Science issue: Women’s Health Care in Prison

6B Annie Bartlett

News

Annie Bartlett is an experienced clinician who describes how her clinical practice is affected by ethical, social and political considerations.

The recent movie “Suffragette” includes some disturbing scenes inside HMP Holloway, a large London women’s prison in which c 500 women are detained. Force-feeding is portrayed; the doctor in the prison, inevitably at that time a man, participates in an alarming restraint. He is attempting to prevent women hunger strikers, suffragettes, dying of starvation. Compelling film making, not least to those of us who have worked in the prison more recently and been confronted in a daily basis with different but equally complex, clinical and moral dilemmas.

There are less than 5000 women prisoners in England and Wales, distributed around 12 prisons. Their needs are complex and their health status often poor. Since 2006, the NHS has been responsible for prison health care. There has been a serious attempt over the last decade to provide these women with health services on a par with those in the community. Women present with a mixture of health problems. Most women in prison are less than 35 years old but they come with the consequences of chaotic lives, poor nutrition, minimal regular exercise and often significant drug and alcohol problems. Many will have lost contact with parents, friends and their own children. Importantly, they will usually have been subject to physical and sexual victimisation, often within their families or from their adult partners; they carry the psychological scars of these experiences as well as, sometimes, showing remarkable resilience.

So the challenge for those of us involved in their care is often to know where to start and to agree, with them, a plan of campaign. Frequently, this will involve rapid decisions about the substitution of prescribed medication for illegal/ toxic drugs of abuse. When they are through the detoxification regime, it means seeing what problems lie beyond the fog of self-medication for a damaged life. This demands not only sound clinical skills but the imagination to see into others’ lives and to work with people not diagnoses. This is a challenge to those who might see the practice of medicine as only a science.

The seriousness of these women’s health problems can be juxtaposed with the usually minor nature of their offences. These are women for whom the appropriateness of imprisonment is hotly debated, not least because their chances in life are worsened by the experience of jail, not enhanced, whatever clinical care we provide. So, medicine sits in a politicised arena of care. Doctors and other clinical staff are potentially morally contaminated by such a close relationship with a still coercive and perhaps misguided state but also obliged to offer care to those who most need it. Luckily, the last ten years has also provided considerable opportunity to thrash these issues out publicly; health commissioners and providers and prisoner patients have found some space to have conversations about what health care can and should do.

Annie Bartlett
Alumna

Annie Bartlett is Professor of Offender Health Care at SGUL
abartlet@sgul.ac.uk

Other Reading
Corston, J. (2007). A review of Women with particular vulnerabilities in the Criminal Justice System.
Home Office www.justice.gov.uk/publications/…/corston-report-march-2007.pdf

Ministry of Justice (2012) Prisoners’ childhood and family backgrounds. Ministry of Justice Research Series 4/12 March 2012. Ministry of Justice: London.

Career Path: Exploring fingerprints from the Big Bang

Reader in Astronomy at UCL
Picture by Max Alexander

Career
I am a cosmologist. In my research, I am contributing to an international effort to understand the origin and the evolution of the Universe. It is amazing that this is even possible, because it involves extreme physics that we cannot replicate in the laboratory. However, at the Big Bang, the Universe itself performed the ultimate physics experiment. The clues to this physics are imprinted upon the oldest light we can see in the Universe, the so-called cosmic microwave background, and the large scale distribution of galaxies. Because the ultimate experiment was done once, and we can’t repeat it, cosmologists have to become detectives. Different theories of the universe produce different fingerprints in these data, and we sift through the fingerprints looking for which one matches what we observe. We are trying to piece together the clues to figure out the narrative about how our Universe began, and how it is evolving. In the past decade we have been able to precisely answer age-old questions such as how old is the Universe, what does it contain, and what is its destiny. Along with these answers have also come many exciting new questions.

Reader in Astronomy at UCL
Picture by Max Alexander

Modern cosmological research is a very collaborative and international enterprise. My work involves a lot of mathematics and high performance computing, the development of advanced algorithms and highly specialized databases to store and sift through the massive amounts data returned by cosmological sky surveys. Some of this work requires me to work in small groups with two or three other researchers, but I also contribute to large global projects with several hundred people in many countries. Since cosmology is very international, I travel extensively, discussing research findings, giving talks, and running workshops and seminars. I also enjoy sharing my knowledge and enthusiasm with my undergraduate and postgraduate students at the university.

Young women today should consider choosing to study the sciences because scientific research is intellectually stimulating, fun, and enables a huge range of careers within and outside academia.

“Blue skies” research is extremely important for our society, and for humanity as a whole, because one can never predict where the next breakthrough is coming from. In addition, science students are trained to think independently and out of the box, and they are adept at using incomplete data to reach useful and robust conclusions. They are often excellent computer programmers. They have great communication and time management skills. For these reasons they are highly sought-after in industry, engineering and finance.

Professor Hiranya Peiris
Alumna (New Hall/Murray Edwards College)

Prof. Peiris is Professor of Astrophysics at University College London.

 

Science at Cambridge: Engineering

5D Kate WilkinsonUniversityMy name is Kate Wilkinson and I have just started my third year of engineering at Murray Edwards.

I had enjoyed Chemistry, Biology and especially Physics at school and college, but was finding it hard to narrow down my interests. My combined interests in science and design led me to attend a Headstart summer school programme for engineering after my first year of college.  I spent a week in another college at Cambridge attending lectures, working on mini-projects and enjoying a taste of university life. This allowed me to discover that engineering is a fascinating combination of all of the sciences applied to real-world problem solving, with room for a creative flare. I became certain it was the right degree for me.

After two years studying the foundations in all areas of engineering, I decided to specialise in Electrical and Information Engineering. For me this choice was significant as I had begun the course wanting to become a Civil engineer.  I never expected to find electronics so engaging. The great part of the course at Cambridge is that it gives you time to identify your areas of interest before you make a commitment.

At the end of last year I had an opportunity to attend a lecture course covering an introduction to Bioengineering. It investigated the structure and function of the eye and retinal image processing in the brain. Although based on biology and neuroscience, the course incorporated many of the engineering analysis techniques we had learnt over the past two years. I was particularly fascinated to learn about the ongoing development of retinal implants comprising a microelectronic chip with light sensitive pixels, which can partially restore sight. I think it is amazing that we can use electronics and information engineering principles to interface with one of the most complex and little understood organs in the body – the brain. It also demonstrates the wide range of areas engineering principles can be applied to.

This year I will take a neuroscience course with the intention of understanding more about the technology that can interact with and simulate stimulus processing in the brain.

I love the practical aspect of engineering, and the part of my course that separates it from the other sciences is the opportunity to apply scientific knowledge to hands-on design. So far this has included scale model bridge building, and the design and testing of a robot.

I would encourage others to study engineering as it is an amazingly diverse field, and you acquire a set of skills that you can apply to so many different career paths. I would thoroughly recommend attending an engineering summer school, or even spending a day work-shadowing, to get a true feel of the subject.

School Winner: What is Chemistry?

Winning Entry William Hulme's Grammar SchoolTwo Winning Entries - WGS & WHGS5C Larissa portrait croppedSchoolAt school they give you an overview. But of course, it doesn’t end there. At college you get more info, at University you get the whole lot. But in life and throughout history, everything to know about chemistry is still endless.

I mean, it took scientists until 1897 to realise that atoms weren’t the smallest things in existence. With this in mind, imagine how many more theories are waiting to be realised and acknowledged. Asking questions about chemistry is truly the best way to find out what ‘chemistry’ actually is.

At one point I said to my mum “Are we made up of cells or of atoms?”. As it turns out we’re made of both! At least I managed to get a clearer vision of chemistry. In fact it made me realise that it seems almost impossible to imagine the size of an atom. Honestly, how can something be THAT small? And even then, how could you possibly imagine the size of sub-atomic particles!

My Mum is a great inspiration to me when it comes to science. You see, she did the whole University life. She got her Masters Degree in Physics at the University of Manchester. Let me also add that she often spoke to the Nobel prize winners for the discovery of graphene! Yep, my Mum is amazing. And even after 4 years of studying science, she says she’s not all that good at it. A couple of years ago I joined my Mum in her workplace in order to gain work experience. I was surrounded by mass spectrometers and large machines that I had absolutely no idea how to use, or even what they did for that matter! Over the week I learnt the different parts of the mass spectrometer and even more about the company. What fascinated me was the function of each part and each object in a mass spectrometer. I even took part in the construction of one section called a ‘quad’. To me, what I built just looked like a weirdly shaped perfume bottle… but apparently it was an essential part to the mass spectrometer. Having actually built the quad, I understood more about how it works. For example, the rods are used to move the ions through the mass spectrometer using forces of attraction. (Or at least I think so, I can’t remember everything from 2 years ago!)

Another interesting thing I learnt was how mass spectrometers are adapted for more practical uses. One example is that of the I-knife (a.k.a. intelligent knife). This piece of technology can be used in medicinal ways: surgeons for cancer patients will use the I-knife as it will be able to identify cancer cells against healthy cells. Thus allowing the surgeon to only remove cancer cells during the procedure.

Isn’t that soo amazing?? As a matter of fact there was actually  a documentary covering the use of mass spectrometers in this way, I felt smart watching it as I already learnt about it during my work experience J.

To return to the point, “What is Chemistry?” I guess all we can answer to that is the different knowledge surrounding Chemistry and even science altogether! Chemistry can be considered the study of different topics such as mass spectrometers. Although, to be more imaginative, one could say that chemistry is the exploration into the unknown to discover and push the boundaries of knowledge. And that is why I love it.

Larissa Aravantinou
William Hulme’s Grammar School

My name is Larissa Aravantinou and there’s not a lot to know about me. Ever since I was younger, I have admired my Mum’s passion for science and particularly physics, although I was pretty bad at physics myself. Instead my mother inspired me to find something I love to study, and I found chemistry. Undoubtedly this is one of my favourite subjects just because I simply enjoy learning everything there is to know about it. I am studying Chemistry as an A level in the school that I have been in for the past 7 years and I absolutely love it. I hope to carry on studying chemistry later in life and eventually follow my mother’s footsteps in finding a scientific career path. 😀 😀

School Winner: Obesity and the ‘fat gene’

Winning Entry Withington Girls' SchoolTwo Winning Entries - WGS & WHGS5C Radhika portrait croppedSchool
Obesity today is one of the biggest burdens on the United Kingdom’s economy; an incredible £47 billion is spent a year on obesity-related illnesses. It does not even stop there; people today are increasingly becoming more and more obese due to the abundance of food in developed countries, so the cost will continue to rise. In 2014, 67% of men and 57% of women were classed as overweight or obese in the UK using the BMI scale. So what is the underlying issue causing this black hole in our economy?

Finding out the sole cause for obesity is extremely complex as there are many risk factors linked to it and there are many opinions as to what can cause it. There is a theory of the ‘fat gene’ (or more accurately, the fat allele) but there is no solid proof that it exists. Studies have shown that, where it exists, the fat mass and obesity associated gene (FTO) may raise the chances of obesity by 23%, but, it is limited to increasing your body mass by a mere 1kg. This means indulging yourself on holiday is more likely to increase your body mass than this gene. So, is the genetic explanation merely an easy way out of eating healthier food?

Unlike the insubstantial theories about the ‘fat gene’, obesity is directly linked to overeating, physical inactivity and the frequency we eat certain foods with scientific facts to provide proof. Overeating causes obesity because food high in fat and sugar are very energy dense so it is most likely that it is more than your body can metabolise at a time so the molecules are stored as fat. Physical inactivity may also lead to obesity because people who live sedentary lifestyles burn less fat than people with active ones and so their metabolic rate is slower than most. Fat is a large molecule compared to simple sugars, such as glucose, so fat requires more physical exercise to be burnt, because it takes longer to be hydrolysed, therefore it is more likely to be stored.

‘It goes to show we’re not complete slaves to our genetic makeup and really can make a big difference to our future health by changing our behaviour.’
(Dr Ruth Loos)

In conclusion, most of the factors affecting obesity are linked to the metabolism of a person. Metabolism may be genetic because if both parents have a slow metabolism, it may be inherited by the child, but people are able to boost their metabolism through varying methods. The point is; genetics is an element, up to an extent, in how a person’s body may deal with food, but, if you are in a society that gives you so many opportunities to eat fatty foods, no matter what gene pool you come from, obesity may be inevitable for many. It is in our power to alter our metabolism through exercise, drinking more water and eating certain foods. Despite genetics being a factor in obesity, promoting a healthy body image through exercise and healthier eating can make the effects of the ‘fat gene’ redundant.

Radhika Sood
Withington Girls’ School

Hi, I’m Radhika and I am in year 12 at Withington Girl’s School. I have had an interest of science from a very young age, from how you can see cells that are only nanometres in size to the extent of the universe. I am particularly interested in the quantitative aspects of the sciences and I enjoy the several challenges school gives us the opportunity to partake in. In my spare time I enjoy outdoor activities, such as playing tennis and am currently working towards my Duke of Edinburgh award. I also enjoy rock climbing, paintballing and zip lines.