9 Ocak 2017 Pazartesi
6 Ocak 2017 Cuma
My swimming odyssey: ‘It felt like a last chance to prove what I was capable of’
I had always thought I could swim. It may have been because I could run. It may have been because I wanted to swim. Or because I only ever did 10 minutes of breaststroke at a time, or splashed off a warm beach. But I really couldn’t swim.
It took 12 months of lessons and practice before I was able to swim in open water, beyond the pool or my home beach in Brighton. Then I could let myself believe I was up to taking on a challenge I had been dreaming of for more than a year: I wanted to swim in the Greek waters of the Ionian Sea. Specifically, I wanted to swim to Ithaca, the island home of Greek hero Odysseus.
Since childhood, I had been fascinated by Greek myths and the heroic tales of the Trojan war. As I grew older and read classics at university, it became Odysseus who captured my imagination more than any other. Legend has it that Odysseus was within sight of Ithaca when he was blown hundreds of miles off course. It took him several years to get home after that. Meanwhile, his wife Penelope stayed at home on Ithaca, spending every night unpicking the embroidery she had completed during the day, having promised her suitors that she would marry one of them just as soon as her sewing was finished. Eventually, a decade after Odysseus set out from Troy to return home, they were reunited. Sometimes you have to wait for the one you love.
I never wanted to be Penelope; instead, I had fought for years to be my own hero, my own Odysseus. I wanted my sense of belonging to come from within, and as soon as I found that, I found D, my husband. Now that I had my own Ithaca, I wanted to see the real one.
There was a deadline to contend with: after a year of marriage and even longer of trying for a baby, we had recently been referred for IVF treatment. I was shaken by the news. My relationship with my body had changed radically over the last few years. Finally learning to have a little faith in what it was capable of had been one of the most rewarding experiences of my life. Now, I was being told that positive thinking was not going to be enough.
Six weeks later, I was on my way to the island of Lefkada, where I was going to spend a week on a guided swimming trip around the islands of the Ionian. It would be an opportunity to see what I was capable of in the water, and to remind myself of the barriers I had overcome, even as I was now confronting a new one.
The evening I arrived was heavy with heat. We all gathered on a terrace overlooking the sea to introduce ourselves and eat together under the vines. J, the leader of the trip, encouraged us to go around the table saying a little about ourselves.
“Hi, my name is Jess and I recently swam the English Channel as part of a relay with some mates.”
“Hi, my wife and I are regular Masters swimmers in the south of France; these are our times…”
“Hi, I’m on this trip with my teenage daughter as a rest before her Olympic tryouts.” And so it went, on and on. These were people who had swum for their country, across their country and to their country. They may as well have been a different species.
The first morning, we boarded a beautiful wooden boat with a taciturn Greek captain who made no effort to hide the fact that he despaired of us all and our sanity. The pattern for the week was quickly set. The boat headed out to wherever the swim was to begin, then we would be briefed on deck about what type of swim it would be. Some were coastal, all the way around an island, with plenty to look at below us; some would be crossings from island to island – more satisfying, but potentially much harder work. And some would be a combination of the two. For most of the week, we would have a morning swim, lunch somewhere nearby, then a bit of time on the boat before a second swim. Friday would be the exception, because that was the day of the heroic 5km swim from Kefalonia to Ithaca.
Being in an entirely unfamiliar environment was all-consuming. I was used to wading into the water; a slow walk with a gradual drop-off. Now, we were clambering or jumping off a boat, straight into deep water. The most striking thing was its clarity. I had never seen anything like it. In Brighton there are only a few days when the water is clear enough to see through, and even more rarely is the ocean floor visible. Now, I could see a whole new universe. In our underwater world, body type had little effect on how we moved. The strength, the glide, the ease of the reach through the water was all that counted.
I found the sensation of travelling between two bodies of land dizzyingly intimidating. Once, managing a single length of the pool had been too much for me. Then, swimming in open water, albeit close to the shore. Then, the unknown length and depth of the river. Each time, I had persuaded myself that if I could relax and focus, I could do it. Each time, I had been proved right. The barriers were not merely physical, but mental.
This was something else entirely. As we reached the farthest point between the islands, the sea became so deep, it was beyond blue; a dark purple, almost charcoal, with shimmers of yellow as the current moved on and on below us. We found ourselves righting and re-righting our course, having to fight to stay straight, rather than being dragged somewhere else. That pull in the water, begun as a ripple on the other side of the world, reached me then, in that moment, as if gently to tug my sleeve and let me know that, perhaps, I was reaching the limitations of what my body could do. And the thought stayed with me all week as we approached Friday, the day of the 5km swim.
We had a pre-6am start that morning, to be ready for a boat trip of more than two hours. I was tired and beginning to ache in places I had never felt before. The mood on the boat was noticeably quieter than usual. Until now, I had enjoyed conversations with the group, getting tips on my technique, as well as hearing stories of their entrancing swims around the world. Today’s early start and the task ahead, though, had left us all but silent.
It’s all about the breath, I reminded myself. Keep the breath steady and you’ll keep yourself steady
My nerves were mounting. Not only was it farther than I had ever swum continuously – by more than a kilometre – but we would be negotiating a busy channel, competing with swells and currents, as well as holidaymakers’ boats and billionaires’ superyachts. And there was the added pressure that we had been told to swim tightly in our groups during the crossing, directly alongside each other for safety: there was no option to slow down to catch my bearings or indulge in panic. I would either let the team down or find myself drifting dangerously alone in the currents.
I sat in the prow of the boat, my legs dangling over the water as she moved slowly through the still, flat, unbroken surface, the sun rising behind the distant islands, and I felt horribly alone. I missed home with a longing I was sure only Odysseus had ever felt. For the others, this was an energetic holiday, but for me it felt like a last chance to prove to myself what I was capable of before I faced the uncertainties of IVF.
As I stared down into the water, a dolphin’s fin broke the surface and danced ahead of us. I yelped; the captain cut the engine. In that instant, I saw that I had been a fool. Only seconds before, I had been feeling so utterly alone while mere metres from such a magnificent sight. The dolphin leapt and pranced ahead, before approaching the boat and swimming alongside it for a little while. I sobbed, overwhelmed at how appallingly close the lowest and the most beautiful moments can be to each other. Yes, we swim alone. But we can never truly know what swims alongside us.
Half an hour later, people started to ready themselves to head into the water. My heart was hammering. It’s all about the breath, I reminded myself. Keep the breath steady and you’ll keep yourself steady.
Now it was time to swim. I became lost in sensory overload within the first few minutes. The light seemed liquid, leaping up and circling me every time I drew my hand through the water, trying to push against the current that was moving with such strength beneath me.
The first hour or so went smoothly, the group moving steadily as one. About halfway, something changed. We were approaching a tiny island, barely big enough to lay a picnic blanket on, and until this point we had been using it as a sighting point, keeping it in view in order to steer a straight course. We were to swim north of it as we passed, which we were all on course to do. As we approached, the ocean floor came up and back within sight. There was some comfort in seeing the sloping patterns of the underside of the island beneath us. Until I realised that it wasn’t moving.
We were swimming at our hardest. Perfectly in rhythm, well warmed up, pulling hard, breathing hard. At last, I felt like a real swimmer. Except I was going absolutely nowhere. An anxiety dream come to life. I was pulling and pushing at the water with all my might, but we had hit the point where the currents were at their strongest. The harder I swam, the less I moved. The rocks below me were entirely static.
I continued like this for five or 10 minutes before panic set in. I knew that to stop was instantly to slide back, away from the group. Exhale. Keep going. Exhale. Believe. Exhale. Glide. But the demons were chasing me now. I had never stood toe to toe against nature in this way before. You can’t fight nature, I thought, and felt tears choke in my throat. I forced an exhale. I wouldn’t let myself think it. But I did. If you can’t fight nature, what about pregnancy? And with that I was lost in a world of worry. Would I ever get pregnant? What would IVF do to me? What would IVF do to us? Would it be worth it? Would we get there? When would I know?
The water swirled around me and roared in my ears. I forced the air out of my lungs, again and again. The salt water was crusting my mouth, and every breath felt like a punch as the sunlight hit my eyes.
Your body might never be the same after this summer, I told myself. Enjoy what you have
Think of home. Be your own hero, be your own Odysseus, be ship, cargo and crew. I repeated these things to myself again and again, forcing physical relaxation until mental solace came. I made myself feel the power in my limbs and lungs, and love it. I was strong. Your body might never be the same after this summer, I told myself. Enjoy what you have.
Eventually, I won the battle. The rocks beneath me slid slowly out of sight. The deep blue returned. I have never been so glad to be swimming so utterly out of my depth. But the horror wasn’t over. About half an hour later, a sort of fizziness began in the tips of my fingers. I had only felt it once or twice before, in the final few metres of running events. I knew it meant that I needed oxygen, and fuel. I realised what was happening and tried to power my way through with positive thinking. Success was limited. My mind had got me thus far, but my lungs had not had the chance to catch up.
I needed help. I called to the rescue boat, and clung to it. J told the others to carry on, while I hauled myself in. My breathing was laboured and erratic, my head spinning and the tips of my feet and fingers numb. I breathed. I gulped at the orange juice on board to get some sugar into my system. I grabbed a handful of nuts. Devastated not to be in the water, I sat, breathing, for five minutes. We were so close to Ithaca. I could make out individual trees on the mountainside. Ten minutes later, I knew I couldn’t let the dream go.
“Can I get back in?” I asked.
J checked me over, to make sure that I wasn’t still delirious.
“I have to reach Ithaca. It’s why I came.”
She nodded. I leapt off the boat and headed for the grey rock. I couldn’t believe there was any strength left in me, and I vowed never to forget the moment that the island’s sea life started to make itself apparent to me. Once again, the sea shallowed, and fish shimmied between crags, sea urchins perched on ridges and starfish danced on the side of the island.
Finally I touched the rock, and burst into tears. Huge sobs, shaking my shoulders, forcing me to cling on to the island to keep myself steady. I had done it. I had discovered a grit I hadn’t known I had. I had slowly, over a year of marriage and a year spent in the water, learned that strength does not always mean merely ploughing forward in the face of adversity; it means changing your plans when what you’re doing isn’t getting you where you need to go; and it means nurturing the confidence to adapt without panicking. The relaxation that swimming demanded of me had taught me that calmness is strength. As I clung to that rock, I had no idea of the extent to which my adaptability and survival skills were about to be tested.
***
As the plane landed back on English soil, I smiled, knowing that I would be home soon and that there were still a few months before the most difficult stages of the IVF swung into action. I was gleeful to be returning to my Penelope, but it was tinged with the melancholy of knowing this summer was past full bloom. I wanted to carry on swimming outdoors, putting my new-found strength and confidence into practice.
I was sure I would be pregnant soon. I was anxious about the side-effects of doing a cycle of IVF, but I was not anxious about it failing.
I was wrong. It proved a brutal and disorienting experience. The cycle ended in early September with me battle-scarred, exhausted and with a streak of red blood that confirmed that I was not pregnant. The Saturday morning after we realised the treatment had not been successful, I woke up at 6am and stared at the ceiling as the tears rolled slowly, silently, down the sides of my face and on to the pillow. What now?
Slowly, the overwhelming duvet of sadness that had swamped us began to shift. While the summer had not been the idyllic sea frenzy I had hoped for, once I looked up and beyond myself, I saw that we were being treated to an exceptionally beautiful autumn. We had agreed to try one more round of IVF, but for now I had a chink of time in which to use my body for as much adventure as it could manage.
As autumn progressed, I swam and I swam, feeling the strength flowing gently back. I had been utterly unprepared for the havoc that the drugs and surgery would wreak on my body. There were extra rolls of flesh that seemed to have sprouted within a fortnight. The belly that appeared as I grew eggs stayed, as did the soft pouches sitting on my hips. My boobs were uncontrollably enormous – the sort of thing mothers-to-be so often take delight in. But, for me, they did not represent an exciting new life change, merely a daily reminder of what I didn’t have. As did the significant amount of internal pain in which the egg collection surgery had left me and which meant that running, and its associated jiggle, was out of the question.
Slowly I emerged from this body that bore no relationship to the one I had built for myself over the previous five years, and took on more and more swims, enriched weekly by the sights, smells and sounds.
Soon, we had a second round of IVF scheduled. I felt fiercely protective towards my own body. Ours was a relatively new love, hard won over miles run and distance now swum. It had taken years to accept that, yes, my body had value, but that value lay more in where it could take me, what it could show me, than in any perceived visual pleasure it could provide for others. I tried to approach this latest quest with the spirit of adventure that had sprung so late in me but proved such a source of joy. I would not yield to any suggestion that my life or my body were lesser if they didn’t incorporate motherhood.
Resolute about keeping my fitness up, I swam lengths twice a week in the pool and continued to swim in the sea, even as the heat slowly started to ebb from it. The day before my second egg collection surgery, I swam in the mouth of Shoreham harbour, feeling my muscles read the movement of the water and warm my blood against the autumn chill. I had rebuilt myself. I was ready.
This time, the treatment went well, and a few weeks later we had a positive pregnancy test. It was followed by the heartbreak of miscarriage. The first round had been disappointment, a setback. This round was crushing grief. My body had betrayed me. Where I had found strength, I now saw inadequacy, insufficiency, weakness. Where I had found beauty, I now saw flesh that served no purpose: a nascent belly, swollen from medication but aching with emptiness, uncontainable breasts bursting with anything but sexuality. Where I had felt self-love, I now saw an unwelcome stranger in the mirror. My body had been rejected, and in turn I rejected my body.
The first time I felt strong enough to get back into the water was in December. I underwent a full winter of cold-water swimming. I never chose to do it; I just chose not to stop doing it. Where so many other plans around me had turned to dust, in one area at least I just had to keep going.
Jumping into cold water if you are not accustomed to it can put huge pressure on your heart, send your breathing into potentially unrecoverable erratic fits and starts, and leave you woozy with hypothermia – too sleepy to swim, too cold to recover. You can’t fight thermodynamics any more than you can fight infertility. But you can adapt. You can acclimatise. You can find joy where others see pain. And this was what I chose. To keep swimming, week in, week out, until what had seemed like an impossibility became golden, a delight.
Through January, February and on towards March, the coldest month, I carried on swimming. Though the sea temperature dropped incrementally each week, my body, as it slowly acclimatised, felt the same each time. After five minutes or so, my body would start to warm me from within, the hard work of the swimming pushing heat as far as it could out into my limbs. My skin would glow red, as if I’d received a thousand tiny slaps. Within half an hour, I would be glowing from within, warm for the rest of the day. Like a hangover in reverse, I had done something that was painful for moments but that left me feeling well for hours. I had made the difficult habitual, the habitual easy and the easy beautiful.
That winter of swimming was a sort of inadvertent exposure therapy. A type of behavioural therapy used to treat anxiety disorders, exposure therapy usually involves helping people to confront their fears by exposing them in tiny, almost insignificant amounts to the thing they are most afraid of.
There are people all around us dealing with sickness, injury and upset, but they choose to keep moving
Over the winter, I repeatedly exposed myself to the elements. As I hit the water day after day, I took myself to a place I never thought I could go. Previously distressed at having reached the limits of what my body could do for me, I rediscovered pride in what it could achieve and where it could take me.
More importantly, I was exposing myself to myself. That winter, I was the heaviest I had ever been. At the time, it felt like weakness, like surrender, but now I see that what felt like unnecessary blubber from hormones, grief or greed was keeping me warm, keeping me in the water to do what I needed to do. To thrive at the weight I was felt not just subversive, but a triumph.
I was emerging from the water calm but energised. I could do more than I’d imagined, and the more I swam, the more I witnessed others experiencing this alongside me. As I glided along in the lido, I saw women slowly easing themselves down the steps, scars the length of their thighs. I saw injured shoulders ahead of me, struggling to swing their arms around but finding fluidity and peace in the water. I saw women who arrived at the seafront jangling with panic or sadness, leaving it serene an hour later.
These quiet, everyday gladiators battling the wet and the cold showed me time and again that it wasn’t just me who headed for the water in times of distress. There are people all around us dealing with sickness, injury and upset, but they choose to keep moving instead of standing at the edge of life, peering in.
When I think about never having a child, a sort of breathlessness, almost a vertigo, comes over me. The same metal vice tightens around my ribcage, the one I felt as I entered the sea those first few times. I don’t know if we will ever have a child. I don’t even know if we have it in us to try IVF again. But I never know for sure what swims beneath me as I push myself through open water.
Swimming has taught me about my adaptability. It is not enough simply to train hard. You must adjust how you move, refine how you approach the water and embrace your environment. In swimming, as in life, I found fortitude and resilience when I needed them most; but I also found the courage to change depending on the weather, the tide or my own body. I have learned not to be frightened; that life is to be lived as a participant, not a spectator.
The most useful thing anyone said to me about grief is that you never really get over it. When you have difficulties with fertility or staying pregnant, the whole experience is a process of accepting that grief might be round the corner. But is that not the very nature of love? To fall in love is to expose yourself to infinite potential for rejection or pain, and to be a parent is to accept a lifelong commitment to the unknown. To love truly is to know that you might lose it in a heartbeat. In the same way that you never know if the wind will change when you’re half a mile from the shore, or the waves might smash you in the face just as you gasp to breathe. We must stand on the shore, proud of the life our bodies offer us, and accept that we’ll never truly know what lies beneath the surface any more than we’ll know what lies ahead. And then we must leap in.
• This is an edited extract from Leap In: A Woman, Some Waves And The Will To Swim, by Alexandra Heminsley, published next week by Hutchinson at £12.99. To order a copy for £10.65, go to bookshop.theguardian.com, or call 0330 333 6846.
My swimming odyssey: ‘It felt like a last chance to prove what I was capable of’
16 Ekim 2016 Pazar
Could Brexit prove terminal for the NHS?
All human life is in Homerton hospital’s car park. Or at least, passing through Homerton hospital car park on the way to A&E or outpatients or maternity. A Bangladeshi woman in a wheelchair. A Hasidic Jewish schoolboy with ringlets and a limp. A bearded hipster with a newborn baby in a plastic carrycot. Inside there are nurses from the Philippines, from Spain, from Italy, from Gambia, from the Caribbean. There are doctors from India, and radiographers from Germany, and anaesthetists from Pakistan, and cleaners from Ghana, and midwives from Nigeria. To cut to the chase: there is everyone from everywhere. And of course they’re not alone in this. With more than half of all doctors coming from abroad – as they have since at least the late 60s – Homerton hospital in the East End of London is like every NHS hospital in every city in Britain.
On the morning of Friday, 24 June, this was a fact that struck Junaid Masood, a Pakistani-born, British consultant urologist when he came to work at Homerton – and it struck him in particular as he looked around the theatre where he was about to operate. “It was the morning after Brexit,” he says. “Everyone was shocked and depressed and I just had this moment of clarity because I looked around and thought, ‘Oh my God, every single person in this operating room today is from the European Union. So, at the end of surgery, I got everyone to hold up a placard saying where they were from and put it up on Facebook. And then it just went nuts.”
It really feels like a loss of innocence to have a symbol of British tolerance dragged through the mud in this way
The picture of his team, smiling in their blue surgical scrubs, featured an Irish radiographer, a German consultant anaesthetist, a Greek urology registrar, three Spanish nurses and himself. It immediately went viral. The Facebook post was shared 19,000 times, tweeted hundreds of thousands of times, spawned copycat photos from NHS hospitals up and down Britain and ended up on the pages of newspapers across the world.
Their smiles, however, look almost innocent now. Last week, the rhetoric of anti-immigration became wrapped up in the survival of the NHS, an institution that has been built upon the hard work of immigrants for almost its entire history. The health secretary, Jeremy Hunt, announced to the Conservative party conference that the NHS needed to become “self-sufficient in doctors” by 2025. It needed to end its reliance on foreign doctors, and it would do this by training an extra 1,500 medical students a year.
This was news to everyone, not least those working in the NHS, or heading up our medical schools or the British Medical Association, because apart from anything else, the numbers simply don’t stack up. “It’s completely unrealistic,” Deborah Gill, the head of UCL medical school, tells me. “It’s a drop in the ocean. An extra 1,500 students is going to make no difference whatsoever.”
But that doesn’t make it any easier to hear. Leonidas Karamountzos, the Greek registrar in Masood’s photo, looks uncomfortable when I ask him about it. “It can make you feel… look, I’m not going to say unwanted. Everyone is so polite. But if you keep hearing, ‘we don’t want any more immigrants, we don’t want foreign doctors’, it does make you feel unwanted in a way. I’ve been here six years, and of course I’m gaining from the NHS, I’m gaining experience, I’m getting paid, but it doesn’t feel fair that after six years you have people saying, ‘You know what? We don’t need you any more. We think we can do without you now, OK?’
“Because I don’t think you can do without us. That’s the thing. But then you get up and you go to work and you try to help British people get better.”
Masood and Karamountzos are telling me this in the tiny gap between their morning clinics and their afternoon surgeries. “It’s absolutely chaos this morning, I have to be honest,” says Masood when he greets me. “The clinic is massively overbooked. But this is what always happens. And you spend 10 minutes more with one patient and there’s a massive knock-on effect and this happens every week, unfortunately, and I’ve got to rush upstairs because I’ve got four patients that need surgery this afternoon.”
This is a familiar story to everyone who’s ever used the NHS. But what’s new is the toxic language of immigration coming up against the day-to-day reality of the NHS. This does feel new and ugly and unwelcome – and, for the 101,000 doctors born overseas who work in Britain, and the 140,000 nurses, and the 64 million of us who depend upon them, it’s a depressing new departure.
Until now, the NHS has been a place apart from what happens politically. It is an institution, something so fundamental to our sense of Britishness that it has somehow managed to resist the xenophobic tide that has become such a feature of British public life. It is something that survey after survey tells us we hold precious; that touches every person in the country, in the most personal, intimate way. And the whole fabric of its continued existence relies on immigration.
Roberta Bivins, a professor at Warwick University who is undertaking a major project to map the cultural history of the NHS, tells me that although the NHS has been leveraged as capital and ammunition by politicians since its very inception, there is something new at work. “We expect the NHS to be above all that. It really does feel like a loss of innocence to have something that is a symbol of British tolerance and cosmopolitanism and egalitarianism dragged through the mud in this way. It is truly shocking.”
The NHS is one of the unique things that unites us as a nation, she says. “It’s a fundamental part of British identity. It’s been something that has represented how much we believe in equality. What I’ve found is that the NHS is constantly framed as the space that proves that Britain is a tolerant nation. Where racial and class and ethnic barriers are overturned. Where you can go and expect Britain to be at its best. Your doctor may have come from anywhere, and you will be treated the same as anyone else.”
And that is still true. “I don’t see people and think, ‘You’re British. You’re Afro-Caribbean. You’re whatever,’” Karamountzos tells me. “For me, a patient is a patient. It doesn’t make any difference to me. Patients are patients and doctors are doctors. This is what counts.”
And for at least 40 years it’s been where the differences between us have been erased. “The NHS would never have survived the pent-up demand from the interwar years had it not been able to import staff from Africa and the former colonies,” says Bivins. “That has always been the price of universal access, and it has been enormously benefiting to British society.
“Even by 1968, 46% of all doctors below consultant came from abroad, and 30% of all nurses.”
What’s more, for much of the UK, she says, it was the first place where middle Britain came across multiculturalism. Part of Bivins’s project is a “people’s history of the NHS”, and as such she’s been gathering stories, “talking to lots and lots of people, and for many, especially older people, they’ll say it was the first time they met a black man or so on. It was where middle Britain met migrant Britain, and in a totally non-negotiable way. It’s the one place where you’d be mixing with people who are not like you, whether in terms of class or ethnicity – and who you’ll be dependent on during some of the most intimate and important moments in your life.”
It was the opening ceremony of the 2012 Olympic games, she says, Danny Boyle’s great visual poem to the NHS, that made them start thinking about the central role the NHS plays in Britain’s cultural life. “And what is astonishing is how much the attitudes and rhetoric have shifted since then. It’s been quite amazing – and depressing – how that has happened in just four years.”
Boyle’s co-writer for the ceremony was Frank Cottrell Boyce, who tells me that the section on the NHS was “Danny’s passion”. He wanted the ceremony to be emotional. “The NHS is where British people are born and where they die… It’s a huge unifying force in British social life and the point of entry for thousands of migrants.” Boyle “really put himself on the line for it – threatening to leave when they suggested cutting it”.
By “they” he means the government, and it turns out there’s a thread here. The culture secretary at the time? Jeremy Hunt.
The BMA – which represents 170,000 doctors – knew nothing of the proposals before Hunt’s party conference speech was made. They were not consulted. The head of the Royal College of Physicians, Jane Dacre, points out to me that 40% of new consultant posts are already not being filled. At UCL, Deborah Gill says that while they welcome lifting the cap on the number of medical students they’re allowed to admit, they’ve no idea how it will be funded, if there will be enough foundation placements, or why it has anything to do with foreign doctors “coming over here, as they do, curing our patients and paying their taxes”.
Nicola Strickland, head of the Royal College of Radiologists, tells me she believes the situation to be desperate and that Hunt’s proposals cannot possibly solve it – in fact, that they are likely to make things worse. To put it into perspective, she points out that only a tiny number of the extra 1,500 students will choose to go on and qualify as radiologists, and they won’t come through the system until 2030, or 2032 for clinical oncologists who the college also represent. “And by that time,” she says, “we’ll be lucky if we have a health service for them to work in.”
Every specialism perhaps believes that its own is most crucial. But Strickland makes a convincing case for how the crisis in radiology recruitment will break the entire system. “It underlies almost every single diagnosis these days, and demand is going up exponentially. It’s increased by 29% in the last five years. But there is simply not the staff. We have hard solid data that shows that we need 260,000 extra trainees a year for the next five years even to catch up with the rest of Europe. We know this for an absolute fact. We are currently tied third bottom with Turkey. Imaging underlies every part of the health system and without it the entire health system will fall apart. I am desperate to get this message out there, and nobody is listening to us.”
A third of radiologists already come from abroad and they are trying to recruit more, but already one in 10 consultant positions is vacant, unable to be filled. “If you believe passionately, as we all do, in free healthcare at the point of need and you see that being destroyed… well, it’s very depressing and demoralising,” says Strickland. “Already 230,000 people are having to wait a month to get the results of their scans and that’s just not right. It causes stress and anxiety, and delays life-saving treatment. We are trying to tell everyone we can. We could train people but the money is not being made available and it’s going to break the health service. I really mean that.”
It’s hard as an outsider to understand quite how big a crisis the NHS is in – if it really is as bad as Strickland says, or if it has always gone through these sorts of episodic cycles. But Anthea Mowat from the BMA tells me that it is real and that the collapse in morale is like nothing they’ve ever seen. “We’ve just done a survey, doctors 10 years post-graduation, and 42% of them say it’s much worse than they expected, and approximately the same number plan to go to work overseas because they don’t feel valued in the NHS.
“We’ve got to the point that our own UK-trained doctors don’t feel valued. And now we don’t value our overseas doctors either.”
In fact, Masood tells me that his department, for the first time, has a vacancy for a registrar and no applicants. “This has never happened to us before. We haven’t had a single applicant.” And a university hospital in London is a more attractive proposition than many posts, such as a GP in Stoke-on-Trent, for example, where 65% of GPs are already from outside the EU. Chandra Kanneganti, head of the British Indian Doctors’ Association, who runs three practices in the city, tells me there are currently 34 vacancies. Most of them have been empty for a year.
But then, he says, because of visa changes it’s almost impossible for Indian doctors like himself (he’s originally from Hyderabad) to come and work in Britain. “Instead they go to the US, to Australia and Canada. In the 1960s, general practice in Britain was on its knees and it was my colleagues who came in droves to work in the inner cities and places no one else wanted to go. They saved the NHS, and the government needs to recognise this and not make this kind of politically motivated attack on us.”
I try to end the interview with Kanneganti, but he won’t let me go. “I am so proud of the NHS, and I love this country. I love it for the way it recognises talent and hard work. And we do work hard and we pay taxes and we do not take benefits and all we are saying is, please recognise this.”
It’s madness that someone as accomplished and hard working as Kanneganti feels the need to justify his position. Or Nancy Ifill, a sister in the emergency department of Whipps Cross hospital in East London. I catch up with her at 11pm, just after she’s arrived home in Colchester, Essex, having left the house at 6.30 that morning. She’s originally from Barbados, came here in 1989 and is now a British citizen. So does that mean she doesn’t feel the insecurity that many non-UK NHS staff feel? That they might not be able to stay.
“I would never say I feel totally secure. You just don’t know. With Brexit, it feels like if they want you to go back, they could. I don’t know if this is being fuelled by Nigel Farage and his ideologies. It’s a similar thing with Trump and Hispanics, but it makes you feel like you really don’t belong. Like you’re a lodger. And when we’ve had enough of you we’ll put you out.”
Does it upset you? “Of course it does. At the end of the day you come here, you contribute to the system. You’re not mooching off the state. And it’s a significant contribution. A society cannot function without a healthcare system. If you don’t have a healthcare system, you don’t have a society. And for people to think that you don’t matter… well, it’s a bit tragic.”
Her colleagues at Whipps Cross are from everywhere. In her team, “I can probably count the number of ‘home-grown’ nurses on one hand. ‘Home grown’! It’s such an insulting, derogatory term.
“Who is this organisation made up of? It’s foreign people. Whether they are nurses, cleaners, doctors, the great majority of people working in the largest organisation in the world are foreign people. If you remove them, you won’t have a system. This institution is at the heart of British life and it’s made up of foreigners.”
It is, and it’s where the ideology of Brexit strikes against the idea of ourselves as a people in the most intimate way possible. Because the NHS is where we are literally at our most naked and vulnerable. It’s at the heart of what we believe it is to be British. We are – as every staff room in every hospital in every British city shows – a country that depends upon the hard work and contribution of people who have come from elsewhere. Who are there when we’re born. And there for us when we die.
We hope.
Junaid Masood, consultant urologist, Homerton hospital, London; British, born in Pakistan
“I came to Britain at a young age because my father came to work here as a doctor. The comments by the health secretary last week were almost like an anti-recruitment message. Jeremy Hunt sort of yelling to the world, ‘Don’t come to Britain because we don’t want you.’
“We’re going to really struggle massively to get skilled staff now. I’ll give you one small example. We have a vacancy for a registrar. This is a good job in a good hospital and we have not had a single application. I don’t know if that is a coincidence, but this has never happened before.”
Leonidas Karamountzos, urology registrar, Homerton hospital; Greek
“It’s made the future very uncertain. I’m not sure what I’ll do now. I’ve had so many colleagues in Greece say to me, ‘Oh, you made a mistake. You went there. Now you’re going to be kicked out.’ It’s certainly going to put other people off coming.”
Could Brexit prove terminal for the NHS?
4 Ağustos 2016 Perşembe
"Less sex? We just have less to prove": millennials on sexual encounters
Millennials – people born between 1980 and 1995 – will be familiar with studies making claims about them, from observations on their eating habits to their anxiety levels. But now their sex lives, or lack thereof, are also being put under the microscope. A US study suggests that young people born in this bracket are less sexually active than previous generations.
This was found to be particularly true for younger millennials born in the 1990s, sometimes referred to as the Snapchat generation.
Eight young people shared their views on this story, based on their experiences:
Helen, 25, Hampshire: my generation is very comfortable talking about sexual identity
I don’t think millennials are having less sex. In my group of female friends, we talk about sex openly and are very comfortable discussing our sexual identity (there is very little or no judgment on this from others).
There should be more information about female sexual pleasure. Websites such as OMGyes should be given more attention. We are really lacking in proper sex education too, especially information about sexual identity and female pleasure.
My biggest fear around sex is getting pregnant. My partner and I practise the withdrawal method (I couldn’t cope with the psychological effects of the pill or the implant). We both hate using condoms. Having had more than my fair share of brief encounters, sex for me is infinitely better in a long-term, loving relationship. It’s much better when you can be completely honest about what you like and dislike, and let yourself go.
Hatty, 25, London: to millennials, the older generation’s obsession with sex seems really backward
Millennials are not less interested in sex, we just have less to prove about it.
In the UK at least, 1990s “ladette” culture saw young women proving their feminist credentials by being more like the boys and having more casual sexual encounters than they might actually have wanted to. Millennials, on the other hand, have no pressure from family to remain virginal (my mum put me on the pill and bought me condoms without batting an eyelid), but also no pressure to be sexually liberated either.
There is also less pressure on men to be macho about sex. I have a male friend who waited until his early 20s to lose his virginity, because he wanted it to be within the context of a loving relationship and he wasn’t afraid to tell people that.
To millennials, the older generation’s obsession with sex and their highly restrictive gender-normative approach seems backward.
Abby, 24, London: young people lack information about sexual pleasure and orgasms for women
Millennials are as interested in sex as any other generation and they want it just as much. Whether or not we are doing it as much, I am not sure, but a quick search on Tumblr will show you that there’s no shortage of interest.
The difference is perhaps that asexuality is now more acknowledged and accepted. People are more comfortable admitting that they have no interest in sex.
People are now more comfortable admitting that they have no interest in sex
Before I started having sex, my biggest fear was that I would be a virgin forever. Now that I’m in a relationship, I don’t have any huge fears or anxieties, apart from worries about getting pregnant. But I’m on the pill and I’m careful, so I’d have to be very unlucky for that to happen.
Young people lack information about sexual pleasure for women. There’s so much information on the internet, if you know where to look, but there are lots of teenage girls and young women who are too focused on male pleasure. It’s important for women to enjoy sex too.
Floarin, 25, London: we now live in an overly sexualised world – maybe that’s led to sex fatigue
I don’t think young people are less interested in sex. We may be even more interested in it. Attitudes have changed and we can speak about it more openly than perhaps our parents did. That said, society is saturated with sexual imagery, so much so that we’ve almost become desensitised to it. That could have an impact on our sex lives. Almost a form of fatigue, where we think about it often, but don’t necessarily engage in it as much.
But that’s very much conjecture. They’re just extrapolations. You only have to look at what they allow before the watershed now, in comparison with only 10 years ago, to see that we live in an overly sexualised world.
Jordan, 26, Essex: nowadays people prefer to stay in, rather than go out and interact
There are many reasons why millennials are less into sex, the main one being the rise in technology. Social skills are dependent on human interaction, and nowadays people do not make effort to go out and meet others, they prefer to stay in and interact online instead. This coupled with worries about contracting sexually transmitted diseases means a lot of people would rather just stay in and watch porn.
Brian, 33, London: our generation has a very different view around sexual identity. We are much more open
I believe interest in sex has increased massively due to the internet and social networking sites. People can now interact with anyone they like through a variety of dating apps. Our generation also has very different views around sexual identity. We have more words to describe sexual identities and lifestyles, such as bi, trans, asexual, polygamous etc. We are much more open.
Alice, 21, Newcastle: I feel really insecure about sex, and there’s less attention given to this
Perhaps my generation is less interested in it – I certainly am. I feel insecure about having sex and there’s less attention given to this. I think advice about performance would be helpful. Instead, people think the only thing young people worry about is sexually transmitted infections and getting pregnant.
Sex has become less important, possibly because of our overexposure to it – it’s all over TV screens, in films and on the internet. We have become less interested in the intimacy of it as a result. As a generation, we also have a lot of other sources of stress that impact on our desire to have sex. I do also think technology has made us less likely to engage in real human interaction, which includes sex.
Bella, 19, Scotland: we’re much more worried about sex
People are just as interested in sex, but we’re just so much more worried about it. I’m still a virgin, I’ll admit that, and it’s not that I haven’t had the opportunity or that I don’t want to have sex, it’s that the idea of engaging with someone like that scares me. I felt all our sex education was very much done in the spirit of scaring us away from pregnancy and STDs. It felt almost like we were being taught abstinence.
Dominic, 26, China: online porn really put me off sex
Many friends, myself included, are choosing not to have relationships and feel no social pressure to have casual sex. I’d like to think that this is because we’re more interested in other things, but these other things may well be Netflix and pointless mobile apps. The last generation were promiscuous, in part, to be rebellious in the eyes of their peers. Nowadays, there’s no social pressure to have sex. Perhaps now we are having sex as much as we actually want.
Online porn really put me off sex as a teenager. I gradually started to find it disgusting and addictive until I quit for many years. But now I understand that it can be part of a healthy sex life if it is not overconsumed.
I am looking for a relationship instead of brief sexual encounters now. I enjoy those special moments when you realise you might like someone, the first nervous touch of their hand or a shared smile. I love how messy and complex love can be, but in my mind, sex and love are two separate things.
Katie, 26, London: I don’t feel like my sexuality belongs to me, it’s just something people use to sell products
The ubiquity of sex has made us a generation obsessed with it, but terrified of the reality of it. We’re also a generation without privacy. As a young woman, I don’t feel like my sexuality belongs to me, it’s just something people use to get clicks or sell products. Just look at the recent Marc Jacobs ad – who is this for? It’s for men, so they buy it for their girlfriends.
I’m lucky enough to be in a happy same-sex relationship, but there’s no privacy in shared houses and there’s nothing sexy about hearing your flatmate snoring/wanking/watching Game of Thrones in the background as you try to have an intimate moment. And as there are far fewer real life spaces for gay women to meet other gay women now, before I found my partner I felt isolated and like queer sex between women was more about men being entertained online, rather than a real and meaningful experience between two people.
Jennifer, 23, London: people have become really bad at having flings and casual relationships
As a historian who focuses on the history of sex and sexuality, I can tell you that the enjoyment and desire for sex is timeless. What I think has happened is that people have become really bad at having flings and casual relationships. One night stands are pretty limited to nightclubs, and who goes to nightclubs any more? Plus no one is interested in mediocre one night stand sex.
But there has become such a fear culture surrounding relationships. Guys are scared to see girls more than twice, in case they accidentally end up with a girlfriend. Girls are scared to admit to guys that they are just looking for a fling or a casual arrangement, in case they look easy and it decreases their value as a woman. Deep down, we know it’s all bullshit, but we’re all inadvertently feeding this commitment-phobe madness.
- Some names have been changed
"Less sex? We just have less to prove": millennials on sexual encounters