Saturday, December 27, 2014

'To change is difficult. Not to change is fatal." ....


    For those who might not understand the ethos behind the charity that I'm working for here in the UK, (Group B Strep Support) I thought I would share the latest post I wrote for their (our) blog. In addition to being the Social Media Coordinator, I launched their blog back in October and this is the post that I am the most proud of so far. It also gives the best insight into the kind of work we do and what is on our plate for the New Year. While the content here is a vast departure from the Rover norm, it still is very much the a day in the life of CC Bella and though ya'll might enjoy reading how I spend my days.
*If any of my readers are here in the UK, please sign the current petition at the bottom if you feel so compelled.



“To change is difficult. Not to change is fatal.” William Pollard
Guidelines for group B Strep screening and education.

    First and foremost, we must remind everyone that routine screening of all pregnant women for group B Strep carriage is not recommended by the UK National Screening Committee nor the Royal College of Obstetricians & Gynaecologists. Screening for the most common cause of life-threatening infections in newborn babies and babies under three months is not currently recommended. Screening does however routinely take place in countries like Australia, Argentina, Belgium, Canada, Chile, Czech Republic, Dubai, France, Germany, Hong Kong, Italy, Japan, Kenya, Lithuania, New Zealand, Oman, Poland, Spain, Slovenia, Switzerland and the USA. Just so we’re clear at how far behind the UK is on this issue.


    The current UK policy is centred around a ‘risk factor’ approach to determining which babies are at-risk. Risk factors include Mum carrying GBS this pregnancy, high temperature during labour, labour starting or waters breaking prematurely and having previously had a baby infected with GBS. The hope was that this strategy would reduce the rate of early-onset GBS infections in babies by up to 50%. Unfortunately these hopes have been dashed by the fact that the rate has barely changed. Furthermore, up to 40% of babies who do become infected are born to mothers without any of these clinical risk factors. So then how is this particular strategy working for us? It simply is not.


   In those countries that do offer universal screening to pregnant women to identify group B Strep carriage, including the US, they have seen much progress. Rates of infection have reduced by up to 86%! What’s even more frustrating is the fact that the current risk based strategy here in the UK was introduced in 2003 after research came out in 2002 stating that antenatal screening strategies would prevent more cases of group B Strep infection in newborn babies than risk-based strategies. So then why would one opt for the less successful approach? We simply do not know.


   These risk factors are showing us time and again that they are not accurate predictors of GBS infection in newborn babies. In a UK study from 2011** we learned that 21% of women carried group B Strep at delivery.  19% of women with NO risk factors still were GBS carriers. 71% of women WITH risk factors did not carry group B Strep. Again, how is it not clear that this strategy is epically failing us? There is, of course, the argument that the reason the rate of infection has not changed much is because of better reporting; i.e more group B Strep cases are being documented since 2003. Well, that may be, but if the risk based approach was actually worth its salt then wouldn’t we see some marked difference/decrease?


   The other argument would be that of cost. Surely the amount of money that is being spent on treating avoidable infections (due to lack of screening) is more expensive than a simple ECM swab test? Last year Public Health England estimated the cost per test was only £11. £11! And isn’t it interesting that the NHS will fund tests for smoking in pregnancy, but not the cause of life threatening infections? They also recently introduced Maple Syrup Urine Disease testing for all newborns, a condition that affects an estimated 1/116,000 babies born. Clearly it’s important to identify and treat those babies as well. But why then are we not also screening for something that 2-3 out of every ten women carry, a bacterium that produces a 1/300 chance of baby developing a group B Strep infection, an infection that kills 1/10 of these sick babies?!


   To add insult to injury, there seems to be a stalwart resistance to change and education across the board.
  • Public Health England has had since 2006 a standard for processing swabs that test specifically for group B Strep in their UK Standards for Microbiology Investigations B 58.
  • NICE: The 2008 and 2011 reviews of the guidelines for ‘Antenatal care: Routine care for the healthy pregnant woman did not update the sections relating to group B Strep in the light of new evidence since 2003, despite requests by a number of stakeholders. The NICE ‘Induction of Labour’ and ‘Postnatal Care’ guidelines contain no mention at all of babies born to women carrying group B Strep.
  • UK National Screening Committee: During the 2012 public consultation, 212 written responses were received and 207 were published on their website. Of these, 93% were in favour of introducing screening for group B Strep in pregnancy and fewer than 4% were against. To say this decision, which went against the opinions of the overwhelming majority who took the time to comment, was hugely disappointing would be the understatement of the year.
    This topic is especially pertinent as we near the end of 2014, because between the New Year and 2016 these guidelines will be coming up for review by the UK National Screening Committee. The Royal College of Obstetricians and Gynaecologists will also be reviewing their group B Strep guidelines. We move forward into 2015 with the firm belief that “We seem to gain wisdom more readily through our failures than through our successes. We always think of failure as the antithesis of success, but it isn’t. Success often lies just the other side of failure.” Leo F. Buscaglia




If you would like to be kept up to date with what’s happening and/or join the cause, please email us at info@gbss.org.uk and/or follow our Twitter feed at @GBSSupport. Please also sign the current petition: http://epetitions.direct.gov.uk/petitions/60515
 


**(Intrapartum tests for group B streptococcus: accuracy and acceptability of screening Daniels JP, Gray J, Pattison HM, Gray R, Hills RK, Khan KS; GBS Collaborative Group. BJOG. 2011 Jan;118(2):257-65. Epub 2010 Oct 13. Full article at http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02725.x/pdf

Tuesday, December 9, 2014

365 days, 4 seasons, 1 extraordinary anniversary....

Today marks my one year anniversary of living in England. I know, I can hardly believe it either!


Extraordinary is defined as very unusual or remarkable.
synonyms: remarkable, exceptional, amazing, astonishing, astounding, marvellous, wonderful, sensational, stunning, incredible, unbelievable, miraculous, phenomenal, prodigious, spectacular.
Yes to all the things. I have had a remarkable, exceptional and incredible year in all that I've seen, done, experienced and learned. It is also astounding, miraculous, and phenomenal that I made it! (haha) I jest, but only partially. Nothing changes the fact that I am unbelievably grateful and spectacularly blessed for this opportunity. Even that though doesn't change the fact that this was also a very trying year for me personally. I cross this finish line feeling as one might expect at the end of a verrrrry long marathon; triumphant, emotional, wiser, positive, but also bloody exhausted.
On one hand, it feels like I've been gone from L.A and the States for two years while on the other the 12 months have flown by at warp speed. The 7 1/2 months prior to getting my job were excruciatingly slow. Since then, I can harldy believe that we're two weeks away from Christmas!

Having a job, especially a job that I enjoy, has been a godsend to my sanity and my sense of contribution...not only to our household but to the world in general. Being the Social Media Coordinator for a charity that is heavily steeped in the medical and political arenas has proven to be fascinating! It's given me a prime seat to better study and understand British culture. But this is not a post about my observations on the English...those I shall reserve for the one woman show coming soon to an American living room near you. Ha! Now, before anyone gets offended, that's not to say that my observations would be negative. Every culture has their pros and cons, we're human for Christ's sake...all perfectly imperfect. And the bottom line is, shit is fucked up everywhere.

Instead, this post is about my year as an Ameri-Brit. A title, in fact, I can absolutely not claim. Even if I've been able to charm a few people into looking past the apparent obnoxious accent and overt friendliness, some of the most basic characteristics that make me who I am are quintessentially American...so much so I think they can smell it on me before I even open my mouth. That's okay though. I can laugh at myself and my American-ness. I can even laugh at, roll my eyes, and groan at all the ways in which Americans as a culture can be completely ridiculous and downright embarassing, but at the end of the day goddamnit I am proud to be one of them. Like I said, shit is fucked up everywhere. So there's that.

On the whole, this year was about was testing and pushing boundaries. This year tested
  • my identity,
  • my independence
  • (and more specifically my identity in relation TO my independence),
  • my personal space,
  • and my patience.
Oh Jesus Christo, my patience. All of these are fantastic lessons, but they are also fantastically uncomfortable, so when you're learning them all at once.... like I said, you end up flippin' exhausted. These are battles I'm continually winning and/or losing on an almost daily basis, but the fact that I keep fighting the good fight is forcing me to break through barriers and push past my own boundaries. It's  also teaching me to see the bigger picture.
I will probably always struggle between my desire for partnership and my intense need for solitude. It's about finding that sweet spot, that middle ground. With the help and love of a good man I'm learning to navigate the waters of interdependence and appreciate it's benefit, and despite the struggles we went through this year we've grown alot and make a bloody good team!  But I also still know when I need to look out for number one. For example, I'm taking me, myself and I to Edinburgh for Christmas. I went from 0-60 as far as alone time when I moved here. Apart from a night or two here or there when Tom had to travel for work, I haven't had any time just to myself that didn't also involve laundry, cleaning or cooking. And as many of you know, I NEED my introvert/hibernation time...otherwise, I gets cranky! As lovely as it was to spend Christmas with Tom's family last year, wandering the streets and galleries of one of my favorite cities, dinner at McKirdy's and curling up on a couch to read and journal sounds like HEAVEN for this year! I also need the space alone to truly look back on 2014 and process it all in more detail. Unfortunately, feelings may have been hurt in this decision, but this is just basic Courtney Maintenance 101. I won't and don't need to apologize for taking care of myself to be at my best. I remember preparing Tom that this is who I am and what I would need from time to time. I think I even said something to the effect of, "I;m gonna need alone time, I may even have to go farming in Egypt for a month." ...So ya know, he was warned :-)

I can't say my dream of living in England has lived up to the hype in my mind, but it's still been a dream come true and that's the gold, isn't it! How many people get to say that? Good, bad, and ugly, I am living an epic life.

I'm not sure how long my time in England will be, but trusting the Universe and it's divine timing has served me pretty well thus far, so when and if it's right to make another move I will know. Besides, Tom and I got up to some super rad adventures in 2014 (Prague, Brussels, Abu Dhabi/Dubai, Wales twice, Hamburg, Dublin, and the Cotswolds) so it's with a smile that I look ahead to 2015.



And there's always Coachella in April to look forward to, two weeks of California sun, fun and friends!!



Wishing everyone a fabulous holiday and a very Happy New Year!


  Till next time... love, hugs and other 'drugs'.
XOXOXOXOXO