The Christmas and New Year break are over and although I enjoyed it, I felt strangely relieved.  I think that’s because although it’s normally a really enjoyable time of year- it can also be highly stressful.  We know stress has an effect on general health. But how much do we know about how stress affects particular conditions associated with the Black community?  Black women have the highest risk of developing fibroids (non-cancerous growths in or around the womb). They can lead to heavy periods, period pain and pregnancy challenges (amongst other things). It is useful to know if stress plays a part in the existence of fibroids since we can control the way we handle stress.

A basic search of the literature doesn’t reveal many studies focused on the link between stress and fibroids.  One study did note that the increase in stress hormone cortisol can cause fluctuations in oestrogen and progestogen. Low levels of these hormones are linked to a reduction in fibroid growth.  This particular US study actually investigated the links between major-life event stress and fibroids in both Black and White women.  The authors reported  that the greater the number of ‘major life events’ the female experienced, the more likely she was to have fibroids. The pattern was evident among white women who had experienced all levels of stress yet only obvious  among  very highly stressed  Black women.  The authors of another study looked at 22,002 premenopausal  US Black women.  They reported that high levels of self-reported racism increased the risk of fibroids.  However, a study on Chinese women did not find any link between stress and the presence of fibroids. You can find out more about these studies here, here andhere.

Due to the small number of studies which investigate the link between fibroids and stress, it is difficult to say whether there is a true link- more work needs to be done in this area.  However, some people do find that they discover their fibroids after a period of stress in their lives. Have any of you had this experience?

Comfort Momoh is a  Female Genital Mutilation/Public Health Specialist at Guy’s and St Thomas’ NHS Foundation Trust in London and  is the founder of the African Well Woman’s Clinic, a service that provides counselling, support, information and surgical reversal to women and girls who have undergone FGM.  

She was an advisor to the World Health Organisation, represented the UK at the UN Commission on the Status of Women in 2001, is the Chairperson for  Black Women’s Health and Family Sport,  is the vice-president of the European Network on FGM and is a member of the UK’s FGM National Clinical Group.

 In 2003, she was awarded the first ever nurse/midwife of the year award by Guy’s and St Thomas’ Foundation Trust , in 2014 she was the recipient of the Nigerian Centenary Awards’ 100 Outstanding Nigerians past and present who have lived in the UK over the past 100 years and in 2008 she was awarded an MBE for her services to women’s health.

[Photo credit: Top Forma]

Have you heard of the expression: ‘don’t do things by halves’?  It normally means that people shouldn’t do things without putting maximum effort into it. So for example – if you are doing an exam you may wake up in the early hours of the day to study and revise. If you have an interview – you read up about the role and company until the point of saturation.  If you’re going out for a New Year celebration, you may select your outfit and venue (and maybe even hairstyle!)  well in  advance.  But for me, doing things ‘by halves’ can take on a different meaning.  It can mean achieving your goal ‘piece by piece’ i.e. piecemeal.  So instead of exhausting yourself to achieve a goal, you could achieve it by breaking it down into manageable chunks or ‘half- measures’

So what has this got to do with the New Year?

Well, every year millions of people make a pledge to be healthier and fitter. But six months down the line – the pledges are largely forgotten and definitely not achieved. Perhaps if we make small changes or ‘half-measures’ our goals would be easier to achieve.

So how can we break down key health and fitness activities into manageable chunks?

1.   Eating more fruit and vegetables

This is a common goal for most people. You don’t have to consume large plates of vegetables or fruits in one go.  Vegetables can easily complement many meals. Why not add some slices of fresh cucumber to your already prepared jollof rice?  Or add scoops of avocado or finely chopped mushrooms to your rice and peas?

2.    Increasing exercise
Do you find gym membership too expensive?  Is it too cold to go for walks outside? Jogging on the spot at home whilst watching your favourite soap for just 30 minutes could burn at least 100 calories! You could start off by jogging through one programme and then slowly build up to two. Do you love exercising to music? Why not find some old school Rnb tunes on YouTube, switch it on and dance while you are doing the dishes?

3.   Reduce fried food intake
Fried food isn’t great for many reasons including the fact that it is high in calories because it absorbs the fat from the oil. But many people find fried chicken irresistible! If you are one of those then why not alternate between fried and grilled food to begin with?  You could have fried chicken on one day then the next time you have chicken make it grilled or roasted. You could do the same thing with other meats.

4.   Reduce alcohol intake
Did you overdo the Baileys or the rum punch at Christmas? Next time you’re out for the evening or even at home and you feel like a drink – why not pour yourself two drinks? One of the drinks could be your favourite tipple and the other could be a glass of water.  You could alternate between the two drinks, sips from one then another.  You would ultimately end up drinking less alcohol.

So hopefully you now have the gist of ‘doing things by halves’ to achieve your goals.  What other ideas can you come up with?

In our new blog series, Inspirational People in Healthcare, we’ll be recognising people in healthcare who are making a significant difference in their field. We hope you’ll enjoy reading this blog series and please do email us the details of anyone in healthcare who inspires you and we’ll include them in this series. In this our first blog in the series, we focus on the Nigerian doctor Dr Bennet Omalu.

Dr Bennet Omalu is a Nigerian forensic pathologist based in the US. He was the first to identify, describe and name Chronic Traumatic Encephalopathy (CTE) in American football players in 2005. He has continued to conduct research in this area and discovered the same condition in war veterans.

Over the years Dr Omalu has tirelessly campaigned for further work to be carried out to protect football players from CTE and to raise awareness of this condition which causes those affected to suffer from memory loss, aggression, confusion and depression. He has testified twice before the US congress and took on the NFL who tried to discredit his work, but later in 2009 the NFL publically acknowledged the link between CTE and football.  In 2013 the NFL reached a settlement with 4500 former football players who stated that the NFL failed to properly educate them of the dangers of professional football.

Dr Omalu’s story was recently told in the 2015 film ‘Concussion‘ starring Will Smith and this led to the formation of the Bennet Omalu Foundation. You can view the trailer for Concussion below.

Dr Omalu has made a significant difference in this field and we salute him for his determination, integrity and bravery.

The Lake Foundation would like to wish you all a very merry and happy Christmas.

You can still indulge today whilst being healthy. Remember to include lots of vegetables with your Christmas dinner – try Brussel sprouts, parsnips, carrots, sweet potatoes and  baked/grilled plantain – and for dessert try a lovely vegan cashew cheese cake.

Additionally, select white meat and fish instead of red meat and keep active – try taking a walk regularly throughout the two week Christmas and New Year period.

As the year draws to an end it’s the perfect opportunity to reflect on the work that we’re doing. As a result of all your support and encouragement we have been very productive and have made significant progress in working towards our mission of improving the health and well-being of the black community.

We are delighted to share our achievements for 2015 with you. Over the past year we have:

1. Continued to run our African Caribbean Cancer Support Group which meets monthly  and were delighted to have been awarded a grant by Macmillan to help us increase its membership.

2. Published our new fibroids booklet which aims to be a one-stop-shop for anyone with questions or concerns about fibroids

3. Continued to offer support to women through our Fibroids Ask the Expert which provides women with questions or concerns about fibroids with access to experts in the field that can provide them with accurate reliable information

4. We welcomed a new member to our Fibroids Ask the Expert, Dr Nigel Hacking

5. We continued with our summer cycling sessions  as part of our ‘Keep Active’ work. These sessions had double the number of people attending compared to the previous year.

6. Delivered a range of health awareness presentations to the  community

7.  Recruited new trustees

8. Our founder was presented with an award for her contribution to improving the health and wellbeing of the black community

9. Published the results from Prostate Cancer Engagement and Empowerment pilotthat we conducted with funding from Prostate Cancer UK

10. We were featured on radio and in AfroRetro magazine

11. We were offered a grant from Sport England to run a cycling club for a year and hope to begin this project in January 2016

12. We teamed up with Black History Walks, Amanda Epe and Dr Sydney Dillard to run a fibroids awareness event with over 200 women attending.

13. We became a member of the Croydon BME Forum

14. We piloted ‘AfroFit’ as part of our ‘Keep Active’ work

This week the UK’s Chief Medical Officer Prof Dame Sally Davies published her annual health report which focused on women’s health. We were very happy that the report had this focus as many of the health issues that affect women can often be ignored,  not talked about or are felt to be too trivial to be of any importance to society. The report communicates this sentiment by stating that:

“Problems ‘below the waist’ are not generally seen as attractive topics for public or political discourse. Women are often reluctant to seek help for conditions that are common, disabling and taboo…”

The report covers a number of women’s health issues including gender-based violence, FGM, eating disorders, pre-conception health, prenatal screening, perinatal mental health, post-pregnancy care, menopause, incontinence, prolapse and women’s cancers. They make 18 recommendations on how to address the challenges associated with these issues and you can read about these here

We were disappointed to see that fibroids weren’t mentioned in this report despite fibroids being very common and having a significant effect on quality of life. It would have been very relevant for fibroids to be have been explored in a report on women’s health and we feel that this was a missed opportunity to explore the impact of fibroids and begin to develop a national strategy to support women.

The authors highlighted the fact that obesity tended to be a common theme in all of the health issues they explored and stressed that action is needed to prevent obesity. Therefore the report made the recommendation that the Government should include obesity in its national risk planning.  This led to the many media headlines this week stating that “Obesity is the biggest threat to women’s health” and that “obesity is as dangerous as our terror threat”.

We were very happy that the Chief Medical Officer’s report focused on women’s health, a very important area and hope that her recommendations are taken forward to ensure that we improve the health and wellbeing of all women. We were disappointed that key issues such as fibroids were excluded from this report and we’ll continue our work in this area.

You can download her full report below.

At the end of last year we conducted a prostate cancer engagement pilot project as part of a large piece of work funded by Prostate Cancer UK to determine the most effective method of reaching the black community with the key messages about prostate cancer.

Local charities were invited to apply for funding to carry out small projects over 3-4 months and we applied for funding to focus on black churches to determine whether, in reality, this is an effective and practical environment to raise awareness of prostate cancer.

Targeting black churches has two main advantages. Firstly, if we take London as an example, a large number of London’s black population attends church regularly. The London Church Census, covering the time period 2005-2012, found that 48% of inner London’s church goers and 21% of outer London’s church goers were black¹.  Based on their figures this equates to 238,158 people from the African and African Caribbean community. This means that by targeting black churches we can reach a significant proportion of the African Caribbean community.

The second advantage of targeting churches is that it provides a very structured environment where a large number of people meet regularly. This, in theory, makes it a convenient environment to deliver health awareness messages. Additionally, many churches have developed their institutions beyond just preaching on a Sunday. Many churches have Men’s Fellowships, Young Professional Networks, Women’s Fellowships, Over 50’s Clubs, Men’s Conferences, Women’s Conferences and social functions. This means that there is the opportunity, in some churches, to select a sub-population within a church that would most benefit from a particular health message.

Whilst there are advantages to targeting black churches there are some logistical challenges. Firstly, churches tend to have a busy programme of events that will have been planned months in advance making it difficult to fit additional events into their schedule. Secondly, the ideal situation would be to deliver a presentation on a Sunday where there is access to the entire congregation, but many churches may not be able to accommodate this.  This means that awareness presentations would have to be delivered on a Saturday or during the week where only a small percentage of the congregation is likely to attend.  Through a flexible approach, being creative with the methods of engagement  and developing  long term relationships with churches it is possible to overcome some of these challenges.

The Lake Foundation being based in Croydon, where there is a diverse population and a significant number of black churches, decided to work locally and target churches in Croydon and the surrounding area.  In our pilot we worked with two churches and explored the best strategy for working with churches to raise awareness amongst their congregations.

From our pilot we  found that:

1. Engaging with black churches can be an effective way of reaching the African Caribbean community with the key messages about prostate cancer because of the potential of reaching large numbers.
2. To reach large numbers in a church setting requires the development of a long-term bespoke engagement programme.
3. There is a need to understand the structure of individual churches to ensure the best strategy is implemented to reach as many of their members as possible.
4. Engaging with churches may include targeting Sunday services for maximum reach and/or organising awareness sessions on a weekday/Saturday to ensure members have a more in-depth knowledge of prostate cancer.

 Recommendations

Overall The Lake Foundation recommended that Prostate Cancer UK explores developing a structured awareness program for African Caribbean churches in the UK or contracting this work out to community organisations. Whilst this may require significant time, personnel and resources we believe it is an effective way of reaching the black community.

Our specific recommendations:

Target Sunday Services

This pilot has shown that targeting Sunday services would ensure large numbers of people are reached but with limited information because of the time constraints of fitting into the Sunday service’s programme

Targeting churches successfully on a Sunday would require two approaches:

• A short presentation during all their Sunday services
• Setting up an information table throughout the day on a Sunday

Specific recommendations:

• Develop a  5-7 minute presentation that could be used for Sunday services
• Develop an easy method to measure the impact of delivering short presentations at a Sunday service
• Be flexible and persistent

Target churches outside of a Sunday service to achieve depth of knowledge

If the aim is to deliver in-depth information about prostate cancer to church goers and if this isn’t possible through a Sunday service due to time constraints then an additional approach will need to be taken.

The pilot has shown that targeting churches through a one-off event (not on a Sunday) is not the most effective method of reaching the largest number of people, this  only reaches a small percentage of a church’s congregation.  Therefore a regular engagement programme is needed.

Specific recommendations:

• Work with individual churches to understand their structure and how best to reach their members
• Identify groups, departments, events and forums within individual churches that can provide an effective environment to raise awareness
• Organise regular events with the same church throughout the year
• Make good use of churches’ communication platforms – social media, website, newsletters, bulletins, TV stations, YouTube channels etc.

We believe that by taking a long-term, flexible and creative approach in targeting churches a significant impact can be made and we’re delighted to learn that Prostate Cancer UK will be launching a new Faith Based Outreach Project using what we learnt from this pilot. We wish them all the very best in this project and hope that is makes a significant difference in increasing cancer outcomes by facilitating early diagnosis and we’d like to thank Prostate Cancer UK for giving us the opportunity to conduct this pilot.

You can download our full report below.

References

1.       Brierley Consultancy, London Church Census and London City Mission, 2013. London’s Churches are Growing.Kent: Brierley Consultancy

We were absolutely delighted to be interviewed on Croydon Radio once again about the work of our charity. We featured on Worker’s Playtime this week where we discussed our mission to improve the health and wellbeing of the African and African Caribbean community and also talked about some of the support we’re offering with our cancer support group.

You can listen to a recording below,  our interview starts about an hour into the show.

We get a lot of questions about natural ways of treating and managing fibroids and in this week’s blog post we take a look at what the research tells us about the effectiveness of complementary medicine in treating the symptoms of fibroids.

Fibroids are non-cancerous growths that develop in or around a woman’s womb. They can cause a number of symptoms including pelvic (tummy) pain, infertility, heavy and/or painful periods, back pain, anaemia, constipation, frequent urination and pain during sexual intercourse.

The exact cause of fibroids is unknown but research does suggest that fibroids are caused by a combination of genetic, lifestyle and hormonal factors.  Those most at risk of developing fibroids are: black women, those who are overweight, women of child bearing age (particularly women who are 25-45 years old), those with a family history of fibroids and women who haven’t given birth.

There are several treatment options for fibroids these include a hysterectomy, myomectomy, embolization, endometrial ablation and new MRI-based treatments. Some of these treatments such as a hysterectomy and endometrial ablation result in infertility and because of this as well as unease with medical procedures, many women are exploring less invasive more “natural” options for managing their fibroids, but are these effective. What does research tells us about “natural” methods, more formally known as complementary and alternative medicine (CAM), for treating fibroids?

What Does the Research Tells Us?

To explore this area we’ll look at one recent research paper which was published in 2014 in the European Journal of Obstetrics & Gynaecology and Reproductive Biology and is entitled ‘Use of Medicine, Surgical and Complementary Treatments among Women with Fibroids’.  This paper summarised a study of 933 premenopausal women aged 31 to 54 with symptomatic fibroids. In this study women took part in face-to-face interviews every year for up to eight years to assess their symptoms following use of the treatment they opted for.

Researchers explored and compared the effect of CAM, Western Medicine and uterus-preserving surgeries. They classified CAM as the use of exercise, herbs, diet, acupuncture and physical therapy; Western medicine included hormonal contraception, analgesics and narcotic pain medicine; and uterus-preserving surgeries included myomectomy, embolization and endometrial ablation.

The majority of women in this study, 57%, didn’t have a hysterectomy or uterus-preserving surgery. The majority of these women used Western medicine to treat their symptoms and the most commonly used type of Western medicine used was anti-inflammatory analgesics followed by narcotic pain medicine.  Fifty percent of women who used the anti-inflammatories said it made their symptoms “a lot” better, but 10% were bothered “a lot” or “some” by the side effects. For women who used narcotics, 60% said it made their symptoms “a lot” better but 30% were bothered “a lot” or “some” by the side effects. Fifty-five percent of women who used the combined hormonal contraception said it made them feel “a lot” better, but 22% were bothered “a lot” or “some” by the side effects. Finally, the progestin IUD was the most effective with 71% of women who used it saying it made them feel “a lot” better, but 24% were bothered by the side effects.

CAM was used by a significant number of women to treat their fibroid-related symptoms. The most common methods used were exercise, herbs and diet. Improvements in symptoms were lower than that observed for Western medicine with 39% of women trying exercise, 38% of women trying herbs, 43% of those trying dietary changes, 45% trying acupuncture and 41% trying physical therapy  saying it made their symptoms “a lot” better, and as expected bothersome side effects were rare, less than 5% in all CAM therapies.

When looking at surgery, women who underwent uterus-preserving surgery had a greater improvement of pelvic symptoms compared to women who used Western medicine or CAM, but the researchers noted that despite this observation women who used Western medicine or CAM“observed significant improvements in pelvic problems as well as dyspareunia (pain during sex), pelvic pressure, bladder pain and menstrual cramps.”

In explaining how CAM works in improving symptoms, it was stated that some foods, vitamins and minerals can decrease the production of prostaglandins which cause a number of fibroids-related symptoms.

Based on their  finding the researchers concluded that “uterus-preserving fibroid surgery is effective, but many symptomatic women can be successfully treated with non-surgical management, including complementary and alternative therapy”

From this research study we can see that diet, exercise, acupuncture, herbs and physical therapy may be effective in some women at treating fibroid-related symptoms. Women wanting to explore any of these as an option should have a discussion with their doctor.

We do recognise that what’s missing from this study is the detail around what herbs and dietary changes women tried and we’ll be contacting the researchers to get some more information about this.

You can read the full paper by downloading it below.