International Students; blog Autumn 2014.

Almost 20% of the 2.34 million students in the UK are from overseas. At the Students’ Health Service, we and the NHS are here to help you with your health concerns, and worries.  Whether you are feeling physically or emotionally unwell, we will try to improve your situation, and allow you to continue with your academic work.

We have a lot of experience dealing with students from all over the world, and are familiar with a wide variety of health and cultural issues that may arise. We are open minded and non judgmental. We want you to feel able to talk to our doctors and nurses if you are worried. We know that English may not be your first language, or that your symptoms may be treated differently in your home country, or that certain conditions are not discussed openly in some places, but we will do our very best to support you and help you to feel better. Sometimes we have to refer you to other teams for help and treatment, ranging from hospital specialists, to psychiatrists, to the Students’ Counselling Service. All of these people are there to support you to, and most are free of charge.

For more details of any possible costs at hospital treatment level, please see our information on the website http://www.bristol.ac.uk/students-health/docs/overseas-guide.pdf

 

It may be helpful to understand a little more about how our service works, so here are the basics;

  • Everyone in the UK should see a Primary Care professional (General Practitioner/ GP or nurse) before deciding whether or not to refer to a specialist. We have a ‘gate keeper’ role.
  • Therefore when you have a health problem, the first team you will deal with will be us, and our receptionists will ask you the ‘nature’ of the problem (no need for details), just to ensure you see the right person in our team
  • Primary Care in the UK deals with 90% of health problems, with only the rare few requiring a hospital team at all.
  • Many of our nurses can prescribe, eg for contraception, sexual health, travel, asthma, minor infections etc.
  • Only use Accident and Emergency departments for EMERGENCIES please!
  • If we are closed then phone ‘111’ to get advice about the nearest Primary Care (walk in) centre, or other options, eg dentists
  • Phoning ‘999’ is for life and death emergencies only
  • We are not dentists, and we cannot prescribe for dental infections etc
  • We are not opticians, and so if you need help with glasses/ eyesight issues, please find a local optician
  • We can refer for psychological support, but you can self refer at our Office for physiotherapy/ podiatry/ LIFT psychology  (all free of charge)
  • For Student Counselling Service go straight to their website http://www.bristol.ac.uk/student-counselling/
  • For blood tests you must see a GP first, to arrange and order the correct tests.

 

We hope this will help you to access health care as and when you need it, but if you are not sure then please do ask our reception team, and they can advise you of what we do and don’t do, or check our website. http://www.bristol.ac.uk/students-health/

 

We look forward to meeting you and helping to make your stay in Bristol as successful and healthy as possible!

 

Health Advice for the Returning Traveller; When to see the GP?

It’s the time of year again when all our backpacking students return from the four corners of the world. Some will be arriving for the first time in Bristol, as international students of course, and many of you will have been traipsing through the jungles/ beaches and villages of the world’s most remote places, possibly even to Coca-cola free zones!

Unfortunately, even if you did everything right, had every last jab, and took all your malaria pills, you may still be at risk of post-travelling illness, so here is a quick summary of what to watch for and what to act on;

  • Tell the nurse/ doctor exactly where you have been, and dates
  • Tell them if you worked in ‘at risk’ environments, eg in a hospital/ clinic
  • Most illnesses will be common conditions like pneumonia/ fungal skin rashes
  • Be honest about malaria tablet history and compliance
  • Report any treatment tried or taken overseas
  • Fever is a common symptom requiring medical attention in returning travellers, especially if it is accompanied by; rash/ jaundice/ breathing difficulties/ bruising/ persistent vomiting/ altered conscious level or paralysis (the latter are extremely rare with only 0.3% of unwell travellers ever requiring hospital admission).
  • Malaria commonly presents with fever, chills, sweats, headaches, muscle pains, nausea and vomiting.
  • Jaundice (yellowing of the skin, and whites of the eyes) can indicate Hepatitis, most commonly type A, from infected food and water.
  • Arbovirus infections (Dengue, West Nile and Chikungunya fevers) are the main cause of viral fevers in returning travellers, and tend to have short incubation periods, typically less than two weeks .ie you will show symptoms within 2 weeks of being infected.
  • Diarrhoea is extremely common in travellers, and those who develop three or more loose stools in an eight-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, may benefit from antibiotics.
  • Prolonged, severe diarrhoea with blood should be reviewed by a GP.
  • Skin rashes are very common, and should be reviewed by your GP if not settling, or if associated with fever.
  • The vast majority of travellers’ infections have a short incubation period, meaning that symptoms will start within 10 days or less from infection. The notable exceptions are schistosomiasis (bilharzia)/ malaria/ TB/yellow fever, and Q fever.

 

 

Therefore, if you continue to feel unwell despite being home, and eating and drinking normally for you, then please come and see one of the GPs. You may also find it useful to look at the following;

 

http://www.nathnac.org/travel/index.htm

 

 

 

Cough it up! When your cough needs a doctor…

It’s the beginning of the new academic year and all you can hear is coughing. Lecture theatres full of students hacking away, and the same in your flatmate’s room, or the shared lounge. Well don’t worry it’s common, and rarely anything to worry about.

It is normal for a cough to last up to 3 weeks, and 10-20% of the population have a chronic cough, ie one lasting more than 8 weeks.

Coughing is a reflex, clearing your throat of irritants and mucus, so asking your GP or nurse to ‘make it stop’ is fairly futile, but some things can dampen the reflex a little, such as honey and lemon juice in hot water. With a dry cough, pholcodine linctus can be helpful. But most cough medicines are a waste of money and therefore we never recommend them. Dextromethorphan is also a possible medication that can suppress the reflex, in certain ‘over the counter’ remedies, so ask your pharmacist for guidance.

 

When to see the nurse or doctor then (several Student Health nurses are trained to listen to chests, so can help you sort this out too)?

See us if your cough has lasted more than 3 weeks, or if you are short of breath, or coughing up blood. Also, if you have chest pain, recurrent fevers/ night sweats or unexplained weight loss.

 

Coughing up green mucus/ sputum is not in itself a reason to worry, as this can happen with viral and bacterial infections. Only bacterial ones may need antibiotics.The symptoms mentioned above are a more helpful guide as to when to get a check up.

Being a smoker or asthmatic may make you more prone to infections, so do mention this when you see us.

We can help you to quit smoking should you decide to take this fantastic step for your wellbeing, and we have a specialist asthma nurse for our asthma sufferers, so do book in with her for regular reviews.

Coughing is common, and in our student population rarely anything to worry about. Try the pharmacy first if you can, and see us if you are worried.

 

 

LGBT+ and your health; a student writes…

There are a lot of ways people like me – LGBT+ people – struggle in life due to society’s stigmatisation of us. Doctors and healthcare services, which exist to care for us, as for everyone, are invaluable and essential to the poor health that arises from these struggles, for complex reasons, so it is very important that healthcare challenges received ideas. The Student Health Service kindly invited me to write a blog on LGBT+ peoples’ issues relating to healthcare, which is definitely a really encouraging thing. I realised it was a difficult topic to be able to cover fully, but I’ve tried to bring together thoughts, evidence and memories that will hopefully be illuminating.

Firstly from my own life, I thought about the way being queer has affected me in terms of my health and the way I access healthcare. Lots of complicated thoughts came to my mind.

I’ve thought about the way, for example, in which fear of rejection for my orientation has prevented me from being ‘out’ to any therapist I’ve had. The effects of not being straight on my mental health have also been very strong, including the damaging shame and anxiety created by realising that I was not straight, as well as the issues it has created in my friendships and family relationships, including fear of rejection.

One time from my life also really stands out to me – I actually thought of when I was younger, of my experiences to do with gender expectations, and not fitting them. I am a woman, and someone who’s seen by others as a woman. However, as a teenager I developed facial hair- I didn’t realise that the feeling of shame about this supposed fault with me and my body, was actually a false shame put upon me from outside, and I didn’t realise I could push back with my own narrative and ideas about how my body should be – perhaps if the doctors I saw about this problem had questioned whether it was really something by necessity negative, I wouldn’t have been ashamed for so long. As I got older I realised that society has strict binary definitions of male and female that are so ingrained and hegemonic it’s easy for many of us to barely notice them. This dictates as wrong, and somehow lesser, those, for example, whose bodies don’t match these definitions. I am cisgender (I understand myself as a woman, and my body’s sex is considered as female), so it has been much easier for me that for those who are transgender, whom I know this gender binary affects very strongly.

How then can doctors help? How could my interactions with doctors have gone better? I’m not sure, and I think it’s a difficult task for doctors that want to help, to do so. I suppose two things to think of are the way in which our health is looked after specifically in relation to our gender, sex, sexuality etc, and of the way in which our general health is looked after, aside from these issues. I thought  that even if doctors simply take a stance of providing a respite from oppressive ideas, actively countering dominant ideas about LGBTQ+ people, that would be a very helpful thing.

I’ve only been able to speak about my own particular experiences here, so I’ve looked for examples and information to shed light on other ways in which LGBT+ affects people’s health. One thing that affects LGBTQ+ people disproportionately is mental ill health, and this was reflected in pretty much every piece of research I found.

The NUS research ‘Education Beyond the Straight and Narrow’ notes that Chakraborty “affirms that discrimination can be analysed as a predictor of mental disorders.”

The research also tells us that “42 per cent of LGBT respondents to the Youth Chances28 survey reported having experienced depression or anxiety, compared to 29 per cent of non-LGBT respondents”, and that this is linked to experiences of discrimination and harassment.

This NUS research talked about the very high rates of ill health, depression and anxiety for Trans students in particular, and this was strongly related to high levels of transphobia, unacceptably long waits for provision of treatment to transition, and stress and discomfort about seeing medical professionals due to dismissive or phobic attitudes.

I have also read, although not in this research in particular, about asexual people’s (people who do not or experience little sexual attraction) experiences of healthcare, including asexual identities being seen as problems or illnesses.

LGB+(Lesbian, gay, bi+) and T+ (Trans+) students were all more likely to consider dropping out than straight and cisgender students, with T+ students being proportionally most likely to consider dropping out due to health concerns, while LGB+ students being proportionally most likely to consider dropping out due to feeling like they don’t fit in (although both overlap significantly). This data reflects the complex nature of reality even more in that black LGB+ students, for example, had a higher likelihood of considering dropping out, suggesting lower levels of wellbeing that need to be considered.

Research also noted that mental health has an evidenced effect on physical health. This must be compounded by the fact that LGBT+ people report attending doctors less, or feeling put off or distressed by negative reactions by doctors, and this can be anywhere, from GP surgeries, to hospital emergency care.

So, in the end it seems to me that healthcare services often fail LGBT+ people if they have taken in societal biases and left them unchallenged, but I think they could definitely help in our lives if they are positive –because they’re at that central, delicate position in which people are going for help.

If you’re LGBT+, and uncomfortable seeing a doctor about something or uncomfortable to talk about something because you’re scared of being looked down upon, it can be hard. I thought that this quote (from the NUS research mentioned previously) was illuminating, even if it’s not directly related to health:

“I’ve had negative experiences or responses to being trans in every university building I’ve been in, including the students’ union (SU), but only in the SU have I ever been listened to about them and those experiences dealt with. So that makes me feel safer there than anywhere else.”

For university support you can contact; lgbt.officer@ubu.org.uk

For medical students; Bristolmedicslgbt@gmail.com

 

 

 

Accessing health care over the holidays!

There are a number of ways to access health care in the UK during the vacation:

  1. If you are in or visiting Bristol, you can access care as usual from the Students’ Health Service.
  2. If you want advice about an ongoing issue for which we have seen you, please make a telephone appointment with a GP. Not all medical concerns can be resolved in this way.
  3. THINK AHEAD- if you are running low on a regular medication,  please send repeat prescription  requests by post, with a stamped addressed envelope.  There will be cases when this is not appropriate, e.g. you need up-to-date blood pressure or blood tests.

This useful link gives further advice,

http://www.nhs.uk/chq/pages/1011.aspx

 

  1. If you are away from Bristol and need medical care you can contact a local GP and sign on as a ‘temporary resident’. We advise our students not to sign on as a ‘permanent patient’ if they are returning to Bristol as a student after the vacation, as this causes problems with transfer of medical notes.  Please follow this link for information regarding accessing healthcare in this way

http://www.nhs.uk/chq/Pages/how-can-i-see-a-gp-if-im-away-from-home.aspx?CategoryID=68&SubCategoryID=158

 

  1. Remember that other clinics may meet your needs e.g. local family planning service, STI clinic or minor injury services. Details of these can be found on the link above.

 

  1. Remember that ‘A+E/999 calls’ are for medical emergencies.  If your local GP is closed and you want medical advice for a problem that cannot wait until the surgery re-opens (but is not an emergency), please call 111 to get advice (as you would normally do in Bristol).

National Smile Month! 19th May- 19th June 2014

Each year the British Dental Health Foundation promotes dental health awareness with its National Smile Month, this year it will be May 19th – June 19th.

 

http://www.nationalsmilemonth.org/page/smile-month-explained

 

Further advice about looking after your teeth while you are a student can be found at

 

http://www.bristolstudentdentalpages.co.uk

 

Students are vulnerable to tooth decay and the beginnings of gum disease – looking after your teeth between 18 and 25 will have long term positive effects as well as saving you a lot of money over your lifetime.

 

Seeing a dentist once a year will help to identify problems while they are small, therefore easier (and cheaper) to sort out. There are lots of preventive things that dentists can do to stop decay in its tracks. One of the simplest things is just having your teeth cleaned, which is enormously beneficial to your gums and helps prevent bad breath. If you haven’t had a snog for a while it could be your teeth need a scale and polish . . .

 

Unfortunately dentistry is no longer free for students but you can get help on grounds of low income by filling in an HC-1 form for NHS treatment. Always use your term time address so that other family income doesn’t have to be included.

See http://www.bristolstudentdentalpages.co.uk/finding-a-good-dentist/nhs-access  for further advice.

 

Looking after your teeth now is so important. As the Smile Month website says, most adults wish they had looked after their teeth more when they were younger. By being good to your teeth and gums as a student, you will have a healthier, trouble free mouth both now and in the future, and that will save you a lot of money.

 

David Obree

Dentist

Redland Road Dental Practice

 

 

Five Ways to Wellbeing at Exam Time

Exam time is a difficult time for everyone, though for some more than others.

So it’s important to remember that you can do things to help yourself remain calm and in control, throughout those weeks when your adrenaline can be flowing a little more rapidly.

 

Here are some evidence based ways that we can look after our mental health, a bit like a ‘5 a day for the mind and soul’.

 

  1. Keep Connected; stay in touch with the people around you, the people who care about you and who can support you in life
  2. Be active; go for a walk/ run/ swim, breathe in some fresh air. Exercise on the Downs. Release that adrenaline in a positive way
  3. Take Notice; notice the world around you, the changing seasons, walk around and observe what is happening. Be aware of your feelings
  4. Keep learning; learning new things can be fun if you make time for it, and for yourself too
  5. Give; do something nice for someone else. Cook a meal/ help out your community/ volunteer. It is scientifically proven that being nice to others releases a happy hormone (oxytocin) and makes you feel better too!

 

However, if doing all these things isn’t enough to support you through a difficult time then remember we are here to help, as are the Counselling service, and other services in the university, like the Multifaith Chaplaincy.

It is normal for exam time to be stressful, that adrenaline can help focus the mind and bring your performance up a notch, but if it feels out of control, and overwhelming then please ask for help sooner rather than later.

Good Luck!

Mental Health Awareness Week 12-18 May 2014; Anxiety

As a GP I really like it when a student comes to see me about their anxiety. Not only because it means they are keen to get help and get better, but also because there are so many things we can offer to ease their symptoms. In the last few years, here at Students’ Health Service, we have tried really hard to provide a variety of treatment options for what is the commonest mental health problem that we see; anxiety.

Anxiety affects people differently (about 1 in 20 people will have it at some time), but in general it makes you feel afraid and tense. It can lead to physical symptoms, as your adrenaline rushes around more than usual. People complain of palpitations (fast heart beat), sweating, nausea (feeling sick), chest pains, and shaking. You can also get headaches, and feel out of breath. It can be normal to feel like this, eg before an exam, but when it starts to interfere with everyday life it can become very challenging. Some people get panic attacks, where the symptoms feel overwhelming, and it can feel like the world is closing in on you, or that you might die. Please ask for help if this is happening. Ideally, please see a GP before it gets this bad.

So what can we offer you?

A variety of psychological (talking based) therapies are available. Relaxation techniques and Mindfulness can be learnt, and the Student Counselling Service provides very regular groups. Just sign up on their website.

http://www.bristol.ac.uk/student-counselling/

Self Hypnosis has been shown to be effective, and a GP can refer you for this; a one off free session provided by Matt Edwards in a confidential environment. Here is a blog written by a student who saw Matt last year;

http://studenthealth.blogs.ilrt.org/2013/02/04/i-tried-self-hypnosis-for-my-anxiety-you-could-too-a-student-writes/

 

Online CBT (cognitive behavioural therapy) is available for those who would prefer this method; sign up via the SCS website.

Free NHS groups, and 1 to 1 therapy are accessed via the LIFT Psychology service; no GP referral required, just contact them on

http://lift.awp.nhs.uk/bristolandsglos/

However, if psychological approaches are not enough, or might take too long and your symptoms are too challenging to manage daily, then medication can be extremely helpful, and can work within a few days of starting it. Any of the GPs will be happy to discuss this option with you.

So remember, anxiety is normal and common, but sometimes it can become overwhelming or a daily stress, so get help and talk to us soon!

The Succeed Foundation’s Vision is “A World Free From Eating Disorders”

The Succeed Foundation has a simple mission to free the world from eating disorders. Through fundraising and investment in innovative research, and the promotion of ground-breaking evidence-based treatments and preventions, the charity aims to tackle eating disorders in measureable ways.

Every individual with an eating disorder is unique. They will not all respond to the same treatment. In partnership with researchers and clinicians, we develop a broad range of approaches and transform the science into practical tools that sufferers can beneficiate in their daily life as a self-help tool. We want to move from awareness to action.

The Succeed Body Image Programme

 The charity has a wealth of sound scientific research behind it thanks to its association with a number of academic institutions; including the University of the West of England; their Centre for Appearance Research is monitoring the Body Image programme in the UK, headed by research fellow and Doctor Phillippa Diedrichs.

The Succeed Body Image Programme (SBIP) is a cognitive dissonance-based intervention.

Dissonance theory suggests that if individuals act in ways that contradict their beliefs then they will typically change their beliefs to align with these actions. The Succeed Body Image Programme therefore, actively engages its participants in of a series of verbal, written and behavioural exercises that critique the unrealistic, ultra-thin-ideal standard of female beauty.

The SBIP is designed to help individuals across all spectrums to establish and maintain a positive body image. Using highly interactive, peer-led, small groups, it is a two-day, intervention program designed by experts and implemented through trained peer leaders on college campuses throughout the UK.  As the first peer-led, evidence-based eating disorders prevention program shown to truly work, The Body Image Program does not specifically focus on eating disorders; rather, it emphasizes creating and reaffirming positive and healthy personal body image through a variety of structured discussions, activities, and exercises. The phenomenal program has a proven track record – not only on improving body image issues, but on encouraging healthy confrontation and communication skills as well. It is the first scientifically supported evidence-based eating disorders prevention program designed.

Fat Talk Free

Fat Talk describes all of the statements made in everyday conversation that reinforce the thin ideal and contribute to women’s dissatisfaction with their bodies. We want to raise the nation’s consciousness about the danger of fat talk and our initiative is to eliminate that kind of talk from our lives and stop appearances critiques and accept the way we are.

This can be achieved by simply changing our conversation.

Our Success depends on collaboration and monitoring our work we want to focus in what works.

to access the support contact the Succeed Foundation Directly

www.succeedfoundation.org

Carers may find this link helpful too;

http://www.succeedfoundation.org/work/skillsforcarers

 

 

When you hear the word ‘counselling’ what do you think of?

Two people in a room; one talking and the other just nodding and listening? 
Films have a lot to answer for, and for me that image conveys nothing of the aliveness of the relationship that counselling offers.

For instance, when was the last time that a friend or someone in your family really listened to your experience, without confusing it or comparing it with their own? 

The real trick of counselling is that it creates the circumstances that mean you can fully be yourself. By providing relational sounding boards and mirrors it allows you to see and hear the self you are in this moment. Sometimes someone else can see you changing when you can’t see it yourself.
Most people emerge from experiences of counselling feeling better than they did at the start, more able to function and on a positive trajectory in terms of their mental health, but the chances of this are much increased if they can come along with some openness to the process, some belief it could help in some way. This is one of the reasons we ask people to refer themselves, rather than being required to come: they need just a tiny bit of belief, and it can be just tiny.

The other surprise to some is that counselling is not just about two people in a room, in fact increasingly this is less and less so. The Student Counselling Service now offers about 300 students direct support each week and whilst some of them will be in individual appointments, most of these are either initial assessments to establish the best pattern of care for someone, one off follow ups to these meetings to support a person’s self help, 20 minute initial meetings to establish support choices, or 20 minute ‘Drop ins’ to offer immediate triage and signposting to support, or to help keep them on track with ‘Beating the Blues’ (our online CBT support programme). Even our regular sessions tend to be for fewer than 6 weeks.

Over 100 of the total seen are accessing our regular closed groups or coming just this week to an open group, or attending one of our workshops. And that’s without keeping a count of the number of people who use our resource library and website self help pages.

Because of the range of what we offer we registered over 1600 students last academic year, and so far this year we are experiencing a 20% increase on that. We can’t work with everyone but we have a number of useful contacts in the wider community of Bristol, so that no one needs to feel alone with their concerns.

And just one little plug for group work. If counselling helps you see aspects of yourself you can’t yet see , imagine what it might feel like if other students just like you provided the sounding board, or if someone in the group told a story that made you feel you were not the only one struggling with similar things. It is a powerful moment, and every group sees it, when someone says, ‘it’s such a relief…I thought it was just me’.

http://www.bristol.ac.uk/student-counselling/

 

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