’s work’ such as caring play a negative role in this context. There are two factors that affect women’s movement between junior and senior positions: the ‘glass ceiling’ effect and the ‘sticky floor’ effect. The ‘glass ceiling’  indicates that there are specific barriers limiting women’s participation in senior positions within organisations and there is evidence that women do remain under-represented in the most senior positions. The ‘sticky floor’ refers to women and other minority groups being ‘stuck’ in low-skilled, low-paid jobs. This results from the lack of access to higher paid jobs due to limited availability of training or promotion opportunities.

Quality of work:

Creating jobs that are fulfilling, secure and well-paid is the key to wellbeing and job satisfaction. Improving quality through training and education, expanding job roles to make it more engaging, paying health & social care workers fair/respectable wages and enabling opportunities for career progression would help lift them off the ‘sticky floor’ and also address horizontal segregation (data.gov.scot).

Gender pay gap:

The Scottish Government’s gender pay gap action plan indicates various measures to address workplace practices which discriminate, undervalue and underutilise the skills and potential of women, and in particular disabled women, older women and minority ethnic women. The report also mentions that women are twice as dependent on social security as men and have less access to resources, assets and occupational pensions. A review of economic gains of equalising gender gap in employment found that it could add £17 billion a year to Scotland’s economy (Close the Gap, 2016). There is a relation between the proportion of gender, ethnic and cultural diversity within senior management and leadership roles and higher quality performance in organisations (McKinsey, 2018).

Intersectionality:

Intersectionality is the cumulative way in which the effects of multiple forms of discrimination combine, overlap or intersect in the life of an individual. Various forms of inequality operate together and exacerbate each other. The charity ‘Close the Gap’ refers to the intersectionality of gender, race and religion as the triple penalty.

Women’s unique health needs (related to menstruation, menopause etc.) can affect women’s work productivity. These are complex issues being addressed through the Scottish Government’s Women’s Health Plan.

The economic reasoning for gender equality can be supported by analysing the population pyramid of Scotland.

The population pyramid (‘age-sex pyramid’) is a graphical depiction of the distribution of the population by age groups and sex.

Scotland’s population pyramid reveals a constrictive pattern with bulging older population at the top and a narrow segment of younger population. In a decade or two from now, the biggest bulge would the over 65-year age group. Populations with a high proportion of elderly people have a higher dependency ratio (ratio of people dependent on the working-age group population). Hence there is a demographic need for our society to support people keen to have children. The motherhood penalty refers to maternity, pregnancy and childcare related effects on women’s ability to work outside the home (Equality and Human Rights Commission). Supportive policies that help employees through pregnancy and parenthood are in our national interest.

Women’s Network:

Dumfries and Galloway Health and Social Care Partnership (HSCP) has set up a network to support and improve the working lives of women in our organisation.

The Women’s Network, launched on June 8th 2022, aims to work collaboratively with staff and management to bring forth positive cultural change. We do feel fortunate that we have women in various senior roles within our HSCP.

Our vision is that women working in the health and social care sector experience a positive work environment where they feel valued, included and free from discrimination. Our purpose is to provide members with a community of support, a safe space to share experiences with other members, enable members to be part of a collective voice to influence positive change, promote inclusion and challenge discrimination. Membership is open to all women working in Health and Social Care. We have formulated an Action Plan for 2022-23 which includes various social, educational and developmental opportunities. There are already various supportive policies in place to help address the issues I have mentioned in this blog. Our HSCP is keen to improve on this.

Therefore, may I call upon you to be instrumental in the change that you desire…  and kindly join our Network ( dg.womensnetwork@nhs.scot ) !

If you are too busy to attend our meetings, we will keep you updated on our journey via email. For issues you are passionate about – do get involved. If you are a woman who is content with your life and work, kindly share your valuable experiences with the Network. If you are interested in our social activities and making more friends, do come along.

Let’s celebrate…the sacrifices and achievements of the past…motivating us to go from strength to strength…to be the best version of ourselves and to make our world the best it can be !

Best wishes for International Women’s Day !

Dr Sonia Cherian, Chair of the Women’s Network and General Practitioner