Today was a day full of lectures at BCU’s South Campus. We started with a lecture on Public Health in the UK given to us by Dr. Sara Zarti. She began by explaining to us that in the UK, they view health as physical, mental, and social well-being. This was interesting to hear because in the United States it seems like the focus is just on physical health with a slowly growing attention to mental health, but social well-being is rarely talked about. This health model is reflected by the UK’s three pillars of public health: promotion, prevention, and protection. An initiative that represents the prevention pillar is the Childhood Immunization Programme. In the UK, parents are given a red book that helps them to manage their newborn’s immunization schedule all through childhood. Dr. Zarti told us that as a result, the UK has achieved 95%+ MMR coverage. However, because the vaccine is fragile, it is important for all children to continue to get their MMR vaccines to protect the people not well enough to get the vaccine and prevent future outbreaks. Another program in the UK that Dr. Zarti highlighted was the NHS Diabetes Prevention Programme. This program supports both prevention and promotion. Part of the program educates people and promotes healthy lifestyles which then prevents new cases of Type 2 Diabetes. Overall, the UK prioritizes prevention to reduce the burden on hospitals and works towards equitable care for all people.
Our second lecture was given by two lecturers and two students, they spoke to us about Midwifery in the UK. The first difference that stood out was the education requirements to be a midwife. In the US, the most common way to become a midwife is through graduate degrees. Although, in some states it is legal to be a midwife without certification. Alternatively, to become a midwife in the UK, the most common path is to go to a three-year midwifery program that is approved by the Nursing and Midwifery Council. Another difference is that midwives in the UK are much more involved with all aspects of childbearing than they are in the US. In the UK, every woman who wants one will have a midwife assigned to them during their pregnancy. The midwife will provide woman-centered care from pregnancy all the way through newborn care. The UK values continuity of care because they have seen positive health outcomes associated with it, so that is why women will typically have the same midwife all through the childbearing process. In the US, this is not the case. Having a personal midwife is fairly uncommon and the stages of childbearing are overseen by different professionals. While it is extremely important in the UK that both the mother and child are safe and healthy, the care given is woman centered as the baby has no rights until it takes its first breath.
After lunch, we had a lecture about mental health nursing given by Jonathan Gadsby. Gadsby gave us a deeply personal lecture about his experience as a mental health nurse in the UK. He started by telling us that only a sixth of the mental health beds that existed in the 1950s exist today. He said this is a result of the idea of institutionalization, or the idea that the environment of a psych hospital turns people in distress into psych patients. In the UK, it has become a goal to reduce hospitalizations of mental health patients. The method that the UK is currently using are Crisis Resolution and Home Treatment (CRHT) teams. These teams can visit patients in their homes up to multiple times a day to prevent hospitalization. Additionally, in the event of hospitalization, these teams help to facilitate early discharge. The efforts of CRHT have overtime decreased average hospitalization time from 2 years to 7 weeks according to Gadsby. In his lecture, Gadsby also challenged the idea of medicalization, which is when something that is not necessarily medical (like a person in distress) is treated medically (with diagnoses and medication). He shared with us a story of a patient he saw during his time with CRHT who struggled with auditory hallucinations and had been forcibly hospitalized over 25 times. This patient had tried every medication and injection available to treat the hallucinations, but none had lasting effects. During one visit with the patient, Gadsby suggested that they try using a workbook created by people with auditory hallucinations and mental health nurses. Over the course of 10 weeks, the patient experienced their first period of silence from the hallucinations. While this is a Cinderella story, Gadsby also shared a story when the workbook did not work with a different patient. That being said, Gadsby’s point that jumping immediately to medicating people experiencing distress may not always be the best solution.
We ended off the day with a Heritage Tour of Birmingham led by Marcia. She started by highlighting the importance of telling the whole story of history. She explained that the suffering of black people is often highlighted in history, and while their suffering was (and is) very real and extreme, suffering and enslavement was not limited by race. She taught us that many white people, mainly women and children, were also historically enslaved. She also taught us about the UK’s Windrush generation. This was a generation of mainly Irish and Caribbean subjects of the British Empire that came to the UK after World War 2 to help rebuild parts of England, like Birmingham. These people consensually came to England and worked to rebuild, but 50 years later the British Empire became the British Commonwealth. Although it sounds like just a name change, this change caused issues of citizenship and deportation for the Windrush generation, who had been living in England for the past 50 years. After our discussion in the classroom, Marcia led us on a walking tour where she showed us various statues and memorials to historical figures. Many of these figures, Marcia explained, had both good and bad elements to them. For example, the golden boys of Birmingham helped build the city, but they also participated in the system of slavery. While slavery is undeniably horrible, removing these statues does not remove what happened. Instead, as Marcia had been saying from the very beginning of our time together, we should focus on reframing the narrative and tell the whole story.