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Module 01

Audrey Brownlow

Module 01: Audrey Brownlow
Teaching notes
Matthew Prior (21 July 1664 – 18 September 1721) was an English poet and diplomat. He once said
“Cured yesterday of my disease, I died last night of my physician.”
This module should be used to encourage students to think about the care provided for people
with disabilities, and to critically discuss the quality and methods of care available. Efforts should be
made to let the students empathise with Audrey’s time in hospital and discuss how care has improved.
Additionally students should be aware of the role of vaccinations, the controversy surrounding the
use of the MMR vaccine, and the discovery and uses of penicillin and other antibiotics, and the
subsequent consequences of their overuse.
Here is an extract about the TB vaccine taken from Wikipedia:
Tuberculosis (TB) vaccines are vaccinations intended for the prevention of tuberculosis.
Immunotherapy as a defence against TB was first proposed in 1890 by Robert Koch. Today, the only
approved by the British Medical Council for tuberculosis vaccine is bacilli Calmette-Guérin (BCG),
which has been around since 1921. About three out of every 10,000 people who get the vaccine
experience side effects, which are usually minor except in severely immuno-depressed individuals.
While BCG immunization provides fairly effective protection for infants and young children, (including
defence against TB meningitis and miliary TB), its efficacy in adults is variable, ranging from 0% to
80%. Several variables have been considered as responsible for the varying outcomes. Demand
for TB immunotherapy advancement exists because the disease has become increasingly drugresistant.
Here is an extract about the MMR vaccine controversy from Wikipedia:
The MMR vaccine controversy started with the 1998 publication of a fraudulent research paper
in the medical journal The Lancet that lent support to the later discredited claim that colitis and
autism spectrum disorders are linked to the combined measles, mumps, and rubella (MMR) vaccine.
Aspects of the media coverage were criticized for naïve reporting and lending undue credibility to
the architect of the fraud, Andrew Wakefield.
Investigations by Sunday Times journalist Brian Deer reported that Andrew Wakefield, the
author of the original research paper, had multiple undeclared conflicts of interest, had manipulated
evidence, and had broken other ethical codes. The Lancet paper was partially retracted in 2004,
and fully retracted in 2010, when The Lancet’s editor-in-chief Richard Horton described it as “utterly
false” and said that the journal had been “deceived.” Wakefield was found guilty by the General
Medical Council of serious professional misconduct in May 2010 and was struck off the Medical
Register, meaning he could no longer practice as a doctor in the UK. In 2011, Deer provided further
information on Wakefield’s improper research practices to the British medical journal, BMJ, which in
a signed editorial described the original paper as fraudulent. The scientific consensus is the MMR
vaccine has no link to the development of autism, and that this vaccine’s benefits greatly outweigh
its risks.

The claims in Wakefield’s 1998 The Lancet article were widely reported; vaccination rates in the
UK and Ireland dropped sharply, which was followed by significantly increased incidence of measles
and mumps, resulting in deaths and severe and permanent injuries. Physicians, medical journals,
and editors have described Wakefield’s actions as fraudulent and tied them to epidemics and deaths,
and a 2011 journal article described the vaccine–autism connection as “perhaps the most damaging
medical hoax of the last 100 years”.
Here is an extract from Wikipedia about the discovery of penicillin:
Penicillin (PCN or pen) is a group of antibiotics which include penicillin G (intravenous use),
penicillin V (oral use), procaine penicillin, and benzathine penicillin (intramuscular use). Penicillin
antibiotics were among the first medications to be effective against many bacterial infections caused
by staphylococci and streptococci. Penicillins are still widely used today, though many types of
bacteria have developed resistance following extensive use.
Penicillin was discovered in 1928 by Scottish scientist Alexander Fleming. People began using
it to treat infections in 1942. There are several enhanced penicillin families which are effective
against additional bacteria; these include the antistaphylococcal penicillins, aminopenicillins and the
antipseudomonal penicillins. They are derived from Penicillium fungi.
Here is an article from Wikipedia explaining about the consequences of the overuse of antibiotics:
Antimicrobial resistance (AMR) is when a microbe evolves to become more or fully resistant to
antimicrobials which previously could treat it. This broader term also covers antibiotic resistance,
which applies to bacteria and antibiotics. Resistance arises through one of three ways: natural
resistance in certain types of bacteria; genetic mutation; or by one species acquiring resistance
from another. Resistance can appear spontaneously due to random mutations; or more commonly
following gradual build-up over time, and because of misuse of antibiotics or antimicrobials. Resistant
microbes are increasingly difficult to treat, requiring alternative medications or higher doses—which
may be more costly or more toxic. Microbes resistant to multiple antimicrobials are called multidrug
resistant (MDR); or sometimes superbugs. A few infections are now completely untreatable due to
resistance. All classes of microbes develop resistance (fungi, antifungal resistance; viruses, antiviral
resistance; protozoa, antiprotozoal resistance; bacteria, antibiotic resistance).
Antibiotics should only be used when needed as prescribed by health professionals. Narrowspectrum antibiotics are preferred over broad-spectrum antibiotics when possible, as effectively and
accurately targeting specific organisms is less likely to cause resistance. For people who take these
medications at home, education about proper use is essential. Health care providers can minimize
spread of resistant infections by use of proper sanitation: including handwashing and disinfecting
between patients; and should encourage the same of the patient, visitors, and family members.
Rising drug resistance can be attributed to three uses of antibiotics: in the human population;
in the animal population; and spread of resistant strains between human or non-human sources.
Antibiotics increase selective pressure in bacterial populations, causing vulnerable bacteria to
die—this increases the percentage of resistant bacteria which continue growing. With resistance
to antibiotics becoming more common there is greater need for alternative treatments. Calls for
new antibiotic therapies have been issued, but new drug-development is becoming rarer. There
are multiple national and international monitoring programs for drug-resistant threats. An example
of drug-resistant bacteria included in this program is methicillin-resistant Staphylococcus aureus

A World Health Organization (WHO) report released April 2014 stated, “This serious threat is no
longer a prediction for the future, it is happening right now in every region of the world and has the
potential to affect anyone, of any age, in any country. Antibiotic resistance—when bacteria change
so antibiotics no longer work in people who need them to treat infections—is now a major threat to
public health.”
Increasing public calls for global collective action to address the threat include proposals for
international treaties on antimicrobial resistance. Worldwide antibiotic resistance is not fully mapped,
but poorer countries with weak healthcare systems are more affected.

Module 01: Audrey Brownlow
Handout 01 – Audrey’s Story
Audrey Brownlow was born in 1945. When she was two years old she was diagnosed with a
tuberculosis abscess on her spine. The treatment for this meant she was kept strapped to a bed
totally immobilised for 5 and half years until the abscess had healed itself. This left Audrey with
breathing difficulties as her torso had compacted. She uses a mobility scooter to get around. Audrey
went on to have long career working for the British Coal Board. She married and had two sons. She
lives in Cambridge now and loves visiting the theatre among many other pastimes.
Read/Listen to the following account from Audrey of her time in hospital.
“My father was an official in the mines and he didn’t see me often but I was being bathed in the
tin bath by the fireside and he came in in his pit muck as they call it and he saw me and saw this
tiny little nodule on my spine. And asked my sisters what on earths that on our Audrey’s back. And
my sister said I don’t know dad but when we try and pick her up under her arms she screams her
head off. He said oh my god I hope that’s not what I think it is. I’m coming home early from the pit
tomorrow; make an appointment she’s going to the doctor’s with me. That point on apparently I was
taken to hospital, I was taken to stay in the hospital at what was Ransom Sanatorium. And the only
cure, the only treatment, that my father was offered for me was a spell, in hospital on a frame totally
immobilised for however long it took for this abscess to fade away or die. The only other choice was
an exploratory operation that had been performed a few times. It didn’t give positive results though
all the time. And my father said well, if you can guarantee she’s going to come home one day we’ll
go for that option. I don’t think he ever envisaged that it would be 5 and half years length. I was
then put on this frame and as my sister said to me, she was one of the older ones, she’d visit with
my dad, visiting then was once or twice a week, not once or twice a day, parents certainly weren’t
allowed to stay with the children and when she visited she said for a long long time, being bright as
I was, she said you would scream when we left “Please don’t leave me, I’ll be good, take me home.”
When you think about it like that there’s no wonder that actually I’ve erased it from my head. I don’t
remember a day of it.”

Module 01: Audrey Brownlow
Handout 02 – Information sheet
Here is some information from the National Health Service (NHS) website about tuberculosis.
Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or
sneezes of an infected person. It is a serious condition, but can be cured with proper treatment. TB
mainly affects the lungs. However, it can affect any part of the body, including the glands, bones and
nervous system.
Typical symptoms of TB include:
• a persistent cough that lasts more than three weeks and usually brings up phlegm, which
may be bloody
• weight loss
• night sweats
• high temperature (fever)
• tiredness and fatigue
• loss of appetite
• new swellings that haven’t gone away after a few weeks
What causes TB?
TB is caused by a bacterium called Mycobacterium tuberculosis. TB that affects the lungs is the
most contagious type, but it usually only spreads after prolonged exposure to someone with the
illness. For example, it often spreads within a family who live in the same house. In most healthy
people, the immune system (the body’s natural defence against infection and illness) kills the
bacteria, and you have no symptoms. Sometimes the immune system cannot kill the bacteria, but
manages to prevent it spreading in the body. This means you will not have any symptoms, but the
bacteria will remain in your body. This is known as “latent TB”. If the immune system fails to kill or
contain the infection, it can spread within the lungs or other parts of the body and symptoms will
develop within a few weeks or months. This is known as “active TB”. Latent TB could develop into
an active TB infection at a later date, particularly if your immune system becomes weakened.
Who is affected?
Before antibiotics were introduced, TB was a major health problem in the UK. Nowadays, the
condition is much less common. However, in the last 20 years, TB cases have gradually increased,
particularly among ethnic minority communities who are originally from countries where TB is more
common. In 2014, more than 6,500 cases of TB were reported in England. Of these, around 4,700
affected people who were born outside the UK. It’s estimated that around one-third of the world’s
population is infected with latent TB. Of these, up to 10% will become active at some point.

How TB is treated
With treatment, TB can usually be cured. Most people will need a course of antibiotics, usually for
six months. Several different antibiotics are used. This is because some forms of TB are resistant
to certain antibiotics. If you are infected with a drug-resistant form of TB, treatment with six or more
different medications may be needed. If you are in close contact with someone who has TB, tests
may be carried out to see if you are also infected. These can include a chest X-ray, blood tests, and
a skin test called the Mantoux test.
Tuberculosis vaccination
The BCG vaccine can provide effective protection against TB in up to 8 out of 10 people who
are given it. Currently, BCG vaccinations are only recommended for groups of people who are at a
higher risk of developing TB.

Module 01: Audrey Brownlow
Handout 03 – Worksheet

Your name:
1) Imagine you are Audrey. Write a diary entry of the way she feels one day during the treatment
she received for her tuberculosis abscess. Remember that she was strapped to a bed and kept
immobilised for 5 and a half years. Imagine what she may have thought about and how she may
have entertained herself whilst she was so restricted:

2) Discuss with the person next to you about how learning about Audrey’s medical treatment
made you feel? Is there anything that could have been done to improve the experience for her?

3) What part of the body does tuberculosis generally infect?

4) How is tuberculosis spread?

5) What is the current treatment for TB?

6) What is the name of the vaccine for TB?

Module 01: Audrey Brownlow
Handout 04 - Comment sheet
Your name:
My comment on the audio/transcript: