Nicole had completed her PhD and was on the brink of starting her dream job in the UK. But when she was threatened with deportation, her anxiety spiralled. Waiting for her immigration appeal, and with no GP to turn to, she became reliant on strangers to give her their leftover medication.

Robin Hood did it again in February 2020.

I received another bulging brown envelope through my letter box, filled with many blister packs of sertraline, the selective serotonin reuptake inhibitor (SSRI) I’ve been taking for the past three years for my anxiety.

“Thank you soooo much [redacted name]. You’re an absolute lifesaver. I’m so grateful,” I texted. Seconds later: “So happy to have been of help.”

This had been our routine over the past five months.

As a person raised by healthcare professionals, who drummed good clinical practice into me from childhood, and as a scientist who has undergone every ethics and integrity training possible for healthcare research, I am aware that by accepting this medication I stepped into a grey area. But I believe I had little choice.

My anxiety has refused to let go of me. It has been firmly rooted from my earliest memories, and has travelled with me through time and across continents.

My anxiety has refused to let go of me. It has been firmly rooted from my earliest memories, and has travelled with me through time and across continents. Trying as hard as possible to ignore it only led to deeper shame and self-stigmatisation. Self-help books brought me temporary relief, and adopting a defiant openness as an optimistic mental health advocate eased the pressure.

My hyper-awareness and research skills led me down a rabbit hole of self-diagnosis, so that when I received an official clinical diagnosis, I wasn’t shocked in the least. The years of deciding to seek medical help and actually doing it were 2016 and 2017, blurring into each other as I dealt with the grief of my father’s death and the realisation that in spite of finishing a PhD in immunology, this field just wasn’t for me.

“Towards the end of 2019 I tweeted about my frustrations and my lack of NHS access... someone aware of my mental health history reached out to me and, unprompted, promised to send me some medication.”

Drug sharing in desperate times

The doctor and I agreed that I would try out a digital self-help platform first. Shortly after, I requested medication. Long gone, at this point, were my early-adult fears of ‘having’ to go on medication. “Let’s start with the lowest dose… 50 milligrams,” said the doctor.  

Two weeks in, I remember walking around wondering if this was the state of calm and togetherness those without mental health struggles were blessed with in their daily lives. It is hard to put into words the feeling of “the edge being taken off”. It could be the disappearance of the lump in your throat, or your reflux dissipating. Your lower back feeling less tight, or your sciatica easing. It is a feeling firmly lodged in your mind that you have a chance of moving past survival into actually living. It is a tangible hope.

I had had the privilege of paying just under £9 for a two-month supply of my prescription over a roughly two-year period. Things changed abruptly in August 2019. My spirits were high, as I had just come out of a temporary post as a laboratory technician and was finally moving into a permanent dream job where my role would be student-facing. 

Then my visa was denied by the UK Home Office, and things quickly spiralled. I was informed that I would be deported, so I had no legal right to work, and could be charged for healthcare services. The health surcharge I had paid was automatically returned to my bank account, and concurrently, my job contract was rescinded. 

While I sought legal counsel, I was advised to lie low – both by my legal team, and by my anxiety. My digital footprint would argue otherwise, but in real life I took this advice on board. With my passport being held by the Home Office, I had no legal identification on me. 

Incidentally, I had already made plans to move to a new house in September 2019 in order to be closer to what would have been my new place of work. This meant that I moved away from the doctor’s surgery I had been registered with for over a year. So I was not registered with a doctor’s office close to my new residence, and was scared to even attempt registration because of my confusion around data-sharing between the NHS and the Home Office.

“This Robin Hood gathered 12 weeks’ worth of sertraline, lovingly wrapped and delivered through my letter box.”

The hypervigilance, both internally and externally, started. I was aware of every itch and cramp. I started having more contact dermatitis flare-ups. Suddenly I was getting, or feeling, ill with an alarming frequency. Being aware of psychosomatic illness in my logical mind didn’t stop the physical symptoms. But then I realised that I would no longer have access to my sertraline prescriptions.

I now accept that I could have probably tried to get myself registered at a doctor’s office, or at least scoped the scene on what it would take for a person caught up in the immigration system to be able to access the medication they need. Simply put, at that time I was not thinking clearly. I was overwhelmed and scared by the knowledge that the hostile environment turns so many service providers into border guards.

The hostile environment, as defined by the Joint Council for the Welfare of Immigrants (JCWI), is “a set of policies introduced in 2012 by then-Home Secretary Theresa May, with the aim of making life unbearably difficult in the UK for those who cannot show the right paperwork”. 

The JCWI further explains how the hostile environment impacts the most basic of activities in everyday life: “…the government set about trying to cut undocumented migrants off from using fundamental services including the NHS and the police, and make it illegal to work, or for a landlord to rent them a property. Doctors, landlords, police officers and teachers are tasked with checking immigration status, and often people who look or sound ‘foreign’ are asked to show their papers in order to rent a home or get medical treatment.” 

When for months I was paranoid that patrol cars driving past my neighbourhood were keeping an eye on me, I preferred to take my chances without seeing a doctor. I am so grateful for my friends and family, who would take it in turns to stay on the phone with me through panic attacks and terrible anxious periods, and for the new lawyer, who’d only just taken on my case, who would call me to persuade me that I was indeed safe. 

I still had no clue what I would do when my medication ran out. On at least two occasions I’d stupidly tried to ration them, resulting in intense suicidal ideation. 

“In the months since, I have received small packages from different friends of my Robin Hood, all of whom are donating their sertraline to me.”

Towards the end of 2019 I tweeted about my frustrations and my lack of NHS access. Shortly thereafter, someone aware of my mental health history reached out to me and, unprompted, promised to send me some medication.

This Robin Hood gathered 12 weeks’ worth of sertraline, lovingly wrapped and delivered through my letter box. Robin Hood gathered this stock from their friends who ‘donated’ their half-used blister packs. In the months since, I have received small packages from different friends of my Robin Hood, all of whom are donating their sertraline to me. 

At least one has also come with a letter of solidarity, which I will keep for ever. Yes, this is indeed an ethical grey area, but I truly need this medication and cannot imagine how I would’ve coped without it in my precarity. 

Research from early 2019 carried out on adult New Zealanders shows that difficulty in accessing medication is one of the factors leading to “lending/borrowing” prescription medication, for their intended therapeutic usage. This research highlights that sharing can have adverse effects such as allergic reactions, but the researchers’ focus was on interrogating risk factors that place individuals in the position where they need to obtain prescription medication this way in the first place.

Of the 232 respondents, 55.6 per cent reported that they had “borrowed” prescription medication from someone else, while 45.9 per cent reported that they had “lent” prescription medication. The most commonly borrowed prescription medications were painkillers, allergy medicines, asthma medications and antibiotics.

The issues of access underpinning this borrowing behaviour, which have been previously described, include not being able to afford a doctor’s fee. These studies, led by Dr Kebede Beyene, serve to evidence an intuitive notion: those of us who need medication and simply cannot access it are likely to ask for it or accept it from those who are willing to give it to us.

Beyene and colleagues further get to the heart of the matter, stating that it isn’t enough to only improve access to medications: the structural barriers within healthcare must also be addressed.

“Those of us who need medication and simply cannot access it are likely to accept it from those who are willing to give it to us. It isn’t enough to only improve access to medications: the structural barriers within healthcare must also be addressed.”

We are currently in a global pandemic. The implications are critical for those who already exist on the margins in this context of healthcare access. Social justice includes improving access to healthcare, optimising healthcare systems, and providing better working conditions for healthcare workers.

When my Robin Hood sent me my February 2020 batch, I was shocked to find a five-month supply. I commented that I hoped within a five-month period I would be able to have my situation sorted out, choosing to believe I would finally be able to see a doctor again.

Neither of us could have known that mere weeks later, global healthcare systems would be focused on Covid-19, and there would be a series of lockdowns. Unfortunately, I would have to ask for more medication because I was still waiting for resolution. Each time I asked, I hoped it would be the last. 

The anticipation I had when my appeal was listed for the last quarter of 2020 got dashed when the appeal had to be adjourned for reasons beyond my control. This means that I am once again waiting for a date to be listed.

I know that with the current state of things, it may take a while for me to access healthcare. I also recognise that continuing to borrow medication is not sustainable, and I will need to register at a GP surgery soon. However, I am grateful for the kindness that has been shown to me and appreciate that my Robin Hood has bought me time to figure things out until I gain some stability.

Nicole (not her real name) is a precarious migrant who has been caught in the hostile environment for a number of years. She is a mental health activist currently involved in various tasks that support migrants and other marginalised individuals.

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Nicole

Author

Thomas is a London-based photographer working for Wellcome. He thrives when collaborating on projects and visual stories. He hails from Italy via the North-east of England.  

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Thomas SG Farnetti

Thomas S G Farnetti

Photographer

Article

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When Nicole was threatened with deportation, her mental health deteriorated. Now without a job, a passport or a doctor, she depends on others to send her their leftover anxiety drugs.

Writer David Jesudason traces the stories behind the marks on his body, from healed acne, a large birthmark, and scars from racist attacks. Most are sources of sadness and anger, bringing memories of isolation and self-consciousness, but one scar is a symbol of happiness and hope for the future.

In ‘The Mirror’, Charles Baudelaire asks, “Why do you look at yourself in the glass, since the sight of your reflection can only be painful to you?” Unlike the ugly man in Baudelaire’s poem, I have no answer and yet I still look. I don’t see beauty in my reflection. I see the marks of racist attacks, traumatic memories and a life spent hiding in the shadows. 

My mirror shows a lifetime of scars – some from birth, some from childhood and some still raw. Growing up in a small, white-dominated town already marked me out, as I was the only person of colour at school. My parents’ immigrant faith in British fairness and tolerance was at odds with the reality I found in the classroom, playground and street. 

Their world view didn’t shift even when I came home crying from primary school after being kicked and punched for looking different. They didn’t want to hear about the vile racism, and so the pain was internalised. 

A scar on my cheek from where my face hit the ground was the only visible sign of a troubled life. Inside, feelings of anger, sadness and depression swirled and were often triggered whenever I glanced at this scar, etched on my face like a marooned tear.

Dark skin tends to scar easily and be prone to hyperpigmentation. There’s also a higher likelihood of having scars from birth. While the tear mark on my face was the first scar that was visible to others, the worst remained covered up for years.

Seeing these images for the first time was quite a paradox. I initially found them distasteful and triggering, but when I worked through my emotions I could see their beauty.

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Written on my body

My birthmark covers the lower half of my stomach with a large brown ‘splatter’-like blemish due to trapped pigmentation. Birthmarks like this were named the ‘Mongolian spot’ by German physician Erwin Bälz over a hundred years ago. Still calling it a ‘Mongolian spot’ today is perverse, as it’s common in groups of people who aren’t of Mongolian origin – I’m of Malaysian and Indian heritage. 

I particularly detested this birthmark when I was younger and hated having to explain it to anyone who saw me unclothed. It’s why I hated swimming, gyms and beaches. It’s why I spent my youth sexually frustrated.

As I type, I glance at my left hand. A small line marks the web of skin between thumb and forefinger and protrudes slightly. Touching it transports me back to my very first memory, one that is imbued with nostalgia and pain in equal measure. 

I am roughly the same age that my daughter is now and full of the wonder the world contains when you’re only four years old. I want to help my mum, and so I carry a milk bottle proudly into the house. The bottle smashes, I pick up a shard and the memory ends.

The scar the shard made is a physical link to this memory and, caressing it, I can instantly feel the same shame I felt as a pre-schooler who had spilt milk. I often touch it when I feel anxious about letting people down or when I’m overcome by a sense of “doing wrong”.

By removing the context of the scarring, the photos feel like an alien terrain to me. I didn't instantly recognise them, and find them enigmatic. I never would have thought something so painful could be so artful.

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I also touch this part of my hand when I worry about my daughter. I’m scared that her light-brown skin will be marked like mine but, worst of all, I fret about how her physical pain will manifest. I want to scream when she picks up a glass bottle, but I know she has to experience the world on her terms and learn to be resilient when trauma inevitably arrives.

Because of her I’ve read a lot of parenting books, including many that claim being a toddler is like being a teenager. However, it was during my teenage years that I started to learn to be resilient – I left home at 16, recovered from acne and wasn’t overly fazed by the scars it left behind. 

The marks around my face eventually disappeared. A feeling of loneliness remained, though, as friends went on holidays without their parents for the first time and I made up excuses not to follow them, worried that the sun would make all my remaining scars worse.

Holidays were never fun, as my mum and dad were convinced that sun cream was a Western thing. Playing cricket once, I came home burned and the scars looked worse, like they were now seared on. 

Our family doctor was untrained in dealing with dark skin, and I remember him being taken aback seeing evidence that I could tan or burn. He said I should try treating my scars with olive oil. Research at the time had been skewed towards white skin and we were his only brown patients. I kept persevering with olive oil and, in those pre-internet days, convinced myself I just had to find the right brand.

Franklyn Rodgers has eerily captured what it feels like for me to look into a mirror. There's so much trauma associated with my skin that I cannot see what I really look like.

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Eventually I gave up trying to heal the unhealable. I was a man with scars and I embraced this with a confidence that would ebb and flow depending on my mental health. However, moving to more cosmopolitan areas didn’t mean the fights and racism stopped. 

In fact, ten years ago I was attacked brutally and punched in my eye by a teenager. The surgery left me with a ringed mark around my eyelid, another stark reminder of how violence has blighted my life and the recurring unfairness of it – no arrests were made. The wound now is a relic to racism, a reminder that prejudice leaves its victims with physical and mental scars.

Is it possible to be like Baudelaire’s anti-hero and feel beautiful despite evidence to the contrary? I don’t think so, but there’s one scar I have that I can look at without distaste. It requires two mirrors to see, as it’s on my back, the result of surgery I had after suffering a back injury. The reason I don’t find this memory painful is because the operation was undertaken just before my daughter was born, and it reminds me of all the joy she has brought me. 

She and I might scar more easily than most, but we experience life together, sharing any pain not with the mirror but with each other. I may be marked by the traumas I’ve experienced throughout my life, but she is the physical representation of all the joy I have and can look forward to.

David Jesudason is a freelance journalist writing for national newspapers including the Guardian and Independent. He also covers film and TV for BBC Culture, music for Kerrang! and green issues for Wicked Leeks.

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David Jesudason

@DavidJesudason on Twitter

Franklyn Rodgers is an artist and creative director whose work explores innovative approaches to re-examining the portrait in contemporary visual culture. His work not only investigates portraiture through narrative, content and context, but also how their placement can open new dialogues in challenging the idea of representation within the language of photography. He has exhibited internationally and his work is held in collections at Tate Britain, ABP and the National Portrait Gallery.

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Franklyn Rodgers

franklynrodgers.com

@franklynrodgerscreates on Instagram

Artist

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Scars mean David Jesudason has never enjoyed seeing his reflection. Recounting the stories behind the marks on his face and body, he finds the only one that symbolises hope and happiness.

Ruby Elliot, also known as Rubyetc, is a cartoonist, illustrator and author who draws about sad things in a funny way and vice versa. She has been published in print (The New York Times, Random House, Orion) online (BBC, Tate Galleries, The New Yorker, Time To Change) and her mum's fridge (The Kitchen). She also runs popular drawing workshops for people of all ages and abilities, in educational settings and beyond. She takes silliness very seriously.

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Ruby Elliot

RubyElliot

Rubyetc on Instagram

Illustrator

Comic

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Ruby Elliot Rubyetc

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A web comic series on our love/ hate relationship with food.

Rubyetc

Weight

Historically, prostitution has been punished, sometimes tolerated and only rarely accepted in society. The stories around sex work have been told mostly by researchers, artists and other academics. But today, mapping the different ways in which sex work has been perceived helps us to understand, and to look beyond stigma.

Agnese Reginaldo is an art historian whose work focuses on the intersection between art and social sciences. Her practice focuses on public-engagement projects aiming to create a more effective connection between the public and contemporary art in museum and gallery settings.

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Agnese Reginaldo

In pictures

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A man tugged one way by a prostitute and the other way by a religious lady

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Discover how societies, from antiquity to the present day, have chosen to regard and treat sex workers. While some communities work towards acceptance, others retain harsh judgement.

Sex work through the ages

14 to 19-year-olds

Join us for this discussion on young people’s approaches to mental health, wellbeing and self-care in the time of Covid-19. Facilitators Alain ‘Fusion’ Clapham and Grace Gatera will host a live discussion based on videos of youth mental health research and linked creative projects, which will be shown during the event. On the panel will also be five RawMinds ambassadors, to provide the perspective of young people.

This event will discuss the work of Wellcome's mental health priority area, which seeks to transform how we understand, fund, prevent and treat anxiety and depression in young people. You will also find out more about the Covid Living project from creative producer Tim Partridge, poet Koleka Putuma and illustrator Ivyy Chen, which explored how young people were coping with lockdown in April to June 2020. At the end of the event there will be an opportunity for questions and discussion. 

This event will be hosted through the videoconferencing platform BlueJeans. After booking a ticket, you will receive a confirmation email with joining instructions. Questions can be submitted in advance using Slido, and you will be able to comment and ask questions live online using the chat function throughout the event. Your microphone and camera will be switched off for the whole session.

Alain is an experienced educator, creative producer and a lead facilitator for YouTube. He empowers thousands of young people to better navigate the digital landscape – while also helping award-winning CEOs discover their own stories of transformation. Alain is founder of @BMTstories – an immersive live and online experience celebrating the ‘awesome everyday’ stories of black men and women. 

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Alain ‘Fusion’ Clapham

@BMTstories

Facilitator

Grace is a lived-experience mental health advocate living in Kigali, Rwanda. She works with Wellcome’s mental health priority area (MHPA) as a lived-experience expert adviser, and is also part of their strategic advisory board.

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Grace Gatera

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Young People, Mental Health and Recipes for Self-care - Alain 'Fusion' Clapham

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This event will have live speech-to-text transcription, which may be useful for people who are D/deaf or hard of hearing. For any assistance, please email us at access@wellcomecollection.org or call 020 7611 2222.

Speech-to-text (online)

Booking a ticket guarantees you entry to the online event. You will be given joining instructions in your confirmation email. If you have any access requests or requirements, for example a transcript of the event, email us at access@wellcomecollection.org or call 020 7611 2222.

Guaranteed (online)

Join us for this discussion on young people’s approaches to mental health, wellbeing and self-care in the time of Covid-19.

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This series of events explores how young people have experienced Covid-19 and lockdown so far, putting their voices at the centre of the discussion.

What Does It Mean To Be Young, Now?

Young People, Mental Health and Recipes for Self-care

Join poet, writer and researcher Jamie Hale and five fellow disabled artists for this online conversation.

They will reflect on their different experiences and practices, and ask what it means to be a D/deaf or disabled artist in a pandemic.

The artists will talk for 45 minutes, and then there will be 15 minutes of questions and answers.

You will be able to watch this event on Wellcome Collection’s YouTube channel, and submit questions in advance or during the event using Slido. Your microphone and camera will not be on. After booking a ticket you will receive an email with joining instructions.

Live captions will be provided by Stagetext, and BSL interpretation will be delivered by Michelle Wood.

A series of articles by Jamie Hale exploring ‘Art, activism and access’, and featuring all of the artists taking part in this event, is also available to read and listen to.

Jamie is an artist, curator, and founder of disability arts showcase CRIPtic. They create poetry, comedy, scriptwriting and drama for page, stage and screen. They have written for publications including the Guardian and Magma, and have performed at venues including the Barbican and Southbank Centre. Their pandemic poetry pamphlet, ‘Shield’, is published in January 2021.

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Jamie Hale

@jamierhale on Twitter

Host

Amelia Cavallo is a blind theatre practitioner, academic and workshop facilitator who works as a multi-disciplinary performer, musical director, lecturer and consultant on access and audio description. They are a PhD candidate studying intersections of gender, disability and sexuality. Amelia co-founded Quiplash, a theatre company making space for Disabled people across the LGBTQIA+ spectrum.

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Amelia Cavallo

Speaker

Miss Jacqui is a poet and songwriter who performed at the 2012 Paralympic Opening Ceremony, and at venues including the Southbank Centre. She knows a lot about working with the cards that you are dealt, and always tries to challenge societal perceptions, like what it means to be a Black woman with a disability.

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Miss Jacqui

Born in Essex in 1959, Keith Salmon studied Fine Art at Shrewsbury and Falmouth Schools of Art in the early 1980s. Registered as blind in 1999, he now works from his studio in Irvine, Scotland and exhibits his semi-abstract landscape paintings throughout the UK.

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Keith Salmon

Emma Selwyn graduated from Access All Areas’ 2016 Performance Making Diploma at the Central School of Speech and Drama. Their work includes ‘My Hands and Feet are Wiggling’ (2016), ‘#Binariesbegone’ (2019), ’Not F**kin’ Sorry’ at Soho Theatre with Not Your Circus Dog (2019), and ‘unReal City’ at Battersea Arts Centre with Access All Areas and dreamthinkspeak (2020).

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Emma/Xandri Selwyn in rehearsals for the virtual reality production of unReal City at Battersea Arts Centre, March 2020

Emma Selwyn

Signkid is the UK’s first and only Deaf music producer, writer and performer, pioneering a unique aesthetic that integrates British Sign Language signing into a visual language for live hip-hop, rap and urban music. SignKid has performed at festivals including Deaf Rave, Wireless and Latitude, and has had extensive BBC coverage.

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Signkid

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This event is British Sign Language interpreted. A signer will be on screen describing the event. For any assistance, please email us at access@wellcomecollection.org or call 020 7611 2222.

British Sign Language (online)

Join Jamie Hale and five fellow disabled artists for an online conversation reflecting on their different experiences and practices.

D/deaf and Disabled Artists on Making Work Now

Join us to explore what it means to be a doctor caring for a society in crisis during a pandemic with GP Gavin Francis.

In conversation with writer Louise Welsh, Gavin will discuss his deeply personal experience of a year caring for patients in rural and urban communities. The two speakers will also reflect on the ways in which the pandemic and its policy measures have compounded existing social inequalities and health concerns.

From treating patients in care homes to those in communal city stairways, Gavin and Louise will reveal what care looks like in different contexts, what can be achieved when we care for each other, and the true cost of the pandemic.

The two speakers will be in conversation for 30 minutes, with the opportunity to ask questions during the final 15 minutes.

This event will be live-streamed on Wellcome Collection’s YouTube channel and available to watch afterwards. After booking a ticket, you will receive a confirmation email with joining instructions.

You will be able to comment and ask questions live online using the chat function throughout the event. Your microphone and camera will be switched off for the whole session.

The event will be live-captioned by Stagetext.

Gavin Francis’s new book ‘Intensive Care’ is out now in hardback.

Gavin Francis is a GP. His books include ‘Intensive Care’, ‘True North’ and ‘Empire Antarctica: Ice, Silence & Emperor Penguins’, and ‘Adventures in Human Being’, which won the Saltire Prize for Non-Fiction, was a BMA book of the year and the Observer Science Book of the Year. He also writes for the Guardian, the Times, London Review of Books and Granta. Gavin can be found on Twitter. 

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Gavin Francis

gavinfrancis.com

@gavinfranc on Twitter

Join us for a live-streamed conversation between GP Gavin Francis and writer Louise Welsh to hear about Gavin’s deeply personal experience of a year caring for patients in rural and urban communities during the pandemic.

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