Call For Submissions: “Cervical Screening – 30 Years of Pap Rape”

IMG_0172This forum is dedicated to a book project led by Linda, an informed woman, an activist, and a contributor to this site. In the UK it will be 30 years since the programme of smear testing began. Women (and men) who want to submit an article for inclusion in this book are invited to post them in the comments section of this forum.

Articles can be on any topic related to cervical screening. The submission date is set for May 31st. Please provide a full name (it can be a pseudonym), a title, and a bibliography (if possible). If you have questions please address them to Linda, and ask them in the comments section on any other post on this site, in order to reserve space here for submissions.

About forwomenseyesonly

Hi. My name is Sue and I am interested in promoting holistic and respectful health care.
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4 Responses to Call For Submissions: “Cervical Screening – 30 Years of Pap Rape”

  1. linda says:

    Introduction

    Cervical Cancer has always been relatively rare in relation to other diseases women can fall victim to; with a less then 1% chance of a woman getting it in her lifetime. Historically, the problem was, even though the risk was tiny, no one could work out which women would get the cancer and which would not. Since no cloistered nuns ever presented with any of the known symptoms, many medical men assumed it was a disease generally found in women giving birth to large numbers of babies. Mostly, it was believed to be a disease in women from the lower socio-economic classes since they were looked down upon for their perceived propensity to have ‘large broods.’

    In the 1920’s American Zoologist Georgios Papanikolaou found a way to check cervical cells to show if abnormalities were present which could indicate cancer was forming. The procedure required a woman to adopt a recumbent position while a wooden spatula was pushed inside her vagina to collect cells from her cervix. The ‘Smear Test’ as the procedure came to be known, was deemed by his peers to be highly inaccurate and unreliable. Results often showed cancer to be present when it wasn’t and very worryingly, not present, when it actually was.

    As bad as the test was, it was seen as being better than nothing at all. With fears abounding in the late 60’s that women were becoming morally lax and having sex with different men all the time; with better living conditions and higher life expectancy, the increasing rates of girls surviving into womanhood and going on to have children of their own; the growing population of immigrant females coming in from the West Indies where the disease was prevalent, (1,2) it was feared by successive governments of the time that expensive treatments for an epidemic of cervical cancer would be a huge financial burden on the NHS budget. To combat this problem, vested interests began colluding to get all women to take Smear Tests. Since Cervical Cancer was known to be a slow developing disease and also as everything in Britain is run on the cheap, it was decided intervals of three years between tests were sufficient enough so as not to miss chances of spotting signs of the disease early while keeping expenditure on the programme as low as possible.

    Due to the fact it’s a highly invasive vaginal procedure; most women were, and still are, extremely reluctant to take the test – and to keep on taking it an average 14 times during their entire adult lives. But by 1988 when the British Cervical Screening Programme was fully rolled out across all of the UK, the NHS began boasting 80+ % of the eligible female population were only too ready to have their vagina prised open for this invasive and regular medical inspection. Knowing the normally reserved demeanour of British women, to reach those fantastic numbers, many now believe some skulduggery must have been at work. With targets to reach, bonuses to be pocketed, jobs to be protected, craftily constructed ‘invitations’ posted out from screening authorities – along with the pressure piled on by GP’s, as well as misinformation, lies, coercion and intimidation – the idea this genital exam is mandatory and women have no choice but to periodically submit to, has been allowed to pervade societal norms and narratives.

    Instead of the Cervical Screening Programme being offered to women as an
    optional cancer screening aid they could choose to have or decline as they see fit, the NHS have run it more as an operation of organised mass rape.

  2. katrehman says:

    Throughout history, men and women have been assigned very different roles. Women have consistently had to struggle to “keep up ” and obtain the most basic of rights that today we take for granted.. The right to initiate divorce, to own property in our own right, to vote, to work outside the home, to join the military, and to serve in war zones. Some struggles, even today are ongoing, such as receiving the same pay as men. Womens roles have long been seen as to be subservient to men.until recently, in her marriage vows,a woman promised to”love honour and OBEY” her husband.
    Another struggle we face today might not be immediately obvious, but it’s in our “health care “. I’m sure we’ve all been to see our doctors and had more time devoted to the subject of our smear test, or pap smear, then we have to the issue we presented with in the first place. I think the system we have today has its roots in the past too, as does the hated speculum that’s used to take the smear test. I’d like to take you on a journey with me, come walk back through the sands of time with me…?

  3. linda says:

    The Role of Practice Nurses

    Prior to the introduction of the NHS’s Cervical Screening Programme in 1988, most GP surgeries didn’t usually employ practice nurses. If they did, they were mostly found seeing to verrucas, nits, boils and trimming the toe nails of elderly people. When it was decided these nurses were best placed to become the ‘front line troops’ in their new programme, the NHS approached the Royal College of Nursing to see if taking smear tests would be something they would be willing to undertake as part of their remit. (1)

    Nurses, seeing this chance to get away from the mundane tasks they were normally relegated to; a chance to shine at last and have near equal standing with GP’s, seized the offer of this new ‘medical’ role. In 1985 the college set about recruiting and training new nurses in cervical cytology testing ready for the programme’s commencement in just three years time.

    Seeing the old style metal speculums that were to be used on women, many nurses felt disbelief they would fit into the vaginal cavity of women, when A – they weren’t sexually aroused, and B – when they were not in labour. Even as late as the eighties the devices were still being based on a one hundred year old design not that much updated from Marion Simms’s original specification. Another problem that became apparent during training was that nurses were unused to not only visualising the cervix to check for abnormalities but they also had difficulty in swabbing the organ for the cells they were expected to collect. (2)

    By the time the first women were being called for screening in 1989 the situation existed that some nurses were more proficient at taking samples than others, while many women were being subjected to the nuisance of having to resubmit to extra smears being taken. On top of that, new to nursing and nervous of their new role, cack-handed nurses often took cells too vigorously resulting in a large number of women left sore and bleeding after the procedure. So many in fact that the line ‘women can expect some spotting or bleeding’ was quickly woven into the language surrounding the intimate test in order prevent come backs from angry women. (3)

    In the past thirty years, however, no single group within the NHS embraced the concept of cervical screening more zealously than these practice nurses. No group has become more focused, more driven, more fanatical; to the point getting women to ‘their’ smear tests seems less like a professional career choice and more of a religious calling.

    In 1991 Anne Mathews was told during an appointment for something unrelated, ‘she would need to have a smear now to save her having to come back for one later.’
    When she replied she wasn’t having one, she felt as though the nurse began threatening her. The implication was that all women had to have them. If they didn’t, they wouldn’t be able to be patients with the NHS.

    *

    In the summer of 1992 Cath Yates booked an appointment after she got a red inked reminder several weeks after binning the original ‘invitation.’

    After getting the second letter she thought it must be something she couldn’t get out of. After all, no one ever gets sent reminders for things unless it’s the electricity or gas people trying to get their money. When she attended the appointment the nurse told her she was a ‘naughty’ girl for trying to get out of it. The implication was that there was no getting out of it.

    When Cath asked what the test was for, the nurse replied it was ‘to keep her shiny.’
    But when she asked what if they found something wrong with her the nurse replied ‘That they’d have to look into it further.’

    *

    In 1993, Jayne Blackwell attended her first smear. Having read the leaflet accompanying the ‘invitation’ she wanted to ask the nurse more about what it was for. She had very little knowledge of cervical cancer and in fact before she had started taking the pill she had never heard of the disease.
    ‘What’s it for?’ She remembers asking.
    ‘To make sure you’re fit and well,’ came the reply.
    This answer wasn’t satisfactory for Jayne’s inquisitive nature.
    ‘Yes. But what exactly is it you are looking for?’
    ‘We are looking at cells to see if they’re healthy.’
    ‘Is the test accurate?’
    ‘Oh, yes it’s completely accurate. We wouldn’t use it if it wasn’t.’
    ‘Do I have to have the smear test?’
    ‘Oh yes. All women have to have it. It’s just one of those things.’

    *

    Kate Watling was also told in 1993, that the NHS had made it so that all women had to have one.

    *

    In each case the nurse failed to give clear information regarding cervical screening. Knowledge of the existence of false positives and false negatives was being withheld. There is no discussion of the low specifity of the test and results were very much dependent on the slide reader’s ability in detecting abnormalities. No mention is made of the fact that women often need to submit to further testing; that this ‘simple’ ‘quick’ procedure carried the risk it could lead to further more complicated and invasive investigations.

    Even in the eighties Practice Nurses were informed about the risk factors for cervical cancer. That having sexual relations from a young age, multiple partners who also came with sexual histories, a previous sexually transmitted disease, and even smoking were relevant factors.

    Not one nurse mentioned it was the woman’s choice.

    Intimating smear tests were mandatory wasn’t the only criminal activities undertaken by practice nurses during the early years of the programme. Home visits, with the intention of intimidating women daring to not be ‘complying’ with the programme became the norm.

    In the mid 1990’s, practice nurses began scanning the list generated by the NHS’s highly secret ‘Open Exeter’ programme and noting down names and address of women thought to be ‘overdue’ ‘evading’ or ‘dodging’ the test and started tracking them down to their homes. Turning up at her unexpectedly at the door would give the ‘defaulter’ little means of escape, thereby guaranteeing capitulation. No doubt this shock tactic had the added effect of sending other women hearing of these ‘visits’ running to their GP’s to avoid the embarrassment of having the practice nurse seemingly dragging them in for ‘their’ missed ‘invitation.’ It was very much a policy of ‘We know where you live and we will come and get you.’ Since no one from the higher echelons within the NHS is recorded as having criticized this method of ‘capturing’ ‘defaulters’ it can only be assumed this policy was considered to be an acceptable manner to treat women.

    According to one Manchester resident, Judith Clough, the local practice nurse paid her an unexpected visit one afternoon in May 1995.

    Having just returned from collecting her three boys from the nearby junior school, she was in the middle of preparing something to eat for their hungry tummy’s, when there came a loud rapping of knuckles on the front door. She was surprised to find the nurse standing there as she had only seen her the day before during a check-up for one of her son’s ears and assumed it was something about that.

    The practice nurse asked if she could come in for a moment as they needed to discuss a private and important matter. Concerned, Judith allowed the women in and directed her into the kitchen. Apparently the young mother had ignored her latest smear test ‘invitation’ as well as the subsequent ‘reminder’ which had duly followed.

    Her GP, having not seen Judith in a while was beginning to be worried about her health. The nurse then began describing in graphic detail how cervical cancer develops – often without the women even realising she has the disease. She went on to relate how the tumour slowly grows until it envelops all the internal organs, giving a drawn out account of a long period of agonising illness in which nothing could be done to ease suffering. Concluding her spiel with a description of someone succumbing to an excruciatingly slow death.

    After reiterating the importance of having a smear test to check the health of her cervix, the nurse went on to tell Judith a time slot had been put aside for her to undergo the exam the following Monday morning.

    What Judith had been keeping from her was that some years ago she was a rape victim. Having had her first smear test around the age of twenty five the mum of three had decided to forgo anymore.

    During the intimate exam she had found herself reliving the ordeal in all its detail.
    The traumatic experience had soured the relationship with her current partner for months. In fact it had taken her a long time to get over it. Almost the same length of time it had taken her to get over the original assault.

    However, somewhat intimidated by the unexpected visit at the so called be-hest of her doctor, Judith was scared to the point she felt she had no option but to do as requested.

    The psychological damage of being forced into having an unwanted and forced genital examination upset her so much she cried for weeks.

    The practice nurse in the meantime will have counted this forced capitulation as a success. Nowhere on the form to confirm ‘consent’ is the added bit of space to record the fact – Judith hadn’t in fact come willingly but had needed her arm twisting into compliance.

    It will have appeared as a successful outcome of a home visit. To the nurse, it was a box to be ticked for another cervix counted done. A pat on the head from the GP and her NHS puppet masters.

    *

    On a snow laden morning of Christmas Eve 1996, Lynne Farrington a resident of Newcastle-upon-Tyne was surprised to find her local practice nurse coming up the drive as she reached to pick up her milk delivery off the door step. The nurse was red faced and breathless as she raced up the path with determined urgency.

    ‘I’m glad I caught you,’ she announced. ‘I’ve come about something vitally important.’

    Lynne let her in, panicking something was wrong. A few months ago her daughter was diagnosed with diabetes and naturally assumed it was something about that.

    She herself hadn’t been to the doctor in years. Keeping reasonably fit with all her dance classes and her two boisterous grandchildren.

    It came as a shock when the nurse began explaining she was extremely worried about her health. It transpired that due to a serious administration error at the surgery her details had been omitted from the list of important health check every woman ‘needed’ to have.

    As she had never had a smear test, there was a chance a cancer growing inside her was being missed. Lynne answered there was no history of cancer in her family, never had been, she didn’t think there was at risk.

    The nurse proceeded to go into detail about a disease which could be transmitted to a woman once she started having sex.

    Lynne scoffed at the idea, telling the woman that she had never slept with anyone but her husband and she doubted he’d ever passed anything on to her. The nurse started
    pressing Lynne needed to have a smear test as soon as possible. How would she feel if in another year she became unwell and after a series of tests she was told it was terminal and there was nothing they could do? How angry would she be knowing she could have had a test before the cancer had even developed? What about her daughter how would she cope without her mother to help her look after two very active boys both under the age of five?

    Lynne found she couldn’t answer; didn’t have a comeback for the pushy nurse. She had gone from bringing in the milk for her corn flakes to dying an early death and leaving her husband, daughter and grandkids to cope without her all in the space of about five minutes.

    What fantastic Christmas cheer the woman brought Lynne that year. But the nurse got a better Christmas present as a result. Another cervix counted. Another box ticked.

    *

    By the end of the 1990’s home visits fell out of favour. While they drove many reluctant women into screening, nurses often found themselves on the doorsteps of some very angry women. Instead they began making a nuisance of themselves in other ways.

    Gayle Chambers was surprised one evening while preparing her meal. Out of the blue she was rung to see why she wasn’t ‘complying’ with her screening ‘invitations.’
    She told the woman she no longer wanted any further tests. In the past few years she felt that smear tests had been forced on her. One while she was recovering from having her first child. It had been painful and humiliating because of the circumstances they were performed in. Having evaluated her own personal circumstances she felt that screening for cervical cancer wasn’t a priority for her.

    For some inexplicable reason she found herself relaying details of her private life to this stranger on the other end of the line. His questions were intrusive and before she knew it she was also giving details of not only her own but that of her husbands sexual history.

    It was only when her husband came into the room by chance and began quizzing why was she giving such private details about their sex lives did she stop and wonder how she had been drawn this unwarranted discussion. She put the phone down, cutting the woman off.

    *

    Wendy Smith, a patient of H—— Health Centre, St Helens was rung to find out why she was ‘ignoring’ her smear test invitations. The conversation apparently went along the these lines –

    ‘Its come to our attention you’ve been ignoring your smear test ‘Invitations.’
    ‘No I haven’t.’
    ‘Our. records show your last one was eight years ago.’
    ‘Yes. That’s right.’
    ‘Its recommended you have them every three years. Can you tell me why you think you no longer require them?’
    ‘Well. I thought I didn’t need them anymore.’
    ‘It’s up to us to decide when you finish having them.’
    ‘Oh. I didn’t know that. I’ve just been throwing the invites in the bin.’
    You’ve been throwing your Smear Test ‘Invitations’ away????’
    ‘Yes. I always throw them away.’
    ‘You throw them away??? Why would you throw them away??? It’s an important life saving test!!!’
    ‘You told me to.’
    Pause. ‘I did???’
    ‘Yes. After my Hysterectomy you said I would probably keep on getting the invites but that I should just throw them away.’
    The line went dead.

    *

    In 2003, after a decade of sensational stories reaching newspaper headlines highlighting nurses found guilty of anything from fraud, theft, sexual assault, to pensioner killings to child murders, the long standing nurse’s council the UKCC (United Kingdom Central Council) was disbanded. It was felt by the then Labour government the organisation was not fit for purpose. Since its inception the Council focused solely on the training and protection of nurses and had failed to introduce measures to protect patients and wider society.

    It was seen that the profession of nursing had fallen into such bad repute in the eyes of the British public a clean sweep was needed to raise the profile of nursing in the public conscience. In the following Spring of 2004 the new Nursing and Midwifery Council was launched. Tasked with cleaning up the profession, its first undertaking was to implement a set of ‘Standards’ every one working in the profession was expected to adhere to. (4)

    This new ‘Code of Standards’ printed in booklet form set out how nurses were to conduct themselves in every area of their work whether dispensing medicine, treating ailments and dealing with patients. (5 )

    The ‘Code’ included instructions on how nurses were go about their everyday tasks as well as how to go about conducting themselves in their private lives.

    1. The people in your care must be able to trust you with their health and wellbeing.
    2. Make the care of people your first concern, treating them as individuals and respecting their dignity.
    3. Work with others to protect and promote the health and wellbeing of those in your care.
    4. Provide a high standard of practice and care at all times.
    5. Be honest and open, act with integrity and uphold the reputation of your profession.

    Broken down, the ‘Code’ impresses the importance of putting the wellbeing of patients first. At all times nurses need to be seen to honest, above reproach, act lawfully and have the utmost respect for the wishes of the people in their care. Most importantly nurses were warned always to gain consent before beginning any treatment, support any decision to accept or decline treatment without prejudice. They must not abuse their privileged position for their own ends. (NMC 2004a)

    According to Kozier (2008) whose book ‘Fundamentals of Nursing’ was once a core book on the reading list of trainee nurses, ‘At all times nurses must abide by the code of ethics laid out by the NMC.’ She argues, having ethics and morals and a clear understanding of right from wrong should be a core value of anyone working in the medical profession. Nurses must allow patients complete autonomy over their own body. This means patients have a right to make their own decisions even if the nurse thinks the choices they are making are not in their best interests. They must accept without question the values, customs, beliefs and wishes of an individual. ((5)

    In Kozier’s opinion, because nurses hold such a unique position within society, they are obligated to be ‘good’ and ‘fair’ and always tell the truth. Giving people sufficient and honest information in which to make a decision. Which must then be left with the individual so as they can decide how to act. They must not speak or act in any manner that could be taken they are exerting influence over patient decisions. This principle forms the fundamental requirement patients must be provided with ‘informed consent’ so the decision to go ahead or refuse treatment can be made before any procedure can be performed.

    She also warns nurses because of increased awareness of the importance of ethical issues in medicine; the NMC Code of Standards must be a framework for all professional actions. Her opinion is that the code of ethics has a higher requirement than just legal standards. To uphold these principles nurses must at all times conduct themselves in a manner beyond reproach and must be continually active in developing and maintaining knowledge, based on accurate research and accurate information. Failure to do this could result in legal action being taken against them. To protect themselves from accusations of criminality it would be wise for all nurses to always be see to be promote human rights, as enshrined in the British Human Rights Act of 1998. (6)

    The British Human Rights Act outlines the basic tenets of the rights and freedoms everyone in the UK is entitled to. The three main effects are – a, Incorporating the rights already established by the European Convention on Human Rights. b, Requires all public bodies to respect and protect human rights. c, Courts will interpret laws in a way compatible with Convention rights. (7)

    Article 8 – Respect for private and family life, home and correspondence, is based on article 2 of the European Convention – The right of any individual to choose who sees and touches their body.

    This important human right was created in the aftermath of the Second World War after the horrors of the holocaust, in which doctors conducting medical experiments on Jewish prisoners was exposed. It is generally taken this right now applies to anyone coming into a medical setting. This is to protect patients from the excess of the medical profession ie. Experimentation; Subjection to unwanted procedures and operations; The right to refuse any treatment considered inappropriate by the individual. (8)

    However, examples of nurses ignoring the Nursing and Midwifery Council’s Code of Standards, ethical consideration, and even adherence to the Convention of Human Rights can be found all over the internet. Thinking themselves safe behind the privacy walls of nursing forums, some feel free to make derogatory comments about women as well as giving each other hints on how best to ‘capture’ them.

    The following are examples of attitudes to women ‘avoiding’ ‘their’ smear tests activists have found on various media platforms. Some are taken from comments in newspapers and one is from a 2014 online edition of Nursing Times

    ‘Treat them like outlaws.’

    ‘Don’t give them (women) anything they can use as an excuse to get out of it.’

    ‘Invite them (women) in for a blood pressure check and while they are there, tell them they are ‘overdue’ for the test, they won’t be able to excuse their way out of it.’

    ‘Our practice makes sure they (women) can’t get away before having one.’

    ‘Be prepared to counter their (women) excuses.’

    ‘Embarrass the hell out of them (women)’

    ‘Try to make them feel silly.’

    ‘We follow up missed appointments aggressively.’

    ‘Grab em and bag em.’ (whatever that means)

    This ‘egging on’ may seem like a great way of sharing ways of getting women to screen, but in accordance with British law they could be interpreted as ‘provoking incitement to rape.’

    If after this reading these comments, a nurse begins applying intense pressure on a woman, then not only is she technically guilty or rape, the writers of these comments are complicit in that woman’s rape.

    Incitement of another individual to commit rape is a crime in the UK. An individual doesn’t even need to be present when the crime has been committed. There just needs to be evidence they actively condoned the attack. The minimum sentence for an individual inciting another to commit rape can lead to a five year custodial sentence. (7)

    The law surrounding rape and attempted rape is more convoluted and complicated than the short forethought at the front of this e-book and in reality it’s extremely doubtful any lawyer would resort to bringing these up if ever a women decided to report an unwanted smear test as a rape. But the ethics and morals of the people placing the comments is still very questionable.

    Despite these tactics, numbers abandoning the Cervical Screening Programme are increasing. There is growing awareness among women of the rarity of Cervical Cancer and the many short falls of the programme. Participation has fallen from 80+% to somewhere around 78%. In some places it is lower that that. In the last three years alone it is estimated around 300 000 ‘defaulter’ and ‘dissenters’ are refusing to undergo ‘their’ smear tests.

    However, Practice Nurses, fearing number will drop below 70%, a point at which the programme will no longer be viable to run, seem intent on clawing back these ‘lawbreakers.’

    As knowledge of the connection between Human Pappiloma Virus (HPV) and Cervical Cancer is becoming more widespread among the public, nurses, have been seemingly confusing the term ‘virus’ with mediaeval mass killer – The Black death.

    The Practice Nurse at G——- Surgery, St Helens, intimated to one woman, adamant she wasn’t having any further tests after a couple of very painful ones, that the virus could be picked up from almost anywhere. A woman going up and down stairs running the palm of her hand along a banister or stair rail could catch it if someone with HPV had recently run their hand along it before them. When my friend scoffed at this tale and got up to leave, the nurse began pressing upon her that it had also been known to be caught from door handles, notes and coins and even from public telephones back in the day before the invention of personal mobile phones.

    *

    There was a similar story from a woman visiting a practice nurse in Broad Green,
    Liverpool. Knowing the woman involved routinely caught buses and trains to and from work, she began telling her that the HPV virus was known to be harboured on the pages of freely distributed national newspaper – The Metro. This is because, she was expected to believe, any number of infected people may have handled the newspaper before them and could have inadvertently impregnated the pages with the virus. No mention was made of any of the other national newspapers. It’s as if the NHS discovered some sinister plot by owners of the Metro newspaper to kill off one half of its readership with Cervical Cancer and was now offering cervical screening to protect against that.

    *
    These flights of fantasy are not isolated to the North of England.

    *
    In Somerset, a nurse implied to a ‘defaulter’ the Human Papilloma Virus was being found on swabs taken from the handles of cups and mugs from Costa Coffee. As if the NHS was wasting time and resources checking used crockery and cutlery in this chain of cafes. If this is the case and the NHS has worked out Costa is responsible for all cases of Cervical Cancer then why isn’t Public Health England warning against frequenting these dangerous establishments? Why aren’t we hearing about the devastating death rate among young people making cups of coffee for a living? No mention of the virus being found in Nero’s or other well known high street coffee chains.

    *
    In Kent, a nurse ‘counselling’ a ‘dissenting’ women lecturing in Health and Social Care in a sixth form college, was told the NHS considers this particular age group – sixteen to nineteen – to be prolific carriers and transmitters of the virus. Touching papers, books, equipment students had handled could easily pass it on to the next women coming into contact with the items.

    *
    In Dorset, a women was told her toddler could pick up HPV from the other children at playgroup. When she was told that scenario was very unlikely, the nurse went on to tell her that because there are several young women looking after the children and all passing it on, it was a breeding ground for the cervical cancer ‘bacteria.’ Apparently, touching children or even handing over toys for them to play with spreads it. The ‘bacteria’ multiplies and ‘breeds’ in the air of these schools kept overly warm for young children.

    *

    The Royal College of Nursing handbook ‘Cervical Screening’ (2011) seems to suggest continued blatant disregard for a woman’s choice to decline smears. After firing nurses up with spurious statistics on how screening has supposedly reduced incidence of the disease, they inculcate the need to keep numbers up, thus ensuring the ‘smooth running of the programme.’

    The College believes women are too ignorant to understand what smears are for. That they may not see the ‘importance’ of screening. Every contact is an opportunity for the nurse to promote understanding. .

    Nurses are advised to keep on badgering ‘them’ with text reminders. Highlight medical records and insert computer prompts to make sure the subject of their non attendance is brought up at every appointment. No opportunity is to be overlooked. They even suggest getting the receptionist to encourage attendance by mentioning it should the woman need to phone the surgery.

    The lightly printed, light blue disclaimer at the foot of the page that it should be ‘born in mind the final decision rests with the individual’ will easily be overlooked a fervent, fired up, pro screener eager to get on to the next page to see what more can be done to ‘catch’ women.

    In 2013 the RCN published ‘Cervical Screening; The RCN Guidance for Good Practice.’

    According to the guide, nurses are obliged to listen to the women’s ‘excuses’ for not screening and to answer any questions she may have about it. This is because, the college believes, women who decide against screening and ignore their ‘invitations’ are simply unsure about ‘the subject’ or are ‘ignorant of issues surrounding screening.’

    Instruction is given that women who are ‘unsure,’ ‘uncertain,’ ‘undecided’ and those who are plainly ‘ignorant’ about screening must have any reluctance overcome with the nurse encouraging them to screen. Stress must be placed at all times on the ‘importance’ of screening. Carrying on the tradition of keeping women ignorant and in the dark, no mention of false positives, false negatives, specifity, further testing and personal choice is to be alluded to. Only that the importance of screening must be stressed.

    A likely scenario between a woman and a practice nurse might go like this –

    ‘I’m unsure about screening.’
    ‘Screening is important …’
    ‘I’m undecided about screening.’
    ‘Screening is important…’
    ‘I’m uncertain about screening.’
    ‘Screening is important…’
    ‘I don’t know anything about screening.’
    ‘Screening is important…’
    ‘Can you tell me what a false positive is please.’
    ‘Its like when you want it to be nice, but it rains…’

    Another scenario might go like this …

    ‘I’m extremely ignorant. Can you tell me what the risk factors are for cervical cancer please?’
    ‘You can get it if you drink in cafes and read old newspapers …’
    ‘I see. I have two small children, should I take them to play group as I’ve heard you can catch it in there?
    ‘The NHS recommends you keep them at home.’
    ‘Right I’ll do that. I teach teenagers am I safe around them?’
    ‘Not really. But you could wear gloves…’
    ‘Would I be safe using the lifts in shops if I want to go up to the floors?’
    ‘Yes. Never use stairs…’
    ‘Well, thank you. You seem to have covered the ‘subject’ in great detail.’
    ‘Screening is important…?

    *
    Conclusion to follow when I can think of something.

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