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um, we have another one of our fantastic weapon. I was in the pediatric Siris at this time. It's on a difficult topic, which is female genital mutilation. Um, and I'm joined this evening by doctor Care and ratty on who? I will not introduce herself. Tool. So you guys okay? Thanks so much. Can you guys all see my slides? That all right? Gonna take that as a yes? Um, So, Karen, I'm an foundation. Your one doctor. Still, um, I am really keen. Teo, pursue pediatrics as a specialty in the future. Um, but the reason why I'm here speaking to you about this quite knee specific topic today despite being enough one is because it's something that, um I was quite interested in at med school on a couple of beers for a couple of friends, and I we actually started a society in medical school because we realized that at least our meds will. My kids, which was bombing them, didn't really focus that much on topics such as F g, M or domestic violence century. Safeguarding topics in terms of a clinical approach. So we didn't feel like we like we knew the theoretical things but we didn't really know how we would do with that kind of thing in in our clinical practice as a doctor on. So with that society, our aim was to essentially conduct on sort of teaching sessions and case these discussions and use instagram exceptional to promote medical education on topics such as this. Um, so I ended up doing quite a bit of research on it. Um, on then, we've been doing a research project on the area on about medical education regarding a gym, Which is why I am I've been giving this opportunity to speak to you all today. Um, I am hoping to make this into active. Um, I appreciate it. Obviously not as good as it would be in your life where you guys could ask me questions to space to face. But I'm hoping to interact with the chat. So if I ask some questions or if you guys have any questions, please, please put it in the chat. Um, that's the only way this will work and keep you engaged because I really want to hear what you guys have to see and think. Um, James, do you want to just explain this slide for me because I am not full. Be familiar with start COPD of one of our sponsors, that mind oblique? Um, actually, they are a website that you can sign up to and they have loads of COPD accredited webinars. She can go two hundreds of different things. Wherever you're interested in whether that's medicine. Seeing anyone that's looking to build a professional portfolio, it's only 8 lbs for a year we need to do is scan the QR code that we have there on you will be able to sign up without 50% discount. Okay, but back to you, Thank you. Know what a mess up talk talking about it essentially by, um So I I guess you guys have all seen the topic and I still here today, but I just need to warn everyone that obviously after, um is quite a disturbing topic on on. If anyone don't have any experience with it in the past, it can trigger memories, and it can be a bit distressing. So please feel free to leave and seek appropriate help. If, at any point, any thing in this presentation distresses you, um, I don't mean for any of it to be distressing. Um, it's purely for medical education. But of course, there's always a risk with the talking such as this. So in terms of what we're going to cover, So we're gonna start with some basics about what kept your ms and the types acceptable. And then we're gonna go through AKI's in order to learn how one might approach it in a clinical scenario. So if you were faced with it as a doctor and then at the end, I'll be time for questions and feedback and things like that. So just to start with, um, just for baseline, um, a lot of you may notice, but fgn essentially is a Tom encompassing all procedures involve in partial or total removal off external female genitalia or any other injury to it for non medical reasons. Now, do you guys know how many types we generally us fighting to Just put your answers into the chart? Okay. Just give me a sec of people to respond. I'm getting a three five off the top of my head. I thought it was for no. I got to tell you what they are. Agent agrees with me. Neural reason many Felix does is well, I got quite a few falls coming in. Good. Yeah, I would agree with you. It's also there are four types. Um, and I'll just briefly go through them now. Um uh, and these are the w actually classifications types. There are other organizations that have equally classified FGM in different ways, but this is the most commonly used own system, so type one is the clitoridectomy. So I shown in the picture that's partial, a total removal off the cleansers and the proper use. Type two is known as excision. So that's partially told her mobile off the clitoris on Labia minora, plus or minus the labia majora type three is something called in fibrilation. So this is essentially one off on the gentle offices. Car on the labia are sewn together with a very tiny opening on left for the patient. As you can see in the photo on Type four is essentially just a broad term depend compass. Everything else that can be any other type of cutting. It could be piercings essentially turn on medical. Um, it can be, um, essentially any other so burning, stinging, exceptional. So there's a number of things that can go under that, Um, where's the other theory? Fights versus so in terms of why a practice like this happens, you have any ideas? What might be the reason that it's been happening for so many years and so many communities? What might be the purpose off this practice, and why does it still happen today? So my understanding was that there were some cultures that had it is kind of a religious aspect. I don't know the details. Few coming, few answers coming in tradition. Cultural reasons, uh, cultural stigma regarding cleanliness. Except so so, yeah, I agree with all of those are some of the main ones. Obviously, this isn't a comprehensive list. So one a sexual suppression on off a woman. So with F g m. It essentially causes health consequences in the area such that, um, women acquire less sexual perplexed on it preserves virginity, causes videos, libido, um so essentially suppresses the sexual drive. A woman on sort of enjoy sex is purely for the purpose off childbearing. Essentially, and then this is cycle expectation. So it's in a lot of cultures. It is a vital passage into womanhood. There's a lot of family and community projects for it to happen. Um, which is why it still happens today. So there's families where, um of the mom or dad me feel may not specifically want that kids have it, but with community pressures, it's inevitable on then. I'm like doing said this Religious believes so. It's important to know that it's not actually a practice that's prescribed by any religion in the world or any bars and off it. But religion is often used to back up the practice or off this tradition. So just before I go any further, um, I thought for some of you may be wondering and I certainly did when we bought it has been do it. But why do we need to know any of this living here in the UK practice in the In the energized, it seems like it should be such a fire weight. Off it comes, So why would we need to know it for our clinical practice Unless we were going to a country where it was practiced? Well, um, this was quite a surprise to me. I actually, when I fell, I slipped into this off a couple of years ago. But because off the significant migraine population in the UK, it is a practice that this quite valuable the problem in for us to know about both because there are people who have undergone it as a child were living the UK home such that we need to know about it, to deal with any health care plans. Quinces. Then there's Children who are currently only you go back home to have it. And then there's communities within the UK sort of cluster communities off certain migrant groups where it happens where the actual practice happens inside the UK, So as you can see, there's loads of different sort of articles about it. It happens more in some part of the others are bigger cities like London, but with a higher, vibrant population. As you can imagine, what happens quite frequently that frequently compared to the best, the country on just a statistic, because this quite shocked me when I looked it up. But just within the first order of 2020 there were 860 newly appointed cases. We just quite a staggering number on this, probably several under boys of cases beyond this number um so just to put into context, that's why I'm here, talking to you about this and why we need to know about this, especially as people in just in pediatrics, because the highest percentage of people undergoing after, um, our our Children blow the air to 15. So I'm gonna go through a case study, and then we'll send you the next day or the best of the presentation, um, by the lens of the study. So this isn't based on a real life story. This is just completely made up. It's just to represent some important points about afternoon, That expendable approach. So German has a 14 year old Somali and girl who was wonderful. It to you. The pediatrician by the GP with recurrent UTI is over the past year, GP also mentioned such a Miller's been feeling quite poorly in terms of more recent t. Just no other significant possibility. A history of drug history, only sort of social, a child of history's that she went home Somalia to visit family about a year to year and a half ago when you almost to do a bad combination, which is part of the work up for recurrent UTI is, and it's something that you're trained to do with nutrition. Well, with Gemellus, her mother appear very uncomfortable and seen extremely hesitant. More than what you perceive is almost you're not getting quite worried about Jamala. As for Mom and her sister had a gym in the past. So that's something you've learned from the family history. And you think this might also be your case Now, obviously, I've given a way that you think this might be a keys, but do you guys know what? In this case, history sort of brings alarm bells for why we should be considering after him a suppository, itty just put you on to them the chat as you've been doing because we'll pull out a couple things. Well, people, it's like thing. Oh, no, mean, it's very quick. So going back home with a family trip to Somalia, I think the mood changes with the first thing that I kind of take that problem because I think well from the issue. UTI and low mood, uh, with her and her sister having had it done, Um, people think visiting Somalia UTI is low mood. Um, really good stuff. Does Yeah, I'm just having a look in the chart. That's really good. You guys are covered. Basically, all of it. Really good. Um, so these are the stuff that so I've stuck up to me to the fact that she was, um, one sort of my age group. Um, just from a country where it's practiced a lot. The type of presenting complaint about the mood, the fact that she went home, the fact that she was quite has it been for the examination on the fact that her mom and sister have had it. And now we're gonna unpack all of these, and I'm sort of go to why these things have gone these alarm bells. So, in terms of where mgs of dramas, Coleman, we've sort of given a part of it away with this keys. So the big green globe is not to represent, um, some of the African nations where it's Coleman. So Somalia has over 98% off, um, women and girls under the left? Yeah, just quite a staggering amount. That's almost every single female in the country on other countries that the green represent are places like booty Egypt urge ria on a number of other Is that everything just briefly lost here in the So please bear with us for just a couple minutes. We'll try and get her back. Court. Perfect. So Kirsten says that they can hear you. Lovely. My wife is right. Um, so, yeah, we are, um as people can hear me that I'm I might just So, um, saying and just go back a few seconds. Um, just going through where James practiced. So they're green globe, um, essentially represents for the African nations. So we've set Somali already, but some of the others are Egypt. Urge Djibouti Expect Can you guys guess what the orange but represents? It's a few different countries, but you know where the rate of F G, um is significantly high. And it's one that I didn't expect when I first looked of the topic. Asian countries, Indonesia. Few of the suggestions coming in, uh, India. Another person saying, India, I'm not sure I'm struggling to over and take myself. Yes. I don't know if you can hear me. Um, Asian countries, Indonesia. Quite a few people saying India, um, Middle East China. Well, I see enough Indonesia and, uh um that would be correct. I thought it would be India as well. Um, I guess I want to say that, but yeah, it is actually Indonesia. It's quite a staggering read of FDA. Um, hum most commonly type one and type two, um, as opposed to a lot of the African nations Where type threes, What would be the most common? Oh, okay. So in terms of breast factors, I mean, this is bringing you down to baby six. But being female, being from a country where it's practiced on having a family history with your mom, ways a steal, your grandmother have had it so much that it happens in the family. So in terms of signs and symptoms. So this is sort of initial things when you see a patient that, um But when you see someone that might make you think about yeah, so difficulty walking or standing as you can imagine, it's quite traumatic. So the area we can cause a lot of PT and discomfort on standing long in the bathroom toilet, appearing quiet, anxious or depressed give you quite a traumatizing event, especially given it's a child that's often going through it. Um, acting differently after an absence from school or college. I'm kind of reluctant to go to the doctors or have routine medical examinations on on a force Just playing evidence in the joint examination. Now, while you may think it would be all fears on a gentle examination, okay, Policy is ever on machines with lost care again. Yeah, Yeah, Kevin is just trying to get reconnected. So apologies. Please do bear with us. In the meantime, we'll came into reconnecting. I'm just gonna pop a Lincoln. A chapter on an exception in a couple weeks, Um, which is a webinar with me all about how to accommodate Children and young people with additional needs. Um, so will that be things like down syndrome, autism, uh, learning disabilities or whole white range of issues that can make doing a consultation or having the young people in hospital quite difficult. So I just put the Lincoln, they're going to take a minute, just register that that is on the 31st of March on, but would just be a minute or two full care. Come back. Okay, So here is just gonna try. Hot spotting is her wife. I totally given up um should be with us for sure. Yeah, I can hear you again here. I hope for me I'm the heart at this lights. Can I see it? It's the complications. Like No, not quite coming up for me. If you want to stop sharing on, turn your camera old. Share the slides on mine. Um, and that might just be easier for your wife. I you have We said, like, unsure. Does that come up for years? We were, Yeah. Complications. Yeah, that's great. Just want me look. Yeah. Perfect. Thank you. I'm not sure when I got cut off, something's gonna we go through this one again. Um, but essentially empty. Um, you can imagine Has a number off both short term and long from my phone contact with the physical and mental, huh? So, in terms of short term, will have things like severe pain, hemorrhage, infection. Sort of factor of some of your pelvic bones. Got injury carded. Tissues of things like muscle and fascia on in the most extreme of circumstances can lead to death most often from severe infection or acute average. Um, in terms of long term problems, it can cause in terms of your physical health that can cause recurrent UTI. So, like in this in journalist case on other problems with the urinary tract, it can cause menstrual problems. It can make childbirth very, very difficult. On specifically, um, vaginal childbirth. It can cause sort of cysts on fistula stuff form. It can cause infertility because it could be two things like P i d oh, many times of your mental health. You can cause severe posttraumatic stress disorder PTSD. It can cause depression, and it can go the other sort of psychological problems in relation, um, sex on intimacy. So a number of consequences really on, Which is why we're here discussing this today can it was changed, like great. So in terms of legal status of FDA, um, it has been illegal since on 1985 so a number of years. But there was an F G, um act in 2000 and three, which essentially sort of outlined the consequences for being involved in Afghan practice. Now it This is obviously a summary of the act. There's a lot more that that's their within it. But there are consequences if you are directly involved in performing. Um the active FGM. If you a cyst someone in performing it on themselves if you somehow assist and and being carried out of broad on If you feel to protect a girl one day, Okay, so that could be a separate as a close contact, etcetera on in terms of the jail time, Um, I'm not 100% sure of. This is completely up to date, but it's for the first three on the slide. It's about 14 years and about seven if you feel to protect the goal under your care. So quite a lot of laws and I mean, they seem quite specific. They seem quite easy to follow. Um, you think they would have been a lot of convictions, but actually next light, please break. The first conviction under this act was only in Feb 2090 despite it coming come out in 2000 and three, where women from London was convicted or being look of conducting FGM on her three year old daughter. So despite the laws existing, it often is quite difficult to prove it often happens that home there's a lot of legal purposes involved, a lot of red tape, so it's not. It's not actually as straightforward as it seems. Right? Slightly. So the case continues. Let's get back to that. So eventually Djamila allows you to examine her on. Let's say you can see tier evidence of time. Three after? Yeah, Just to sort of simplify things. What do you do now? So you're a pediatrician. You have this condom of shows 14 or 15 year old girl I've seen here Evidence of FDA. Um, what do you do? Does anyone know what is the next step? Just pull up your incidents. The job. Okay. So I can see that we've lost care and again. But yet, um, do stop posting fruits and suggestions for what we're going to do in this case. Work here and rejoins. Um, Stacey 100 convictions were there, um, so I think what he was saying This is the first one only happened in 20 million team, which obviously six years, six years know 16 years after the law first came into place on then I can see a suggestion from Iniesta refer to safeguarding absolutely trial protection work up from Tracy year's Chart Protective Services report for the police. Yeah, I agree with that. suggestions? Yeah, now, for Adrian has been really interesting. So as an ambulance crew, we would report it to the police on and put in an urgent safeguarding through and report it to the hospital if you transported. Um, so it's really interesting to get perspective from another healthcare professional. So then say these coming and make sure the patient's safe of the priority. Absolutely so any sort of so flooding issues we have our first priority is making sure that we think the patient is safe. And then we're going to raise our safeguarding concerns. Uh, the necessaries that tree has required informed police mashed. So for those that don't know, that's a multi agency safeguarding hub referral, which I know they do in the West Midlands safeguarding feelings are saying it's Section 47 which is a removal of a child from the home. They're all really good suggestions, guys. No, and that's a really interesting question from Dylan's. I would safeguarding already be aware of the family as the sisters have fgm? Well, uh, justice said, maybe get some comes involvement, so I'll have to run some of these by care. And how confident would one of you beat with where you work or where you study actually going through the process of reporting this and would, you know, kind of who to tell. So I know very cause we have paramedics, pas, doctors, nurses, NP's etcetera. But we never run. Know exactly who they would need to speak to, how they would go about filling up this safeguarding paperwork. So, Kevin safeguarding lead? Absolutely. Your your trust should have sound a whole panel of people that are in charge that you can escalate this stuff to be experts, and they would have contacted you to take you through it. You know, it's like I don't think anyone would know much about where I lived. I think there's more training available in more diverse communities. That's really interesting. Actually, I found when I was a student, actually that basically the doctors that new most about it were GPS or hospital doctors practicing in areas with your much more diverse community where they saw all this stuff more frequently. Um, major thing. Yes, he knows what to do. Which is not surprising given his previous coming about, uh, what he would do as part ambulance crew. Um, yet running it by a pediatric consultant or the safe one, and it's always a good idea. They're a good source of knowledge. Uh, nothing that go feelings is saying, working in Children's eating with a single front door and 24 hour access to general pediatrics. He would be fine with moving this forward, insuring the child safety. Excellent. It's really good stuff, and I'll see if I can keep down so a little. We're waiting for care, and I'm gonna do my best to take you guys through some of the slides. Um, we can always catch up with her and a bit of a white house them totally down. So mandatory reporting duty, which has been in place, is October 2015. That's, um, for any regulated professional eso That's health care, professional social carrier teachers. We don't because anyone we could have safeguarding responsibilities is part of the job. They have to report this any concerns And Children 18. Hi. Are you back here in? I'm so sorry. Suggestions? Remember one coming in. I've got some of them. They're really good on. It was a really interesting question. I just want to run past Yeah. So what safeguarding. Likely already be aware of the family because of the sisters having had f g m previously. That is a very good question. Something I did not think of when I made up this case on. Yeah, probably. So, um, you would still have to be before this with the manager. You're pointing, but you're right. It's less likely to have been able to happen if they were where argument say that. Say that they only found out recently that the family no was fighting it. Kind of kind of. If they are, know that may be the, you know, it's just it's have it done when they lived in another country. Um, well, that it went unreported. Exactly. Haven't presented for help, so yeah, but yeah, you're right. So in that to know, they would like to be normal. Safeguarding. Um, it's a very good point. Um, we have time. So much for taking over, um, during my because I wasn't doing a particularly good job, so you might want to go over the mandatory reporting juice. Okay, So, essentially, I heard of it. But since October 2015 for all regulated professionals. So whether that doctors, nurses social can teachers, except there's a long list. But, I mean, tell therapy sessions All I'm under it. Um, there we have a duty to if we see after, um, as a result of examination or if someone under the age of 18 directly discloses to us that they undergo this procedure, we have a duty to fall of this magnitude reporting. Um, and I'll tell you exactly what it involves in the next couple of slides. But essentially, a failure to comply with it is a bit Mr Practice issue. So this is a legal beauty. Go to That's lighting. Great. I'm gonna talk you through exactly what you need to do, because, I mean, I've heard of this man here a boarding duty. But people tell you these things, and don't really tell you what you need to do with it. So you want a telephone? 11. Oh, one. So that's currently the normal. It sounds like your foot lost hearing you again. Um, actually, how we would go about doing are mandatory reporting. Um, so you call 101 in the UK, which I'm sure many of you know is are non emergency crime number um on what parents put here is that we explain that we're making a report under the F G M. Mandatory reporting duty. Um, so that's you know, that's a specific things that we need to say. And we're going to give our detail. So our name have to get hold of us, you know? What role are we? You know, we worked the ambulance service were doctor, except your where we work. Details of the organization, safe burning, lead patients, details and name, age date, birth address on what it is that made us, um, make the report so you could see it might be that they disclose something to it. It might be that we've examined a young person or a may just be that kind of, you know, we suspect it based on some of the things we talked about earlier. So we might be seeing a young person with mood changes from that she's in the bathroom. Or often, that's really, you know, not wanting to be examined. Um, on, like with a lot of our reporting, the safeguarding, we want to do it soon as possible. Um, because you know, it's fresh in our head will get all the details. Right? Because we don't. You know, we don't wanna We don't miss represent something important. Like, Listen, we want to get the ball rolling as soon as person. That's possible on then. Another really important thing that there is, but here is that it's a personal duty. So if you're the one that took the disclosure or examined the young person, you can't just say to, you know, the next doctor, uh, next nurse to come on, shipped out. By the way, I saw a young person. I think that, um, earlier, can you just report it for me? It is your responsibility. You're the one that has the duty and the mandatory reporting to get that done. Okay, So what's the reports that using that crime number, we can also discuss it with a local safeguarding league, which is something lots of you all said you were doing a chat. That's excellent. Um, we're going to see, you know, are there any other safeguarding actions required? So I know one or two of you were saying, you know, make the young personal child safe. Um, but, you know, they are in a family. We think, actually that having been uncovered, they might be lucky to be taken outside the UK and then like the abuse. Other reasons we might be worried about the safety so you could discuss that with your safeguarding lead and then the next step, which is really important to make a record of your findings. So a few months ago, we did a safeguarding talk where we talked about how important it was it without documentation. Um, so with this reporting, like birth stuff that you write down, maybe later relied on in court. So it's really important that your fines accurate. You need to say what you did. You need the time, the police reference number, the justification of what you did. Because it may be, you know, six months down the line a year down the line, they will be pulling up a photocopy of that report that you wrote and trying to either, you know, convict someone or putting in order to protect a young person. So it's really, really important that we make our about documentation accurate. You know, we even do sketches a queen body map to be trying to represent something on the young person and then four. So I discussed with the family and child. So generally with any again with any safeguarding prefer that we make it is it is important that we discuss it with the family so long as we don't think that me telling a child's parents or KERA Oh, I had to put in this safeguarding concern because of X y Z that that might lead to some harm of the child. So instead, if that was the case, we would go and talk to our safeguarding lease. We may look at admitting person's one of the pediatric woods, and then we would discuss it with the family. So we make them say first, and then we come and discuss it with family. So you need to tell him that we're making the report. Um, it should be, you know, we want to be telling them in a timely manner. We want to let them know what's going on. There are patient information. Leaflets will help you as the doctor or health care professional having this conversation, but also really useful for the family if they you know, because they might not take all of this. Anyone go be quite stressful conversation, I'm sure lots of your found as healthcare One delivering this off or any sort of bad news. Um, people don't take everything in one. So, actually, having something you can refer back to is really useful. I mean, I mean, I know what you eat and you're joining us, but it, uh are you on it? Turned off my camera. It helps. Well, can you hear me? So I've just gone through your steps. Credit report into that. If you want to take over from Thank you. Here. Um, I'll try. I really don't know if this going to go out on me again. Try. Oh, I'm really sorry, you guys Okay? So once you've done the basic reporting, essentially what happens after that is that there's an assessment of the case, like without a safeguard in cases of the multi agency team, Um, for a meeting that convenient to that includes your healthcare professionals, police, social care, azelas, anyone else that's relevant in that particular case. So in terms of health care professionals so that this is even more relevant to peed. So because this manager reporting is for Children on the under the age of 18. A pediatrician then has to leave the assessment on the health needs, so that can include with world for genital examination, a general health assessment treatment under fourth or any health needs that identified on assessment for any additional see fighting concerns that might be there. Next light, please. So just before moves the next flight. Jess. It is not a question that links in something that used it. So what is the protocol for first time presentation of someone that's over 18? I am coming to that, like two sides. I will be going through it, Um, and then in terms of, apart from healthcare, just good to be aware of what everyone else is sort of doing so social. Can police develop on appropriate pathway, so they use protection orders? Um, sort of look at what are the safeguarding response is required, whether there's any safeguarding that's needed for any family, out of business or any other criminal investigations except us today. Look into that thing. So it's sort of a holistic assessment involving both help, couple and police and social can needs and the next slide. So this is just best of a guide a flow chart. I'm not expecting you to read it on the slide, of course, but it's just to know what it looks like if you ever wanted to look further into the manager reporting duty and it's by the Department of Health, and it's really useful to sort of guide exactly when it applies and when it does in and what you need to do. Um, so it's just a useful tool to be around. Oh, is that readily available? Kind of on the Internet or Internet? Yes, where you just search up at your manager appointing interesting gland. It's It's sort of like the first thing that comes up. Uh huh. So now we're coming to what? This doesn't apply to go people. Anyone over the age of 18 who disclose that they've had a gym or if you identified her and someone over the age of 18 apparent then discuss, is that the child is after, Um, if you think the goal might have had it, but you're not able to see signs of symptoms on day. Haven't disclosed it on if obviously that's already been reported these cases. So you're local regarding lead on follow local safe that so it sort of dependent. So in terms of in over 18, it depends on if they're presenting with the colon that's directly linked to it. Or if you're seeing it in like an obstetric something, for example, with a complicated vaginal delivery, whether it to see guarding issue at the time or if it's just that you're seeing consequences years later off something that happened in the past where it's no longer safe guarding issue. Um, but then you just have to be aware of the health consequences and of what? Which is what we went through on those before. I understand why Jaime treated the same way they would be otherwise. So, for example, recurring UTI The street address recurring UTI is and you go through the same procedures. But But in obstetrics, I think it's all the more relevant. So they've got specific political for women who want to go on FGM. But I'm not going to go through that in detail just because I want to focus, but one the peed side of it and sort of initial reporting, and I just don't think I'm quite put the knowledge to go through on the details of obstetrics. But there's loads of resources on that, Um, which I'll highlight at the end if you want to look into that kind of thing. But I would just consult your local safeguarding heat. And if you're worried about someone over the age of 18 next, okay, so obviously, we've been through F g M. And we've been to all of the legal stuff. But I just thought I should touch on, um, actually having this consultation with this trial and the parent, um on like, um, well, it was James really? Who explained it earlier about when you're trying to speak to the family about it. It's a very difficult conversation to navigate because it's a very sensitive subject and it's sort of in grade and people's tradition and families. So language is really, really important. Um, now the use of the word victim with the survivor, it sort of never ending to be, and it can be really tricky, but a good tip. It's just sort of use use what the person who's undergoing it or the family member is using. So that's how they identify themselves. And if you use that, it's harder to go wrong where you put the label on the reason why you think they are. Then people can get offended. Oh, no. This is obviously easy for me to see. It's harder and actually clinical practice, but it's just a good guide. Um, again using sort of the times that the patient used to describe what's happened, trying not to use sort of judgmental or extreme terms of things like barbaric or hateful. Even if that may be how you view it, you might end up alienating offending the patient. And then there's just less likely to trust you. Um, I'm trusted key in this scenario. You want to be firm but sensitive in the conversations. You have to explain to them very clearly that these protocols or what you need to follow on this is for their safety, but at the same time, be sensitive about how you approach it on. Try not to be too intrusive. So while we do need to know what what happened and you do need some details, you don't need to ask for every single detail about the event because, okay, the patient under their family member is at risk of being reach or my ties. So it's really important to remember that nights like so obviously happened to a single case, and that's one of the ways it might present. But this is just sort of a cup. You different other ways you might encounter doing technical practice. Um, so I'll just give you guys a second to breathe, would. But it's just a few examples, so sort of highlights situations in which your mind should be considering after young as a possibility and therefore looking into it. So that could be The family wants to take a family where you have no one family history. Bactrim was going home to visit relatives. Um, someone with recurring UTI is. And if you have a country of origin again, obviously, a lot of these are based on generalizations. But it's less that these means that the person is after, um, But it's more that give these back to the president is just something that should be in the back of your mind when you're looking into the cases well, next life and these are just couple of resources. If you guys were interested in looking at this topic a bit more, but there's a really great learning program on on after, um, on the learning for healthcare. Um, sort of website. It's like a more do is not very long at all. It's quite lengthy oriented and it's it's just a good training platform toe of look into what I've spoken to you about in a bit more detail on. Have a few more cases, few more examples and think so. If you're interested, that's a good place to start. And then there's loads of resource than guidance in the UK government website on the RC PCH website on the MRC. Oh geez, that's often Gardening website. There's just loads of cases where you can go to the gun information, but these are sort of more. But this learning platform is targeted at healthcare professionals. That's a good place for us to start. Bye. Well, that's it. I think this record should connect the divide it by phone, but there's a link. I've just seen James Post in the chart. I know this has been a bit sort of, Yeah, lovely walking with the wife. I problems. So I apologize again about that, but it was out of my control little bit, but I hope this has been helpful and useful to you. I would really, really appreciate the feedback. Um, just to guide any future sessions I given this, um, a little break. Um, on. I am very glad to answer any questions that you guys might have. What? To try it all into them or case we get you to the rite sources. Yeah. Please pop many questions in the chat. Okay, So thank you has been great. Quick question wise. Manager reporting. Not necessary. If the mother discloses, uh, her daughter has had fgm Really good question. Something I thought about before and looked into. But I think essentially mandatory reporting is very sort of very specific thing that encompasses a very small sets of scenarios. Um, on it. The reason why it doesn't encompass a mother disclosing it or any other way that you find out that a person has a gym is likely because there's other safeguarding said measures in those cases. And if a mother does disclose that the daughters have gym, then in that case you would try and sort of speak to the child about it, or try and examine them if they're able to or refer them for the appropriate examination. Such that then that can go on to be a manager reporting duty. Um, on. It's tricky because if a mom is disclosing, then you've also got to think about how, If she has let this happen, then you're thinking about the legal consequences for the mom. So it the whole thing becomes a lot more complex, which is why they made the man she reporting. So it's simplified and relevant, only certain scenarios. But you're right. I mean, it's not that it's not that you ignore if, um, um or a family member disclose it and start that the procedure is not as straightforward in terms of I'm going straight to the police. I mean, you can still follow safeguarding policies and investigated further. It's just not a straight call under that, particular because I believe is, well, it can affect, um, visas and immigration status counter. So if you leave the country and assist someone with having actually himself, you could not be allowed back into the country. Yeah, because that comes out that they're a stressful of Are you tract outside the country s So it just gets really complicated. Um hum and you fill out the feet that we didn't read it more We do. Look at it. We're hoping to kind of have a look at some of the data from this big back and maybe do some research to see how well this topic is taught, uh, by UPS. And also how well this topic is taught medical school, nursing, school, hospital induction. Just to see whether it's something that perhaps need more attention or we can improve on. So do take five minutes. Fill out. You will get a scientific A Thank you, Felix. I can see that, he said. He's completely feedback. Awesome. Uh, I do sign up. Who? Our next weapon on two weeks on. It's already on metal. I'll make a Facebook event over the weekend. Thank you very much for joining us. Thank you for your talk here. It was really interesting on the island locks, uh, giving me this opportunity. And thanks so much for attending and bearing with my wife trouble. We'll leave it there, and I will have a ways to treat the stuff uploaded to go to YouTube and mud. Meddle in the next couple of days. Okay,