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‘I had found a lump in my neck when I was about 24 and I just felt it was nothing at first, and it was actually vanity that made me go and check it out properly. Thank God I did, it turned out to be cancerous and I had to have treatment.’
Vannessa Amadi
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As I entered my twenties I was repeatedly told to make the most of this time and seize every opportunity. These years weren’t the years for comfort living but instead the decade for challenging myself; the time to break down barriers and live my life to the absolute fullest. But in order to live your best, you need to ensure that you are on your A game when it comes to your health. This starts with knowing your body, being aware of any changes to it and taking care of yourself.
We all have different approaches to our health; there are those who, at the smallest sign of an ache and pain, book an appointment to see a doctor. Then there are people like me, who put off seeking medical attention unless I’m in such physical pain that I can’t carry out my everyday tasks, which then forces me to go to the hospital. We say ‘health is wealth’, but we need to be proactive in seeking help and advice about it.
However, we live in a time where it can be difficult to keep on top of health advice, and a study by E45 recently revealed that we are bombarded with conflicting health messages. British women are in a constant state of confusion when it comes to their health and well-being. From ‘how much water should we drink every day?’ to ‘Is red meat healthy?’, the majority of UK females (79 per cent) admit they are worried about getting it wrong in terms of their health and well-being.34 Not surprisingly, 81 per cent of women feel baffled by information overload and 49 per cent of women said that they turn to the internet for guidance, with 14 per cent scrolling through social media for the best advice. But if you’re like me and have ever googled your symptoms when you’re ill, then almost had a mini panic attack from your subsequent self-diagnosis, you know how unhelpful it can be.
There is more to a healthy life than eating brown bread and hitting the gym. Our health is determined by a lot of factors: things like biology, genetics, culture and, of course, lifestyle. There is no harm in occasional tiredness, but when it becomes a pattern and you’re bordering on exhaustion, that’s a warning sign. Different groups of people have different health considerations and risks, and for black women it’s important for us to know about the diseases that can affect us. It’s about taking care of yourself and your body, in all ways possible. After all, the best advocate for your health is you.
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‘We need to be better at understanding our bodies and understanding the changes in our bodies.’
Charlene White
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When I was younger, I would look at the children’s medical encyclopaedia and flick through it, learning about the various illnesses. But when it described symptoms of various conditions and showed images of those symptoms, I couldn’t always relate to them. Often the description would refer to symptoms that were only visible on white skin, with a red patch denoting pain, and – having dark skin – I didn’t think it applied to me, even though I was a child just like them.
Knowledge is power, and when it comes to your health, knowing what to do, what to look out for and how to take positive steps can save your life. Cancer affects all communities, but according to Cancer Research UK, black women in England are almost twice as likely to be diagnosed with advanced breast cancer compared to white women. Shockingly, late-stage disease is found in about 25 per cent of Black African and 22 per cent of Black Caribbean breast cancer patients. In white breast cancer patients, the figure is 13 per cent. Experts say there are various reasons for this, but a low awareness of symptoms and screening (meaning abnormal cells or tumours are found at a later, more advanced stage) is one of the key issues.
Black women are less likely than white women to go for a mammogram when invited by the NHS. Spotting the early signs of cancer is very important, as the sooner it’s detected and treated, the better the outcome. Heather Nelson, from BME Cancer Voice, says: ‘Women, especially women of colour, are less likely to go for screening. You’ll get leaflets through your door and they will predominantly show white middle-class women. There’s no representation of South Asian, African descent etcetera. If you get information like that, you’re going to look and think, “That’s not about me.”’35
But unfortunately it is about you and me. How can we safeguard ourselves against diseases, if we don’t take the necessary preventative actions in the first place? Ask yourself when was the last or the first time you went for a mammogram? Or if you even know what mammogram means? If your answers to questions like these are erring on the negative, it should really be a wake-up call. Regular screening is the best way to find breast and cervical cancers early in most women. Talk to your doctor about what screening tests are right for you.
Like breast cancer, the awareness and prevention of cervical cancer is lower amongst women from an ethnic minority background. Research shows that these women may face different barriers to screening than white women. A study by Jo’s Cervical Cancer Trust revealed that a third more black, Asian and minority ethnic (BAME) women of screening age (12 per cent) compared to white women (8 per cent) said they had never attended a cervical screening appointment and only 28 per cent of BAME women said they would feel comfortable talking to a male GP.36
Charlene White is the patron of the charity Bowel Cancer UK, and is dedicated to raising awareness of the disease. Her mum was diagnosed with bowel cancer and she stresses the importance of early detection; a lack of awareness of the symptoms in the young causes delays in diagnosis and treatment. ‘We need to be better at understanding our bodies and understanding the changes in our bodies, and I don’t think that we are that great at doing it. Yes, it’s because we take for granted that we have an amazing health service, so we just kind of assume, well, if something happens, then it’s all right, the NHS will fix me and I’ll be fine, but unfortunately it doesn’t work like that, it doesn’t always work in that way. When it came to my mum’s diagnosis, the doctors didn’t necessarily spot what it was as soon as they should have done, and by the same token she didn’t necessarily go to the doctors as soon as she realised she was having symptoms. I think it’s really important for people to understand, yes, the symptoms of bowel cancer, but just cancer, full stop. With women checking their boobs, with men checking their prostate, all of those things, and not really see it as being like an icky thing that no one really wants to talk about, because not talking about icky things can kill you.’ Bowel cancer is the third most common cancer in the UK, and as Charlene’s experiences prove, checking for changes in your body and being aware of the state of your health can be life-saving.
The lack of health literacy among black women leads to us being less likely to get ourselves checked. Ask yourself: when you received your cervical screening invitation, did you go? Did your first cervical cancer screening happen at the age of 25? It should have. As Heather Nelson said, it doesn’t help that the leaflets and information about cancers predominantly affecting women mainly feature white women, further exacerbating the notion within BAME communities that these issues affect ‘them’ and not ‘us’. But it is vital that we become more aware of these diseases and what they can do to us, because refusing to acknowledge them will not make them go away.
Black people are the most likely to suffer from blood-related diseases such as sickle cell, diabetes and hypertension – conditions that often require blood transfusions and in the case of diabetes (which affects black people in higher numbers) can also lead to organ transplants. Out of a population of roughly 4.4 million black people (according to the last census),37 about 15,000 people and counting suffer from sickle cell, a disease caused by irregularly shaped red blood cells, which have a shorter lifespan than normal red blood cells and can get trapped in blood vessels, leading to a heightened risk of infections, strokes, lung problems, anaemia and severe pain when blood cells get stuck.38
Sickle cell is a disease that predominantly affects people like ourselves, of African and Caribbean origins, so we need to know more about it and how to treat it. Right now, it could be said that in the black community, we are failing our brothers, sisters, children, mothers and fathers who suffer from this disease because we are not donating enough blood. This is critical because people with sickle cell disease, as well as other blood-related illnesses, such as diabetes, rely upon regular blood transfusions (every 3–4 weeks for sickle cell sufferers) for survival and to be able to live an ordinary life. In addition, stem cell and bone marrow replacement treatments are also used to treat blood-related diseases, yet without regular black donors how can the doctors do this? At the moment only 1 per cent of black people in the UK are active donors (roughly 10,000 people), which means that fewer people are registered donors than suffer from sickle cell alone. Here’s another sobering stat: only 20 out of 1,282 people who passed away in 2015 were registered as black organ donors, even though there are 600 people on the waiting list.
The effects of these shortfalls can cost lives – most sickle cell carriers have a shortened lifespan (40–60 years), but this can be significantly compromised by a lack of blood used for transfusion; and black people are more likely than white people to need organ donations due to our heightened risk of suffering diseases that can lead to organ failure.39
This is why it’s so important that we become more clued up about the need to donate blood and organs. These shortfalls can only be met by a massive increase in donations from within our own community. We cannot rely on others to solve it for us, because similar blood types are more likely to be found within ethnicities, and because certain rare blood types in black people can only be found within those of the same ethnic background, the lack of organs and blood available currently means that black people have only a 20 per cent chance of finding a suitable match from an unrelated donor.40
The dearth of black blood and organ donation is so stark that government health officials and NHS Blood and Transplant have launched several campaigns targeting the African and Caribbean community,41 such as the Be There campaign in 2015, and most recently #ImThere. The Be There campaign offers some simple steps to become a more proactive donor, steps which are as easy as reapplying a coat of nail varnish. Really simple actions, such as visiting the national www.blood.co.uk website, can help to make regular blood donation routine in our lives, and to also learn more about organ donation and how to sign up as a donor.
The NHS website also offers easily digestible information, such as how often to donate blood, where to go to do it and apps that will enable you to be kept in the loop of available blood donation sessions and centres, so it really is worth a look. Often the idea of donating blood seems like a chore, but it doesn’t need to be.
The fact that campaigns such as this have been repeated over the years, despite raising awareness, shows that there is still a long way to go before our community normalises and fully embraces blood and organ donations. Acting upon the knowledge we now have is the only thing that will make these life-saving donations within the black community commonplace, in the way they should be.
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Hair done, nails done, everything did
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When was the first time you had a relaxer? I had mine when I was six. I was told my hair was too tough, too hard to manage. Several burning scalps later, I had a relaxer every year until I was 16. Fast-forward to years later, and if you ask any black woman: ‘What is the most damaging beauty product they could use?’ the resounding answer would be ‘relaxers’.
Health issues affecting black women are not only restricted to diseases and infections, but also to products that we have been using and that have been marketed to us for centuries. Cosmetics targeting black women are more likely to contain potentially harmful ingredients than those marketed to the general public, according to a study by the Environmental Working Group. As we have discussed in the Representation chapter, black women have fewer beauty products available to them, and it’s shocking that these products are more likely to contain hazardous chemicals. But the negative effects of products like relaxers aren’t restricted to how they make your hair look and feel but also to what they may be doing to our bodies in the long term. To say ‘pretty hurts’ would be putting it mildly, how about ‘pretty kills’? The cocktail of chemicals used in relaxers and hair dyes reads like an ingredients list for a DIY chemical bomb. Relaxers are laced with corrosive chemicals like sodium hydroxide – used in drain cleaners – and women who have been exposed to them for prolonged periods have been known to develop ailments such as cancer, asthma and fibroids.42 Suddenly a bit of dry scalp and hair breakage seems like the least of our hair-routine-induced worries.
Among the most serious of health concerns associated with the chemicals used is uterine fibroids. Another recent study into the use of hair relaxers found that the condition is estimated to affect 80 per cent of black women who use them over their lifetime. When you look at the ingredients – which can include formaldehyde, ammonia, bleaching agent, DMDM hydantoin, linalool methylparaben and propylparaben – we shouldn’t necessarily be surprised. Other dangerous side-effects of popular products range from dermatitis to occupational asthma.43 The products also often contain EDCs (endocrine-disrupting chemicals), which have been linked to various reproductive and birth defects,44 along with breast cancer and heart disease.
This is genuinely scary because these are everyday products marketed to and used en masse by black women, which can and do lead to life-threatening diseases. Sadly, it doesn’t just stop at relaxers and dyes, which a lot of us have already been made aware of. The dangers to our health, masked by our cosmetics culture, are a lot more insidious, and products that have been a staple in the black-girl haircare regime, such as Olive Oil Sheens and Pink Luster, contain higher levels of toxins, steroids and hormone-disrupting chemicals than cosmetics made for non-black women.
Out of more than 1,000 different products and ingredients researched, relaxers unsurprisingly came out as some of the most hazardous, but hair dyes marketed to black women were also shown to be very dangerous.45 Ingredients used in these dyes, such as ammonia, have also been linked to asthma and rare lymphatic cancers, bladder cancer and multiple myeloma (cancer in the white blood cells).46
For centuries black women have been encouraged to undertake so-called ‘health and beauty regimes’ and to use products that compromise our health. Douching and the use of products such as talcum powder are habits that have been passed down through the (black) generations. I remember when I was younger how my white friends would ask why I moisturised every day, and to me it just seemed obvious; I moisturise because that’s what I’ve always done, and because my skin feels ashy without my daily cocoa butter. This is similar to the relationship that many of us black women have with practices such as douching and using vaginal deodorising products. It’s just something we’ve always done.47 But the roots of some of the most harmful black-dominated practices, such as douching and using talcum powder to maintain intimate hygiene, are sadly intertwined with historical misogynoir, which should be a red light in itself. Misogyny deems that vaginas are taboo and racism narrates that black people are dirty,48 so add those together and, voilà, we have a highly toxic mix. And this heightened scrutiny of black female hygiene breeds insecurities and compulsions that are in turn capitalised upon by multinational cosmetic companies.
A chilling example of how dangerous this can be is the case of Jacqueline Fox from the US. In 2013, before losing her battle to ovarian cancer, Jacqueline sued Johnson & Johnson for $72 million. She believed that talcum powder, which contains carcinogenics such as phthalates, was linked to her illness. While she won her legal action, Johnson & Johnson successfully appealed the first ruling. Soon after her death more than 1,000 women also sued Johnson & Johnson.
It is often these dangerous, potentially deadly, products that are the most vigorously marketed to black women. Are you feeling the need to have a spontaneous cupboard clear out now? Me too. Racial targeting is in no way unique and it is sadly very much in keeping with the overall theme of the disregard of black women’s health by the beauty industry. But this isn’t as simple as black women only having a higher number of dangerous products marketed at them. The questionable ingredients in beauty products is a universal phenomenon affecting women of all races. But the crucial difference is the fact that there are fewer products available to black women which are deemed as safe and healthy to use. The report by the Environmental Working Group last year, illustrates this by showing that less than 25 per cent of products marketed to black women got high safety ratings, compared to 40 per cent of products aimed at the general public.49
The point of bringing this all to light is to demonstrate how toxic racism, which isn’t always explicit, is genuinely diminishing our ability as black women to live long and healthy lives. It really is a bitter pill to swallow, that we are exploited and compromised in industries that rely upon our hard-earned cash, especially as we pump so much more into hair and beauty than our better-catered-for non-black counterparts (estimated at about six times more than women of other ethnicities).50 The cosmetics industry continues to show a marked lack of respect for our race, and studies show that manufacturers are less likely to spend the money on putting products used by black women through the same robust testing regimes as they are for white women.51
So what is the solution? It is a difficult one to remedy, as the onus shouldn’t be on us to control what goes into the haircare products that we buy, nor is it even feasible to expect this. Also, I don’t know about you, but the ingredients list on the back of packages looks like Latin to me. However, it is useful to google what is in your cream or shampoo and to ensure that none of the products in there have been blacklisted elsewhere. And, as Yomi has discussed, the natural hair movement has meant that plenty of hair and beauty bloggers are also able to offer advice on what is good to use and what is not.
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‘I had to learn to put the brakes on everything and take care of myself because at one point, I was shaking every day, and I was like, “Yo, if I’m not here tomorrow, the world will continue. I want to be here; I want to be around it all.”’
Estelle
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Being busy and building an empire in your defining twenties is often seen as winning at life. But too often our pursuit of success can compromise our health. As we have discussed in the previous chapters, many of us live by the mantra that we have to work twice as hard to get half as much, whether that’s in the form of aiming for a promotion, proving yourself at your new job or studying for exams. When I am in work mode, I find myself almost allergic to resting, seeing procrastination not only as the thief of time, but rest and sleep as hostage-takers of progress and harbingers of failure. Being black and female, we can feel more pressure to overwork ourselves compared to our white peers, because we are blighted with the double disadvantage of race and gender – triple if we are from lower economic backgrounds. It’s great to strive for social, occupational and economic elevation, but unless we’re careful, the price of this can compromise our quality of life and our ability to actually attain success. So, for starters, you should make sure you are able to get that minimum of six hours or more of sleep a night, rather than relying upon coffee and caffeine-laden energy drinks.
As black women, we can push ourselves too hard, but – as Yomi has said – we also often refuse to show weakness, despite being well aware of the injustice of our station as black women, who must dodge the slings of sexism and arrows of racism in a world that wants to keep us at the bottom of that societal pyramid. This can, of course, make us into formidable women and many of us, like Denise Lewis, look up to our first examples of an unshakeable work ethic in the face of adversity, which often come in the form of our mothers. Denise recounts, ‘My mum was a great inspiration to me. We grew up in a very small family. My mum was a bit of a powerhouse, and she was my world. I watched her pretty intensively, working two jobs just to keep everything running smoothly; she has always, always been a hard-working woman. So I guess she was my primary source of inspiration as a person that really taught me that you have to work for anything that you want in life, and when it seems like the odds are stacked against you, with perseverance and commitment and a need and willingness to push yourself, you can make things work.’
The strong black female figure striving despite the weight of the world on her shoulders. Sounds familiar, no? Many of us grew up with strong female figures in our lives who grinded night and day, and often did so without complaint or regard for their health, determined to put their families first. This really is inspirational and we should emulate the drive of these women. However, we also need to do a better job of acknowledging the pressure we put ourselves under to be strong women who never break down or show signs of struggle, and we need to acknowledge that this can be very harmful to us. A study published by the University of Georgia, in the US, gives a worrying exposé into how race and socioeconomic disadvantage can genuinely affect our path to success, our health and our overall life expectancy. The study looked specifically at black youth in the US and their struggles to succeed, but the experience of working against the limitations of systemic racial and class imbalance are paralleled by black youth (and adults) in the UK.
The study found that ‘white blood cells among the strivers were prematurely aged relative to those of their peers’ and suggested that those (black youths) with an ‘unrelenting determination to succeed’ were more likely than their white peers to get sick or contract illnesses in the process of working towards their goal.52 Stress doesn’t only cause insomnia, anxiety or depression (which in themselves are extremely worrying states), but the study also showed that there was an alarming correlation between strivers and problems with cardiovascular and metabolic health, as well as diabetes, hypertension and arthritis.53 White Americans, in the study, seemed relatively immune to the negative effects of the pursuit for success. This is not because they are naturally more resilient, but because in a world that orbits on an axis of white privilege, they don’t have to be as resilient.
Of course, stress is something that all people of all races are exposed to and race is not the only determining factor. Class and gender in particular also play a massive role. However, the reason it is important to flag this up is for it to serve as a wake-up call for us to be more aware of when we are burning ourselves out. As we discussed in the microaggression chapter, black women can be especially vulnerable to the impacts of race-related stress.
Earlier we looked at the importance of going to the doctor when you notice changes in your body. In 2006, Vannessa Amadi was working on various different projects in her PR career and started to feel very stressed: ‘It’s hard to put your health first, I had found a lump in my neck when I was about 24 and I just felt it was nothing at first, and it was actually vanity that made me go and check it out properly because it was growing and I thought, I don’t want a big old lump hanging out my neck. That’s the only reason I went to the doctor, and thank God I did, it turned out to be cancerous and I had to have treatment.’ Unfortunately, the lump turned out to be Hodgkin’s Lymphoma and her doctor told her it was related to the excessive stress she had been under.
There are so many parallels between Vannessa’s story and the stories of so many of us reading this book, living life, assuming we are invincible and ignoring signs of ill-health, especially when they are not inhibiting our day-to-day routines. Gloria Boadi agrees: ‘At times people think “We’ve always done it this way, my parents did it this way and they came through. I’m the product of a strong black woman.” A good friend of mine at work, at that time I was a housing officer, was doing two jobs, as we often do because we sometimes have to be the sole breadwinner, we’ve got to clothe our kids, plus look after extended families – we take on these roles. She came back from holiday and she wasn’t well. I said to her, you need to relax, just take a day off, because, trust me, if you drop dead they will replace you tomorrow. She said – she actually used this term – “I’m a strong black woman. I’m fine.” Three days later, she was dead.’
Managing stress is something I’ve had to get better at over the years. Rather than seeing it as rite of passage in the pursuit of success, I’ve had to take self-imposed breaks in order to manage it. I’ve learned that being good at my work is great and working hard is essential to this, but not at the expense of my health. Sometimes it’s as simple as me declaring verbally, ‘I can’t come and kill myself!’ to remind myself to put things into perspective. Estelle’s approach has been similar: ‘I had to learn to take self-imposed time off. I remember taking almost a year off one year, and it was partly because I was just exhausted, had nothing to write about, had nothing to talk about, and I was just tired. I remember getting on the internet one week and someone had been like, “Oh, Estelle’s lazy, she should’ve done this, that and the rest,” and I was like, “Do you realise that I haven’t slept in three years, physically, been to sleep for more than four hours, for three years? Let alone the ten years prior to this that I had spent trying to get to this point? I’m going to take a break. I don’t care if you don’t like it.”’ She advises us to be resolute in our self-care and to be able to step back from stressful situations, or unrealistic expectations: ‘It was forced on me because I got to a point where I was just shaking. Every time you saw me I’d be out here talking and doing what I was doing, but I was physically shaking, and then I decided that I was going to take a few days and nap. So every so often now, whenever I feel myself going to a point, I just make a decision, “All right, now I’m going to take the weekend off.”’
However, Estelle acknowledges that this does require a level of discipline as well, especially when you have responsibilities and may not want to let anyone down. But setting fair boundaries is key to maintaining self-preservation: ‘I had to learn to put the brakes on everything and take care of myself … I was like, “Yo, if I’m not here tomorrow, the world will continue. I want to be here; I want to be around it all. I’m not going to die, you’re not going to have me out here on drugs, drunk, strung out, after all this work and everything I’ve put into my career, and also how much I mean to myself, let alone everyone else, so will my mum be crying because her daughter collapsed?” So I went on a self-imposed, “Promise yourself, whenever you feel like you’re about to lose it, you’re going to take a break,” and that’s what I do. There is success and there is drive, and absolutely, do it while you’re young, do it in your twenties, but know that you need to take some time off. Yes, “We have to get it while we still can,” but it’s your life, it’s your career, it will still be here. Take your time. You will be okay. The world is not going to implode on you, people will not forget you, do your work, just do great work.’
If you sacrifice yourself in the pursuit of success, you will have done it for an undeserving and ungrateful world. So rest, say no to too much work, but also take a step back and allow yourself to disengage and detox. Go on holiday, actually take your permitted leave when you can and when you’re away from work genuinely switch from work mode to holiday mode: but properly, no peeking at work emails. Lady Leshurr describes suffering from similar burnout effects, induced by the non-stop demands of being a rising rapper; ‘Last year I had over a hundred shows, and I didn’t know that I was going to get burnt out. I was thinking, yes, let’s do these shows! I’ve done it, but I burnt out at the end because I’m hardly eating, I’m losing weight, I’m just the opposite to who I was at the start of the year, so it’s something that I just had to experience to realise that, wow, I actually need a break, because it’s going to help my mind, my body, my soul: physically, mentally, emotionally. So yeah, it means a lot to have breaks and just relax every now and again.’
What do these women have in common? Three black women, confident in their craft and deserving of success, yet damaging themselves due to the insurmountable burden of expectation from themselves and the demands that the world places upon them. What else do they all have in common? They are only human and they all eventually had to stop because their physical and mental health was being severely compromised. And what is notable in each case, is that working too hard actually inhibited their ability to do their best at their roles at that specific time.
Their examples reassert the need for self-care. Often we find ourselves alone on our journeys to achievement, without moderators there to remind us to stop and rest. As a society we also applaud working oneself into the ground as a sign of strength, admirable determination and resilience, but unrelenting resilience can be very detrimental. Succumbing to the need to give your body a rest should in no way be seen as weakness.
It’s also okay to ask for help, as Yomi discussed in the previous chapter. As black women, we have to be more open and proactive in doing what we can to help ourselves mentally, which involves trying to limit the effects of stress and societal pressures on ourselves. Combatting burnout is simple, but it does take a lot of mental rewiring of priorities. It is important to acknowledge when the expectations placed on you by yourself and others become too much, and to know that you are not undermining your ability by taking a step back for the sake of your own regeneration. As we have seen, overworking doesn’t only make you tired, it can lead to depression, anxiety and other medical issues. This isn’t about ‘slacking off’ and compromising the trajectory of your success, it’s about encouraging us to be able to say no to unrealistic expectations and to instead be more time-efficient and use the time we do have to work more effectively.
It’s important, as Estelle and Lady Leshurr say, to physically take yourself away from the surroundings that you associate with stress, and then use that time to clear your head, rewire and get back into an effective mode. Work incredibly hard, yes, but also work hard to take that weekend off where you relax, sleep and regroup. It is this that will make you as productive as possible when you get back into work mode; after all, everything we use – our cars, our electronic appliances, even our phones! – need to be recharged at some point, so why wouldn’t this be the case for our minds and bodies? Looked at this way, you’re actively making your holiday or break a necessary but bloody enjoyable element of your overall mission.
Always put your health first, strive for the best and work hard. So let’s live our best lives, but do so in moderation and without jeopardising our health.