Woman's Hour - British Ambassador to Ukraine Dame Melinda Simmons, Kirsty Sedgman, Black women and cancer, Eleanor McEvoy and Averil Mansfield

Episode Date: February 25, 2023

Dame Melinda Simmons, the British Ambassador to Ukraine, joins Hayley Hassall to mark one year on from the Russian invasion. She talks about the impact the war is having on women and girls in the country, as well as the strength and heroism women are showing as they adapt their lives to exist in a constant state of war.Who decides what’s reasonable or unreasonable? And how do we agree as a society on what is ‘reasonable’ behaviour? Dr Kirsty Sedgman speaks to Nuala McGovern about her new book, ‘On being Unreasonable: Breaking the rules and making things better’, which addresses societal divides over what is, or isn’t, reasonable. New research from Cancer UK has shown that Black women from Caribbean and African backgrounds are more likely to be diagnosed with cancer at later stages. To talk about why this happens and what needs to be done to help black women get diagnosed earlier, Nuala McGovern speaks to Kruti Shroti from Cancer Research UK and Adobea Obeng, who tried three times to get medical help before being diagnosed with incurable breast cancer. Irish singer-songwriter Eleanor McEvoy joins Nuala McGovern to talk about her newest album, ‘Gimme Some Wine’ and her UK tour. She explains how lockdown gave her time to heal and reflect on her life while creating new music, and how a purple AGA helped her to get over a particularly bad break-up!Averil Mansfield qualified as a surgeon in the early 1970s, a time when female medics were outnumbered my men eight to one. When she told her consultant she was getting married, his reply was: ‘what a pity!’. She joins Hayley Hassall to talk about her inspirational career and her thoughts on the current state of the NHS.Presenter: Hayley Hassall Producer: Lottie Garton

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Good afternoon and welcome to Weekend Woman's Hour, the programme each Saturday where we gather together the best bits of Woman's Hour from the week and put them all together for you. Coming up on the programme today, black women are more likely to get a later cancer diagnosis, a study by Cancer Research UK has shown.

We'll hear from someone who tried three times to get a later cancer diagnosis, a study by Cancer Research UK has shown. We'll hear from someone who tried three times to get medical help before she was diagnosed with incurable breast cancer. And we'll hear from the inspirational woman who became a female surgeon in the 1970s when it was an all-male world. People would be surprised and almost reluctant to believe that you could be that person with that amount of responsibility. It sometimes worked in the opposite direction, of course, because once they discovered that in fact you were that person with that responsibility,

then suddenly it seemed as though you must be something extra special. Plus, the woman who has written a book about how we live in a society divided by what people view as reasonable or unreasonable and find out why one of Ireland's greatest singer-songwriters bought a purple agar cooker. It is the best thing. It caused me far less grief than the man ever did and I didn't run off with other agars or anything like that. And people said, get a neutral coloured one in case you want to sell that.

I said, no, I'm getting a purple one. I love my purple one. So, yeah. That's Eleanor McAvoy, who you'll hear more from a little bit later on. But first, the Russian invasion of Ukraine on February the 24th, 2022, has created Europe's largest refugee crisis since World War II. The war has severely impacted social cohesion, community security and the resilience of local communities, especially women and girls. Approximately 5.4 million people have been displaced inside Ukraine, with 8 million people registered as refugees across Europe.

The Office of the United Nations High Commissioner for Human Rights recently verified more than 7,000 civilian deaths, but says that the real numbers could be much higher. Currently based in Kiev, Dame Melinda Simmons has been the British ambassador for Ukraine since September 2019. She joined me yesterday and told me what it feels like thinking back to that time, one year ago, when Russia invaded. It was such a traumatic time for everybody. For me, for my staff, those of us who were evacuated, and particularly my Ukrainian

colleagues who found themselves fleeing. Actually, this morning, I had a really lovely session with my staff in which we encouraged each other to talk about what we were reflecting on today. And most of us talked about how hard it was to think of that time. But we also talked about the strength that we took from it, how we coped, what we had learned. And most importantly of all, how differently we all felt now that we were back. And I've characterized this myself as this time last year being consumed with uncertainty. And I was certainly afraid. All of us were afraid at that time. It was so impossible to tell what might happen, particularly to Kiev, to the capital. And this time we think

of ourselves as people who are determined, who feel like we're making a real contribution. And that's not just actually staff at the British Embassy in Kiev, that's people all over the recently de-occupied, free places. Of course, Kiev classifies itself as being deoccupied. Russians having tried to get into Kiev, people going about their work and opening up businesses and finding ways to contribute to the economy and build their lives. All of that is characterized as a positive way to contribute towards the defense of Ukraine. So how I feel now is really different from how I felt a year ago. That difference I can tell in a lot of the things you tweet about and a lot of the interviews you've done. And that travel from fear to determination. I mean, you've mentioned that you are now the eyes and ears of Ukraine so that we and the rest of the world can really understand what it's like that. But that must be incredibly difficult position for you. When you took this job, you never imagined you'd be in the middle of a war zone.

How is daily life for you now and how are you and your colleagues coping with that? Well, actually, you know, the ambassador job is always busy. So being busy isn't different. The difference leading an embassy through wartime is that the job stops being a job and it becomes a life because war isn't a five day a week thing it's and russians don't stop shelling kiev at the weekend so they can go and have a rest so the uncertainty about how your daily life is going to be is a 24 7 thing and also talking with ministers with officials or frankly with survivors or witnesses or activists or people delivering humanitarian aid is also a around the clock

thing. So I think the biggest difference for me in terms of the work I do is, of course, it's all geared towards the UK effort to support Ukraine to defend itself, but it's relentless. And the pressure of keeping your resilience going through that relentlessness where you may not get the chance for the downtime. And of course, I'm separated from my family because they can't live with me here while this war is going on. Those probably are my main sources of pressure. And of course, 90% of those who have fled the fighting are women and children. What is daily life like for those women who have stayed?

I know you go out and meet them often. How are they coping? Well, of course, if they're in places like Kiev or Lviv, largely if they're in the west of Ukraine, they may have more carer responsibilities. And certainly for many of them whose partners have been mobilised, they're now the main person in the household keeping things together. That's like your daily life, but amplified with more uncertainty about your family. If you're in a recently deoccupied place in Ukraine, if, for example, you're in Sumy or Kharkiv or even Kherson, which is currently being shelled relentlessly, then it's more about survival because there's so much less available to you, less in terms of products that you can buy, and obviously less in terms of work that would generate income. If you are a woman

who's living inside an occupied part of Ukraine, from all that I'm able to hear, because of course I can't go into Russian occupied parts of Ukraine, it is a nightmare, a nightmare that will only be told through survivor testimony after those places are de-occupied. I want to move on to one of the most disturbing events of this war. You tweeted last April that rape is a weapon of war and there have been what has been referred to as an alarming increase in gender-based violence and transactional sex for food and survival. I'm just going to read one of your tweets. You said, rape is a weapon of war, though we don't yet know the full extent of its use in Ukraine. It's already clear it was part of Russian arsenal. Women raped in front of their

kids, girls in front of their families as a deliberate act of subjugation. Rape is a war crime. Now, it's very difficult for me to read that and it must be horrendous for you to be made aware of. But I know it's a big concern for you. It's also an issue I've been passionate about for most of my career. So I've done a lot of work that the UK has been a leader on preventing sexual violence, ran that conference 10 years ago, another one last year, to keep the issue of sexual violence in war on the agenda. And it's been heartbreaking to be in a country where the sheer scale of it, it's still unknown, of course, because there are still occupied parts of Ukraine, that it's really clear how rape is being used as part of this hybrid war to subjugate people. And I put that tweet out after the

liberation of places like Butcher and Brovary, where we saw all of us have now seen all visitors to Ukraine have gone to these places and seen what Russian troops have done there. But the invisible thing, so they have seen mass executions and murder of people, shooting people in their cars as they try to escape. It's appalling stuff. But the invisible side of this, which and why I put my tweet out, was what happened to people who were trapped, who couldn't escape. And that included widespread sexual violence. It's incredibly important to me personally, but it's certainly an important part of UK policy that we talk about this and we support it. And it's one of the areas that we are giving our support to. And one of the areas that First Lady of Ukraine has stepped up to, to speak about and give some championship to, because this is a country among

many countries where people don't talk about this kind of thing. It's quite taboo. Women don't talk about sexual violence. They didn't use to talk about domestic violence very much. So you've got a journey really to enable women to feel that if this has happened to them, they can acknowledge it as a thing that has happened to them. You talk about raising awareness about it, but how are the authorities attempting to combat the violence against women? Actually, I think they're doing a pretty good job. Again, they've got an issue of scale, like all parts of government do. But you have the Ministry of Social Policy making sure that their law enforcement and their social services are appropriately trained,

and the Ministry of Interior working together with them to make sure that services are integrated, which means that if you're a woman to whom something like this has happened, there is a place that you can go to where you can speak to social services to health care you can give your story to a lawyer and have it recorded you can speak to police about security in your area you can stare to shelter this was already evolving before the war so actually this is something that ukraine knows how to do but it is the scale of it that is the challenge to try to make that available to that many more women and again funding shelters and this sort of care and funding for the reporting of crimes

is another area that the UK is active in here. And I know that women are playing an active part in the war effort as well. While registering for military service is compulsory for men, women can choose to volunteer, can't they? And in fact, aren't they making 22% up of Ukraine's armed forces? So what role are women playing on the front line? Well, so they are fighting now. So in the early years of women joining up, they tended to be

assigned to administrative roles, but now they are able to take combat roles. And they are doing that. And I'm sorry to say that women are also dying on the battlefield alongside men. And that's it's all incredibly hard, but that too is incredibly hard. They face some administrative issues that we've also given publicity to to make sure that they're not forgotten for example making sure they have access to the right size uniform is a thing, the right size medical care which of course has to be bespoke for women and that has been a journey but a journey which the Ministry of Defence here is making good progress on but it's important to remember that there are so many different ways to be defending your country. You can be fighting on the front line, but there are also a rising number here of women deminers.

This is on its way to being the most mined country in the world. The landmass of mines in this country is equivalent to the size of Britain at this stage. The challenge is enormous. So you need women as well as men stepping up to help clean areas of land so that people can work and so that fights can proceed. And this sort of gender equality is something I know you're really passionate about. It's been really high on your agenda with your work in Ukraine. What do you see as the impact of women's involvement in the war long term? Because some are saying that many women involved in this war will chip away at traditional sexist attitudes and it will perhaps create a more equal society

afterwards. What do you make of that? I think it's perfectly possible. One thing that I do think has happened here is that, as in probably, you know, situations of war elsewhere, it throws up many different kinds of hero. So people have many more pictures of what constitutes bravery in their country. So of course, there is frontline bravery and military bravery. But there's also community bravery, and there is family bravery. And people are talking about this at all different levels. It's also becoming clear how many women have been agile in setting up businesses and moving them online so that they can trade, they can make stuff and sell it. And this too is being recognised. So I definitely think that has a long trail after the war ends.

I wondered, you talked earlier about initially having that fear, but now having that sort of acceptance in a way. Just earlier this week, you tweeted that sirens were sounding in Kiev, and there's been a lot of those in the last few days so you've had to move away from the windows pick up a book and carry on it sounds so matter-of-fact it's commonplace which is sad in itself but it sounds like the fear is lesson two how is it for you and your team there at the moment yes I think all of us are in a place where we are alive to it we we all we often talk with each other actually about how sirens can make your hand shake they can make your you know heartbeat faster they can actually sounds that aren't sirens that you think might be like just the sound sound of a motorbike or something on the road can make you start as if as if something is happening but

none of us talk about it as an active fear uh all of and all of us talk about not being complacent nobody ignores an air raid siren but But we factor it in to the daily work, and we are deliberate in carrying on, in keeping calm and carrying on. And if we have to continue our work away from windows, then that's what we do. I've lost count of the number of times I have moved my laptop down into the basement of this house and carried on my work, or I've moved from sleeping in my bedroom to sleeping in a teeny room next door that's got no windows. It's just become a thing. I never, ever want it to feel normal,

but I never want to let it overwhelm me. Dame Melinda Simmons, the British ambassador for Ukraine. And of course, we thank her and everyone in her team for the amazing work they're doing. Who gets to decide about social norms, about what's reasonable and unreasonable behaviour? Is it okay to breastfeed in public, to topple the statue of a slave trader, or to let your children play in the garden while others are working from home? Well, according to Dr Kirsty

Sedgman, the author of a new book on being unreasonable, breaking the rules and making things better, we're living in an age of division. Dr Sedgman spoke to Nuala and began by explaining why she uses the terms reasonable and unreasonable. Well, it's because when I started thinking about this back in 2014 now, when I had my first baby and suddenly found myself being judged by the world for all my parenting choices, I asked myself exactly that same question. I kept using the word reasonable and unreasonable rather than one of its synonyms like acceptable or appropriate. And I wondered why. So I did some digging and I found that from about the 1800s, something called the reasonable man standard really became embedded within every aspect of the international legal system as a kind of objective, neutral, imaginary figure that was used to judge everything from reasonable accommodations in disability law to reasonable use of force in cases of police brutality to reasonable conduct in complaints of sexual harassment. And then when I traced it backwards, I found that that idea of the reasonable person or before that, the reasonable man, it's at the heart of our Western moral philosophy. Let's turn back to breastfeeding

for a moment, though. You say that was the personal eye opener that showed you two sides of reasonable or unreasonable. Explain that a little more for our listeners. Well, it was August 2014 and I was finding feeding just really difficult. And at that same time, breastfeeding itself was all over the news because I don't know if you remember this, but a mother who was sitting in Claridge's restaurant was told to cover up her feeding baby with a tablecloth. But that went viral really when Nigel Farage waded in saying that it's not too hard surely to breastfeed discreetly. And then I was sitting at home nursing my little baby and I realised that people were

erupting over this. And the arguments on the one side, people were saying that, well, it's the legal right of feeding parents not to be made to feel uncomfortable when people, when they're giving their kids the necessary nourishment to survive. But on the other hand, the opposite side of the argument said that it's my fellow citizens' right to expect that people like me should take reasonable measures not to inflict our breasts on other people and make them feel uncomfortable. And when I watched that backlash unfold, what I realised is that fundamentally, everyone had just such very different ideas about what it means to be reasonably discreet. Does it mean facing the wall? Does it mean slinking away to the loo,

getting out any one boob at a time rather than both of them simultaneously. And then the big question for me is how can anyone confidently really advise on what is reasonable without going through my own lived experience? Well, that is an interesting one, because I think if I've understood correctly reading the book, you would have been you would have understood maybe not fully Nigel Farage's position, but you said you would have thought previously that it was reasonable to cover up before having the baby, before realising how difficult the whole machinations of breastfeeding that baby in public might be.

And I'm wondering then, if you can understand that pre-baby person and the person that you are now, how would that ever come to a compromise if both people are so sure that their way is the correct way? Well, for me, I would never have dreamed of shaming other people, but I did think that I would be covering up with a feeding cloth. And then I realised that actually I needed to sit totally still for up to an hour so that things didn't slip. I had to keep an eye at every second on my baby's mouth, otherwise nearly instant pain and damage.

And legally, it's really important that women have the right to breastfeed in any way that makes them feel comfortable, because otherwise we can see really low rates of breastfeeding throughout the anglophone world, which to some extent is down to that fear of being shamed. Yes, and you talk about the look and the tut-tutting in so many aspects, which you talk about it as well in other public domains, whether it's on an airplane, for example, with a kid crying. But you are calling for people to be unreasonable, to make things better, to break the rules. How do you understand something like that happening? And what sort of instant are you talking about? Well, that really is the big question at the heart of the book. In a world where everyone thinks that they're being reasonable how together can we figure out what's right so when I talk about breaking the rules I do it with the necessary care I'm absolutely not

suggesting that anyone should be able to do whatever they like at any point without consequence the last thing that we need is more selfish people who are just thinking only about themselves. So what I'm really talking about here are cases of great injustice, whether it's the climate crisis that we're currently facing, or racial discrimination or violence against women, those cases where throughout history, being reasonable and calm, and engaging in endless civil debates just hasn't fixed things, then maybe we need to give ourselves and other people permission to be unreasonable. So what are you talking about, civil disobedience? Yes, so one of the cases that I talk about, because I'm based in Bristol, is the famous Colston statue incident.

And I look into all the things that happened for years beforehand, those attempts to play by the rules by campaigners, to set up petitions, to talk about the issue, to persuade. And the reasons that those attempts to be reasonable got blocked for really for decades. But it's only a certain sort of unreasonable that you want? Yes, because of course, we need to be able to draw lines. We have to be able to draw moral lines between acceptable, unacceptable, appropriate, inappropriate, between good and bad. But who draws them? And how do you decide them? If there's such a difference of opinion, which we've seen, you don't have to go too far in any sphere to be able to pick them out. And I'm not even talking about social media yet. Absolutely. And manners, consideration, respect, all of those things are fundamental to the proper

running of societies. I'm not questioning whether we need those things at all. What I'm questioning is whether they are as simple and common sense as we often consider them to be. Because take manners. Historically, manners have been absolutely used to make shared social life better and cleaner and safer for everyone. But also, at times, they've been wielded by the powerful as a weapon to divide and disempower. And that's really hard to figure out in rhetorical, hypothetical terms. So a really specific example, manners, rules like wash your hands before eating food. That's good. Of course it is. But rules like which set of cutlery to use first at a posh dinner, that kind of etiquette. Well, that's really nothing to do with safety or kindness. It's

about figuring out who belongs at the table and who doesn't. Dr Kirsty Sedgman there speaking to Nuala about how we decide what's reasonable and what's unreasonable. Well still to come on the programme, have you ever bought something to get over a breakup? You'll hear how a purple agar cooker was a game-changing purchase for one of my next guests, the brilliant Irish singer-songwriter Eleanor McEvoy. Plus the woman who became a surgeon in a medical world full of men and when she told her consultant she was getting married the response was what a pity. Avril Mansfield will be here talking us through her career and what she thinks about the current state of the NHS. And remember that you can enjoy

Woman's Hour any hour of the day if you can't join us live at 10am during the week. Just go to BBC Sounds and search for Woman's Hour. New research from the Cancer Research UK and NHS Digital has revealed that black women from Caribbean and African backgrounds are more likely to be diagnosed with cancer at later stages, when treatment is less likely to be successful. This study is the first to show that ethnicity is a significant factor in late-stage diagnosis. Well, to discuss the reasons for this inequality, Nuala was joined this week by Kruti Shroti, Head of Policy Development at Cancer Research UK, and Adobia Obeng, who sought medical help three times

over two years before she was diagnosed with incurable breast cancer at age 31. Nuala asked Kruti why black women are more likely to be diagnosed later. We don't know exactly what the reasons are, but previous research does give us some clues. We know from previous studies that ethnic minority groups have lower awareness of the signs and symptoms of cancer. And even if they do spot something, there are more barriers that prevent them from going to their GP to get it checked out. So for example, we know that they are more likely to be embarrassed about talking about these issues to their GP. And interestingly, Black and Asian communities are also more likely to have fatalistic attitudes towards cancer. So an attitude which is, well, there's no point doing

anything about it because it's not in my control. So I'm not going to go and see my GP. But something I think that's really important is that while these behavioural factors are a really important component, it's not just down to individual behaviour. There also seems to be differences in access to care. So ethnic minority groups are more likely to report having to go multiple times to their GP compared to white groups to get referred for further tests. So clearly there is a systematic problem here that we need to address. Well, I want to bring in Adobia. Welcome, Adobia. For our listeners, you are black.

What was your experience of finding out you had cancer? My experience was, it was a devastating experience, obviously. First of all, finding out that I had breast cancer and then obviously finding out that it was a secondary diagnosis and unfortunately, like I say, in my case, incurable. Take us back to this journey that you've gone through from your first inclination to visit a doctor what was that? So I found a lump in my breast in 2016 so I would have been 29 at the time and sort of my first sort of thought wasn't you know oh let me go and get this checked out it kind of was a small lump in my breast um and I kind of was getting on with my

day and my my life but I noticed that the breast lump was getting bigger and I thought okay I need to get it checked out um when I first initially went to my GP um had an exam and I was told that it was just ordinary breast lumps, and it was nothing to be worried about. And because of my age, my GP wasn't concerned. And I was sent on my way. And I just continued on with life. And I did so, you know, until 2017, when the lump had grown, you know, even larger, and I was starting to notice it and I started to notice all the discoloration and the dimpling which you know at the time like I say I didn't I wasn't aware of it but at the time I was presenting all the symptoms of breast cancer um and then like uh

had to go to the GP again um and then I was told again that it wasn't anything to be worried about and it's just a breast lump and if it becomes painful then I should come back. My goodness my goodness um it continued tell our listeners what happened next. So um in April of 2018 I was going to work an ordinary Monday and I had an excruciating pain in my chest, a pain that I've never experienced before. And I was finding it very difficult to breathe. Luckily, I was with a work colleague and we went to my local accident and emergency. And when I arrived there, I was told by the doctors on duty there that I had musculoskeletal pain and was given some painkillers and sent home that following week I the pain was getting even more excruciating I was

finding it difficult to move around to breathe and I insisted again when I went into A&E again that I need a scan some sort of of scan, because something is not right. And, you know, I need to find out what's happening. I did have a CT scan done. And I was told in May of 2018, that I had breast cancer. And unfortunately, it had spread to my lymph nodes, and they were querying areas in my lung and my bone at the time. So, yeah, that was that was pretty much my journey. And it was an uphill battle because I had to insist that I needed some sort of scan because something wasn't right. Adobia, I mean, it must have been incredibly traumatic.

But to bring you back at that point, when you were told that, what went through your mind? I mean, up until the time I had all sort of the tests, I had to have a biopsy and a mammogram and all the tests that you need for them to find out exactly what's happening. I was actually in denial for a very long time. said the words you have breast cancer that I actually you know had to take a step back and realize wow this is serious and I have this serious disease but up until that point cancer I wasn't thinking that I had breast cancer I was going through the words of the GP telling me that I'm too young and it's nothing to worry about it's breast lump so yeah it was a it was a very difficult and traumatic experience for me. And I want to hear more about your life and thank you for sharing that Adobe I'm sure it's very difficult but Kruti what about that that experience that that that poor Adobe went through?

It's really difficult to hear isn't it and you know the sad truth is that this isn't one instance. What research suggests is that this is happening systematically and it needs to be addressed. What I would like to see is the government do more to make tackling these inequalities a priority for the health community. And some of that is going to have to include um making sure that we have more data um better data sets so that we can understand what's going on and we can address that we can uh actually understand what the barriers are and we can address the problems um it's also going to need to be resourcing the health service properly because if the health service haven't got the headspace to address these really important issues, which they haven't at the moment, they are on the brink, then it's not going to be going to be possible to move forward.

I'm going to read a little of the Department of Health and Social Care statement that we just received. More patients are being diagnosed, they say, and start in treatment earlier with 92 community diagnostic centres open since 2021, delivering over 3 million tests, scans and checks, including to detect cancer. We also recently announced a £10 million investment in more breast cancer screening units,

as well as software and service upgrades. The NHS Help Us Help You awareness campaign includes advertising targeted to reach black, Asian and minority ethnic groups to address challenges to earlier diagnosis, such as fear of what might be found.

They go on to say, addressing cancer together with other conditions in a joined-up strategy will allow us to focus where there are similarities in approach and ensure care is focused on the patient. But that wasn't you, Adobia. It wasn't about a fear of what might be found. No, it wasn't.

It was, I mean, in my opinion, sort of being misdiagnosed. Like I said, I was presenting all the symptoms of breast cancer. I had obviously the lump, I had the dimpling, I had the discolouration. The only thing that wasn't happening that I didn't have was the leaking from the nipple, but I was presenting all symptoms of breast cancer. And unfortunately that wasn't picked up on. Why do you think it wasn't? I mean, I have different theories, but I feel perhaps maybe the GP just didn't know what breast cancer looked like on a dark skinned person. So perhaps, you know, they weren't able to just pick up on those symptoms on my body, unfortunately. Maybe they didn't have access to the medical journals that shows how breast cancer

presents on darker skin. But I feel that had he have known what to look for, what it would look like on my skin, maybe he may have been able to pick up on it sooner when I first sort of went in. I'm so sorry to hear that.

A question did come in from a listener to you, Kruti. Does black women in your research include women of mixed race? It doesn't. Black women, we are specifically referring to Caribbean and African women. I understand. Adobia, let me go back to you. Your life now, that was 29 when you first found the lump, 31, I believe, by the time you were diagnosed. Tell me about now. Well, now I'm on a hormone targeted treatment, which is working fantastically. I will be coming up to my sort of five years of being on treatment and having my condition stable in May of this year. But it has been, you know, it's been, like I say,

it's been an uphill battle. I've had, you know, my down times. I've had great news. I've had bad news. I've had, you know, emotional times as well. But I maintain on trying to stay positive and just kind of having faith in the treatment that I'm on, which is, you know, working wonderfully for me at the moment.

Yeah, we wish you the best of luck with that. Kruti, you know,obea there mentioned black skin for example or not being able to perhaps be familiar with the skin or some of the symptoms what else needs to be done to try and change these numbers that you've seen yeah there are a few things. So I think that it's really important that we do more campaigns to raise awareness of the signs and symptoms of cancer targeted at those communities where awareness is lower. where black men are at higher risk of prostate cancer. And there have been a lot of campaigns over recent years to raise awareness of this amongst both black men and GPs. And we're seeing much better diagnosis rates, early diagnosis rates amongst them. Cancer Research UK run talk cancer workshops with community leaders

to help them have conversations about cancer with their community. And these are aimed at breaking down barriers to get people to see their GP if they have a concern. And it also emphasises the importance of early diagnosis. Just before I let you go, Adobia, have you gone back to those doctors that didn't diagnose you? Have you had that confrontation? No, I haven't.

I feel like I'm still harboring some kind of resentment um yeah you know and a little bit of a disappointment and anger in that situation I actually moved GPs as well I completely moved a GP surgery um I think like I said trying to maintain a sort of like a positive mindset and just kind of moving on and moving forward with my life um it's not something that I'm thinking about going to sort of approach or um speak to them about I kind of have made my decision to leave the GP practice that I was at that you know misdiagnosed me and um now I found my voice and if anything you know presents or I find that my treatment isn't how I expect it to be I will speak up about it now um and I think that's a isn't how I expect it to be. I will speak up about it now.

And I think that's a good lesson that I learned from my experience. Hodobea Obeng there, talking to Nuala about her experiences of being diagnosed with breast cancer. And you also heard from Kruti Shroti there from Cancer Research UK. Earlier this week, Nuala had the brilliant Eleanor McAvoy in the Woman's Hour studio. Eleanor is one of Ireland's foremost songwriters and has worked with the likes of U2, Sinead O'Connor and Mary Black. She's the composer and co-performer of A Woman's Heart and the title track for the best-selling Irish album in Irish history and one of Ireland's favourite folk songs. And she's currently on a UK tour with her latest album, Give Me Some Wine, which has themes ranging from breakups to motherhood and female friendship. Eleanor began by telling Nuala about what inspired the album.

Well, it was recorded and conceived of really during lockdown, which is part of the reason why it's called Give Me Some Wine. The other reason why it's called Give Me Some Wine is, of course, the magnificent painting on the cover by Chris Golan, wonderful British artist called Chris Golan that I've been collaborating with. And he was painting paintings about my songs.

I was then writing songs about his paintings and we were going back and forth. Sadly, he passed away in 2017. But that was how that came to be on the cover. So, yeah, during lockdown, like a lot of people, I think I reflected on my life and where I was and, you

know, you know, what my role was in the music business now as a 56 year old, now 56 year old woman, you know, how do I fit into them? You know, we could see what the doctors and nurses were doing. What was I doing? And without wanting to get too new agey about it, I'm a huge believer in the healing power of music. And, you know, I think that, you know, my mission when I get up on stage is to, you know, to make people who are down or tired after work, to transform them, to bring joy into their lives. And that's not to say that you don't hit the darker spots. You address the more serious issues, be they anorexia or breakups or whatever. But if I'm not sending them home at the end of the night with joy in their hearts, I feel I have failed. I feel there's so much darkness out there. There's

so much dark literature, dark theatre, you know, so that's kind of my aim. Well, our listeners are going to get a little bit of a live performance in just a few minutes time. But let's learn a little bit more about you. You studied music at Trinity College in Dublin, played in orchestras I was also reading but when did the songwriting come into play? To be honest Nuala I was always songwriting it's just I never really sang them for anybody so I mean I had hundreds of songs written you know literally before I'd ever played one to any. I don't know what I think I thought I was you know Emily Dickinson or something and I was going to die at 35 and they'd find all these thousands of songs in my bedroom. I don't know what I think I thought I was, you know, Emily Dickinson or something and I was going to die at 35 and they'd find all these thousands of songs in my bedroom. I don't know what I was thinking, but it was odd because once I'd written the song,

I didn't feel the need to play it. For me, the joy was in the writing or the buzz or the compulsion was in the writing part, still is, to be honest. But then when I was in symphony orchestra, I played a track to my brother and he said, oh, Eleanor, you've got to be doing this. You know, I borrowed his band and did a demo and then just started to look for. I actually had a turning point moment. I walked into the symphony orchestra one day and I mean, you're on a salary when you're in an orchestra and all that. But I had been and I was down the back of the second violins, you know, and this gentleman had been moved down behind me and he used to lead the orchestra, a very, you know, eminent violinist. And I thought, oh my God, as you get older, you get moved back in this job. You know, most jobs as you get older and get more mature and

get more experience, they move you up the chain, but of course your fingers go, you know, and I thought, oh, Eleanor, give the songwriting thing a shot, just try it. So that day I went to the manager of the orchestra and said, look, Patty, I won't be, you know, I'm going to be leaving my notice and, you know, don't be calling me again after X and X weeks. And I went. What does Paddy say now? I don't know. I haven't seen him for years actually, so

I don't know. I bet he's heard you. But some of the tracks going back to the album are very personal to you. Yeah, you know, I'd had a time, I mean, obviously COVID was a tough time for our industry, but to be honest,

it was nothing compared to what had happened to me prior to that. I'd had a lot of stuff happen to me at the same time, Nuala. You know, my dad died and a couple of weeks later, my relationship of 23 years literally just like that overnight went.

And it was an awful shock. And, you know, it was very horrible and complicated. And it turned out he'd had somebody else in another country the whole time he'd been with me. Yeah. So, I mean, it was you find out 23 years of your life has been a sham and it puts you with certainly it put me into a very dark psychological place. I mean, I experienced darkness that I don't think I've ever experienced in my life. So I had to think, OK, how do you how do you how do you get yourself out of this? Or, you know, so for me, I said, OK, just start again, start a new life.

And for me, that sort of worked. And by the way, don't worry, there's only two tracks about it on the album in case anybody thinks I'm going to hear that. But it is an awful lot to take on. And was this kind of towards the end of lockdown or? No, it was just before. So it was a year before lockdown. OK. So I had a year of kind of trying to get over that and then lockdown hit. And, you know, I feel very guilty saying this, but in a way, lockdown provided me with a bit of time to heal because I was pretending to the world I was fine. Because, you know, in my business, you've got to get up on stage. The show must go on. You know, if you want to make a living, you've got to get up on stage the show must go on you know if you want to make a living you've got to keep doing it um and I just had to kind of withdraw a bit from social media and all

that just to kind of you know start again essentially and kind of reinvent myself and um and I decided god Eleanor this time like what decisions have you made in your life girl that have that led to this you know and I But that sounds like you're blaming yourself. Well, you know, I've since had, again, I'm sounding very new age here, but I did go for therapy and I have to say it was absolutely transformative. And I wish I'd gone 20 years ago because I put up with stuff I should never have put up with.

It wasn't really a big thing in Dublin, though, in the 70s and 80s. It wasn't. You know what it was like. I mean, you know what it was like back then. God, I was just saying to you, you know, when I was in college, like I was telling my daughter now, you know, contraceptive was illegal

when I was in college in Ireland. Like I wasn't just frowned upon or hard to get. It was against the law. The Students' Union sold condoms one time. They got arrested, you know. So times have changed. Yeah. We were looking at you guys over here.

You had like the, you know, and the NHS, you had it for free. And it was definitely, and Ireland has changed a lot. But that is so interesting that you've kind of started again, I suppose, after lockdown. And what is it like then touring? Because you're in the middle of it at the moment. It's great. It's, I'm loving it, you know, but you know,

it made me look at like things like the song I'm going to do for you, South Ham Street, you know, it's a little tiny street off Grafton Street. One day I was there, this is ages ago, like things like the song I'm going to do for you, South Ham Street, you know, it's a little tiny street off. Love South Ham Street. One day I was there, this is ages ago, but I met my ex, you know, from 30 years ago from college. I'm showing my age there, but anyway. And when I thought about that, I thought during lockdown, I was thinking, God, the road's not taken.

What if I had gone that road instead of that road? You know, so it was all of this kind of reflection. And yeah, maybe that's something that comes. I know you went through that terrible breakup, but the an age that you reach as well. You mentioned you're 56, that maybe there will always be that reflection of the road not taken. I think there will. And I think it's it's easy to say, oh, well, I wouldn't have ended up. You know, you don't know. You just don't know in life. Things could have been worse. You know, you have to take, you know, the sliding door moments and just, you know, get up and get on with it, you know.

Well, you know, we talk about the breakup there. I believe there's a connection to a purple aga that you have, the cooker stove range. Yeah, well, after the breakup, I don't know. I bought a purple AGA in a moment of, I don't know, midlife crisis or something. But it is the best thing that caused me far less grief than the man ever did. And I didn't run off with other AGAs or anything like that. So, yeah, I just love it. And people said, get a neutral coloured one in case you want to sell.

I said, no, I'm getting a purple one. I love my purple one. So, yeah. Well, a lot of people, because I threw it out to our audience, there's nothing that they are, if not responsive. Let me see. After a break-up, I bought myself a plane ticket to East Africa and had an adventure. Absolute

winner. When I left my husband 35 years ago, I bought a pink fluffy dressing gown. He hated pink and a piece of breaded chicken. He was a vegetarian. All my dressing gowns are still pink and a piece of breaded chicken. He was a vegetarian. All my dressing gowns are still pink and not that my husband would notice. She has a new one now who loves her and is happy

with whatever she wears or eats. I dyed my hair red, says another, when my ex told me he was leaving. He hated red hair. Oh, he's in my bad books too then. I bought myself a lovely convertible BMW when the divorce was finalised. That's Terry. Let me see, Amanda, a new lipstick.

Essential. I also took the opportunity to try something I've thought of for a long time, but never done. A new hair colour. Nothing too dramatic. Oh, here we go again. But a bit of red goes a long way. Is red the colour post-breakup?

I don't know. There's another call-in segment. Let me see, another post-breakup gift. I recently split from my husband. I bought myself a concert ticket and a hotel room to meet friends from an online fan club of the same band. Not something I could have done before and I'm so excited. Isn't that wonderful?

Eleanor McEvoy there, talking to Nuala about her life and music and her album, Gimme Some Wine, is out now. And thank you as always for your messages into the programme. Here are a few more we got about things that you bought after a breakup. Frances in Scotland says, I bought a Black & Decker drill and have never looked back. Lucy texts to say, the day an ex-boyfriend got married, I bought myself a second-hand soprano saxophone. 30 odd years later, playing in a street band with a bunch of glorious friends is one of the loveliest things I do.

Best breakup purchase ever. Ansara sent us an email. I bought myself a beautiful Art Deco cocktail cabinet when my ex-husband moved out. I now have regular cocktail parties and get to spend joyful time with my friends. Cheers. Well, cheers to you all and thank you for those messages. My next guest has made waves in the medical world and has done so more often than not as the only woman surgeon in the hospital. Avril Mansfield qualified as a surgeon in the early 1970s, a time when women medics were outnumbered by men eight to one. Nonetheless,

Avril rose through the ranks and went on to become the UK's first female vascular surgeon and first female professor of surgery. Now aged 85, Avril has written her memoir, Life in Her Hands, and she joined me earlier this week. She started by telling me what first got her interested in surgery. I started to read books when I was about eight or nine about medicine and particularly about surgery and the history of surgery. And I was fascinated by the fact that people were exploring operations without them knowing whether they could work or even if people could survive, perhaps, for example, having their chest opened. Somebody had to do it first. And as a small child, I was captivated by that. And I wanted to go along in that direction. I was used to seeing women doctors. Surprisingly,

my school doctor was female. The person who delivered me into the world was female. So women doctors were not a rarity for me. So it seemed perfectly reasonable that I should think I could go along in that direction in my future career. And talking about how you came into this world, I was fascinated to read that your first interest into medical research was when you learnt about your own quite traumatic birth for your mother and how there was no real understanding of your mother's complications. Did that map your interest into surgery? It certainly mapped a specialty interest in my future career because she got a deep vein thrombosis and a massive pulmonary embolism which very nearly killed her and I was completely perplexed by this and fascinated by why it should happen and a lot of my research was about why that should happen and how we can prevent it from happening. It's much less frequent now than it used to be,

but in those days it was often fairly lethal. Yes, and I'm sure your family are very proud about that. But I believe you were in the local paper when you were a child and you said you wanted to be a surgeon, but they printed that you wanted to be a nurse. Why was that? Was that just because it was seen as inappropriate or unlikely that girls could be doctors?

No, it was my mother. My mother thought it was above my station to say I wanted to be a doctor. Certainly not a surgeon, but certainly just to say you want to be a doctor. You can't say that. You can say you want to be a nurse if you must. And I have nothing against nurses at all. I love nurses. But I wanted to be a doctor and I wanted to make that quite plain. So I was really very cross about that. But yes, indeed, they did publish that. Well, when you were a child living in Blackpool, there was no NHS, of course. And I read with fascination you describing your father coming home with his wages and putting money in a pot

on the mantelpiece for the doctor. So becoming ill or being in an accident must have been quite a worry then. What was life like for you before the NHS? It was extremely difficult and it is really a very strong memory when the NHS came into existence and that pot on the mantelpiece could be removed. Things like my mother requiring surgery to correct for the damage that had been done when I was born put a huge strain on family resources. It had to be paid for. It wasn't going to come free. So I saw that weight of responsibility that came from quite a small income. My father was on a relatively small wage as a welder,

which is what his job was. So to see that change, to think that everybody could be treated properly and when they needed it was a wonderful step forward. Even for a child of eight or nine or whatever age I was at the time, it was very clear that this was a momentous moment. But I do wonder how you look on the medical students of today, because, for instance, you talk about current students not being able to perform minor operations until much later in their study, in their career. But how much do you think today's teachings have changed from when you were there? And is that positive or negative in some ways? In some respects, it's changed. But in truth, the medical students are just the same.

They're wonderful young people who really do want to be looking after patients, doing the best for patients. They are all like that. And we need to foster that in our young students. We need to encourage that because that's really what we all want when we're sick. We want somebody who wants to care for us and to give of their best to us. And most students do. Clearly the fact that they can't do some procedures when they're students, which I was allowed to do, is just the way of life. It's pushed things back a little bit and I sometimes am concerned that people don't discover whether they really have aptitude for something like surgery, which is after after all, a skill, they may not learn that at an early age. They may have to wait a bit before they can discover

whether that really is the future career for them because of putting it back to a slightly older age. Yeah. You going into that world as a surgeon and then as a consultant as well, it was a male-dominated environment and you were often overlooked. You were called a slip of a thing and someone presumed that you were just taking someone's history and the doctor was on their way. Were you overlooked and how difficult was it in that environment for you? Well you would write in a way that people would be surprised and almost reluctant to believe that you could be that person with that amount of responsibility. It sometimes worked in the opposite direction, of course,

because once they discovered that, in fact, you were that person with that responsibility, then suddenly it seemed as though you must be something extra special. So being female was not without its advantages. You stood out from the crowd. You weren't one of a huge crowd of men. You were the odd female. So there were some benefits from being the occasional woman.

And I believe when you told your senior surgeon that you planned to get married, he said, what a pity. I thought you had such a promising career ahead of you. He did. I was really disappointed by that because he was a great supporter. He was the senior consultant and clearly, you know, from a different era, not used to having women who wanted to pursue a career in surgery. And he saw it as something that you had to be totally dedicated to and there wouldn't be room in your life for anything else.

But I proved that that was not the case you could do both. You did and then you went on to set up the Women in Surgery Initiative what what have you done for women beyond just succeeding yourself you've you've helped so many generations after you as well? My hope is that what we did with that Women in Surgical Training scheme at the college was to make them aware of the fact that it's perfectly feasible, perfectly possible, and indeed desirable for women to pursue a career in surgery. There's nothing odd about it. There's nothing wrong with it. And it is, of course, an extremely fulfilling career. And a lot of women have said you can't be what you can't see. And so making it more visible, I think, was really very important. And the other aspect of it was that we were, at that stage, only 2% of surgeons were female.

And we were approaching about 50% of medical students were female. So the sums just didn't add up. We needed to encourage some of those women going into medicine to believe that it was perfectly okay to become a surgeon if that's what you wanted to do. I've said all my life that what's most important is that you actually take a good close look at the career of surgery because you're going to be stuck with it for the next 30 years. And it is quite a demanding job, as you can imagine, and a wonderful one. Don't get me wrong, I loved it. I loved every minute of it. But you do have to make sure that that is what you want to do. So I encourage young women to explore it and enjoy it. Yeah, bringing us to that current generation, many of the papers are inundated with stories of the NHS strikes at the moment.

Now, you said to yourself that you were in this to help people. Altruism was the core of being a doctor for you. You wouldn't walk away from anything. So with that in mind, I'd love to know your opinions on the recent strikes in the NHS. How do you feel about doctors going on strike? It's often criticised as leaving vulnerable patients without care. Isn't that a difficult question? I kind of guessed you would ask me about this. This is woman's life. We need to push aside. But it's something I know that I could not have done. I couldn't have walked away. I never could. And sometimes I would actually dedicate myself to a

patient when perhaps I should have been dedicating myself to some other issue in the family or at home because they were paramount. The patient was always the paramount concern as far as I was concerned. I understand and sympathise with the situation that the medical profession is in. I want the health service to succeed.

I want it to be successful. I want it to engage with the young people who are working in it so that they are content to stay in it and are properly paid to do what they're doing in it because they do work hard, extremely hard. But it's just, for me, it would have been extremely difficult to walk away from a patient. I'm sure it's difficult for them too. I don't think any of them actually want to neglect their patients. They just need to give a message to someone and

that's the way they're finding to do it. You're right. And it is a difficult subject, especially in your position. I don't know what you're going to do next. You've got so many awards, you've achieved so much, you've even met the Queen. What is next for you, Avril? Well, I took up the cello in retirement, so that's really the thing I need to concentrate on is getting better at playing my cello, which I love. Of course she did. She's unstoppable. Well, the brilliant Avril Mansfield was talking to me there and her book, Life in Her Hands, is available now. That's all from me this afternoon but don't forget to tune into Woman's Hour on Monday at 10am when Nuala will be speaking about marriage. As the Marriage and Civil Partnership Minimum Age Act comes into effect she'll hear from people who got married before they were 18 about their experiences and we'd love to hear from you too.

Were you married at 16 or 17? Did it last or do you regress it? You can text WOMEN'S HOUR on 84844. Text will be charged at your standard message rate. Check with your network provider for exact costs. And you can contact us on social media. It's at BBC WOMEN'S HOUR or you can email us through our website. Nuala will be here on WOMEN'S HOUR on Monday from 10. Have a lovely rest of your weekend.

I'm Sarah Trelevan, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started like warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby.

It's a long story. Settle in. Available now.