Woman's Hour - Women and Gaming; ICU nurse Dawn Bilbrough; Poulomi Basu; Puberty blockers

Episode Date: June 30, 2020

Dawn Bilbrough is a critical care nurse from York who in the early stages of COVID-19 posted an emotional video on social media that went viral. She was appealing to the public to stop panic buying as she was unable to get the basics in her supermarket after her shift ended. She joins Jane to discuss the impact of the video and what it has been like working on the frontline. This week Woman's Hour is focusing on women and gaming – and today we hear from cyberpsychologist Dr Daria Kuss who's been investigating the links between game-play and well-being. Our reporter Lotta Haegg also speaks to Emma Brown from Oxford, who's discovered a new-found motivation for exercise thanks to a virtual reality headset, and Lucy Hull from Birmingham who plays video games to forget her complex health problems.Last month information on the NHS website about the use of puberty blockers was changed. It had previously said that the drugs used to supress hormones at the onset of puberty in children experiencing gender dysphoria were fully reversible. The NHS now offers the cautious advice that: “Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria”. NICE, the body which provides evidence-based guidance for the NHS is currently examining the latest clinical guidance on puberty blockers and cross sex hormones as part of a review of current policies. Deborah Cohen, Health Correspondent for BBC Newsnight explains what medical questions there are about the use of puberty blockers and what the current review means. Poulomi Basu is an Indian artist, photographer and activist, whose work advocates for the rights of women. Her new book Centralia takes the reader deep into the forests of central India, where a little known and under reported conflict between an indigenous tribal people and the Indian state has been simmering for more than four decades. Poulomi went to the region and was embedded with female guerrillas who shared their documents and stories with her.In the final part of our series 'Troupers' - which celebrates the many and varied ways in which volunteers support our communities - we meet Sarah Burrows. She talks about her efforts to help families protect and support children affected by a parent being sent to prison. The reporter is Laura Thomas.

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. Hi, this is Jane Garvey and this is the Woman's Hour podcast. It's Tuesday the 30th of June 2020. Today we've got Dawn Bilbreth, a critical care nurse who went viral. We'll talk to her in a moment. Also today the NHS website has changed the information it provides about the use of puberty blockers. Why? We'll discuss that on the programme today and more women and gaming a little bit later. But first of all,

let's say good morning to Dawn Bilbre, who is joining us from York. Dawn, good morning to you. How are you? Good morning, Jane. I'm fine, thank you. How are you? Yeah, not too bad at all, thank you. And it's wonderful to hear you sounding in better shape than when you went viral back in the... Well, actually, I think it was officially the day before lockdown in late March. Yes, I believe it was. Just the day before, which is interesting. Yeah, OK. Well, we'll play a little bit of your viral video and then we'll have a chat.

So let's hear you just before lockdown started. So I've just come out of the supermarket. There's no fruit and veg. I heard a little cry in there. I'm a critical care nurse. I've just finished 48 hours of work. I just wanted to get some stuff in for the next 48 hours. There's no fruit.

There's no vegetables. I just don't know how I'm supposed to stay healthy. And there's people and people are just stripping the shelves of basic foods. You just need to stop it. Because there's people like me that are going to be looking after you when you're at your lowest. Just stop it. Please.

Dawn, it's pretty painful to hear that again. You were really, really at the end of your tether, weren't you? I certainly was. And yes, it is quite painful to hear. It's quite surreal. It's like it painful to hear. It's quite surreal. It's like it's not me. It's very strange. So are you, before you did this,

are you the sort of person who would have done it, if you see what I mean? Do you recognise that sort of behaviour in yourself? I mean, these have been extraordinary times. So I guess we've all behaved differently. No, no, I rarely use social media. I use it to keep in touch with friends, usually. But yeah, that was that was all very bizarre. I posted the video.

And there was just something inside me that thought I just need to post this and hopefully locally, it will be seen and people will have a little bit of, I don't know, raise awareness, really, of how your actions have consequences but well we all know what happened it ended up going onto every platform and went worldwide so yeah and did you regret it at any time no no like i say it is very difficult difficult to hear and see it now because it is like it's a different person um but no i don't regret it at all i think it had the desired impact well bigger than the desired impact actually because, because I wasn't expecting the fallout from it. Yeah, but you're actually good. Well, you're pretty confident it really did change behaviour.

How has your working life been over the course of the pandemic? I know that you you're a locum, aren't you, in critical care. So you work for a number of different hospitals and trusts. Yes, that's correct. It's settling down now. Initially, it was the sheer volume of patients that we were seeing with Covid. We were all pushed out of our comfort zones quite significantly. It was quite a difficult experience. What we have now is we're all very exhausted. It's been three and a half months now working out of our usual critical care environments

a lot of the time. So yeah definitely still working out of our usual critical care environments a lot of the time um so yeah definitely still working out of our comfort zone generally on every shift and of course we have to work in ppe because we have so many patients that we're not sure if they have covid because we've had quite a few negative tests that have come through and then they've gone to prove that they are positive so yeah how often does that that happen when somebody actually initially shows up negative? Frequently. Right. Yeah, yeah.

And you yourself had symptoms. Did that ever develop into anything or don't you know? I haven't been tested, but I was quite unwell. And it took me three weeks to get myself back together again and to get my energy levels back to where they were previously. I'm convinced that I did have COVID, but I never had the test. So it's difficult to say. And when you see images, as we all have done over the last couple of days, of crowds on beaches in city centres,

we know that the pubs are going to reopen, though not in Leicester, this coming weekend. What's your take on all that? I think psychologically people do need to get back a little bit of the normal lives. But I think we also need to be remembering the social distancing guidelines are there for a reason. They're science based. And as a health care professional, well, as an e-key. And as a healthcare professional, well, as an e-key worker, actually seeing those images, personally, I found it very, very hard to watch.

And in a sense, it kind of makes what we do every day seem a little bit unimportant to people, when actually we need support right now. And we're going to need to continue that support over the next few years. We're going to need the support. Well, in a way, I suppose we're going back to the point that you were making in that viral video, that the work you'd done you felt had been dismissed and that people were behaving in a way that simply wasn't right in the circumstances. And you appear to be suggesting that some people are doing exactly that again all over again. I think it's important to realise that all of our actions no matter how

small can have an effect on somebody else and I think it's just key to remembering that at the moment especially now. Yeah okay thank you well you've made your point very clearly today and certainly in that video thank you very much Dawn that's Dawn Bilbrough who was the critical care nurse who made that video after that last shift where she just tried to get some food and there was just, you remember that phase of lockdown, the shelves were just stripped bare. It was, I don't think any of us actually will look back on our behaviour with much pride when we go over all this at the point where it might be at an end when we can start considering it all again. Dawn, thank you very much indeed for taking part today. Now we are looking this week at women and gaming. There are all sorts of stereotypes about gaming and the truth is those stereotypes

are not the 21st century reality and researchers are now looking at the links between gameplay and mental well-being. Dr Dariah Cuss is a cyber psychologist from Nottingham Trent University. Emma Brown is from Oxford. She exercises these days using a virtual reality headset. That means you can get up to all sorts of stuff, yoga on a beach in Bali, when in fact you're cosy in your front room at home. First, you're going to hear from Lucy Hull from Birmingham, who plays video games to forget her complex health problems.

She spoke to our reporter Lotta Haig, who's also a keen gamer. I'd escaped to video games. I'd sit and play. I'd got very depressed. This is when my kidneys start to fail. I've had a kidney transplant and I was on dialysis for most of my 20s I guess I'm looking at whether or not gaming has had a positive influence throughout a lot of that period I really think it has

even with going to dialysis it'd be 6 o'clock in the morning I'd have to be there to dialyze I'd sit there I'd have to be there to dialyze. I'd sit there, I'd have all the sterile equipment next to me. I'd be playing different games out of the PS2, PS3, and I'd just sit there and play. It helped the time pass. It's like a distraction and an escapism sort of thing. Generally, in an everyday scenario, it's of course very good to just have some sort of a distraction to be able to switch off from your day-to-day life by means of going into the game. But then, of course, with women who may have psychological problems or where something has happened, maybe they've been traumatized in some way, then games, again, may be very beneficial with regards to building communities and finding others who you may be able to talk to,

finding a connection with people who may be able to just, you know, give you a different sense of who you are and perhaps give you a different perspective. So we know that online games are really, really good in terms of tapping into positive psychology, you know, increasing our creativity, being more positive being more sociable i know it sounds a bit silly but i can't run i can't do roles and things like that you do feel empowered by it it does help you focus and not think about okay i'm in pain 24 7 but here i I can just play, I can be in another world. I'm not this sick person.

I was walked over for many years and taken advantage of, but I've got to the point where I've found my inner strength and I'm like, no, I'm not going to stand for that. There's quite a bit of research out there, and I've actually done quite a bit of research also at Nottingham Trent University looking into gaming motivations. And they tend to differ quite significantly across genders. So, you know, males tend to play more for reasons of competition or to understand the game mechanics better, you know, to understand the structures of the game, to make use of the different elements that the game allows them to make use of. Whereas for a lot of women, the social element is quite crucial.

You know, and a lot of women, the social element is quite crucial. And a lot of online games nowadays are inherently social games. People play with hundreds and thousands of players around the world. It's a very social experience. There's lots of chatting involved, getting to know another person, getting to know people in a guild, for example, or in a clan, where groups of people come together to play together as well. Playing different roles, for example, is another quite important opportunity, particularly for women as well, you know, stepping into the shoes of an idealized character, maybe stronger, maybe prettier, maybe more powerful, which may in some instances be a better representation of the self.

I don't feel depressed when I'm playing. I feel like myself again. I went through a very abusive relationship before I met my husband. Video games helped me through that. They have feelings as well, the characters. They're specifically designed to have different feelings to make the user think, am I going to go down the good path or am I going to go down the bad path am I going to just say no I'm not going to come and help you but with everything that you're going through in your personal life you think no I'll I will help them you're trying at least to get it accomplished somewhere else in another outlet in the game when I finish playing it's like I'm not

in as dark a place as I was I sort of had my eye on VR thinking, oh, that might be a way to exercise that might make it actually fun. And then this year I found out that my blood pressure was like really, really, really high. And it was a bit of a wake up call. And I just sort of realised I really needed to start doing some form of exercise that I could stick to. And that sort of of what happened about the same time the new headsets came out. So then I started looking into, oh, maybe there's other forms of exercise you can do in VR. And I just found this growing community, sedentary gamers who'd got into it and were now getting super fit. And then just other people who'd got into it for

different reasons, other therapeutic reasons. And what would you say are the benefits of doing it that way than, say, going to a gym and doing this? I'm not an athletic person. You know, I've tried doing aerobics DVDs at home. I've tried taking it running and I just find it incredibly boring and I resent spending my spare time on it. And the thing with doing the VR exercises, it's just, firstly, it's a lot more fun.

I don't have any trouble sticking to doing it and actually I miss it on the days when I don't do it it's like oh god I really want to go and do a VR workout I'm not going to explain this very well because I'm not a neurologist but as I understand it VR kind of tricks your brain so basically I think your brain is so preoccupied with all the stuff that's going on in VR you don't notice other things like pain or getting tired as much. And so you work a lot harder. And I definitely do work a lot harder than when I was trying to go running or trying to do aerobics DVDs. What we find nowadays is a lot of gamification in all sorts of different areas of life.

You will find lots of mental health apps, for example, where gamification is used, where people are engaging with an app such as Headspace, for example. They are fulfilling a number of tasks and in the end engaging with the app may indeed make them feel better. So one of those apps that has been developed was by the gaming designer Jay McGonigal. It's called Superbetter. And scientific studies have been done on that kind of app where it's been shown that the psychological benefits for depression and anxiety symptoms of using Superbetter on a regular basis may even outperform cognitive behavioral therapy. And I think this is very, very promising. These are great results where gaming elements can be incorporated within different contexts in order to increase people's well-beings, to support them in terms of learning new things. So, you know, when we're thinking about learning, you can think about an app like Geolingle, for example, where language

learning is enhanced by means of using gamification principles again, you know, using that kind of gaming element to make people engage with it more. Like a lot of people, I struggle periodically with stress, depression, anxiety, and it definitely helps a hell of a lot with that as well. I mean, I think exercise generally does. But then with VR, you've got the kind of escapism element as well that I think probably helps a bit more with that. I don't want to reinforce the idea that video games are violent, but you can go in a video game and kill stuff,

and if you've had a rubbish day, it makes things feel a lot better. I was on antidepressants for about a year. I came off them about the time I started the VR exercising. And I actually found that the VR exercising was helping me a hell of a lot more than the antidepressants. Well, that was Emma Brown finishing that report from Lothar Haig. We should say, of course, you must get the proper medical advice before you stop taking antidepressants. Tomorrow in that series on women and gaming, you can hear from two veteran gamers, Liz and Bridget.

That's with Jenny on Woman's Hour tomorrow. Now, at the end of May, the NHS website changed its information on the use of puberty blockers. It had said that these drugs used to suppress hormones at the start of puberty in children with gender dysphoria were fully reversible. Now, the information is a little more cautious. Deborah Cohen is the health correspondent for Newsnight. What the old version said was the effects of treatment with GNHR analogues, and that's the name of the drug, we use one called tryptorelin, are considered to be fully reversible,

so treatment can usually be stopped at any time after a discussion between you, your child and your MDT, so that's multidisciplinary team. Now the new version has changed actually quite substantially. And that says now little is known about the long term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service, and that's the clinic that young people go to if they are questioning their gender identity,

advises this is a physically reversible treatment if stopped. It is not known what the psychological effects may be. It also adds, it's also not known whether hormone blockers affect the development of the teenage brain or children's bones. So it's recognising that there's a lot of uncertainty about what we know and understand about puberty blockers in the long term. But presumably that uncertainty isn't new, it already existed when the previous advice was on the NHS website. Yeah, I mean, we know actually quite little. I mean, these are drugs in children. I mean, it's a drug that is given for very different uses in adults, but in children it's used for precocious puberty,

and that's what you call off-label use. Now, off-label means when you licence a drug, you get a licence to sell it for a certain condition because it's quite well studied. In this case for children, it's precocious puberty. What off-label means is that a drug that is used in a different dose or a different formulation to the one that it's actually licensed for in the case of puberty blockers for gender dysphoria it's licensed for a whole different condition if you like and what we know about the evidence base is that there's you know it's been limited

by the lack of what we call a randomized control trial and that is the gold standard evidence to try and find out what a drug actually does and we also know that there's been lack of control groups and the studies that there are are small and with quite short follow-up so there's never really been a robust evidence base for puberty blockers, but it's the first time that the NHS is recognising that in quite a robust way. Yes, so the fact that the NHS website had said the effects of treatment with GNHR analogues are considered to be fully reversible, so treatment can be stopped at any time,

or I think they actually said can usually be stopped at any time, there really wasn't the evidence to back that statement up, was there? No. And what's interesting, and again, you have to caveat a lot of what you talk about in this area of healthcare with the fact that most of the studies are not well done or well designed or you know they're limited in in follow-up and design of the study methodology is what we do know is that some small studies have suggested they're actually not that small for the area but but these are dutch studies that young people, if they start on a puberty blocker, the majority then go on to cross-sex hormones.

So that's taking the hormone of the gender that you wish to transition to, so testosterone or oestrogen. So the idea that fully reversible, you know, there are question marks over that. Is this new level of concern partly explained by the fact that there are now more natal females taking puberty blockers? I'm thinking in particular of concerns about the long term effect on bone health, for example. I think it's been sparked by a few things. We looked at it for Newsnight. And I think there is a growing concern about the number of people who were referred to the clinic. And I think by clinic you mean? The Gender Identity Development Service.

It's escalated. And I think because that has happened, there's been more scrutiny, more questions. Some people have what you call sudden onset. They will suddenly decide that they identify as a different gender. So there's been a whole host of reasons, I think, for the increase in scrutiny. But certainly one of the main things that's happened is there is a review of the evidence of puberty blockers and cross-sex hormones that is being led by Hilary Kass, Dr class who is the former president of the royal college of pediatrics and child health and she's leading review into the evidence for puberty blockers for cross-sex hormones and also for the for the clinical decision-making pathway that means how how young people are referred into the service

and what and what pathway they follow and actually it's nice that is doing that the national institute of health and health and care excellence is is actually leading that review that evidence review so there's been a few things there's been quite a lot bubbling around and in fact jackie door price who's the tory mp for thurrock asked matt hancock the secretary of state for health and social care um and given the changes to the NHS definition or the NHS description of puberty blockers, she just only asked on the 25th of June, she tabled a question in the Commons. What steps are the NHS Gender Identity Development Service at the Tavistock Centre taking to amend its services as a result of the updated guidance on the treatment of gender dysphoria published on the 28th of May because there are questions

over what should happen next should the parents of those young people be informed about the evidence or the advice on the evidence. She hasn't yet had an answer to that question has she? No not as far as I know. And of course the coronavirus presumably is having an impact on this part of the NHS as as it is on every other? Yeah as I understand it they're not doing face-to-face consultations and there are no new endocrine clinic referrals so what normally happens is a young person will go to JIDS, the Gender Identity Development Service at the Tavistock, and have what is supposed to be a minimum of three sessions before decisions are made about how the young person and all their family want to cope with the gender dysphoria that the child is experiencing.

And one of those steps might be to go to the endocrine clinic and receive one of these puberty blocking drugs. And at the moment, there's no face to face referrals and no referrals to the endocrine clinic. But I suppose what we can gather from the new advice on the NHS website is that there is a slightly, there's simply a different approach here a different attitude right at the beginning of treatment just that the pretty clear hint that parents and indeed the young people involved need to think more carefully for longer about the possible long-term implications of starting treatment yeah and in and it's in i mean you should in theory be told fully informed consent also involves being told about what any unknowns of treatment are or possible long-term as with

any other kind of treatment absolutely i mean that is what your your duties are as a clinician certainly as a doctor you you are supposed to tell people about the knowns you know the unknowns and and the uncertainties and and actually what what you what we should be doing is studying all these long-term effects and and i i think there's a sense that perhaps young people have been let down by the lack of evidence generation in that part of medicine. Yeah, but how do you get that evidence, Deborah? You could follow people up in a study, and the Tavistock has attempted to do that.

I mean, the outcomes, they started a study in 2010, I think it was, an early intervention study. The outcomes of that have not all been fully published. And, you know, that is what happens in healthcare. That's fairly standard practice. If you have an uncertainty, if you have question mark, you do a study and you follow people up. Clearly, there might be challenges in doing that study. But that is how we learn in medicine. That's evidence-based medicine. I suppose I was thinking about the practical issue of its long-term health implications we're perhaps talking about. And of course, we don't know. This might be 25, 30 years down the track, mightn't it?

Yeah, it could be. And like I say, there are challenges, but there are challenges with all medicines. Some side effects don't appear, whatever the treatment is or whatever the intervention is, some side effects don't appear till years and years and years and years down the line. And that's always one of the challenges of drug development and drug regulation. I mean, how many times have we had stories where a drug has come onto the market or a device has come onto the market and it appears to be safe, but you follow people up further down the line and actually there are problems.

I mean, that is what happens. That is the voice of Deborah Cohen, who is the health correspondent for the BBC Two programme Newsnight. Now, Jenny's here tomorrow, or on Thursday as well, and on Thursday she's going to be talking about gender bias in the workplace. Does it still exist in your place of work? Perhaps actually you're not going into your place of work at the moment,

but you still could be impacted by it in some way. Have you ever felt that you've been on the sharp end of all this? And what, if anything, has your place of work done to try and eliminate the effects of gender bias?

That's On Woman's Hour with Jenny on Thursday. A little ahead of that, the You and Yours phone-in is today, of course, at 20 past 12. And the subject today, are you going on a summer holiday abroad? Or were you hoping to? How do you feel about it now? 03700 100 444. It's the usual Radio 4 phone number and the lines open after 11 o'clock this morning. Now let's talk to Poonamee Basu, who is the Indian artist and photographer and activist, somebody whose work really focuses on women and her latest book is Centralia. It's about a conflict in central India, really honestly barely reported or widely understood in the West. Pallami, good morning to you. Good morning, Jane. Can we start with a very brief explanation of this conflict that has been

going on now for decades? Yeah, sure. So Chhattisgarh is one of the states that make up for what is known as the Red Corridor, a region that's running up in the central east of India, in which the Maoist insurgents known as the Naxalites are in conflict with the Indian government because it's really a war over land and resources. So most of the land in which the Naxalites and the Maoists, who are also tribal people of the region, the indigenous people, live on extremely rich mineral resources like bauxite, aluminium, iron and coal. So they've continuously been displaced over the last decade or so. And so they've taken up arms to fight against the government. Right. I mean, you've explained that very, very well. And I guess it's important for those people listening now who think, well, what on earth has this got to do with me? Precisely because of the resources this land has,

we are all, all of us in the West are connected to this. Yes, absolutely. One of the reasons the book doesn't begin mentioning the place where the conflict starts is because I wanted a sense of universality when you see the work. And I wanted to see that this kind of price for progress, people have paid in the West. We've seen the Native Americans, we see what's happening in Brazil. And this is the same thing that's happening here. And one of the reasons I decided to work on it,

because I wanted to see how issues of environmental justice are related to, say, climate justice and women's rights and indigenous movements. You know, there's like an intersectionality that's going through all these different issues. And I was really interested in seeing the fig leaf of democracy that we call in India right now and see what's happening, you know. Yes. I want to talk about how you did the work and how you took these, in some cases, deeply disturbing, but also very beautiful photographs.

But can we just acknowledge that the book itself, Centralia, is an alluring thing. At times it's really rather pretty, whilst it can also be deeply, deeply upsetting. Yes, absolutely. I think it was my artistic vision to sort of make the book something that is sort of mirroring the forest and the land, you know, which is something that is um sort of mirroring the forest and the land you know which is something that is alluring and there's a lot of allure and magic and you know uh expensive resources there

but at the same time it's rough so the cover of the book kind of um uh takes that hue and it's sandblasted on top of a man's face so it's like a relationship of a person to their land so when you touch the book you have that feel that it's going to be, you feel earth, but at the same time, you know, it's going to be a rough ride when you actually look at the book. So that was the idea, yeah. When did you last visit the area and just how dangerous was it at the time? Well, I visited the area in 2018.

Last couple of years, I've been working on the book. So it is a very dangerous area it's completely militarized and almost everyone has been intimidated and have been forced out of the area the human rights lawyers who are working there a lot of the last few journalists who are working there they've all been pushed out and activists as well the state is completely intimidated by the forces and the police. The brutalities are huge. Massacres are massive. You know, there's a lot of rape of women going on. And there's a lot of killings of what we say is fake encounters and cleansing of the forests of the Maoists. So it's

extremely dangerous and it's very deep. And there is no one way of figuring out what is the true way of telling this story. Yeah. Well, and that is something that you make no bones about that. You are very honest about that. And indeed, there's a quote here from the book, the Maoist won't tell you and the police always lie. So it's not as though you are attaching yourself to one side of this. You're trying very hard not to, in fact. Yes, absolutely. Because, you know, I mean, it's very hard to have, I mean, take a side and go into this place. Because firstly, I come from a, although I'm Indian, and I'm from Bengal, where the movement intellectually started, you know, but at the same time, I'm a woman of power and privilege compared to a lot of the people here. So unless I've absolutely, you know, if I've lived and grown up in that land, I'm not a person who will understand it fully well to take those sides. That's why the book is multi-layered and has different labyrinths and voices of indigenous activists and, you know, grassroots people, along with my voice in the book, which I thought was the right way to sort of present the story. Some of the young women you feature are, they are very young. They are also

terribly vulnerable. They've had wretched lives. And in many cases, they have been forced to become members of the terrorist organisation. How would you react to criticism that you were romanticising them to a degree? Well, I don't think I was romanticizing them. I was just trying to understand what women do in a country like India when pushed to extreme situations. How do they challenge their own roles and stereotypes, you know? Because these are women who have lived in grinding poverty, and I've seen malnutrition. I've met women who were in a family of seven.

I've just had one meal to share between all of them. I've met women who've seen their sisters get raped and seen their houses burned down, you know. So and that has made them join the guerrilla. And also they have not only fought the social and economical realities and state violence, but they've also fought class system and caste system and patriarchy, you know. So, I mean, no matter what you think about the agenda of the Maoism and the movement of the terrorist organization, but at the same time, it's pretty extraordinary to sort of seen the kind of life these women have gone through and how they're fighting back. So for me, it was important to tell the story as an Indian woman, you know, where I see all in where I have run away from home to find

a life of freedom and violence. You know, this is connected through most women I know, you know, so I wanted to tell that story. Do you, how close do you get to them? And do you share any of your own experience? Oh, absolutely. I think, I think very, photography is an exchange, you know, I mean, I mean, you have to make yourself vulnerable and reveal your own secrets for them to trust you, you know, because you're asking for a lot in return, a photograph doesn't come easily, you know, you can, it's a lot of trust. So I spend a lot of time talking to people and talking to women before I actually take a photo. So I told them stories of my journey, you know, how I left home when I was really young and how I came from a family of child

brides and, you know, domestic abuse and how that is sort of a common theme between a lot of us and how we sort of connected over it. And that's when they opened up and they started telling me their stories. Did you ever feel that they resented you? Were puzzled by you? What did you think they thought? I think they were puzzled by me a little bit. And also the fact that I was carrying a Hasselblad camera through which you could see what was happening. They were just mesmerized by it, all of it as well, you know, and they found it quite amazing that I was in the village on my own and a woman who's just five foot three inch old you know just walking around you know in the remote areas like they were very confused and perplexed by me yeah right um well it's a

fascinating look at what is well an extremely troubling and very complicated situation but thank you very much for talking to us we appreciate it and that's Poulami Basu the Indian artist and photographer and her book is Centralia. Now, Troopers is a series of features we've been running about. Women who just spot something that needs doing and they get on and they do it. And Sarah Burrows was a manager in the Youth Offending Service in Oxfordshire. Back in 2011, she was dealing with children and young people coming into the criminal justice system for the first time. And she began to wonder just how many of them also had a parent in prison in some cases.

And she discovered that for young men, that figure was 65%. It just seems so blinding obvious. If you know that 65% of boys are going to go on to offend, then actually why not intervene really early and stop that happening but i knew there was a need in terms of wanting to support the families but did families actually want that was that what is that what they needed um and so but like lots of different village halls at the weekends um and no one turns up so So you would advertise? Yeah, and go out to all the different schools, put in flyers in the GP surgeries, put them on notice boards. And what did the flyers say?

Something like, have your partner in prison, would you like support for you and your family, and if so, contact us. So some did contact, but nobody showed. So we had quite a few occasions like moving the location and looking and I'd have volunteers there really supportive and we'd take all the stuff around and nobody came. And then in a community hall in Oxford City, eight women came who didn't know one another. And one, this was a grandmother, and she had looked after her grandchildren since they were 18 months and three years old.

And they were 13 and 16 at the time. And she just sat and cried and cried and cried. Shame, stigma, isolation, how they're viewed by their community, how the children are bullied in school. You mentioned the part that shame plays in this situation. Do you want to just talk me through that specifically? I think as a society, the way people who have a parent in prison are treated is quite appalling. From their addresses being printed,

well, the person who's going to be serving the sentence is no longer at that address, but there's children at that address. And often the response is, well, they weren't thinking about their children when they committed an offence, but actually it's the children that are left there. They really have so much bullying from that. We've had people assaulted. We've had someone with feces through the door

and actually what does that say to children about a society caring their parent offending isn't actually anything to do with them children don't actually want to often talk about it to other children because there is a lot of bullying so we've got one little boy he was four

and so he was four, and so he was at school about to be five, and he was the only child in the class not to be invited to the birthday party, as an example. And actually starting your school career of being the child ostracised for something that you haven't done is quite unbelievable, really. And how did that play out for him? That he felt really obviously sad, angry and couldn't understand why and so then it was necessary to do a piece of work with the school

about actually talking to parents about how the child might feel. So it sounds to me like you respond to each case quite uniquely, it's quite a tailored response in terms of what each family each child might need yes and at different stages um throughout the sentence people need different things and every family is different so it's around the family dynamics so we support children whose father will be going back to the family home. We support children who have no contact with their parent in prison, maybe because of the offence type or maybe because they're the victim. We support children whose parents have already separated, but actually they still were having a relationship with that parent who is inside. So it's really different for everybody.

Do you deal with many families where it's the mother that's in prison we have had um quite a few mothers but it's mainly the fathers i remember working with 165 children and 10 of those are living with their grandparents and that often is the mother the one that is serving the sentence, or both parents, or the father serving the sentence and the mother having drug and alcohol issues. How many years did you do this on your own? I was on my own until February this year and now have three colleagues I work with.

Initially I did it on my own on a voluntary basis and then how I grew it was um somebody um worked on like a very small part-time basis and then as we got a bit more funding um increased her hours and it went like that and she was amazing did you always know I mean that obviously there's the moment with the empty halls but once you got past amazing did you always know I mean that obviously there's the moment with the empty halls but once you got past that did you always know that you you could do this I wasn't going to give up no I no I knew that there was a need and if there's a need then it might not be the way that I think that it should go but then listen to others listen to the families and adapt adapt it but yeah i felt so

and i still do really really passionate about it and children um about as a society we should create change for them and if i can do a small part of that then yeah i've got something here i want to read to you this is from somebody who you've supported. Sarah has changed my life. If there were more Sarahs around, the world would be a happier place. Do you hear stuff like that often? The parents we support are fabulous. I mean, I've met so many interesting women.

They're amazing. And in fact, just before I came in here, one of the mums phoned me and I said, I can't talk. And she said, oh, you should have told me you were coming and I'd have done your nails. I mean, everybody is, they're really lovely women that I work with. Yeah. What would you like to see happen in the next few years? The thing that I find staggering is there is no government databases of who these children might be. Nobody knows who they are and that was why it is difficult to set something up. I just think that there should be a way of capturing this information and supporting children earlier and that's what I'd really like to see change. We don't know who

these children are. That was Sarah Burrows talking to our reporter Laura Thomas. Her charity, that's Sarah's charity, is called Children Heard and Seen and it now operates in Oxfordshire, in Berkshire and in Birmingham and it continues to offer virtual support services during lockdown. So that's good to hear. Now, to your thoughts on the programme today. First of all, to the conversation about puberty blockers with Deborah Cohen, who is Newsnight's medical editor, correspondent. This from Alison, who says, I was interested to hear this.

The interview was factually based and informative and focused on an area of real concern to many parents, that of the growing realisation that the long-term impact of puberty blockers are not known. The NHS wording has changed not insignificantly, and it was a measured and thoughtful exploration of the issue. But Alison goes on, I would appreciate a follow-up interview in the next couple of weeks to evaluate the changing situation in the UK, in particular, the rising numbers of natally born females diagnosed with gender dysphoria and the effects of the pandemic on this number. Yes, Alison, that is interesting. Of course, we don't know whether the pandemic will

have a significant impact on that, but I guess it's worth checking up on. Amanda also emailed along the same lines just to say that she'd like to thank Deborah Cohen for giving such a measured and informed response to the questions. Amanda says, this is an important issue and I'm happy that Woman's Hour was able to make listeners aware of it.

This is something completely different from Alex, who says, can I implore you to ask your guests to drink some water before they speak to you? People are sounding dehydrated and it would be solved just by advising them to drink a glass of water. Right, Alex, that's almost certainly my fault. I guess if we had the time, we would ask people to have a sip or two of water. I don't actually think, I mean, I have water with me in the room or coffee if I'm on a good day and someone's got me some. And it does help to have something with you. But guests, particularly now, well, they're never with me.

They can't be in the studio with me. They're often at home. They are tense. I don't think it would, and I don't blame them, by the way. We're all tense. I don't know whether it would help if they had water 10 seconds before they spoke to us. If they're in a difficult position, perhaps sitting in their bedroom on their own, talking on national radio, they might well sound nervous.

So I wouldn't hold it against them. But yes, OK, we'll take that on board. Let's advise all our guests to have a drink before they take part in the programme and the presenters as well. Margaret was listening to the interview with Dawn, who was the critical care, still is a critical care nurse. If Dawn feels she may have had COVID and she is a critical care nurse, why on earth was she not tested? Surely she should have been and now should be tested for antibodies. Nurses in my local hospital are tested every Thursday with results on Friday. Well, that's a fair point, Margaret. I should say, as Dawn made clear, she works across a number of different hospital sites

and for a number of different hospital trusts, so it may be slightly more complicated in her case. But it's clear, of course, that nurses are very vulnerable and certainly ought to be tested. And we had this email too from Alison, who is actually talking really about the impact of all this on care workers. She says, those of us who work in the care home sector are always under extreme pressure.

We've been experiencing severe pressure almost every shift for years and we struggle with shortages of staff and equipment of all sorts, including gloves and aprons. And we have watched in disbelief as nurses complain, NHS nurses complain about stress and anxiety as a result of their experience of nursing sick people during the pandemic. Every winter, care home staff nurse sick residents who've succumbed to winter viruses. The recent pressures, sometimes hysterically described on social media, are the normal daily experiences of many of us,

and we respond to this professionally, working long hours and extra shifts week after week, month after month for years. Obviously the media is only interested in hearing from those who want to return, who want to turn their working life into some sort of drama, not the thousands of nurses who cope and have coped in extreme circumstances for years. OK, to that individual who clearly absolutely has a fair point there, I would just say that I don't think this programme can be accused of ignoring people who work in the care sector. In fact, it's a subject we have gone back to time and time again. And the subject of care generally is something that I know many people in this programme feel very passionate about covering,

because so many of us have either done it in the past or will do it in the future or are doing it right now. So I absolutely, I hear your pain because it's quite clear that you feel that those of us in the media at times can be guilty of perhaps over-romanticising some aspects of the current situation and ignoring the reality for so many people in the past as well, which I take your point completely

and will make very sure that we don't fall into that trap in the future. But thank you for contacting us. And you can always do that. You can email the programme whenever you like via the website bbc.co.uk forward slash Women's Hour. Tomorrow, Jenny's going to be talking to Amanda Craig, the novelist. And on Thursday, she's looking at gender bias in the workplace. It shouldn't be happening, of course.

But do you feel you've been a victim of it? Are you an employee or perhaps you're an employer? Let us know how you're getting on in this difficult area. You can email the programme to bbc.co.uk forward slash women's hour. BBC Sounds, music, radio, podcasts. Hello, I'm Tim Harford, the presenter of More or Less. And I believe that if you want to understand the world, which is a very big, very complicated place, then numbers are an absolutely essential tool, like a telescope for an astronomer or an x-ray machine for

a radiographer. Numbers answer questions we can't answer in any other way, such as how I'm Sarah Trelevan, and for over a year, your world. 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.