The Black Bag Spring 2021 Edition

THE BLACK BAG

BRISTOL MEDICAL SCHOOL Spring term Ed., 2021 1

The University of Bristol Medical Students’ Magazine Est. 1937 Editor-in-Chief: Molly Van der Heiden Vice Editor: Emma Harvey Illustrator: Barbara Piecha Social Media Representatives: Cecilia Gran & Chloe Wong Contributors: Adewale Kukoyi, Alice Watts, BAME medical student group, Emma Harvey, Eve Miller, Guy Wilmott, Katherine Grigg, Kathryn Orr, LGBT+ Health society, Matthew Summers, Molly van der Heiden and Zin Htut

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The Black Bag Spring 2020 Editorial ……………………………………………………………………………....4 Poem: Let’s Talk …………..…………………………….…………………………...5 President’s address ……………………………………………..………….………..6 Galenical’s committee 2021/22………...…………………………………….……..7 Interview with Dr Kirsty Biggs: Infant feeding education………………………8 Why medical training has got to change………………………………………....11 How to be a LGBTQ+ ally……………………………………………………..…..13 Imposter………………………………………………………………………..……14 An honest reflection of TB2 in year 2……..…………………………….………..16 How to bribe the Brits 101………………………………………………………....17 Who wants to be a millionaire? Interview with Mainga Bhima…………….....18 Pfizer vs. AstraZeneca Top Trumps……………………………………………...20 21 x 21 km for Matt Ward: the final marathon pictures………………………..21 How do you stay at home if you are homeless?: the impact of the COVID-19 pandemic on rough sleepers……………………………………………………..23 BAME medics: Why our work is important…………………………………….25 Ye Olde Black Bag……………………………………………………...…………..26

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EDITORIAL Welcome dear readers to the Spring term issue. Again, it has been a rather strange sort of term. When I wrote last term’s editorial, I was looking forward to declaring this spring issue as the first post-pandemic publication of The Black Bag’s history. Alas, we are not there yet, but the end of the Boris Johnson’s roadmap is in sight. I am sure for many of us, patience is wearing exceptionally thin and I for one cannot wait for restrictions to be lifted. Even just a small example is that I would love to be able to meet with the Black Bag team face to face. I am sure I am the first editor in its 84 years of publication to conduct all my team meetings via video chat. Some hilarity has definitely resulted from this, including many frozen faces or conversations that one would have preferred to have be muted.

This term’s issue is a lively one; exciting interviews including a Bristol medical student “Who wants to be a millionaire” winner, an honest reflection of term 2 in year 2 including a rather dashing pillow patient, vaccine top trumps, some more serious musings on the TV series everyone has been talking about, It’s a Sin. One of my favourite articles in this issue is our anonymous piece on Imposter syndrome – incredibly relatable and rather beautiful. Do explore through the issue and if you disagree or it sparks any thoughts in you and you want to share then drop us a message as we are always looking for more contributors.

Scrolling through the top news stories of this Spring term, they are disappointingly but not unsurprisingly a mass of COVID information. There was also the brief fame that Bristol had around the world for the Kill the Bill protests and we have seen the rolling out of the UK’s vaccine programme with many smug medical students beating their Granny for their first dose. However, for me the memory most etched in my mind will be the way that we, as a medical school, have rallied together. I have truly never felt so close to my fellow students despite the physical distance. I want to encourage you all to continue talking to one another and making sure we help each other and ourselves. On that note I want to include a poem I wrote for the Galenicals Let’s Talk Campaign on the following page. Do give it a read and consider what the words mean to you.

M.van der Heiden Editor-in-Chief

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Let’s Talk Once I lit a tiny spark And it caught some leaves amongst the dark It furled and fought the howling wind Only growing louder And never did it thin Once I ripped a paddling pool It spit and spat and began to drool The waves began to crash and grow And it followed me up the hill Onto my toes Once I split a bag of seeds At first just a smattering of glistening beads But that summer they grew and thrived And I wondered why I had kept them So deprived in their tiny bag Once I told my friend That I often had thoughts Of despairing and no hope of mend And of tying myself in knots Once my friend told me Not to put the fire out For I would be unable to see Not to try to close the hole Or hide the words in the undergrowth Once my friend told me Let’s Talk M. van der Heiden Editor in Chief

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PRESIDENT’S ADDRESS Fellow Medics, it is a great honour to be invited to write an address to you in this year’s Spring Edition of the Black Bag. When I was elected as President of Galenicals, I was humbled but equally challenged by what I saw as an opportunity to bring Medical Students together within these bizarre times.

It would be naïve of me not to mention how difficult the past year has been. COVID-19 infection rates and Public Health restrictions have been overwhelming, especially restrictions on travel which have prevented us from seeing our family and friends. My main target for my year as President is to ensure that, while we spend our time at Medical School learning how to protect others, we have the means to ensure that we are safe and well.

Despite the current climate, I am looking forward to the year ahead and hopeful that the government’s roadmap leading out of lockdown will allow for us Medics to be safely reunited in-person very soon for a variety of events that the newly elected committee are planning for you all including an awards dinner, “what to expect on Outplacement” and “coping well away from home” talks, sub-society webinar, Intercalator Refresher Programme, and our first Multiculturism Fair just to name a few.

The elected committee have been fantastic in the few weeks that they have been in their roles.

Collectively, we have decided on the following key priorities for the year. Firstly, improving out-placement students’ wellbeing. This will involve expanding our Welfare Rep Network across the academies and ensuring that there are spaces for students to talk and discuss their concerns weekly. Secondly, I want to create a system which ensures that all students are aware of Galenicals’ actions for the year and have the opportunity to raise concerns more easily. With regards to student recognition, I’m excited to be working with the events team to give out Galenicals awards this year, recognising outstanding contributions to others both within the Medical School and beyond. Finally, I want to ensure that current intercalating students feel ready to go back to Clinical Placement in September after many months without it by putting on refresher programmes for revision.

I wish you all a pleasant Summer Term and do feel free to reach out to me at any point if you wish to chat or you have any concerns.

Alice Watts Galenicals President 2021-21 6

~ GALENICALS COMMITTEE 2021-2022~ Alice Watts – President Aarti Jalan – Placement Vice President Jai Patel – Campus Vice President Gunchit Sharma – Treasurer Max Shah – Alumni Director Joel Bevan – Colleges Director Sri Movva – Communications Director Sabrina Sajjad – Equalities Director Abby Netherwood and Eliza Burdass – Events Directors Mary Huang – International Director Tom Ferreira – Sponsorship Director Jemi Maliyil – Sub Societies Director (Academic and Representation) Alex Doulah – Sub Societies Director (Arts and Charities) Murray MacKay and Polly Pittman – Sports Directors Ffion Williams – Welfare Director Isabel Burridge – Secretary

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Interview with Kirsty Biggs: Infant feeding education Kirsty Biggs is an academic foundation year 2 doctor who works in Stoke. She went to medical school in Brighton and did an intercalated BSc in Reproductive science at Imperial. During her intercalation, she did a cross-sectional project on formula supplementation in the postnatal ward. It was after this (when she returned back to medical school) that she then started her breastfeeding education work, after she witnessed doctors giving inappropriate advice during a pediatric placement. Her main interest is in Infant feeding, but she is also involved in other obstetrics and gynecology topics.

MV: Did you enjoy your medical school, and was it hard to intercalate externally ?

KB: I had a great time at med school, like I hope most people do, and got myself involved in lots of fun extra-curricular stuff as well as some research and teaching projects. At Brighton, they made it really easy for us to intercalate externally. I knew I wanted to do something O+G related and fancied the chance of experiencing student life in a different city.

MV: Why do you think you are so interested in Infant Feeding?

KB: Prior to intercalation, I knew very little about infant feeding. I was aware that ‘breast is best’, however really didn’t understand the true extent of the benefits. I think it is just amazing that something completely natural, and free, can have such an impact on health, economy and wider society. Breastfeeding plays a key role in achieving sustainable development goals, encompassing health, poverty, education, gender equality and sustainable consumption.

MV: Do you think medical students get enough training on Infant feeding?

KB: This was my motivation for the breastfeeding education project! The only reason I really knew anything about infant feeding is because I happened to do my dissertation on it, so I suspected it was under-taught. As doctors we are important role models for women, and it is important we have the knowledge and skills to support mothers and help them to make informed feeding choices. I was delighted to find that 97% medical students* believed doctors to play a role in supporting breastfeeding, with 93% expressing a desire for further teaching on the subject. *based on 411 students (years 4/5 or 5/6).

MV: What made you pick an academic F1 compared to the mainstream programme?

KB: I realised during intercalation how much I enjoyed research and decided I’d like it to be part of my career. The academic foundation programme (AFP) gives you, paid, dedicated time to work on something you’re interested in, alongside the usual clinical work. It’s a great combination and adds some variability to my week. I have a flexible schedule which has allowed me to develop new skills, build my CV and undergo multiple projects.

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MV: What is your proudest piece of research so far?

KB: My breastfeeding education project; a national survey on the inclusion of breastfeeding in the undergraduate medical school curriculum, and assessment of students’ related knowledge, skills and attitudes.

MV: Through my own research, I have found that infant feeding is vastly impacted by sociocultural factors. For example, the most deprived areas of Bristol have the lowest breast-feeding rates compared to more affluent areas. I asked a doctor who is currently doing a sustainability fellowship why he thought this was. He suggested that we should lie a lot of the blame with formula milk companies who advertised their products as more beneficial to a baby’s health. Do you think this is true? What other factors do you think are involved with this issue?

KB: I agree, a significant responsibility lies with the formula industry. Under the WHO International Code of Marketing of Breastmilk Substitutes, companies are not allowed to advertise artificial formula for babies under the age of 6 months. This has unfortunately left a loophole which essentially allows widespread advertising of their products. By using similar branding for all their products, businesses can in effect advertise all their products without breaking the law. Most of the components in infant formula are unnecessary and can actually be harmful. In short, the formula industry is unethically misleading parents and undermining the value of breastmilk.

MV: A recent survey in Bristol found that 63% of the mothers interviewed stopped breast feeding early due to embarrassment of feeding their child in a public place. Do you think the government and companies are doing enough to support these women? What other steps do you think could be taken to reduced stigma?

KB: A difficult question. Normalising breastfeeding is sadly not going to happen overnight, and as always there is a balance to strike. Although formula-milk companies are only allowed to advertise follow-on milk, there is no breastfeeding promotion in the media to ‘sell’ breastfeeding. Bottle-feeding is all around us from slogans on baby clothes and bottles

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for dolls, to the mothers we see on television programmes. I think education (in schools) and increased early exposure to the benefits of human milk could play an important role in normalizing breastfeeding for our future generations.

MV: The benefits of breast feeding one’s child include mental health, physical health and saving the planet. How do we encourage new mothers to breast feed without alienating those who simply cannot?

KB: There are several targets set by the Baby Friendly Initiative including antenatal infant feeding discussions and early inpatient support. From the work I did in London, it was apparent that many mothers, including those breastfeeding, were not aware of many of the benefits of breast milk. I think really the focus needs to lie with helping women make informed choices and supporting them to continue breastfeeding. I often get asked why I am so pro-breastfeeding and I try to explain that it’s not about pressurising women who have chosen to use infant formula but providing women with the support to do what is best for them. National data suggests that 80% women stop breastfeeding before they want to. This gives a really important message that we need to improve our support.

MV: What are the three most important things you would like all medical students to know about Infant Feeding?

1. Breast milk is an incredible resource. As quoted in the Lancet ‘If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.

2. Please remember, as a doctor you are a role model. Women will listen and respect what you say. Be careful not to give inappropriate advice. It is much better to refer them to someone who does know, than to undermine the correct advice a woman may have received from her midwife.

3. I also would advise everyone to watch ‘Embarrassed’ by Hollie McNish on YouTube.

MV: If you could give one piece of advice to your first-year medical self what would you say?

KB: Not advice really, but I’d tell her to keep having fun.

Thank you so much to Dr Kirsty Biggs for allowing us to interview her. If you want to get more involved with breast feeding education, then please do check out the Bristol breast project online. The Breast Project is the first UK-wide scheme created to enhance breast education in medical school and inspire the next generation of aspiring surgeons to consider breast surgery as a future career.

Follow them online @breastproject.bristol

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WHY MEDICAL TRAINING HAS GOT TO CHANGE I couldn’t take my eyes off the screen. Squeezed next to some fellow medics in a student room, on placement in Bath earlier this term, we were watching the TV series ‘It’s a Sin’. The show follows the lives of a group of gay men in their early 20s who move to London in 1981.

As the show unfolds characters get HIV/AIDS, and over time many of them die. We, the viewer, lose the people we have grown to love and are left feeling like a mother who lost her son prematurely. Previously, I had only given the most cursory interest to the AIDS pandemic. I wasn’t born till 1999, a decade after the worst of the drama, and it was not a topic I remember discussing when I was growing up in West London.

‘It’s a Sin’ prompted me to think about the human factors at play in this much earlier pandemic of the 1980s, one that was wrapped up in homophobia. A huge number of men, running into the hundreds of thousands, were rejected by their own families when they had, or died of AIDS. None of this rejection had occurred to me – that parents would burn their children’s possessions if they had died of AIDS to erase all traces of their family connection.

Nor had it crossed my mind just how difficult it might have been to be a carrier of HIV. In the show, Richie is the confident, jokey protagonist. He knows he has HIV but still continues to have sex with other men. After Richie’s death, his friend Jill explains that Richie felt ashamed and felt that he deserved to get a virus because he was gay. I could not understand how a victim of a pandemic might feel such self-loathing and as if they deserve to die.

The series affected me profoundly, as I know it did for many other medics who watched the series. The word spread fast among us medics: watch this series and be amazed as well as chastened. We were all left with the same question: “Why, given the huge impact of this epidemic, had we had no formal teaching on the AIDS pandemic at medical school?”

The TV series prompted discussion with my friends on the existing curriculum that medics are taught. COVID has also prompted general discussion at family dinner tables up and down the country about pandemics. We all felt ill-prepared when questioned by our families on previous pandemics – not just AIDS, but other medical catastrophes throughout history. We were no longer the resident ‘we know-all-about-medicine-and-are -delighted-to-answeryour-questions’ in our families. From feeling ignorant about AIDS, I realised that my ignorance did not stop there. There were other important medical pandemics I knew nothing about: the Spanish flu, the eradication of infectious diseases, or the SARS or Ebola epidemic.

I realised that the only history of medicine teaching came in my medical training was when individual lecturers deemed it relevant to their subject matter. I recall one lengthy lecture about the history of vaccinations, where the lecturer explained the story of Edward Jenner 11

with great animation. Other lecturers might begin their lecture with a brief timeline on the development of the advances within their speciality.

But overall, in general the history of medicine has been largely an indulgent afterthought for those interested.

The history of medicine is not viewed as key to our syllabus.

There are no questions in finals that demand an understanding of the past. Nor are there optional courses provided that advance an understanding of the history of medicine. This must change. Teaching on how medical advancements have been made in the past needs to be included in our training. This would foster a new understanding of current treatment, informed by a more in-depth knowledge of the past.

Take AIDS for example. Watching the series gave me a sense of how important it is to be sensitive to patients who have suffered from decades of prejudice. AIDS patients were often treated poorly by male doctors, who were prejudiced against their sexuality. Whilst we might hope that doctors today are immune from such prejudice, it is important to recognise that we may well have other biases and preconceptions that we are not even aware of.

It might encourage medical research: time and again, the battle to introduce new treatments and approaches in medicine has been long and hard fought. Chance has often played a role too. Just knowing this would foster a new spirit of patience and a long-term perspective in medics who were interested in working in research.

Knowledge of how the world has previously tackled pandemics, how new drugs and therapies have made their way into the BNF would bring a new humility to us trainee doctors. So often in the past, doctors have been mistaken. Returning to the treatment of AIDS: the series revealed how AIDS patients were wrongly given chemotherapy, as if they had cancer. I personally was humbled at the suffering they wrongly endured at the hands of the medical profession.

For all these reasons, understanding the past would enrich and give perspective to doctors.

Now that I know more of the history of AIDS, I would like to believe that I would be a better doctor for my own AIDS patients. In conclusion, I would advocate for curriculum change. We need a slot for understanding the history of medicine in the GMC’s ‘outcomes for graduates’ to improve the practise of tomorrow’s doctors. Watching television is good. Studying and being tested on your knowledge in a formal academic setting in the training of doctors is better Written by Katherine Grigg

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How to be an LGBTQ+ Ally Student voices

I asked some of my fellow queer medical friends what makes a difference to them. These points might encourage you to reflect on your own behaviour and biases but remember everyone is unique and these people do not speak for the whole of the community.

He/Him For me, being a good ally is simply about being aware of the LGBT+ community and about making sure that those little, small things that make people feel more accepted/included become part of a normal routine. For example, asking ‘are you seeing anyone/are you dating anyone?’ rather than saying ‘have you got a girlfriend- making no assumptions. Being aware of pronouns etc.”

An ally to the LGBTQ+ community is a heterosexual and cisgender person that actively supports the community and the movement towards equality.

An ally should both amplify the voices of individuals within the group and individually challenge the behaviour and ideas that continue to oppress and damage the LGBTQ+ community If you want equality, you are already an ally but to be an active ally there is more work to be done

Here’s how you can get started:

She/Her “Something I appreciate is not assuming the pronouns of a partner. When people ask, “have you got a boyfriend?” it’s awkward to explain no, and it sets a very heteronormative way forward that makes me feel defensive from the start. Despite knowing they are probably very accepting, a part of me worries from that point forward about coming out to someone who may not be inclusive.

Medical professionals have assumed the same and it’s difficult to feel comfortable to speak ally to the LGBTQ+ is a openly, An especially when havingcommunity conversations heterosexual about sexual health.” and cisgender person that actively supports the community and the movement towards equality.

He/Him “I don’t think non-queer people realise how powerful their opinion can be in a room. If I raise a point about LGBT+ inclusion or wellbeing, I often get the impression people may think it is me just shoehorning my identity into the situation. When someone who isn’t personally affected by that issue in their day to day lives speaks up on it or backs you up when you speak up on it, the others in the room definitely take more notice. I often voice something in a medical setting because I feel an LGBT+ perspective hasn’t even been considered in that situation, only for that to be met with silence or just awkward looks around you. This can be so crushing; that silence An ally should both amplify the voices of often masks shame and an unspoken individuals within the group and disapproval for your identity. Privilege is powerful and the opinion of non-lgbt+ people is often still far more resonant and audible above our own. Yes, that needs to change in due course, but until then, back us up!”

1. Check your privilege and learn about the history, oppression and challenges of the LGBTQ+ community 2. Be open minded when listening to others 3. Reflect on our own unconscious biases and prejudices 4. Don’t assume people are straight and cisgender, start to think outside the heteronormative world we live in 5. Language matters – get confident with the right language when talking with LGBTQ+ people 6. Call out the problematic behaviour and language when it is used and educate others on why it isn’t acceptable 7. Know that you will sometimes make mistakes and take responsibility when you do 8. Turn your allyship into an action rather than a label by doing the work

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IMPOSTER I love being a medical student. I love the learning, I love the patients, I love the lanyard. But I’m realizing now that, along with these loves, there are some strange, insidious, destructive other feelings that have followed me around since I first took my seat in St Michael’s Hill Lecture Theatre and Eugene Lloyd said that for at least half of us our future spouse was sitting in the same room.

Every now and then I get the feeling that I don’t belong, or that I’m a fraud and I don’t deserve to be here.

My thoughts can turn from good to bad to ugly in the space of a few seconds, and I’m fed up with this self-doubt and self-sabotage.

Here’s a few examples I’m walking into Biomed (I know, crazy, we actually used to walk into buildings), feeling proud that I’m at medical school à I remember all the people that didn’t get into medical school and I feel guilty à I remember the fact the medical students are meant to be studious, and I feel undeserving of my place because I spend more time on Instagram than I do studying Or: My friend gets a high mark in a test and I’m proud of them à I start worrying that my mark was a little below the mean (within the standard deviation of course) à I start hating myself that my subconscious takes me to such a competitive place and wonder why I

can’t just be happy for someone else without making it all about me Since first year I’ve lived in fear of “getting found out”, of the medical school realizing they’ve “made a mistake”, that ticking the box that sent me an acceptance email was an accident and that I shouldn’t be here. The years spent leading to applying for universities and the years before that spent playing with toy stethoscopes and then arguing with a friend at school about who would be the best doctor and then cautiously contacting distant medical relatives and begging for work experience meant that when the email “we would be delighted to offer you at a place at Bristol Medical School” arrived I couldn’t quite believe it. Then there were the sleepless nights waiting for A level results and then they arrived and were perfect and then I was in. U1 by night; dissection room by day.

Since then, I’ve been looking for excuses for them (“them” “them” the shape shifting heads of year, Hugh Brady, the mayor of Bristol, the BMA, GMC, MDU, FML, the government, God Himself, whoever) to realise their error and kick me out. In first year, it was when I forgot to accept my accommodation offer in time and almost didn’t have a place to live. Even if it was all fine in the end and all blew over and all la di la lovely jubbly why did you get yourself so worked up about nothing, I still told myself “that’s not what a medical student would do, forget an important deadline like that. You’re not good enough; what’s next, forgetting a patient’s allergies and prescribing penicillin?”.

I would be on a night out in first year, dancing on tables in Brass Pig, flinging away my inhibitions with every twist or shimmy and then suddenly: what if they find out, what 14

if they burst through the doors now and I’m off the course just like that because I’m drunk, there’s a hundred medical students here but it would be just my luck wouldn’t it, I’d be the one, they’d say “future doctors don’t drink Thatcher’s Haze, you’ve had too much, you’re jeopardising public trust in the medical profession, time’s up”.

This year, Covid-19 restrictions have been the perfect breeding ground for my doubts and insecurities. The “negative selfschema” has become a broken record of “what if someone saw when I put my hand on my friend’s shoulder when we were walking around the Downs / when I went into their house to do a wee / when I met up with seven people outdoors”.

There are informants hiding behind every tree; cameras in the garden; MI5 agents on the specific mission of catching me out and reporting me to the GMC. It’s been a while now and I should be pretty secure in my medic identity.

I’ve passed the exams, I’ve got my mini-CEXs, I’ve got “a pleasure to work with” and “a great member of the team” immortalized in annual TABs. But there’s always something, there’s always a little niggle. And I’m trying to work out why. Perhaps it’s something to do with my demographics – maybe the boys don’t feel like this, maybe the private school alumni don’t have to watch their back every wrong turn, maybe I’d have more confidence if I’d taken a gap year. But really, I embody all those labels that this broken society favours - I’m “middle class”, white, able-bodied. When my laptop broke in first year, I could buy a new one; during lockdown 1 stuck at home I had that sacred room of one’s own to work in. If this is how I feel, how much harder must

it be for those who don’t, like me, have the money or whiteness or able body?

“I know it’s a cliché, but I really have always wanted to be a doctor”. That was innocent 17-year-old me, trying to impress the stern examiners in the Anson Rooms of Bristol Student Union. I dreamt of being a medical student most of my short life, but maybe that is the exact problem – a dream can never feel real. We call doctors lifesavers, extraordinary, “NHS heroes”. But they’re not – they’re human, and medical students are too.

Notoriously we are perfectionists, and we measure ourselves against incredibly high standards. Maybe we need a bit of that drive in order to succeed, but if the goal is becoming superhuman, that’s a battle we can only lose.

Maybe it is just me who feels like this, but my guess is that most of us succumb to the “imposter phenomenon” from time to time.

The sooner we realise what our brains are doing to us, the sooner we can halt their self-destruction.

The truth is, I got this place at medical school because I deserved it, and you did too. We do our best.

We’re not perfect, but we’re good enough. We will make mistakes (hopefully not too many of us will prescribe penicillin to someone who’s allergic, but you know, as long as you reflect and learn from your experience…) but that is part of life.

Take a deep breath, fling your lanyard round your neck and let’s go get ‘em.

Anonymous

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AN HONEST REFLECTION OF TB2 IN YEAR 2

The challenges posed by the second teaching block remained the same - remote learning. It was interesting to see how we would approach TB2 in a remote fashion as we got more clinical. Namely, patient examinations stand out. I would have never imagined I would be using my Littman Classic III stethoscope (yes, I'm name dropping) to auscultate a pillow that had a Beats Headphones case for its head and a clothes hanger for its neck (see picture below).

Cardiovascular and Respiratory examination (I have the Abdominal one to look forward to).

In other news, we also completed our 'Low Mood' symptom case, which was, out of all cases I've done, the most unique. Despite the COVID circumstances, we managed to have our Secondary Care placement in Psychiatry, where we were shown around the Callington Road Mental Health Hospital virtually. In addition to this, we had live breakout sessions on Zoom (sigh) in fields ranging from Art Therapy, CBT and the most interesting of them all - Music Therapy. I'm sure most second years can agree and say the latter was indeed an experience.

Still, this case in particular, challenged some of my preconceived notions about working in mental health, and it was an invaluable experience.

Nonetheless, alongside many in my year group, I persevered, and this surprisingly was a great learning experience. The lack of responsiveness and pulse from the patient - I mean pillow - was something new but still allowed me to go through the ordered steps of

Then it was vaccination time! I received my first dose of the Oxford AstraZeneca vaccine, only for the Government's vaccine committee to conveniently recommend that "Under 30s should be getting a different jab". We'll see how that situation unfolds, but for now, I'm eagerly looking forward to some restrictions being lifted and the potential option of in-person teaching!

Written by Adewale Kukoyi 16

The news we have all been waiting for…Brits may be allowed to grace the world with their presence again. We may soon be able to immerse ourselves in another culture, practice our language skills and mix with the locals. Or is it complain, talk loudly in English, and eat chips? With the prospect of going abroad and complaining there too, I’d say things are rather looking up.

Are you looking for white sand, sea air, and sex on the beach? Have you heard of Weston-Super-Mare? For the downcast and downtrodden amongst you, the tropical island of Lola Lo’s will have to suffice. Just flash your shiny new vaccine card and you’re in (*medics only).

That’s a point, think about all those poor unvaccinated people in the world.

Auntie Vaxxer and her organic children want their annual all-inclusive summer retreat, but it looks like a soggy camping trip in the Lake District will have to do. Did someone say, ‘organised fun’? Tie-dye and tantrums over scrabble are on the cards, unlike the vaccine.

Maybe you simply can’t let go of dreams of sizzling in the sun this summer – after all, how else are you going to achieve leathery skin by the age of 40? The potential traffic light system might yet save you from quarantine. On the downside, however, your precious student loan would have to suffer – the price of PCR tests doesn’t exactly fit with the cheap and cheerful holiday you’ve been planning for yonks.

All of a sudden, a COVID-crammed SneezyJet has lost its appeal - a staycation may be just the ticket! Just beware of the mass exodus to the last available AirBnBs in Cornwall, though. I think I’ll just stay at home.

Written by Kathryn Orr

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Who wants to be a millionaire?

Interview with Mainga Bhima

Who is Mainga Bhima? A bubbly and ever-effervescent second year Bristol medical student, a good friend of mine from my CBL tutorial group, and now, the winner of £64,000 after appearing on the TV show Who Wants to be A Millionaire?

‘The whole experience was just so surreal, like a fever dream,’ Mainga sighed, reflecting on a process that began with an application form in August and ended with the recent airing of the episode at the start of February.

Brainstorming a get-rich-quick scheme, born out of necessity from the all too familiar burden of university tuition fees, was what inspired Mainga to submit an application form for the world-famous game show last August.

‘I’d watched the show a lot before, and I’d always sit there at home with my family, answering the questions myself and thinking I could get to at least the £32,000 question. And you know me, (Zin), I’m a smart aleck and like to give everything a go. So, over the summer, when my sister and I were planning how to get rich quick and I really needed the money, I just thought: why not?’

In a curious twist of fate, the question that won Mainga £64,000 was about the publishing company she worked for in her career prior to joining Bristol University in 2019. She flashed a gleaming smile as she recounted hearing the pivotal question and talked animatedly.

In 2013, Penguin merged with which other company to form the world's largest book publisher?

A) Simon & Schuster B) Random House C) Pan Macmillan D) Harper Collins

‘When I heard it, I couldn’t believe it. I really thought that it was like Slumdog Millionaire and I was going to go on to win the million,’ she said. ‘But when I was preparing for the show, I did notice that people getting questions like that are more common than you think.’ She then referred to a previous episode 18

about a contestant who was asked a question about Loch Less, where he had lost his leg in a car accident.

‘To be honest, there was a lot of good luck involved in me getting how far I got,’ she said with great humility. ‘The 50/50 went my way and then there was the Penguin (publisher) question. But to be honest, you need the good luck - they definitely try to make the studios as stressful as possible!’ The pressure of making it onto the hot seat was real, and palpable.

‘Watching from home, it might look easy, especially with the earlier questions.

But the actual thing is so nerve-wracking, you end up second-guessing yourself quite a lot. They don’t even play any music for the early questions, it’s completely silent in the studio at first!’

Mainga was also not allowed to inform anyone of her winnings for two months until the episode aired in early February.

‘It was really hard, especially because I actually lost my phone on the train home,’ Mainga exclaimed with a gracious chuckle. ‘So I had to tell people that I lost my phone in the middle of a lockdown, but obviously I couldn’t say that it was on the train back from Who Wants to Be a Millionaire!’

Finally watching the episode in which she participated was also a surreal experience for Mainga. ‘It’s amazing how much they edit out actually, as I was in the hot seat for over 40 minutes. I’m quite glad they gave me a nice edit and cut out some of the more silly things I said!’

Mainga was pragmatic about what to do with her winnings. Her reflections on what the money meant to her was emblematic of the stresses money can either relieve or exacerbate in the modern age, especially for a medical student in the midst of the Covid-19 pandemic.

‘It's nice that the money can take so much pressure off me as it covers my tuition fees, especially in such a challenging year to be a student and there aren’t the usual avenues of making money through part-time jobs and so on.

There is also some leftover, and I’m going to invest it and hopefully use it towards buying a house.’

We also entertained the thought of other members of our tutorial group who would do well on the show and any pieces of wisdom or advice she has for future contestants. ‘Just be yourself, and remember you’ve got this far into the selection process for a reason.’ After a contemplative pause, she quickly added: ‘And pick your Phone a Friend really wisely!’

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When asked to summarise her experience, ‘Why not?’ was the resounding lesson Mainga had to offer. She gleefully implored me, and as many people as possible to embark on experiences like hers: ‘You never know what could happen.’ It was fitting that Mainga’s message to embrace such opportunities was one all of us can apply to just about any aspect of our own lives. It was also one of great optimism as we welcome the coming of spring and hopefully, the gradual waning of the pandemic as vaccination progresses.

Her final words? ‘Everyone should go for it, I’d love for the whole of the med school to get stinking rich.’

With her eternal generosity and exuberance, it is difficult to find anyone who deserves £64,000 more than Mainga Bhima.

Written by Zin Htut

VACCINE TOP TRUMPS

Illustration by Emma Harvey

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21 x 21 km for Matthew Ward: the final marathon pictures

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We couldn’t have asked for a better day, that makes it 21 Saturdays with no rain! Firstly, a big thanks to everyone who joined us for each loop. We certainly got bored of the route but you guys really kept us going, BIG LOVE . Over the last 6 months we have been blown away with the support on each of the runs and it was even sweeter to see you all at the finish line and throughout the day on Saturday. Without all of the cheering there was no way that our legs would have carried us over that finish line - you really did make all the difference!

On personal note we really couldn’t have done this without you lot. This has been such a huge part of our lives for the past 6 months, at the end of the day it’s not about us or the running it’s about celebrating Matt and reducing the stigma around talking about mental health. We wish Matt had known how many people loved him and seeing the endless support for each and every run along the way shows just how much he was cared for and how deeply we all miss him. We’ve raised nearly £16,000 in memory of Matt for Samaritans and this will hopefully go a long way to supporting people in the future. https://www.justgiving.com/fundraising/mattward21

We are planning to start up a running club in honour of Matt in the weeks to come so keep your eyes peeled for further info on that too! Remember this is not the end, just a pause for something new from here. Matt will always be with us in the future as we remember him in days to come, but it will be different than a Saturday morning half marathon.

Heaps of love, Matt and Guy xxx

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How do you stay at home if you are homeless?: the impact of the COVID-19 pandemic on rough sleepers An old man huddled in an alcove besides a supermarket, his hands outstretched for a warm drink or food.

A woman asking passers-by for spare change so she can find shelter, braving the cold and chancing the generosity of strangers. A young man queuing for shelter, barely eighteen, wishing for warmth and a roof over his head.

The faces of homelessness, much like its causes, are myriad in number and variety.

It is easy to forget that throughout the COVID-19 pandemic of 2020, the instruction to ‘Stay at Home’ may have wildly different meanings for different groups of people. How do you stay at home if you are homeless?

For the rough sleeping community, the government’s much welcomed ‘Everyone In’ scheme provided emergency accommodation for 15,000 homeless people in unused hotels and hostels. According to a study published in the Lancet, 266 deaths were avoided during the first wave among England’s homeless population, as well as 21,092 infections, 1,164 hospital admissions and 338 ICU admissions. There have largely been no sustained outbreaks of the coronavirus amongst the UK’s homeless community, in contrast to the devastating impact the pandemic has had on the USA’s rough sleeping population which is now regarded as a ‘pandemic within a pandemic.’

While this may indicate that the ‘Everyone In’ scheme was

resoundingly successful, the government itself has acknowledged that up to 90 percent of rough sleepers were not accommodated during the first lockdown. Now that we are in the depths of winter, emerging from a second, shorter lockdown in November, it is clear that the pressure faced by homeless shelter and support services is immense and only increasing.

There are many elements contributing to the intense strain on these crucial services.

Statutory homelessness figures in London are at 15-year high, due to a number of factors that ultimately stem from the pandemic response: increased incidences of domestic abuse, rising youth homelessness, job losses and the economic recession. Furthermore, support services are also reporting significant levels of staff absence due to illness and self-isolation. This incurs additional administrative costs to replace them with agency staff or redeploy existing staff. Recent funding from the government has not been ringfenced and given the vast range of challenges local authorities are facing during this pandemic, not all are providing more funding for support.

Yet without additional financial support, many services may be forced to shut-leaving thousands of rough sleepers back on the streets.

There are no easy fixes in a crisis like the one we have faced with COVID-19 in 2020. The impacts of the pandemic

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and the ensuing lockdown are multifaceted and in a normal year would be considered serious and widespread issues in their own right.

However, as students living in Bristol, the difficulties faced by the homeless community and these services may offer unique opportunities for us to help and to learn from. Help Bristol’s Homeless is a well-profiled and invaluable source of support and accommodation for our city’s rough sleeping population, with a direct partnership with our medics hockey team. Their recent Christmas shoebox and rucksack appeal highlights the generosity of our community as well as the importance of such services and fundraising drives. They are always in need of fundraising efforts and activities, making them an excellent organisation to be involved with. These fundraising drives and events make a vast difference to the quality and quantity of services and spaces they are able to create and maintain for the homeless population in Bristol.

As many of us returned home for Easter and Christmas for a much-needed respite from unprecedentedly strange versions of terms at university, I would encourage everyone to reflect and research small things that can be done to help support homeless people in your local area. From shoebox appeals to working as a call companion, there are a number of opportunities that can make a huge difference to a population that continues to face immense struggles this winter as the pandemic continues.

By Zin Htut

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Why our work is important by the BAME Medical Student Group

The BAME Medical Student Group (BAME-MSG) is a group of University of Bristol medical students that was formed in 2019 to improve racial representation within the MBChB curriculum. We sit as an advocacy group between medical students and the medical school and work to ensure teaching surrounding diversity will be integrated into content taught throughout the course, providing an understanding of the ways ethnicity and race affects the clinical presentation and prevalence of disease. We also aim to increase awareness of social issues affecting practice such as cultural bias and sensitivity, which is recognised in the GMC’s Outcomes for Tomorrow’s Doctors. Importantly, by providing an avenue for BAME students to work directly with the medical school, we hope that this work could help address the BAME attainment gap and our school being actively anti-racist.

As tomorrow’s doctors, it is important we are all adequately trained to treat a diverse range of patients which reflects the diverse world we live in. We know that BAME patients disproportionately have worse health outcomes, and this has been further exacerbated and brought to the forefront by the current COVID-19 situation. An example is black women being 5 times more likely to die from childbirth than their white counterparts. The racial disparity even extends to the medical devices we rely on so much with black patients being three times more likely to have oxygen levels missed by pulse oximetry. These examples highlight a structural bias within healthcare that continues to endanger the lives of BAME patients.

Some of our members gave their thoughts on why the work we do is important: Ifrah Omar: “The BAME-MSG is a great way to get involved in many opportunities around the BAME medical student experience. It’s an active and lively group of like-minded students who are working to improve BAME representation in the medical school curriculum, in research and anything healthcare related. I joined after discussions with a friend regarding our frustrations about the lack of diversity in dermatology teaching and these ideas are now being implemented directly by the medical school. If you are someone who enjoys collaboration and has ideas about projects or changed you would like to see, I would highly recommend you join BAME-MSG” Ayesha Abbas: “At present, a structural bias still exists within the healthcare setting at the expense of BAME patients. BAME-MSG is a fantastic collaboration between passionate students with the common goal of decolonising the medical curriculum and implementing tangible changes from the very start to reduce this gap. My decision to join BAME-MSG was based on the fact that I desperately felt like I needed to get more involved to make important changes, particularly because of the lack of practical clinical skills teaching specifically on BAME patients, including recognising life-saving clinical signs (such as cyanosis, jaundiced

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and many others.) The group has already given me the opportunity to engage in discussions with course leads to better implement teaching regarding natural differences that occur between patients of ethnic minority backgrounds such as differences in eGFR, from earlier on within the curriculum. Overall, BAME-MSG is a great way to improve BAME representation at the start of a medical career where it is most important, which hopefully will then be reflected in clinical practise.”

Sabrina Sajjad: “As we get further along in our medical degree, it isn’t long before we start discovering all the extra requirements expected of us – from research to teaching, leadership to degrees, it is apparent that doing Medicine goes far beyond the curriculum for many pathways. For some students, this is something they know about, something they can work on – they have that help and connections. But for those from underrepresented groups, accessing these opportunities is a lot harder – and this unequal access is not only part of, but reinforces, the systemic inequalities that prevent underrepresented groups from progressing into their full potential. It’s a bitter cycle, evidenced by the BAME attainment gap where, even after overcoming the social barriers that prevent BAME students from entering university, they still do not have an equal footing – and it also feeds into our future medical careers. This feeling of constantly ‘playing catch-up’ to others is something I strongly resonated with. It led to me joining the BAME-MSG, during which time I was able to create the BAME Research Initiative at Bristol Medical School. This scheme is only one more step in closing the gap – it helps connect BAME medical students with mentors that can open the pathways into academia for them. I’m really proud of the work that this group is doing – by providing the resources, networks and support that BAME medics need, we are actively making a change.”

Khadija Meghrawi: “I helped set up the BAME-MSG to increase racial representation in all aspects of the medical curriculum, because patient safety is endangered when we aren't taught how to use our skills on everyone in our population, including people of colour.

It is crucial that we understand medical knowledge doesn't exist in a vacuum - the erasure of race or in fact the harmful practice is a result of the influence of our history of racism and colonialism. We must actively work to ensure all medical practice is being researched and made effective for all in order to help combat the start inequalities in healthcare that we're seeing in minority ethnic populations, including patients with darker skin tones.

The BAME-MSG has been key as a forum for students of colour to be empowered in their involvement in this process. We relay our concerns and ideas to the medical school academic staff and have been working alongside the Medical Anti-Racism Task Force to translate this into tangible action.

We must create an environment where racial disparities are seen as a priority not just in isolated areas but throughout the year, because it must be relevant to all of our practice.

This includes through initiatives such as increased skin diversity in dermatology, learning clinical signs on a variety of races and understanding the different prevalence of diseases depending on ethnicity. We also aim to increase awareness of social issues affecting practice such as cultural bias and sensitivity.”

Some notable things we have done so far include: • Working with the medical school over the past year with various academics to begin the conversations diversifying different areas of medicine • We organised the medical school agreeing to a list of commitments in response to BLM which were declared in a public letter • We ran a "Race in Clinical Medicine" event with over 80 medical students, where concepts of race in medicine were presented across the year

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How every medical student can play a part.

We believe that every medical student can and should play a part in tackling racial representation within the medical school. This includes: •

•

•

Flagging issues within the curriculum: We urge all students to be curious about how diseases and symptoms present on BAME patients as this will make us all better doctors for our future patients. We have also created a form for students to highlight any lectures/learning materials/tutorials/cases where they feel BAME representation can be improved. This can be found through the link here: https://forms.office.com/Pages/ResponsePage.aspx?id=MH_ksn3NTkql2rGM8aQVG 5vLW72-SThBq72gpD8-5gVUNTE5SzE3UTNGNk82SzZCVEpSQVZGQVU2RC4u Educating yourself on the issues: Galenicals have put together resources that can act as a starting point for education on some key issues. It includes videos, podcasts, petitions and research that has been done into various important topics. This can be found here: https://www.galenicals.org.uk/bame-education-for-allies Stand up to discrimination: It is important that we all stand up against discrimination of any type within our various academies, the university and beyond. As doctors, we have a key part to play in influencing and leading change!

Be sure to look out for us! :) Written by the BAME MSG group.

YE OLDE BLACK BAG 2013

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Thanks for 28 reading J Lots of love, The Black Bag Team