Illustrations by Kirsten Synge
The Portrait Series: International Women’s Day 2023
JOSEPH returns to its annual Portrait Series in celebration of International Women’s Day 2023. This year’s theme #EmbraceEquity focuses on giving a voice to inspirational women and their lived experiences of gender inequality.
In light of recent events, JOSEPH has chosen to highlight the UK’s National Health Service with three women who dedicate their working lives to helping patients and those in need of the unique care that the NHS provides. Our featured women have been illustrated by artist Kirsten Synge.
Speaking to Dame Cathy Warwick, Mabel Bond and Sarah Adomah we aim to shine a light on the exceptional work these women do and allow them to share their stories, the pressures they face and what we can do to support our National Health Service.
The NHS is under enormous pressure, yet in our lifetime, we will all rely on care and assistance from its staff and services. JOSEPH will be making a donation to NHS Charities Together to help enhance the level of care it is able to provide and support its life changing work.
Illustrations by Kirsten Synge
Dame Cathy Warwick
With decades of experience in the field, Dame Cathy is a trained Midwife while also holding leadership positions as Chair of the British Pregnancy Advisory Service and Non-Executive Director at the Kingston Hospital NHS Trust. She was appointed a CBE for services to healthcare in 2006 before receiving a DBE in 2018.
The theme for this year’s IWD is #EmbraceEquity. Why do you feel that this year it's important to highlight the difference between equity and equality?
Equity is about ensuring that everyone starts from the same point. Equality doesn't really include that business of lifting people up so that they then have an equal chance. Just the other week a maternity support worker was telling me that she wanted to go to university to study Midwifery, because she loves it and her job so much. But she is a single parent, paying for all three children’s care and cannot afford to go. What we need to do is develop things like apprenticeships, that offer someone who cannot afford to study the opportunity to get into the profession in the same way as someone who had the money. Equity enables equality.
What first inspired you to explore midwifery?
My father was a doctor which naturally led me to pursue a degree in nursing at Edinburgh University. But when I first decided to explore the world of midwifery, I actually felt like an outsider with my degree – it wasn’t particularly common to have one in this field, with most nurses choosing to train specifically as that. So, I decided to undertake an additional one-year course in Midwifery to match my peers and become more specialist.
Equity is about ensuring that everyone starts from the same point. Equality doesn't really include lifting people up so that they then have an equal chance. Equity enables equality.“
What is the most rewarding part of your role and working for the NHS?
For any midwife, the best part is getting to know a woman and giving her continuity of care, from antenatal through birth to postnatal care at home. If you can be the midwife who stays with a woman throughout her journey, that can become a very close relationship, and it's incredibly rewarding - some of my best friends now are women whose births I attended! I've been trying to promote that kind of service for women throughout my career, however, unfortunately, right now, it's extremely difficult as we don't have enough midwives to provide such a ‘luxury’.
How has gender imbalance impacted you in your role?
When I was a younger midwife, at St Mary’s Paddington, the most senior obstetricians were men. My team and I were trying to abolish the requirement to shave women as part of the birthing process, as it was very uncomfortable and had no scientific impact. They were fine – all but for one obstetrician who came back and said, “Over my dead body, I want all my women shaved!” My friend wrote him a letter telling him, “If you want your women to be shaved, you'll have to come and do it yourself!” – he never did! I had to manage this power balance all the time – some males in senior roles had a sense of authority that I found quite problematic.
How do you try to overcome this?
Back then, we did a lot of imagining them in their pyjamas! It helped adjust our mindset. But over the years, when campaigning to these senior men for change, I made my arguments more centred around the women and the impact on service, rather than about myself. I'm lucky nowadays because I've managed to hold some quite senior positions myself and am known in the world of maternity services so don’t encounter this pushback.
What are the challenges you face currently that you would want readers to know?
Without a doubt, it is not having enough people - midwives, support workers and, indeed, obstetricians. Maternity care is very much a team delivered service. But if there’s 10 women in labour and only 5 midwives on ward, it’s hard to provide the quality of care we are expected to give. But this shortage isn’t because of a lack of interest - one of the big problems is that midwifery courses used to be supported by bursaries but that was removed some years ago. It can be incredibly expensive for people to train as a midwife, particularly if they've already done a degree and accumulated debt. They struggle financially and then, when midwives qualify, they do need support which sometimes we're failing to provide. It’s a vicious circle. Now that pay is also so below inflation, it is becoming an issue like never before.
What is a common misconception about your role?
That all midwives are nurses; a midwife is a specifically trained person that can look after women and babies without a doctor being involved. So long as everything's normal with the pregnancy, a woman might go right through the pregnancy, birth and postnatal period and never see a doctor. And, also, that there are male midwives! There are very, very few, but from my experience they have been just lovely – it’s wonderful to see men who choose to go into more nurturing, caring professions.
Which women have most inspired you in life or work?
I've always been inspired by the various wonderful women I've met as I've gone through my own training as a midwife. The midwife who oversaw the labour ward when I was training, for example, was just fantastically supportive. In my personal life, my biggest inspirations are my two friends that I go out climbing mountains with. There's three of us that have now climbed all the Scottish mountains, the Munro's, and that's quite a feat – there’s 283 of them!
Illustrations by Kirsten Synge
Mabel Bond
Mabel studied at the University of Greenwich and undertook multiple diverse placements before honing her specialism as a Staff Nurse in Accident & Emergency. Mabel works under intense pressure and pace to deliver immediate and often life-saving care to those patients most in need.
The theme for this year’s IWD is #EmbraceEquity. Why do you feel that this year it's important to highlight the difference between equity and equality?
Equity wasn’t a word I was familiar with in this context – we have a lot of training on equality and diversity, but equity makes sense, doesn’t it? An example would be if a patient has a learning disability and you give them a form and say fill this in, they’re going to need extra assistance to fulfil this requirement. Alternatively, if a patient wasn’t fluent in English, we would use a language service so that we can offer the same service to them as everyone else. Equity is being adaptive to needs, based on what they require to be equal, and the same applies for gender.
What first inspired you to explore A&E nursing?
I began work at the Trust because they offered a rotation which was perfect for someone unsure about which area to pursue. I did six months on a surgical ward then six months at the height of the pandemic in infectious diseases. I was then lucky enough to get my top choice of Accident & Emergency – programmes like ‘24 Hours In A&E’ have made this very popular due to the fast pace and drama! Six months wasn’t enough as there was so much to learn, so here I am two and half years later still learning. It’s an area where they invest resources into developing your knowledge.
What is the most rewarding part of your role and working for the NHS?
When people come into Accident & Emergency, they’re at their worst. They're vulnerable, they're in a lot of pain. They might be going through a severe mental health crisis. So, I think it's nice if you get to see a positive outcome. We recently had someone arrive showing convincing symptoms of a heart attack and we did everything that we initially needed to do, but there were delays getting him to the lab and he went into a cardiac arrest. The team came together, we started resuscitating him, and he came back. Seeing that he got the outcome we wanted and that we were then able to follow up his progress afterwards is a satisfying feeling.
When people come into A&E, they’re at their worst and most vulnerable. Seeing those people get the outcome we want and follow up on their progress afterwards is a satisfying feeling.“
How has gender imbalance impacted you in your role?
There tends to be a stereotype that men are doctors and women are nurses (so perhaps male nurses face an imbalance here too!) but it can sometimes feel as if we’re not as respected as doctors. I can recall one scenario where a patient was not very happy, and the nurse was trying to defuse the situation and calm things down. But it wasn’t until a male doctor came along and confirmed the same thing that they believed it. Patients can also speak in a way that is sexually inappropriate, which you question would be said if they were speaking to a man.
How do you try to overcome this?
Where I work there is more female doctors than male, so this helps! In terms of inappropriate gender- based language, our department will not tolerate anything that makes you feel uncomfortable or unable to perform your job in the way that you would hope to. That's quite reassuring as the overall attitude empowers you to have confidence in a situation. We can issue verbal warnings, file incident reports, and have a security team to assist if we need.
What are the challenges you face currently that you would want readers to know?
Everything you hear in the media, especially now with the strikes regarding staff shortages, burnout, low pay – it’s very real. I recently had to take a week off on holiday, because of long working weeks, it’s important to do so. A lot of people will pick up extra shifts for extra pay, even when they've got time off, and drive themselves into the ground which isn’t good for them or patients.
What is a common misconception about your role?
That, as professionals, we’re not also vulnerable. The amount of violence and aggression we get is shocking! Sometimes it's drug or alcohol induced, sometimes it's mental health related. Other times it's just people not being very nice. I don't think there's anyone in my specific department that hasn't been verbally, physically, or sexually abused – it’s a horrific thing to think about as we're there to help people and save lives, yet we're receiving a lot of abuse for doing that. I think that's something that maybe the public aren't aware of.
Which women have most inspired you in life or work?
There have been many professional women who have influenced me during my training. But personally, the first person that sprung to mind was my nan, Diana. She’s fiercely independent. She’s remained single for over 40 years, likes to do things for herself and she's not afraid to say it as it is! Next time someone is rude to me on the job I’ll think ‘What would Nanny Diana do?’ She’d poke them with her stick and tell them straight!
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Illustrations by Kirsten Synge
Sarah Adomah
Sarah is a Lead Breast Clinical Nurse Specialist at The Royal Marsden NHS Foundation Trust, a world leader in cancer care, treatment, and research. Sarah also led the charge in developing the first breast prosthesis in the UK to offer a variety of skin tones, designed to accommodate mastectomy patients from diverse ethnic backgrounds.
The theme for this year’s IWD is #EmbraceEquity. Why do you feel that this year it's important to highlight the difference between equity and equality?
I think the problem is that over the course of time we have confused these words which doesn't help. Equality is about fairness, but this assumes we all have the same needs and same solutions. Equity is more about recognising that each one of us has different circumstances and allocating the resources to help that person achieve their goals. In health, that is especially important as everyone should be able to access the same services. With breast cancer, for example, some women may have to go through a mastectomy, when we remove the whole of the breast. We would give these women a ‘softie’, which is a soft breast shape material to wear in their bra, to give an illusion that they are symmetrical. But for as long as I have been an oncology nurse, we have had two colours that we give to women – beige or pink - which is completely inappropriate for somebody like myself. So, I sat down with my colleague, Natalie Johnson, who is a breast plastic surgeon, and worked on a solution. With the help of the Royal Marsden Cancer Charity, we created the first ever skin tone-based prosthesis for women of colour to meet everybody’s needs.
What first inspired you to get into oncology?
Growing up, I just had this innate passion to help people. My path towards cancer was initially a fascination in terms of seeing how body cells become abnormal and a curiosity to find out more. Growing up in Ghana, cancer was unmentionable, and my knowledge of it had been skewed by myths and misconceptions. It became something that I wanted to educate others about, make a difference, and change the conversation within black ethnic communities.
What is the most rewarding part of your role and working for the NHS?
I am a key worker for anyone who is being diagnosed with breast cancer. Once they walk through the door with a diagnosis, we are there to explain the treatment pathway, help them process it and make informed decisions. We're there to support that person throughout the whole journey and beyond. The most rewarding part of my job is the relationship you develop with people. It is a privilege to be trusted with intimate information they sometimes wouldn’t tell anyone else. To paraphrase Maya Angelou, ‘people will forget what you said, people forget what you did. But people will never forget how you made them feel.’ And that is so important.
You have to tell yourself ‘I deserve to have a seat at the table.’ I do my best to be a role model to women in the workplace, sharing information and networking to bring them with me, and not leave them behind.“
How has gender imbalance impacted you in your role?
As a black woman, my skin colour has undoubtedly impacted the imbalance I’ve experienced. You witness racism and bias in your everyday life, and I'm not going to try and brush it aside and say it doesn't happen, because it does. There have been times where I've been to meetings where I'm the only black woman in the room, and people look at you almost like you shouldn't be there. They look at you as if to say ‘why are you here? Are you the cleaner?’
How do you try to overcome this?
You have to somehow tell yourself (and find that support around you to say), ‘I deserve to have a seat at the table.’ I feel like I have a big mouth and according to my colleague I don’t mince my words, but you may have to develop those skills. If the situation presents itself, I will call it out. I also do my best to nurture others and be a role model to women in the workplace, to help them achieve the next step ahead of them. Sharing information and networking to bring them with you, and not leave them behind.
What are the challenges you face currently that you would want readers to know?
We are in a very dire state where access to necessary resources is not available. When you go to work, you want to give your best and have a conversation with a patient without feeling pressured about the time or how many people are in the waiting room waiting to be seen. And we don't have that. I feel very heavy hearted. We need more breast care nurses, we need more doctors, we need to provide patients with counselling as soon as they need it. Pay isn’t the only reason we have staff shortages – there is a lot of burn out, compassion fatigue and for some people, it’s the frustration that they don’t feel heard, listened to or able to meet expectations.
What is a common misconception about your role?
We often make a joke in our office, that Clinical Nurse Specialists are everybody's dogsbody! Because we do a bit of everything for everyone from admin to social work to counselling. It's often seen as that we’re a jack of all trades and master of none, even though we are specialists in our field. We’re happy to help though, of course!
Which women have most inspired you in life or work?
There are so many! I think I alluded to one of them before, Maya Angelou, but there is also a writer called Tererai Trent who wrote a book called The Girl Who Buried Her Dreams In A Can. It is a true story of a girl who always wanted education but at the time was living in Rhodesia, where girls were not allowed to go to school. For work, the wonderful Leanne Pero, who was interviewed in 2021, and is an absolutely amazing, amazing, amazing human being. Her strength, dedication and drive to help others and make a change is just great, and we’ve been lucky to collaborate within our community. In my career, I've had a personal tutor, Jacquie Woodcock, and from the moment I met her she has formed a huge part of my career, offering advice, support, and guidance. And, finally, my family. A lot of women in my family have been nurses and they motivated me to do whatever I wanted and achieve my goals.
About the illustrator: Kirsten Synge
Originally from Norfolk in England, Kirsten completed a first-class BA Hons Degree from Central St Martins in Fashion Design Womenswear with Print. Her career spans over 20 years, working for luxury fashion brands such as Moschino, Pucci and Temperley, where she specialised in print and embroidery design. Today Kirsten works as a freelance design consultant for luxury brands including Hermes, La Double J and Louis Vuitton, alongside starting her own label soon.
In 2020 Kirsten was diagnosed with bowel cancer. As a cancer survivor she is passionate about quietly raising awareness of bowel cancer and has experienced first-hand the importance and positive impact of health care workers.
Finding out at the start of a pandemic while you are alone in a hospital that you have cancer is utterly terrifying. No one was allowed into the hospital with me to hold my hand, but having a female surgeon, a female oncologist and a team of female nurses following me the whole way to get me through it all was incredible on many levels. I am grateful beyond words to all the health workers, but above all, the team of skilled women that saved my life. I painted the three portraits to show the health workers not in busy corridors, behind a curtained bed, or an overcrowded hospital, but outside in gardens and under the blue sky full of flowers and bees… it’s where your mind wonders in your most desperate hospital moments. I do hope they like the gardens i put them in! ”
Explore her work here: kirstensyngestudio
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