Media Storm - S2E1 Gender health gaps: The true cost of chronic UTI - with Athena Lamnisos and Dr Christine Ekechi

Episode Date: June 23, 2022

Off-label antibiotics ordered from Hong Kong, bacteriophages cultivated in Georgia, bladder fulguration undergone in Turkey - these are some of the lengths countless women are resorting to in desperate bids to rid themselves of chronic urinary tract infections (UTIs). In March, the NHS finally recognised the existence of chronic UTI, a debilitating condition affecting 1.7 million people - mostly women - in the UK. But months later, our exclusive research reveals sufferers are spending up to hundreds of thousands of pounds treating themselves, while NHS healthcare guidelines fail to mention the condition at all. This week, Media Storm dives deep into underfunding, lack of research, misdiagnosing and medical gaslighting impacting healthcare for women and minority groups. We’re joined in the studio by Athena Lamnisos, CEO of The Eve Appeal, and Dr Christine Ekechi, obstetrician & gynaecologist, to discuss the roots of this “gender health gap”, the intersections within it, and the role of the mainstream media in reforming - or reinforcing - the status quo. The episode is hosted by Mathilda Mallinson (@mathildamall) and Helena Wadia (@helenawadia). Guests: Athena Lamnisos @eveappeal @athenalamnisos1 Dr Chirstine Ekechi @DrEkechi (T) @dr_christine­_ekechi (IG) Sources: Chronic UTI UK statistics: https://cutic.co.uk/what-is-chronic-uti/ Outdated urine testing: https://bit.ly/3ybEvn6  Endometriosis diagnoses (UK): pslhub.org/learn/patient-safety-in-health-and-care/womens-health/appg-on-endometriosis-inquiry-report-2020-endometriosis-in-the-uk-time-for-change-october-2020-r3279/#:~:text=Summary,care%20at%20the%20right%20time. (note 2009): https://pubmed.ncbi.nlm.nih.gov/19196878/ Medical student gender ratios (UK): https://bit.ly/3beU58B US news analysis May 2021: https://www.frontiersin.org/articles/10.3389/fpubh.2021.644284/full Get in touch Follow us on Twitter http://twitter.com/mediastormpod or Instagram https://www.instagram.com/mediastormpod or Tiktok https://www.tiktok.com/@mediastormpod like us on Facebook https://www.facebook.com/MediaStormPod send us an email [e-mail] check out our website https://mediastormpodcast.com Music by Samfire @soundofsamfire.  Media Storm is brought to you by the house of The Guilty Feminist and is part of the Acast Creator Network. Become a member at https://plus.acast.com/s/media-storm. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Td Bank knows that running a small business is a journey, from startup to growing and managing your business. That's why they have a dedicated small business advice hub on their website to provide tips and insights on business banking to entrepreneurs. No matter the stage of business you're in, visit td.com slash small business advice to find out more or to match with a TD small business banking account manager. We're back, Media Storm Series 2. Hello. Oh my God. It's so great to see you. Sorry, I can't.

I don't think a day has gone by without speaking to you since we started Media Storm. You message me every time you go for shit. Yeah, I literally couldn't miss you back. Well, I'm so excited for episode one where we're talking about women's health and the gender health gap. A quick disclaimer first. that. In this episode, we will talk a lot about women's health, and we will also talk about how the health of transgender and non-binary people play into the gender health gap. We will talk about the history behind women's bodies and how they have been typically

marginalized, but when we speak about cervixes, uteruses, vaginas, and any part of that anatomy, we are, of course, including anyone who has that anatomy, no matter how they identify. I feel like one of the many accepted curses of having, a vagina is UTIs from sex. Urinary tract infections. Yeah. Do they just come from sex though? No, they don't.

I'm just projecting very much. It used to be a real problem in my life. And then suddenly one day someone, a girlfriend who's also had way too many UTIs, tells you there's some really straightforward maintenance you can do to protect yourself, like peeing after sex. And you're like, hey, why the hell has no one told me this before? I could have done without festivals scavenging for leftover cranberry mixes, which probably doesn't even work. I don't know, Helena, how much of an issue has UTI been in your life? Oh my gosh. I mean,

I'll tell you what I could have done without. I could have done without a UTI which turned into a kidney infection. Oh my God. Landed me in hospital, in A&E on a drip the day before I started my first ever job in TV. Oh, no. Way to enforce the men. that women can't work because we're beholden to our bodies. I was lying in that A&E bed and I was sending an email to a boss I had never met going, I'm in A&E on a drip and I don't think I'll be able to get in in five hours. So sorry. But what we learn from your experience is that these things are no joke.

In fact, as I've been learning for some women, sorry, for probably over a million women in the UK and for some men, UTIs are anything but funny. If they're not successfully treated, they can become chronic. I've spoken to people who have been crippled by UTI for years and it's soul destroying, it's life destroying, and it really, really needn't be. So I only learned about infections of this sort because a friend of mine got UTIs all the time,

but I didn't know it was actually termed as a chronic condition as opposed to kind of regular UTIs happening over and over again or that it had a name. Well, yeah, that's actually a really good point, because until recently, it didn't formally exist. But after a lot of campaigning by people affected, the NHS recognized the existence of chronic UTI in March and listed it on its website. But other than that, not much seems to have changed, not the treatments available, nor the testing methods. I've been looking into what that means for sufferers who essentially end up diagnosing and treating themselves over years of chronic illness. Well, that sounds, well, it sounds a lot of things, frustrating, risky, but also expensive?

Exactly. And we have some exclusive research about just how expensive that is. We surveyed sufferers around the UK and found out that people with chronic UTI are sinking thousands, in some cases tens of thousands, into experimental, off-label and sometimes quite extreme solutions, many of which are not available in the UK. Today, we'll be hearing what drove them to such lengths. And then I'll see you back in the studio with some very special guests to discuss everything around this media storm.

Women are twice as likely to die. Black women are four times more likely to die in pregnancy than white women. Even to say the word, period. You can see there was blood coming out of her wherever. In total, I was to confess a person. Four or five times over six times. Isn't this fascinating that as soon as women do something?

with their bodies. The reaction is, what will men think? Welcome to Media Storm, the news podcast that starts with the people who are normally asked last. I'm Matilda Mallinson. And I'm Helena Wadia. This week's investigation, gender health gaps, the true cost of chronic UTI. I had a lovely job. I had a social life. I used to love going to the theatre. He used to enjoy having friends over for meals. This is Caroline Sampson. In her mid-50s, she got a UTIS. a urinary tract infection, not uncommon. But this UTI never went away.

That was six years ago. I am struggling to get through every day. I'm on the phone to Samaritans very often. You know, if I didn't have my children and I didn't have my husband, I would seriously do something about this because this is not living. This is not living. This is getting through the day. And this is not a life that I want to lead.

It's hell. It's absolute hell. Chronic UTI affects up to 1.7 million women in the UK. But its existence has only recently been recognised by the NHS in March this year and it remains absent from official healthcare guidelines, which are issued by the National Institute for Health and Care Excellence, aka Nice. How does a condition as ordinary as a UTI become, as Caroline describes, so debilitating?

Chronic UTIs, we think, develop when an acute infection is left untreated, or it doesn't get better with standard over-the-counter treatments that you're given at the chemist or the short causes of antibiotics that GPs can prescribe only three days or at best five days. Meet Susanna Fraser from Bladder Health UK. Nice guidelines say that patients with UTIs should just be recommended self-care at first. If that doesn't help, a urine test may be done and antibiotics prescribed. Women are given three days' worth, men are given seven. But for many women, it's just not enough.

What we do know is that it's predominantly women who are affected. Women have much shorter urethras, so they're anatomically predisposed to bladder infections. Nice cite side effects and antibiotic resistance as reasons for caution. And though they agreed that a longer cause could help those with repeat infections, they said it was not possible to analyse data separately for that group. In short, they don't distinguish or even mention UTI that is chronic. So on the NHS treatments are very, very limited. There's only one clinic treating patients on the NHS for this sort of condition based in London,

and they are offering long-term antibiotic treatments. The limitations are that it can take years and years, and obviously that can have a long-term impact on gut health and things like that. What Susanna is pointing to is antibiotics have side effects. When I was on antibiotics, it was a constant merry-go-round between thrush, bacterial vaginosis, nerve pain, neuropathic pain. So it's not the answer for everybody. And at the moment, there's nothing else available. And I think it's just scandalous that we are living like this.

It's like a hidden epidemic of women who are struggling with these symptoms. and nobody is listening and nobody's doing anything about it. Caroline, is your doctor prescribing you anything at all now? No, there's nothing I've got left to try that doesn't give me these awful side effects. I've been independently trying to find treatments. I have sought out Chinese medicine, but then they started to affect my gut. I've spent a fortune in all these treatments, these natural supplements. I've got a cupboard full of supplements that I can't take or don't work.

And can I ask, what is the most... extreme solution that you're now considering. There's a solution that is very extreme, and I'm not brave enough to do it myself, but it's a process called fulguration. And several women are flying out to turkey to have their bladders vulgarated. It's in effect a burning off by laser of the disease tissue. Fulguration is the use of heat to destroy abnormal tissue. The NHS uses it to treat cancer in the bladder, but not UTIs.

So 58-year-old Megan Fernandez fluted Turkey. for forgaration after three years with chronic UTI. I asked what drove her to such lengths? Pure desperation. My symptoms were horrendous. I could walk. I could hardly leave the house. I was just chained to the toilet in agony, bleeding, weeing. It was just awful. I can't live like this. I just can't.

So therefore, yeah, I would consider anything. How much did this initial trip cost you? So of the whole treatment and going out there coming home. home, you know, hotel expenses, taxes, and flights, it was a £5,000. We are definitely put in a position where we have to self-diagnose and put in a position where we may have to buy antibiotics online. How do you know which antibiotics to buy? Because the test results will give you the sensitivities to what your bacteria may or may not respond to. And these are, these are tests that you pay for. Pay for yourself, yeah. Yeah. So just to note that the

Mycogen test actually costs £280. The broth test is £75. The NHS's method for urine testing dates back to the 1970s. An investigation by eye news in 2019 found it misses up to 50% of infections and the NHS flags shortcomings on its own website. But NICE said there are no plans to update this method. Testing gaps is one reason why some UTIs go untreated and ultimately become chronic. Megan, overall, how much do you think you've spent on treating your condition yourself in the past three years? Probably over £10,000. It's heartbreaking. I have to work to pay for these treatments. I struggle at work sometimes. It's hard, it's tough. It's just destroyed your life. And what we have to suffer and put up with is just unbelievable. And we're just abandoned totally by the NHS. They just don't care. One urologist,

I saw told me to suck it up, drink less and have my bladder out. They are just really horrible, sexist, unkind, unsympathetic, arrogant men. There are thousands of women being misdiagnosed like me every day, probably as we speak now. And it's just not fair. It's not right. You said men there. Have all the urologists that you've seen being men? They have.

And you just feel like you're bashing your head against a brick wall. They say it's in your head to go and sort out your mental health. You know, your mental health is bad because of this illness. Nothing will sort out your mental health until the symptoms go. To me, they are so discriminating against women's health. Women's health is undervalued, underrecognised and underfunded. Megan's not alone among the women that I speak to in having felt dismissed on account of her gender. The urologist I saw was very arrogant. He was very dismissive.

It were really dismissive. He said to me, look, you haven't got an infection. I suggest you go and see a psychiatrist. They said that it was my period. I'm a grown woman and I know the difference between a period and not a period, especially when it's my own body. And I was sitting in front of him sobbing in pain and I said, think about how you treat women

who come and sit in front of you. I think you'd need to allow for the fact that women might actually be expressing the truth when they tell you that their body doesn't feel right. They're in pain and not tell them to go and get psychological. medical help. Urology, the urinary field of medicine, is very heavily male-dominated. In the UK and Ireland, men constitute 88% of doctors in the field.

Yet, as Susanna told us, women are the ones anatomically more likely to suffer from urinary infections. But there are men affected. My name's Simon Jones. My experience with chronic UTI has been for four or five years now. And gender biases may not be helping them either. Yeah, I think that often they don't believe males have UTIs. I think you tend to get left a bit more.

Failed by the NHS's long-term antibiotic treatments, Simon, like Megan, started looking a long way from home. I'd had over 20 courses of antibiotics in about 18 months. My GP actually wouldn't let me take any more antibiotics. And I was like, well, if I can't take antibiotics, how are you going to treat the chronic infection? And they were kind of like, we don't know. I was like, well, that's not very helpful, really.

So I took it off my own back to look at alternative therapies. I was in the fortunate position where I had some savings, and I was a bit brave and took myself off to Georgia for the bacteria phage treatment. Phage therapy uses bacteria-eating viruses to fight bacterial infections, and we can tailor these viral armies specifically to an individual's needs, using broth urine testing to identify the culpable bacteria. I was only there for two weeks. I was sent home with about three months of bacteria of ages, and then I purchased another set about every three months.

The NHS has used it to treat cystic fibrosis, but again, doesn't offer it for chronic UTI. And so Simon flew to Georgia. It was extremely scary. Going to a foreign country on your own for medical treatment choice, I'm saying my mum. My mum was extremely concerned. So how much did that episode cost you? My initial treatment was around 4,000 euros and then it was 500 euros per batch of treatment. And you bought three batches up front but you've ended up needing to buy more semi-regularly.

Yeah, yeah. Simon, how successful has this treatment been for you? I wouldn't be here now without it. It cleared my infections without any question and with a lot less pain and anguish and grief that antibiotics would have been for me. People with chronic UTIs are being forced to become their own doctors, and that means paying for private treatment. We surveyed sufferers around the UK to find out just how much this was costing them. Our respondents spent an average of £1,500 each year on repeat costs like testing consultations and self-sought antibiotics. Extreme treatments like fulgaration or private surgery were costing up to £7,000 at a time.

One person has spent £60,000 over 23 years of suffering, another sinking 50 grand a year on round-the-clock care, having been crippled by infection for 15 years. They list ultrasounds and cystoscopies, herbalists and dieticians, acupuncture, physiotherapy and mental health counselling, as medical costs they've incurred. And then there's non-medical costs like sanitary pads and new mattresses needed due to, incessant blood-filled urination, with even private consultations only sparsely available in the country. They face childcare and travel costs every time. Of course, the NHS does offer some free antibiotic treatment, and this does work for a lot of them.

Started it. Great, and is it quite quiet where you are? Yeah, yeah. Katie Hay from Leeds is one of the lucky ones. The NHS's antibiotics are helping, but she has to pay for private consultations. not to mention urine tests, to actually get them prescribed. You see, the NHS only has one clinic treating chronic UTI in the whole of the UK.

And Katie couldn't get a referral. I cried on the phone to the Eurogain and said, you know, my funds are running out, I'm on maternity leave. The only reason that we could afford this treatment is because my husband's stepfather passed away. So we received a bereavement payment. I can't do anything. I can't spend this money on my home or me and my husband or my child or things that any normal person would be able to spend the money on. I have to spend the money on treatment that really should be funded

for thousands and thousands of people that are in the exact same boat as me. So that battle continues. Katie just turned 28. She says her illness has robbed her and her husband of much of their youth, their social life, their sex life. You want to be close to the person that you meant to be close to her, but you can't always do that. And when you see someone in pain or someone that you love in pain, sorry, that's also really hard for him to see me like that. So there's guilt there too of, you know, am I ruining your life? we've got together and then you've been saddled with me and I've got all these conditions

and all these problems and we can't always do the same thing as every other couple. Last year, Katie gave birth to a healthy baby boy. It was a dream that her and her husband believed might never come true. That were a conversation that we had not long after we got married because we needed to be realistic. Some days I couldn't even stand up straight, so technically I couldn't even look after myself. How would I look after another human being? All this from a UTI. So a question. Is chronic UTI an unsolvable issue? Or is it a solvable issue that's being overlooked? The relative success for some of our sources of treatments like fulguration and phage therapy suggests the latter

may be true. But there is research being done. Atacap is a small company run by Oxford academics, including Professor Eleanor Stride. They're working on a new technology to deliver antibiotics into the body in a much more targeted way. So these are tiny little spheres of a polymer

that basically act as little sponges, so they suck up large amounts of drug. And what that means is that they can latch onto the cells that we're trying to treat. and enable us to deliver much, much higher doses, but crucially doing that locally. So if you take a pill or you have an injection, drug goes absolutely everywhere on your body. That's sometimes a problem because it tends to produce side effects. And it also means that the amount of drug that ends up at the target is really, really small.

So we're trying to address that by basically cramming all the drug into this little capsule. But, Eleanor, correct me if I'm wrong, you're struggling to get the funding needed to complete your research. We are, yeah. I think UTI has not been properly recognised as this very, very serious condition that it is. I think it's still seen by a lot of people as something that, you know, you get one of these things, you take three days of antibiotics, it goes away. That is not the case. It's a huge problem in the UK and the US. It's an even bigger problem in the developing world. People die from this. I'm going to be direct. Do you think that gender health inequality has played a role in research of this kind not being taken seriously enough or not being adequately? funded? Short answer, yes, I think it has played a huge role, I'm afraid. It's a horrible thing to

admit, but I think there has been a failure to do the research on a lot of conditions that primarily affect women. We need to shout more about it. We need to get pressure to fix it. It's a worldwide problem, awful for patients, and it's driving antimicrobial resistance. And by antimicrobial resistance, you mean harmful bacteria building up an immunity towards the antibiotics that we depend upon to cure them. So once they've been exposed to the drug, they evolve and they evolve very quickly to become resistant to that so that next time you treat with the drug, it doesn't kill them. I know that this has been known almost since the discovery of antibiotics.

Alexander Fleming himself was being really passionate about this in the 1940s saying, we've developed these things, we've now got to be really careful about how we use them and, well, we haven't been. Just how big a problem is antimicrobial resistance? It's colossal. It is already killing a very, very large number of people per year. Depending on how you count it, it's one of the leading causes of death. UTI is a big contributor.

It's one of these things. It's not glamorous. People don't like talking about it. We've got to get over that. Chronic UTI is just one example of a neglected health issue that primarily affects women. So is this a question of gender health inequality? And if so, where is that inequality coming from? That takes us on to part two of the problem.

podcast. Thanks for sticking around. Welcome back to the studio and to MediaStorm, a news podcast that starts with the people who are normally asked last. This week, we're looking at the gender health gap and whether our universal healthcare really is as universal as it claims. With us are some very special guests. Our first guest is CEO of the Eve Appeal, a charity championing gynecological cancer awareness by tackling stigma and unequal public health policy. She has written about gender health inequality in the Huff Post, the Metro, the Telegraph and more. It's Athena Lemnissos.

Hello, welcome. Thank you so much for joining us. Oh, delighted to. Always pleased to talk about vulvas, vaginas and everything in between. Speaking of knowing our bodies, our second guest, is an established obstetrician and gynecologist who advocates against gender and racial inequalities in her field, chairing the Race Equality Task Force at the Royal College of Obstetricians and Gynecologists. That's really a mouth for that line of work. It's Dr. Christine Akechie. Dr. Christine,

thank you so much for being here. And thank you so much for the invite and well done for saying that completely without tripping up. Yeah, almost. If I hadn't patted myself on the back, it would have a bit more cool. Well, in the first half, of this episode, we hear Matilda's investigation into chronic UTI, how little specialised help there is available on the NHS, how much money, patients, mostly women, are being forced to spend on diagnosing and treating themselves as a result. Now, on its own, chronic UTI is a fairly anecdotal example, but the truth is, of course, there are countless conditions like it, such as endometriosis, a condition that affects one in ten women, but takes on average eight years just to be

diagnosed in the UK. And from our research, last series of Media Storm, we found it was 11 years to be diagnosed if you're plus size. Athena and Christine, it's a big question, but what are the starkest examples of gender health inequality that come to mind today? Where do we begin? Well, I think the first point I would make is, and you've talked about UTIs and we could list off a number of other conditions, things like thrush. But I think what's important to, you know, think about and talk about in relation to the gender health gap and health inequalities is we must not limit ourselves to the bikini area, you know, quite literally. If you're talking about mental health, you can look at these issues through a very, very clear lens.

If you look at immunisation across the board, you can look at these issues through a very, very clear gendered end. So that's how I'd answer that question in the first instance. but we can go through a long list of diseases where you can see really stark issues. You know, I couldn't agree with that more, Athena. If we are asking the question as to whether there are gender differences, then the first place to start is with the conditions that affect both men and women. And I think one of the classic examples of this was the research from a group in Leeds that found that women presenting with symptoms of a heart attack

were 50% more likely to be given the wrong diagnosis compared with men. So for me, that is in a way the clearest evidence we have where we have men and women presenting with similar symptoms and yet women are more likely to be given the wrong diagnosis and if they're given the wrong diagnosis when they're having a heart attack, then of course they are more likely to die. and this is what we wish to prevent. But I also strongly agree with Athena, in my role as a gynecologist,

often what we're also fighting against is the stigma attached to the gynecological conditions. And men and some of the conditions they have do not necessarily have the same degree of stigma. And if we place that stem within the medical profession, where we know that for the longest time doctors, even gynaecologists, were predominantly male, and if there were, if there happened to be embarrassment, either on part of the doctor or on part of the woman herself, then of course we can see how this impacts and delays diagnosis and indeed eventual outcomes. I think we need a little history lesson to understand where this comes from. In the investigation I've just done, we learned that 88% of urologists

are male. For the sake of optimism, I'm going to point out that I think 60% of UK med students are now female, so maybe the change we need is coming. But historically, 100% of medics were men and women weren't allowed to practice at all. And just in a very obvious way there, Christine, how has unequal access to the medical profession shaped our knowledge, our priorities? And how intersectional are the changes that we're now seeing? Historically, wherever you have any sphere that is dominated by men, then we will see the influence in terms of their ideas, in terms of a paternalistic approach, filter down within that sphere.

And medicine is no difference. I remember at medical school, most of the anatomical drawings were based on the male form. And of course, you know, the female form came about. But mostly it was the female form in the pregnant state. It was almost as if the female form in the non-pregnant states didn't really exist or wasn't really worth talking about. You know, medicine is built on paternalism like so many things.

It's certainly not used. So if you look at something like the 1850 census, the average life expectancy for a woman is 49, so premenopausal. So, you know, so it's no wonder that in terms of research into menopause, it's a relatively modern condition. You know, a, you know, a woman in the 1840s was either pregnant, breastfeeding, pre-pubescent, or dead, quite frankly. Morbid laughter from everyone. Yes, that was morbid laughter, definitely not. encouraging laughter. I feel like shame has been such a definitive part of the history of women's health.

Since antiquity, basically, our bodies and our minds have literally been pinpointed as a source of evil. You know, we have like in the Bible, it was Eve eating the apple. For the Greeks, it was Pandora opening the box. And through chunks of history, male physicians weren't actually allowed to touch or inspect their female patient's bodies. Athena, at the Eve Appeal, you campaign a lot to tackle that stigma around gynecological cancer and encourage people to get to know their own vulvers, ovaries and everything in between. How much of a barrier is shame to diagnosing and understanding women's health today? Undoubtedly, the quality of the conversation between a doctor and patient is not helped

if either of that party are embarrassed, don't have the language, that there's any form of kind of stigma attached to talking about the issue. There's a, you know, a real difficulty talking about the very name. So using the word vulva can often cause a lot of discomfort, let alone the lack of knowledge around that that is a word. And that is a part of the body that's distinct from the vagina and is not, you know, about down there. It is, you know, a distinctive part of the body. There's a lot of embarrassment about talking about menstrual health. It's about talking about bleeding, discharge, changes to discharge, pelvic pain, you know, all of these things carry with them issues. We know it's a really important barrier to cervical screening.

We're pretty much a 20 year low at attending cervical screening appointments within certain age groups. I'm too embarrassed. I do not want to show my body to a doctor. Oh, I haven't been waxed this month. I don't want to go. I haven't got my best knickers on, whatever it is. And those are things that we absolutely need to address. And the whole issue of shame and embarrassment is compounded by the number of products that not just are on the market for, you know, in inverted commas, feminine hygiene reasons. You don't have masculine hygiene aisles in supermarkets and a whole suite of products. But you do have feminine hygiene products galore. You also have increasing numbers of products like face masks for your vulva, exfoliators for your vulva, special oils.

And all of these things are the best unnecessary. Secondly, can be very harmful. But also they perpetuate the message that somehow a woman's body is somehow the sort of dirtiest, dankest place. on earth and requires all of these things to make it smell of roses, which it shouldn't smell of anyway. This stigma and this shame around our bodies. I mean, you talked about the importance of language, Athena. I'm trying to, and then immediately came to my head all of the words for vagina I've ever been told to use except for vagina. In our families, they were boboes. I don't know what you had in your families. I heard Mermaid's purse at school, and I'll never forget that as long as I live. That hurts horrible. Michelle Obama has a hair, has a great quote, which is put your health at the top of your to-do list. And I think that there's

a great deal of truth there. Christine, I really want to ask about medical training. In our episode last season on Fatphobia, I spoke to somebody who now runs a course at the Royal College of Physicians, which trains doctors in how to speak to plus-sized patients. Given that we still have the echoes of the myth of female hysteria, you know, what about medical training? Our medics properly educated about ongoing sexism and racism as well in the field? So I think that's a brilliant question. The truth is that this is something that medical educationalists and those in charge of the medical curriculum are becoming more and more cognizant of.

But we can always do better. And it's great to see medical students themselves contributing to these changes in the curriculum. So, for example, you may have been aware of the medical student from UCL that noted that the medical illustrations, for example, often featured people with paler skin from European backgrounds and has worked towards changing that. That being said, I often push back when the complete focus is around the medical system and hierarchy as if it operates in silos. And I always make the point that our medical education and our medical system and indeed the medical professionals are only ever reflective of the society from which they're drawn. So it's quite unrealistic to think that we will only change the medical system if we don't

really have this wider discourse around our society and how we treat women and where we place women in that society and where we place people who are minoritized. Absolutely. And top, top of that is the media and portrayal of images that are chosen when you're talking about health conditions and how they compound people's bias. Tell me, you know, monkeypox has been in the press, God knows how many times. Have you seen an image of monkey pox on any white skin? No. Well, I saw one more recently after it had been called out. I just keep noticing it and just thinking, good grief. You know, with the number of cases that we now have all over Europe, I just find it impossible, but someone somewhere can't take a damn photograph. You know, it's just we're compounding something,

which is completely unhelpful. And there are a number of conditions that, you know, you do have to check your own bias about. Yeah, I feel like with any women's health article, regardless of what the health issue is we just have like a skinny white woman doubled over in pain and it's like it may not even be about like anything to do with the gynecological or stomach area but she's skinny and she's white and she's doubled over in pain absolutely and and we don't use any images of you know that kind of spotlight on your pelvis that kind of bikini area

shot we would don't use them on any of our communication lines as kind of honed in images I'd say at least 50% of the stories that go into the media. So when they pick up our surveys or they cover our campaigns, that's the image that they'll use. I'm glad you've steered the conversation this way because, of course, this is media storm, and we need to talk about what the mainstream media is getting wrong. And I think when it comes to coverage of women's health issues, we have seen some increase lately in reports coming out. You know, Davina McCa calls, Menopause, documentary, got two million views just recently.

But I think that there's a real skew to the nature of that coverage. So last year, an analysis of US news media showed that women's health coverage, while has increased somewhat, is skewed very heavily, firstly, towards pre-menopausal target audiences, and secondly, towards contraception. So contraception accounted for 99% of all women's health articles tweeted by US News site. And I think that's quite telling about where are priorities. around the women the female body are.

There has been an explosion of discussions around women's health, which is great and encouraged. But if you are to drill down into that data, a lot of those studies have a slant away from black women, unless they're talking about black women dying in maternity. And I think that's just a very important point. A lot of the media reports, if they step out of black maternity,

will then tend to veer towards everything else that black women are more likely to find from a negative aspect within their health. From a gynecological perspective, what I have seen is that many black women have presented whilst pregnant, absolutely scared, thinking that they are going to die whilst pregnant.

Equally, I have noticed many women come along absolutely frightened as to whether they are going to suffer from menopausal symptoms. So I think it's really important here to point out that, of course, I really welcome the spotlight and I welcome the discussion. We really must have balanced discussions and balanced discussions that shows the experiences in particular of black and Asian women in the maternity space. How can all health be reported from a race-sensitive perspective? you know, how can we have a more integrated mainstream media?

I think the first thing is that it's important to acknowledge that racism does exist within our society and that impact on the health outcomes for all individuals that live within that society. I think it's also important to remember that not all black women have the same experiences or are the same. So avoiding this trap of homogenising anybody who isn't Caucasian and then find I think when we are looking for expert opinion, we also should acknowledge that often the people that inhabits the platforms of experts, for many reasons, tend to be white male, which doesn't mean that females or females from ethnic backgrounds who have the same level of expertise don't exist. It's just that they may not necessarily have had the same opportunities to reach that space. So I think really working hard to find those individuals that can give that diversity of experience. is so vitally important.

Time now to talk about headlines and the current affairs of women's health. The Express makes our list today with an article on gender and language. I'll read the headline. The headline is, NHS branded ridiculous for dropping women from advice on cervical cancer.

Now, I see a lot of issues with this article. The headline says the NHS has been branded ridiculous. But when you scroll down, you see that this top line is based on a single tweet from a random person. And the person who wrote that it was ridiculous is not even identified, leaving me wondering why they've been deemed headline worthy. The headline also says that the word women has been dropped from advice on cervical cancer, which again is not true. It's still in subheadings. It's still on some of the advice. It's just slightly less prominent and slightly more inclusive. So does the reality warrant a headline, especially given

how underreported so many pressing women's health issues and trans health issues are, is this just textbook fearmongering pushing the idea that trans inclusivity in healthcare harms women? Athena, you talk about this quite a lot. Yes, I do. I mean, because, you know, we want to prevent every single case of cancer that we can. That's the truth. If you have organs affected, We want you to come forward for screening. We want you to be aware of the signs and symptoms. We want you to be seen by a doctor. In a health setting and in health messaging, we know what the evidence is, that the more

inclusive you are, the more that you represent minorised communities, the more that you have messages in language that includes people, the more they will land. And that's very, very important. So the evidence is really clear. Trans patients have very high barriers to accessing healthcare. They have very few services that are tailored to them. They feel very excluded from health messaging. So having health messaging that includes them is very important.

Has the word women been eradicated? No. Is it helpful to reduce people to organs? No. Are there a whole set of people who were born women, but who have had to have organs removed because of cancer or whatever? Does that make them not identify as women? No.

I think we are very clear about where the evidence is about inclusive language and what's really important is to have clear messages. And I do get very frustrated about articles like this because I do just feel like they take up valuable space and then they trend on Twitter and I don't know, in a public system like the NHS, that's ostensibly for everyone. And it just, it feels sad to me that people think it's about erasing people and not bringing more people in. From my point of view, of course, the NHS is for everyone. Now, it's important that everybody feels included in that space. So whether we are talking about people who identify as cis women, people who are trans men, people who are non-binary. It's important that we are considering how language evolves. Language does evolve. Language evolves to make sure that nobody is left behind. I find these type of debates a distraction. And I think it's important for myself as a clinician not to get taken by that distraction, but to always focus on promoting the health of everybody with which I have that expertise. It is just important that the individual, who presents to me tells me how they want to be referred to, and ultimately, it is a name.

It's also important to note that for some people, it is important that there is the visibility in terms of the language and the representation that makes them feel safe to enter a particular space. So I think we have to be cognizance that sometimes by omission, we can leave some people out. But again, I think these type of sort of faux debates are not reflective in any which way as to what the majority of the population think, or indeed the majority of doctors who just want to do their best. Thank you so much, Bo, for sharing your insights.

Before we go, Athena Llamisos, where can people follow you? And do you have anything you would like to plug? Follow us at As Eve Appeal on all channels, so Instagram, Twitter, Facebook, etc. We have a nurse service called Ask Eve. And I'll just finish off with a story about Ask Eve. and an online series that we run called Probably Nothing.

The reason it's called Probably Nothing is that the majority of the people who call our nurse service, you can either telephone or you can email in, and it's focused on signs and symptoms and risk factors. So you can call in and say, you know, I've been bleeding in between periods and after sex. Could that be something worrying? Should I see a doctor? Whatever your query is. 90% of the calls or emails start with, it's probably nothing but.

and then you ask the question and that's the important thing it probably isn't cancer but it just might be and it's always best to put your health first thank you so much sharing that with us and dr christine ekechie where can people follow you and do you have anything to plug well i can be easily found on twitter on instagram but i like to point women and indeed anybody else that finds this subject matter interesting or relevant to the numerous organizations organizations that are working towards this space. So whether it is the amazing Eva-Pil or indeed the Royal College of Obstitians and Gynaecologists or the amazing group five times more, I think it's always important to acknowledge the number

of organisations, charity organisations and third-sector organisations that work together with people like myself but are doing the incredible work on the ground. Thank you for listening. We'll be back next week with some bonus content, then episode two on a board. Accessing Abortion in the UK and how the mainstream media report on reproductive rights will be out on the 7th of July. Follow MediaStorm wherever you get your podcast so that you can get access to new episodes as soon as they drop. If you like what you hear, share this episode with someone and leave us a five-star rating and review. It really helps more people discover the podcast and our aim is to have as many people as possible hear these voices.

You can also follow us on social media at Matilda Mal. at Helena Wadia and follow the show via at MediaStorm pod. Get in touch and let us know what you'd like us to cover or who you'd like us to speak to. MediaStorm, an award-winning podcast from the House of the Guilty Feminist is part of the ACAS creator network. It is produced by Tom Silinski and Deborah Francis White. The music is by Samfire.