This book received a commendation in the 2005 British Medical Association Awards. In a world that is predominately visual, it is interesting that the written word is often valued as superior and bestowed a much higher status. This is not the case in Looking after my balls, an informative book designed to help men with intellectual disabilities to know more about their ‘balls’ (testicles) and about how to best care for them.

The book has two sections. The first 31 pages use colour illustrations only to tell the story of Tom, a young man with intellectual disabilities who discovers a lump while carrying out a routine testicular self-examination when in the shower. He seeks help immediately and attends the doctor. Following tests and an ultrasound scan, he is informed that the lump is benign. Section two of the book provides useful guidance on looking after one’s testicles and what changes to look for. The book does not cover treatment for cancer. (This is addressed by Getting on with cancer, another very informative book in the highly praised Books Beyond Words series for people with intellectual disabilities.

The book is ideally suitable for anyone who prefers information conveyed through pictures or understands illustrations better than words; people with learning or communication difficulties; people with literacy problems and people for whom

English is a second language where an interpreter is not available. Good use is made of vivid colour and mime to display the changing emotions of each character as the story progresses. Although this is used to very good effect in the majority of pictures, there is one where this is not the case (page 31). This comment may seem petty, but it is an important one as the final illustration tells of Tom receiving the good news of his test results and therefore a critical climax to the story. While in the illustration the doctor is clearly pleased to inform Tom that the lump is not malignant, Tom’s expression of relief is perhaps too subtle for the average reader, let alone a reader with intellectual disabilities. Tom’s carer Danny looks gormless, apathetic and distant throughout some of the story, and is not an appropriate stereotype of support workers or professionals (although some readers may be able to identify one from their own caring experience!).

By using only illustrations, a carer is encouraged to sit down with the person with intellectual disabilities and assist them to take the meaning they need from each picture. The carer is encouraged to allow the reader time to set his own pace and not necessarily go through the whole book on one occasion.

After the reader with intellectual disabilities discloses what they understand is going on in the story, the carer is encouraged to prompt the reader to explore each picture in greater depth so that a richer understanding is developed and enhanced. The authors suggest such prompts as:

  • Who do you think that is?
  • What is happening?
  • What is he or she doing?
  • How is he feeling now?
  • Do you feel like that?

One may include one’s own verbal prompts based on the assessed needs of the person being assisted, e.g. Have you ever felt like that and if so when?

For those readers and their carers who would rather not tell their own story of the pictures, an easy ready.made story is provided after the pictures.

Some people with intellectual disabilities may lose the thread of the story as they move through 31 pages. However a creative and sensitive carer should have no difficulty selecting a carefully chosen handful of manageable pictures to meet the reader’s assessed needs.

Looking after my balls is culturally sensitive to the world in which people with intellectual disabilities live. A useful glossary of medical words is also provided near the back of the book.

While most symptoms of testicular cancer are covered in the book, a number of key symptoms are not highlighted, i.e. a build up of fluid within the scrotum, or blood in the semen which the person may notice when ejaculating; rarely, some men experience tenderness around their nipples. This may be due to the release of hormones that are produced by some testicular tumours, or because the cancer has spread to the chest area (NHS Direct 2006).

Pages i–vii, entitled ‘How to look after my balls’, are copy.right.free and may be photocopied (provided the copies are used on a not-for-profit basis). I would strongly recommend that the editor of FRONTLINE and his board give serious consideration to publishing these pages within the magazine, to ensure this important health promotion material is seen by a wider audience. It is also available free of charge in a pdf leaflet for.mat on http://www.intellualdisability.info/leaflets/booklet_forweb.pdf

Professor Hollins and Consultant Wilson have, in collaboration with the illustrator Beth Webb, produced an excellent, informative testicular awareness book. They have tackled a complex issue clearly, sensitively and with considerable professional expertise. One of their primary intentions is to actively empower and engage the young person with intellectual disabilities in the health surveillance and health promotion process. They are to be commended for this. As noted above, this book is suitable for people with intellectual disabilities, their relatives, friends, sup.porters and advocates, teachers, social workers and health pro-fessionals, such as community nurses and GPs.

LOOKING AFTER MY BALLS, By Sheila Hollins and Justin Wilson (Books Beyond Words series for people with Intellectual Disabilities) Illustrations by Beth Webb. (2004) Gaskall/St George’s Hospital Medical School, London. Paperback ISBN 1 904671 05 5, £10-00-


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