BBC newsreader donates kidney to save mother

A BBC news presenter who donated a kidney to save his mother's life says her health has been 'completely transformed' since having the operation.

Sabet Choudhury was told his mother Sakina, 70, could have only three years to live after her kidneys failed.

He said he had "little choice" but to donate a kidney, as she could have been waiting 10 years for a transplant because of the lack of deceased donors among black and Asian people.

"She could have waited to find a kidney from someone on the Organ Donor Register, but that would have taken a long time, which she did not necessarily have," he said.

The operation was a success, but he said the wait for other black and minority ethnic (BME) families could be "long and fatal".

Transplants are more likely to be successful if the donor is of a similar ethnic background because blood and tissue types are more likely to match, according to NHS Blood and Transplant.

Sabet, a presenter for BBC Points West news in southwest England, is urging more black and Asian people to register to donate organs.

'New lease of life'

Sakina, who is of Bangladeshi origin, suffered kidney failure in December 2013. Doctors said she needed a new kidney and immediately began searching for a donor.

Sabet, 41, from Gloucester, said it had been hard to watch his mother having to be hooked up to a dialysis machine three times a week with a "pretty poor quality of life".

"Dialysis keeps you alive, but it doesn't make you better," he said. Many patients, especially older people, only survive for a few years on dialysis and need a transplant to save their life.

"You don't want to see that happen in front of your eyes, that quickly, knowing you can do something about it," said Sabet.

After months of tests, Sabet was told he would be a suitable donor. About a third of all kidney transplants carried out in the UK are from living donors.

His initial fear was the procedure would affect his health, but he was back at work within six weeks of the three-hour operation, carried out in Bristol in November 2014.

"I've returned to full health since the operation," he said. "In fact I'm probably healthier now because the process has made me more health conscious."

He said the new kidney has given his mother a new lease of life. "The difference between how she is now and how she was before is like night and day. She looks 10 years younger.

"Being free of that dialysis machine … it's as if her arms and legs have been untied. She has rediscovered a lust for life that I thought she would never have again."

'You could save nine lives'

People from an ethnic minority background have to wait around 10 months longer than average for kidney transplants because of the shortage of matching donors.

Only 3.5% of people from ethnic minorities are on the Organ Donor Register, while more than a third of those needing a transplant are from ethnic minorities.

"My view is that if you are prepared to take, you should also be prepared to give," said Sabet. "You will be helping people in your own community. One person donating their organs could save nine lives. That's a beautiful thing.

"If you do sign up, it's a good idea to tell family and friends about your intentions," he said. If you register your wishes without telling the people closest to you, it may come as a surprise when they are trying to deal with their loss.

"Telling your loved ones that you want to be a donor will make it easier for them to agree to the donation in the event of your death," said Sabet.

Some people may be reluctant to donate organs, believing it goes against their religion, but the major religions in the UK all support the principles of organ donation and transplantation.

Find out what your religion says about organ donation on the Organ Donation website.

Living with sickle cell anaemia

Pamela Gyebi-Ababio, from Croydon, is passionate about raising awareness of sickle cell disorder and how it affects people. She gave this interview in 2008, when she was 18.

Watch a video of Pamela Gyebi-Ababio talking about her life with sickle cell

“I’ve had sickle cell anaemia since I was born, but my earliest memory of it was when the head teacher in primary school picked on me because I wore socks over my tights to keep my ankles warm,” says Pamela. Keeping warm can help prevent a sickle cell crisis, or bout of pain.

“One of the reasons I want to raise awareness is so that people can understand how the disease affects others, and how they can be sensitive towards sicklers, especially in schools.”

Talking about sickle cell

Pamela got involved in publicising sickle cell disorder after letting her consultant and her sickle cell advisor know that she wanted to raise awareness. She has since given interviews in the national media, talking honestly and openly about her life with sickle cell.

“I want people living with sickle cell to have more confidence in themselves and to realise they aren’t the only ones, and that we can still achieve,” she says. “It gets a bit stifling working hard for something, like exams, and not being able to do well due to bad health.”

Sickle cell disorder (SCD) is a group of inherited blood disorders that evolved thousands of years ago in areas of the world where malaria occurs. The most common is sickle cell anaemia. Most people affected by sickle cell anaemia are of African or Caribbean origin.

SCD affects the blood’s ability to carry oxygen around the body. A protein called haemoglobin doesn’t work properly, and turns red blood cells into sickle (crescent) shapes. These can get stuck in blood vessels and block the flow of blood, causing terrible pain, known as a sickle cell crisis.

People with sickle cell anaemia can also feel very tired. Resting, drinking water and keeping warm can help stop a crisis coming on.

How a crisis affects your life

“Crises come on in different ways,” says Pamela. “Sometimes I feel pain in my arm, deep in the tissue. Sometimes the pain is in my leg or waist, which is worse. It feels a bit like electric shocks. I take painkillers and drink lots of water to try to stop it coming on. There are times when it’s too painful to move, and I just have to rest in bed.”

Her most serious crisis happened when she was 16. Severe pain in her shinbones meant Pamela couldn’t bear any weight on her legs, and she was taken to hospital in an ambulance on Christmas Eve. “They gave me morphine and I was allowed home after five days,” she says.

Pamela had to take months off school, and was unable to walk without a stick or someone to lean on.

She says her biggest difficulty has been the effect on her education. “My GCSE predictions were A stars, As and Bs, but I got eight Bs,” she says. “I missed some work deadlines as I was in hospital. If I could just have at least 80% attendance, I know I would achieve the grades my brain is capable of.”

Pamela repeated the year and is now studying for A levels in maths, biology and chemistry. She hopes to become a doctor.

Family history

Pamela’s family is supportive of her work to publicise sickle cell anaemia. Her parents, originally from Ghana, both have sickle cell trait. This means they have no symptoms but they have the gene associated with the disorder, and can pass it on if they have a baby. They weren't aware of this until they had Pamela. Their three younger daughters don’t have SCD.

There's now a screening programme to detect sickle cell trait in pregnant women and sickle cell disorder in newborn babies. Men and women can get screened before starting a family.

Since April 2007, Pamela has had blood transfusions every month to help stop her body producing sickle cells. As a result of the transfusions, she is also having treatment to prevent the build-up of iron in her blood, something that people with sickle cell cannot cope with.

“Sometimes I feel sickle cell spoils my dreams, but I have to stay positive and think of other ways of doing what I want,” says Pamela. “I want to get people talking about sickle cell disease, so there’s less stigma."

The diabetes champion

Grace Vanterpool is a nurse consultant in diabetes. In 2006 she became Nurse of the Year and received an MBE for her work raising awareness of diabetes.

Watch a video of Grace Vanterpool talking about raising awareness of diabetes among BME communities

Grace is the only African Caribbean nurse consultant in diabetes in the UK. “It’s amazing really, because diabetes affects all people but particularly African Caribbean and Asian people,” she says.

It’s estimated that 2.35 million people in the UK have diabetes, a condition that affects the body’s response to sugar. It can result in serious health consequences, such as heart disease, stroke, eye and kidney problems and damage to the nerves of the feet, which may lead to foot ulcers. With proper care, however, people with diabetes can live healthy, active lives.

Helping people live with diabetes

Grace works closely with patients, GPs and practice nurses, as well as training students and clinicians to provide high-quality care. She also works to ensure that all local services for people with diabetes provide the same standards of care.

She and her colleagues at Hammersmith and Fulham PCT and Imperial Health Care Trust support around 5,000 patients and their families. “We do telephone consultations, visit homes and link with dietitians, podiatrists (feet specialists) and retinal (eye) screening.

“Seeing patients feel better is amazing. I help them learn how to measure blood sugar levels, inject insulin and eat well. They begin to see their blood sugar levels improving."

Raising awareness in the community

Making sure people know about diabetes, and improving the lives of people who have it, are the driving forces in Grace’s work. She has been involved in innovative ways of raising awareness, including taking to the streets when she worked in Slough between 2001 and 2004.

“We had a double decker bus that went around town, testing people for diabetes and giving out information,” she remembers. “During evenings and weekends, we’d go wherever people gathered, such as train stations or the university. We also went to local factories, mosques and churches. We discovered that a lot of people had diabetes but didn’t know it.”

It’s thought that around half-a-million people in the UK are not aware they have diabetes.

Grace and her colleagues also attended the local Asian Mela festival to encourage people to get tested. “We were inundated with people. That first year we had one table, and it was so successful that by the fourth year we had a marquee.”

She continued raising awareness among black and minority ethnic (BME) communities under an award-winning project called Action Diabetes. As a result, in 2006, she won Community Nurse of the Year and overall Nurse of the Year at the Nursing Standard awards.

In November 2006, she went to Buckingham Palace to accept her MBE award. “Prince Charles seemed to know quite a lot about diabetes, and asked about reducing risk,” she says. “I said you have to eat healthily and exercise.”

From Slough to the Caribbean and back

Grace always wanted to work in the NHS. She was born in Slough, Berkshire, in 1958, and her parents relocated to their home in Anguilla in the Caribbean when she was six. “It was lovely, unspoilt and hot, but there was no university then. After doing my O-levels I knew I wanted to train in the UK,” she says.

At 17, Grace moved to Slough to train as a nurse. She began her career as a state enrolled nurse (SEN), rather than a state registered nurse (SRN). An SRN can progress to a more senior level, something Grace didn’t realise at the time.

“I just applied to do nursing, and was put on the SEN course,” she says. “I felt disappointed when I realised I couldn’t become very senior, and I think this is something that happened to many BME nurses at the time. But I didn’t let it deter me.” In 1989, Grace interrupted her diabetes work to take a year-long conversion course to become a state registered nurse. She passed with distinction.

Back in 1978, Grace’s first job was on a surgical ward before she took a break to marry and have her daughter, who's now in her 20s. Grace has specialised in diabetes nursing ever since joining Hammersmith Hospital in 1985. "I was working in outpatients when a consultant approached me to work with her in the diabetes department. It started from there," says Grace.

"The important message is not to ignore diabetes, as it's a progressive condition. It's the biggest cause of blindness in the UK's working population, but this and other complications are preventable if diabetes is managed well and monitored."

The hospital housekeeper

Icilda Rodney worked in the housekeeping department of Guy's & St Thomas' hospital for 41 years, helping to clean the hospital. She was interviewed in 2008.

Watch a video of Icilda Rodney talking about her life and work at Guy's & St Thomas' hospital

Looking back on her long career, Icilda is pleased to have played a part in the smooth running of the hospital: “I helped people in a way, that’s how I look at it. I’ve made a difference, keeping the place clean and neat”.

She joined the hospital’s kidney unit in 1967, after hearing about the job through a friend. “I worked as a domestic, running errands, cooking and cleaning,” says Icilda. “It was a very friendly unit, and the patients all knew me by name.” She remembers cooking special meals for kidney patients who were using dialysis machines.

“When they came on to the machines, sometimes they didn’t want the meals that came from the kitchen, so I cooked loads of sausages and bacon, and they would eat and eat and eat.”

Nine to five

After three years, Icilda moved to the dental department, where she sterilised and packed dental instruments. She was offered a job in the sterilising department but didn’t want to move. “So I started to clean instead. I cleaned the sinks, emptied the rubbish, tidied up, and I’m still there today.”

She has arrived regularly for her 7.30am start (in the early days it was 8am), five days a week. Weekends were spent with her husband, who was a builder, and her son and daughter, now both in their 40s.

On her retirement, Icilda plans to return to the parish of Portland, Jamaica, where she was born. She feels lucky to have visited Jamaica a lot in recent years, and it feels closer than it did when she first left at 18.

Leaving home

“I was sent to England by my mother because she thought I would have a better life here,” says Icilda, whose guardian when she arrived was her stepfather’s niece. “Saying goodbye to my mother was awful, because I knew I would miss her very much, but I knew if I had a better chance in life I would be able to help her in whatever way I could.”

Icilda didn’t see her mum again for nine years, after she’d married and had her children. “I went back for a visit, and it was joy all over!”

Icilda’s first job was in a ceramics factory in Stoke-on-Trent, which she didn’t enjoy. “I started the second day I was in England, and within a week my hands were blistered from burns from the ovens,” she says. “The boss swore, he had no manners, and I wasn’t used to that.”

After three months, she moved with her guardian to Brixton, London, where she worked in a shirt factory, and soon married and started her family.

Six years after leaving Jamaica, Icilda started at Guy’s & St Thomas’. She remembers getting lost frequently when she first worked there. “I can laugh about it now, but at the time it was awful, it’s such a big hospital,” she says.

Friends, family and history

Icilda has made good friends from different countries during her years in the NHS. “Some of them have returned back home and I’ve been able to visit them. I’ve been to America, St Kitts and Antigua. I’ve also remained friends with people here, we go out for meals and so on.”

Icilda feels it’s important to celebrate black history month. “We’ve had 200 years of slavery, and the fact that slavery is abolished and we are now free – we should celebrate for that reason alone,” she says.

“I have come across racism, but it’s very hard to put your finger on it. Sometimes you know the way a person speaks to you, there’s a bit of racism there, but I ignore it. Working as a domestic, I think some people look down at you, and that hurts sometimes.”

Icilda plans to spend time in England with her children and grandchildren, but she is also looking forward to going back to Jamaica. “I’ve still got family there, two brothers and a sister, nieces and nephews, uncles and aunties,” she says.

“The plan was to move back with my husband, but unfortunately he died five years ago, but the dream is still there so I'll do it by myself."

The rare-blood donor

Rudolph Isaacs has given more than 41 pints of blood since he first donated in 1991. His blood is a rare sub-group, U-negative, and he gives blood regularly.

Watch a video of Rudolph Isaacs talking about what it's like to give blood, and why he does it

Rudolph didn’t know what his blood type was until a spur-of-the-moment decision one day in September 1991. “I walked past a drop-in blood donation centre,” says Rudolph, who was born and grew up in Plumstead, London. “I was 28 at the time and always liked doing something to help other people, so I decided to walk in and do it.”

It’s lucky he did, because it turned out he has a rare blood type. In 2008, Rudolph was one of only 28 U-negative donors in England. U-negative is a rare sub-group within main blood types (such as A, B and O), and occurs only in people of African or African Caribbean descent. Around one African Caribbean person in 400 has it.

Life-saving blood

Rudolph found his first donation easy. “I was fine. I didn't have any problems with the needle," he says, laughing. "I was a professional boxer so I’d had some cuts in my time.”

Rudolph’s blood can be given to anybody who is B-positive (this is his main blood group), but is especially valuable for people who need regular blood transfusions, such as people with haemophilia or sickle cell anaemia.

"The way I look at it, someone in your family might need it one day, and it’s you that could save them. You never know what’s around the corner"

Rudolph Isaacs

This is because people who have regular blood transfusions can develop a serious reaction to certain parts of donor blood cells, called antigens. Many develop a reaction to one or more of the common antigens that most people have in their blood. Rudolph's blood does not have the common U antigen, and can be given without the risk of reaction.

“When the staff told me my blood wasn’t very common, I was surprised,” says Rudolph, who is now a train maintenance fitter. “I had no idea. I asked my mum about it, and she didn’t know either.

"I feel great giving blood, knowing that I’m helping someone.”

Donating "on call"

U-negative blood is so precious that sometimes donors are asked to give blood "on call" when it is needed. Under National Blood Service (NBS) regulations, a person can’t give more than three donations a year. This is usually every 16 weeks. But when blood is desperately needed, people can be asked to donate again after 12 weeks, which Rudolph did this year.

The NBS has also sent U-negative blood abroad to help patients in other countries when stocks are low.

At his first donation, Rudolph saw a leaflet about bone marrow transplants and put his name on the bone marrow register too. A bone marrow transplant can help treat people who have leukaemia. He'd like to see more people giving blood, no matter what their blood type. He believes that the reasons people give for not doing it, such as not having time or being scared of needles, can be overcome.

“Just do it,” he says. “If you don’t like needles, look away. It only takes 40 minutes of your time, and you could save someone’s life.”

African Caribbean donors

The NBS needs more African Caribbean donors. Only 1.5% of registered blood and organ donors are from African Caribbean or Asian communities. Body tissue has very specific characteristics, which means that transfusions and transplants are far more likely to be successful when the donor and recipient are of a similar ethnic background.

Rudolph has three children – two sons, aged 17 and 20, and a daughter, 14. He'd be proud if they decided to donate too. “I have no idea what their blood type is, but I’d be happy if they became donors,” he says. “It’s a good thing to do. My oldest son is coming with me next time I go."

Rudolph, whose mum is Jamaican and whose dad is Ghanaian, says: “The way I look at it, someone in your family might need it one day, and it’s you that could save them. You never know what’s around the corner.”

If you're inspired by Rudolph's story, you can find blood donation centres near you.

This interview was given in 2008.

The nursing trailblazer

Nola Ishmael, OBE, is a qualified nurse and health visitor. She was the first black person to become a director of nursing in London and helped shape policy in the Department of Health.

Watch a video of Nola talking about her work as a health visitor and mentor

Nola officially retired from the Department of Health in 2003 but is still busy working with health trusts and charities, as well as mentoring people from BME (black and minority ethnic) communities.

She is passionate about improving health services and has a natural ability to organise and question. “I have always had a tendency to challenge people who ask me to do things that I don't consider fair,” says Nola. "I don’t do it in a rude way, but in a matter-of-fact way, without getting emotional. I’ve been gifted with clear thinking and good English, which has helped me over the years.”

'Breaking down barriers and shifting mindsets is what I aim to do' Nola Ishmael, OBE

Starting out

Nola was born in Barbados and arrived in England when she was 20. She came to study nursing as part of the British government's drive to recruit nurses from abroad.

It was 1963, and she arrived on a grey August day. “It was very exciting,” she says. “I was fascinated by the people and the architecture, but nobody had told me about the smoke coming out of the chimneys. That was strange.”

Nola has happy memories of her nursing training, where she met students from many countries. She initially studied in Hertfordshire and qualified in London in 1972, after a break to get married and have her son and daughter. Over the next few years, she worked as a health visitor and managed community nursing services and clinics in Southwark, London, before aiming higher in 1987.

“I applied for the job of assistant director of nursing in Greenwich, which was unheard of for a black person. This was the 1980s after all,” she says. “I prepared thoroughly for the interview so I’d be relaxed. I even rehearsed how I would sit.”

Nola now teaches such preparation in her mentoring work. “I want BME individuals not to feel overwhelmed by anything that they’re asked to do at a high level,” she says. “I nurture and grow confidence the way other people grow tomatoes.”

Becoming a role model

Nola got the job in Greenwich and later became director of nursing. She created policies, re-organised work systems and adapted the nursing service to meet patients’ changing needs. This included training health visitors who could speak the languages of the local community.

“One year, we trained 12 health visitors who between them could speak French and six Asian languages,” Nola says. “That made a big difference because we had people who could communicate with the population in a meaningful way.”

In 1994, Nola joined the Department of Health, advising on policy, and a year later the chief nursing officer asked Nola to become her private secretary. “I said yes because it was a good career opportunity, but also because it was important for BME nurses to see that one of us could crack that glass ceiling,” she says.

The job involved managing offices in Leeds and London, overseeing projects and keeping fully informed of NHS issues. “I remember one Saturday spending all day in my dressing gown, on the phone, trying to get information on something that had happened that day,” says Nola. “You didn’t decide to wait until Monday.”

After a year, Nola moved to other work in the Department of Health, and oversaw the Mary Seacole awards for 10 years. The award gives funds to nurses, health visitors and midwives to improve health services for the BME community. In 2000, Nola was “overawed and very, very grateful” to receive an OBE for her services to nursing.

Helping others

She feels passionately about sharing her experience and skills with others, especially helping BME individuals to achieve their potential. “The barriers that people think are out in the world are sometimes in their own mind,” she says. “Breaking down these barriers and shifting mindsets is what I aim to do.”

Nola has been aware of racist attitudes from time to time. “Nobody has been overtly rude to me, but I’m not going to say I haven’t seen people look at me as if to say, ‘Who do you think you are?’” she says. "But I can speak up without being rude or losing my dignity. I don’t collude in my own invisibility. I let people know – that might be your perception of me, but it's not mine.”

For Nola, black history month is a time to shine a light on the contributions the BME community makes to society. “This month is one way to say that you, too, are important.”

The A&E surgeon

Dr Tunji Lasoye is a consultant in Accident and Emergency (A&E) at King’s College Hospital, London. He also visits schools to talk about the effects of knife crime.

Watch a video of Tunji Lasoye talking about his work in one of London's busiest A&E departments

Tunji grew up in Nigeria and moved to England in 1992. He first came to King’s in 2000 to do the final part of his specialist training in A&E. He had joined the Royal College of Surgeons in 1997, and chose to use his skills within emergency medicine.

“I enjoyed all aspects of my training, but A&E felt like a natural choice,” says Tunji.

When he realised he was treating victims of stabbings who were not much older than his son, he became interested in educating young people about the effects of knife crime. The youngest person treated for stabbing at King’s in October 2008 was a 14-year-old girl.

“For the last six years, the trend in youngsters getting involved in violence and knife injury has been growing,” he says. “In A&E, we were patching these young people up, but as a parent it struck me, what do these young people know? What does my son know? I just didn’t get what they were thinking, and I didn’t think they knew enough about what a knife can do.”

Answering teenagers' questions

In 2003, Tunji helped the police force produce an educational DVD on the dangers of knives, but he thought young people would benefit from a more personal approach.

“I felt that interaction with a medical person would be more helpful, and the children would be able to ask any questions they wanted,” he says. “I made it known I’d be happy to talk in schools, and that’s how it started.”

The first group Tunji visited consisted of 13- to 15-year-olds. “They knew they could inflict pain with a knife, but didn’t realise that people can die from being stabbed in the leg,” says Tunji. “The life-threatening danger is hitting the big artery in the leg and bleeding to death. There can also be tendon or nerve damage that makes normal function impossible.”

The A&E department also treats victims of gun crime, who tend to be in their late teens or early 20s. Knife crime is affecting younger teens. Tunji uses pictures of knife wounds in his discussions, and he always gets teenagers to talk and ask lots of questions.

The question he is most often asked is how he got to the position he is in today. "This often opens up a discussion about motivation and self-belief," he says.

As well as educating young people, Tunji’s job involves the day-to-day management of the A&E department, teaching medical students and treating patients. “The most rewarding part of my job is the interaction with patients,” he says. “We’re in a position to transform someone who could have died into someone who is able to walk home.”

Becoming a doctor

Tunji always wanted to be a doctor. His mother and extended family raised him after his father died when Tunji was five. His uncle was in medical school at the time and inspired him.

“If you were good with maths and science, which I was, it was natural to apply that to medicine,” says Tunji. “I got my primary medical training at Obafemi Awolowo University, then came to the UK because it was the best place to get surgical qualifications.”

He studied in Hereford for 18 months then moved to Lewisham in London. Tunji was struck most by how peaceful life was. “I thought the UK was a fantastic, peaceful place. The police didn’t carry guns, which seemed strange as in Nigeria we see American films that show police carrying guns,” he says.

During this time, he met up with Mercy, a friend from his Nigerian university days, and they later married. They now have a son and two daughters.

Tackling discrimination

In the UK, Tunji was suddenly part of the minority ethnic community. “I was the only black man on the streets of Hereford,” he says. He was made to feel welcome and has not experienced racism.

“From that point of view, I’m fairly fortunate,” he says. “I cannot pretend there aren’t issues around racial discrimination. Some are overt, some are less so. But I think with education and public awareness, that is changing. People will not generally mind each other because of the colour of their skin.

"The overt, fairly vocal ways of expressing racial discrimination come from a minority.”

He believes self-confidence is an important factor in conquering any kind of discrimination. “If a person has self-esteem and works to be the best they can be, then they’re less likely to get irritated or offended by comments about the colour of their skin. If I meet someone who feels they have been victimised, I try to help them realise that they’re better than they’ve been made to feel.”

Although A&E keeps him very busy, Tunji prioritises any requests from schools for a talk about knives. “Education is so important,” he says. “My hope for the future is a society where we are all at one, with no unnecessary violence.”

This interview was given in 2008.

Keloid scars and hypertrophic scars

Some scars grow lumpy and larger than the wound they are healing. This is called keloid scarring. It can happen to anybody, but is more common in people with dark skin, such as people from African, African-Caribbean and south Indian communities.

The body's tissue naturally heals itself when it is damaged. This healing process can cause scars to appear.

If the skin is broken (for example, by a cut, bite, scratch, burn, acne or piercing), the body produces more of a protein called collagen.

What are keloid scars?

Hypertrophic scars

Hypertrophic scars are another type of raised scar that can also restrict movement.

Unlike keloid scars, they are within the size of the original wound.

Hypertrophic scars can last for several years.

Collagen gathers around the damage and builds up to help the wound seal over. The resulting scar usually fades over time, becoming smoother and less noticeable.

However, some scars don't stop growing. They "invade" the surrounding healthy skin and become bigger than the original wound. These are known as keloid scars.

Some scars become red and raised within the size of the original wound. These are called hypertrophic scars. Find out more about hypertrophic scars.

"A keloid scar is an overgrown scar that can spread outside the original area of skin damage," says Hermione Lawson of the British Skin Foundation. "Keloid scars are shiny and hairless, they're raised above the surrounding skin, and can feel hard and rubbery."

Keloids affect around 10-15% of all wounds. They can appear anywhere on the body, but usually form on the shoulders, head and neck.

They can last for years and sometimes don't form until months or years after the initial injury. New keloid scars are sometimes red or purple. They're not usually painful, but some people feel embarrassed or upset if they think the scar is disfiguring them.

Experts don't fully understand why keloid scarring happens, but these scars are not contagious (they're not catching) and there is no risk of them turning into cancer.

Who gets keloid scars?

Keloid scars can affect anyone, but some people are more likely than others to get them. "People with dark skin get keloids much more easily than people with fairer skin, and it's common in people with black skin," says Lawson. It's thought that keloid scarring may run in families.

Keloid scars can develop after even a very minor injury. "Burns, acne scars and wounds that get infected are particularly likely to form keloids," says Lawson.

"You're at higher risk of getting a keloid scar if you have had one before."

Can I reduce the risk?

You can't stop a keloid happening, but you can avoid any deliberate cuts or breaks in the skin, such as tattoos or piercings, including on the ear lobes.

What is the treatment for keloid scars?

There are several treatments available, but none have been shown to be more effective than others. Treatment can be difficult and isn't always successful. Treatments that may help flatten a keloid include:

• steroid injections
• applying steroid-impregnated tape to the area for 12 hours a day
• applying silicone gel sheeting to the area for several months, although a review of studies found that it is unclear whether this works or not to prevent or treat keloid scars

Other options are:

• freezing early keloids with liquid nitrogen to stop them from growing
• laser treatment to lessen redness (this won't make the scar any smaller)
• surgery to remove the keloid (however, the keloid can grow back and may be larger than before)

If you're bothered by a keloid scar and want help, see your GP.

The sickle cell pioneer

Dr Nicky Thomas is a consultant health psychologist at Guy's and St Thomas’ NHS Foundation Trust, London. She moved to England from Jamaica in 1966 at the age of 12.

Watch a video of Nicky Thomas talking about her work with sickle cell patients

In 1997, she set up the UK’s first adult health psychology service to support people with sickle cell disorder.

Nicky's aim is to help patients and their families live as normal a life as possible. Sickle cell disorder is a chronic (long-term) illness that affects the blood’s ability to carry oxygen around the body. Symptoms include bouts of pain, called a sickle cell crisis, which can need hospital treatment.

She is full of admiration for her patients. “I think people with sickle cell disease are phenomenally resilient and resourceful, and a fantastic group of patients to work with,” says Nicky. "They’re very inspirational.”

As a health psychologist, she encourages patients to make positive changes in their behaviour and how they think about their health and illness. When she joined Guy's and St Thomas’ in 1997, admissions for sickle cell patients were high and their stays in hospital were long.

She found that some patients believed staff didn’t take their health needs seriously and some people's quality of life was suffering. Some believed they could never live a normal life.

“If you live with sickle cell, your life is often interrupted by a crisis,” she says. “You might have to cancel plans such as holidays. School is interrupted and you may feel you can’t achieve. This can lead to the development of anxiety and depression.”

Helping change happen

Nicky and her colleagues use a range of psychological approaches, including cognitive behavioural therapy (CBT), to help patients feel more in control of their lives and their health.

CBT encourages people to identify negative thoughts and behaviour, and to come up with positive ways to change them. Nicky helps patients find ways to cope with their illness and to get involved in a life outside hospital, such as getting work or going to college.

“Today, our patients are holding down jobs, many have children and some are undertaking higher studies. One 50-year-old gentleman has just completed a master's degree in psychology,” says Nicky. “We help people learn a balance between living a normal life and being mindful of their illness, such as coming to hospital for routine screening.”

There are now fewer hospital admissions, and stays are shorter. “When people are admitted because of a crisis, it's often managed quickly and they’re discharged soon after,” says Nicky.

Successful support for patients

She stresses the importance of the team approach. The sickle cell team includes haematologists (blood specialists), nurse specialists, health psychologists and community nurses.

“It's a comprehensive service, and it aims to meet all the patient’s care needs,” says Nicky. The service is highly successful, supporting more than 530 patients, and now includes three health psychologists.

It has also expanded to help people with other blood disorders, such as haemophilia.

Nicky started her NHS career as a nurse, and moved into psychology in her 30s. She feels that her nursing experience enhances her work today, as it helps her understand the practicalities and challenges of life on a ward.

After 12 years as a nurse, she took a break in the 1980s to have her children – she has two daughters and a stepdaughter – and wanted to invigorate her career. “I knew that if I went back to nursing I needed to bring something new to my profession. I felt I wanted to get into psychology,” says Nicky. She did her psychology degree and a PhD while raising her children.

“I guess my philosophy in life is 'no gain without pain'," she says. "Whatever you choose to do, you need to commit to that. Learning never stops. I feel I’m constantly learning.”

Believe in yourself

When it comes to racism, Nicky is forthright. “If I said I’d never experienced racism in my life, that would be a lie,” she says. “Racism comes in all guises, and one way I’ve tried to overcome any sort of racism is to let my work speak for me. When you do good work, it’s difficult for people to keep you down.”

She doesn’t experience overt racism at work, but she knows people in minority communities who have. “My advice is to challenge it in an assertive way and to get support from the structures that are set up to help you do that.”

As well as admiring the patients she works with, Nicky draws inspiration from people in all walks of life, including her grandmother. “My grandmother raised me in Jamaica until I moved to England to join my parents,” says Nicky, who lived in Leeds and Harrogate. “She brought me up to believe I could achieve whatever I wanted, and to believe in myself.”

Sickle cell anaemia

Pamela Gyebi-Ababio, 18 at the time of this interview, from Croydon in South London, has three AS-levels and wants to be a doctor. She also has sickle cell anaemia.

Watch a video of Pamela and her parents talking about sickle cell anaemia

“I’ve known I’ve had sickle cell anaemia for as long as I can remember. I’m determined it won’t stop me enjoying my life or achieving my goals. I did miss a lot of school one year because I was unwell, but I repeated the year and I did AS-levels in Maths, Biology and Chemistry.

A sickle cell crisis

“The main effect of sickle cell anaemia is that I can get a sickle cell (sickling) crisis. My red blood cells, which are sickle-shaped rather than round, get stuck and block the blood flow. Resting, drinking water and keeping warm can help stop a crisis coming on, so I make sure I look after myself.

“Crises come on in different ways. Sometimes I feel pain in my arm, deep in the tissue. Sometimes the pain is in my leg or waist. This is worse, but I can usually deal with it. It feels a bit like electric shocks. I take painkillers and drink lots of water to try to stop it coming on. There are times when it’s too painful to move, and I just have to rest in bed.

“I had crises throughout my childhood and have been hospitalised several times. I love dancing and got into the Royal Ballet School when I was nine, but I couldn’t continue because my health was bad. That was disappointing."

Coping with crisis pain

"I had my most serious crisis when I was 16. I was taken to hospital in an ambulance on Christmas Eve because I had severe pain in my shin bones. It was awful, and I couldn’t put any weight on my legs. I had been experiencing pain there for a few weeks and joked with my friends that I was getting old, but suddenly it got worse.

“In hospital they gave me morphine, and I was allowed home after five days. The pain was caused by sickle cells building up in my bone marrow. For the next few months, the pain was bad. I couldn’t walk without someone to lean on, and I wasn’t able to go to school again until April.

"I made myself learn to use a walking stick, even though I hated it because it made me feel old, and I went to school. Just being there helped. That was the school year I had to repeat, but my school was very supportive.

Missing out

“Friends from church and school came to see me, but there were so many parties that I couldn’t go to. In the end, I asked my friends not to invite me so I wouldn’t know what I was missing. Mostly, all I could do was rest. Sometimes I couldn’t even listen to music as the bass hurt my legs.

“Pain can make me feel frustrated, and I get snappy. Once, in hospital, I asked my little sister to get off the bed, and I didn’t say it in a nice way. It’s not like me. I went to a psychologist to help me deal with the pain. She helped me gain confidence and realise that I need to put my health first. Now if I’m ill I’ll take the day off, whereas before I’d carry on and do my work, which would make me worse."

Blood transfusions

“I started having blood transfusions in April 2007. The idea is to stop my body producing sickle cells.

"Before my first transfusion, I was nervous. I’d seen the ward and knew I’d have a needle in my groin, but they used a local anaesthetic, and I didn’t really feel anything after that. It took about an hour.

“Three or four days after that transfusion, I went on a trip to Hastings with my church and I played football for the first time in two years. It felt so good! I hadn’t been to a park for two years because I’d been unwell, and it was wonderful not to be tired or aching. I felt normal. I felt like me.

“I have transfusions every four weeks through a cannula (a small tube inserted in my arm), and that will continue for two years. Unfortunately, because of the blood transfusions, I now have too much iron in my blood, so I also have to have treatment to reduce that.

“I still have the odd day, or even the odd week, when I feel unwell and have to take it easy. I started getting a crisis during my AS-levels and had to go to school on a crutch, but the school gave me extra time and let me rest in the nurse’s room.

“Luckily none of my three younger sisters has sickle cell anaemia. In the future I’d like to become a doctor and open a health clinic abroad, or be a pathologist and research disease. I haven’t decided yet."