Even if your voice shakes

In the last month or so we have seen more references to the abuse of power than has perhaps ever been seen before in my lifetime. The #metoo response to the Harvey Weinstein revelations has shown the extent of sexual harassment and abuse in our modern society. If you have read any of these posts you will,like me, have likely been deeply affected. Alongside that the shocking statistic that in just one day in the UK this year 95 women and 90 children were turned away from refuge. This is an endemic problem which we aren't dealing with.
I have found myself disturbed and upset and yet honestly I was not surprised. I too had experience something aged 18 and never reported it. At the time I saw it as a sleazy move that I managed to escape from. I learned from then how to avoid a similar situation with that individual. I didn’t recognise it as an abuse of power at the time but it was. I didn’t realise either that I was unlikely to be the only one, I just wondered what I had done to invite it. I told no one, I accepted it as a norm and adapted. My self confidence was dented and my voice was repressed and I was a bit more cautious. 
It was a similar feeling that I had had when I went to an older male GP when I was in my early teens. I had a rotten cough that wouldn’t go after a viral flu type illness. I felt really unwell and my parents had encouraged me to see the GP as I wasn’t improving. I went on my own and when I told my story he shouted at me and said I had to have patience to get better and told me not to waste his time. I was appalled, scared and left with an overwhelming sense of shame. I internalised that as well as my fault and it gave me a fear of doctors for many years. Again I did not see it as an abuse of power, I felt I had done something wrong. Again I told no one. When I was diagnosed with asthma, 20 years later I did think of that day. Not only a bully but a clinician who failed to diagnose me properly. The abuse of power comes in many forms.
Years later when I was being followed up after having treatment for breast cancer, I challenged the local system which required you to strip to the waist and wait till the doctor came around the screen to do the consultation. It was never the same doctor. I have rarely felt so exposed and vulnerable. So I said can I keep my clothes on as I want to ask a question and don’t feel comfortable doing that half dressed. The nursing assistant left the room in a flourish. The next time the door opened it was the consultant. I hadn’t seen a consultant since my treatment years earlier. "What is it you want" she said to me and I flinched and momentarily forgot. But I was a bit older then and drew up my courage, channeled my anger and asked my question. I remember actually feeling a bit scared and wondered why I had bothered to have the temerity to challenge the system. All of these happened within a healthcare setting.
 Yes even the first one when I was a student nurse, the man was a charge nurse. Such is the power of hierarchy in these settings. Now I have had many many good interactions and excellent care since then but I am also much more confident, knowledgeable and assertive now.I’m certain that has helped me manage to negotiate a better balance of power in relationship with the professionals I have met since then as well as the fact I can speak their language. 
Over the last almost 20 years I have been in roles where I have supported the voice of those with lived experience to influence the improvement of services within both public services and from a third sector base. This is all about re-balancing power in healthcare. But I still hear people involved in delivering and improving services say it’s so hard involving people, they don’t want "the usual suspects". Its oft repeated that they need to involve hard to reach ( seldom heard or hard to hear is more accurate) groups but don’t know how and so on and so on. It’s such a familiar refrain. But is it really hard or is it just too much of a threat to the power base of the current system? Knowledge of how to involve people will not be enough to change culture, for the culture to change in any situation where the power is imbalanced, there needs to be a shared will to do this.
Are we there yet? I’m not sure but this is a time of change and disruption and we need to take the opportunity to challenge the abuse of power wherever it exists and the culture that perpetuates it. I know from my own experience that it will be hard but not to give in. That’s what Ive learned eventually, don’t give in.....


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