Quarterly Meeting Notes

Date & Time: 7th March 12, 10am – 1pm

Venue: The Abbey Centre, 34 Great Smith Street, SW1P 3BU

Theme: Men’s Health & Wellbeing

Eddie Chan, BME Health Forum Chair and Director of the Chinese National Healthy Living Centre, welcomed all to the meeting and introduced the first item.

Item 1:

Working with men in the Health Trainer service

José Vega, Health Trainer, Rain Trust

What is it about?

Seeing people on a one to one basis to improve people’s lifestyle and long term health.

We can look at 5 areas:

• Healthy eating
• Physical exercise
• Stress
• Smoking
• Alcohol

We offer six sessions with each session lasting 45 mins.

Our role is to motivate our clients to make lifestyle changes.

We are not counsellors or fitness instructors. Rather, we offer motivation to get through the barriers that stop us from doing what is good for us.

We link in with other services and refer clients to the appropriate services.

How do sessions work?

In the first session we decide on an area to work on. Once we have decided on the area to work on make an action plan.

e.g. Healthy eating – perhaps the client is not eating enough vegetables.

Ideally goals are made from the clients’ own suggestions. The Health Trainers role is to find out what is stopping the client from achieving their goals and see how to get through these barriers.

The goals are always SMART (specific, measurable, attainable, relevant, time-bound)

Important to note the world cannot be changed in 6 weeks. We do however review the goals each week and we try and help them to become their own Health Trainer.

Venues:

All over the borough (Westminster)

• Community centres
• GP surgeries
• Penfold Hub

Do men use this service?

At the moment more women use the service than men. We are really keen to encourage more men to take part though.

Case study:

A man staying in a hostel with mental health problems was actually referred to a professional for help with those issues. However, he also needed to stop smoking and he ate unhealthily.

We were able to help change his eating habits and eventually, with additional     help from the health improvement team, he was able to quit smoking.

Another man was obese (150kg) and worked long hours arranging events. He was over eating and drinking too much. In the 6 weeks of the programme he managed to lose 7 kilos.

It is really rewarding for those concerned to see changes being made.

Q&A

Question: Do you have difficulty in engaging men? Men do seem to be less motivated. They are less likely to male an appointment for their health.

Answer: Trying to get men interested in health is more difficult. What we have tried is to go to make orientated spaces e.g. pubs and have handed out flyers and talked to men there. It does work.

Question: What was the success rate with talking to men in pubs?

Answer:Well if you leave leaflets and don’t press too hard – we have been surprisingly successful before.

Question: How about BME men? How do you find it to engage with this group?

Answer: It is a challenge but we are determined to reach this group. This is one of the purposes of coming to talk here.

Question: How do you overcome the problem that some men who might need your service might not be able to read or speak English?

Answer: We do have Health Trainers with different languages and we are willing to use interpreters or family members if the participant agrees to this.

Item 2:

Supporting Bangladeshi Tobacco users in Tower Hamlets

Dipul Ghosh and Abdul Kurshed, Tobacco Cessation Advisors, Queen Mary, University of London.

We have worked as Tobacco cessation advisors for the Bangladeshi communit for the last 10 years.

We are trying to improve the quality of life of helping to reduce the smoking and chewing of tobacco.

In the Bangladeshi community the chewing of tobacco is a cultural norm.

What is the basic ingredient for Paan chewing?

• Beetlenut
• Lime
• Paan leaf
• Flavourings
• Tobacco

Paan is like a vegetable – harmless on its own.

Some points about tobacco:

There are 4000 chemicals in a cigarette with 600 permitted additives.

20 cigarettes leave this much deposit in your lungs [they showed the audience a jar full of red liquid]

Particular health risk of chewing tobacco is Oral cancer

Other health risks of tobacco (chewing/ smoking):

Lung cancer

COPD (Chronic Obstructive Pulminary Disease)

Heart disease

Affects unborn babies – they can be pre term births and babies have less weight.

How many Bangladeshi men use tobacco? 42 – 45 %

In terms of chewing, women seem to chew tobacco far more than men. In Tower hamplets 47% of women chew as opposed to 2 –5% of men. It is perhaps because it is an activity prepared and done at home and women spend more time in the home than men. However men certainly smoke more.

Is there any benefit?

• Relaxation
• Social – friendships
• Colours lips
• Relieves mouth pain
• Controls appetite and so keeps weight down

How do you know if someone is heavily addicted to tobacco?

-How much do they smoke daily?

-How soon after waking up do they start chewing? (15/ 30mins? – then yes)

Q&A

Question: What is the fatality rate from chewing tobacco?

Answer: We are exactly sure – however there are surely deaths relating to this habit.

Question: Who does one contact for support?

Answer: We are called the Bangladeshi Stop Smoking Project – we have men working with men and women working with women and we are culturally sensitive.

Question: What about medicine support?

Answer: You can go to your GP for this but we also provide medicine to help and it has been very effective.

Question: How did you make the argument that the service was needed specifically for the Bangladeshi community?

Answer: We are based in Tower Hamlets  which has a majority Bangladeshi community.

Question: Roughly how man shops are selling Paan chewing products in Tower Hamlets?

Answer: 123

Question: Can they sell to people who are underage?

Answer: Absolutely – there are no health warnings on any of the packets.

Question: Are there other problems if you swallow the tobacco?

Answer: Yes – if you swallow you have a higher risk of cardio vascular disease and stomach ulcers.

Question: Do you find that religious or community leaders are a help or a hindrance to your work in helping people to stop smoking/ chewing?

Answer: The religious leaders help us; in our religion you are not allowed to use tobacco – if it damages your health Islam does not allow it.

Question: If someone doesn’t live in Tower Hamlets can they still use the service?

Answer: Yes

Question: Do religious leaders actually advise people not to use tobacco?

Answer: Sometimes they do yes – on special occasions like Ramadan the Imam delivers messages to the community.

Item 3:

Prostate Cancer in African Caribbean men

Suresh Rambaran, Support & Information Specialist Nurse, (African Caribbean Communities), The Prostate Cancer Charity

The Prostate Cancer Charity is the largest Cancer charity in the UK. We have a Helpline providing information and advice and spend 2 days in the week going out into the community providing support and raising awareness.

We also fund research and in 2010 awarded grants worth £1.7 million. It is currently Prostate cancer month (March).

37,000 men are diagnosed with prostate cancer every year and 250,000 men live in the UK with prostate cancer. It is the most prevalent cancer in men. 10, 000 men die every year.

Many people don’t even know what the prostate is – and also have the misconception that women have a prostate as well.

Men in general do not pursue cancer information – particularly in the black community and some are worried that prostate issues are related somehow to homosexuality.

The prostate produces some of the fluid that makes up semen. Testes also have a role in prostate cancer relating to the reduced production of testosterone.

Benign Prostatic Hyperplasia (BPH) – is a non cancerous enlargement of the prostate and has the same symptoms as Prostate cancer. When men grow older there is a change in hormone levels which can cause an enlargement of the prostate which squeezes the urethra. There is a medication you can take to treat this and there is also a medical procedure.

Prostatitis – is an inflammation of the prostate which generally affects younger men (20 – 50 years). It can be acute or chronic and can keep coming back. It is treated with antibiotics. 

Prostate Cancer – occurs when the cells within the gland divide and grow in an uncontrolled manner.

What are the risk factors?

• Age
• Ethnicity
• Diet

80% of those living with prostate cancer will be 70 – 75 yrs. The older you get the more likely you are to get it. Usually over 50.

African/ Caribbean men are 3 times more likely to get prostate cancer. Research shows that African American men get diagnosed later and also may be susceptible at an earlier age. In America, due to a different health care system the majority of African American men do not have equal access to health care as they are unlikely to have insurance.

Genetics appear to play a part in the development of prostate cancer – you are 2.5 times more likely to develop prostate cancer if your father or brother has had it.

West Africans in the UK seem to be at higher risk.

Diet: Asian diet versus Western diet. South Asian men have the lowest instances of Prostate cancer. High levels of saturated fat, dairy, and red and processed meat seem to be more common in Western countries than South Asian countries.

Symptoms:

Most men with early, localised prostate cancer do not have any symptoms.

A weak or reduced urine flow

Needing to urinate often (especially at night)

Feeling the bladder is not completely empty

A desperate need to urinate (urgency)

Difficulty starting to pass urine (hesitancy)

Having an enlarged prostate does not increase your risk of prostate cancer but both can occur at the same time.

Less common symptoms – are problems getting an erection, blood in the urine, and a new pain in the lower back.

Check ups/ tests

PSA – Prostate Specifiv Antigen (this does not diagnose cancer

DRE – Digital Rectal Examination (many are not comfortable with this and you can ask not to have it).

Prostate Biopsy

The prostate gland makes a protein called prostate specific antigen (PSA) 

The PSA test:

• does not diagnose cancer
• may indicate there is a problem with the prostate
• can give false positive or negative results

Because of the false positive/ false negative possibility in the result there is much debate in the value of the screening tests.

There is no screening programme in the UK but any man over 50 can go to their GP and request a test. However if you are high risk and you are worried you can have the test before this time – it is your right. Many GPs will ask you if you have any symptoms and if you say no they will not offer it. You will have to ask for the PSA test.

It is important that all men can make an informed choice.

One of the things you can do is improve your diet. You can have less saturated fat and processed food and more fruit and vegetables. Lycopene is also beneficial (it is found in cooked tomatoes).

There is a confidential Helpline for those who have queries.

[To see a copy of the power point presentation for this talk click on this LINK.] Please note this is for viewing purposes only and the information is accurate at the time of delivery. If you would like the Prostate Charity to give an awareness talk to you community please contact Suresh Rambaran at suresh.rambaran@prostate-cancer.org.uk

Q&A

Question: Does the biopsy give clear results?

Answer: When you have it you are given a local anaesthetic and 8 – 12 needles are inserted but sometimes they can miss the cancer.

Question: Does sexual activity raise the risk factor for prostate cancer?

Answer: There is no conclusive evidence for this.

Question: How come there is no emphasis on a screening programme?

Answer: It is for the reason that there is a lot of false positive and false negative results. You cannot widely advocate something that could cause more harm than good.

Item 4:

Delivering health services to young people (Shisha awareness campaign)

Abdul Jaleel, Project Coordinator – Making Communities Work and Grow

MCWG have several projects/ programmes including

• supplementary school
• Youth Service
• Women’s group
• Health Campaign – currently centred around Shisha awareness.

Abdul Jaleel has been working in the community for 10 years (currently 28 years old) in Tower Hamlets.

He is delivering the project to Arabic speaking communities.

What are the challenges of delivering a project to young people?

Background – the NHS commissioned MCWG to deliver a project around Shisha awareness for young people.

After the smoking ban came into place in 2007 Shisha cafes suddenly became big business and extremely popular with young people. Also because it became illegal it became difficult to regulate.

There is a big drive now to raise awareness of the health risks of shisha smoking.

We are delivering workshops at community events and educating young people to become mentors.

Barriers/ challenges: It is a cultural practice and we don’t want to offend people. It is also hugely popular/ ‘trendy’ amongst young people of all cultures.

Mohammed Jawad (shishaware.org) has completed a survey with 3000 young people and has done a lot around raising awareness about the risks of shisha.

Risks/ misconceptions around Shisha:

The water filters out the tobacco – NOT TRUE

It doesn’t contain tar – NOT TRUE, it does contain tar as burnt tobacco creates tar.

We are still at the early stages of discovering the proper health risks of shisha. The risks are not clearly written as on packets of cigarettes.

In the beginning shisha use was isolated to Arab communities but now with integration it is becoming a ‘fashion’ thing. It is prevalent is eastern European countries and also Israel – not just a Muslim thing.

We are trying to change attitudes around use of shisha. We are trying to go to schools – deliver workshops. We  are need to be mindful of the way we deliver these workshops, especially in school settings and it is a challenge.

Q&A

Comment: I have a friend who smokes in front of his kids and says that it’s ok as the scholars say that it is ok. When smoking was banned in the UK and much of Europe tobacco companies targeted other countries such as Muslim countries.

Answer: Shisha smoking can a lifestyle choice – those who don’t take drugs or drink alcohol it can be an alternative. The scholar thing is a misconception – anything that tarnishes our intellect or health is not acceptable.

Question: Does it contain tobacco?

Answer: Yes – but also people experiment with it and mix drugs with the tobacco and put vodka in the water – this is a greater danger. It is called ‘cooking’.

Question: Does the project highlight at all the damage that underage smoking can bring particularly in terms of sexual violence towards young girls who go to shisha smoking  places, and the damage that this can bring to the community?

Answer: I am not sure as there is a lack of research here at the moment.

Question: I work with adults with learning difficulties – do you have any campaigns targeted at people with learning difficulties e.g. information in easy read formats.

Answer: The project has only just started in January but we will be definitely looking into this.

Question: Do you think the smoking ban has contributed to making shisha more popular/ ‘fashionable’ and also attracted more women to it?

Answer: It’s definitely become more fashionable since the smoking ban and the risks not highlighted or socially condemned.

Question: How do you reach young people – you said it was difficult?

Answer: We approach schools and we try and be very persistent. Working in partnerships with NHS or Mohammed Jawad (who is well known) can help us as well. We also try and approach young people by making the parents more aware to monitor their children, for example spreading information in women’s groups.

Quesion: Do you have anything like a mobile exhibition that you could take around to libraries and schools?

Answer: No but that is a brilliant idea.

Question: If it’s not documented it must be difficult to impress young people of the risks. What vehicles are you intending to use to deliver the information to young people? If you don’t use effective vehicles to convey the information there is not much point.

Answer: Well we will use the methods and ideas outlined above - Ideally we would first need a thorough research completed to impress the government. However this was intended as a small project for the Arabic community and there is not enough money for something more widely targeted.

Item 5:

Bowel Cancer Screening

Gemma Nichols, Public Health Programme Manager – Screening, INWL

My role is to oversee the screening programmes for Westminster, Hammersmith & Fulham and Kensington & Chelsea. These are:

• Cervical cancer
• Breast cancer
• Bowel cancer
• Diabetic Retinopathy (eye screening)

Bowel cancer screening is the newest screening programme to be rolled out. It started in 2006 and we have been struggling to get people involved.

Who’s eligible?

What happens?

Issues that we are facing engaging BME communities

Facts:

1/20 people will develop bowel cancer. It is the third most common cancer in the UK and the 2nd leading cause of cancer deaths. 16, 000 people are dying from it every year. Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16%.

Overview:

The programme started in 2006. The screening tests detects possibility of bowel cancer at an early stage by detecting polyps/ blood in stool.

How does it work? What happens?

There are programme hubs. There are 5 hubs spread out across the country that are responsible for sending out letters and sending results.

Screening centres:

Provide endoscopy services and specialist screening nurse clinics for people receiving an abnormal result.

Responsible for referring those requiring treatment to their local hospital multidisciplinary team (MDT).

Who is it for?

60 – 74 year olds are asked to do it but if you are over 70 you can self refer.

How does the kit work?

It is called a Faecal Occult Blood (FOB) test. It shows up the amount of blood in the stool and whether there are any polyps present.

The FOB does not actually diagnose cancer

If you have a positive result from the FOB test you will be asked to go for another test - a colonoscopy.

The FOB test is done at home and sent to you in the post with a pictorial instruction leaflet. The letter is translated into 15 languages.

We are currently working on improving the kit and explanation leaflet to make it even easier to use.

The results are returned within 2 weeks.

Results:

You either get –

• Normal
• Unclear
• Abnormal

 Most people (98/100) get a normal result. However getting a normal result does not guarantee that you are not at risk of cancer.

Unclear result – usually means that you just need to do the test again.

Abnormal result – is not a diagnosis but  a colonoscopy will be offered following an abnormal result from FOB test.

What is a colonoscopy?

A camera on a long tube is passes into the back passage and guided around the bowel.

5/10 who have a colonoscopy have a normal result

4/10 will have polyps removed

1/10 will be diagnosed with cancer

Do I have to have a colonoscopy if I have an abnormal FOB result?

Depending on the other conditions an alternative may be offered. During the appointment everything is explained to the patients.

How reliable is cancer screening?

No screening is 100% reliable.

You need to be aware of the symptoms and check. Knowing what’s normal for you is important. Any change of regular habits or abdominal pains should be considered. If bowel cancer is detected at an early stage there is a 90% chance of recovery.

On the 31st January there was an 8 week National Bowel Cancer Campaign. This is separate from the screening programme but is linked. The idea was to normalise talking about poo to help raise people’s awareness via TV campaigns, radio (was also on 4 or 5 of the big ethnic radio stations) and also in some national newspapers.

[To see the power point presentation for this talk click on this LINK.]

Q&A

Question: If the test does not diagnose bowel cancer – does it detect polyps?

Answer: Yes it detects blood and so indicates if there is a possibility of bowel cancer and that it needs to be looked into more.

Question: Statistics say that once it develops it is one of the more aggressive cancers.

Answer: Yes - signs and symptoms come much later and at a time when it is much less treatable.

Question: Do you have to wait until you are 60 to screen yourself?

Answer: When a National screening programme is set up they look into the highest risks related to age.

Question: Is there an ethnic connection to who gets Bowel cancer?

Answer: There is no monitoring or ethnic recording on who takes up the screening but those who get Bowel cancer are more often men and more often from Asian or Black Caribbean communities.

Item 6:

Cancer Wellbeing Event

Melanie Christodoulou, Community Engagement Coordinator, Hestia

On the 26th March 2012 in Kensington Town Hall there will be a Cancer Wellbeing Event from 3pm – 7pm.

Melanie also announced some funding available to come up with a Healthcare project for anyone working with 14 – 19year olds. The deadline was 15th March  and mainly open to K&C residents but they were also looking for Tri-borough participants.