Due to the length of some of our articles, we have a few of them located on their own pages.

Raynaud's Phenomenom (High-Arched Palette related to Breastfeeding)
The Truth About Disposable Diapers
Birth Blessings

 

Inflammatory Prose

               by Aliss Terpstra

I just had one of those moments. You know, the ones where you suddenly realize why you do what you do at the same time that you realize you are very alone and swimming against the tide. Well, it just happened to me so I kicked Luke off the computer -- he's gaming his life away these days -- and came all the way up to the smelly attic with the second hand smoke reeking in through the walls from next door because I just had to write this and tell it to a kindred soul.

I was down the street fixing Art's typewriter. Art is 87 years old with bad hips and his wife had a stroke so life in a three-storey semi-detached is not so much fun for them anymore. I was kidding him about needing the typewriter to write his inflammatory political tracts and he laughed and said, "Oh no, that's my son David. He's a communist."

Just then, said son David arrived with his wife, to visit his aging, ailing parents, so Art took me downstairs to introduce me. I shook David's hand and said, so you're the communist? and he laughed heartily and said, "Damn right! and proud of it too" and we laughed about inflammatory prose for the religious right (Art) and commie left (David) and I said I wrote inflammatory prose about childbirth.

David's wife, sitting gloomily exhausted and sour-faced on the couch opposite, piped up in an angry voice that sometimes midwives weren't good enough for everyone, because lots of women need life-saving help in hospitals, with doctors. She, of course, was one such. Without any prompting from me she launched into her horrible birth tale. It seems she was carrying a huge baby, almost nine and a half pounds, and he was too big to come out and it was too late to do a cesarean and she almost died and "they" (why is it always "they"?) pushed him back in so they could do the episiotomy and she tore terribly and he almost died and that was twenty-seven years ago. It was so awful and "they" saved her and "they" said she should never have a baby larger than seven pounds because she was so small.

(She was bigger than me.) "Oh," I said. "Did you have an epidural?" She said they had given her the epidural because she couldn't stand the pain because the baby was so big, and after many hours of that he started coming out but his shoulders got stuck and it was too late, you know, he was too big and should have been taken by cesarean. "It" never should have happened (I guess she meant the vaginal birth). "You didn't have any more children, then?" I asked. "I couldn't have any more," she said, still visibly angry (but at whom?). "I got pregnant with my second and my womb just collapsed at six months."

She was seething with resentment against midwifery and natural birth, and it was the epidural which had gotten her baby stuck, and it was the brutal obstetrical manoeuvre that had damaged her cervix so that it could no longer hold a baby in, but she was mad at me. ME. Twenty seven years later.

I said goodbye and nice meeting you and so on, and went home and asked the goddess to send some forgiveness into that woman's heart. For herself. And a blessing on her poor broken womb, that tried so hard and was sabotaged.

Sometimes I want to pack it in, you know?


Hepatitis vaccine safety questioned
Some parents resist required B virus shot for infants, but health
officials say risk slight
By Andrew Park SMTP:apark@statesman.com
Austin American-Statesman Staff
Published: Nov. 30, 1998

The statistics say Pamela Daviscourt is crazy to worry about the  hepatitis B shot the State of Texas wants to give her 20-month-old son.  Only about 22,000 of the 20 million people in the United States vaccinated against the virus have reported bad reactions to it, and no one knows whether those reactions were even caused by the shots. But Daviscourt doesn't think she's crazy to hold off. Infants have little chance of catching the virus except from their mothers, and she doesn't
have hepatitis B.

Still, why not give the boy the vaccine, which he'll eventually need to enter public school here? The issue, she said, is safety. She said she fears the vaccine carries more risks than benefits. "My approach has been to feed my child as nutritionally as possible and keep his immune system up," said Daviscourt, who recently moved to Austin from Washington state. "I just believe if his immune system is strong, he is going to be resistant to anything out there." Unlike some opponents of
immunization programs, Daviscourt harbors no religious or political objection to vaccinating her child, just concern about recent reports of bad reactions to the hepatitis B vaccine. A small number of people have developed arthritis, chronic fatigue, symptoms of multiple sclerosis and other conditions after taking the shot. Similar reports in France brought that country's hepatitis B immunization program to a halt last month.

In Texas, the state Health Department receives at least 50 to 60 reports each year from people who have suffered health problems after being immunized for hepatitis B, ranging in seriousness from headaches to deaths. Officials say they have no way of knowing whether those reactions were caused by, or even related to, the vaccine. "Though no vaccine is risk-free, the hepatitis B is one of the safest," said Sharon Duncan, hepatitis coordinator at the Texas Department of Health. "The
benefits outweigh the risk. We do believe that it is safe."

The department recommends that all newborns and children up to the age of 12 be vaccinated against hepatitis B, which can lead to chronic liver diseases, including cancer. This year, all children entering public school in Texas had to be immunized against hepatitis B, and the shots were offered to seventh-graders in Austin public schools this month. The effort did not come about because hepatitis B poses great risks to children. The virus is primarily transmitted among adults who have unprotected sex, share drug needles or are exposed to contaminated blood. There is also evidence that it can be passed through saliva and tears and from a mother to a child in the womb. Locally, only a few cases of hepatitis B in children are reported each year.

Still, immunizing all infants is widely considered the only way to
protect against an outbreak of the disease. Health departments complain that they cannot get teen-agers and adults to be vaccinated once they have begun risky behavior or other exposure to the virus. Better to immunize them while they're young and receiving other vaccines, the logic goes, and it's an argument supported by the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the World
Health Organization. Baylor College of Medicine immunologist Bonnie Dunbar also believes in universal immunizations and has worked for two decades developing vaccines to protect public health. But since watching two people suffer neurological failures after taking the hepatitis B vaccine, she has spoken out against its further use.

The vaccine, developed by drug companies Merck and Co. and SmithKline Beecham, was the first recombinant DNA vaccine put on the market in the United States. Unlike conventional vaccines for measles, mumps and polio, the genetically engineered hepatitis B shot does not contain a live form of the virus. Theoretically, the shot won't give you hepatitis B, as sometimes happens with vaccines that contain a live virus. But Dunbar is convinced that in some people, a protein in the recombinant mixture triggers an autoimmune reaction, provoking the body to attack its own nerves and tissue. She has cataloged more than 100 cases of autoimmune disorders found by other scientists, but she can recall two other cases from memory: her brother, whose rashes, joint pain and chronic fatigue have been determined to be side effects of the hepatitis B vaccine; and one of her students, who suffered temporary blindness in one eye and deteriorating eyesight in the other after taking the shot. The CDC and both drug companies acknowledge hearing of similar cases, but they call them extremely rare.

Dunbar worries that newborns who are given the vaccine are even more vulnerable to that risk because of their less formidable defenses. Under Merck guidelines, newborns and teen-agers receive the same dose of the vaccine. "We know from our animal lab experiments that the immune system of the neonate is very different from the adult," Dunbar said. "It has to be studied." The CDC says it's looking into the effects of the vaccine and will have results to report next year. Drug companies are also trying to determine how long the immune response to the vaccine lasts before booster shots are needed. That has yet to be established.

In the meantime, a growing number of Texas parents are resisting the state's effort. Some physicians worried about the effect on infants advise expectant mothers to decline the hepatitis B vaccine when they arrive at the hospital to give birth. Other physicians sign one-year medical exemptions that allow children of concerned parents to enter school without the shots. Many parents opt to apply for an exemption that allows a permanent out for children whose families believe in the anti-vaccine tenets of certain religions. Others have joined a Cedar Park group, Parents Requesting Open Vaccine Education, that has lobbied the Legislature and the state Health Department for more information about the hepatitis B vaccine before its use is expanded. Still, pushing against the vaccine's momentum is not easy. "I just felt such pressure," said Terri McDermott, an Austin mother who refused to have her son vaccinated for hepatitis B when he was born in June. "I think had I not said, 'I'm following up with my own doctor,' if I didn't basically have some excuse, then I would have been pressured into doing it."


If I hear one more person say     


*Isnt he a little old to be nursed?* I will have to tell them that
although my child's personal life is no business of theirs, where in the directions does it say nurse for exactly xxx number of days? Is it personally painful for you to know that he still, at three and a half, needs comfort from his mother?Does it bring up abandonment issues that you havent even thought about dealing with? Why? Is it better to see a Barney bottle dangling from his lips?

*My you have your hands full,dont you?!* I will have to refrain from biting their heads off and just say that I have two hands and two kids, whats the problem? Because I dont have a man with me, I can't function in society with two children?How do you know that I dont have a harem of men, who I just gave the day off to, and my limo is waiting outside?

*Boy, he has got you trained. He sure is spoiled.* This is my personal favorite. A six month old baby is unable to become spoiled. Only fruit can do that. I hold him because he is a BABY(duh..hello?) I strive to become *trained* by my children. How else am I going to learn how to be a great mom? How would I know that Nathanial doesnt like his food to touch on a plate? How else would I know that he likes cereal with the milk on the side,or that he doesnt like to sleep with pillows? How about Gabriel, if I dont learn from him, how would I know he hates socks on his feet, or that he just wants to be held upright so he can see what is going on? These may seem trivial to you, but when you are a kid, food organization is crucial.

Socks are a pretty important issue when you cant even sit up alone. And by the way, where are your kids? Shouldn't you be more concerned with them,anyway?

*But, dont you want to DO something with your life?* Uuuuhhhh..., something more important than nurturing and mothering the future caretakers of this world? What exactly would that be?

Amy B. Rawson
http://www.capital.net/~lvmyboy
MaMa to the boys
listowner of singlemom stay at home list


Solo in Saskatchewan     

I am just as hard-core a feminist as the next woman, but I believe part of that involves protecting our sons from the same injustices we protect our   daughters from.  What are people thinking?  It's okay to cut up your son's penis? 

My childrens' honourary grandfather agrees with me that circumcision is male genital mutilation and was happy to hear that I didn't have it performed on my children. Grandpa Mike was homebirthed and did not undergo this trauma at birth.  How refreshing to meet a supportive member of an older generation. 

I am so upset about how easily circumcision and bottle feeding are condoned in our society.  The poor babies of our world . . . we say we are first world . . .   but we are  savage and brutal to each other. 

I just moved to an area where there is much domestic abuse. The supremacy of men in our culture is so obvious; there is much I am feeling about this. It hurts to watch the women I want to know be trampled by the men in their lives just because they do not allow themselves the vision to see, and cannot or will not  express their needs.  (ie. I need you to cook, clean, read stories to the children, not put the kids down emotionally, admire me instead of our neighbour's wife, take out the garbage, don't belch/fart/swear, hold hands, pay off  the mortgage, want me.)  We all learn about this in our own time, but it still hurts.  I am getting deja vous writing this. I look forward  to relating to other single moms,  all of us struggling alone, together.

Heather Fairley
Saskatoon, Saskatchewan
hfairley@yahoo.com


The Midwife Cried         new08.gif (291 bytes)

by Susan Peer

A couple birthed at home with the midwife, six
weeks early. It was a beautiful birth and very
moving: both the husband and wife were caring and
loving Christians.

She went for the follow-up visit and the woman met
her at the door to tell her that they had circmucised
the baby. The midwife felt like she had been punched
in the stomach.

She had come to check the baby, so she went upstairs.
She told the mother that she would not take off the
diaper, but the mother insisted and removed it
herself. They butchered that boy: it was the worst
circumcision the midwife had ever seen.They left no
foreskin at all.

The midwife turned to the mother.  "Why?" The mother
replied it was important to their faith. The midwife
usually addresses circumcision  in her childbirth
classes, the last of the series.  Because this baby was
born six weeks early the parents never never got to here
about it.

This midwife is one of the most gentle and
compassionate women I  have ever met, and she broke
down and cried in the telling of it. "The parents were so
happy, and offhanded about it," she said, "I wanted to
hurt them."


Breastfeeding Battles
Nursing Cole
by Michelle Massie

Tiny. Tiny, tiny, tiny. It was all I could think of as I sat hunched over the plastic bassinette, watching my newborn son's chest pull deeply to capture each breath. With a respirator tube down his throat his facewould crumple again and again into a soundless cry. He frantically waved the arm that was punctured and encircled in IV tubing. He would startle every few minutes. I sat under the harsh warming lights; holding his micro hand, singing lullabies in a quaking voice. Helpless.

Nicholson (Cole) Pace Massie was born September 9, 1997 at 33 weeks gestation. He was one of the "lucky" preemies; he weighed a downright hefty 4 pounds, 4 ounces. But that didn't change the fact that I could not hold or nurse him. He had to eat through a gavage tube. I was crushed that his first meal was glucose water.

"as nicely as you can, let them know your life will end if you don't get to nurse . . ."

Fortunately, I have a friend who's been a La Leche League leader for nine years and had also had a baby go through NICU. She was a terrific support to me but her best words of advice were: "As nicely as you can, let them know that your life will end if you don't get to nurse." They became my words to live by. Cole was born at Hungtington Memorial in Pasadena and one of the criteria for getting him released is that he be "nippling all of his feedings." In other words, the bottle. I begged and pleaded...told them I wanted to nurse and that I was terribly afraid of nipple confusion.

I asked if they would use a cup or a spoon when I was not there (at that time I didn't know about the dental syringe) but they insisted that wouldn't give him any sucking practice or shape his palate. They also worried that he'd work so hard at nursing he'd burn more calories than he took in. But I was so insistent they brought in both a lactation consultant and an occupational therapist for me; they even wrote a special order not to use a pacifier unless all other methods of comfort had been tried first. I spent 12 to 14 hours a day with him; they do not provide rooms for parents to spend the night. The nurses were always encouraging me to go home and rest but I far more stressed at home than when I was with my baby.

After two or three days they let me do Kangaroo Care (holding skin to skin) and I held and rocked him for hours on end; interrupted only by two stints under the billirubin lights for jaundice. It was several days before they would even let me attepmt to nurse him (his IV was now in his forehead where he couldn't swat at it). I couldn't wait! I just knew he'd latch on and get it...that we'd sail off trouble-free into our long and happy nursing relationship. I put him to me...he latched on! Then, he took two or three weak sucks... and fell deeply asleep. My heart broke. Would it be the bottle forever? I couldn't bear it.

The lactation consultant came in the next day and tried several tricks...we ended up using a nipple shield to put pressure far enough back on Cole's tongue to keep him sucking. (For the uninitiated, babies don't develop the coordination to suck, swallow and breath while feeding until around the 34th week). She also showed me how to use the Supplemental Nursing System (a bottle with a long thin tube) attached to my finger. I would still have to pump until he could nurse strongly on his own. Oddly enough, some of the nurses asked if they could watch me use the SNS because they were unfamiliar with it. I was astonished to hear this but encouraged them to watch in the hope that they could help others who would come after me.

After the longest 13 days of my life, my baby boy came home. To call it grueling is to understate. I'd have to nurse him with the nipple shield and try to keep him awake by tickling his cheeks, switching sides every couple of minutes and changing his diaper. Then, we'd finish off the feeding with the SNS...lasting up to an hour because he'd take such long pauses between sucks. And he nursed around the clock. He was an unbelievebly fussy baby and I was so drained thought I would die. Within a couple of weeks of him coming home the fussiness really got bad...he would scream, cry, scratch, kick and generally flail his way through every feeding. He would latch and re-latch, cry, re-latch, and struggle some more. At my wit's end, I went to the Lactation Institue in Encino. They figured out that when Cole would pause while using the SNS the milk would continue flowing and pool up in his cheek. Without having to work for it,he'd get a nice big swallow. I was dumbfounded. He'd gotten "nipple confusion" after all! Once I knew what the problem was I tossed everything. I sat on my bed and nursed my son around the clock for aweek. I had to corral him by trapping his wild arm under my arm cradling his head. I kept his other flailing arm and legs under my bent arm (which also had to compress the breast so he could keep a hold on it with his tiny mouth). It was like nursing a bucking bronco. My husband had to stand next to the bed with a plate and feed me. This was definitely not the sensitive nursing scenario I had pictured and I thought it would never end.

But end it did. Now, my son nurses perfectly. His skin is pink and beautiful. He has lovely rolls of baby fat and sweet breath. Sometimes he pulls off and gives me a big fat grin with his two little bottom teeth before going back to business. I"m so in love and attached I can hardly stand it.

My advice? Get all the support you can; La Leche League, professional lactation consultants, breastfeeding friends. Hold your preemie to make up for the time he spent in the plastic box and sleep with him next to your loving, warm body. But most of all please, please, please persevere and nurse your preemie. God knows they need it.

Michelle Massie

Los Angeles, California


Reducing Episiotomy

Most physicians have been educated during the era when episiotomy was a routine part of vaginal birth. During this era, episiotomy was  thought to protect the baby from the dangers of the second stage and reduce the risk of pelvic floor relaxation for childbearing women.

Recent studies of episiotomy fail to demonstrate any of these benefits.

The recently published Canadian randomized trial of episiotomy found that women who gave birth with an intact perineum, subsequently had the least pain and the least difficulty resuming sexual intercourse. Another finding of this study was that median episiotomy was associated with a substantial risk of tearing into the sphincter or the rectum (3" or 4" degree tears). Women with these types of tears had the most morbidity associated with episiotomy.

Mediolateral episiotomies are generally recognized as more difficult to repair and substantially more painful than median episiotomy. This leaves the accoucheur with a clinical dilemma. This new evidence would suggest that one of the goals of normal childbirth care is to assist at birth in a way that would minimize the need for episiotomy. It is clear that there will always be a need for episiotomy but it will be limited to more specific indications, like fetal distress, shoulder dystocia or when the perineum is edematous or ischaemic. Each accoucheur will have to make a clinical decision about the risks/benefits of median versus mediolateral episotomy. This will depend on his or her experience and expertise as well as the risk of serious extension of the episiotomy. As yet, no one knows what a normal episiotomy rate should be. Some have suggested five percent for multiparous women. The most recent randomized trial from Argentina suggests rates should be at least less than 30%.

This is an enormous change from rates close to 80% which were common in the 1970's and 1980's.
--The Accoucheur


 

10/15/98

Spare the Rod
    by Belinda Parsons

The Melbourne Age 16/9/98

Smacking a child is not supposed to happen at all any more. Not even with an open hand. Since the 1940s, paediatricians and psychologists have been saying it is just not OK, that there are other, more effective, ways to manage children.

But not everyone agrees and now, more than 50 years on, legal experts believe there is a need to set a bottom-line standard with uniform national laws governing the physical punishment of children.

Existing laws already prohibit the use of unreasonable force to hit a child, but this week a committee of legal advisors recommended that the definition of what constitutes "unreasonable'' needs to be clarified. An offshoot of the standing committee of attorneys-general has proposed that the law be reformed to specifically outlaw "causing or threatening to cause harm to a child that lasts more than a short period'' or "causing harm to a child by use of a stick, belt or other object''. This, they say, should amount to criminal assault. Only a smack with an open hand should be seen as legally acceptable.

But despite the weight of legal and child expert opinion, the reality is
that even the most loving and astute parents will, at one time or another, probably smack their children.

Clinical psychologist and the author of Fight-Free Families, Dr Janet Hall, says it is a natural reflex action. "We are conditioned, if you like, to smack because we were smacked,'' she says. "It just comes naturally; it's almost as if it's part of our neurology.''

Hall often begins her parenting talks by asking how many people can
remember, at least once, being punished by their parents when they were little and saying: "I'll never do this to my children.''

"And yet you find yourself doing exactly that thing,'' she says.

But despite the tendency to fall into a pattern of smacking, she says, the costs to the parent-child relationship can be great. "A child who is
intimidated by the threat of being smacked or any kind of threats will feel negative feelings towards a parent, as in either revenge or resentment, and that builds up over time,'' she says. The child will either retaliate or walk away and, either way, the parent-child relationship is damaged.

"Every time you smack a child, you could be putting another negative in the bank balance and, at the end, when your child grows up, suddenly you have no relationship. You're left wondering why.''

Still, Hall believes there are times under highly specific conditions, such as when a child is in danger, when smacking can be justified. In those cases, she says, punishment needs to be immediate, consistent and delivered without anger or any other emotion.

She welcomes the proposed changes to the law, saying rules are there to help us not to cross the line into unacceptable behavior. Parents need to be aware of times when they may be prone to lash out at a child, such as when they are tense, stressed or sick themselves.

When parents are in danger of losing their cool and smacking their child, Hall suggests alternative strategies, such as taking 10 deep breaths, taking time out by going to the toilet, or calling somebody - possibly a telephone counselling service.

The director of Melbourne University's Centre for Community Child Health, Professor Frank Oberklaid, says there are many child advocates in Australia, North America and the United Kingdom who argue that any physical punishment is unwarranted. He and many others would like to see a ban on all physical punishment of children.

Oberklaid says when Dr Benjamin Spock first advocated his controversial idea that parents should avoid physical punishment and babies should be fed on demand in 1946, he was roundly criticised. But, he says, Spock has since been vindicated.

Children are the most vulnerable members of society and need to be
protected, he says. "There's a fine dividing line between parents
disciplining kids and abusing kids.''

Oberklaid says physical punishment is not effective and a parent should not need to use it to discipline children. "At least in a theoretical way, it serves to reinforce naughty behavior, because the child is still getting attention. There are good strategies for managing problematic behavior, which do not rely on physical discipline.''

The principle behind behavior management, which can even be used for young toddlers, is to ignore unwanted behaviors and to reinforce wanted behaviors, he says.

Oberklaid acknowledges that, every now and then, even parents who don't generally use physical punishment will resort to it. He recalls when his daughter was about two she ran out in front of a car. "My wife screamed, the car screeched to a halt and my wife just instinctively smacked her. That was a mixture of relief and 'don't ever, ever do that again'. It's a little different from using physical punishment on a regular basis as a form of discipline.''

But, he says, physical punishment sends the wrong message to children about violence. "In a society where we are already terribly concerned about the mixed messages kids get about aggression and violence because of TV and so on, to smack children gives them the message that physical aggression is an OK way to get rid of frustration and to discipline others. It's likely then to be reflected in the way that a child approaches peer relationships and so on.''

And, at some stage, the child will grow too big for parents to rely on
smacking as a form of discipline.

A senior lecturer in social work at Melbourne University, Dr Dorothy Scott, also welcomes the proposed changes to the law, saying it will be helpful for those working in the child protection field to have a clear legal statement of the community's bottom line on physical discipline.

She believes there has been a steady shift over the past generation away from the use of physical discipline. However, most parents still use it to some degree with children of pre-school and primary school age, Scott says.

We shouldn't forget that the most important factor for children is the
emotional climate in a family and the quality of parenting, she says, not whether or not they are smacked. "Certainly, frequent and heavy resort to physical discipline often coincides with a poor emotional climate in the family.''

"The traditional, more middle-class ways of disciplining children, which have been the withdrawal of love from the child, are infinitely more damaging than a warm, working-class family that occasionally uses a smack to assert parental authority,'' she says.


 

11/2/98

Bad medicine

Sarah Boseley on the disasters that have forced the medical profession into bout of self-examination.

What has happened to our doctors, those men and women with stethoscopes, white coats and an air of comforting authority whom we have admired and trusted from the first time they laid a cool hand on our feverish young foreheads? New tales of scandal, horror and wrong-doing by those people seem to break every day. And to think that we once thought them the nearest thing to saints on earth.

We hear of the GP whose patients' bodies are being exhumed, we learn of the consultant gynaecologist who used his surgical knife with all the subtlety of a mowing machine inside women's bodies and left them broken and bleeding. And what could be more distressing than the Bristol case, in which the arrogance of two heart surgeons led to the deaths of tiny babies whose lives could have been saved if their parents had only known to take them somewhere
else.

There is growing unease. We thought we knew these people. Have doctors changed? Have they disavowed the Hyppocratic oath which debars them from doing harm? Or are the wrong sort of people entering the profession? Junior doctors are on drugs, we hear. A study last month in the Lancet, the
esteemed medical journal, said two thirds of them drink too much, a third of the men smoke cannabis and more than 10 per cent use other drugs, from LSD to cocaine and amphetamines. Only this week, a new study suggested one in 10 doctors could be suffering from an addiction, and the British Medical
Association called for random dope-testing in hospitals and GP surgeries. The NHS Executive is now considering a ban on alcohol on hospital premises.

How can the overwhelming trust the public have for so long felt for their doctors survive? Next week things will only get worse, with the opening of the public inquiry into the Bristol babies case, which will examine in minute detail not only all the deaths we have already heard about, but also the desperately sad stories of tiny children who were brain- damaged, and
adults who died during heart operations at the hospital.

What are we to think? Perhaps something fundamental has happened. Look at the case for the prosecution. In Greater Manchester, Dr Harold Shipman, a GP, has been charged with murder. Not one murder, but four. Not a spontaneous crime of passion, but the killing of women patients in his care. Women who trusted him and put their lives in his hands. He is also accused by police of altering the A 300,000 will of 81-year-old Kathleen Grundy so that he became the sole beneficiary. To the appalled astonishment of local people and the wider public, police have said they are now investigating the deaths of 90 people who were on Dr Shipman's books.

But does the man, who, it must be remembered, has not been tried and is as yet only under suspicion, look like a monster? No, he looks like any hard-working, caring GP.

The number of complaints about doctors from the public, heard at the General Medical Council, is at an all-time high. Last year, the disciplinary body received 2,500 complaints, 500 more than in the previous 12 months. Doctors are being struck off at the rate of two a month.

Rodney Ledward was one of them. The case was shocking in the extreme. The GMC heard of seven years of bungling and botched operations at the William Harvey NHS Hospital in Ashford and at St Saviour's private hospital in Hythe, both in Kent. Women put their trust in him, and he abused it. Mr
Ledward told 54 year-old Jenny Gurney her ovaries were healthy. Five weeks later he took them out without her consent during a hysterectomy and left her with internal damage. She had to have two litres of blood drained from her stomach in a further operation.

The consultant was found guilty by the GMC of damaging women's internal organs, operating without consent and walking away while they were still bleeding. The reaction to the revelations was horror and astonishment that Ledward could have been so arrogant and incompetent (he switched off his
mobile phone after the operation that was to prove his last, and nobody could reach him to say his patient needed help) and that he was not stopped earlier. The first complaints against him came in 1991. This catalogue of disaster is disturbing both for the public and for those in the medical profession who are now working on major, far-reaching reforms in an effort
to stop these horrors happening, and to keep the public's confidence in doctors alive. Trust is the central word. "Patients trust doctors with their lives and well-being," said Jeremy Lee-Potter, chairing the professional conduct committee of the GMC that dealt with Ledward. He echoed Sir Donald
Irvine, the GMC President who had the unenviable task of dealing with the Bristol surgeons.

"At the centre of this inquiry is the trust that patients place in their doctors," he said, as he struck off James Wisheart, a senior children's heart surgeon and John Roylance, the chief executive of the United Bristol Healthcare Trust. Sir Donald has been trying to bring about change for some years. Bristol was a watershed, but only because it crystallised the concerns of the public. There had been a feeling for some time that the
medical profession was out of step with society. Suddenly the stripping away of the mystique from the Bristol heart surgeons showed that even the most caring doctor can be flawed by arrogance or insularity. "Part of the anger with the profession, particularly post-Bristol is a frustration that the sense of trust and certainty doctors give us has somehow been betrayed,"
says Sir Donald.

Dr Ian Bogle - the GP who heads the British Medical Association, which has been working with the GMC and the Royal Colleges on the way ahead - acknowledges the scale of the problem. "There is no way I can do other than accept that some damage has been done by the publicity over the last few
months," he says.

"We have been working with the GMC for nearly a decade to try to put in the structure we now have, which will hopefully reassure the public, patients and ourselves that we can minimise the chances of these things happening again," says Dr Bogle.

The GMC recently spelled out the duties and responsibilities of doctors in a booklet called Good Medical Practice, which has gone to everybody in the profession. Those who breach this ethical, moral and professional code could be hauled before the GMC, they have warned.

It tells a doctor that patients have a right to be told if something has gone wrong, that they must be honest, listen carefully to their patients' needs and not abuse their trust. The doctor must keep his skills up to date. The Government now means to ensure he or she does by sending specialists into hospitals to make sure doctors' skills are up to standard.

We have always expected all these things of a doctor, and it is a measure of the changing times that they need to be spelled out in print. But what will fundamentally alter things, if it works, is the duty the GMC has now laid on doctors to blow the whistle - to tell the bosses if one of their colleagues is not performing properly.

It was only the fact that the consultant anaesthetist Stephen Bolsin, who now works in Australia because, he claims, ranks closed against him here, was prepared to become a whistleblower that the Bristol scandal was exposed.

One of the most disquieting aspects of the Bristol case was the sheer arrogance of the eminent people it involved. They appeared to feel inviolable, untouchable.

The reformers need to topple such patrician doctors from their ivory towers. There is far less of a problem with the younger doctors. Medical schools now teach them how to break bad news to a patient or relatives - how to talk to them on their own level, not at one remove.

Sir Donald says he is determined to "change the culture". Doctors have to be aware of the expectations of the outside world, and not only how they match up to them, but how their colleagues do as well. "We're developing a culture in which it is not only possible but seen as responsible, to be listening,
to be open when things don't seem to be right," he said. "To confront it. This is not about whistle-blowing. It is about early detection. When things aren't quite right, the best and most supportive thing must be to say we seem to have a problem here." Unfortunately, this did not happen with Rodney
Ledward. It was only because other consultants were called in to put right the damage he had done that his inadequacies were made public. There are those who wonder if self-regulation can be made to work at all, since it did not work with him.

Sir Cyril Chantler, Dean of the Guy's, King's College and St Thomas' Hospitals' Medical and Dental School, is another reformer who does not underestimate the scale of the problem. "I think there's a whole spectrum between those who don't think there is a problem and those who are as aware as we are that there is," he said. "And there are some people who would
define the matter differently.

"When something went sour is difficult to know. There comes a moment when you suddenly wake up and realise something has changed. But you don't realise, until you look back, how much has changed. The recent spate of cases at the GMC, including the Bristol case, has concentrated everybody's minds, but I think people have been trying for some years in all parts of
the profession to get people to recognise that we need fundamental change."

In a lecture he gave this month in Illinois, Sir Cyril, who is a children's kidney specialist, called for a "fundamental re-examination of the role of physicians in our society". Both he and Sir Donald think the fantastic advances in medicine of the last few decades have helped destabilise the cosy relationship that patients had of old with their doctors: "Medicine
used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous. The mystical authority of the doctor used to be essential for practice. Now we need to be open and work in partnership with our colleagues in health care and with our patients."

Patients want old-fashioned values from their doctors, says Sir Donald and not just the latest technological wizardry. But that is where medicine and society are out of step. Now that doctors have advanced science at their fingertips, they have forgotten how to talk to the patient. And one of the things they have failed to explain is that, as Sir Cyril puts it, "doctors
do not save lives, although we can on occasions help to prolong them". Physicians need to remember their role as the "amicus mortis", he says- "the friend who tells you the bitter truth and stays with you to the inexorable end". The new relationship between doctor and patient - friends,
equals and mortals - can only be hastened by the huge amount of information about medical treatment now available to the lay public, particularly on the Internet. Every doctor now has a story about the patient who arrives and tells the medic what his problem is and what the best treatment will be, he has read it on the net, and he's right.

Claire Rayner, chair of the Patients' Association, thinks the damage to the profession done by all the scandals may be limited. "People have lost a certain amount of reverence for the profession, but many, many people say they have a marvellous relationship with their own doctor. People do have
enormous respect for those they know and believe are good." But she admits they are much more affectionate towards the GP, who they know well, than the hospital doctor. She thinks people do not like the secrecy that hospital doctors seem to be immersed in - they feel that if something goes wrong,
they will not be told and they certainly will not get redress. "People say, they look after their own, don't they, and they are making too much money," she said.

After all the horrors of Bristol, it was the issue of merit awards which affronted the public, she said. They could not believe that James Wisheart was given a merit award worth around A35,000 a year after the inquiry began.

It was Frank Dobson, the Health Secretary, who read the public mood accurately and insisted he would find a way to remove the award. If the reforms that the GMC and other bodies have set in train do not satisfy the growing public disquiet with doctors, he has already indicated that he might
not be averse to looking for more radical solutions himself. There is everything to play for.
The Guardian (UK)
Website: http://www.guardian.co.uk/
Copyright Guardian Media Group plc.1998


11/02/98

Measles

Is measles a deadly disease, as the Australian and other   governments claim, or simply a common ailment of childhood with some beneficial aspects?

"In the vast majority of children who catch measles, the disease disappears within 10 days and the only aftereffect is lifelong immunity to another attack," says the esteemed  MacMillan Guide to Family Health, edited by Dr. Tony Smith, the Deputy Editor
of the British Medical Journal in 1982 (before the common use of the measles vaccine).

In Sanskrit, measles translates into "visitation by a goddess." Since antiquity, it has been noticed that  children who experience a measles infection have  developmental leaps afterward.

Studies show children who get childhood diseases when  young  have fewer chronic auto-immune problems, such as asthma, eczema, arthritis, and certain cancers.

Measles is dangerous to a malnourished child and  kills millions in developing countries, even though many  have received the measles vaccine. Mortality from measles  can be reduced effectively through proper nutrition and hygiene. Vitamin A supplements, which reduce mortality by 23 to 80 %.

Is the MMR (Measles, Mumps and Rubella) Vaccine Safe? The Australian Vaccination Network (AVN) report reactions  from a child who died of bronchiolitis in early August '98, after a DPT vaccine and a child who became deaf after the MMR vaccine. These events were not reported by the doctors involved.  If doctors are not reporting reactions,   vaccines' safety cannot be assumed.

The MMR vaccine, produced by Merck, Sharpe and Dohme, contain three separate live viruses: measles, mumps and rubella. The measles and mumps portions are produced in chick embryo cell culture; people with severe allergies to eggs should not receive it. (Most babies have not tried eggs before receiving their first vaccine.) The rubella portion is cultured on the cell lines (tissue) of an aborted fetus. The Australian government says  fetal tissue is not used but themanufacturer's package insert   states human diploid cells are used.

The MMR vaccine has been associated with the development of such conditions as Guillain-Barre syndrome, multiple sclerosis, autism, Crohn's disease, attention deficit disorder, attention deficit hyperactivity disorder, epilepsy, irritable bowel disease, permanent brain damage, and death. There are  21 adverse vaccine reactions listed by the manufacturer in the vaccine package insert, but not included in information  given parents.

The UK government is considering withdrawing this vaccine from use and has already introduced a monovalent (one component) measles vaccine in preparation for this withdrawal. More than 2,000
damages claims are against the UK Government on behalf of children, killed or injured by this vaccine since 1994.

Japan withdrew the MMR vaccine from use in 1993 because it was causing aseptic meningitis. The hydrolyzed gelatine it contains may place vaccine recipients at risk of developing CJD, the human
equivalent of mad cow disease.

Why, if the government is trying to prevent  measles, is it using a vaccine with three components? The more components, the greater the chance of sensitivity to ingredients and adverse reactions and the greater the load placed on a child's immune system.

Is the MMR Vaccine Effective?

The Australian government claims the MMR vaccine protects 95% of those who receive it, but the South Coast Public Health Unit  says 46 percent of children who received the MMR vaccine showed no antibodies to measles after. In an outbreak of measles in Western
Sydney, the parents of 78 percent of those who came down with measles say their children had received the MMR.

There are  instances in the USA, where vaccination is compulsory and compliance is in excess of 98 percent, in which outbreaks of measles occur.

So Why Vaccinate?

In Australia, every child between the ages of 1 and 18 will be targeted during this campaign by a combination of advertising, reminder notes and public education.  The AVN, after being approached by families whose children have been harassed by school staff because of
refusal to permit this vaccine, will prepare legal action on behalf of these families. The AVN seeks provision of full and accurate information to parents about the side effects of the MMR vaccine.

Children who receive this vaccine can contract measles and infect others for up to a fortnight even if they show no symptoms themselves.Many  children  have been diagnosed by doctors with measles one to two weeks after receiving their vaccines.

Undue pressure is  placed on Australian parents, who are not being given information to  make educated choices.

The Australian Vaccine Network, PO Box 177, Bangalow
NSW 2479  Australia    phone 02 6687 1699
fax 02 6687 2032,  http://www.avn.org.au.              
email: van@mypostbox.com


The Gold Box         

Some time ago a friend of mine punished his 3-year-old daughter for wasting a roll of gold wrapping paper. Money was tight, and he became infuriated when the child tried to decorate a box to put it under their Christmas tree. Nevertheless, the little girl brought the gift to her father the next morning and said, "This is for you daddy." He was embarrassed by his earlier overreaction, but his anger flared again when he found that the box was empty.

He yelled at her, "Don't you know that when you give someone a present, there's supposed to be something inside of it?"

The little girl looked up at him with tears in her eyes and said, "Oh daddy, it's not empty. I blew kisses into the box. All for you Daddy."

The father was crushed. He put his arms around his little girl, and again begged her forgiveness.

My friend told me that he kept that gold box by his bed for years. Whenever he was discouraged, he would take out an imaginary kiss and remember the love of the child who had put it there.

In a very real sense, each of us as parents has been given a gold container filled with unconditional love and kisses from our children. No more precious possession could anyone hold...

Author unknown.

 

 

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