swot in nursing - 1224 Words

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Analysis Of The Payment Practices Between Companies,...

While there is heterogeneity in the payment practices between companies, executive compensation plans must include four basic components: base salary, annual bonus tied to accounting performance or another agreed indicator between the parties, stock options and incentive plans long term (including restricted stock plans and performance plans based on accounting more exercise). Under the crossfire of public opinion, the bonus word became almost word, synonymous with unbridled greed, something to be fought. But despite all the weeping and gnashing of teeth the last two years, the variable compensation was off the list of fatal victims of the crisis. Capitalism still could not invent better way than the bonuses to reward those who deliver the†¦show more content†¦There is the difficulty of justifying wages like these when companies have laid off many employees. The expectation is that these excessive salaries are reduced this year, thanks to new rules imposed last month by the Securities and Exchange Commission. Besides super salaries and bonuses, companies offer a benefits package, which are very negotiable an executive to another, but it usually involves a high standard car, high level of health insurance for the family, specialized courses for professional education for the children, wife expenses and, the company sometimes also offers sophisticated houses. Multinationals also have policies to encourage the training and professional development of employees, with courses and trips. Professionals also have advantages to work in environments that emphasize the quality of life, health, and ergonomics. Over the past 15 years, the compensation of the executives rose to astronomical figures compared to the reality of other countries. With inflated salaries and high bonuses, directors and vice presidents had in their favor the market, so they could choose the employer who paid more. The party is now over. The unfavorable economic scenario that these same professionals who have been targets of true corporate auctions are now in the court of sight. In the dance of the restructuring, the most affected were and still are the top of the pyramid executives. Because of the shrinking of the

The assessment and treatment of a diabetic ulcer with be discussed. Free Essays

string(58) " the importance of good footwear as I was in the army†\." Introduction For this tissue viability assignment the assessment and treatment of a diabetic ulcer with be discussed. Wound healing and it properties will also be mentioned in regards to holistic factors affecting the chosen patient (pt). In accordance with the Health Professional Council (HPC) a standard of conduct, performance and ethics, a pseudonym has been used to protect the identity of the pt discussed (HPC 2008). We will write a custom essay sample on The assessment and treatment of a diabetic ulcer with be discussed. or any similar topic only for you Order Now I certify that confidentiality has been maintained, for the purpose of this assignment the patient will be called Mr Sim.An ulcer is a defect effecting loss of epidermis and all or part of the dermis (Lookingbill Marks 1993). The skin comprises of three layers, and is the largest organ in the body. The average adult has 21 square feet of skin (2 sq m) weighing up to 3.2 Kg (Benbow 2007). The three layers of the skin are, the Epidermis this consists of dead skin cells which shed continuously and it protects against certain bacteria. The epidermis also acts as a barrier to prevent evaporation and absorption of water. The Dermal Layer consists of capillaries, sebaceous (oil) glands, sensory receptors which transmit sensations such as itch, pain and temperature, and hair follicles all held together by elastin and collagen. The Subcutaneous layer contains fat and connective tissue that houses larger blood vessels and nerves. This layer is important in the regulation of temperature of the skin itself and the body. The size of this layer varies throughout the body and from person to person (Brannon 2007). The skin is a complicated structure with many functions. If any of the structures in the skin are compromised through poor blood supply, trauma, surgery etc. a wound may develop. â€Å"A wound is a loss of continuity to the skin â€Å"states Dealey Cameron (2008) The phases of normal wound healing †¢ Inflammation – a reaction to tissue damage / infection †¢ Reconstruction – granulation tissue starts to form. †¢ Epithelialisation – the wound becomes covered with epithelial cells. †¢ Maturation – scar tissue starts to fade and blend in with the normal tissue Case Study The subject of this study is a male patient aged 69 years, for the purpose of this case study the patient will be referred to as Mr Sim. Mr Sim attended as a new patient to the podiatry department at his local clinic complaining â€Å"something has been catching on my socks†. On examination of Mr Sim’s foot a large area of callus was observed on the plantar aspect of his right fifth toe (ball of foot under little toe) there was some brown discolouration due to extravasation (leakage of blood into the skin) indicating that there could be an ulcer under the callus. It was explained to Mr Sim that further assessment and treatment would be necessary to determine what and why the problem was occurring. The podiatry assessment tool was used to provide a holistic approach to assessment of medical history and social factors that may affect the foot health of the patient. The tool has a systematic problem based approach to undertaking clinical assessment and a detailed history; it is similar in outlay to a Patient Orientated Medical Review (POMR). Both the POMR and the podiatry assessment tool include a description of the presenting complaint which is an important part as it determines what the patient considers to be important and can be used to establish agreed expectations. Both models include previous and current medical history including any operations, illnesses or injuries which is of high importance in wound healing as systemic disorders or medication can have a large impact on wound healing. Both assessment tools include a detail of any known allergies, any family traits and social factors such as smoking or drug taking. The factors assessed in the above tools are recognis ed as being significant factors in wound healing. Rainey (2005) lists medication, illness, smoking, alcohol consumption and mobility as factors that affect wound healing. In addition to the POMR the podiatry assessment tool focuses on the factors that may affect the patients foot health for example previous or current occupations, an appraisal of the patient’s footwear and assessment of patients gait, vascular assessment, condition of skin, skin colour, skin temperature as well as palpating pedal pluses. A neurological assessment using a 10 gram monofilament, which is the standard neuropathy test in primary and community care in the united kingdom since National Institute for Clinical Excellence (NICE) guidelines for the management of the diabetic foot were published in 2004 (Boulton et al 2006). However the podiatry assessment tool does not include an assessment of the nutritional status of a patient which has been regarded as a key factor affecting wound healing (Dealey 2 005, Rainey 2005), and malnutrition is a very important cause in delaying the healing process (Morrison 1992). Using the podiatry assessment tool it was found that Mr Sim was diagnosed with Type 2 diabetes nine years ago and had recently moved to the area from abroad after losing his wife of to whom he was married to for forty four years, he now lives in the same road as his nephew. Mr Sims has good control of his diabetes taking metformin 500m mg twice daily, his recent HBA1C was 7.3 % this is regarded as tight glycaemic control (Lee et al 2006) His nutritional status adequate, he reports no strong family history of diabetes or heart disease, he occasionally has a glass of red wine. Mr Sims also takes medication to control hypertension (high blood pressure), bendroflumethiazide and aspirin, a cholesterol tablet as a precautionary method, and painkillers and antiflammatory treatment for osteoarthritis. He also mentioned that the pain in his back was increasing, and was taking a course of antibiotics for an infected cut on his hand obtained whilst gardening. For some time now he had been ex periencing bouts of tingling in both his hands and feet. He expressed that he takes good care of himself never smoked, eats well and keeps active, and he states he has â€Å"an awareness of the importance of good footwear as I was in the army†. You read "The assessment and treatment of a diabetic ulcer with be discussed." in category "Essay examples" All patients with diabetes should receive an annual foot check by a trained health care professional (NICE 2004), this includes the application of a 10g monofilament to five points on each foot, to assess the protective sensation in the feet and the extent of any sensory neuropathy. Peripheral sensory neuropathy is thought to affect 20 – 40% of the population (McIntosh et al 2004) and is a major factor in the development of diabetic foot ulceration. Both feet were tested using the 10g monofilament this resulted in 0/5 probes being detected on both feet indicating peripheral neuropathy, however the dorsalis pedis and posterior tibialis were palpable in both feet, skin colour, texture and temperature and capillary refill was 2 seconds indicating good blood supply (Dealey 2005). Baker, Murali and Fowler (2005) state that the palpation of foot pulses is not a good indicator for a good blood supply. A Doppler gives a more accurate result when assessing vascular status it assists the diagnosis by determining the presence or absence of a compromised arterial flow in the lower limb (Dughil 2006) Jeng et al (2000) concluded that if a person cannot identify the pressure from a 10g monofilament on their skin approximately 98% of the sensory ability has been lost. When the 10g monofilament is applied to the foot it buckles at a given force of 10g, inability to feel this is a significant indication that neuropathy is present and protective pain sensation is lost (Edmonds and Foster 2000). Neuropathy presents itself in various ways; motor, sensory and autonomic nerves are affected and there is no conclusive proof as to what causes neuropathy. Factors such as high glucose levels can cause chemical changes, harming blood vessels, which supply oxygen, to tissue. Motor neuropathy, causes abnormal foot pressures, the structure of the foot can change, giving abnormal pressure areas. Sensory neuropathy can give reduced sensation, masking pain, allowing for callus build up, and leading to ulceration. Autonomic neuropathy, which leads to dehydration of the skin, is commonly known as arteriovenous shunting (A.V). Neuropathy is detected by using a 10g monofilament. This is used on high pressure areas to detect if the patient can feel pain or not. These results, however, may not always be reliable, as they rely on patient feedback, therefore clinical judgement, must always be upheld at all times. Diabetes affects the vascular supply to the foot, leading to reduce or absent pulses, causing poor tissue viability, decreasing healing time. Excess glucose and cholesterol deposits in the lumen of blood vessels, reducing the diameter, which in turn, increases heart activity causing hypertension. Aspirin is used as a prevention, it is classed as an anti-platelet drug which reduces platelet aggregation. Aspirin inhibits enzyme COX, which reduces platelet production of TXA2, which is a powerful vasoconstrictor. Mr Johnson* is currently taking Atenolol, hypertensive drug as well as Aspirin to reduce the chances of thrombosis or MI. It was explained in detail to Mr Sim about the complications of diabetes and how it may affect the feet, during the discussion Mr Sim became upset about the loss of his wife, â€Å"she always looked after my feet particularly because of the diabetes†. It was important to establish a good rapour with Mr Sim, as the lesion was causing him no discomfort apart from catching on his socks. The recent loss of his wife, his back pain and hand infection had put a lot of stress on Mr Sim. Depression is twice as likely to occur in people with diabetes and this can have a link to fluctuating blood sugar levels. Mr Sim is also experiencing pain from his back and is still grieving about the death of his wife and coming to terms with living alone. Stress is recognised as a factor in delaying wound healing (Dealey 2005; Glasser et al 1999; Kiecolt-Glasser et al 1995). Cole-king and Harding (2001) found a statistically significant relationship between anxiety and depression and delayed i n chronic wounds. Communicating with patients can reduce anxiety and promote the natural healing process, conversely lack of communication may impair healing (Collier 1994) It was then explained to Mr Sim extenslevily about the lesion of his foot in regards to his general health without adding to his stress levels. Education has proven to be vital in the management of diabetes (NICE) . It was suggested that on debridement of the callus that there could possibly be foot ulcer, with Mr Sim’s consent the callus was removed using sharp debridement an ulcer was revealed. The ulcer measured 1cm x 1cm and probed to a depth of 5mm to tendon but not to bone, the base of the was ulcer was sloughy and yellow and appearance showed no sign of infection, sharp debridement was used very carefully to remove slough. Slough in the base of an ulcer is an ideal breeding ground for bacteria which increases the risk of infection and delays healing (Rainey 2005).If infection was noted healing will be delayed and may spread to surrounding tissue or bone. At the time of assessment Mr Sim’s ulcer showed no signs of infection, although he was taking a course o f antibiotics for the infection in the wound on his hand. Diabetic problems such as peripheral ischemia or neuropathy can mask signs of infection this was considered on assessment. The wound following sharp debridement was flat and pink, this was significant as rolled edges would indicate infection. The condition of the skin was dry and showed no signs of maceration. The use of tool to grade the ulcer can provide objectivity and help with communication between health professionals. The tool used in this study was EPUAP European Pressure Ulcer Advisory System 1998, in this case the ulcer was caused by excess pressure over an area affected by peripheral sensory neuropathy. There are many wound classification systems including SAD, SINBAD and PEDIS, however the EPUAP grading system was protocol for this particular community trust. The ulcer was classified as a grade four pressure ulcer which is described as extensive destruction tissue necrosis, or damage to muscle, bone or support ing structure with or without full thickness loss. The choice of dressing being â€Å"Activon Honey Tulle† produced by Advancis medical the gauze is impregnated with pure Manuka honey, this was used firstly to complete the debridement autolyticly. Secondly for the antimicrobial purposes and its aid to deslough and control odour in the wound. Benbow (2008) states a mosit environment is essential for optimal wound healing. Other dressings are considered also for their topical antimicrobial agents, such as Iodine and Silver. Iodine was an option although none where available in Clinic. Iodine is a popular choice for the use in Podiatry. Silver dressings are more expensive than the honey and also should only be used when there is clinical sighs of infection (British national Formulary: BNF, Nov 2009), so, as in Mr Sim’s case there was no signs. The secondary dressing was a foam dressing designed to absorb and retain any wound exudate to stop the wound from becoming macerated and inhibiting wound healing. ‘Biatai n’ was the dressing choice as this is one of the foam dressings used in the clinics. This was needed as the Activion Tulle does not have any absorption properties. These dressing were held in place with ‘Mefix’ an adherent tape. Mr Sim was given instructions to keep the dressing clean and dry until his next appointment Holistically the treatment plan was to contact Mr Sim’s, G.P regarding his depression over the loss of his wife, and referral to the local diabetes centre. A lengthy discussion was held on the importance of good footwear and changing shoes regularly, as although Mr Sim’s shoes where good shoes they were very old and the innersole had worn out penetrating to the outer sole (hole in bottom of shoe). A total contact insole referral was made to relieve the pressure long term. Temporally a pad was mad to deflect pressure away from the ulcer overlying the dressing in situ. Effective reduction in pressure relief is essential to heal a diabetic foot ulcer and to prevent reoccurrence (Armstrong et al 2001). A education booklet was supplied titled Diabetic foot Ulcer, if a patient has the knowledge and understanding of their treatment plan they are More likely to comply (Dowsett 2004). Mr Sim was as asked to return to clinic in five days as part of his dressing regime, he reported he had an appointment with the G.P the following day to discuss his depression. He had also received a letter from the diabetes centre with an appointment for the following week. The NSF (National Service Framework) and NICE the National Institute for Clinical Excellence set standards and put polices in place for every health care professional to follow, all patients with diabetes present with an ulcer must be referred on to a multidisciplinary team to receive the best care possible. The multidisciplinary team consists highly trained podiatrist, diabetologist, consultant, nurses, orthotists all of which specialises in complications of the foot and lower limb (NICE 2004). The dressing was removed the wound measured a reduction in depth and circumference 7mm x 6mm depth 3mm, exudate levels where low, there were no clinical signs of infection, no maceration or further callus formation, the same dressing was applied and along with padding. A further appointment was made for seven day’s time , ideally the dressing change should be five days but due to staff sickness this was not possible. At this appointment Mr Sim had seen the G.P who had referred him to a bereavement councillor. The diabetes Centre had furthermore made a referral to the orthopaedic department who are fitting Mr Sim for orthopaedic footwear for pressure relief in accordance with NICE guidelines (2008). On conclusion the outcome for this case study was a positive one, the patient was assessed holistically to identify and factors which may hinder the healing process, this not only includes the factors directly affecting the wound but also indirectly by affecting the patients qualit y of life including dealing with bereavement, housing issues etc. The Department of Health (DH 2008) stated â€Å"Delivering improvements for people with long term conditions is not just about treating illness, it is about delivering personalised, responsive, holistic care in the full context of how people live their lives. Our journey to achieve this has started, our challenge is to continue to take it forward and the evidence compels us to do this†. REFERENCES HPC Armstrong, D.G., Nguyen, H.C Lavery, L. A., (2001) offlanding the diabetic foot wounds. Diabetes care 24 (6) 1019 – 1022 Baker, N., Murali-Krishman, S., Folwer, D (2005) A users guide to foot screening, part 2, peripheral arterial disease, the diabetic foot 8 (2) 58-70 Benbow M (May 2007) Back to Basics – Skin and Wounds. Journal of Community Nursing Vol 21 (5) p34 Benbow M (2010) Ageing Wound healing, Journal of community nursing. 24 (5) 36-38 Brannon, H M.D former about.comguide Collier, M (1994) assessing a wound. Nursing standard 8 (49): 3-13 Dealey, C. (2005). The care of Wounds. A guide for Nurses. Blackwell Science, oxford. Dowssett (2004) Dughill, S., (2006) peripheral arterial disease. Why screen in primary care Nursing times 102 (16) 38-39 Glaser, R., Kiecolt-Glaser, J.K., Marucha, D.M.D MacCallum, R.C., Laskowski, B.F., and Malarkey, W.B (1999). Stress-related changes in pro inflammatory cytokine production in wounds. Archives of General Psychiatry 56 (5), 450-456. Cited in Dealey, C. (2005). Marcucha, P.T., Malarkey, W.B., Mercado, A.M Glaser, R. (1995).Slowing of wound healing by psychological stress. Lancet, 346 (8984) 1194-1196. Cited in Dealey (2005) Rainey, J (2005). Wound Care, A handbook for community Nurses. Whurr Publishing, London. Lookingbill ,D,P. Marks, J, G (1993) principles of Dermatology. London; W.B Saunders company. How to cite The assessment and treatment of a diabetic ulcer with be discussed., Essay examples

Resource Allocation for Care of Children-Free-Samples for Students

Question: In a Hospital Context, how would you prioritise what share of resources goes to care of children versus care of the elderly including Palliative Care? Answer: Introduction The current assignment focuses on the concept of allocation of resources and priority setting for catering to the care needs of children and old age people in a hospital setting. The resources could be diversified into different types such as financial resources, physical resources such as machines and equipments. The human resources also play a crucial role over here which includes recruiting the right healthcare professionals. The assignment emphasizes upon setting up of priority care needs of the children and the elderly. The requirements for both the age groups are different and require high degree of specializations. The assignment also focuses upon the economical and no-economical measures which further impacts upon the care strategies undertaken within a hospital environment. Care ethics As a pediatric care giver, one bears the responsibility of caring for many delicate and vulnerable lives each day. Its fully ethical to set priorities of quality care giving on every shift assigned to without fail which forthrightly includes physical presence. Even though the child medical profession is quite involving and overwhelmingly demanding, the individuals in these positions should ensure they attend to all children's emotional and physical needs (Ameritech College of Healthcare 2015). Openness to the child-patient family and any other supervisor(s) is a virtue to be upheld at all time. Commitment to provide the best care to the child should be paramount given that terminal illnesses aren't a usual occurrence in children. The "uncommonness" of the disease incidence presents the child's care provider with unique challenges in care provision to the child and his or her family (Get palliative care 2017). Although diverse clientele groups often demand various needs, the resources to satisfy these requirements are redundantly scarce. Nevertheless, these conditions still do require satisfying, and thus individuals or entities have to devise means to curb them. One way of achieving this is via ordering them in a hierarchical format beginning with the most sensitive/demanding. Priority setting culminates to the "process of involving clients and stakeholders in determining which needs are most important" (The University of Arizona 2010). Priority setting at the hospital level. In the recent past, priority setting research has delved on macro and micro level surprisingly despising the hospital level of health care provision (Barasa, Molyneux, English and Cleary 2015). Barasa, Molyneux, English, and Cleary quotes that the neglecting of the institutional level should now be covered given the essential responsibility that hospitals Harbor in providing health care services (2015). It's prudent not to view patient care provision as a comprehensive treatment practice since patient needs, across all demographics, are diverse and multifaceted (King University 2014). The changes in adults hold potential positive or negative health precursors even as many of the elderly's body functions continually deteriorate (King University 2014). Resource allocation for care of children The provision of optimum and standard care services are dependent on allocation of the right amount of resources. For the purpose of which the resource allocation system needs to be designed. As commented by Norheim et al. (2014), the funding for the personal budget is done by the council aimed towards the availability of supportive frameworks for meeting the care needs of the children. Therefore, in order to meet the diverse care requirements of children the Australian government, Department of Health (DOH), have inculcated a number of intervention policies aimed towards child health care within a clinical setup. As commented by Smith et al. (2013), the policies are aimed towards the allocation of optimal resources for implementing programs such as Child Health Check Initiative(CHCI) and Expanding Health Service Delivery Initiative (EHSDI). The resource allocation and the funding for the allocation of the resources are dependent upon differentiating and prioritising the levels of su pport needed by the children. The support levels can be differentiated into low support, some support, small support, lots of support and exceptional support requirements. The support service requirements can be divided into different bandings based upon the Resource allocation system (RAS) score. The RAS score can be divided into different score groups such as 0-69, 70-145, 146-185, 186-210, 211-220. As asserted by Nord and Johansen (2014), a score 69 or below means less support is required by the growing children. In this context, the health and well being outcomes are met through the provision of universal services. The score board of 131-145 points at small support service requirements, where the child depicts a mix of health needs. Therefore, children facing such adverse conditions need to provided with adequate support with the help of equipments and well trained staff and nurses. The score of 171-185 means that universal services alone are not sufficient to meet the health requirements of the children. Therefore, personal budgeting and continued support through social services can be helpful. This is further supported by high and very complex c are needs, which aims at providing care and support services through the integration of multidisciplinary channels. The multiple channels include health, education and social care services which are extended through EHSDI. The priority setting forms an important component of the care plan and treatment process. For catering to the care concerns of the children within a hospital setting the assessing cost effectiveness initiative had been applied over here. The method specifies the community value, combines technical and due process and is explicit in nature. As commented by Whitty et al. (2014), the care provision is based upon guidance from economic theory, social ethics, empirical experiences. This helps in addressing the patient centred needs by drawing upon a specified list of plan. Priority setting for elderly Allocation of resources for the elderly is dependent upon the setting up of and implementation of important instruments such as the Aged care functioning instrument (ACFI). The implementation of such policies helps in focussing upon the core care concerns for the budgeting and the allocation of policies. As commented by Hipgrave et al. (2014), the implementation of such approaches are useful in measuring as well as checking the average care costs in longer hospital stays. The funds are allocated based upon profiling of the care needs or concerns of the patients. As argued by Drake (2014), caring for old people often brings us to dealing with the concepts of end-of life palliative care. Thus, such care provisions are mainly provided to patients suffering from incurable chronic conditions. The only aim of the provision of such care treatments is to make death a less painful experience for the support users. The priority setting in the following area of care management is mainly non-economic in nature. This could be attributed to the dependency upon huge infrastructural support such as life support systems and modern diagnostic interventions and tools. However, a mixed method could be followed over here which includes Program Budgeting and Marginal Analysis (PBMA) along with consensus priority setting. The PBMA approach is based upon resource re-allocation and follows an explicit manner of decision making (Conklin et al. 2015). The process is supported by hard and soft evidences which help in implementing the resource allocation system. Additionally, implementing a consensus based approach helps in providing support services to the ones with impaired cognition and decision making approaches (Mitton et al. 2014). The consensus approach keeps the wishes and the demands of the patients at the centre of the care treatment process. However, the same also takes into consideration the valuable inputs from the attending physicians or the family members of the support users. Parameters of priority setting: The CDC quotes that immunization is not for the children alone (2017). This is because childhood vaccinations do wear-off as one age (CDC 2017). An individual may be prone to immunizable illnesses "due to age, lifestyle, health condition, job or travel" (CDC 2017). It is therefore proper for every individual to undergo childhood, traveling, career-related, health-related and age-related immunization procedures. It is prudent to note that adult vaccination is more condition-based than is child immunization. Also, more than ten Million children, under five years of age, are estimated to die every year with roughly 70% succumbing to preventable diseases. This shows the urgency of preteen and teenage vaccination over adult vaccination since the immunization procedures are essential steps towards children health and future protection (U.S. Department of Health Human Services 2017). Health care providers are usually the ones who administer vaccines and thus play a significant role in educ ating children caretakers of the vaccines' life-saving functionalities and safety (Miller et al. 2015). Medical institutions should, therefore, prioritize available resources focusing them on disease prevention practices like the preteen vaccination processes and awareness. Recent studies in the United States show that massive government expenditure savings ($1.38 trillion) were realized when the government adopted a children vaccination program for vaccine provision and administering to all children whose families could not support their acquisition (Whitney et al. 2014). The savings were realized due to prevented illnesses, hospital admissions and premature deaths which cut on the demographic working age group thus reducing and or terminating their respective economic input (Whitney et al. 2014). Health care facilities should, therefore, concentrate resources on child vaccination activities by providing required training to medical practitioners, public vaccine awareness, preventi on drugs and equipment, seasonal follow-up with the kids in learning institutions among other practices promoting child immunization (Miller et al. 2015). Physical activities Physical activities have been said to promote public health responsibilities achievement by local authorities in places where lost productivity is estimated at billions of dollars due to sickness absence and premature death (The National Institute for Health and Care Excellence 2013). Many of the chronic illnesses in the elderly are diet and lifestyle related which means that the individuals possess prior experience of physical exercise. The elderly sick can, therefore, perform physical activities with minimal supervision given their high cognitive abilities relative to the preteens. There are also several facilities and equipment in healthcare institutions that can be used by the sick elderly to perform physical exercises. On the other hand, children lack the prior experience of physical activities, the cognitive ability to comprehend the need for physical activities added to their inability to perform these tasks on their own. Despite the vitality of physical activities to the chil dren, the severely sick amidst them sometimes fail to get as much physical exercise as they require (Canadian pediatric Society 2011). To alleviate this situation, medical institutions should (New Jersey Department of Children and Families 2017): Set aside at-least 50 square feet room space per child to allow maximum child mobility and exercise space. Have personalized individual resources for children with different ailments to prevent spreading of communicable diseases while at the same time allowing the physical activity of each child. Acquire outdoor space for children physical activities. All in all, the healthcare facility should have adequate health care personnel due to the uttermost and constant care needed for the sick children as they perform the physical activities. Malnutrition Malnutrition, the nutrition imbalance, can also be defined as cause and consequence of ill health originating from proteins, energy or micronutrients deficiency in a human body. Malnutrition directly causes an estimated 300,000 deaths per annum and is indirectly causing roughly half of all under 5years children deaths. Contrary to the belief that malnutrition is a condition affecting starving children in third world countries, malnutrition is common in developed countries too especially in hospitalized populations (patient 2016). In these communities, the elderly suffer malnutrition if they are suffering from diseases or conditions that affect appetite, have gastrointestinal function problems or have severe mental health concerns. On the other hand, children who are susceptible to malnutrition if they are premature (weaning time), chronically ill, neglected by caregivers among other poverty related complexions (patient 2016). Health facilities should, therefore, be ultimately vigilan t of the sick pre teens dietary needs by providing balanced diets to the children thus managing and curbing malnutrition. Conclusion The assignment takes into consideration the different resource allocation procedures along with priority setting for the care and management of the old and the young. In the current assignment a Resource allocation system where scores have been provided to individual support users based on their care needs. The scores allocated further helps in designing of the care plan whether some and small support services are required or exceptional support services are required. The aged care however follows the ACFI framework for resource allocation. The setting up of the priorities forms another important constituent of the care management process. Thus, implementing approaches such as ACE and PBMA can help in sustaining the resources for long term care. References Ameritech College of Healthcare (2015), Blog,7 Pieces of Practical Advice for Nurses Raising Kids, viewed 21st August 2017, https://www.ameritech.edu/blog/7-pieces-of-practical-advice-for-nurses-raising-kids/. Barasa E. W, Molyneux S., English M. and Cleary S. (2015), Oxford Academic journals, Health policy, and planning, Setting health care priorities in hospitals: a review of empirical studies, Vol 30, no. 3, pages 386-396. Canadian Pediatric Society (2011), Caring for kids, growing and learning, Physical activity for children and youth with a chronic illness, viewed 23rd August 2017, https://www.caringforkids.cps.ca/handouts/physical_activity_with_a_chronic_illness. Coetzee M. (2005), University of Cape Town, School of Child and Adolescent Health, Article;Are children really different from adults in critical care settings?SAJCC, Vol. 21, No. 2. Conklin, A., Morris, Z. and Nolte, E., (2015). What is the evidence base for public involvement in health?care policy?: results of a systematic scoping review.Health Expectations,18(2), pp.153-165. Drake, T., (2014). Priority setting in global health: towards a minimum DALY value.Health economics,23(2), pp.248-252. Get palliative care (2017), Pediatric, Pediatric vs. adult, Adult vs. Pediatric Palliative Care, https://getpalliativecare.org/whatis/pediatric/adult-vs-pediatric-palliative-care/. Hipgrave, D.B., Alderman, K.B., Anderson, I. and Soto, E.J., (2014). Health sector priority setting at meso-level in lower and middle income countries: lessons learned, available options and suggested steps.Social science medicine,102, pp.190-200. Kidshealth (2017), For parents, when your child is in the pediatric intensive care unit, Nemours children health system, https://kidshealth.org/en/parents/picu.html. King University (2014), 7 Types of Nurses with Age-Specific Competencies; Nurse with young patient; Nurses bring comfort to patients of all ages, viewed 21st August 2017, https://online.king.edu/nursing/7-types-of-nurses-with-age-specific-competencies/ Kluge (2007), Medscape General medicine, Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession, Vol 9 no. 1, PMC1925021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925021/ Miller ER, Shimabukuro TT, Hibbs BF, Moro PL, Broder KR, Vellozzi C. (2015), The CDC supports nurses in promoting vaccination, Vaccine Safety Resources for Nurses,The American journal of nursing, Vol115 no. 8 page 55-58, doi:10.1097/01.NAJ.0000470404.74424.ee. Mitton, C., Dionne, F. and Donaldson, C., (2014). Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis.Applied health economics and health policy,12(2), pp.95-102. New Jersey Department of Children and Families (2017), State of New Jersey, Department of Children and Families, Requirements for additional physical facilities for centers serving sick children, Regulations: 10:122-8.4. Nord, E. and Johansen, R., (2014). Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY.Health Policy,116(2), pp.281-288. Norheim, O.F., Baltussen, R., Johri, M., Chisholm, D., Nord, E., Brock, D., Carlsson, P., Cookson, R., Daniels, N., Danis, M. and Fleurbaey, M., (2014). Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis.Cost Effectiveness and Resource Allocation,12(1), p.18. Patient 2016, Professional reference, Malnutrition, Malnutrition, viewed 24th August (2017), https://patient.info/doctor/malnutrition. Smith, N., Mitton, C., Bryan, S., Davidson, A., Urquhart, B., Gibson, J.L., Peacock, S. and Donaldson, C., (2013). Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey.BMC health services research,13(1), p.247. The Centre for Disease Control and Prevention (2017), Vaccine information for adults, What Vaccines Are Recommended for You, National Center for Immunization and Respiratory Diseases,viewed 24th August 2017https://www.cdc.gov/vaccines/adults/rec-vac/index.html. The National Institute for Health and Care Excellence (2013), NICE guidance, lifestyle, and well-being; physical activity, what can local authorities achieve by encouraging people to be more physically active?[LGB3], viewed on 24th August 2017 https://www.nice.org.uk/advice/lgb3/chapter/what-can-local-authorities-achieve-by-encouraging-people-to-be-more-physically-active. The University of Arizona (2010), Program planning and evaluation; Priority setting, College of Agriculture and Life Sciences; Cooperative Extension, The University of Arizona on 21st August 2017 https://extension.arizona.edu/evaluation/content/priority-setting. U.S. Department of Health Human Services (2017), Vaccines, who and when, viewed 23rd August 2017, https://www.vaccines.gov/who_and_when/index.html. Whitney C. G, Zhou F, Singleton J, Schuchat A. (2014), Centers for Disease Control and Prevention (CDC), Benefits from immunization during the vaccines for children program era - the United States, 1994-2013, MMWR Morb Mortal Wkly Rep. 2014 Apr 25; 63(16):352-5. Whitty, J.A., Lancsar, E., Rixon, K., Golenko, X. and Ratcliffe, J., (2014). A systematic review of stated preference studies reporting public preferences for healthcare priority setting.The Patient-Patient-Centered Outcomes Research,7(4), pp.365-386. World Health Organization 2008, Manual for the Health Care of Children in Humanitarian Emergencies. Geneva: (2008). 1, Triage and emergency assessment. https://www.ncbi.nlm.nih.gov/books/NBK143755/.

Racism free essay sample

This paper focuses on the lives of a group of girls living in a periurban community outside of Maputo, Mozambique. Using participatory methodologies, we hear directly from the girls the influencing role gender and culture has in preventing girls from accessing a higher quality of life. Noticeably absent in girls and poverty related dialogue are the voices of girls living with poverty, as well as the fundamental role of gender inequality and culture in relation to the opportunity and capacity of girls becoming visible, having voice and agency and ultimately leaving a life of poverty. BIO Dr. Zainul Sajan Virgi’s research is based in Maputo, Mozambique where she is focusing on the lives of vulnerable pre-adolescent and adolescent girls and the possibilities for accessing a higher quality of life â€Å"as seen through their eyes†. Zainul is the first recipient of the Jackie Kirk Fellowship in Education. Zainul has worked as a community / international development expert in Canada, Mozambique,Tanzania, and India. We will write a custom essay sample on Racism or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page She has utilized her research skills and translated the outcomes into recommendations which have been implemented successfully by governments, non-profit organizations, as well as donor agencies. â€Å"Children, particularly girls, continue to inherit family poverty. This cycle must be broken. † UNESCO, 2003 p. 5 INTRODUCTION Childhood poverty is a reality in every part of the world. Today, one billion children globally live with poverty (HDR, 2012). Of which 30 million children live in relative poverty in 35 of the world’s richest countries (UNICEF, 2012). Eradicating poverty and in particular girlhood poverty has been an elusive goal. In 1948, governments, decisions makers, donors and NGOs first committed to eradicating poverty by adopting the Universal Declaration of Human Rights (OHCHR). A more concerted effort was made towards eliminating childhood poverty with the adoption of the Convention on the Rights of the Child (CRC) in 1989. The CRC was designed to protect the child and ensure that s/he was able to access a higher quality of life. In September 2000, the largest gathering of world leaders in history approved the UN Millennium Declaration which included as one of its key goals, the eradication of poverty and hunger by 2015 (MDG website). With focused attention on poverty that began 64 years ago, some progress has been made, however much work remains as noted by the following statistics. One billion children or 1 in every 7 individuals continue to be deprived of one or more essential services for survival. 1. 1 million children do not attend primary school (UNICEF, 2010). 640 million children are living without adequate shelter; 400 million children do not have access to safe water, 270 million children do not have access to health services. 10. 6 million children died before they reached the age of 5 in 2003; about 29,000 children per day (Shah, 2010). An estimated 60 percent of the chronically hungry are women and girls and 20 percent are children under the age of five (WFP, 2009). Why Girlhood Poverty? A wide body of diverse research in the fields of anthropology, developmental psychology, medicine, sociology, and education (Shonkoff, 2009; UNICEF, 2008) all underscore the importance of development during the early years of childhood in relation to the formation of intelligence, personality, and social behaviour (Farah et al. , 2006; Brown Pollitt, 1996; Winick Rosso, 1969). The effects of neglect during the early years of life can be cumulative and lasting (UNICEF, 2008). There has also been a call since the late 1990s for research with girls and boys that engages their voices, particularly during their early adolescent years. Cannella (1998), for example, notes that â€Å"the most critical voices that are silent in our constructions of early childhood education are the children with whom we work. Our constructions of research have not fostered methods that facilitate hearing their voices† (Cannella, 1998, p. 10). I would add that the voices specifically of young adolescent girls are notably absent in relation to poverty, gender inequality and the affects of cultural and social norms in their lives. Considering that 70% of those classified as poor in the world are women (UN WOMEN), I presumed that girls living with poverty must face different challenges than those 3 xperienced by boys in transitioning out of a life of poverty. In reviewing data pertaining to childhood poverty used by leading organizations such as UNICEF, I noted that not all data pertaining to children in general had been disaggregated by sex or age. In the absence of sex and age disaggregated data, the statistics presented seem to give the impression that girls and boys of all ages experience poverty in similar ways. However, UNICEF indicates that there is still an incomplete understanding of how poverty specifically impacts girls. There is also limited research which analyzes the relationship between childhood poverty and girlhood (Delamonica et al. , 2006). Poverty research as seen through the eyes of girls would highlight a combination of elements including gender inequality, cultural influences, lack of property and land rights; lower status; lack of decision making ability; inconsistent access to basic rights including access to clean drinking water, sanitation, heath care and quality education, upward mobility employment; limited ability to protect oneself from physical and sexual violence (UN WOMEN). Why Use Participatory Methodologies? If we begin with the premise that the end goal is to develop effective policies that will address multiple real life issues faced by girls living with abject poverty, then a critical first step is to engage girls for whom the policies would have a direct impact and for whom poverty is an intimate reality. The second step is to develop space for them to critically reflect on their past, present and future lives. Space is needed to listen to their ideas for solutions that could transform individual and community challenges into strengths. Space is also important to learn directly from the girls the teps needed that would lead to effective and meaningful improvement in their quality of life. After all, creation of knowledge is the hallmark of empowerment. Numerous research studies have acknowledged the essential role of effective participation which leads to some form of empowerment. It also results in a more equal sharing of power between those who have access to power and those who ar e traditionally barred from having power (Nelson Wright 1995). Dominant narratives in many societies throughout the world hold the view that children are not able to participate in making important decisions that affect them. Girls, especially girls living with poverty are often not consulted or even asked to participate in civil society, nor in research about their lives. Challenging that perspective is the empowerment approach which encourages us to â€Å"question these dominant narratives and to seek out alternative stories that challenge assumptions about children’s capacities† (Rappaport, 2000, p. 5). Another growing area of research—the sociology of childhood— nudges us to listen to children’s perspectives and view children as experts in their own lives. Children’s expertise can be cultivated by teaching them specific skills. Participating in research, for example, can help them gain more control of the resources that affect their lives. Children, therefore, can become advocates for themselves and others (Langhout Thomas, 2010, p. 64). 4 Participatory research has great potential for marginalized girls, who are normally silenced, to develop a sense of self by offering their unique perspective on their lives, community, challenges and strengths. And in the process of participating in participatory research, they can have the potential to become leaders within their own communities (Mathews et al. , 2010). The Case of Mozambique Mozambique is a country that has been shaped by war, struggle and multiple ideologies which has resulted in its limited transition from being the poorest to the fifth poorest country in the world (UNDP 2010). Culture plays an influencing role on decisions made by governments and the policies they choose to support (Sen, 2004). Mozambique is a hegemonic patriarchal or male-dominated culture. The Portuguese colonizers for over 400 years also reinforced male supremacy in Mozambique (Stoler, 1995). The combination of culture, differing ideologies and long periods of war has had a direct impact on two critical sectors in Mozambique – health and education. For example, during 15 years of armed conflict between FRELIMO and RENAMO, public infrastructure was deliberately targeted, with schools and teachers in particular being singled out (UNICEF, 2006) along with doctors (Finnegan, 1992). In total, damage was estimated at $20 million (Hanlon, 2010), a staggering amount for an impoverished country. The combined human and financial losses left Mozambique with little choice but to turn to the international community for increasing financial assistance. Mozambique’s increasing financial dependence led to the neo-colonization of Mozambique, this time by South Africa and the West. The multiple forms of domination also led to increasing influence by foreigners on Mozambique’s policies, including health, education and the use of foreign funds (Paraskeva, 2006; Sousa Santos, 2002). Currently, Mozambique is considered to be the eighth most donor-dependent country in the world (de Renzio Hanlon, 2007). The support is limited to financial and does not adequately address gender, culture, poverty or capacity building issues, thus leaving Mozambique in a weakened dependent state (Porter, 2005). Health and education sectors considered to be key sectors towards alleviating poverty are heavily reliant upon donor aid. Issues regarding girls living with intergenerational poverty and the role of culture and gender inequality do not even appear on the agenda. Setting The fieldwork (see Sajan Virgi, 2011) was conducted in an all-girls’ school and community situated in a peri-urban area just outside the capital city of Maputo. The school is supported by an Italian church community and provides grade six to twelve education. During the first year of the three year program, girls commencing their education receive practical life skills training along with regular academic courses. The importance of sharing and working together is emphasized with the hope of enabling the girls to move out of the survival mode that has been their existence to date. The community members live a poor quality of life as 5 they confront the multiple challenges of poverty. i Many of the homes are headed by grandmothers. The girls move into the community to live with their grandmothers or other relatives, after having lost one or both parents, often to AIDS. Sometimes, they also move from other provinces in order to find better job prospects without having any family or relatives in the community. These girls often experience life challenging circumstances including death of their loved ones, loneliness and the bearing of responsibilities that are age-inappropriate. Participants Ten girls between ten and fourteen years of age were selected from Year 2 and Year 3 of the program by the Head and Class Teacher to participate in the study. The majority of the girls entering Year 1 of the program predominately speak Chagani and very little Portuguese. From a class of one hundred in Year 1, upwards of 10 different dialects were spoken. Since the girls from Year 1 were just in the process of learning the Portuguese language, the Head Teacher felt that their ability to be engaged and contribute in Portuguese would be limited. Design and Procedure The study was conducted over a six-month period. In all, the girls participated in sixteen sessions, some of which took place during school hours and others after school. I realized that if I wished to hear the voices of girls who had been silenced for generations, multiple data collection methods would be required to ensure that each girl found comfort and ease with at least one data collection method. Keeping this in mind, I used a variety of participatory tools including drawings, photovoice, focus groups, semi-structured qualitative interviews, informal conversations and reflection pieces to engage the girls and learn from them the complexity of barriers that are present in their lives as they attempt to access a higher quality of life. Photovoice is a term coined by Caroline Wang and Mary Ann Burris in 1992 which places a camera in the hands of the people and asks them to record their lives, experiences, strengths and challenges (Wang Burris, 1997). One of the most powerful outcomes of photovoice is the space it provides participants to create new knowledge and draw meaning from it. In total, the girls produced 30 drawings and 130 photographs on the issue of intergenerational poverty and their ideas regarding possible solutions. Analysis of Visual Data As Gillian Rose (2001) and others highlight, there are several different ways of working with visual data such as photographs, based on such questions as, ‘Who took the photograph? ’ and ‘What does the photographer say about the image? ’ and even ‘Where is the photograph stored or displayed? ’ In other works, two additional questions have been posed, ‘How can photos be used within a participant-analysis approach? ’(De Lange et al. , 2006) and, ‘How do we work with a single photograph? (Moletsane et al. , 2007). My main approach was to rely on what the girls themselves chose to photograph (in terms of categories), and their own passion and enthusiasm when choosing from the images and 6 photos on which to focus. They also provided the framework and context to the photos, thus enabling their readers to understand, following Freire (1970) the meaning they were making of their own lives. The photos permitted me to see the world through their eyes. Since photographs were used as an entry point for dialogue and debate, it was the follow-up discussions that provided even richer data with respect to the barriers the girls face in trying to acquire a higher quality of life. For example, I asked the girls to draw their perception of poverty, a higher quality of life as well as the elements needed to bridge the gap. The girls, while presenting their drawings, discussed the material aspects of poverty, as well as the emotional and social side of poverty. I also used photovoice to understand from the girls their perception of strengths, challenges and ideas for solutions in relation to poverty. The photographs produced by the girls visually depicted the life of a girl living with poverty. Discussions generated from the photographs taken by girls resulted in lively discussions and debates on topics ranging from gender inequality, inaccessibility to quality health, nutrition, education, and sanitation to gender violence and much more. During the focus group, I noticed that some girls remained silent. I introduced the idea of reflection pieces to enable these girls in particular to express their thoughts on issues raised. I also encouraged the girls in general to include in their reflection pieces unanswered questions pertaining to focus group discussions and/or to share their topic suggestions for the next focus group. The girls also conducted interviews with one older female relative. The interviews were organized around such issues as identifying female roles and responsibilities, discovering what older female relatives would have changed in their lives and why, as well as understanding from these female relatives what they thought could trigger the process of change in the quality of life of the younger generation of women in their community. Given that the families lived with abject generational poverty, I was interested in seeing how the girls themselves would discover similarities or differences between the lives of their grandmothers, mothers and aunts and their own lives and what steps they would take, if any, to address these issues. I also set aside time for unstructured qualitative interviews which evolved into dialogues. The girls directed the focus of the conversation according to the issues they raised. The use of multiple types of data resulted in richer information and diverse opportunities for the girls to express their thoughts and ideas. On a personal note, what I found remarkable was witnessing how photovoice (see Wang Burris, 1997; Sajan Virgi, 2011; Sajan Virgi Mitchell, 2011) enabled participants to switch from being participants in their lives to becoming observers of their lives. This change in perspective is the trigger needed, I believe, for critical reflection, analysis and for the development of appropriate solutions. As one girl said so eloquently, â€Å"I saw myself for the first time. † ii It was with this kind of realization that the girls, again following Freire (1970) saw themselves no longer as passive recipients of knowledge, but as active contributors to new and relevant knowledge, ideas and solutions. It was at this moment that they became visible to themselves and to each other. 7 HEARING AND SEEING THE PERSPECTIVES OF GIRLS In this section, through the girls’ stories and photos, they become visible, gain agency and voice. Their stories and photos enable us to understand the multiple challenges of poverty and the critical role gender inequality and cultural norms and values plays in erecting obstacles preventing them from leaving a life of poverty. Gender Inequality The term gender inequality can be problematic as it gives the impression that inequality experienced by girls and women will be the same. This is not the case. The inequality experienced by girls during their formative years, a unique period dedicated to intellectual and physical growth results in the under-development or limited development of girls’ physical and intellectual capacity. If girls do not achieve intellectual and physical growth during this critical period, the impact is permanent and difficult to alter at a later stage in life. This is because at the age of 10, a girl’s capacity for basic learning has been determined (Temin et al. , 2009). By the time she is 15, her body size, â€Å"reproductive potential and general health have been profoundly influenced by what has happened in their lives until then† (UNDP, 2004 p. 3). For the girls in the study, gender inequality, a fundamental barrier to accessing a higher uality of life appeared in many forms including lack of voice, agency, predetermined roles and responsibilities, disengagement from decision-making, power imbalance, vulnerability and inadequate quality of health as noted by their examples below. Girls Remain Invisible In The Home and Amongst Society Girls living with poverty face numerous forms of power which challenge their ability to contribute towards knowledge and meaning maki ng. The following are excerpts from the girls’ reflections pieces. Beatriceiiiexplains her invisibility: â€Å"In my class, I am the poorest girl. I know this because all the other girls can bring food to school, they have slippers that are not broken, and they have a school bag, notebooks, pens and pencils. I do not have these things. I usually wear the same clothes during my holidays. The girls at school all have different clothes to wear. I am often left out of the group. During recess, when everyone plays together, no one asks me to play with them. In class, the teacher pays more attention to girls that have a little bit of money. Often, my hand is raised because I know the answer, but the teacher rarely asks me to answer. Nine out of ten times, my answer would have been correct. But, no one will know that. No one will treat me differently. † Rita in her reflection piece notes the challenges of lack of agency: â€Å"At home, I am the last person that is heard, if at all. No one asks me for my ideas, even if it is regarding my school. My brothers and uncles always speak on my behalf. My mother I know she wants to know what I think, but she never asks me. I think it is because she does not want to make my brothers 8 and uncles unhappy because we are dependent on them for money. So many times I wish she would stand up for me and for herself. If we have less things or less food, that would be okay. But, to always be silent, that makes me unhappy. † In one of their collective reflection pieces written after girls had presented their drawings depicting poverty and their ideas for a better quality of life, the girls highlighted the necessity of Government support in their lives. They note: â€Å"without Government support, it will not be possible to change our lives, because we do not have money and need money from the Government. † During the first focus group session, the discussion turned to policies. The girls were asked to consider â€Å"what type of policies would you develop for women in your family and community? Fatima’s proposed policy addressed the long hours of work undertaken by their mothers and grandmothers for little pay: â€Å"I would ask the Government to pass a policy which ensured that our mothers did not begin work until 8:00am. Our mothers leave for work very early in the morning, sometimes before we even rise. They come home very late at night. They are too tired and often just go to sleep. We need our mothers at home with us. We miss them very much. We wish our mothers had different work opportunities like that of men in our community. The men work shorter hours and always seem to have money, unlike our mothers and grandmothers. † Beatrice made the observation that: â€Å"Isn’t the Government supposed to take care of poor people? Shouldn’t everyone have something to eat every day? My grandmother does her very best to take care of us, but, the only thing she can do is either work as a housemaid or work in the shamba (field). She is too old to do either. So often, we do not have any food to eat. † Power is the connecting thread in these excerpts. We learn that the power to engage, to participate in decision-making, to be heard as experienced by girls living with poverty is always in the hands of others: other girls living in poverty, but slightly better off; teachers; uncles; brothers; older women; aunties and mothers. Power in these girls’ lives is being shaped by culture, gender, tradition and policy. Role of Culture – No One Takes Us Seriously UNESCO during the World Conference on Education for Sustainable Development, Bonn, Germany organized a special side event entitled The forgotten priority: Promoting gender equality in education for sustainable development on April 2, 2009. The girls at this special side event spoke at length about the role of culture or social values as a tool to legitimize gender discrimination. In working with and learning from girls engaged in this study, culture also emerged as a root cause for the girls’ lower status and the limited opportunities and choices available to them to exit from a life of poverty. Patricia often commented, â€Å"no one takes us seriously when we talk about becoming a teacher, nurse, journalist or doctor. † At the same time, Fatima elaborated: 9 â€Å"So many of my friends’ mothers are sick. We have all experienced death. There is always someone who is sad. I want to become a doctor so that I can take care of them. But no one expects me to do this. They only expect me to get married and have children. When I talk about becoming a doctor, they do not encourage me. I know my mom wishes I could be a doctor, but she cannot give me any money to help me. So she just remains quiet. My dad, I think he thinks I am just being a child. But he doesn’t treat my brother like that. He encourages and expects my brother to make money. I want more, but I do not think I will have what I dream of†. A strongly patriarchal society like that found in Mozambique elevates the status of a son above that of a daughter, with respect to status, roles and expectations. Pre-Determined Lower Status of Girls and Women â€Å"The low status of girls and women is a formidable obstacle to poverty reduction† (UNICEF, 2001 p. 21). This powerful statement succinctly underscores the impact of the lower status of girls and her inability to independently exit a life of abject poverty. Patricia during a Focus Group shares her inability to challenge her brother: â€Å"I cannot challenge what my brother says. My mother will not challenge what my brother says. I am not allowed to make any decisions. I wanted to go to another school, but my brother decided this school was better for me. He did not even visit the school. He didn’t even have to give a reason for his decision. It was like he said it, so it had to be correct. My mom accepted his decision. I had to follow it†. Beatrice in her reflection piece writes: â€Å"My sister did not want to marry this man. He was much older. No one listened to her. She cried for days. She even stopped eating food. But, no one listened to her. She has been married for two years. She looks so thin and unhappy. She does not attend school. I cannot see her. I am not allowed. Her husband does not want me to see her. She is scared to disobey him. Last year, I saw her by chance. We exchanged looks, but could not speak to each other. He was with her. I am afraid that I will have to marry soon too† Yolanda shares her inability and that of her mother to engage in decision-making in her home: â€Å"Even though my brother is younger than me, he is able to make decisions for me. My uncles who live far away from me make decisions for me. My mother who works hard to take care of us, she cannot make any decisions for me or my brothers†. Lack of voice and agency is amplified in child marriages. Notably, it is young girls who are married to much older men, rarely the reverse. Rosa had been married for 1 year. She did not share her marriage status even with her closest friends for 11 months: 10 â€Å"I am so embarrassed. He is an older man. I wish my life was free like my friends. By marrying him, I am helping my family, so it’s okay, but I still feel sad, very sad and alone. My life will be forever different from my friends. I did not have a choice. I just had to accept it†. Culture And Its Influence On Girls’ Pre-Determined Roles And Responsibilities The Chronic Poverty Research Center (2005) has confirmed that poor families are heavily dependent on the labour of girls in particular. The cost of this increasing dependence is that school is seen as a less likely option (CPRC, 2005). Pre-determined roles and responsibilities assigned to girls leaves them tied to their homes and fields. The gender division of roles typically attributes collection of water, obtaining food and wood, as well as caring for the sick and elderly to girls and women. Paula in her reflection piece highlights her love for learning, but she also underscores how her chores interfere with her learning: â€Å"I enjoy coming to school. I like learning. But, often I cannot come to school. Sometimes it is because I am so hungry I just do not have the energy to walk to school. I try to sleep so that the time will pass by quickly. Other times, I am busy with my chores. When I miss a lot of school, I get left behind. It is difficult for me to understand what is going on in class. I cannot stay behind to ask my teacher to help me because she will ask me for money. I also need to go home and complete my chores, so I cannot stay behind†. Fatima shares her thoughts regarding the difference of opportunity between her brother’s ability to attend school and her lack of opportunity to attend school in her reflection piece: â€Å"My family makes sure that my brother is able to attend school. But for me, they feel it’s okay if I do not go to school. They feel it’s much more important for me to learn how to keep the house clean, cook and take care of younger siblings as this will be my responsibility when I grow up. When I say that I like going to school, I like to learn, they tell me that is my brother’s job not mine† The amount of time and energy expended by these girls’ daily chores including fetching water hampers their ability to attend school regularly. As Paula shared during a Focus Group: â€Å"We need water every day. If I wake up late and start collecting water later, then I have to miss school. Often, when I am sitting inside the classroom, I find it hard to concentrate. I have a headache. I am tired from collecting water. I just want to sleep. Carla highlights how boys are treated better than girls: â€Å"Boys are treated differently than girls. At home, I am expected to do all the chores which takes my time away from homework. Boys can walk down the street confidently, while we walk cautiously and in groups. I wouldn’t want to be a boy, because boys steal and don’t look after their families. I prefer to 11 take care of my family. But, I still wish I had the freedom and choices that boys have which are not available to me. Why do girls have such difficult lives in comparison to boys? No one even asked me what I wanted to do with my life. The main reason identified in literature for this imbalance between sons and daughters is the ‘mother substitute’ role that girls often play. The unequal gendered distribution of labour within the household is evident when women take on paid employment outside the home, in the absence of alternative affordable child care optionsor in times of illness of a family member, the girls bear the additional labour burden, usually at the expense of their education (Jones et al. , 2010). Adequate Nutrition – Basic Human Right Adequate and appropriate nutrition is a fundamental requirement for development. Important to note is that â€Å"the quality of care and feeding offered to children †¦ is critically dependent on womens education, social status, and workload (UN Sub-Committee on Nutrition, 1997). Appropriate nutrition is mandatory for a strong and healthy immune system leading to a significant decrease in illness and overall poor health. Children who are healthy are able to focus on their education and learn better than those that are hungry (WHO, 2010). â€Å"Better nutrition is a prime entry point to ending poverty and a milestone to achieving better quality of life† (WHO, 2011b). Food always played a role in every conversation with the girls. Even if the topic being discussed was unrelated to food, somehow food always became an integral part of the conversation. Notably more than 60% of chronically hungry people in the world are women (WFP, 2009). The girls during their reflection pieces, semi-structured interviews and Focus Groupsshared the scarcity of food in their homes. Their comments were similar to Patricia: â€Å"Food is not always available. We often have black tea and bread for breakfast. Our next meal is usually at night. † The girls’ lives are physically demanding which includes walking for long hours under the hot sun in search of water and firewood. With poor nutritional intake, it further taxes their already weakened bodies. The girls’ bodies are also still growing and therefore adequate nutrition plays a fundamental role for current and future health, as well as capacity to learn and retain new knowledge. Hunger and malnutrition are the worst outcomes of abject poverty (ECOSOC, 1999). The girls demonstrated the impact of hunger clearly in the following statements they prepared together during a Focus Group session: â€Å"It is hard to concentrate at school when we are hungry. Sometimes we just stay home if we haven’t had enough to eat. We try to sleep so that the time passes by faster and hope that our mothers and grandmothers will find food so that the pain in our stomachs would disappear. † 12 Figure 1: Feeling Strong â€Å"I like this picture very much. I remember clearly that in this picture I had eaten food that day†. â€Å"We are strong because we are happy and we are happy because we have eaten. † Photo Credit: Rita  © Sajan Virgi, 2011 The words spoken by these girls in relation to the photograph they took in response to the Feeling Strong prompt (Mitchell et al. , 2006) speaks volumes and underscores the importance of food in the lives of girls living in abject poverty. And it highlights the importance and value of engaging participants first if we wish to gain a deeper and more holistic understanding of the challenges they face, and then developing relevant and dependable policies and strategies. Critical information like the role of food can be missed without direct engagement of the girls as they cope with the harsh realities of their daily existence. Access To Clean Water – Basic Human Right Lack of access to clean water and basic sanitation is a silent crisis affecting more than 33 percent of the global population (Bartram et al. 2005). Approximately 443 million school days are lost each year due to water-related illness (Barry Hughes, 2008). Despite research endorsing â€Å"150 years of acceptance of the healthful effects of clean water, an estimated 1. 1 billion people still lack access to it, and 2. 6 billion people lack access to adequate sanitation† (Barry et al. , 2008 p. 785). 13 In Mozambique, most women, particularly in rural areas spend on average 15-17 hours per week collecting water. Using these hours of water collection per week as a basis of calculation, it translates into ~40 billion hours a year – a staggering number equivalent to France’s entire working force (UNDP, 2006). The time used to collect water takes away from completing homework, attending school, alternate training opportunities for girls and young women, as well as time to secure upward mobility employment for women. The girls during a Focus Group spoke at length about time it takes to gather water. In their collective reflection piece, they stated: â€Å"We start collecting water between 4am and 5am every day, including weekends. It is difficult carrying water while dodging cars and trucks as we try to cross busy streets. The truck/car drivers don’t stop; they keep driving fast and make us run across the road with our water. We wonder why they don’t slow down and consider how difficult our job is carrying water under the hot sun. When we come back from collecting water, we are always very tired. † From this brief reflection, the girls have raised issues related to gender, power, status and pre-determined expected roles and responsibilities. The girls all agreed that the collection of water was mainly the responsibility of children, predominately girls. Rita shares how tired she becomes after collecting water: â€Å"Some of us have to make 20 trips to the well, others have to make 10. The water sources can be far away, some as far as 60 minutes. It is very tiring. The water feels very heavy on our heads and our arms hurt from holding 20 liters of water. Some of us weigh 25kg others weigh 35kg. Carrying 20 liters of water, several times a day is very hard – particularly when we haven’t eaten anything from the night before†. Collecting water consumes ~30% of the girl’s day light hours in the winter, and ~25% of their day light hours in the summer from the data. The majority of girls living in economic challenging circumstances do not have access to electricity; consequently day light hours are critical for studying. Furthermore, given the amount of energy required to collect 20 liters of water several times in a day under the hot sun and only being rewarded with a cup of black tea is certainly taxing on the girls’ overall health. Their noticeable low levels of energy and their inability to concentrate on new materials being taught at school can be attributed to several factors, including physical stress on their body from collecting water compounded by limited nutritional and water intake. The photograph below captures Paula’s expression effectively as it communicates the burden she bears having to carry water every day. 14 Figure 2: ‘Collecting Water’ Every morning, I wake up at 5am to fetch water. I carry at least 20 large containers of water as shown in the photo. When, I’m finished, I am very tired, very tired. Photo Credit: Paula  © Sajan Virgi, 2011 Access To Proper Sanitation – Basic Human Right Sanitation plays a significant role in developing capacity for girls and women. Poor sanitation facilities severely disadvantage girls and women by increasing their probability of contracting illnesses. Girls and women have the greatest physical contact with contaminated water and human waste. They are expected to dispose of the family’s wastewater and feces; as a result they are vulnerable to biological pathogens and chemical hazards. Unsecure and unavailable toiletsoften prevent girls and women from relieving themselves the entire day. Accessing toilets at night also poses increased safety risks for girls given the distance of toilets from their home. Girls miss out on school once they begin menstruating due to unavailability of adequate washroom facilities at school (UNDP, 2004). This further debilitates girls’ attendance at school. Their ability to catch up on concepts that increase in complexity with each passing grade is difficult if not impossible. The girls in this study discussed issues related to poor sanitation and the impact on their lives. Yolanda writes in her reflection piece the problems of rain mixing with sewage water: 15 â€Å"When it rains, the water causes a lot of problems. It attracts flies that can cause cholera. The smells are unbearable. The washrooms become muddy and dirty with the water leaking both inside and outside the washroom. As a result, the waste and dirty water leak out into the yard. Children often play close to the washrooms because of limited space for play. They also play with the contaminated mud building different things and soon after fall sick†. In the picture below, Carla talks about issues related to poor sanitation, lack of playground space leading to children becoming sick. Figure 3: ‘Contaminated Water’ This picture shows the washroom. The water leaks from the washroom. As a result, the area is very smelly. Children play in this area as there no places for children to play. It is not healthy for the children to play in areas that are not clean. Photo Credit: Carla  © Sajan Virgi, 2011 DISCUSSION In analyzing the girls’ photos and dialogue, the data underscores gender inequality and cultural norms and values as root causes giving rise to feminization of poverty. Three important conclusions become apparent which should be addressed simultaneously in order to afford girls the maximum opportunity to secure a higher quality of l ife. These are: unavailability of age and gender disaggregated data; critical role of engaging girls in policy decision making; and, the role of culture in relation to pre-determined roles and responsibilities. Importance of Age and Sex Disaggregated Data Data informs policies. Decision makers develop policies based on data available to them. But it is important to keep in mind that â€Å"crucial in all policy practice is framing, specifically who and what is actually included, and who and what is ignored and excluded† (Gaspar Apthorpe, 1996 p. 6 emphasis mine). Harold Lasswell emphasises further the inequality that exists in policy development by indicating, ‘who gets what, when and how’ directly impacts the types of policies developed, who benefits and whose needs are not considered 16 Lasswell, 1950). Therefore it is important to ensure that decision makers have access to a holistic set of age and sex disaggregated data in relation to girls and poverty. However, the Center for Global Development indicates that governments and international agencies for the most part first focus on girls between 0 to 5 and then again at 15 years of age. Girls between the ages of 6 and 14 are neglected (Temin Levine, 2009). With limited esearch focusing on girls and poverty between the ages of 6 to 14 years, notably critical years reserved for intellectual and physical development, policies are being developed for girls that are void of comprehensive data related to the same. Also, current data does not identify the root causes giving rise to the feminization of poverty in relation to girls and poverty. Policy makers instead have access to more general conclusions like in order â€Å"to break the cycle, children must be provided with the appropriate food security, shelter, healthcare, education, public services (i. e. ater and sanitation), and with a voice in the community† (UNDP, 2004 in UNICEF, 2005 p 6). Such a conclusion makes the assumption that boys and girls do not experience unique obstacles whilst living with poverty even though UNICEF and UN WOMEN acknowledges that poverty has a female face. Therefore, a holistic set of age and sex disaggregated data is required to uncover the root causes that prevent girls from exiting poverty over and above boys. Only when policy makers are armed with appropriate data can they in turn develop high-impact and meaningful policies specifically for girls living with poverty. Hearing and Including the Girls Voices in Decision-Making Is Essential For Success Developing relevant and effective policies can only be possible if beneficiaries are being consulted in identifying their strengths, challenges and ideas for solutions that essentially results in the creation of new knowledge. Amartya Sen highlights the importance of engaging individuals who live in the multi-faceted world of poverty daily. Speaking at the Network of Policymakers for Poverty Reduction, an Inter-American Development Bank initiative, Sen underscored that â€Å"human beings are thoroughly diverse. â€Å"You cannot draw a poverty line and then apply it across the board to everyone the same way, without taking into account personal characteristics and circumstances† (Sen, 2003). What Sen highlighted is that poverty is not a homogenous experience and therefore requires the engagement of girls and women in order to understand how poverty specifically and intimately impacts their lives . UNDP argues that in order â€Å"to break the cycle, children must be provided with †¦ a voice in the community (UNDP, 2004). And in order to understand the role and impact of social institutions, policies and culture, girls who have intimate knowledge regarding the role of such institutions, policies and culture in their lives must be heard, particularly when girls’ experiences with poverty are multi-dimensional and intersect with other forms of social exclusion including ethnicity, disability, sexuality or spatial disadvantage (Jones et al. , 2010). In order to highlight the multi-dimensional reality of poverty experienced by girls, quality of life indicators could be designed to highlight the obstacles that are present in girls’ 17 ives at specific junctures that prevent girls from furthering their goal of exiting a life of poverty. Quality of life indicators would be ideally drafted in conjunction with girls living with abject poverty. These indicators would continue to provide decision makers and researches increased insight towards the root causes of poverty for girls. The girls’ participation through the use of visual methodologies to raise issues and seek solutions in their own community cannot be overlooked. It should be encouraged. For empowerment to become a part of these girls lives, there are a number of conditions that should be part of their lives. The girls must have consistent voice and space to reflect on their lives, challenges, strengths and ideas for solutions. There must be opportunities for contributions made by girls coming out of their own authentic experiences and presented to decision makers in order to develop dependable and relevant policies. As such, girls should be engaged in the entire process from identifying issues to prioritizing them to proposing solutions. The girls should not have token representation or be solely seen as providers of information. Otherwise, we will risk losing valuable information that comes as a result of their intimate experience with complex and multiple challenges related to abject intergenerational poverty that is notably part of their daily reality and not ours. It cannot be overstated that girls’ voices need to be heard and included in decision making to ensure that policies being developed are relevant to their lives and lead to dependable development and a higher quality of life for the girls and their succeeding generations. Acknowledging The Role Of Culture In Girlhood Poverty As highlighted by the girls, cultural norms, values and expectations are also a root cause that ensures that girls will remain the face of inter-generational poverty. Without incorporating culture as a distinct and critical category in relation to addressing gender inequality and disempowerment that currently exists and has existed for females for centuries, it will be challenging if not impossible for countries to achieve the goal of gender equality, empowerment and poverty alleviation for girls. At the local level, it would be important to identify internal gatekeepers noted by girls and their role in preventing girls from exiting a life of poverty. It would also be of value to include civil society and community leaders when designing gender equality and empowerment strategies and policies particularly in relation to cultural norms and values. Girl Development Rank In order to capture the unique obstacles faced by girls living with poverty, a tool should be developed to capture the girls’ diverse needs, strengths and ideas for solution. I am proposing a tool I have termed Girl Development Rank for the purposes of dialogue. The Girl Development Rank (Sajan Virgi, 2011) would be tool designed to increase our understanding of barriers that are present for girls living with poverty during their unique development years as they attempt to negotiate a higher quality of life. The development years as noted earlier are years in which girls have the opportunity to achieve maximum 18 intellectual, physical, social and emotional development. Since there is an absence of age and sex disaggregated data that holistically captures the diverse obstacles related to feminization of poverty, the Girl Development Rank would be designed to capture obstacles giving rise to gender inequality and the affects of cultural norms and values. Since the Girl Development Rank would identify the barriers experienced by girls living with poverty, it would also be used to develop high-impact solutions related to alleviating girlhood poverty. The Girl Development Rank could have age categories as follows: 0 2; 3 – 6; 7 – 10 and 11 – 15. The rank would be designed to measure quality of life including access to basic necessities including sanitation, water, nutrition, health and education. The Girl Development Rank would be a live tool evolving to meet the needs being identified by girls living with poverty. With respect to education for example, using the stories shared by the girls, it would seek to capture access, retention and completion. In addition, literacy would be included both in the primary and secondary language used for education and business. Time in relation to responsibilities in the home and field would be measured. Creative ways of measuring status, voice, agency would also need to be explored. Measuring a change in cultural, societal norms and traditions may be challenging. However, indicators outlining how political and legal reforms are responding to issues related to identity cards, inheritance, violence and child marriages could be used as key success indicators. An educational curriculum that demonstrates gender equality would also be an important indicator for a change in societal and cultural norms. Laws that are enforced which prohibit child marriages and violence perpetuated against girls will be strong indicators to demonstrate a change in cultural and societal values. Finally, the employment opportunities afforded to young women would be a strong indicator of gender equality. To better understand how pervasive the problem is from an age perspective, it would be important to include age-disaggregated data for all relevant indicators. CONCLUSION What is needed from researchers, decisions makers, donors, NGOs and governments in order to achieve a higher quality of life for girls is a ‘shift in our paradigm’ (Greene et al. 2009) from working for girls to working with them in partnership. It starts by listening to girls, identifying root causes, gaining deeper insight into their unique life experiences, understanding their needs, dreams and then enabling them to realize their potential. By engaging girls, enabling them to become part of the solution process, they wil l learn skills that are essential for moving their lives from abject poverty to a higher quality of life. It will only be through engagement that their voices will become stronger and more confident. In turn policies inclusive of girls’ input will have a great chance for optimum success enabling abject poverty to eventually become a distant memory (Greene et al. , 2009). The challenge before researchers, decisions makers, donors, NGOs and governments alike is to achieve this ‘shift in paradigm’, by identifying and addressing the root causes of poverty and ultimately achieve the elusive goal of releasing girls from a life of abject generational poverty permanently. 19 Notes Although I was not able to gather specific data on the community, discussions with school personnel and the girls indicate high levels of unemployment, female-led households which tend to have lower incomes, and illness. The girls throughout the research spoke in Portuguese. The comments made by the girls were translated into English and verified by the participants. iii ii i The girls’ names have been changed in order to protect their identity. Racism free essay sample Racism has been around for a long time. Dating back to the 17th century and continuing on through the 1960’s, and even into today. It has been a major issue since the colonial and slave era has existed. There were many rules regarding whom could be citizens, who could vote, and who could do what and where. Slavery may have been one of racisms biggest forms but that does not stop it from continuing on today. Far too often people are stereotyped by their skin color, or how they dress and choose to act. Trayvon Martin is the epitome of these stereotypes at its best; the 17-year-old Florida boy was fatally shot in February because of his clothing†¦ a hooded sweatshirt. Stage One: Racism has been alive in America since it was founded. African-Americans have been the targets of it for most of America’s history. In the 1860’s the Jim Crow laws were passed that required separate facilities for blacks and white in all public institutions. We will write a custom essay sample on Racism or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Both sides of the party observed this the blacks and the whites. African-Americans asserted the existence and offensiveness of the condition. Millions, even those who are not from our area of the world, have observed Travyon’s case. Everyone has taken offense to this specific case no matter what the skin color. Stage Two: In the past the government claimed that the laws were justified because the blacks were â€Å"separate but equal†. Today the law is involved in all sorts of hate crimes and victims of racism. When Travyon was shot many agencies responded, and it is still an on going matter. They are investigating and looking at both sides while trying to figure out what really went down. Stage Three: The African-American community asserted there claims and demands again, expressing their dissatisfaction with the public facilities the government provided which were always inferior to those provided to whites. Today the African Americans still rebuke the claims that are not fair. Victims of racism do not always get the outcome they are hoping for. Today, Travyon’s shooter remains free because no one â€Å"knows† what happened nd there is still no proof of anything. In the eyes of many, and all races, this is unjust and unfair because an innocent man was killed and no justice has been served. Stage Four: In response to the injustice of blacks, organizations known for anti-racist and civil rights activism emerge, such as the NAACP (National Association of the Advancement of Colored People). Travyon’s death will be another example in the fight against ra cism. It has sparked a new passion in the hearts of many which will lead to a bigger movement for justice and equality. It will only help to catalyze the movement of people who want to act against it and defeat it all together. The future is in are hands. Racism has come a long ways in the last few centuries and at times we thought we had conquered it. Racism is something that has been around for hundreds of years and sadly probably isn’t leaving any time soon unless we do something about it. It may take new faces and change its form but may never totally disappear. It is something that is wrong and unfair and we need to do our best to make it a better place to live.