Learning to live in the unforced rhythms of grace
I look out of the window and I see
Clear, blue skies
Vibrant colours of autumn blazing
in the morning sun
Crisp frost bringing out the beauty
of our garden.
And yet I know
thick, dark clouds cover our earth
blotting out the warmth of the sun.
Devastation and despair wreak havoc
across the nations.
And where is God?
8 days’ silent retreat at Mirfield
8 weeks’ holiday in Laos and New Zealand
Being able to ‘work’ from home in our lovely annexe, looking out on the Breathing Space garden
Getting more involved in Breathing Space – retreats and quiet days, spiritual direction…
Regular mid-morning coffee, toast and marmalade with Lois
Getting stuck into some exciting new projects
No more mandatory training on manual handling, infection control and preventing deep vein thrombosis
Designing a national child death review system for Jordan
Starting a PhD
Gardening, DIY, walks in the countryside
No more appraisals
Finishing my book on Rembrandt’s Bathsheba
Painting
Just enjoying the peace and beauty of Breathing Space…
Last week I received an email from one of our administrative team at the medical school, reminding me that I have just over two months to fully clear my office – to shred or archive all old research papers and data, get rid of the mountain of books and files, empty my filing cabinet, clear my hard drive, and hand back all my IT and other equipment.
Once I’d got over my initial shock and the reactive ‘I can’t possibly do that, there’s far too much, and what about all that academic stuff I want to keep on?’ I realised that perhaps it wasn’t such a bad thing after all. I do need to wake up to the fact that, come October, I will no longer be a paid employee of the University with all the benefits (and responsibilities and frustrations) that brings. It is also high time I had a good clear out of all the accretions of 13 years as an academic.
When was the last time I opened that file of research interviews I did back in the late 1990s?
So, taking the bull by the horns, I started work on one of my filing cabinet drawers. After filtering through each file, I think I ended up with just two or three papers worth keeping.
This particular drawer held all my case notes from the South West Infant Sleep Scene study I did with Peter Fleming in the early 2000s. As I started shredding the interviews from those early home visits to bereaved families, I reflected on the blessing it has been to meet with, and hopefully offer some support to, so many amazing families.
The dramatic drop in SIDS rates in the 1990s has been one of the most impressive successes of epidemiological research this century. I have been immensely privileged to meet and work with many of the leading researchers from around the world who contributed to this work, and in my small way, to contribute to ongoing research, teaching and practice that has seen SIDS death rates continue to fall to this day.
At times it has been truly heart-breaking to meet with families in the horrendous trauma of their child’s death. But it has also been encouraging to know that the work we did in Bristol and elsewhere has contributed to more compassionate and thorough responses to unexpected child deaths. I have, over the years, had many expressions of thanks from bereaved families who have appreciated the care and support they have received from my colleagues in health, police, and social services.
And, even more encouragingly, over the course of my career, I have seen the numbers of children’s deaths decrease.
When I started my medical training in 1982, nearly 8,000 children in England and Wales died before their fifth birthday. By the time I started work as a consultant, that figure had fallen to less than 4,500. Now, as I retire, the figure is just over 3,000. Just looking at the past two decades, that suggests there are 15,000 children and young people alive today who might not have been if our mortality rates had stayed at the 1997 level.
Has my work contributed to that fall?
Perhaps I will never know, but I like to think that, in some small way, my research and teaching and the little steps I have taken to engage with individual parents and children might have made a difference to some. And perhaps, with so many others making their small contributions, we may just be moving towards a world where children don’t die.
‘Over the last 40 years, child sexual abuse (CSA) has become a regular, if discomforting, focus of public concern and attention. A constant stream of news items, investigations and arrests, public inquiries and statements from politicians and authorities can leave the impression that child sex offending is being countered by the full opposition of the state and community. This impression is deceptive. There have been, of course, meaningful advances in child protection and therapeutic responses to victimised children and adult survivors, and improvements in public awareness and understanding of CSA. Nonetheless, the challenges that CSA have always posed to child protection, health services, law enforcement and society at large – including the prevalence and secrecy of CSA, the complexities of prosecution and the multiple impacts on victims – remain with us today. Meanwhile, patterns of sexual offending against children continue to evolve with the development of new technologies and strategies for sexual exploitation.’
The latest issue of Child Abuse Review is a themed issue focusing on the ethics and evidence of child sexual abuse. In an accompanying editorial, freely available online, our Australian associate editor, Michael Salter, explores some of the issues raised by the papers.
We include a paper by David Pilgrim which provides a powerful check on impulses towards the minimisation of CSA. The tendency to minimise the abhorrence of child sexual abuse is thoughtfully challenged by Pilgrim, and is addressed later in the issue in a paper by Ethel Quayle and colleagues analysed material from the International Child Sexual Exploitation database. One of their disturbing findings was an increase in self-produced images (sexting), and the high levels of coercion involved in such activity. This adds a challenging new dimension to the ongoing effort to protect children from such abuse.
‘Two‐thirds of self‐produced images involved coercion, challenging the view that self‐produced images are less concerning than those taken by others. Manipulating or coercing a child to produce a nude or sexual image emerges in this study as a common and harmful strategy among online child sex offenders, casting debates on so‐called ‘sexting’ in a new light.’
Two helpful reviews in the issue provide up-to-date research evidence on the causes of CSA (Estelle Clayton and colleagues) and structural brain abnormalities associated with it (Damyan Edwards). The themed issue also includes new research on multi-agency responses to CSA (Lindsay Voss and colleagues) and on the impact of sexual abuse on boys and men – typically an under-researched and overlooked group (Madelaine Ressel and colleagues).
‘The impact of sexual abuse on boys and men is a prominent and ongoing concern’’
Click on the link below to see the full table of contents, read Michael Salter’s editorial and for details of online access.
Editorial: Child Sexual Abuse: Ethics and Evidence. Michael Salter.
Reviews
Academic Disputes about Adult‐Child Sexual Contact: A Critical Realist Appraisal. David Pilgrim.
The Aetiology of Child Sexual Abuse: A Critical Review of the Empirical Evidence. Estelle Clayton, Christine Jones, Jon Brown, Julie Taylor.
Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes. Damyan Edwards.
Original Research
Multiagency Response to Childhood Sexual Abuse: A Case Study that Explores the Role of a Specialist Centre. Lindsay Voss, Helen Rushforth, Catherine Powell.
Children in Identified Sexual Images – Who Are they? Self‐ and Non‐Self‐Taken Images in the International Child Sexual Exploitation Image Database 2006–2015. Ethel Quayle, Linda S Jonsson, Karen Cooper, James Traynor, Carl Göran Svedin.
Abuse Characteristics, Multiple Victimisation and Resilience among Young Adult Males with Histories of Childhood Sexual Abuse. Madelaine Ressel, Jennifer Lyons, Elisa Romano.
Training Update: Eradicating Child Sexual Abuse (online toolkit) by the Lucy Faithfull Foundation, 2016. reviewed by Sarah Nelson
Book Review: Dark Secrets of Childhood: Media Power, Child Abuse and Public Scandals by Fred Powell and Margaret Scanlon, Policy Press, Bristol, 2015. reviewed by Marguerite L Donathy and Nicole Horton
By the time I retire in September, if you include my years as a medical student and exclude my year abroad in Cambodia, I will have spent 35 years as part of the British National Health Service: exactly half the time it has been in existence.
What a privilege to have been able to serve in what I still believe to be one of the best health systems in the world. In a recent poll, readers of the BMJ voted “providing care based on need and free at the point of delivery” as the NHS’s greatest achievement in its 70 years (https://www.bmj.com/content/361/bmj.k2809). I fully agree. Having seen people in Cambodia die because they haven’t been able to access proper health care, and families go into irrecoverable debt to pay for worryingly poor hospital treatment, I am incredibly grateful for the care we receive from the nurses, doctors, cleaners, porters and all the other dedicated, hard-working staff I’ve had the privilege to work alongside.
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community” Aneurin Bevan.
There are, of course, countless other achievements of our national health service:
To name but a few.
As one commentator put it though, ‘perhaps the NHS’s greatest achievement is its sheer survival’. In spite of political interference, budget freezes, almost constant reorganisations, rising public demand, and media criticism, the people who make up the NHS continue to offer a great service.
In the years that I’ve known it, the NHS has changed. Gone (I trust) are those days of traipsing down a ward with my fellow medical students in the wake of an arrogant surgeon who would then proceed to humiliate both us as students and the patients under his (invariably it was a he) care. Gone are those not-so-halcyon junior doctor days of being on call for upwards of 72 hours and struggling to keep our eyes open long enough to write out a prescription or calculate the fluid requirements of one of our patients. Gone (to a large extent) are those days of treating patients according to a consultant’s whim rather than following protocols based on sound evidence.
But I wonder whether, with some of that, we have also lost something of the heart of the NHS? Of the camaraderie of those evenings on call, where we would linger with the nurses over a cup of hot chocolate on the children’s ward; of the small cottage hospitals where everyone called each other by their first name; of the sense of fulfilment when you had cared for a patient right through from their initial clerking in the emergency department to writing (by hand) their discharge letter as they walked out once more happy and healthy; of the art as well as the science of medicine?
Who knows?
Whatever the changes, and whatever may lie ahead for the NHS, as I retire from it, I feel incredibly proud and grateful to have been a part of what it is.
With less than a week to go to the BASPCAN 2018 Congress, Clare Shaw, Congress Poet in Residence looks to a Rhesus monkey for insights into stress, serotonin and early attachment, the last of her monthly poems which you can read here
“A specific polymorphism in the serotonin transporter gene is associated with deficits in early neurobehavioral functioning and serotonin metabolism, extreme aggression, and excessive alcohol consumption among monkeys who experienced insecure early attachment relationships, but not in monkeys who developed secure attachment relationships with their mothers during infancy” (Suomi, 2003).
Let me tell you this:
I have unexpectedly sophisticated skills
at maths.
These have helped me incalculably
to resist attack.
I am determined never to die.
Social in nature
I have lived among people
and was always afraid.
This way I survived.
At home in the water
I can fly.
There was one star in the sky
and I loved it
though it often went out,
Oh, I am a great success.
I would not abandon my daughter
or eat her
and who hasn’t slapped or bitten or kicked
when driven to it
by fear or threat?
Who would not fight
for a mate, for a fuck, for fruit
or the light? For the child
on their back?
If this is not love,
then what is this weight?
And who would not sing it in flight?
Clare Shaw, Poet in Residence for the BASPCAN 10th International Child Protection Congress considers the impact of neglect on the developing brain.
With just 3 weeks to go, it’s not too late to register for the congress and what promises to be an exciting and stimulating programme combining cutting edge science, evidence-informed practice, and reflective creative space.
You can read all of Clare’s poems and find out more about the congress here.
Dreams:
you can’t find your mother.
A series of rooms
one after another
each smelling of urine
and dust.
And of course
there are ghosts –
you fear them like murder.
By night, there are spiders and mice.
Then sleep is a space
with no air.
It’s too hot.
All of your words have been sucked out.
The books on the shelves
are rotten. You read them.
You almost forgot that door
and the corridor leads to outside.
In the yard,
how small you are
in this rain
you will never own.
It’s all falling around your ears.
The rabbits are still in their hutches
and no-one has fed them
for years.