Bureaucracy and Babies
Thoughts, or something like it.
I
It is sacrilegious to hate on the NHS1 in this country. Hating on something does not mean not appreciating it. On the contrary, the art of hate – or to quote 50 Cent “I need you, I need you to hate” is what moves things forward. I was under the impression the NHS hires service designers to make services better, but it seems those activity sheets, papers with ideas, and sticky notes remain untouched, filled with promise and possibilities, and never implemented (or like everything else, they are filled with the same SHIT ideas). I read the article “Are we too impatient to be intelligent?” (recommended by Dense Discovery) and started to think about who on earth are the private consultants the NHS haemorrhages money on, and never mind the actual ministers in charge of it who propose ridiculous things like League Tables (how did those work out for unis?). I mean hospitals are finding ‘inventive’ ways of making money, such as charging people for wheelchairs and some hospitals are even charging people for a copy of their ultrasound photo (!!!).
I recently gave birth and had varying experiences throughout the different stages of the journey (antenatal, labour, post-natal). The first was mediocre, the second was great, and the last was poor, which, according to my conversations with midwives and other healthcare provides, was the main complaint they received about the service.
The news is filled with scandals over maternity care across the UK, and once you’ve experienced it, it's easy to see why. And London’s services are much better than in other parts of the country. Birth happens every day and has been happening since the beginning of time. Despite this fact, we know little about it and are ill-equipped to deal with it through our healthcare providers.
The UK pays its medical professionals little money, there are eight patients to one midwife (technically 16 if you count each had baby, not considering twins, etc., plus their birthing partners). In addition, the hierarchy of nurse, midwife, and assistants means all responsibility falls entirely on the midwife. Then there’s the shift turnover which disrupts care, and happens without warning. The shifts are long, and the managers who run the hospitals and clinics realised that after COVID, you could do a lot by asking people to come into the clinic instead of home visits. Let me repeat, five days after you’ve birthed a baby, you are expected to make your way – doesn’t matter how far you live – to the health centre to get your baby examined. The health centre itself is not equipped to host pregnant women or parents and their babies. There isn’t even a changing table in the toilet and not enough seats to breastfeed!
We have seen more than seven different midwives throughout the pregnancy and after birth because our midwife was sick (we were not informed)2, there is a shortage of midwives and they keep moving our appointments around. Sometimes you are treated by a student sitting with a junior midwife who have an alarming lack of empathy. We also were not assigned a midwife until we flagged it during our 20-week scan when we had a load of questions for the ultrasound technician. We were ‘missed’ on the system.
When the midwife and the health visitor do visit you at home, they are worse than a Google search, reminding you that absolutely everything can kill your baby, causing a sense of paranoia that new parents do not need. I must stop listening to their advice, itself consistently generic.
What takes the cake however is trying to dispose of the medication (needles) they gave me because I was not provided a medical waste bin. Never one to shy away from exploring the user journey of any service, I went all in. The process seemed as straightforward as going to your GP and dropping it off, but it’s not. I went into a nearby hospital who told me they can’t dispose of this because they do not have the capabilities. Now, hold the phone, this is a hospital right? Everything in the West is impossible. Apparently, the pharmacy can’t dispose of it either, and I have to contact my council, who provides a service if you sign up to it. I’m not on medication, it’s a one time thing! But the council also does not dispose of needles and have no idea how I was given such information. I had to call my GP, fill a form for them to arrange a delivery, and wait. I still have not heard back two weeks later. So instead of being a model citizen trying to do the right thing, I did what most people do.
II
Canadian bureaucracy is worse than British bureaucracy because Canada is in the stone age when it comes to online services. Note: whilst the UK is better, they should refrain from making everything an online service.
I’m attempting to access my government account and every time I think I have the username and password sorted, they come up with a new way to sign in and I’m locked out. The service options they offer can only be accessed in country, which I am not in. This means I have to call them, and good luck getting hold of them. The only good thing is they have a phone number, unlike 99% of the UK services (Home Office I'm looking in your direction).
I’ve been locked out of my Canadian bank account because my card expired and I was given no warning. When I called the bank, they needed information I can only access through the app. Once I managed to miraculously find a paper copy, they said they could issue me another card, then realised the “space” to write in international addresses doesn't allow room for postcodes (UK runs on postcodes). Then they double checked and realised they cannot issue me another card for 60 days to prevent fraud. Therefore, I am locked out of my account until 2025. FFS. This is how banks keep you in debt.
Finally, I’m trying to register my newborn child as a Canadian citizen. I first have to apply for a citizenship certificate, which seems even more complicated and even more so because the baby is born outside of Canada and I am born outside of Canada and I can only apply “on paper” not online, and I am considered less of a Canadian citizen. The wording on the form will confuse even the most fluent English speaker, followed by a save button that doesn't actually save anything. There is also the requirement to have an official passport photo from a photographer with the same requirements as adults for a newborn baby (even the UK allows you to do this at home with your phone), the height of the baby, and information from my parents immigration to Canada that forces me to ask them to dig up paperwork they might not have immediate access to.
With all the computerised systems, the biometrics, etc., I am certain all these items are on file and you can just type in the name and it all appears. Jordan, with all its bureaucracy that you wonder how people think this stuff up, seems less confusing because I can do it in person in two hours, and even less times if I know the right person (nepotism has its perks).
NB
Having a baby in London without family and where everything is a big distance is tough. The experience is an emotional rollercoaster and a test of people’s kindness. We have been overwhelmed by the kindness shown to us from people we barely know, who have been so generous (even when sometimes the gifts are beyond their means), and disappointed by close friends I have not heard from. Weird how things work.
Things
Designerly Ways of Knowing: It’s back baby! The first edition of the book is sold out and it’s now been reprinted by Set Margins. New cover (Palestine, represent!), new publisher, same book. Order it here.
13 DEC, SOAS London: I am on the panel for the newly released book Producing Palestine: The Creative Production of Palestine through Contemporary Media. Free, register here.
SAVE THE DATE – 28 January 2025: The London book launch for my book Design Otherwise: Transforming Design Education in the Arab Region (pre-order from Bloomsbury). Details to come, and North American and EU dates to follow for Feb/March.
NEW WORK: Moments of Palestine 🇵🇸 is a series of 117 photographs documenting what I call “moments of Palestine” around London from October 2023 to September 2024. Contact me for more details. ⬇️
Read//Check Out//Listen//Watch
My good friend Nina Paim has officially launched her independent feminist design publisher Bikini Books, and the first title is Briar Levit: On design, feminism, and friendship. Check out the website.
In uni, my friend Arty was instrumental in shaping my musical tastes and introduced me to the Avalanches album Since I left you. Everyday by the Avalanches is from the B-side to the Since I Left You single CD. 🎶
I was not a fan of the more recent releases but I am jamming to x-ray eyes by LCD Soundsystem 🎛️
Subway Takes is a brilliant short ‘podcast’. It got me thinking about how London lacks this type of content. There are more London-centric things now (more needed), but I wonder if because the US is so “Americana” it has more city-centric content? It would be better without celebrity features though. Watch Subway Takes here and read more about Kareem Rahma, the man behind Subway Takes, in this article.
Not denying there differing experiences of the services.
Our original midwife has yet to meet our baby and may never meet our baby.