High risk: global health’s culture of fear

Every year, London’s contemporary art scene behemoth – the Whitechapel Gallery – commissions artists to engage with a topic relating to children. This year, Brazilian artist Rivane Neuenschwander has interpreted that brief to create a physically moving collection entitled ‘The Name of Fear‘.

Exploring childhood fears, its title comes from the 1972 song ‘Araçá Azul’ (1972) by Brazilian composer, singer and writer Caetano Veloso, and echoes the poem ‘O Medo’ (Fear) by Brazilian poet Carlos Drummond de Andrade. Neuenschwander attempts to write psychological health, trepidation and hope through an installation of child-sized capes, sometimes two-armed, sometimes two-headed, but all a form of accoutrement that envelops the body.

You can watch and listen to Neuenschwander talking about her work here. A selection of pieces from ‘The Name of Fear’ are shown following:

'Guns and Knives'. Image Credit: A Bow-Bertrand.

‘Guns and Knives’. Image Credit: A Bow-Bertrand.

‘The Name of Fear’ is a successor to her collection of over a decade ago ‘I Wish Your Wish‘ (2003), once again inspired by the cultural heritage of her homeland and the pilgrim tradition of bandaging their wrists with fabric on which their wishes and hopes are inscribed. The wish proposition and fulfilment chain is, surprisingly perhaps, frequently linked with deep-rooted personal fear.

'Ebola'. Image Credit: A Bow-Bertrand.

‘Ebola’. Image Credit: A Bow-Bertrand.

‘Fear’ in the context of global health needs some definition. The Oxford English Dictionary describes it as: ‘the emotion of pain or uneasiness caused by the sense of impending danger, or by the prospect of some possible evil’. Certainly, the subject of fear has a history of negative associations, being linked to derogatory labels such as ‘wet’, ‘coward’, ‘wimp’ as well as diagnostically identified as triggering stress and inspiring the millennium era acronym FOMO (fear of missing out).

However, ‘fear’ is an abstraction, and cannot be delineated by any such qualitative frames. After all, what is the film industry’s horror genre for, if not to entertain through inducing fear? So too, fear is something to be considered from both anthropological and psychological stand-points. Way back in the seventeenth-centry, when Robert Burton published ‘The Anatomy of Melancholy‘ (1621), he identified his subject as transitory, caused by a composite of mental perturbations, fear, discontent and vexation of spirit, worthy of consideration and alleviation.

'Sadness'. Image Credit: A Bow-Bertrand.

‘Sadness’. Image Credit: A Bow-Bertrand.

This latter point appears crude but is pivotal to considerations of the role that fear plays in global health. In the international age of Big Data and health policy analysis, ‘fear’ is often used interchangeably with ‘risk’, with little thought given to the differences between the two. ‘Risk’ bears a possibility of loss, reversal of fortune and active engagement with a situation, while  fear remains a complex state canvassing both measurable and qualitative indices.

It is my thinking that fear is the precursor to all the risks taken in the field of humanitarian aid. This past weekend I attended a development conference as an elected Global Health Ambassador for an organisation called Selfless. In his opening speech, founder  Dr Na’eem Ahmed shared his vision and motivations. He referenced the desire to make a difference to communities that could best profit from cost and user effective health interventions.


The organisation’s central belief is that human endeavour is the most potent tool to encourage social change. What is it that instigates that endeavour? Fear. Ahmed, like fellow speaker Seth Cochran of the fast-growing start-up Operation Fistula which seeks to achieve comparably nominal levels of fistula occurrence across critical areas Africa and Asia as benchmark continents of Pan-America and Europe, are engaging in risky business.

Selfless and Operation Fistula are founded by individuals who are acutely aware of their own humanity, and afraid of the possibility that under different circumstances they could well be in need of the aid which they help to provide. The modern ‘we’ all fear the unknown; the ‘other’; hypothetical scenarios. Many media outlets do a remarkably good job of scaremongering the general public with headlines such as ‘the UK has all conditions required for malaria mosquito to thrive’, and ‘the migrant crisis: you could be next’. True, but unreliable.

When used appropriately, the intangible, universal state of being afraid and of experiencing fear can be channelled into global health policy that addresses a crisis or conflict dilemma, while controlling and capping that emotive experience. It would be plausible to speculate that Cochran, a private equity professional turned humanitarian, and Ahmed, champion of the self-coined term ‘skillanthropy’ fear becoming the complacent, profitable, upper income national they could easily be perceived as. Regardless, altruism and fear can generate potentially world-shaping wins for the humanitarian sector when risks are taken, managed and outcomes used as learning points.

'Strangers', Nightmares'. Image Credit: A Bow-Bertrand.

‘Strangers’; Nightmares’. Image Credit: A Bow-Bertrand.

The crawling ribbons of Neuenschwander’s ‘Ebola’ cape were inspired by a child’s fear. Hanging limp on its display stand, there is little that could conjure that same transitory state of being. And that is precisely the point. By choosing to put on cloaks of fear – of natural disaster, of epidemics, of failed vaccine supply chains, of famine – of fears that impact the world’s health and its’ citizens’ ability to survive, we are choosing to inhabit a space in which change is possible.

'Thunder'. Image Credit: A Bow-Bertrand.

‘Thunder’. Image Credit: A Bow-Bertrand.

The capes enact what psychoanalytical studies, most notably those of the formative Sigmund Freud, might call ‘projection’ ( the process whereby aspects of ourselves – usually negative ones – are not recognised as part of our being but are attributed to another. It is a way of disowning our own desires, fears or antagonisms). By holding up our fears for inspection through art, writing and experience, high-impact policy can be considered, and collective fear can be turned to positive, multi-disciplinary health change for a brighter future.

Sustainable Development Goals: delivering a promise

Tomorrow marks the start of the three-day New York based summit at which the United Nations’ Sustainable Development Goals (SDGs) will  be officially launched. The global health community has long been aware of their pending introduction, transforming and reconfiguring models put in place by the Millennium Development Goals (MDGs) fifteen years ago.

Image reproduced with permission of the United Nations

Image reproduced with permission from the United Nations

The SDGs were first borne as outcomes from the 2012 Rio+20 Conference with associated The Future We Want document, and their structuring and identification has been on the international agenda ever since. It is unlikely that these targets are widely identifiable or recognised by the general public, not least one which has been inundated with potentially inaccessible labels (Millennium Development Goals offers no notion scope nor duration), with SDGs another acronym in the bureaucratic health professional’s toolkit.

But the SDGs must prioritise active reception by the community who envisaged and proposed them: international health leaders and organisations. The general public are of secondary concern in the dissemination of the materials and projects associated with these goals. A lesser acknowledged, and unfavourable reality ahead of this week’s summit, is that for many in the global health community, the SDGs represent yet another set of paper goals, with accompanying attitudes of scepticism as to their benefit, novelty and effectiveness in terms of time and resources.

Image reproduced with permission from the United Nations

Image reproduced with permission from the United Nations

Of course, the shapers and movers of global health cannot be uniformly branded with this attitude, but pervasive symptoms of it are identifiable in precursors to these goals. In early July, UN Secretary-General Ban Ki-Moon released the final report on the progress of the Millennium Development Goals (MDGs). The review found significant progress across goals, notably in the world’s efforts to combat malaria, with deaths at an all-time low and 6.2 million lives saved since the start of the Millennium. Speaking at the event in Oslo, Norway, Ki-Moon highlighted: ‘the report confirms that the global efforts to achieve the Goals have saved millions of lives and improved conditions for millions more around the world’.

However, the review was largely overlooked by those to whom it was targeted. The analysts had already played their role, offering statistics that figuratively marked diseases in the red or green  in terms of their relative success in meeting the indicators of the MDGs. However, their was a stark lack of coverage by the participants and protagonists of the MDG action points themselves. Even in the case of success stories such as malaria where targets were historically surpassed, recording a 69% decline  in the rate of child deaths from the disease in Sub-Saharan Africa, the two sole published messages relating to this were from Malaria No More and Roll Back Malaria in a piece penned during my internship.

Image reproduced with permission from Malaria No More

Visual coverage of the MDG final report, reproduced with permission from Malaria No More

This remarkable progress was largely due to a tenfold increase in international financing for malaria since 2000, along with strengthened political commitment and the availability of larger-scale, pioneering tools such as diagnostic testing and artemisinin-based combination therapies. This has substantially increased access to malaria prevention and treatment interventions. Over the past 15 years since MDG 6 was conceived, global malaria incidence has fallen by an estimated 37 % with a 58 % decrease in mortality rate [see Figure 1].

Figure 1: Taken from Millennium Development Goals Report 2015

Figure 1: Taken from Millennium Development Goals Report 2015

Notwithstanding that this data warrants exposure, perhaps one of the reasons  that coverage of the official expiration of the MDGs was limited is because figures are projected to the end of 2015. Many professionals are aware of the watered-down credibility of using such hypothetical statistics to qualify supposed success stories. Perhaps also, active partners are aware that even in instances where results exceeded the MDG target, the fight against disease, inequity and access to healthcare is far from over. The global health community must be reinvigorated and be able to act critically and broadly to fully capitalise on the frameworks the SDGs will offer.

Speaking in a conference call with the Roll Back Malaria Secretariat, Tim France, Managing Director of Inis Communications identified the need to spark ‘the global health community, making them realise the full potential and fresh approach of the SDGs’. Final draft reports of the SDGs have already been released which offer a clear, and surely immobile picture of what these 17 targets will look like.

The proposed SDGs, reproduced with permission from the UN

The proposed SDGs, reproduced with permission from the United Nations

The SDGs diverge from the MDGs in terms of aspiration, content and scope. Drawing on wider and long-established models in two threads, the proposed goals canvas development of natural resources and environment while also accommodating pivotal anthropological and diversity considerations. Combining both analysis and standardised methods, the SDGs prioritise a multisectoral approach to tackling current and future international health concerns and crises.

While interning at Roll Back Malaria, my on-going project was to compile appropriate and compelling communication messaging to closely associate malaria with the SDGs. As the nexus of social and health related projections and ambitions for the near future, there is congestion amongst disease and partner profiles wishing to secure their association with the demands and commitments required of the SDGs. In many ways, this feverish work designed to gain a platform indicates that the global health community is willing to reenergise and ensure they #LeaveNooneBehind.

Image reproduced with permission from the United Nations

Image reproduced with permission from the United Nations

Certainly, the fight against malaria is not over. The disease still poses a major health security challenge with an estimated 3.3 billion people at risk globally. A multi-sectoral approach is essential moving forward, to secure the progress that has been made up to this point. Ki-Moon emphasises that ‘the year 2015 is a landmark for humanity. The deadline for the MDGs is upon us, and a new universal development agenda [SDGs] for the next 15 years will be adopted by world leaders in September’.

The SDGs represent an opportunity to set renewed challenges and feasible goals in the progress towards eliminating poverty, inequity and preventable diseases everywhere, for everyone. Don’t let the SDGs become an empty acronym – civilian or health professional, be sure to follow coverage of this week’s summit, and help make these targets a promise that can be delivered on.

Photojournalist of the month: Peter Biro

It is always best to come clean, so I will mention now that Peter Biro is a very recent photographic discovery of mine. He came to my attention after he liked and followed me on Twitter with the publication of my post featuring a selection of humanitarian photojournalists.

Biro certainly earns himself a place on that list. Senior Communications Officer and resident photographer for the International Rescue Committee (IRC) he is currently based in Thailand. His writing and photographs have taken him, and lead us,  across the world, from his current reporting areas of Afghanistan, Chad and Indonesia, back to Cambodia and Kosovo where he was based as a United Nations employee prior to joining the IRC in 2003.

He couples his commentary with images, which are characteristic for unusual perspectives that shift the viewers’ focus around the portrait, resting finally on the faces that the lens searches out. Below are a selection of Biro’s most recent moving images from his coverage of conflict and natural disasters.

Nepal Earthquake response, May 2015. Photograph credit: Peter Biro.

Nepal Earthquake response, May 2015. Photograph credit: Peter Biro.


Escaping Nigeria's brutal violence. Photograph credit: Peter Biro.

Escaping Nigeria’s brutal violence, April 2015. Photograph credit: Peter Biro.


Escaping Nigeria's brutal violence. Photograph credit: Peter Biro.

Escaping Nigeria’s brutal violence, April 2015. Photograph credit: Peter Biro.


Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.

Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.


Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.

Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.


Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.

Powerful photos from South Sudan, November 2014. Photograph credit: Peter Biro.

Watch out for next month’s photographer feature.

Stitches in my mind

I am Danni, I’m not sure why I write poetry or when I started, but I know I find it cathartic and helpful. Mental health, and human relationships, seem to be a strong focus of mine at the moment. Perhaps because I’m going through counselling, or perhaps I’ve reached a reflective age.

I’ve had anxiety and depression for a very long time, but I’ve never considered it to be mine alone. Inspiration comes from past events or images from art or the news, very often just from people watching, and usually when I’m trying to do something productive. These two poems are in some ways totally unconnected, but complement each other. One is an introspective reflection, and the other a speculation, on the subject of mental health.

Screen Shot 2015-09-19 at 19.22.31Danni Darling Man on Train

Man On A Train was, unsurprisingly, written on a train. The man got on, and you could feel the whole carriage mentally edging away and praying for him to not sit near them. He shared my table, greeted me joyfully and pulled out his sewing. And I wrote a poem. Since then, I’ve often wondered if my attempts at ‘normalising’ his actions were somehow patronising. I sincerely hope not. I hoped to challenge assumptions. But that is not up to me to decide, once I have given this piece to the reader, it becomes theirs to do with what they will. Screen Shot 2015-09-19 at 19.23.15Danni Darling You Left a Depression in MeYou Left A Depression in Me was inspired by my reflections on hereditary mental health. My mother and most of my family seem to suffer from mental health conditions. I drew on childhood memories mixed with Freudian dream references in attempting to do this.

Space on the page is important to me, as I feel it can imitate the jarring motion of my thoughts so much better then any collection of words. The images I use follow this in being sometimes broad and overwhelming, and other times zooming in to such detail as can only be focused on with true observation.

Danni Darling can be contacted here.

Gender bias in the caring profession

The tone of this article can be set by opening with a lateral thinking puzzle:

A father and son were involved in a car accident and rushed to the hospital. On seeing the unconscious young boy, the surgeon exclaimed, ‘Oh no, that’s my son’. How can this be true?

Think about it. No, the surgeon isn’t the grandfather. No, the father doesn’t possess shape-shifting powers. The surgeon was the boy’s mother.

Gender bias exists and persists across the many strata of medical professions. Top-tier positions (in terms of training requirements and pay-scale) are still perceived as being dominated by men as the recent #ILookLikeASurgeon Twitter phenomenon has highlighted. At the lower end, males in the caring profession frequently experience bias in a role traditionally assumed to be held by women. A quick Google image search for ‘carer’ returns at least twenty results of female carers in action, before a male so much as appears.

A ‘carer’ is here definable as someone holding a front-line domiciliary adult and elderly social care role, with its sister-career, nursing, also experiencing similar training and social bias against males. On the UK’s Radio 4’s Today Programme, Professor Martin Green said that the government needed to to do more to recruit men into these positions. The Department of Health responded saying that it would continue collaborative work to promote applications from either gender to the caring professions.


This article focuses on carers working in residential and inpatient settings

Care England, the largest representative body for independent care providers in England corroborates UK Government statistics from 2012 which have remained static. Across the caring sector 84% of represented workers are women, with only 16% men. More needs to be done, with a systematic approach to changing perceptions that care roles are female dominated and that high-end clinical professions are the domain of men. There are practical education measures that can be taken to change social perception of who delivers care.

But it is not just external stigma that influences uptake and pursuit of care roles by either gender, but also personal belief systems. Skills for Care, an employer-led workforce development body for adult social care in the UK, which works with employers to ensure that the appropriate skills and values are obtained, researched this issue. They found that men were often deterred from applying to the caring profession as they thought it was associated with menial tasks.

Adult social care predominantly provides for third age persons. The United Nation’s 2013 World Population Ageing Report identified that population ageing is taking place in almost all countries in the world. Ageing results from decreasing mortality and declining fertility. This dual process sees a relative reduction in the proportion of children and an increase in the share of people in the common working ages and above. The global share of older people (aged 60 years and over) increased from 9.2% in 1990 to 11.7% in 2013 and will continue to scale up as a proportion of the world population reaching 21.1% by 2050.

UNFPA report

Reproduced from UNFPA ageing in the 21st century report

With such a top heavy future world, the gender bias in the caring profession must be addressed. Elderly men frequently prefer male care, and for all caring professionals, fair and appropriate public perceptions must be promoted. In the UK, despite reservations surrounding its introduction, the National Living Wage should increase the number of applications from both men and women to this sector.

While gender-based attitudes must be critiqued and progressed, the caring sector as a whole must seek to encourage more people to join from all walks of life. Many developed world countries already have aged populations, but the developing world is following a similar trend. As the matriarchal carer role becomes reassessed in such countries, and women demand equal career opportunities and roles, anything the national and international health communities can do to promote applicants to caring positions should be encouraged.

After all, dementia and related disorders that are associated with a need for care do not solely target one gender. Our future wellbeing and healthcare support will, in part, be determined by the economic and social buoyancy of national and international caring services – a sector which cannot be undervalued. Getting behind campaigns such as #ILookLikeASurgeon offers more than just a human interest piece – such participation reshapes how we view ourselves and our career trajectories by promoting challenging and visual debate.



Bamford, Nikole, Mindbending Lateral Thinking Puzzles

Image Credit: Keoni Cabral, Flickr

Europe’s migrant crisis: difficult questions

The complexities, heterogenous contexts and causes of Europe’s current migrant crisis can’t be defined by a series of questions, but they serve to offer a framework in which to consider how action is, and should be, taken on-going.


The participants of this crisis are not solely the migrants themselves, but also the governments and political personnel involved in the protection of their state, the citizens that accommodate asylum seekers, and the stories they tell for those left behind. Migrants predominantly come from areas of economic or political disturbance and conflict. As images in the press have indicated, migrants canvas all the life ages, from children (such as the now ubiquitous snapshot of the Aylan Kurdi, the Syrian boy washed up on a Turkish beach) to adults, able-bodied to disabled, solo and collective. However, the United Nations High Commissioner for Refugees reported on 1 September that 72% making the crossing are adult men, representing a self-consciously able workforce. Their common denominator is their desire for a life worth living.

Migrants walk on the railway tracks between Bicske and Szar, some 40 kms west of Budapest

Migrants walk on the railway tracks west of Budapest. Image credit: Freedom House, Flickr

Definable as any person who changes his or her usual country of residence as asylum seekers or economic movers, ‘migrants’ as a term is often misguidedly used interchangeably with ‘refugee’. Refugees are guaranteed some form of protection under international law, whereas migrants are not necessarily secure. Refugees are identifiable as being obliged to leave their home due to persecution for reasons of race, religion, or identification with certain social and political orientations. Asylum nations cannot return these persons to their countries of origin if it would put their lives at risk.


According to the UN Refugee Agency (UNHCR) over 380,000 migrants have arrived on the shores of Southern Europe in 2015. The term ‘European migrant crisis’ was coined and put into use in April 2015, when five boats, carrying over 2,000 people to Europe sank in the Mediterranean Sea, with at least 60% of those passengers dying. While Antonio Guterres, UN High Commissioner for Refugees alarmingly said that ‘there is no humanitarian solution for this tragic humanitarian crisis’, many migrants feel differently. Among those arriving this week in Germany, there was a resurrection of a motto that circulated during the Arab Spring: ‘the power of the people is greater than the people in power’. Both must work together to see what solutions can be arrived at, even if they do not offer a universal answer.


Political unrest in Africa, the Middle East and South Asia is reconfiguring migration trends in Europe.


Infographic reproduced from UNHCR

The most commons migrant origins include the Middle East (Iraq, Syria,Yemen), Africa (Eritrea, Gambia, Nigeria, Somalia, Sudan), the Western Balkans (Albania, Bosnia and Herzegovina, Kosovo, Macedonia, Serbia) and South Asia (Afghanistan, Bangladesh, Pakistan). To reflect the use of technology to map and find solutions to this crisis, Doctors of the World have created a fascinating real-time map with digital agency Impero which monitors positive Tweets (#RefugeesWelcome) along the routes taken by migrants.


In 2011, thousands of Tunisians arriving at the Italian island of Lampedusa marked a watershed moment in the number of illegal border-crossing detections in the EU following the start of the Arab Spring. Shortly after, Sub-Saharan Africans who had previously fled to Libya from upheaval in the post-Gaddafi era followed suit to Lampedusa. More recently, the world’s media and global health leaders have attended to the spectacle of asylum seekers arriving at the Greek island of Lesbos, near the Turkish mainland, which has fast grown into a key migrant gateway.


The migrant crisis situates itself within the topical wider concerns and allegiances of immigration. The International Organisation for Migration has collaborated with the World Bank to create a data visualisation of the figures and populaces that comprise each nation and is available here. It is a helpful overview, outlining the migrant movements in and out of countries. Individuals seeking asylum are fleeing from conflicts, persecution and poverty that rage beyond their continent’s borders, arriving in the EU to seek safety. Migrants, like refugees, want a better and more secure life. Europe and the global media are only recently registering this influx as a crisis, because it is only now that the tipping point has been reached by the developing countries Lebanon, Jordan and Turkey who had, and continue to, shelter some 3.6 million Syrian refugees.

Screen Shot 2015-09-15 at 16.53.19

Infographic reproduced from BBC, UK

Since the start of Syria’s Civil War in 2011, these countries have absorbed migrants and refugees, but can no longer support a basic standard of care, with international funding inadequate and resulting in overcrowded, impoverished refugee camps. It is unsurprising that from the masses, many such inhabitants looked further afield, not least to the lifeline thrown Chancellor Angela Merkel which ensures that asylum seekers that reach Germany can overturn EU law that demands migrants seek documentation and protection in the first country at which they arrive.


They come by sea. They come on foot. They come desperate.

Irish Defence Forces, Flickr

Operation Triton, June 2015. Image credit: Irish Defence Forces, Flickr

Paolo Pellegrin’s captivating photos depict the so-called ‘human flood’ that continues to hit the Greek island of Lesbos and surrounding coastlines. MSF Sea is a newly formed, coordinated programme that carries out relief and rescue missions in the Mediterranean Sea via their boats Argos and DignityI. The tide of peoples crossing the Mediterranean experience life-threatening dangers due to the unpredictable nature of their vessels, navigation and tides. This year alone, 2,850 EU-bound migrants are reported to have died in transit. It is unlikely that this influx will abate until mid-October, when only the most-foolhardy will risk the sea struggle. This apparent alleviation will only be short-lived, with yet more migrants expected to make the crossing to Northern and Central Europe in 2016.


European countries are reacting to, and dealing with, the migrant crisis in various ways. Some nations have adopted more liberal asylum policies (including France and Germany), others have offered financial support to enable mobilisation of humanitarian support and practical care, while still others have built fences topped with Dannert wire (as is the case in Bulgaria and Hungary). On Wednesday 9 September, the President of the European Commission Jean-Claude Juncker, called for root-and-branch reform of disparate immigration policies in the EU. In this speech, he also called for European states to accept binding quotas to resettle 160,000 refugees, with the possibility of work for asylum-seekers. It is apparent that questions keep needing to be posed, but while answers can shed some light on the situation, it is practical solutions that must be prioritised.


Image Credit: C. Thomas Anderson, Flickr

Book of the Month: Warrior without Weapons


MdM’s Book of the Month series kicks off with Dr Marcel Junod’s ‘Warrior without Weapons‘ translated from the original French titled ‘Le Troisième Combattant’. Published in 1982, Junod’s publication certainly has more recent equivalents on the personal humanitarian narrative scene, but few offer such a compelling account. Relating his experiences between 1935-45 as an International Committee of the Red Cross delegate, the book takes us from his first missions in Abyssinia with mustard gas bomb air raids, to Spain in the throes of Civil War, Poland via Germany, ending up in Japan. There, he was amongst the first international medics to treat and be exposed to the clinical aftermath of the atomic bomb attack at Hiroshima. Difficult, challenging, moving, ‘Warrior without Weapons’ remains an essential read for understanding the struggles of humanitarian activists and professionals internationally.

Expect the slim work to be an extension of its closing words:

. . . all these pictures are not merely out of the past. They are still with us all today and they will be with us still more tomorrow. Those wounded men and those pitiful captives are not things in a nightmare; they are near us now. Their fate is in our care. Let us place no reliance on the slender hope which lawyers have aroused by devising a form of words to place a check on violence. There will never be too many volunteers to answer so many cries of pain, to answer so many half-stifled appeals from the depths of prison and prison camp. Those who call for help are many. It is you they are calling.

World Suicide Prevention Day: what is enough?

World Suicide Prevention Day, this year, like every other, invites critique and reservation. Prevention confers an active movement to stop a death – one taken by the self – from arising.

The very existence of a designated annual date indicates the prevalence of suicide, and the need for engagement and awareness of its causes and consequences. In a UK-based Samaritans report released earlier this year, they found that across 2012 to 2013 there was a 4% increase year on year, with a total of 6,233 recorded deaths. Of those, 4,858 were male.

These findings match a trend seen across the Atlantic. Suicide Awareness Voices of Education (SAVE), suggest that suicide is the 10th leading cause of death in the United States for all ages. To put this in context, that equates to an average of 105 US citizens committing suicide per day.

Facts and figures, however, offer little hope on days such as this. World Suicide Prevention Day must not be about oppression, prevention, and the lexicon of ‘committing’ must undergo a thorough process of revision. Instead, global health leaders must inspire a system of trust with an appropriate language. Acceptance, awareness and ease of access to healthcare must be prioritised.

It might seem blindingly obvious, but we can all alert ourselves to the warning signs for suicide. Knowing what they are, and how they can manifest, is a key step to reaching these priorities. Yet, of course, one suicide is never equivalent to another.

Reproduced with permission from beyondblue

Reproduced with permission from beyondblue

The cocktail of circumstance, reasons and history that can lead to such an event varies from person to person. This must be acknowledged, while all ‘prevention’ work needs to become humanised – driven by an understanding that these are feeling, mutable lives of people just like you or I.

Suicide remains something forbidden. Time and again, colleagues, friends, anonymous communications users express concern that by openly discussing suicide it might be contagious, triggering, or suggest a potential course of action. I firmly believe this is not the case.

A sensitive and informed dialogue offers a network. One which supports, and makes certain that all members of society, regardless of race, religion, sexual orientation or diagnosed status, are aware that there absolutely is help available. Such an infrastructure exists across many psychiatric services within the NHS, but it is not uniform, nor does it parallel education of the layperson.

With the endorsement of the Royal College of Psychiatrists, the NHS released a publication titled ‘Help is at Hand’. It is more than just a document. It remains this country’s authoritative guide on how to transcend statistics and offers practical, and potentially life-saving, advice.

Suicide impacts both the individual and their entire social environment. Open eyes, open ears, open hearts – these might just offer a cue or lifeline to those who need it most. Together, we can reduce the recourse to suicide.

Further help:

If there is something troubling you, there are people who want to listen.

The Samaritans are available 24 hours a day, 365 days a year: 08457 90 90 90 (UK),   116 123 (ROI)

PAPYRUS offer a confidential help and advice line and specialist support for young people: 0800 068 41 41

People care, and they will care enough.

Struggling to sleep: Turning off in a world that never stops

Society’s attitudes towards sleep seem contradictory: stay awake and you are damaging yourself; sleep and you are lazy. Regularly neglecting sleep leaves you more likely to catch a cold, put on weight, become depressed, suffer from high blood pressure, have an accident – and more, warn several articles. Being well rested makes you happier too. But you snooze; you lose. Those essays and reports will not write themselves. And when you do have some free time, sleeping does not seem like top of your list: there is always something you could be doing, with opening hours spanning more and more of the night and the worlds of Internet and television open all hours. Caffeine and sugar cover tiredness. While essential for your health, suddenly sleep seems incredibly boring and unproductive and cheatable. Society seems to want all the benefits of sleep, without wasting time actually sleeping.

We want to be either wide-awake or fast asleep, nowhere in between. We have scheduled bedtime, calculated the hours we will get before the alarm, shut our eyes and hope we will fall straight asleep. But it is not like turning a switch on and off. People are not machines. Thoughts fill heads and hearts beat. And sometimes we get stuck in the limbo between being awake and asleep. Like we have forgotten something so simple and natural as falling asleep. Something we just did from birth, like breathing, that thought only complicates.

I have never been great at sleeping at the best of times. But last exam term, things got worse than ever before. It started with being awoken several nights in a row by noisy neighbours but soon turned into insomnia. Studying Psychology, I knew how important sleep was, but that only made my lack of it more frustrating. I averaged around 4 hours sleep in chunks, a night but I would lie for the full 8 hours. Wasting time. Doing no work. But becoming more frustrated than rested. Getting to sleep got harder and harder, with each noise I could not control making my heart race. I would lie, wide-awake, watching the hours pass on the ceiling. And when I would eventually fall asleep, it would only be for a short time before something, in my hyper-alert state, would wake me up. Reality seemed like a nightmare and I would dream about not sleeping; it was as if the fabrics of dream and reality had been sewn together. I was exhausted.

Eventually I began to seek advice – from friends, strangers, the Internet. It was both reassuring and worrying that this problem seemed so common. More than anything, it surprised me. People do not tend to talk about sleep. Informed, I tried all the tips. My sleeping has improved, with mental effort and the help of various herbal remedies, but it is still not normal – if there ever is such a thing – yet. These collages, then, are a representation of a typical night of me, now, getting to sleep, aided by as many things as I need. (See below for a story-line.) We take so many things to keep us awake and help us sleep now that you would wonder how we ever managed without them. It seems we were powered by pills and supplements. Sleep is becoming increasingly medical and political and, if we keep cheating it, historical.


Collage storyline: 

“Sleep well.” “I’ll try,” you reply with a sigh. And, taking your last sip of chamomile tea with an herbal sleep tablet from Boots, you flick on the switch of your CD player and bedside lamp. Hanging like a limp sponge from your middle, you dangle your arms to the floor in front of the mirror. They brush the carpet lightly between breaths and the sounds of heavy rain falling. As you begin to lose the boundaries of your body you crawl into bed; you stuff plugs in your ears and cover your eyes with darkness.

RAIN lullaby3

Then you just lie there. Like you’re waiting for something to happen. For someone to take you into the dream-world. You’re drifting into sleepiness; you can feel it But it’s like jumping off the edge of a cliff into nothingness and you cant quite let yourself do it.

hold on_ waves

You try reciting poetry in your head, picturing forests and beaches and any other mind game you can think of. But thoughts keep interfering and you just lie there. The well-intentioned orders to “sleep well” scrape around your mind. If only sleep was something you could just order yourself to do. But the more you think about it, the harder it becomes.

sleep well_2no light

It’s been hours and you know because you’ve heard the clock chime once, twice. And you’re still waiting. You’re getting frustrated. You’re fed up with wasting time, of being tired. You’re so aware of yourself lying here, of the morning drawing nearer when you haven’t said goodbye to yesterday yet. Sleep has never seemed further away.


The melatonin tablets are your last option. They don’t always work and you know they’re not good for you but sometimes you’re just desperate. And with a glug and a sigh you begin to sink into black blankets. As if erased, your mind ceases to think. It’s like you don’t even exist any more. And you disappear into sleep. A cheat.

melatonin 3mg

And tomorrow you have to do it all again. Stay awake for a day and sleep for a night. Who would have thought something so natural as the sun rising and setting would become so complicated? In a world that never switches off, we’re becoming powered by pills.

half a cup of coffee, half a cup of camomile


© SOPHIE BUCK. Sophie Buck is a third year Psychological and Behavioural Sciences student at the University of Cambridge who enjoys making collages and other art in her free time. She feels that sleep – and the lack of it – is becoming a global issue in a world that just won’t turn off.