Latest news with #obstetrics
Al Jazeera
08-08-2025
- Health
- Al Jazeera
In my Gaza maternity ward, life and death coexist, but so does hope
It is 2am in the obstetrics and gynaecology emergency department of Assahaba Medical Complex in Gaza City. Through the open windows, I can hear the never-ending hum of drones in the sky above, but aside from that, it is quiet. A breeze flows through the empty hall, granting relief from the heat, and a soft blue glow emanates from the few lights that are on. I am six months into a yearlong internship and 12 hours into a 16-hour shift. I am so tired that I could fall asleep here at the admissions desk, but in the calm, a rare sense of peace envelopes me. It is soon shattered by a woman crying in pain. She is bleeding and gripped by cramps. We examine her and tell her that she has lost her unborn baby – the child she has dreamed of meeting. The woman was newly married, but just a month after her wedding, her husband was killed in an air raid. The child she was carrying – a 10-week-old embryo – was their first and will be their last. Her face is pale, as though her blood has frozen with the shock. There is anguish, denial, and screams. Her screams draw the attention of others, who gather around her as she falls to the ground. We revive her, only to return her to her suffering. But now she is silent – there are no cries, no expression. Having lost her husband, she now endures the pain of losing what she hoped would be a living memory of him. Life insists on arriving It is my sixth night shift in obstetrics and gynaecology. I am supposed to rotate through other departments – spending two months in each – but I have already decided to become a gynaecologist during this rotation. Being in this ward brings joy to my life – it is where life begins, and it teaches me that hope is present regardless of the terrible things we are enduring. Giving birth in a war zone – amid bombing, hunger, and fear – means life and death coexist. Sometimes, I still struggle to understand how life insists on arriving in this place surrounded by death. It amazes me that mothers continue to bring children into a world in which survival feels uncertain. If the bombings don't take us, hunger might. But what surprises me most is the resilience and patience of my people. They believe their children will live on to carry an important message: That no matter how many you have killed, Gaza responds by refusing to be erased. Childbirth is far from easy. It is physically and emotionally exhausting, and mothers in Gaza endure excruciating pain without access to basic pain relief. Since March, the hospital has seen a severe shortage of basic supplies, including pain relief medication and anaesthetics. When they cry out as I stitch their tear wounds without anaesthesia, I feel helpless, but I try to distract them by telling them how beautiful their babies are and reassuring them that they have gotten through the hardest part. With constant hunger here, many pregnant women are fatigued and do not gain enough weight during pregnancy. When the time comes to deliver, they are exhausted even before they begin to push. As a result, their labour can be prolonged, which means more pain for the mother. If a baby's heartbeat slows, she might need an emergency Cesarean section. Practicing medicine here is far from ideal. Hospitals are overwhelmed, and resources are severely limited. We're constantly battling shortages of medical supplies. On every night shift, I work with one gynaecologist, three nurses and three midwives. I usually deal with the easier tasks, such as assessing conditions, suturing small tear wounds, and assisting with normal deliveries. A gynaecologist takes the more complicated cases, and a surgeon performs the elective and emergency Caesarean sections. The surgeon always reminds us to minimise the consumption of gauze and sutures as much as possible, and to save them for the next patient who may arrive in desperate need. I try to discard and replace gauze only after it is completely saturated with blood. Power outages make things even more difficult. The electricity cuts out several times a day, plunging the delivery room into darkness. In those moments, we have no choice but to switch on our phone flashlights to guide our hands. During a recent shift, the electricity went out for nearly 10 minutes after a baby was born. The mother's placenta hadn't been delivered yet, so we used our phone lights to help her. Many of the best medical professionals in Gaza have been killed, like Dr Basel Mahdi and his brother, Dr Raed Mahdi, both gynaecologists. They were killed while on duty at Mahdi Maternity Hospital in November 2023. Countless others have fled Gaza. Most of the time, the doctors around me are too overworked to offer guidance or teach me the practical skills I had hoped to learn, though they try their best. Still, some moments pierce through the exhaustion and remind me why I chose this path in the first place. These encounters stay with me longer than any lecture or textbook could. At dawn, a new baby During one shift, a pregnant woman came in for a routine check-up, accompanied by her five-year-old daughter, whose smile lit up the room. She had come to learn the baby's gender. As I prepared the ultrasound, I turned and playfully asked the little girl, 'Do you want it to be a boy or a girl?' Without hesitation, she said, 'A boy.' Surprised by her certainty, I gently asked why. Before she could respond, her mother quietly explained. 'She doesn't want a girl. She's afraid she'll lose her – like she lost her older sister, who was killed in this latest attack.' Another day, a woman in her tenth week of pregnancy came to the obstetrics clinic after being told by a doctor that her baby's heart was not beating. As I performed an ultrasound to check the fetus, to my surprise and relief, I detected a heartbeat. The woman cried with joy. On that day, I witnessed life where it was thought to have been lost. Tragedy touches every part of our lives in Gaza. It is woven into our most intimate moments, even around the joy of expecting a new life. Safety is a luxury we've never known. At 6am, as dawn breaks on the morning of my shift, we welcome a new baby born to a mother from the Jabalia camp in northern Gaza, an area surrounded by Israeli soldiers and tanks. As the first rays of sunlight pierce the delivery room, the mother cries happy tears, her face flushed as she hugs her baby girl. Having endured a night filled with fear, missiles, and snipers, the mother and her family managed to reach the hospital safely. In this moment, they celebrate and find a reason to hope again.
The Sun
03-08-2025
- Health
- The Sun
From STIs to stress – everything your discharge can reveal about your health and the urgent warning signs
ALTHOUGH it's not often talked about, vaginal discharge will affect most women at some point. But what's normal? And when could it be a sign of something sinister? 5 Discharge comes in sorts of colours and textures, and how it looks and smells can reveal a lot about your health. Dr Shazia Malik, an obstetrics and gynaecology consultant and UK medical director at Daye, tells Sun Health: 'Understanding your body's natural discharge is incredibly helpful and empowering. 'This way, when something goes wrong, you'll be able to spot it quickly. 'If you're already noticing some changes in your down-there fluids however, it might be down to one of these conditions.' 1. STIs YOU might assume that if you've got a sexually transmitted infection, you'll experience pain, itching or a rash. But did you know, STIs are often asymptomatic in women? 'Up to 70 per cent of chlamydia and 50 per cent of gonorrhoea cases show no symptoms,' says Dr Malik. 'But, when symptoms do appear, they may include abnormal discharge (yellow, green or grey), unusual odours, irritation and discomfort during urination or sex. 'In underwear, you might notice yellowish-green discharge from gonorrhea, frothy yellow-green discharge from trichomoniasis, or mucus-like discharge from chlamydia. 'It can also present with bleeding between periods, after sex or pelvic pain.' If you suspect you might have an STI, it's important not to turn a blind eye. 'Women should see a healthcare provider if they notice changes in discharge, unusual bleeding, pain, itching or genital sores,' says Dr Malik. 'Untreated STIs can lead to pelvic inflammatory disease (PID) - a serious infection that occurs when bacteria spreads from the vagina to the upper reproductive organs. 'It can cause permanent damage. Research published in the National Library of Medicine suggests it could increase your risk of infertility five-fold. 'Most conditions, when caught early, respond well to treatment. 'Help is available through GPs, sexual health clinics (many offer walk-in appointments), and home testing services.' 2. Bacterial vaginosis RENOWNED for its fishy-smelling odour, around 23 to 29 per cent of women who are of reproductive age will get bacterial vaginosis (BV) at some point. Not familiar with this common condition? Dr Malik says: 'BV produces thin, greyish-white discharge with a distinctive fishy odour that intensifies after sex.' Antibiotics prescribed by your GP can effectively treat symptoms, however, according to research published in the journal BMC Medicine, more than half of sufferers will experience a recurrence of BV symptoms within six months. Dr Malik says that this pattern 'reflects the delicate balance of your vaginal microbiome' - the collection of bacteria that live inside the vagina. You might notice white, chunky patches in your underwear, along with intense itching, redness and burning during urination or sex Dr Shazia Malik 'A healthy vagina is dominated by lactobacillus bacteria, which maintain an acidic environment that naturally defends against harmful organisms,' she adds. 'BV disrupts this balance, and even after antibiotics clear the infection, if beneficial bacteria aren't restored, the vaginal environment remains vulnerable.' You can support your vaginal microbiome by reducing stress levels, avoiding harsh soaps when washing, minimising baths and going for showers instead, and even trying vaginal probiotic supplements. 3. The monthly cycle ALTHOUGH some discharge can indicate problems with your health, some types are in fact very normal. 'Healthy discharge ranges from clear to whitish with a mild odour,' confirms Dr Malik. 'It changes throughout your cycle. 'It's minimal after menstruation, clear and stretchy before and during ovulation, and thicker and cloudier after ovulation. 'These changes reflect hormonal fluctuations affecting vaginal secretions.' Getting to know your version of normal helps you recognise when something isn't quite right. You could try tracking your monthly discharge on a note on your phone or an app such as Flo (iOS and Android). 5 4. Thrush CAN'T stop itching? If you're also noticing thick, white, cottage cheese-like discharge in your knickers, then you might be suffering from thrush. 'Thrush affects three out of four women at some point in their lives,' says Dr Malik. 'You might notice white, chunky patches in your underwear, along with intense itching, redness and burning during urination or sex.' Like BV, thrush represents another type of microbiome imbalance. 'While BV involves bacterial overgrowth, thrush occurs when candida yeast – normally present in small amounts – multiplies excessively,' says Dr Malik. 'Although antibiotics are necessary for bacterial infections, they can inadvertently disrupt your microbiome by reducing the beneficial bacteria that normally keep yeast in check, which explains why thrush often follows antibiotic treatment.' When your period pain could be a medical emergency By Isabel Shaw, Health Reporter MOST of us take period camps to be part and parcel of periods, right? It's true that pain is part of the normal mechanism of menstruation, but when they're really bad, this is not normal and could signal a problem that may land you in hospital. Dr Fran Yarlett, GP and medical director at The Lowdown, says: "Period pains can usually be managed with simple painkillers, such as paracetamol and ibuprofen. "If the pain is still not controlled or you have other symptoms such as a high fever, offensive vaginal discharge or pain that can be pinpointed to a very specific area, it's advisable to speak to a doctor. " 1. Ectopic pregnancy An ectopic pregnancy happens when a fertilised egg implants outside the womb and affects one in every 80 to 90 pregnancies, or 11,000 pregnancies every year. "The pain is typically one-sided and associated with possibly some brown spotting or bleeding with a positive pregnancy test," Dr Fran says. Other symptoms can include: vaginal bleeding, brown watery discharge, a missed period, discomfort on the toilet and pain in your shoulder. 2. Toxic shock syndrome Toxic shock syndrome (TSS) happens when Staphylococcus enters the body and releases toxins, which can lead to sepsis - a life-threatening immune response to harmful bacteria. It is sometimes associated with tampon use, but can also be linked to skin wounds, surgical incisions, nasal packing, scrapes, burns or other areas of injured skin. Symptoms include: a high temperature, muscle aches, a sandpaper-like rash and flu-like symptoms. 3. Appendicitis Appendicitis is a painful swelling of the appendix - a small pouch connected to the large intestine. The pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may worsen the pain. Other appendicitis symptoms include: nausea, vomiting, loss of appetite, constipation or diarrhoea, a high temperature and a flushed face. 4. Endometriosis Endometriosis is a common but relatively unknown health condition associated with crippling period pains. It affects up to one in 10 women in the UK and causes tissue similar to that in the womb to grow in other areas in the body. Other symptoms include: heavy periods, pain when you pee or poo, pain after sex and extreme tiredness. 5. Coil perforation The copper coil is an effective, hormone-free contraceptive used by millions of women in the UK. In rare cases, it can cause perforation - when it punctures the wall of the womb. Other symptoms include: severe pelvic pain, continuous bleeding, sudden period changes, pain during sex and not being able to feel the threads. 6. Cancer In the early stages, womb and ovarian cancer can feel like period cramps. Other symptoms include: back pain, feeling feel quickly, difficulty eating and needing to pee a lot or urgently. Worried you have thrush? 'Treatment includes antifungal creams, pessaries or oral tablets,' says Dr Malik. Your pharmacist can help you choose the right treatment for you. If your thrush keeps coming back, book an appointment with your GP. Thrush can also affect men, with symptoms including irritation, burning and redness around the head of the penis and under the foreskin; a cottage cheese-like discharge; an unpleasant smell; and even difficulty pulling back the foreskin. 5. Stress WHETHER it's caused by intense work deadlines, kids or simply a schedule that means you never come up for air, stress can have a huge impact on your vaginal health, including your discharge. 'When you're under stress, your body releases the hormone cortisol, among others, that can disrupt the delicate hormonal balance controlling your menstrual cycle,' says Dr Malik. 'The science behind this is fascinating. Stress activates your hypothalamic-pituitary-adrenal (HPA) axis, which can interfere with the hypothalamic-pituitary-gonadal (HPG) axis. 'This regulates reproductive hormones like oestrogen and progesterone. 'This disruption can lead to changes in vaginal discharge and even cause breakthrough bleeding or spotting between periods.' Research published in the American Journal of Epidemiology also found that psychological stress can affect your immune system, making your vaginal microbiome more vulnerable to imbalances and infections. Doing what you can to reduce your stress can help to normalise your menstrual cycle. Can you devote more time to relaxing, away from technology, emails and messages? Are you able to delegate any jobs to someone else? Small changes can make a big difference. 6. Cancer ALTHOUGH your discharge-related symptoms are unlikely to be cancer, it's wise to get clued up and know what's what when it comes to gynaecological cancers. Cervical cancer is the 14th most common cancer in women, with around 3,300 new cases every year, according to Cancer Research UK. Around 7,500 women are diagnosed with ovarian cancer in the UK each year, while 9,800 women are diagnosed with womb cancer. Dr Malik says that cervical cancer can cause persistent watery, blood-tinged discharge with an unpleasant smell. 'Womb cancer often presents with watery discharge that may contain blood, particularly concerning in postmenopausal women. 'Ovarian cancer may cause discharge changes alongside abdominal bloating. 'Other warning signs include persistent pelvic pain unrelated to your menstrual cycle, pelvic pressure or fullness, changes in urinary habits, pain during intercourse, unexplained weight loss and extreme fatigue. 'It can also present with bleeding between periods, after sex or pelvic pain.' These symptoms should never be ignored. Although it may not be cancer, it's vital you book an appointment with your GP. 'Early detection through regular screening and prompt medical attention significantly improves outcomes,' Dr Malik says.
CBC
11-07-2025
- Health
- CBC
Researcher calls for rural health investment after Dawson Creek's only ob-gyn leaves community
Social Sharing For nine weeks, the residents of Dawson Creek, B.C., have been without a doctor of obstetrics and gynecology. The most recent obstetrician-gynecologist (ob-gyn) left the small northern community this spring, and although there are some alternatives, anyone with high-risk needs now has to drive one hour north to Fort St. John. The Northern Health Authority said it is actively recruiting to fill the vacant position, which served the census area of about 17,000 people. It said anyone who needs care can contact the Chickadee Clinic in Dawson Creek, a maternity clinic with nurses, midwives and doctors who can support families through pregnancy and postpartum. For those with more serious needs, they'll have to go further afield. This comes as B.C. faces a shortage of health-care workers throughout the province. Jude Kornelsen, co-director of the University of B.C. Centre for Rural Health Research, said there is an "urgent" need to fill the gaps locally when health-care services like obstetrics become unavailable in rural and remote areas. "However, it's a really difficult time in health care right now," she told CBC's Daybreak North host Carolina de Ryk. For the past several months, the province has been running a campaign to attract U.S. doctors and nurses to B.C., and fast-track the process for some health-care providers from other jurisdictions to become registered to practice in British Columbia. But even so, physicians are still retiring or moving on, and thousands of British Columbians remain without a general practitioner, let alone specialist care. Dawson Creek's most recent ob-gyn left this spring, after arriving in the community in July 2024. The ob-gyn before that spent about two years in Dawson Creek, according to Northern Health. Kornelsen said communities with smaller populations tend to require specialist care during pregnancy less often — because there are fewer people who would need it — and can have great experiences with family physicians and midwives. Having specialists in rural communities can actually be challenging, she said, if they don't have enough work to sustain a practice. But if they do, they often have so much that it leads to burnout. "It's not sustainable for one provider to shoulder the responsibility of all high-risk care, namely because they're on call pretty much all the time," Kornelsen said. "I've talked to many solo obstetricians across rural communities and they basically say that to have time off, they have to leave the community, otherwise they feel compelled to help out if needed." A rural locum ob-gyn program does exist, bringing physicians to communities for the short term. On July 8, there were job postings for ob-gyns for both Dawson Creek and Fort St. John. "We definitely need to strengthen the locum program to make sure that the providers we have in communities can get a rest," Kornelsen said. She said there has also been an effort to support family doctors with "enhanced surgical skills" so they can perform low-risk procedures. When it comes to pregnancy and birth, that would include things like C-sections on patients who don't have significant complications, she said. "They could be available to do emergency caesarean sections locally, which means that those birthers who will probably have uncomplicated delivery can stay in the community to give birth with the reassurance that if complications arise, they can be looked after safely." But, she said, health authorities should be investing in more team-based care, because it's not just the ob-gyn performing deliveries, it's nurses and other health-care workers, too. Additionally, there needs to be more money put toward infrastructure for medical services in those communities.
Arab News
27-06-2025
- Health
- Arab News
KSrelief opens obstetrics and gynecology clinic at Gaza hospital
RIYADH: Saudi aid agency KSrelief has officially opened a gynecology and obstetrics clinic at the Patient Friends Benevolent Society Hospital in the Gaza Strip. Founded in 1980, the hospital in Gaza City's Al-Rimal neighborhood is one of the few that remain operational in the territory amid devastating attacks by Israeli forces during their ongoing war with Hamas, which began in October 2023. KSrelief opened the clinic on Wednesday in cooperation with the UN Population Fund, which works to improve reproductive and maternal health worldwide. The initiative is part of Saudi efforts to support the Palestinian people and help improve and maintain the healthcare services available to them, the Saudi Press Agency reported. On Thursday, Saudi authorities delivered $30 million in funding to the Palestinian Authority. It was the latest installment in ongoing financial support from the Kingdom that Palestinian officials said has been instrumental in efforts to maintain the health and education sectors. It has helped meet the costs of running hospitals, purchasing medicines and medical equipment, keeping schools open, and providing other essential services.
Times
26-06-2025
- Health
- Times
Times letters: Failure to follow basics of maternity care
Write to letters@ Sir, Alice Thomson's article on the 'dire state of maternity care' in the UK is to be welcomed ('Too many women see childbirth as traumatic', comment, Jun 25). I am an obstetrician who has worked in the UK, New Zealand (under a no-fault system) and Australia (with litigation). A no-fault system has appeal given the astronomical costs of maternity litigation in the UK. However, I disagree that 'a no-fault policy would encourage the medical profession to open up about their mistakes'. A 'mistake' is when a doctor or nurse gives an incorrect dose of a medication. Most of the tragedies in Morecambe Bay, Shrewsbury and Telford were not 'mistakes', they were failures to enact the basics of maternity care (failure to listen to women, failure to recognise risk factors, failure to escalate care appropriately, inappropriate attempts to achieve vaginal births and delays in performing emergency caesareans). These failings have been compounded by NHS trusts covering up errors, blaming victims and, now, destruction of records. A no-fault system will, by definition, minimise the consequences of the actions I have described at a time when women and society are seeking transparency and Rob BuistBondi Junction, New South Wales Sir, The basic truth is that the technical skill levels of those delivering babies are poor. Until that is addressed tinkering will not make much difference. The insertion of local anaesthetic into the perineum, and a carefully performed episiotomy (a surgical incision in the perineum) with a surgically accurate repair afterwards, should be the minimum standard expected of anyone delivering babies. Leaving the mother to strain and then rip her perineum is barbaric. Wes Streeting needs to listen to a wider range of opinion and devise additional training and monitoring of practices, whether by midwives, medically qualified practitioners or even a new 'birthing technician'. Perhaps that could be a meaningful role for physician associates, those non-qualified physician assistants that are being Piper, FRCSDartmouth, Devon Sir, Wes Streeting has announced a national investigation into maternity services owing to repeated failings, yet often there is a recurrent theme of women and their partners not being listened to when they feel there is a problem. Nearly 40 years ago, when my wife was in labour with our first-born, we overheard her being quickly labelled as the young female doctor making a fuss. She was given strong injections of painkillers and sedatives, one of which was used to treat schizophrenia at the time, and only then examined to reveal she was ready to push. Our daughter was delivered rapidly, flat and barely breathing. With no paediatrician in sight I was asked to give her the antidote injection. I dread to think what would have happened had I not been medically trained. Until 'attitude to patients' is given the highest priority in the training curriculum and in continuing personal educational development, I can see the same headlines in another 40 years' David MaddamsRet'd GP and GP trainer, Ware, Herts Sir, Resident doctors may be 'excited' or even 'energised' by the prospect of strike action but they appear to have lost sight of the fact that many of them are trainees ('Medical union 'excited' about walking out again', Jun 25). Are they really 'excited' to lose valuable training time, and risk damaging their exam results and harming their opportunities to achieve promotion to the higher grades? One does not learn by standing on picket Hoile, FRCSRet'd consultant surgeon, Hempstead, Kent Sir, The belligerence of the BMA and junior doctors horrifies me. The claim that they are 'excited' at the prospect of further strike action is both sad and misdirected. These newly qualified doctors need to remind themselves why they chose to study medicine. One would hope it was because they wanted to be part of our NHS, striving to cure the sick, rather than wanting mega salaries. The biggest reward is surely grateful FabriciusUpper Clatford, Hants Sir, To fund the government's pledge to spend 5 per cent of GDP on defence by 2035 (Jun 24), a 'defence bond' should be issued immediately. This would have a maturity of ten years and carry no interest. The subscribers to the bond, which would itself be non-negotiable, would benefit in terms of inheritance tax due upon their death: the bond would have 2x the value of the bond as a credit against their IHT bill. To ensure that the Treasury remained supportive of this IHT credit, the multiple of 2x the face value would be reduced for those subscribers who died before the ten-year period was completed. Many British citizens, like me, would consider this unusual investment a way of increasing the safety of our William CastellFormer chairman of the Wellcome Trust; Oxted, Surrey Sir, I agree with Robert Duffield's recommendation of a crackdown on fraud and error (letter, Jun 25) as the way to fund the £40 billion needed for our security, but many previous attempts at this have produced limited returns. We should be bold and introduce the publication of tax returns: the honest have nothing to fear; the dishonest will be caught out by their neighbours, and be forced to pay up, by HMRC and peer HaywardLlandrindod Wells, Powys Sir, I wholeheartedly agree with your leading article ('Battle of the Bulge', Jun 24) on the benefits of prescribing Mounjaro to a broader cohort of patients in need. I work in primary care and have seen astonishing results in patients paying to take this medication: it is beneficial not only in reducing the chronic illness often associated with obesity but also in the psychological wellbeing of this group. Unfortunately our local integrated care board does not share this enthusiasm and has issued a directive to all GPs in Suffolk and northeast Essex advising that GPs should not provide these medications directly for weight loss. Instead, the local NHS has chosen the community outreach service model. This means that access is available only through a specialist NHS weight management service — which is not operating at present. It would seem that those most clinically in need are subject to a postcode lottery of ShirleyNurse practitioner, Nayland, Suffolk Sir, Your editorial suggests that you agree with Wes Streeting's view that making Mounjaro widely available on the NHS will cure the country's economic ills by enabling patients to return to work and reducing demand on the NHS. Although there may be some people in whom a 25 per cent reduction in body weight will prompt a return to work, I suspect this will not be the case for most. This is because obesity per se does not stop you from working, and many of the psychological and social factors leading to people becoming obese are also the reasons that stop people from working. A more likely scenario is that by prolonging life expectancy these medications will lead to increased demand on the NHS and social services at a later date, with an associated and unbudgeted increase in cost to the Oliver DukeConsultant physician (ret'd), London SW2 Sir, I fear Polly Mackenzie is being rather fanciful in her idea that the government can persuade benefits claimants that finding a job would be good for them ('This is how you get the sick back to work', Jun 25). I am sure there are some people who, given the appropriate support, would welcome the chance of employment — but there are many more for whom a life on benefits is always going to be preferable to getting out of bed every morning to go to a job that is likely to be thankless, tedious and not even financially beneficial. Unfortunately the appeal of a life on benefits over the drudgery and low pay of employment has been increasing for decades. This attitude has now become baked in and will take more than gentle persuasion and platitudes to WardIpswich Sir, Steven Morris (letter, Jun 25) states that 'two in five disabled people with complex needs will struggle financially if these cuts go ahead'. This appears to be the key to the conundrum: how does the government reform the benefits system such that the target is the three in five disabled recipients of personal independence plans who would not struggle financially?Andy ThorpLittle Canfield, Essex Sir, I applaud James Marriott for reminding us of Joan Didion's motto 'I write to find out what I am thinking' ('Not reading or writing would be unthinkable', Jun 24). The problem predates AI. I taught A-level pupils for several decades and always insisted on handwritten essays, although once these were composed students were welcome to type them out if they chose. Note-taking, planning, structuring and ordering one's ideas and then writing them — with careful choice of words so as to communicate precisely the points one wants to convey — can be done competently on a computer by few seasoned writers. Many undergraduates who write directly on computers find their essays returned with low marks because they are unstructured, poorly expressed and replete with unconnected points. AI only compounds the HamlynLondon W5 Sir, I concur with Henry Mabbett (letter, Jun 25) about there being too much sport, but for more personal reasons. Whenever I look at my dear husband, he has his eyes glued to his iPhone or the television. My life is constrained by the near-constant cacophony of commentary on darts, tennis, rugby, football and cricket, whereby homely marital communication is ebbing away. I have to wait for breaks in play if I want to catch his attention. What a life!Jan NorrisBroadwas-on-Teme, Worcs Sir, India's home minister, Amit Shah, says the day is coming when Indians who speak English will feel ashamed to do so ('Modi minister tells Indians it is shameful to speak English', Jun 24. Shah might be reminded that when Jawaharlal Nehru delivered his maiden speech on becoming prime minister in 1947, he addressed the nation in English and championed it as a vital language for India's StewartLondon W11 Sir, I have often been impressed by the comments of Matthew Parris (Notebook, Jun 25). Now I learn he can spot an Englishman among the 'pixels' of 10,000 faces; no Welsh, no Scots, no Irish, no white Europeans, just Englishmen. What a BryantWinscombe, Somerset Sir, I rather like Matthew Parris's attempt to link Jarvis Cocker with the ardour, longing, irony, tenderness and passion of another five white Englishmen. May I suggest as an alternative five Gerald Finzi, Edward Thomas, Eric Ravilious, and both Mole and Mr Toad from The Wind in the Willows?Stephen PollardTunbridge Wells, Kent Sir, My mother would have agreed with Victoria Hawthorn's mother (letter, Jun 25) that a gentleman should wear well-polished shoes, but would also have insisted on a snowy white handkerchief in his CowieShandon, Argyll & Bute Write to letters@
