As we are coming into the end of the first month of 2024, we thought we would take the opportunity to introduce our new team members who have recently joined our organisation. Melanin Medics would not be able to continue to uphold our various streams of work without the dedication and generosity of our volunteers so we are incredibly grateful to them!  We proposed to them a challenge of describing themselves in 3 words and have shared some of their responses below! New Members: Communications Team From left to right, Emma Brew - FY1 (Secretary), Faith Lambo - 3rd year medical student (Social Media Officer), Funmi Asekun - 5th year medical student (Social Media Officer), Ellen Nelson-Rowe - FY1 (Blog Lead) We are delighted to have 4 new members to our Communications Team. They are looking forward to seeing Melanin Medics continue to extend their reach and create new events adapted to current demand, and continue to foster an even greater and more connected community of young black medics through nationwide events and our social media presence. Emma has a career interest in dermatology and medical education. She describes herself as “introspective, reliable and sensitive”, also astutely recognised by 16personalities test!  Funmi has interests in ENT, Paediatrics and OBGYN. She describes herself as “curious, caring and diligent” as she loves exploring new things especially through travelling and hobbies and her determination: “once I set my mind to doing something, I want to do it and do it well! (or at least, learn how to do it better!)”.  Ellen is an aspiring ENT surgeon who describes herself as “empathetic, efficient and extroverted” - alliteration intended! Ellen says that her outgoing, eager nature has helped her to network widely and meet people from all streams of life which has nurtured her ability to relate to others and adapt to working with others effectively. New Members: Academic Team We are delighted to have 2 new academia officers: Kwaku Duah-Asante (FY1) and Michael Atife (3rd Year Medical Student). They are excited to see they can support the research network to help students and doctors alike through webinars and blog posts. They are both passionate about diversity and “hope to do their part in making the lecture halls of tomorrow more diverse by helping the next generation get a foothold. No black talent should be lost for lack of guidance” Michael describes himself as “outgoing, enthusiastic, cheerful. I like to seize the day with a smile on my face!” New Members: Programmes Team We are delighted to have 2 new members to our programmes team: Giulia Olayemi - Outreach Officer (Final Year Medical Student) and Patricia Ogunmakin - Education and Training Officer (Enrichment Programme) (Core Anaesthetics Trainee). They joined Melanin Medics to provide others in a similar position with the help and support they wished they had received, and to be part of a network of incredible Black Medics! Trish describes herself as “motivated, passionate, resilient. All three are needed to overcome adversity and I strongly believe with these skills, you can achieve anything you wish to!” New Member: Events Team We are delighted to have Ginika Okaka  join our events team. She is a 4th year medical student with interests in Obstetrics and Gynaecology, Paediatrics and Global Health, who joined Melanin Medics to help promote diversity in medicine. Representation in healthcare matters and factors such as socioeconomic background or race should not be an obstacle to becoming a doctor. She describes herself as “curious, open and kind” - “I love asking questions and researching things that pique my interest.I'm open-minded and outgoing. I like to try new things and get out of my comfort zone often. My favourite quote is that people may forget what you said or did but will never forget how you made them feel!” New Member: Advocacy Team And last but not least, we are delighted to have Naomi Ehigie join us as an advocacy officer who has previously supported our enrichment programmes events. She is a current FY2 and has interests  in medical education and widening participation. She is excited to channel her skills into bridging gaps and nurturing future medical leaders with such a talented team. We are incredibly excited to see what they will participate and achieve with us in 2024, under the direction of our chief executive Olamide Oguntimehin and Directors who have recently undergone a new structure you can read more about here. I look forward to writing and hosting guests on our blogs for the rest of 2024! Dr Ellen Nelson-Rowe, Melanin Medics Blog Lead

Annually in November, we see men compete to grow impressive moustaches to fund raise for Movember - the leading global charity for men’s mental and physical health, particularly for prostate and testicular cancer. We thought we would contribute to raising awareness by interviewing Mr Jonathan Noël - consultant urological surgeon, based at Guy's and St Thomas' NHS Foundation Trust. He also leads in prostate cancer diagnosis at Lewisham and Greenwich NHS Trust for the South East London Cancer Network. He is a double robotic surgical fellowship trained urologist and performed an excess of 100 robotic procedures in his first twelve months as a consultant (which is impressive compared to the average UK surgeon performing 46 per year!). He was born in the UK, then raised and attended medical school in the Caribbean. He is also a third generation surgeon, his father practices in the island of Grenada! You can find more about his work on his website. Health awareness: prostate cancer 1. What is one thing you wish everyone knew about prostate cancer? I wish people knew it has no symptoms at an early stage. It is important for families to talk to each other and understand their own risk, as a lot of people seek this out after their diagnosis. We need to see more openness and vulnerability around men and break down the “strong, mighty and never sick” stereotype - we are all human. It is also useful to know about the genetic relationship to breast cancer in families, which can also increase prostate cancer risk. 2. What are typically the most common first symptoms patients report? Most patients that present with symptoms can do so when the disease is advanced, such as urinary symptoms = haematuria (blood in urine), back pain at night and flank pain. It is important to note that it is not an old man's disease! We can see people present as early as in their fourth decade. 3. Once a patient is diagnosed, what is the typical journey to go through to get treatment? So most patients are referred by their GP following an elevated PSA above age specific normal range (blood test used primarily in clinical suspicion of prostate cancer) or a hard prostate discovered on examination. In a clinic, we go through a patient’s history, risk profile & perform an examination which is part of a clinical assessment. Next, we usually request a MRI scan which can avoid a prostate biopsy if it is normal. However, if there is an area of suspicion on the MRI, we perform a biopsy with precision to pick up clinically significant cancer, as opposed to without an MRI. If it is low risk or clinically insignificant cancer, we put these patients on active surveillance, which usually involves monitoring the PSA every 6 months and an MRI every 2 years. If it is intermediate or high risk prostate cancer, they tend to proceed to treatment which is discussed in a MDT (multidisciplinary team meeting where other specialists are present such as oncology and radiology) to recommend the best course of action such as radical surgery, radiotherapy or chemotherapy, or a combination! 4. How would you recommend men reduce their risk of developing prostate cancer? Men can get check their risk with this tool created by Prostate Cancer UK: https://prostatecanceruk.org/risk-checker Like all cancers, maintaining a healthy lifestyle is important - exercise, avoid excess smoking and alcohol consumption. These will improve a patient’s cardiovascular health as well. Actively being aware of your family history is important too, as you may be informed to enquire about PSA testing! 5. Do you think a national screening programme will come to fruition soon? At present, the UK does not have a national prostate cancer screening programme due to concerns about overdiagnosis and overtreatment. However, we should consider this carefully, as we know that “Black men are disproportionately affected two times more likely than white men and three times more likely than Asian men”. Additionally, the National Prostate Cancer Audit (NPCA), led by the Royal College of Surgeons, have discovered that black, elderly and deprived men were all less likely to receive radical treatment for their high risk disease. Important evidence we have for screening from the US is from 2012, the US preventive services task force downgraded PSA screening. However, following a surge in advanced prostate cancer presentations, in 2018 the task force recommended PSA screening discussions for men aged 55-69. 6. Tell us more about the community health initiatives you have been involved with to raise awareness Since 2019, I have been involved with an annual event hosted at a London barbershop owned by Kevin De La Rosa. It is converted into a mini auditorium and health fair complimented by cook-ups and music. It is a non-intimidating, relaxed environment to have discussions and learn a lot from patients. You can hear more about our initiative here: https://www.youtube.com/watch?v=p94UkqpyOzE This has received great support from prominent figures including Errol McKellar, MBE (60 year old football coach, former garage owner and prostate cancer survivor). Furthermore, local faith leaders such as Bishop Lennox Hamilton from Lewisham Greater Faith Ministry also hosted prostate cancer seminars in his community of south east london. I join these gatherings to speak about secondary care of prostate cancer diagnosis and treatment. I am honoured to receive perspectives on varied journeys from patients, which help us improve our service. Career Insights 1. Why did you choose urology as a career and why should aspiring surgeons choose your specialty? I’ve always wanted to do surgery and was particularly inspired by the technology used in urology. My mentor in Barbados, who I observed using a laser surgical system to treat prostate enlargement, is what sparked my decision to specialise in this field. In 2023, living in a digitalized world - technology in surgery is essential. This specialty lends itself well to balance between elective and emergency work. There are unknowns in prostate cancer, which makes it an interesting space to help build new knowledge in, particularly in respect to health inequalities. Also, you do not have to only do high risk surgery to make a difference in the field - it has everything for every career ambition. Urology offers the opportunity to make an impact with medical therapies in addition to surgical procedures. 2. What’s your favourite thing about your job? It has to be the consultation at the beginning - I really enjoy speaking to people and learning about their decision and journey to a diagnostic clinic. I also enjoy the challenges of robotic prostate surgery - no single operation is the same, yet the outcomes are so important to get right. 3. Where do you see the future advancement of robotics in urology in the next 10 years? Seeing additional specialties getting involved to improve on our robotic surgery further (we already see advances in colorectal, thoracic and ENT outcomes). It will be advantageous to see multiple specialty collaboration; when all surgeons in a hospital can use the system. For example, an iatrogenic bowel injury during prostate cancer removal and general colorectal surgeon performing robotic repair. I would like to see robot systems being more affordable, not only for developing countries, but for smaller NHS hospitals to use for the benefit of their patients. Additionally, it would be great to see smaller sized robots - at present they can take up a fairly large footprint in theatre! 4. Do you have any other final words for our readers? → We need to keep questioning the role of prostate cancer screening in the UK, particularly for groups of patients at higher risk than others. → Encourage your patients to know their risk! Use the risk checker and talk to their GP about PSA testing → I would not change my career. I encourage surgical trainees to find mentors and learn from their experiences. It gives fulfilment to mentors to support you and see you progress. → Robotic surgery is the future - everyone needs to get involved during training! We hope you have found this interview insightful! We can all play our part in raising awareness and supporting men to be open about their health. Dr Ellen Nelson-Rowe, Melanin Medics Blog Lead

In Part 1, we highlighted some changemakers of the past, who had an impact in history serving as inspirations to this very day. In Part 2, we are celebrating 'changemakers of the present and future' who are bringing fresh perspectives to what the world of medicine and surgery can offer. We are going to spotlight four esteemed varied individuals who have broken the mould of expectations within clinical medicine to pursue their passions. Let’s begin with two incredible women, seeing as the national theme for Black History Month this year is “Saluting our Sisters”. Dr Uyiosa Ogunbor Dr Ogunbor is an award-winning, multifaceted medical doctor, TV personality and entrepreneur. Her excellence shone even from medical school where she founded an organisation Medsimple - working with schools to raise aspirations and mentor students pursuing a career in healthcare. She is actively involved in healthcare leadership and management, having shadowed the CEO of a £600M NHS trust and is also a member of the NHS Clinical Entrepreneurship programme. She has also used her medical experience to educate on health topics on Channel 4 health series. Some of her other interests lie in finance and property investment where she writes a successful newsletter to provide advice. You can find out more about her in this fantastic podcast - listen here Dr Rochelle Pierre Dr. Pierre is an anaesthetic trainee following the ACCS route. She is the Founder of the British Caribbean Doctors and Dentists Association, a supportive community for fellow Caribbean doctors, dentists, and students, aiming to support each other, be involved in outreach programmes, advocate for health inequalities, and host health promotion events. Recently, she received two Caribbean Global Awards for her excellence in community health service and best healthcare staff organisation. Additionally, she serves as a trustee for StreetDoctors, empowering young people to save lives. Dr. Pierre also has a passion for music and works as a DJ at various festivals and events. Now onto the men! Mr Carlon Fitzpatrick Mr Fitzpatrick, an orthopaedic surgeon by background, is the co-founder and Business Development Director for Encode Health - a company that works by setting the standards for tracking and tracing of medical devices. Encode Health won international awards for their innovation in COVID-19. He is also the director of ‘Bee Sting Cosmetics’, a luxury natural skincare brand. He is also actively involved in the British Caribbean Doctors and Dentists Association. Dr Ivan Beckley Dr. Beckley is the CEO of Suvera, a healthcare company that enables virtual care for people with long-term conditions in the UK. His entrepreneurial background began during medical school, where he completed internships at companies, including Google's DeepMind, which sponsored and funded his MSc in Health Data Science. He was also part of the first group of UK medical students appointed as NHS Clinical Entrepreneurs. He is an esteemed public speaker on international stages and has also hosted a successful podcast: The Bias Diagnosis, where he explores health inequalities in modern medicine. We hope you have found these four spotlights inspiring, as they have and continue to make a national and global impact. It is important, however, to mention that there is often a misconception that if an achievement isn't publicly shared on social media, it is not important. We are all changemakers, perhaps in ways we don't even realise, and it does not have to fit within the constraints of clinical and academic achievements to count. A possible definition of being a 'changemaker' could be a person who strives to have an impact, no matter how big or small, in order to bring sustainable solutions, often in pursuit of their passions. What's your definition?" Happy Black History Month! (though we should all be celebrating it all year round!). Dr Ellen Nelson-Rowe, Melanin Medics Blog Lead

This year, our theme for Black History Month (BHM) is black Changemakers in medicine of yesterday, today and tomorrow. This blog factfiles esteemed doctors of the past born in the 19th century, serving as a bitesize Black British history lesson! Dr James “Africanus” Beale Horton (1835-1883) Dr Horton graduated from Edinburgh University in 1859, attributed as the second person of Nigerian descent to qualify as a doctor. He served in the British Army as a Staff Assistant Surgeon in West Africa (predominantly Sierra Leone and Ghana). This experience inspired multiple acclaimed medical publications based on tropical medicine - notably, “The Diseases of Tropical Climates and Their Treatment” is accredited for describing key symptoms of sickle cell disease contributing to its discovery. He also lobbied for higher education and medical training for West Africans. Dr John Alcindor (1873 - 1921) Dr Alcindor, of Trinidad descent, also graduated from Edinburgh University in 1899 and established his own general practice in London, becoming known locally as the celebrated ‘black doctor of Paddington’. He was rejected by the British Army to serve during World War 1 but despite this prejudice, he went on to be awarded a Red Cross Medal for his work helping soldiers at railway stations through signing up as a Red Cross Volunteer. He is also known for his research particularly in cancer and correlating poverty and diet with poor health. Additionally, he was a great advocate for racial equity and became president of the African Progress Union. Dr Cecil Belfield Clarke (1894-1970) Dr Clarke was born in Barbados after winning an island scholarship, he graduated from Cambridge University in 1918, also certified as a surgeon. He similarly opened his own practice in south London and later on in the 1950s, Clarke was elected to the BMA Council as representative for the West Indies, as well as Senior Medical Advisor to Ghana. He is renowned for being the inventor of Clark’s rule - still used globally to calculate pediatric drug dosages based on weight. He is also known for his civil rights activism working alongside Dr Harold Moody founding the League of Coloured People. Seeing as the national theme for this year’s Black History Month is “Saluting our Sisters”, it is important we pay homage to black women as well. Whilst there has been recognition of Black pioneering nurses in Britain such as Mary Seacole (1805-1881) and Annie Brewster “Nurse Ophthalmic” (1858-1902), there is little known about black female doctors during this era, if any. This is most likely due to the compounded barriers for women in the UK gaining a medical qualification. It was only in 1865 the first (white) female doctor Elizabeth Garett Anderson was openly qualified after private education with professors. However, we recognise that in 1864, Dr Rebecca Davis Lee Crumpler (1831-1895) became the first Black woman in the United States to earn a medical degree after serving as a nurse - an inspiration for us all across the globe. Unfortunately no photo of her has survived (she is often mistakenly adjoined to a portrait of Mary Eliza Mahoney - the first African-American nurse). We hope you have found these historical insights informative. What stood out to you about their profiles? What does being a Changemaker mean to you? We will explore this further in part 2 where we will celebrate Changemakers of the present and future who are bringing fresh perspectives to what the world of medicine and surgery can offer. Happy Black History Month! (though we should all be celebrating it all year round!). Dr Ellen Nelson-Rowe, Melanin Medics Blog Lead Sources: https://zodml.org/discover-nigeria/people/industry/james-beale-africanus-horton https://news.band/from-the-archives-meet-james-horton-the-1st-man-who-proposed-modern-independent-nation-for-igbos-1865/ https://www.forcesemployment.org.uk/news/black-history-month-dr-john-alcindor/ https://spartacus-educational.com/SLAalcindor.htm https://theblackcurriculum.com/blog/blackhealthcareworkers https://www.bma.org.uk/news-and-opinion/a-forgotten-hero https://www.caths.cam.ac.uk/about-us/history/black-history/c-b-clarke https://www.womenshistory.org/education-resources/biographies/dr-rebecca-lee-crumpler (All photos used - taken from public domain with unknown authors)

Sickle cell disease, an inherited genetic mutation, holds a significant place in the health narrative of Black communities. Its genetic footprint is deeply intertwined with people of African ancestry, influencing not only the prevalence of the condition but also the unique challenges faced by those living with it. This blog piece will delve into some of the challenges people with sickle cell face when accessing healthcare. Understanding the Prevalence Globally, sickle cell disease stands as the world's most prevalent genetic blood disorder, casting a profound shadow in England, where it affects 1 in every 2,000 live births, and affects 15,000 individuals living with the condition (1,2).While this genetic anomaly is not exclusive to Black individuals, it is undeniably more common within this community. This concentration is largely attributed to its historical origins in malaria-endemic regions, where a genetic mutation providing resistance against severe malaria contributed to its propagation over generations (2). The prevalence in Black populations is further shaped by complex dynamics, including heterozygote advantage, intricate inheritance patterns, and historical migration routes, particularly among African Americans and Afro-Caribbean communities (2,3). Healthcare Disparities for Individuals with Sickle Cell Disease The path for Black individuals living with sickle cell disease is fraught with intricacies and disparities within the healthcare system (4). They frequently encounter delayed diagnoses, inadequate pain management, and limited access to specialised care (4,5). These challenges are exacerbated by some healthcare providers who may grapple with fully comprehending the nuances of the disease and the unique needs of Black patients (4,5). In 2019, a global survey conducted by Novartis brought this issue to the forefront. Shockingly, nearly a quarter of painful sickle cell crises were managed at home, with 39% choosing to avoid hospitals due to previous negative experiences (6). Common reasons for this avoidance included a lack of understanding among healthcare providers (26%) and the intensity of pain (19%) (6). Unfortunately, stigma and misconceptions about sickle cell disease persist within the UK. The "No One's Listening", a All Party Parliamentary Group (APPG) inquiry report in 2021 revealed inadequate care within the UK's general hospital wards and emergency departments (4). Healthcare professionals were believed to often lack awareness, training, and positive attitudes toward sickle cell patients (4). Investment in care was insufficient, and communication among professionals faltered (4). Furthermore, racism was thought to compound these issues, with patients unfairly labelled as 'drug-seekers,' leading to dismissive attitudes and a lack of empathy (4).Disparities in care and geographical variations were also evident, particularly between specialist departments and general wards (4). The Call for Change In 2022, a national audit further exposed the alarming variations in pain management for sickle cell disease across England (5).Despite recommendations from the APPG, subsequent research by Public Digital in 2023, commissioned by the National Race and Health Observatory, continued to reveal unmet needs during acute crises, inconsistent care plans, and a reliance on family members for medication management (5). Hence, individuals in crisis were described to often be hesitant to seek help, citing a lack of trust in the care they would receive due to deficient knowledge and delayed access to pain relief (5).The lack of communication and collaboration among some healthcare professionals in hospitals perpetuated these challenges (5). However, direct access to specialist sickle cell nurses or teams was identified as a significant improvement (5). The Emotional Burden However, this battle extends beyond physical health. Living with a chronic illness like sickle cell disease exacts a profound emotional toll, leaving a lasting impact on mental well-being on individuals and families. This psychosocial aspect is intricately intertwined with cultural factors, including the prevailing perceptions of illness and healthcare within the black community, presenting a multifaceted challenge. The Sickle Cell World Assessment Survey (SWAY) in 2023 revealed that 41% of respondents experienced significant impacts on family life. Additionally, 44% reported feelings of anxiety, and a disheartening 45% grappled with depression, underscoring the emotional burden (6). The Path Forward In the face of these challenges, a resounding call for advocacy and research specific to sickle cell disease within the Black community emerges. Charities such as the Sickle Cell Society continue to advocate, support, and represent people affected by sickle cell disease (4). NHS England recently launched the campaign "Can you tell it's sickle cell?" to raise awareness in emergency care of the signs of a sickle cell crisis as part of a broader effort to improve care for patients with sickle cell disease across the UK (8).In addition to this, NHS England is also investing in a new blood group genotyping program, in partnership with NHS Blood and Transplant, aimed at improving the transfusion process for patients with inherited anemias like sickle cell disease and thalassemia (9). Conclusion This blog post has aimed to shine a spotlight on the profound impact of sickle cell disease within the Black community in the UK and the significant challenges that persist in ensuring consistent, high-quality care, highlighting disparities in healthcare access that demand our attention. It is clear that individuals living with sickle cell disease bear a substantial emotional and physical burden. However, in the face of these challenges, there is a call to action for advocacy, awareness, and dedicated research to tackle this pressing issue. Organisations such as Sickle Cell Society, along with NHS England initiatives, are making efforts to raise awareness, improve care, and provide essential support to those affected. As we look to the future, we hope that continued efforts, increased understanding, and unwavering support will lead to a more equitable healthcare landscape for individuals living with sickle cell disease in the UK, ultimately enhancing their quality of life and well-being. Written by Dr Oby Otu Enwo (Public Health Academic Clinical Fellow in East of England) References https://www.hematology.org/education/patients/anemia/sickle-cell-disease#:~:text=Approximately%2070%2C000%20to%20100%2C000%20Americans,the%20production%20of%20abnormal%20hemoglobin. https://cks.nice.org.uk/topics/sickle-cell-disease/background-information/prevalence/ https://www.hematology.org/education/patients/anemia/sickle-cell-trait https://www.sicklecellsociety.org/no-ones-listening/ Lugthart, S., Kotsiopoulou, S., Lumani, A., Eleftheriou, P., Drasar, E., Brown, R., Webster, A., Chakravorty, S., Stuart-Smith, S., Velangi M., Atoyebi, W., Howard, J., and Telfar P. Acute and chronic pain management in sickle cell disease: Outcomes of an Englis national audit. Hemasphere. 2022 https://www.novartis.com/news/media-library/sickle-cell-world-assessment-survey-sway-results Hemasphere 2022. Black sickle cell patients’ lives matter: healthcare, long-term shielding and psychological distress during a racialised pandemic in England – a mixed-methods study https://www.england.nhs.uk/blog/can-you-tell-its-sickle-cell/ https://www.england.nhs.uk/long-read/new-project-to-blood-group-genotype-all-patients-living-with-sickle-cell-disorder-and-thalassemia-launched-by-nhs-england-and-nhs-blood-and-transplant/

Oyindamola Adeniyi, a 4th year Medical student, and a recipient of the Diana Award 2023 shares her tried and tested tips on how she masterfully balances the many hats she wears. "How do you balance everything?" is a question frequently asked, and for good reason! As a medical student, social entrepreneur, mentor, and volunteer, I have embarked on the journey of honing the skill of managing multiple projects simultaneously—a journey that is still ongoing. Within the realm of medicine, where the workload is demanding and stress levels run high, it can often feel like there is little room for anything beyond the confines of the profession. Over time, I have discovered that by diligently applying specific strategies, we can empower ourselves to assume various roles and develop layers of identity that go beyond the stethoscope. Oyindamola Adeniyi is a 4th year medical student, mentor, strategic communications officer at MelaninMedics, co-founder of the Black Excellence Network and a worthy recipient of the Diana Award this year. With all things considered, we must ensure that we look after ourselves and put our mental well-being above all things – remember that by investing time to rejuvenate your spirit, you enable yourself to give generously from a place of abundance. Ultimately, wearing multiple different hats alongside medicine is no easy feat – it requires discipline, structure, and a clear understanding of your 'personal why'. According to James Clear, the author of Atomic Habits, "...the person who builds better habits gets better results. It's not the outcomes. It's the inputs." A practical framework and consistent effort will enable you to diligently manage your work, studies, and projects while avoiding excessive stress and burnout. With these elements, alongside the guidance provided above, one can embark on the journey of mastering the balance between external projects or side hustles and a thriving medical career.

We spoke to Dr Robyn Anderson about her experience as part of the first cohort of participants to join SurgIn: The Lewin programme. Dr Robyn Anderson is currently an F3. She will be a CT1 come August, having secured a general surgery theme post. She will start in cardiothoracics, moving to plastics surgery, and then general surgery for the rest of her time as a core surgical trainee. Why did you join the SurgIn programme? So I'd always known about MelaninMedics, and I saw it on the Instagram and I thought, It sounds really weird - but I'd actually had a similar idea earlier in the year before I saw the application. It was because I thought that there's not really like an official mentoring or support system for black medics, especially in surgery. I knew that a lot of what MelaninMedics had done was with medicine, but I hadn't seen anything like it for surgery. So initially I was just like, I'll give it a go and do the application and see. But actually I think it was almost craving to be around other black people with my same goal because everyone else that I knew bar like one of my friends - either didn't want to do surgery or was white. So just to have a place where I could air those frustrations, learn from people who have probably been through and thought through the same processes that I was going through at the time - I thought was really good. And I think it was also appealing because it wasn't a massive commitment, but I felt like what they advertised I could get quite a lot out of because it was only like 4 or five sessions throughout the year, which isn't a lot to make. But I thought that if it was what it said it was going to be, then I would get a lot out of it. What sort of things do you feel black doctors who want to go into surgery miss out on? I think it's that element of somebody very plainly telling you this is what you need to do. I think at the leadership session that we had, I think it was Christine was talking about how we don't have an old boys club. And it's people saying to you this is what they're saying. But this is what you actually need to do. Which in surgery, I feel more so than medicine is more prevalent. I just found that people were very unwilling to - I guess I found a few registrars - but people were very unwilling to share that. I think sometimes in order to get ahead in surgery, and to plan through your path in surgery, you need to know what you actually need to do. How do you feel the SurgIn programme has prepared you for your future surgical career? I think the practical sessions that we had, like the interview sessions and the initial session to do with applications, that was quite helpful for me. Also just that inspiration of seeing people who have done it, I think for me it was a lot, especially in the East Midlands, there aren't very many black surgeons, male or female. But one thing that SurgIn has shown me is senior female surgeons in all specialties. Which is something that I don't think without that, I would have been able to see and also to have the opportunity to ask them questions and interact on like a more, not informal level, but a more comfortable level. So I'd say the practical sessions that we had were really helpful. And in those sessions, I feel like everybody was very honest, which then helped when I was doing other sessions and preparing for interviews. I didn't go on any official courses - I just did block practice with you obviously. And then, some things that my Deanery put on for free. I found in the deanery ones, they just gave positive feedback, which is great, but it's not actually helpful. I liked that in the MelaninMedics one there was obviously the positive stuff, but they gave you those little hints and tips of "You're not quite doing this right," which was more helpful I felt. On the kind of, I suppose, less hard evidence side, just having those opportunities, inspirations and people who I feel like going forward, if I had any issues or I wanted to talk to someone about it, I wouldn't feel, I wouldn't feel worried to contact people in the future. And I think it's that network that I was missing before. What is one thing you will take forward from your experience in the SurgIn programme? I would say, it's kind of a combination of two things. Always go for the opportunities that you think will fit for you, even if you don't necessarily believe that you'll get them - go for them and within that, don't think that you can't because of x, y and z. I think a lot of the people I've spoken to and the people who have done talks at the sessions, they've kind of had a 2 common themes. One is "I just did what I enjoyed and what was my passion and it worked out". So like why not go for it? Like why not You? And also that, if you work hard in whatever you're doing, people will see that and you will work hard if you've got a passion for something. I think I found it quite difficult, in probably the last like 18 months, to know what to go for, what to say no to, what to pursue. A lot of the times when I've asked in the programme, people said if it's something that you're passionate about and you feel like you can take it forward, don't let other people’s doubts about you stop you from going for something. I guess as black people, as black surgeons, as black women, we won't always have people on our side. So if you don't advocate for yourself, then who's going to? What was the most memorable event that you attended? I would have to say it's probably the last one that I went to, the leadership one. It was a really nice variety of speakers - so there was a T&O Reg, Miss Christine Mitoko, who's in Neurosurgery and then a consultant who's a respiratory consultant who's spoke to us about types of leadership and management. And he just went through a lot of things - he went through the 16 personalities. And I think I've always thought of myself as quite not an introvert, but I'm not really the person who's going to stand at the front. Because of that, I think I've always subconsciously thought that I wasn't maybe best suited to lead. And that day kind of showed me that there are different ways to lead, and even if you're not the loudest, there are still ways to put yourself forward and to be assertive and authoritative for people to listen to you, in an arena or a space where people might not want to. I think that's something that I will remember - just because it was so different and it changed my perspective completely on me being a leader and how I can impact the space that I'm in and other people. What would you advise black female doctors who are considering applying for SurgIn? This is really like corny, but do it. Just go for it. The experience that I've had in surgeon I've not seen or experienced anywhere else. I'm part of the British Society of Black Surgeons. I'm part of lots of other societies and organisations that are for upcoming black surgeons. But I think it's that in-person, like having the sessions, being there, having those conversations even just like the conversations you have in the tea breaks like those are things that you don't, I haven't seen, that you get in any other programme. I think sometimes those are the most valuable things - making those in-person connections and seeing where you can fit in. Any final words? I would just encourage everyone to do it. And I think it's about taking those opportunities when they come, but the SurgIn is a very, very unique thing to be a part of. And even when I tell my friends about it and what I'm doing, they're all like that must be really good. Because literally every time I come back, I'm driving home on the phone to my mom. Like, "Mom, you will never guess what, I'm so excited, I'm so inspired, I really want to do this." I feel like sometimes, when you're not surrounded all the time by people who are like pushing you to go for things and putting you forward for things, you need that little boost stuff so often to be like, "yes, I can do it. I've made the right decision." There are people doing it, enjoying it. It's a space where the people who come to talk to us are very honest, none of them have been like "ohh yeah, it'll be easy, it'll be fine." They've been very honest about their experience, but also been very practical in that,"Yes, it was hard. But I did this, this and this to make it a bit easier. So like if you try this way - maybe it will be better for you." Do you know what I mean? And learning from the experience of others who have been through it and also looking at surgeons who didn't take the straightforward path that everyone talks to you about, I've found really good because, I'm intent on enjoying my life. So I feel like the linear pathway that they try and shove everyone down is just not for me, and I've not, until SurgIn, I've not seen anyone who hadn't done that path, so that's also an encouragement for me. Surgery can work for everyone, because I feel like, it's portrayed as a career where you have to be like, "surgery is life" - you can't do anything else. We've seen people who have made it work for them, which is really encouraging for me.

I never truly understood what burnout meant until I experienced it for myself. For almost a year, family and friends would constantly remark that I looked tired, and warned me about the dangers of burnout. I ignored them, I convinced myself that this was part of being a junior doctor, that we were going through a pandemic, that I needed to enjoy myself now things were opening up and that sleep was the sacrifice. However, after almost 2 years of working as a junior doctor, I was forced to rest, as my mental and physical health plummeted and I had no other option but to take time off work. I thought I only needed a few days, but one week turned into one month. Initially it was hard, I felt ashamed and worried about what people were thinking and felt like I had failed as a doctor. But over the days, I realised just how much I needed this time of rest. With the help of my support network and therapist, I was able to start my journey of recovery and healing. Having come out of burnout stronger and (I hope) wiser, I want to share what I’ve learnt on this journey so you can learn from my mistakes and stop yourself from embarking on this destructive path. Understanding Burnout has become increasingly prevalent in our fast-paced, high pressure society. To effectively address burnout, we need to understand what it means and its underlying causes. Burnout is defined as a state of mental, emotional and physical exhaustion resulting from chronic stress and is commonly attributed to work or caregiving roles. Burnout can be triggered by various factors, including excessive workload, lack of control or support and a misalignment between personal values and job demands. During my foundation training, my body was constantly in stress mode. I would frequently go to a busy 12 hour shift on less than 4 hours sleep. As any healthcare professional can attest to, working during covid was an exhausting time. The physical toil of long hours with minimal staffing hours and stretched resources, coupled with the emotional distress made work extremely stressful and overwhelming. Recognising the warning signs of burnout is crucial for early intervention and detection. Listening to your body, listening to those close to you and paying attention to how you’re functioning can all help with that. Some common indicators include - persistent physical and emotional exhaustion despite adequate rest, increased negativity, reduced productivity and adverse physical symptoms. Instead of listening to my body, and using my days off to rest, I would cram in as many social activities as I could. People pleasing, a lack of boundaries, chronic anxiety and a constant desire to keep busy meant that I had very little downtime. I continually ignored the physical and mental health symptoms I was experiencing, and eventually it was to my detriment. The importance of self-care Self-care has become a very popular term in the last few years, but what does it actually mean? Self-care involves taking deliberate actions to care for yourself, prioritise your personal needs and maintain a healthy balance in life. For me, this meant taking the time to simply do nothing. Rest is important, it is a crucial part of preventing and recovering from burnout. Rest allows you to stop, pause and reflect. It helps you to replenish the inner resources you have been draining out into work, friendships and relationships. Remember, you cannot pour from an empty cup. Eventually you will have nothing left to give, even to yourself. It is easy to feel guilty for doing nothing, and switching off is never easy; but once you understand the benefits of giving yourself the time and space to just be, with nothing scheduled, no plans, no tasks; then it will quickly become a non-negotiable part of your weekly routine. Self-care enables you to function at your best physically, mentally and emotionally. Once I started prioritising this, I saw an almost immediate improvement in my mood, physical health and work. Engaging in activities that brought me joy and relaxation helped me to unwind and recharge; and improved my ability to cope with challenges. Remember, self-care looks different for everyone. Write down a list of what self-care means to you, without consulting external articles or opinions, and make sure to incorporate these things into your life. Practising self-care is not a luxury, but a necessity for living a healthy life. Set boundaries and learn to say no This advice applies to both your professional life and your personal life. Setting boundaries was new territory for me, and something I spent a lot of time working on in therapy. I learnt that by having zero boundaries, I lost my sense of self-identity. I was unable to prioritise my own values, goals and needs. Alongside this, it led to overwhelming stress, strained friendships and lack of personal time. In the workplace it is so easy to say yes to every task you are given, even when you are drowning in discharge summaries, ward jobs and managing sick patients. Saying no at work doesn’t mean refusing to do things, it is about having the ability to recognise when you can’t do something right there and then, or even that day; and having the confidence to communicate this. Staying late every shift to complete jobs that can be done the next day won’t win you a prize, but it could cost you your wellbeing. By setting boundaries and saying no when necessary, you cultivate self-respect, establish healthier relationships and create space for self-care and personal growth. It’s an act of self preservation and self-care that ultimately allows you to lead a more fulfilling and balanced life. Learn how to ask for help This is one of the most important, yet arguably one of the hardest things to do. The saying “a problem shared is a problem halved” never rang more true than when I was suffering from burnout. Often other people can see things that you can’t see, and if it were not for my friends’ persistence, I wouldn’t have gotten the help I needed. I wouldn’t have recognised that I needed a break, and I wouldn’t have had the courage to open up to my supervisors. Once I found the courage to ask for help, things started to change. It was like a weight was lifted off my shoulders. After months of suffering in silence, I opened up and received the help and support that I so desperately needed. Recognising the importance of asking for help demonstrates self-awareness and humility, acknowledging that you don’t have to face challenges or solve problems alone. By embracing the act of asking for help, you open yourself up to a world of possibilities, nurturing your overall well-being and creating a supportive network that can uplift you in both challenging and joyful times. Experiencing burnout was an eye-opening and transformative journey. I’ve learnt that prioritising self-care and maintaining a mindful approach to work and personal life are the keys to avoiding burnout and fostering long-term wellbeing. Learn from my experience and create a sustainable path towards a fulfilling and resilient future. Written by Dr Ife Akano-Williams

"I’ve been at work for 12hours and everyone I’ve spoken to has been a complete stranger.” I often find myself saying this to my medic friends during our catch-up phone calls. It’s difficult to imagine that being surrounded by patients and colleagues all day can still result in the feeling of loneliness. Despite the constant human interaction and buzzwords like ‘teamwork’, medicine can be one of the loneliest professions. Loneliness – the resulting negative emotional response to the perceived degree of isolation. When we hear the word loneliness, the mental image is typically that of a frail, old lady; but loneliness can occur at any stage in life. The competitive nature of medicine can often leave medical students and trainee doctors feeling alone whilst surrounded by many. Success in medicine is often associated with solitary work such as putting in long hours to study rather than seeing friends, attempting to get a publication or trying to meet that ARCP deadline. This can often make us vulnerable to social isolation and the feeling of loneliness. The work we do can be lonely in itself. We are privileged to be in a position to see people at their most vulnerable or be their only source of strength during what may be their most difficult time in life. The emotional burnout we often face and the unspoken rule of not showing weakness means we often hesitate to talk about our struggles. This can sometimes leave us feeling more isolated than ever. Your colleague may not ask for help openly, it may be in the way they slowly retreat from social interactions, it may be in their voice or their body language and this may be the perfect time for you to ask, “Is everything alright?” Dr Rose-Anne Nunoo, CT1 ACCS trainee shares her tips to combat loneliness. The feeling of loneliness does not mean you're alone - it's a normal human reaction to dealing with life’s difficult circumstances such as the constant movement throughout our career. This means that medicine sometimes makes it difficult to maintain our social circles. The impossible task of trying to reconnect with loved ones around an on-call rota is often a breeding ground for loneliness. Sometimes trying to explain this to your non-medic loved ones feels as though you’re speaking a completely different language. Next thing you know, the days and weeks of not being able to reconnect turn into months and sometimes years. Here are my tips to help combat loneliness: Understand that feeling lonely is normal and is usually a signal to act on your current relationships. If you are new to a town or city, try to find your own tribe; if you run join a running club or if you go to the gym, go to a class. Be sure to find your community. Learn to leave work on time without feeling guilty. Looking after yourself is just as important as looking after your patients. Be part of the Doctors' Mess! It's a great way to meet others and have a life outside of work and increasing our connections with like-minded individuals. Remember to create a good work life schedule to allow you to reconnect with others. Always speak to someone be it a friend a colleague or relative or well-being service on those difficult days.

Exams, exams, exams! To some the bane of one’s academic progress, to others just another hurdle you need to jump in order to progress. However you see them, they are unavoidable (usually) and inevitable during higher education so it’s best to know how you’re going to tackle them and EXCEL! Naturally, “exam season” can be a daunting experience despite how many times you’ve sat exams in the past. Sometimes it’s the feeling of being overwhelmed by the vast amount of information that you are expected to learn and retain, the pressure to perform well or the realisation that you’ve got 2 weeks left until your exam and haven’t even touched the syllabus! Whatever it is you’re feeling, know that others before you have been in the same boat, yet they excelled. Exams are important and just like anything else you give importance to in your life you, should aim to attribute the same mind-set to exams. With the right planning and mentality, you should be well-prepared come exam day. Dr William Adeboye MBChB, MRes (Dist.), Academic Foundation Doctor, shares his tried and tested tips for exam success. I would like to share the advice that I wish I had as a younger student about to embark of the numerous of exams that would make up my 6th form, Medical school and Master’s degree journey - you can tell I like studying! Do stick with me and hopefully this helps you in your endeavours. Disclaimer : This is, by no means, an exhaustive list but from doing my own research and seeking advice from peers, I’ve found these key points to be extremely useful. Finally, remember that exams are unavoidable and inevitable. You want to be well-prepared in order to help you excel. Also, whilst reading this you may have noticed I refer to doing well in exams with the word excel. It was intentional. If you’re reading this I don’t want you just to pass, I want you all to EXCEL! Good luck with all your future exams. References 1. Dunlosky, John et al. “Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology.” Psychological science in the public interest : a journal of the American Psychological Society vol. 14,1 (2013): 4-58. doi:10.1177/1529100612453266 2. Karpicke, Jeffrey D, and Janell R Blunt. “Retrieval practice produces more learning than elaborative studying with concept mapping.” Science (New York, N.Y.) vol. 331,6018 (2011): 772-5. doi:10.1126/science.1199327 3. Rasch, Björn, and Jan Born. “About sleep's role in memory.” Physiological reviews vol. 93,2 (2013): 681-766. doi:10.1152/physrev.00032.2012 Written by Dr William Adeboye MBChB, MRes (Dist.) Academic Foundation Doctor

The WHO states that health equity is achieved when everyone can achieve their full potential for health and well-being (1). In the UK, 65% percent of black people reported that they had been discriminated against by health care professionals because of their ethnicity (2). As a black female General Practitioner, figures like these pull on my heartstrings. Various thoughts raced through my head about the message I wanted to convey about Health Equity and Black Women in the UK. The area of health equity which means the most to me as a black woman living in the UK, is maternal health. I am most probably biased because I became a mother about 1.5 years ago and have a daughter. However, writing this post forced me to reflect on how I as a health care professional spent my first pregnancy ignoring the figures on the black maternal mortality figures . I distinctly remember being in hospital, days away from delivery, hurriedly turning off MP Bell Ribeiro Addy's speech, which evidenced the harrowing issues facing black women during childbirth. At that particular moment, I didn’t have the emotional bandwidth to listen to the 'statistics' relating to hopeful mothers-to-be like myself. Dr Matilda Esan, a General Practitioner, shares her experience as black woman in the UK - as a mother and a healthcare professional. So again, I ask myself what message would I like to convey on what feels like a heavy matter. Deep down, I want to portray a truthful picture on  black maternal health in the UK with a positive slant. The first issue to consider  when exploring health equity in black women is use of the term BAME. For many years BAME has been both an unavoidable and problematic term, as it lumps together the experiences of every ethnic group you can imagine and  dilutes the voice and the experiences of individual ethnic minorities. The relevance of this, is that it makes assessing the health experiences of black women in Britain difficult. Of course, amongst friends, families and professional circles we have anecdotal evidence. However, the things which prompt policy changes and cause people to listen are hard facts and research which highlight the extent of the problem. In maternity care, you may well be familiar with the fact that the MBRRACE 2018 and 2019 reported that black women were five times more likely to die in pregnancy. In the 2020 report, this reduced to four and in the 2022 report, this reduced to 3.7 more times likely. Though change is happening and things are getting better, it is evident that more work still needs to be done. The repeated themes in speeches and articles that you read is that black mothers don’t feel that when they express health concerns such as, being in pain, that they are believed or being taken seriously. In regard to work that is being done, there are numerous charities, organisations and MP’s who have worked tirelessly to ensure the experiences of black women are heard in the spaces which really matter like Parliament. The charity FIVE x More were responsible for founding the UK’s first awareness week dedicated to Black Maternal Health in  2020 and since then  it has continued to gain traction and go from strength to strength. Furthermore, many Black Female Obstetricians and Doctors, in addition to their clinical work, have advocated in various spaces for black women to try to pave the way to ensure that things change. So whilst figures remain uncomfortable, the question those of us occupying health care spaces should be asking ourselves as individuals  is , “What small steps can we take towards making a cumulative big difference?” As a general practitioner, I give my pregnant patients space. I ask about their previous experiences, I ask about their concerns, their anxieties. I do my best to listen and act on clinical things which need to be actioned in a timely manner. These days, once patients are referred to the midwife, our involvement as the GP can be quite limited. So for me a black mother myself, I really try to make the interactions I have with my patients count. Many times, I don’t have control of what happens to my patients in the hospital. However, what springs to mind for me is the Maya Angelou quote “People will forget what you said. People will forget what you did. But people will never forget how you made them feel”. At the end of the day, I am the first contact in a pregnant patient's journey. I am also one of the first contacts post delivery. My aim is to ensure my patients feel comfortable at the beginning of their beautiful journey. That way, whatever obstacles they may encounter on the way, they always know I am a telephone or face to face appointment away. They can trust and be assured that if they are worried, then I too will be worried and escalate things appropriately. Ultimately the power to address health inequality in black women in the U.K. lies within each of us. The way we can choose to do this can vary - be that through advocacy when dealing with patients, being willing to listen emphatically and take appropriate actions or by enacting policy changes on a larger scale. References: 1. Health Equity - Global. https://www.who.int/health-topics/health-equity#tab=tab_1 Accessed: 2023-03-23 2. State of Black Britain Report - BEO (blackequityorg.com) Accessed: 2023-03-23

Growing up in Kenya, I never thought much about my identity as a black woman and how the world would treat me. After all, why would I? I was surrounded by other black people, specifically, black women, and my skin colour and heritage never meant that I had different lived experiences to others. I just was - I just existed. Fast forward to being a medical student in a UK university, and like in most UK medical schools, being part of a minority. I became hyper-aware of my identity and what I represented. It’s something that no one ever prepares you for, especially if you’ve grown up in an environment where you’ve never had to think about how the world relates to you. For me, it dawned as a realisation over time, and after that you have a different view of the world. I always think of it like a coming of age, an clandestine growth spurt. Except this time, it’s all in your psyche and you start to figure out where you fit in the big, wide world. Now as a black female junior doctor, my day-to-day experiences on the job are starkly different to my colleagues. It’s in the way some patients are surprised when I introduce myself as their doctor or the fact that even though I introduce myself with both my names, I can’t bear to have another person either tell me my surname is too difficult to pronounce, butcher the pronunciation or ask me where I’m really from, so I end up saying, “Just call me doctor *insert first name*.” My full name is on my name badge and I notice the uneasy glances when colleagues or patients internally debate if calling me Dr *surname* vs Dr *first name* is worth the effort. I appreciate the colleagues and the staff who ask me to pronounce it for them so that they learn how to, but generally these are few and far in between. It's in the way I’ve resulted to hoarding some scrubs that actually fit me and have reclaimed as my own and have gone the extra mile to get my own better fitting scrubs. The type that are not too frumpy or too tight in the wrong places. It’s in the way my hair or any new hairstyles is a topic of discussion whenever I meet people, and they ask to run their hands through it without my consent. It’s the way I’m frequently mistaken for another black member of staff on the ward because, “You both look so similar, I couldn’t tell you apart with your hair different this week.” It’s in the way the system is set up for everyone else and you need to fit in it. I remember being in theatre as a medical student and at that point, my locs were shoulder length, but they couldn’t fit in those flimsy theatre caps even when I tried to combine two of them! A friendly anaesthetist saw me struggling in the changing room and went out of her way to get me the bonnet type scrub cap and since them I always have a stash of those types of scrub cap in my bag for any impromptu trip to theatres. Now my locs are bra-strap length and I’ve bought myself several vibrant African print theatre-caps which I proudly wear for my scheduled theatre days and they keep my locs tucked away neatly and might I add, fashionably. I’ve received more compliments on them than any other item of clothing I own and when I put them on, I feel that they, in their own small way, make the system fit me. It's in the way black patients, especially women, react when you walk into the room and introduce yourself as their doctor. It’s in the way there’s always a subtle nod or smile of acknowledgement whenever you meet a black colleague of any profession working in the same hospital, let alone, department. Sadly, it’s also in the way that you get treated on the job – there are higher standards for you to meet and you need to work at least twice as hard as they do just to get the same recognition. I was once pulled to the side by a senior who, in response to my emotional breakdown at the end of a tough on-call shift, told me, in not as many words, “You are a black woman who wants to do surgery – people already think you don’t fit in and will undermine you. You need to be tougher.” Although the context of this was ill-intentioned, it does summarise succinctly the way the world sees me. To the world, I am a black woman, therefore, I am simultaneously iron-clad yet undeserving of accolades. I am to be stoic but not too much to earn the label of ‘angry black woman’. I am to be reserved or risk being labelled the ‘loud, aggressive one’. All these experiences have shaped the person - the black woman, the doctor - I am today. I will no doubt accumulate both reaffirming and destructive experiences as I progress in my career. In the future, I know I will have highs and lows as a black woman in medicine which may pale in comparison to the ones in the past. I have been fortunate to have people who pour their cup into mine so that it never runs dry – I am working on keeping it at least half-full most days. The ones who remind you who you are and what you represent everyday – your ancestors’ wildest dream. You are here, you exist, fully and unapologetically.