I Never Sang for My Father – Family Therapy

Tom Garrison was a mayor of a small town in Westchester County and highly respected by the community but most did not know that he was distant, cold and egocentric with his family. He had a negative relationship with his own father and idealized his mother. He drove his daughter away when she decided to marry a Jew, and alienated his son with his egocentricity, ritual storytelling and possessiveness. Tom has a history of being abusive toward his children, as Alice described to Gene, â€Å"he beat you when you were a kid. You've hated and feared him all your adult life. † Even Margaret admits that she suffered neglect from her husband. Tom's behavior causes difficulty forming close relationships with his family, and his strained relationship with his son peaks after his wife dies. Neither of them know what to do without her and they start to argue again. He shows two different sides of himself to the world and his family. His history seems to have impacted the way he interacts with his family members. He was distant from his father and is repeating that pattern with his own wife and children. He maintains distance from them and encourages the triangulation between his him, his wife, and his son, because it feels safer for him. He is also triangulated with the television. While he struggled during his childhood, he had become very successful and well respected as an adult. During the film he stated â€Å"early in life I developed a will of iron,† but Tom used that same â€Å"will of iron† to raise and control his children, and even drove away his own daughter because he refused to accept her choice of a husband because he was Jewish. The main conflicts within the family are that everyone fears Tom and that he pushes everyone away by ritually telling the same stories, bragging about his success, and showing little to no interest in his wife and children. His demanding methods and distant emotions prevent him and his grown children from being able to love and communicate with each other. The triangulated relationship begins to become evident when Tom and Gene were in the garage and Tom explained that he received Gene's letters from California. Gene's letters triggered Tom's anxiety about him moving away, so he talks to Gene about his mother, trying to transmit the anxiety onto his mother's health and Tom not being able to care for her in Gene's absence. If you were to go out there, I mean to live, it would kill your mother. God, you know you're her whole life† he said. He makes no statement about what effect it would have on him if Gene moved to California. Tom reinforces Gene as his mother's emotional lifeline because he is distant from both Tom and Margaret and can only work with the other two members by bringing in a second person. When Gene spoke to his mother about it, she confirmed the triangulation and asked him â€Å"wh y doesn't your father just admit that it would upset him? † If I had this family in therapy, I would start with creating a genogram, because I feel that's the least intrusive way to get a holistic picture of the family and help me understand multigenerational patterns. I would try to join the family by asking questions to get everyone on board, such as â€Å"Do you want to continue to react to him in ways that keep conflict going, or would you rather feel more in charge of your life? † to help build an environment conducive to movement and change, and ask the family to role play so that I could see and intervene with how they interact with one another. If the wife was still alive, the goal would be to bring the husband and wife into a closer relationship to prevent the triangulation from continuing. If the wife had already passed then the goal would be to help the remaining three in the family talk about the role of the mother and come up with rules for boundaries so that expectations could be clear and they would have a better understanding of themselves. At the end of the movie Gene and Tom's relationship was very strained, because they didn't have the support of the mother anymore and they were left to deal with their relationship with each other as it was, without her help. When Gene asked Tom to move with him to California, Tom became angry, seeming to feel like â€Å"No one cares about me, I'm just the money making machine. † He refused to go and felt abandoned that Gene had even asked. If Tom had changed his response to Gene's proposal to move to California then it could have seriously impacted the future of the family because Tom and Gene didn't speak very much until he died. Tom could have asked Gene to tell him more about it, to invite a conversation, rather than to receive Gene's suggestion as an attack toward his quality as a father. Or if Tom saw his son's invitation as gesture of affection and had considered moving to California, the quality of their relationship would have likely improved. The story â€Å"I Never Sang For My Father† was touching and easily-personalized. Most families have difficulties trying to attain or maintain an adult relationship with one's parents. The relationship parent-child changes when the child grows into an adult and the child feels more empowered. Tom did not entertain the idea of Gene feeling more empowered as an adult, he treated him more like a child because it helped his ego. I felt angry at the father, seeing him as impossible, ignorant, and stubborn, but it's important for me to note that it's imperative that I'm aware that is my opinion based on projection from past experiences, and that some may become angry with the son for not confronting his father sooner. Keeping these biases in mind is helpful so that I remain neutral during family therapy and I look at the family from a systems perspective, not a â€Å"he's right and she's wrong† perspective. I resonate with this story because I'm an only child and I was triangulated with my parents for a while before my dad passed away. My dad wanted to be the good guy, so he would always go up to my mom to tell her to scold me for doing something, losing something, or anything. This was because my father didn't feel secure enough in himself to be able to scold me and know that we would still have a solid relationship. So in order to make up for his handicap of not being able to give me instructions, he had my mom step in, who was willing to be â€Å"the bad guy,† and had her scold me for him. In the end, he needed my mom to help him communicate with me because he had depended on her for so much. This makes me think of how Gene's mother was the bridge between Gene and his father, and when she died they were stuck with the relationship that they had. Fortunately, in my family center triangulation, my mother and I had a more solid relationship and could talk about things. This makes me think about my future with my spouse. What baggage will I carry with me from my family life? What will I likely triangulate for? I like to say that I have good communication and I don't see a reason to triangulate, but I don't believe myself because I think that the issue doesn't have to be big in order for triangulation to manifest. After watching this movie, I felt like family therapy looks like an impossible feat. I realized how many eyes are on you all the time when you're in session with a family. I imagine that those with social anxiety disorders or therapists who tend to be more introverted don't especially like group therapy or family therapy. If there is one thing that I take away from this class, it's that everything happens for a reason in a family. Everything manifests for a purpose, to serve some function in the family.

Men and Women Will Never Be Equal Essay

Men and women will never be equal just like an apple and an orange, both are fruits, but have different taste. In general, men and women are physically, mentally, and emotionally different but does that really mean men and women will never be equal? The word â€Å"equal† means â€Å"the same as†. So, is a woman the same as a man? Study shows that an average women earns a year is lower than what men would earn, men and women both play different roles in the society, both important, but are not equal, for example, women are said to have taken more days off in a year than men; due to maternity leave, but as a mother, they would need to take care of their children as well. Men on the other hand, are known to be stronger; which brings to the idea that they work more than women do. According to research, it is more likely that men are committing more crimes such as thief, murder, rape; more men are being imprisoned than women. Women are sometimes defined as the â€Å"primary victims of war† as they lose their husbands, fathers, and brothers during war. Men and women are convinced they will never be equal, probably as early as human’s earliest days. In further logic, there are more differences between men and women than similarities. In coeducational schools, males and females tend to choose specific options that the other gender does not do, for example, fashion and engineering. Which in general, mainly only have one gender in the class. In general, men are stronger than women; that has convinced the society with the help of each gender’s actions, men would usually appear as bold, strong, and brace while the females are usually shy, polite, and feminine. People are also persuaded that men can carry two bricks at once, while women can carry only one it is not necessarily true, but it is an instant impression that it is true. Men and women will never be equal is a fact that will not really ever change; that doesn’t mean they aren’t the same just not equal. It is a good thing that in this society, although men and women will never be equal, we still get along. Read more:  Men and Women Should Have Equal Rights Essay

Letter of Intent Essay Example | Topics and Well Written Essays - 1000 words

Letter of Intent - Essay Example The researcher states that admission into McGill's Counseling Psychology program will not only fulfill the career ambitions, it will also fulfill the purpose in life. The researcher would like to devote his energies to showcase the effects of parenting on a child's overall development. It is a subject that the researcher naturally holds close to his heart. McGill University has been his preferred university since he was 16 years old, living in Malaysia. At the time, the author was looking at education options while planning to run away to Canada as a naive teen. The McGill University with its prestigious accolades, facilities and student life, was an easy winner. Since then, the author has always wanted to study at McGill and now armed with a Psychology degree from New Zealand, the next step is clear. The researcher picked Counseling Psychology because he wants to be out on the field working with people. Besides being able to work with some of the most respected psychologists in this program, the author is drawn to the non-thesis aspect of it. The researcher is happiest when the assessment is continuous and hands-on performance is evaluated - he performs at his peak that way as he likes taking challenges head-on. In addition, the author is attracted to the certification as a counselor one receives at the end of the program, with the option of doing a Ph.D. later on. Currently, he is volunteering as a childcare facilitator at the Young Parents Program in NDG and as a research aide at the Talwar's Research Center at McGill. Along with that, the author is also working as a freelance writer to save up for his post-grad fund. Prior to this, the author was an international student mentor in his alma maters where he provided mentoring, guidance and English language aid to students from China and Japan. The researcher really loves working with people and he enjoys being a positive part of their life. The researcher confesses that his time as an international student me ntor was the happiest moments of his life. It was a start to the discovery of his career path to be a counselor. Although the author may not have stellar results like some of his peers, he has a lot to offer in terms of his personal interest, future plans in this field and the will to accomplish whatever it takes to make this ambition work. The researcher is prepared to work extremely hard to get to where and what he wants. He is even proud of his apparently meager accomplishments because at one point in time, graduating itself had seemed a tall order for him. To cut a long story short, the author had not been making the right choices in life but he has since bounced back. The researcher has learned through the counsel of one very remarkable lecturer that the choices in life are mine to make, and mine to live with, regardless of the circumstances or his upbringing. The researcher is taking that advice again as he is writing this letter. The researcher is making the choice to seek en trance in one of the toughest programs at McGill University because he knows he is worth it.

The Staggers Act Research Paper Example | Topics and Well Written Essays - 1250 words

The Staggers Act - Research Paper Example The Staggers Act was a Federal ruling that removed restrictions from the American railroad industry. The main aim of the Act was to restore the highly-controlled structure of the US rail transportation system that operated since the enactment of the Interstate Commerce Act (‘87) (Eakin, et al, 2010). The regulation forced private railroad businesses with the adoption of price control and counter the emerging competition in the industry. This meant that the private firms would adjust their operations to other non-profitable routes in order to enhance their survival in the industry. The provisions of the Staggers Act entailed the requirements that rail transporters could inflict any given fee for services. The provision was applicable in situations where the carriers did not experience competition from other sectors. Another stipulation was the removal of the industry-wide rate regulation to facilitate an all-inclusive business environment (Gallamore & Meyer, 2014). The other cha nge was that one railroad would be free to provide access to the others in case of a single railroad in order to avoid rail congestion. The intent of the Act was to ensure that the railway transportation flourished despite the entry of new players in the industry. It is evident that airlines and automobiles provided alternative transport systems to the passengers. As a result, the private railroad firm started to adjust charges in order to fight the emerging competition within the industry (Feldstein, 1994). The Staggers Act’s aim was to protect the public railroad by ensuring that charges favored all players across the industry. It is also prudent that the existence of the Interstate Commerce Commission (ICC) ensured that all transport corporations observed the new ruled imposed on them. This was a noble step towards restoring normalcy

The Changing World of Work Research Paper Example | Topics and Well Written Essays - 750 words

The Changing World of Work - Research Paper Example In the last ten years, jobs have been outsourced in large numbers and a dramatic change has occurred in the location and method of work. Another key driver of the modern and more importantly, the future age is diversity in the workplace. The transformation of the world into a global village has removed the cultural barriers. More and more people migrate to other countries every year for studies, work or both. This has made society multicultural in general and the workplace in particular. There is the diversity of age, gender, culture, language, ethnicity, religion and caste. All of these factors of diversity give rise to the variety of perspectives which are quite beneficial for organizations in the competitive environment, but at the same time, also expose the organization to a lot of risks. Some of the risks include racism and dysfunctional conflicts among the employees whereas benefits include larger market value because of a diverse population of customers. Managers have experien ced a significant increase in job responsibilities as they have to not only address the needs of the customers but also have to fulfill the increased demands of employees. According to (Heerden), research concludes that young employees fundamentally look for three things in the changing world of work. They are briefly discussed below: 1. Opportunities for learning and development: Young people seek jobs where work would be challenging, yet they want to be rewarded upon succeeding. Professional growth at work is the biggest attraction for young job seekers. People want to serve in different positions and perform different roles in order to gain maximum experience. 2. Selection in a renowned organization which would decide the career path: In order to keep employees satisfied and motivated for work, employers need to share their strategies with employees and explain to them how their strategies are consistent with the requirements of the business. Thus, employees need to be engaged in work for which the employee-employer rapport is extremely essential. 3. Flexibility in life: Having achieved a higher standard of living, one of the key priorities of all working people is to have increased control over their personal and social life. The conventional 40 hr week that has been so for long is now changing. People want the freedom of duty hours and employers often have no problem unless the work is affected. In today’s work environment, ways to communicate have altered a lot. The changing trends impact many industries and hence, the career plans. A look into the future: In light of the aforementioned preferences of employees in the work environment, the work environment in the future would be more complying with the employees’ desires as it has in the past. It is obvious that an electronic system would be increased in use in the future. Therefore, it makes sense to assess the future work conditions for employees keeping the electronic system into conside ration.  

Genetically Modified Crops are a threat to bio-diversity and cannot Research Paper

Genetically Modified Crops are a threat to bio-diversity and cannot sustain the world's increasing human population - Research Paper Example Genetically modified organisms were first authorised for sale as food in 1994, amid different views from the international community over the benefits and costs of genetic modification, its associated applications and the cultural, ethnical, social and political issues arising from its use (Orton). Some consider it unnatural proposing its rejection while others, concerned about the pollution, nutritional issues and food supply, are more open to technological innovation. Some still want more information prior to deciding whether to support the full release of GMOs to the environment. Numerous environmental threats from the use of genetically modified crops have been identified and they include the loss of agricultural species and their wild relatives through the process of gene flow, despite it still occurring in non-GM crops (Orton). Throughout the 20th century, conventional breeding has created a huge number of hybrids and as a result, varieties which have contributed immensely more yields, stable harvests and reliable farm income. Despite this, the battle against world hunger is still far from over. The rapidly increasing human population, insufficient poverty eradication programs and the changing demographics have greatly battered the successes of the Green Revolution (Orton). For genetic modification of food to continually meet the need of the ever increasing world’s population, both bio-technology and conventional technologies are necessary. Depending on the context, genetic modification still remains a controversial issue both as potential threat and as an opportunity for biodiversity conversation. Biodiversity is defined as the variability among living organisms from different sources that comprise of the marine, terrestrial, aquatic ecosystems and other ecological complexes that they are part of, including the diversity within species, between species and of ecosystems. The pressure on biodiversity is continually increasing. The main predominant threats on biodiversity include loss of habitats, degradation from agriculture and development of infrastructure, pollution overexploitation and invasive alien species. Several responses have been made concerning the loss and degradation of biodiversity and although these have failed to reduce the decline, more effort is needed (Roller). Some responses include those of adopting policies that manage the invasive alien species and genetically modified organisms (including crops). GM crops pose a risk in reducing the agricultural and crop diversity which are the basis of poor farmer livelihoods and the food sovereignty of developing nations. Three quarters of the original varieties of agricultural crops have been lost since 1900 as export led agriculture has encouraged monoculture for a more uniform global market. GM crops threaten to eat away at biodiversity more (Roller). GM proponents argue that genetic engineering is indispensable so as to supply tomorrow’s world with food a nd natural resources. However there has been a drastic decrease in the diversity of the flora and fauna field. Due to the spread of commercial seeds and high performance cultivars, well adapted local varieties have been eliminated. Farmers become continually unable to cultivate their own seeds. GM â€Å"super-plants† usually accelerates the reduction in diversity as they are designed for implementation of mono cultures and economic sovereignty (IUCN). This demonstrates the amounts of variants that have been and

Assesment of Wal-Mart's international expansion strategy Essay

Assesment of Wal-Mart's international expansion strategy - Essay Example These locations where Wal-Mart has a well-established or newly-established presence were the product of joint ventures, foreign direct investment for wholly-owned Wal-Mart cash and carry stores, and through intense acquisition strategies. Wal-Mart in China Wal-Mart chose an export-led growth strategy in China as well as foreign direct investment for wholly-owned Wal-Mart stores. One of the main reasons for selecting this particular entry strategy is the difference in currency value between the Yuan and the U.S. Dollar, especially at the time of market entry in the 1990s before China became its current industrialized entity. Chinese domestic firms, additionally, have significant credit restraints for business development that restricts international trade activities (Manova, Wei and Zhang 2010). Limited credit availability gives Wal-Mart a significant advantage as it can procure capital from its domestic operational environment (i.e. The United States) to perform expansion, improve op erations, and also ensure better procurement of international goods for sale in China. Limited credit availability in China gives Wal-Mart a significant competitive advantage as research data shows that exporting or foreign-owned businesses perform better than domestic Chinese firms (Manova, et al). Having access to more capital and credit gives Wal-Mart the ability to set lower prices as a means to outperform domestic firms operating in the same sales industry as Wal-Mart in China. Further, Chinese consumers are extremely price sensitive and a recent survey indicated that Chinese consumers consider pricing above all other factors when buying merchandise (Suessmuth-Dyckerhoff, Hexter and St-Maurice 2008). Chinese consumer willingness to defect to another brand is significant when prices rise by a mere five percent (Suessmuth-Dyckerhoff, et al). Wal-Mart is a well-established promotional leader in the United States and other Westernized countries, thus it has an immediate advantage i n talent expertise upon entry into a foreign market. Coupled with price-sensitive buyers, Wal-Mart can simply transfer its existing everyday-low-price model directly in the new region without significant costs of redesigning organisational structure or service delivery design. Long-run operational cost reduction is the methodology for entering China under direct investment in wholly-owned businesses due to environmental and social conditions in this country. Additionally, Chinese consumers learn a great deal about Western culture through media exposure and their personal travels which has led to a great demand for Western brands (Emmons 2002). This determined the export-led strategy for taking domestic product and flooding it into the Chinese market based on social demographic characteristics of the Chinese consumer. The high Chinese demand for U.S.-produced products is also supported by a vast global infrastructure for procurement needs, thus satisfying budget related to the supply chain. Furthermore, the political environment in China is growing ever-more favourable for foreign direct investment, such as reducing the tariff rates associated with foreign exports (Carbaugh 2009). Governmental restrictions and supplemental

Basel 1 2 and 3 Essay Example | Topics and Well Written Essays - 3000 words

Basel 1 2 and 3 - Essay Example Basel I, II, and III agreements have given birth to a new era of international banking cooperation. Through technical, qualitative and quantitative analysis, these agreements have assisted in harmonization of banking supervision, capital adequacy standards and regulation across the eleven member states of the Basel Group and the emerging economies. Contrary to this, the strength of these agreements-their technical and qualitative benchmarks limit the comprehension of these accords within policy circles causing confusion among people while interpreting them and wrongly applied to majority of the world’s political economies. However, even in situations where the Basel system has been rightly applied, neither accord has secured long-term stability within nations banking system or sector. Therefore, a full comprehension of the intentions, rules, and shortcomings of the three Basel accords is significant in assessing their impact on international banking and financial system. With the recent collapse or major investment banks, such as Bears Sterns, Lehman Brothers, AIG and others regulation has become increasingly important in today’s economy. The lack of regulation allowed these banks to borrow massive amount of capital and invest in high-risk securities. The Basel Committee attempted to force these banks to hold cash reserves in order to prevent a total banking collapse; sadly, the international banking system thwarted any attempt to do this thus making the collapse inevitable. The Basel I accord was a set of global or international banking regulation installed by the Basel committee to enhance bank supervision, which laid down the minimum capital requirement of banks and other financial institutions with the aim of minimizing credit risk. Banks that operated globally are required to maintain minimum amount of capital based upon a percentage of risk-weighted assets. After the Basel committee in Switzerland, the G-10 members started to discuss

What Are the Key Factors Which Lead to the Downfall of the Romanov Dynasty Essay Example for Free

What Are the Key Factors Which Lead to the Downfall of the Romanov Dynasty Essay 1917 saw the conclusion of the reign of the Romanov Dynasty, as well as the demise of Russia’s last monarch, Tsar Nicholas II. It is evident that the downfall of the Romanov Dynasty was directly linked to key factors such as the autocratic style of the Romanov dynasty and the nature of the social structure, as well as the evolving nation of Russia, as a result of industrialisation. The Romanov family was viewed by the people of Russia as leaders ‘sent from God’. However as the 20th century neared, this mystical admiration the public possessed for the royal family receded and was replaced by intellect. A growing sense of political and social awareness of the lower classes, as well as the introduction of democratic ideas from the West had sparked a change. The twentieth century saw the birth of new ideologies such as Leninism, Marxism, Liberalism and Socialism. These ideologies proposed new models of government techniques and questions the ruling of the Romanov Dynasty. Tsar Alexander II sensed the rising threat of terrorism threatening the Imperial family and more importantly the Dynasty’s autocratic rule. The responsibility of Russia was bestowed upon Nicholas II, son of Alexander II, based on the dynasty’s ritualistic practice of passing the throne to the Tsar’s eldest son or closest senior male relative. Nicholas II was reluctant to accept the responsibility of Russia, as well as its 126 subjects; however he acknowledged the burden of the crown as a spiritual experience destined by God. By the beginning of the 20th century, Russia had established itself as a vast empire, however in comparison to other countries; Russia was a ‘backward society’ with mostly undeveloped resources. At this time, Russia had established rigid class distinctions, with 88% of the population farming the countryside as serfs, whilst land and high government positions were owned by 5% of Russia’s population. In 1816, serfdom was abolished and peasants were free, however were required to pay compensation for land that they believed they already owned. Although agriculture remained the principle means of maintaining a livelihood for the lower class, peasants often struggled to live above starvation level, as they used inefficient farming techniques and had little land available to them. Those who struggled with agrarian lifestyles flocked to the cities, consequently causing a major increase in the urban population. As a result factory working conditions also suffered. Factory workers received low wages, at times only 25-30% of British workers, as well as long working hours, sometimes extending to 15 hour shifts. Workers were forced to endure these conditions, with little hope of assistance, as the Russian government had provided no means by which workers could express their grievances or dissatisfaction with their present conditions. The Tsar’s power was unlimited with no political party or constitution to inspect the Tsar’s ruling, as well as a secret police, known as the Ohkrana, which terrorised those threatening public order. ‘I shall uphold the principle of Autocracy as firmly and as undeviating as did my late father’ (Nicholas II, first proclamation, 29th January, 1895 source:Punch,9 February 1895 ) This proclamation illustrates Tsar Nicholas’s incentives to intimate his father Alexender II, by means of resisting modernisation and change, in the nation of Russia. Despite these obvious signs of corruption within the Tsar, the public, largely due to the coercive influence of the Russian Orthodox Church, continued to hold a mystical admiration for the Tsar and the royal family. However, while the myth of Tsar Nicholas or the public’s ‘little father’ retained some currency, the events of the years 1904 to 1905 disrupted this myth dramatically. In 1904, the government’s decision to go to war against Japan highlighted its weakness. The two countries had been competing for years over territory and influence in the Korean peninsula of Manchuria. Nicholas, along with most Russian’s believed that a brief encounter with Russia’s vast navy and army would be the solutions to their present conflicts with Japan. Nicholas was wrong. The war ended with the humiliation of Russian defeat, in August 1905. Confirmation of the Russian government and military weakness heightened discontent and fueled many reform movements. Meanwhile other incidences, such as the massacre or ‘Bloody Sunday’ on the 9th of January 1905, sparked political unrest in the capital of Russia. On this day a large crowd of people marched towards the Winter Palace, in St Petersburg, presenting a petition to the Tsar. The petition demanded a series of measures that would improve the position of those being exploited by their factory owners. â€Å"Don’t refuse to help your people, lead them out of the grave of disfranchisement, poverty and ignorance Tear down the wall between you and your people, and let them rule the country with you Look without anger at our requests, they are not intended for an evil but for a good cause, for both of us† (Petition of the Workers and Residents of St Petersburg for Submission to Nicholas II) This extract displays the continuing confidence in the Tsar and assurance that he will overcome his evil advisors and attend to the struggling lower classes. However this confidence in the Tsar was completely destroyed by the following event. Under command, troops, who were guarding the palace, opened fire on the crowd, killing 100 protestors and wounding almost 300. Although it is still unknown who directed the final orders, Nicholas’s absence from the protest, eroded the iconic image of the Tsar and the myth upon which the Tsarist system was sustained. Hostility towards the blood bath was generated from the lower proletarian classes and reverberated upwards throughout the empire. As a result nine months of strikes, peasant revolts and mutinies among the army and navy, followed. Workers began to form councils, known as soviets, where worker’s representatives would voice their grievances and political protest campaigns were fashioned. Under immense pressure from these disturbances, the Tsar was forced to make compromises to the demands of the people in order to preserve the support of the public. On the 17th of October, the Tsar introduced the October Manifesto. This granted the people of Russia the freedom of conscience, speech, meeting and association. The manifesto also promised the introduction of a Duma, or parliament, elected by universal suffrage. The design of the Duma was to provide the people of Russia with the power to create and approve laws. The intentional exclusion of the word ‘constitution’ ensured that the Tsar autocratic power remained unscathed. The Duma was the Tsar’s puppet; he could dismiss and announce the duma, personally choose and dismiss ministers and declare new laws unaided, at any time. The first two Duma’s lasted only a few months before they were later dissolved, by the Tsar. The third Duma survived as a result of an alteration in the electing process of representatives. Subsequently the Duma became dominated by land-owners and businessmen who were more conservative and ‘trustworthy’ elements to the Tsar. This alteration destroyed the sole purpose of Duma as it hindered all classes from expressing their opinions. Although evidence of reform in the government was present, the manifesto did not address current problems affecting the lower classes such as poverty, low wages and poor working and living conditions. The grievances of the lower classes remained unheard and the gap between the Tsar and his subjects widened. For these reasons recently legalised parties such as the Social Democrats and Socialists revolutionaries had a willing audience. By the end of July 1914, the revolutionary discontent echoed the events of 1905 revolution. When World War II commenced early August 1914, Russia was in no state for battle. Although intensified emotions of patriotism temporarily calmed civil disputes, the hardships of the war brutally hit the home front. Russia’s undeveloped economy struggled to sustain the war efforts and keep up with increased demands. By late 1914, dreams of a short successful battle were doubtful. In addition to previous hardships, concerns of high causality rates, inadequate medical care and shortages of resources, such as food, weaponry and ammunition were affecting the Russian front. In Mid 1915, Nicholas II, with the aim of improving Russia’s current stance in the war, accepted the position as Commander-in-Chief of the Russian forces. Nicholas II had few military skills and was surrounded by ministers who had been chosen by himself, therefore were also sufficiently inexperienced. Meanwhile, German-born Tsarina Alexandra was temporarily responsible for the home front whilst her husband was away. The Tsarina was greatly influenced by Grigori Rasputin, a Russian mystic who was praised by Alexandra for his fanatical abilities to help her haemophilic son, Alexi, the heir to the throne. Tsarina had little political ability and looked towards Rasputin for advice. Due to the nepotism within the royal family, Rasputin was able to quickly posses doctrinal powers and become a influential member of the Russian court. The influence Rasputin had on the royal family as well as the scandalous relationship assumed to be between Alexandra and Rasputin discredited the Tsarist government. These scandals affected the way the public viewed the royal family and supported the idea that the royal family was easily dominated by religious mystics. By late 1916, discontent within Russia had reached crisis point. The duma and the majority of Russia’s upper class no longer supported the Tsar. The Tsar had lost his authority in the eyes of the public. By 25th of January 1917, St Petersburg, the capital of Russia, was at a standstill. Numerous factories were shut, shops closed, public transport ceased to run and radical political leadership seemed to be using all possible means of protest. Unlike 1905, troops did not restrain the strikes; some even rebelled and joined the workers. Tsarist authority had vanished. On the 2nd of March 1917, Nicholas II abdicated and within a few hours, the Grand Duke, Nicholas II’s brother, refused the responsibility of the throne. This was the definitive end to the Romanov Dynasty. In conclusion, although the Tsar’s character had great effect on the downfall of the Romanov Dynasty, it was ultimately the fault of Romanov dynasty’s ineffective style of government. As Russia became more industrialised, larger, and far more complicated, the inadequacies of autocratic Tsarist rule became increasingly apparent. Ritualistic beliefs such as the nepotistic process by which successive monarchs were selected, was unsuitable in an ever evolving world desperate for change and development. The Romanov Dynasty’s Autocratic approach to leadership had been successful for the previous three centuries, however as the twentieth century approached, the need for social and political reform advanced with it. For this reason, Nicholas II, was a victim of a time warp, where despite his best efforts to maintain authority of the autocratic crown, was forced to abandon inherited methods of leadership. He was trapped in a modernising world with outdated beliefs and traditions. Nevertheless, to a minor extent Tsar Nicholas was responsible for his own demise as he was aware of the changes occurring within the nation, however he didn’t not administer the needs and wants of his subjects.

The Fairytale of Illusions Essay Example for Free

The Fairytale of Illusions Essay Once upon a time in a far away land unseen to man, there was a powerful realm called Fairytale country. The largest kingdom within Fairytale country was the Magical Kingdom which was owned by the selfish King Americus and Queen Eura. Magical Kingdom was a place filled with beauty, peace, and harmony. It was considered as such because of the beautiful, peaceful, and harmonious people inside the Magical Castle. What most outsiders did not know was the fact that the ordinary residents of Magical Kingdom have a different outlook on their situation. There was no beauty in their place, no peace, and absolutely no harmony. The Magical Castle took no notice of these predicaments. They merely solved the residents’ problems by means of magic tricks and illusions that their problems have been solved. When the farmers would complain about the lack of compensation from the castle, the King and Queen would order their illusionists to make the farmers believe that they have increased their payment. This way, believing that they were being given more than enough of what they truly deserve, all the residents loved the King and Queen The beloved King and Queen of Magical Kingdom later bore an extraordinary princess by the name of Selene. The King and Queen were so proud of their only daughter that they invited the most famous and powerful fairies of Fairyland on Selene’s baptism to grant her eternal gifts. There were thirteen fairies present on the baptismal celebration. Only twelve were recognized and invited by the King and Queen. They blessed her with eternal gifts of beauty, wisdom, kindness, compassion, obedience, creativity, wealth, diligence, honesty, loyalty, innocence, and happiness. All these gifts were believed to stay with her for the rest of her life to restrict her in a life that was to be dictated by her parents. The King and the Queen were so delighted that their daughter would be expected to live a perfect and happy life just like the other princesses in the Fairytale country like Snow White, Belle, Aurora, and Rapunzel. They hurriedly instructed all their servants to prepare a glamorous feast for the newly-baptized baby. Amidst the festivity, no one ever noticed the thirteenth fairy who attended the baptism. The thirteenth fairy, a loner who mostly enjoyed the company of the ogres and dwarves in the forest, thought that the gifts for baby Selene were too common and boring. She knew of the King’s evil and misleading deeds so she initially planned to end the life of the child on her eighteenth birthday. Remaining hidden among the crowd, the fairy flew silently and slowly to the elegant cradle of the royal baby. â€Å"How indeed beautiful you are, young Selene,† the thirteenth fairy whispered softly. The innocent look on the baby’s face made her change her mind about the death wish she was about to cast to her. She realized that she cared too much for the town to ruin a potential rescuer. She decided to give her something that the other stupid and ignorant princesses of Fairytale country do not possess. â€Å"Today, I will grant you the most powerful gift—a gift that no other princess deserves to have. This gift will soon change the wicked and cruel ways of this kingdom. However, the gift will only manifest upon your 18th year on Fairytale country. † In a silent chant, she whispered the gift to the innocent Selene and disappeared into the crowd. Years passed by and Selene grew up into a fine young woman. She was extremely beautiful extrinsically and intrinsically. The people of Magical Kingdom adored her, and even the other princesses within the Fairytale country wished to be a friend of hers. At a very young age of fifteen, she had plenty of royal suitors who desired to marry her once she turned eighteen and become ready for the throne. Quite expectedly, her parents had already pre-arranged her future marriage to Prince Gorf of Marioland. He was the son of King Harry and Queen Hermione. Selene reluctantly agreed for the sake of her parents’ happiness. However, her secret friend, Lance, would always convince her not to give her consent. He was a secret friend because he was an ordinary boy from outside the castle who would regularly sent her charcoal sketches of the world outside by wrapping the paper around a rock and throwing it over towards her bedroom window. Lance would write her stories about the outside world which she found to be exactly the opposite of what she saw from her castle window. She would often write back asking more questions about the real world. Lance claimed it was hell outside, and what she merely saw from her window were illusions created by her parent’s magicians and illusionists. However, the King and Queen were quite strict in terms of her extreme friendliness with the ordinary residents of Magical Kingdom, so they kept the friendship secret. Later on, they stopped writing to each other when Lance accused the King and Queen of fooling their people. Selene never believed him because her parents would always remind her how good they were to the residents and how ungrateful these residents were to them. Despite these claims, Selene wondered why they prohibited her to roam outside the kingdom. â€Å"There are dangerous people outside our gardens, dear Selene. You are not to go beyond those fences for you might be held captive by rebels who wish to dethrone your father,† the King explained when Selene implied an interest in seeing the world outside the castle grounds. â€Å"We cannot please everybody even though how hard we try, my dear. † â€Å"Dethrone you? How can they possibly even think of replacing you? They owe you their life, father,† Selene protested with a puzzled look. She could not believe that there were even evil people who exist. This was the result of being given the gift of innocence. â€Å"Indeed, indeed,† the Queen interfered. â€Å"We have given them everything they need but still some of them abhor us. Yet, it is understandable, Selene. They are of the lesser beings. Please just promise us never to cross that fence. † Since she was gifted with obedience, she never dared to see the world outside the castle until the morning of her eighteenth year on Fairytale country. Early that morning, when most of the servants were still asleep and the guards’ eyes were half-closed, she woke up in haste with a strange feeling of curiosity. She suddenly got out of bed and silently roamed around the garden of the castle. She noticed the tall and heavily-cemented fence that separates the castle from the world outside. She thought she heard a sound coming from behind that fence. â€Å"Is someone there? † She called out softly afraid to awaken the guards on duty nearby. â€Å"Selene! † She heard someone replied at the other side. She recognized that familiar voice and that voice was the only person who never called her princess. â€Å"Selene, come out here. I’ve dug a hole for you where you can slip out of these fences. † Selene followed where she thought she heard the voice the loudest then looked down. There was a small hole beneath the stone fence where her small stature was capable of crawling out. â€Å"I can’t,† she hesitated. â€Å"What do you mean, you can’t? I’ve dug this hole for over a month to prove what you previously accused of me as lies,† Lance insisted. Finally, she gave in. She carefully bent down to ease her way through the small hole that Lance had hollowed out for her. She was transformed into a world much different to her previous one. She saw dead trees and starving animals. She caught sight of a seemingly deserted town very much opposite of the town she saw from her window view. She saw the rugged and tired image of Lance looking at her. One by one, the ordinary residents came walking towards her. All of them appeared to be starving and filthy. Nobody seemed to be the reflection of the nourished people her parents have described before. She could not believe it. â€Å"What is this place? † She asked in horror unable to believe she was just a few steps away from her castle. â€Å"This is your town, Selene,† Lance murmured in a sympathetic tone. â€Å"Help us, Princess†¦Ã¢â‚¬  she heard the approaching townspeople said. â€Å"Help us. † She was startled by the sudden bolt of thunder and lightning which pierced the sky. She noticed the sudden shift of the townspeople’s attention from her to the castle behind her. In shock, she had forgotten the existence of a place before her. She shifted her gaze to the castle. She stared in horror as she caught whole view of the castle’s repulsiveness. It was covered in dark moss, fully surrounded and enveloped by dark bulging clouds. The facade were ornamented with cracks and the towers were fully nested with ugly crows. It was not an image of beauty and absolutely not a place of peace and harmony. It was an image of darkness and evil only covered with elegant ornaments and illusions. Illusions—everything the princess have known before were merely illusions. Among the flock of trees, the thirteenth fairy smiled as she saw the look on the princess’ face. The fairy was torn between the feeling of pity towards the princess’ previous life of ignorance and delight that she had finally made her way outside that ignorance. Her eyes were finally opened to the real world outside her fairytale life. â€Å"At last, the gift of reality has already been consumed. †

Importance of Art Education in Primary Schools

Importance of Art Education in Primary Schools Art is the quality, production, expression, or realm, according to aesthetic principles, of what is beautiful, appealing, or of more than ordinary significance. It is also the class of objects subject to aesthetic criteria; works of art collectively, as paintings, sculptures, or drawings. There may be a few variations in the precise naming of the activities it is generally accepted that the triumvirate of creating, performing and appreciating dance as a conceptual basis underlies all phases of dance education. (Davies, 2003) Why are the arts important to young children? The role of the visual arts in early childhood education has long been recognised and valued as an essential component of the curriculum. (Eckhoff, Angela, 2011) The arts consist of variation of appreciation. The different forms art such as dancing, drawing and painting, performance art, sculpturing and many more. Art needs to be included in the schools curriculum and encompass the knowledge of the arts education to the children. Art appreciation can be inculcate to children at young age. Knowing and understanding of the arts may also help children to express themselves in different creative art forms in which they are comfortable in. Art nurtures the child to be inventiveness as it engages the child in a process that helps in the development of self-esteem, self-discipline, cooperation, and self-motivation. Childrens self-esteem will improve as there is not right or wrong in self creative creation. In this way, childrens are able to complete task with self-discipline and longer patience in completing an art piece regardless whether it is an drawing and painting piece or a dance and music piece. Working cooperatively will also be enhanced childrens patience such as dancing together with music and other children to produce a wonderful piece of musical. Most importantly children needs to be self-motivated to have the interest in arts. At times while working with each other to produce an art piece also needs problem solving, contributing ideas and respecting each other. Each child will have to communicate in a variety ways to express their thoughts and produce the art piece they want it to be. The belief that art education should encourage the childs creativity, imagination, and expression did not mean that all previous pedagogies were replaced. (Jolley, 2010) Imagination helps children with expression in dancing and also helped in language to find the correct vocabulary to describe their expression. Childs creativity should not be obstructed or corrected by the adults or educators. Updated pedagogies helps to improve and also work on the previous believes. Forms of art In terms of aesthetic and creative education, dance has much to share with drama, music and the visual arts. (Davies, 2003) Dancing is an activity that needs time to work on and gain wide experience. It needs to work with choreographing of movements and music together by trying out and composing the art piece. Performing can be taken to mean to do, to show, to dance, creating as making, trying out, or composing, while appreciation is the outcome of watching, viewing, talking about and drawing about dance. (Davis, 2003) It may be an expressive dance in a drama which could be a class activity having children to have a discussion with their ideas and suggestions on how the characters should dance, facial expression , choosing the piece of music to express the mood of the scene and moving along with the music. Children would have trials and errors along the way in the making and appreciating in every part of the dance drama they have created. In terms of dancing consist of being a creator or maker, a viewer or spectator or as a doer or performer. (Davies, 2003) Certain movement ideas frequently used by in informal situations seem to belong together and can be utilised in dance. (Davis 2003) Educators on their part, they can facilitate the students by guiding exploring different ideas of movement such as running and leaping, turning and twisting, moving and stopping suddenly. Children will be able to choose the right movement they would want to include into their dance. Educators may also guide children choosing the instrument they would like to use for the movement using different sounds. For example, the sound of the fast ringing bells can be the movement of running. Another form of art is drawing. Drawing from observation still represents a key component of statutory art education for children aged 5 to 14 years of age. (Jolley 2010 ) Drawing involves imagination and creativity and expression. Drawing helps children to express their thoughts with different kinds of lines and shapes. Observation also plays an important part in drawing. For example, children may observe a stalk of flower or the movements of the grass when the wind blows and draw the expression of what they have observed using different lines. For example, curvy lines, straight lines and zig-zag lines. Once children are allowed to make representational drawings, rather than mere line and shape, they are often directed towards forms of subject matter such as cubes, cones, prisms, and so on, whether copies from pictures of three-dimensional models. (Jolley,2010) Children may also move to a higher level to explore drawing representational drawings with their imagination. Educators may guide children by introducing the drawing of different lines such as horizontal line, vertical line, wavy line and spiral line. Students will then apply what they have learnt in their drawings. Students will also need to be given opportunities to observe the environment around them , space for creativity and imagination. Children are then taught to draw more controlled lines. (Jolley, 2010) Teachers go for PD? It will be beneficial for educators to undergo training attaining higher level certificate may also attend a more intensive and substantial art modules. In this way, it will equip the educators with more knowledge and understanding of art education. Educators will have better skills to guide the students and facilitate the child to explore the choices or methods he could use to express his art piece. School management may also encourage their educators to attend professional development to be equipped with updated skills and pedagogies. Student will not be bored with structured ways of teaching art and lessons are more enjoyable for students to learn. Arts education in the curriculum planning. According to the Ministry Of Education, Singapore, Kindergarten Curriculum Guide (KCG), aesthetics and creative expression is being part of integrated learning in the holistic development of the child. In the school planning, it has to include the childrens experiences in visual arts, music and movement allow children to be expressive, creative and imaginative. (Kindergarten Curriculum Guide, 2008) Therefore, it is essential to plan the schools curriculum according to the framework and arts will not be left out. In the schools curriculum, children are also taught to learn appreciation of visual arts and musical instruments. Children will be given chance to discuss about their own art works such as describing the lines , colours and shapes used. (Kindergarten Curriculum Guide) Children will also be given opportunity to appreciate, learn and explore the different sounds made by the instruments. Conclusion Art is important in young childrens education as it is one of the ways to help children to express themselves through different channels such as dance, drama and visual arts. Children need not to be afraid making mistakes as art promotes creativity, imagination and expressions. It is also essential to have arts education in the school, so as to have educators to guide the students and giving then opportunities to explore different kinds of art such as visual arts, drama and music and movement.

What is the role of Owen in Translations? :: English Literature

What is the role of Owen in Translations? One of the first things Owen says on returning to Baile Beg is â€Å"I can’t believe it. I come back after six years and everything’s just as it was! Nothing’s changed!† It is really Owen who has changed into a different person after his time away from Baile Beg. His primary role in the play is that of a translator for the visiting English, but within his role of translator he is also vital to the play as his presence allows relationships between the characters and the plot to develop. Owen provides many contrasting point of views due to the fact that he is working for the English but also a Baile Beg resident. He is a representative of the more forward - thinking Irish, such as himself and Maire. He and Maire realise that for the natural progression of the Irish society they need to work with the English and not against them. Owen has passed the cultural divide that exists between the Irish and English because he can communicate with them and understand their point of view. He has also progressed as an individual through knowledge and understanding. This could be Friel’s way of saying that progress can only come after understanding. Manus can also speak English but chooses not to, this shows the importance of communication to progression. He prefers to use a language, which is becoming less widely used, this may be a symbol of the backwardness of his homeland. The most significant enemy in the re-naming of the places is that the Irish believe it to be a removal of their heritage and tradition, as Manus says, â€Å"What’s incorrect about the place names we have here?† Owens’s view on the idea of preservation of tradition is very questionable. For example when he and Yolland are discussing what to call Tobair Vree he asks, â€Å"do we keep piety with a man long dead, long forgotten, his name eroded beyond recognition, whose trivial little story nobody else in the parish remembers?† Here Owen points to the Irish people’s almost instinctive fear of change. He thinks that tradition is silly and just an excuse to hide from progression. Owen is the neutral and less passionate character in the play; therefore the audience find it easier to relate with Owen. In fact it is possible to call Owen the chief narrator. Although Owen is the translator in the play he acts as more of a barrier of understanding because when translating for Yolland and Lancey he omits details and changes meanings for words. A good example for this would be when he changes Maire’s sentence of â€Å"Has he

The Role Of The Front Office :: essays research papers

The Role of The Front Office A security program is most effective when all employees participate in the hotel's security efforts. Front office staff play a paticularly important role. Front desk agent, door attendants, bellpersons, and parking attendantshave the oppurtunity to observe all persons entering or departing the premises. Suspicious activities or circumstances involving a guest or visitor should be reported to the hotel's security department or a designated staff member. Several procedures front desk agents should use to protect guests and property have already been mentioned. For example, front desk agents should never give keys, room numbers, messages, or mail to anyone requesting them without first requiring appropriate identification. Similiarly, the front desk agent should not announce an arriving guest's room number. Guest's may be further proteceted if the front office prohibits staff members frrom providing guest information to callers or visitors. Generally, front desk agent should not mention guest room numbers. People calling guest's at the hotel should be directly connected to the appropriate guestroom without being informed of the room number. Conversely, someone asking for a specific room number over the telephone should never be connected until the caller identifies whom he or she is calling and the hotel employee verifies the identity of the person in the room requested. A person inquiring at the front desk about a guest may be asked to use the house phones so that they connect only to the hotel operator. The caller can then be properly screened to provideadditional security. Front office staff may also inform guest's of personal precautions they may take. For example, front desk agents may suggest that guests hide and secure any valuables left in their cars.

Feasibility of Nationalising the South African Mining Sector Essay

Introduction The mining industry forms the foundation of South Africa’s economy. Currently South Africa is the biggest producer of platinum in the world and one of the top producers of gold. Julius Malema, the leader of the African National Congress Youth League (ANCYL) was at the forefront of having a detailed perspective on the nationalisation of mines in South Africa at the beginning of 2010. Malema believes the nationalisation of mines will solve all economic disparities in South Africa. There are many South Africans who agree or disagree with this idea. The following discussion will provide answers to why it should be done and who benefits or why it should not be done and what the shortcomings are and the costs that the country will incur if it were to be done as well as examples of nationalisation in other countries (Roberts, 2011). Discussion Nationalisation is the operation of transferring ownership from the private sector to the public sector. According to the minister of finance, Mr Pravin Gordhan stated on the March 14, 2011 that nationalisation of South Africa’s mines and other economic assets are not government policy. â€Å"Nationalisation of mines means the democratic government’s ownership and control of Mining activities, including exploration, extraction, production, processing, trading and beneficiation of Mineral Resources in South Africa†(ANCYL, 2010). Therefore this would mean that no mines would be publicly owned but they would be owned by the state. It has been sixteen years since apartheid and the white minority of 10% of the population owns 80% of the country’s economic wealth. The Freedom Charter is a document that expresses the economic, social and political will of South Africans and according to the document, the mineral wealth of South Africa belongs to the people as a nation. â€Å"It is against this background upon which a concrete position on the nationalisation of Mines is formulated in order to guide the ANC in the transfer of mineral wealth beneath the soil to the ownership and benefit of the people as a whole† (ANCYL, 2010). If the state owns the mines it would allow them to manage the economy by controlling the important industries. They could also invest a larger amount of money and make their services more efficient. Nationalisation of the mines does not mean all sectors are in the hands of the country’s citizens and that they will benefit from all the sectors. It does not yet say anywhere what the ratio (between state owned and privately owned) of the division will be when nationalisations occurs, if it does. Therefore people shouldn’t think that the state will automatically have over half or a larger percentage. An important factor is whether nationalisation will be with or without compensation. It would almost be impossible to nationalise with compensation as the government currently doesn’t have the figure of about R 2-trillion which is how much it would cost to purchase the mines. But on the other hand, expropriation without compensation would cause a collapse of the Johannesburg Stock Exchange (JSE). This would bring down provident and pension funds at the same time. A large number of servants and citizens would be without their retirement investments as well (ANCYL, 20 10). Therefore this poses a big problem already. Some people might think why the mines should be nationalised. Below are three reasons. 1. â€Å"Nationalisation to increase the State’s fiscal capacity and better the working conditions† (ANCYL, 2010). It states that the money received from taxes is not enough to help each and every single South African citizen, which it is not. Education, healthcare, safety and security and housing will not be provided to the masses if the government is not in control of the important sectors. There have been other success stories, such as in Botswana where nationalising the mines provided mineworkers with a safer working environment and higher wages. 2. â€Å"Nationalise to Industrialise and Create more jobs† (ANCYL, 2010). More jobs will be created and industrial investors will be attracted to add to education, expertise and the economy. 3. â€Å"Nationalisation to transform South Africa’s unequal spatial development patterns† (ANCYL, 2010). This means the areas that will be focused on will be ones which will be sustainable in the future as well as effective. Smaller areas that have never been mined before could be targeted as it will provide more jobs in these areas which rarely see economic activity (ANCYL, 2010). Malema believes that everybody in South Africa has the right to the wealth that is produced and that the state should own the larger part of the mines. â€Å"South Africa is divided as we speak. We’ve got two economies in one country, two nations in one country, and it is nationalisation that will unite us† (Andrew, 2011). He also believes many jobs will be created once the mines are nationalised. Patrice Motsepe, a South African businessman, states that he would back Malema’s decision as long as it is in the best interests of South Africa. The ANCYL believes South Africa’s minerals, water, land and marine resources should be used to maximise growth of South Africa’s economy and not purely for profit (Shivambu, 2010). If the mines are nationalised, new economic centres will be developed, new industrial development zones will be established, jobs will be created as the mines owned and controlled by the state will increase local beneficiation and industrialisation of the available mineral resources, and local economies will be developed (Shivambu, 2010). General Secretary of Congress of South African Trade Union (COSATU), Zwelinzima Vavi says that â€Å"Nationalisation can bolster our economy and it will always ensure development† (Beukes, 2011). He said that the nationalisation of the mines will make available money to all the people of the country, not only those who are currently working in the private sector (current mine owners) (Beukes, 2011). One of the ANCYL’s argument is that nationalisation was a demand found in the Freedom Charter and that South African citizens should share the mineral wealth of the nation between each and every one (Achary, 2010). Thus there are valid reasons for the mines to be nationalised but the major concern is the cost that the country would incur to make nationalisation happen. â€Å"Nationalisation is an unaffordable, untimely and frankly unnecessary suggestion, which has already undermined market stability† (Time, 2009). It would cost South Africa R1.4 to R2 trillion to nationalise the mines which seems silly if you think South Africa has the fifth biggest mining industry in the world. This figure does not include extra running costs as well as the costs that go with running loss-running mines. This shows it is a big part of the economy and would be tough to be nationalised. This figure is the same as trebling South Africa’s national debt over a single night, which is unrealistic (Time, 2009). â€Å"The debate on the thorny issue heated up with business executives and analysts warning that nationalisation would damage the economy† (Isa, 2011). Many say it is a disaster and has been for every country who has tried to pull it off. Susan Shabangu said â€Å"consideration of the step was misguided, as the real issue was to address povert y, unemployment, and inequality† (Isa, 2011). This shows that the debates that are ongoing will deter foreign investments. The ANC do realise that it’s close to impossible to nationalise the mines and come off on the right foot but are currently looking at models of how it could be implemented effectively (Isa, 2011). The nationalisation of mines has also been seen as a ploy to try and save Black Economic Empowerment (which has been in place in South Africa for a while, but has not achieved what it hoped to) and not focusing on the amount of poor in the country as well as the amount of unemployed workers (Business Day, 2011). The market value of South African mines (listed) is almost 850 billion rand which is above a third of the country’s total Gross Domestic Product (GDP). Therefore the government should be more concerned over matters such as the education level and the health of the countries people. â€Å"Zambia nationalised the copper mines, which supplied 90% of its exports, in the early 1970s. It ended up hiring back the multinational copper companies to manage them† (News24, 2010). Zambia is the world’s 11th largest producer of copper. The mines were nationalised in 1969 and at this time were exporting about 700 000 tonnes of copper per annum. By the year 2000, exporting figures had constantly decreased to 225 000 tonnes. The result of the decline was partly because of a lack of investments as well as mismanagement of the mines. â€Å"Zambia has neither the capital nor the skills to run the mines by itself† (Time, 1969). Other factors were the drop in the price of copper, a lack of skills among the citizens in Zambia and they were unable to raise capital. They lacked a strong plan with which to back up their initial aim (Time, 1969). Restrictions were placed on exports and imports which resulted in exchange rates rising and therefore gains from exports reduced. Zambia also failed to save earnings when the copper price was high and thus when the price fell, they suffered immensely. Even though the situation is not exactly the same, it does show that to nationalise mines a lot of debate needs to occur as well as research and obviously the country needs the required funds to make sure it can be made possible. South Africa does not have these funds at the moment and thus would not be able to nationalise the mines unless they are willing to operate with huge debts which is unfeasible (Osei-Hwedie, 2003). Conclusion â€Å"Nationalisation is an unaffordable, untimely and frankly unnecessary suggestion, which has already undermined market stability† (George, 2009). This statement sums up the idea of nationalisation of mines in South Africa. It obviously has its advantages such as giving higher wages and creating more jobs but it is clearly evident that the positives are outweighed by the negatives. With so many jobs in South Africa’s mining sector at stake, it is irresponsible to talk about placing this key sector of the economy in the hands of government people. The country does not have nearly enough funds for this project to take place and thus in my view should not take place in even in the near future (Marais, 2010). Reference List ACHARY, N. (2010). Nationalising the Mining Sector in South Africa [Online]. Available: http://www.suite101.com/content/nationalising-the-mining-sector-in-south-africa-a281585 [Accessed 25 September 2011]. ANCYL (2010). Towards the Transfer of Mineral Wealth to the Ownership of the People as a Whole: A Perspective on Nationalisation of Mines. [Online]. Available: http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page71654?oid=158357&sn=Detail [Accessed 22 September 2011]. ANDREW, M. (2011). Nationalisation will unite SA, says Malema [Online]. Available: http://mg.co.za/article/2011-08-05-nationalisation-will-unite-sa-says-malema [Accessed 21 September 2011]. 3 BEUKES, W. (2011). Vavi joins ANCYL in calls for nationalisation [Online]. Available: http://mg.co.za/article/2011-08-06-vavi-speaks-in-favour-of-nationalisation [Accessed 25 September 2011]. BUSINESS DAY (2010). Nationalisation won’t help poor – Nzimande [Online]. Available: http://www.businessday.co.za/articles/Content.aspx?id=147053 [Accessed 26 September 2011]. GEORGE, D. (2009). Nationalising South Africa’s mines would cost R1.4-trillion [Online]. Available: http://da.wwc.co.za/newsroom.htm?action=view-news-item&id=6967 [Accessed 25 September 2011]. ISA, M. (2011). Nationalisation talk ‘costing SA jobs’ . [Online]. Available: http://www.businessday.co.za/Articles/Content.aspx?id=150052 [Accessed 27 September 2011]. MARAIS, E. (2010). Budget Speech: Nationalisation of SA’s mines [Online]. Available: http://www.da.org.za/newsroom.htm?action=view-news-item&id=8231 [Accessed 23 September 2011]. NEWS24 (2010). Zambia’s nationalisation woes: ANC [Online]. Available: http://www.news24.com/SouthAfrica/Politics/Zambias-nationalisation-woes-ANC-20100730 [Accessed 20 September 2011]. OSEI-HWEDIE, B. (2003). Development Policy and Economic Change in Zambia [Online]. Available: http://www.dpmf.org/images/Zambia-devt-bertha.html [Accessed 24 September 2011]. ROBERTS, J. (2011) SA’s mining industry losing ground [Online]. Available: http://www.businesslive.co.za/southafrica/sa_markets/2011/08/04/sa-s-mining-industry-losing-ground [Accessed 25 September 2011]. SHIVAMBU, N. (2010). The case for the nationalisation of mineral resources [Online]. Available: http://mg.co.za/article/2010-09-21-the-case-for-nationalisation-of-mineral-resources [Accessed 23 September 2011]. TIME MAGAZINE (1969). Mining: Nationalization in Zambia. [Online]. Available: http://www.time.com/time/magazine/article/0,9171,898567,00.html#ixzz1YgJNdxqy [Accessed 22 September 2011].

Public Health Care Service In Cameroon Essay

Social services consist of goods that are part of major resource bases that must be managed effectively in order to fulfill the ongoing development need of the country. The public health care system (PHCS) is one of the resource bases that directly benefits from government budget allocation. Throughout Cameroon, researchers observe major differences and unequal share distribution in the access and utilization of the public health services. These incongruities become obvious when examining the distribution of health infrastructures and health workers throughout Cameroon. A closer analysis shows that the organizational imbalance of public health establishments, along with inappropriate internal and external administrative politics (financial weaknesses and inadequate governance) in the management of PHCS are the most significant obstacles affecting the effectiveness of the health staff, the efficiency of the PHCS and the equity of public health services delivery in Cameroon. Human Resource Distribution First, the number of health care workers across the country is significantly inadequate with approximately 1 physician made available for about 10,000 inhabitants, compared to 1 for every 3,000 as recommended by the World Health Organization (WHO). Furthermore, it has been reported that there is about 1 nurse for every 2,250 individuals, compared to 1 for every 1,000 as recommended by the WHO. Table 2-1 shows the statistical trend in the number of physicians, nurses, midwives, dentists and other health care providers from 1980 to 2005, as well as the increase in the number of pharmacies. Even though the numbers that are displayed in this table seem large, and bearing in mind that the population has been steadily increasing since 1980, there is a discrepancy between the number of providers working in the health care industry and the number of people living in Cameroon. Indeed, in 2001 the human resource deficit in the PHCS has been estimated to total approximately 9,000 persons. In addition to the deficient number of health care workers, there is unequal distribution of health staffs throughout the country with wide distribution disparities between urban and rural areas, which point to obvious disparities in access to care between poor and non-poor. Studies show that while the ratio of health personnel stands at 1 for 400 people in urban areas, their ratio of health personnel decreases tenfold, and is pegged at 1 for 4000 people in rural areas, requiring rural residents to travel long distances to receive the necessary medical care. Such imbalance between health workers and the population requiring the health services raises concerns about the effectiveness of the health providers, since it is likely that their competence would be diminished due to the heavy load of patients they must care for. Because PHCS facilities are selectively located, there arise problems of equity in access. Equipment and Facilities Distribution The distribution of equipment and facilities resources also indicates that the PHCS is poorly equipped to provide adequate health services to meet the needs of the population. The physical resources– buildings, equipment, and supplies– have been woefully deteriorating for some time. Most of the infrastructure and the equipment of the PHCS are outdated. Facilities are unevenly distributed among provinces, as well as between urban and rural areas. Table 2-2 shows that there is 1 health center for 8,500 people, 1 hospital bed for 770 people, and 1 health facility per 85,000 people, which is clearly insufficient to meet the medical needs of the population, and at the same time, provide appropriate medical care. Though the total number of health centers has increased twofold rising from 1,893 health centers in 1990 to 2,144 health centers in 1996, the inequitable distribution creates issues of disproportionate access to health services. Therefore, though there might be sufficient facilities for providing primary care for the country’s population, the problem of uneven geographical distribution of health care facilities and the lack of trained medical personnel in remote areas, are incongruent and remain unresolved.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Health professionals and trained support staffs, valuable and indispensable assets of any health care system, are crucially scarce in the Cameroonian PHCS. Health professionals need to be trained and motivated to perform at optimal levels; however, in Cameroon, there are no incentives to encourage competent health workers to stay in the public sector or provide good quality services in the public facilities. Those health workers who remain and work in the public health sector have been primarily assigned to urban public facilities due to their general reluctance to relocate to remote areas of the country. Consequently, there exists an oversupply of qualified health providers with an attendant oversupply of infrastructure in mostly urban areas; whereas, there is an undersupply of qualified staff with the attendant undersupply of adequate infrastructures in primarily rural areas. Hence, the shortage and uneven distribution of trained health workers nationwide as well as the insufficient and disparate distribution of health facilities promote overcrowding of many public health facilities. Taken together, these prevailing conditions limit the effectiveness of health care workers, and contribute to underutilization of facilities in other areas, all resulting in inefficiency of the PHCS. The disparities of health services across the country can be noted in Table 2-2.   Inadequate Governance and Lack of Funding Apart from the decrepit health facilities, the accompanying technical support centers are also quite outdated with inept and corrupt bureaucratic administrations. Routine procedures that should normally be completed within a matter of hours can take several days to be resolved. Such ineptitude points to a lack of administrative discipline and an ingrained culture of corruption in the public healthcare system. From administrative procedures to medical procedures, patients– especially the poor– have to bribe the personnel in order to obtain medical service delivery or they have to be prepared to undergo several trips to the healthcare institution just to receive appropriate medical care. Furthermore, there is no proper management accounting system in public health facilities, raising issues of inadequate management. Earned income from performed services are not all reported and when they are it remains quite unclear which charges correspond to which services.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A number of conflicting phenomena that retard effective development of PHCS have yet to be resolved or corrected. The conflict of interest and the agency problems arising when publicly employed physicians also manage public health facilities seems not to be a major concern of the MOPH. Physicians employed to serve public facilities may tend to divert patients to their own private clinics or they lack the necessary rigor and ethics in the delivery of medical care. There is therefore a clear shortage of competent and skilled healthcare managers and a lack of management leadership capacity resulting in extensive internal administrative weaknesses.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The lack of strategic planning in the conception and the implementation of health projects and programs also contributes to the failure of initiated health projects. Managers at public facilities, mainly possessing only basic medical background, lack the vision, the leadership capacity and the management discipline required for the function of healthcare manager. They approve projects presented to them, for example, based on subjective (highest under the table kickback) rather than objective (impact on population health status and improvement in quality of life) considerations. They do not have competent support staff to assist them in performing business strategic evaluation, which is necessary before engaging in any project. Such preparatory analysis would include environmental scanning, strategy formulation, strategy implementation and evaluation and control of operations. Thus, the lack of strategic management capacity and the inability to learn from past mistakes and others’ experiences favor wastage of precious resources and promote inadequate governance of the PHCS.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Significantly, the PHCS is clearly under financed. Health care organizations must generate cash flow, acquire assets, and put those assets to work, just as manufacturing and banking organizations do. Though the public budget allocated to PHCS has more than doubled in the last couple of years, going from CFAF 24,048 billion or 2.16% of the national budget in 1997 to CFAF 120,844 billion or 7.82% of the national budget in 2005 (Table 2-3), it is important to note that such growth coincided with the implementation of several economic reforms and the approval of loans from the World bank (WB). Moreover, a significant amount of the monies available were heavily invested in the restructuring of some health facilities, the building of roads to increase access to care and the training of health workers. But despite the increases in government funding, the financial allocations are indeed meager considering the ongoing needs of the growing population. For instance, the structural renovations performed were certainly not sufficient to insure quality of care delivery nor were they enough to ensure increased use of health services. Furthermore, primary health care centers and district hospitals, even those with trained staffs, lack adequate technology to diagnose many infectious diseases, and they regularly run out of medical supplies and pharmaceutical drugs. External contribution to the financing of health care in government budget has increased also, rising from 26.53% of the total health investment in 1997 to 32.10% in the year 2000, as shown in Table 1-3. However, the management of such funds is troubling to the degree that in most cases health facilities do not receive the bulk of the monies from foreign financial benefactors. Internal organizational structures plagued with heavy bureaucratic barriers and heavy corruptive practices prevent the proper and fast disbursement of the external fund contributions, raising issues once again of internal dysfunctional organizational structure and inadequate governance. The lack of rigorous and transparent handling of funds leaves severe deficiencies in financial accountability and encourages false reporting and embezzlement of health funds.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In addition, the MOPH has not been able to allocate monies equitably across the territory based upon the consideration of the geographic spread and economic need of the total population. Instead of using the donated funds for the revival of essential programs such as health prevention campaigns, immunization campaigns, information campaigns, and targeting services most frequently used by the poor, about 60% of government health expenditure is devoted to urban health facilities serving only about 20% of the population. Such preferential allocations create an issue of inequality in access and utilization of care. Moreover, households are then obligated to assign larger shares of their budgets for health expenditure. Meanwhile, the poverty rate has been steadily increasing nationwide.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Another factor causing the low financing of PHCS is the practice of either wrongful or unwise disbursement of funds in the sense of not considering future development and advancement. Most funds earmarked for health care development are sunk into production costs (maintenance of major equipment, payment of salaries, replenishing of inventories, and so forth) with nothing substantial left for infrastructural developments and quality improvements in delivery care. Foreign Aid and Healthcare Expenditure Essentially, external institutions have dictated a number of economic constraints on national budgetary decisions. Cameroon is one of those countries subscribed to the WB/IMF structural adjustment program (SAP) which imposed drastic cuts in the national budget for health which went from 120 billion CFAF or 3.3% of the total GDP in 2002 to 58 billion CFAF or 1% of the GDP in 2005.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The SAP policies required already indebted countries to: (1) shift from production of domestic consumption food to producing cash crops for export; (2) abolish food and agricultural subsidies to reduce government expenditure; (3) severely cut health, education, and housing program funding and reduce salaries; and (4) devaluate the currencies and privatize government-held enterprises. The reform designed to stabilize the economy exerted adverse effects instead on the economy of borrowing countries like Cameroon. In reality, [the World Bank] imposed harsh measures, which exacerbated poverty, undermined food security and self-reliance and led to resource exploitation, environmental destruction and population displacement. The health sector was particularly adversely affected, and few proactive steps were taken to protect vulnerable populations and ensure ongoing availability of basic services. Following the expenditure cuts, especially in the national budget for public health, the following conditions occurred: (1) the integrated health centers lost qualified personnel and a shortage of basic health materials ensued; (2) the training of health workers was interrupted, which in turn affected the motivation level of doctors and health workers; (3) there was a shortage of medical supplies, a breakdown of transportation and problems of inadequate management; and (4) medical consultations and hospitalization declined despite the increases in acute infectious diseases. More generally, the quality of care delivery in public facilities declined and studies showed that more patients sought care in private institutions despite their higher costs.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In addition to all the obstacles of an already struggling PHCS, the combined effects of infectious disease epidemics of tuberculosis, malaria, and HIV/AIDS, further strained the public health sector beyond its limits. The failure of the public health system to provide appropriate medical care for individuals who had contracted these diseases– large segments of the population — led the latter to choose more expensive private medical services. Consequently, as shown in Table 2-4, the household budget for health expenditure skyrocketed and rose from 4% in 1983/84 to 9.6% in 1995/96 resulting in a household spending on health from $14 to $20.6 per capita. The increase is mainly due to elevated out-of-pocket payments charged for private medical services, raising the issue of inequality once again in the use of care. The WHO has estimated that the cost of a basic package of health care delivered to 90% of the population in a low-income country like Cameroon would be a $13 per capita (table 2-5).    However, a further analysis of the region matrix in table 2-5 and the distribution of household per capita health expenditures by population decile (which is a partial source to income group matrix) in table 2-6 reveals even more drastic inequalities in the distribution of health expenditure across income groups and between urban and rural regions.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Thus, in 1998, the per capita household expenditure for health by the poorest 10% of the population was only $5.4 while for the richest 10% it was $90.4. This translates in the utilization of private health services– more effective delivery– by the part of the population with higher income and the utilization of public facilities–less effective delivery– by the poorest portion of the population. The wide middle class will seek medical care from public, private or traditional providers based upon their current financial means.   The table 2-5 highlights the wide inequalities in the distribution of health expenditures between urban and rural areas (and to a lesser extent among rural areas). In Douala and Yaounde (the two largest towns holding about 40% of the population) the capita health expenditures were $51.9 and $46.1 respectively compared to $18.5 and $18.9 in the rural plateau and rural savanna. Such imbalances are due to the fact that households have higher incomes in urban areas, government spending is higher in urban areas and enterprises, both public and private, are concentrated in urban towns.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  An evaluation of the performance of the PHCS reveals, therefore, that the principal elements and characteristics of successful health systems including accessibility to facilities, appropriateness of medical treatments, effectiveness in access of care, efficiency in delivery of care and equity in use of care, are all seriously lacking in the Cameroonian PHCS. Effectiveness: Public Health Care System Performance In Cameroon, public health facilities perform below expectations due to organizational, managerial and financial issues. This below average performance results in reduced effectiveness of public healthcare providers, inefficiency of the PHCS and unequal access to health services by a large portion of the population who needs it the most.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Budgetary cut backs have also led to a moratorium on the construction and equipping of health facilities, a freeze on the recruiting of public health employees, and a shortage of sufficient qualified personnel. In addition, the distribution of health workers across the country is inappropriate due to discrepancies in regional distribution of health facilities. In a major way, salaries have been slashed with the attendant consequences of the lack of motivation and lower performance (low morale) among health personnel.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As a result overall, the main quality indicators have deteriorated in the light of WHO standards. The per capita ratio of physicians, nurses, hospital beds, health centers and pharmacies shown in Table 1-1 indicate major discrepancies in the distribution of health resources across the territory. Human resource planning is to be revised and working conditions are to be ameliorated in order to attract more care providers in the public sector, increase productivity and effectiveness of the PHCS.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Not only is there a shortage of human resource personnel, but there are also supply management deficits. Inventories are not kept accurately, so doctors and nurses can help themselves to medications directly on shelves, and supply depends on availability of resources rather than based on any demand assessment. This means that inventories and supplies are replenished whenever funds permit. Moreover, supplies are not equally distributed among health facilities. Urban health facilities tend to receive more stock and resources than rural or remote health facilities, but medication and medical materials are in more grave demand in these latter areas. In some rural facilities, syringes and surgical material such as gloves and bedding are re-used. Some facilities even lack beds for patient and the laboratory material to perform blood or other tests. Thus, equipment that are needed for the care of ill patients are regularly in excessive quantities compared to other areas, and are lacking in other areas or where there are none at all.   All these factors engendered by internal and external mismanagement at both the financial and the organizational levels affect the rate of use of public health services, and, ultimately undermine and negate the efficiency and the effectiveness of the PHCS. Efficiency: Utilization of Public Health Facilities Several constraints have arisen during the last decade, which led to a significant decrease in the utilization of the public health care system. The government suspended recruiting and training of health care personnel because of lack of funding. Table 2-1 shows that there are fewer than 20,000 health care workers for a population of almost 17,000, 000 people. The prevailing (accepted) corruption in public health facilities is manifested through the observation of health personnel offering health care services which are normally free in exchange for financial favors. In Cameroon, though many medical services such as vaccination and delivery of essential drugs, are supposed to be free of charge, more often than not, personnel charge patients with nominal fees for these services. Moreover, the culture of â€Å"clientelism† is deeply rooted in the PHCS. Notably, medical services afforded to patients are prioritized not based on the severity of patients’ illnesses, but rather on the level of rapport between the health staff and the patients or the amount of money the patients have at their disposal to be used to bribe the health staff. Health managers and health providers in the concerned facilities do not regularly investigate or follow up patients complaints simply because they belong to the same professional pool as those personnel who exploit the patients and accept bribes for routine medical care. Moreover, the lack of incentives from the MOPH to reinforce the delivery of free services and the fact that MOPH authorities are responsible for nominating those health managers, all factors which serve to undermine the effectiveness of any civil action against the malpractices observed in public health facilities.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In essence, as an intern in the Hospital La Quintinie in Douala in 2000, this researcher witnessed instances when patients bribed health personnel to receive health services they had already paid for at the cash register. This researcher also saw bodies being dumped in the front yard of the hospital and remaining there for hours before being dispatched to the morgue. In another instance, this researcher was informed of an individual who had sued a physician for negligence. The doctor had received a telephone call late at night relating to the difficult delivery of one of his patients; however, the doctor had asked the nurse to deal with the issue and turned off his cell phone, which resulted in the death of the patient. However, the case was dismissed and the physician, who did not even receive a temporary suspension or a reprimand, is still working at that facility. Also, seriously ill patients are still left unattended in waiting areas for extended hours. This situation fosters long lines and extensive waiting times, altogether discouraging many patients from seeking medical care in public health facilities. The efficiency of the public health system can be judged by the utilization of the services by the people for whom they are intended. According to the North West province records, during 1989 and 1995, there were 173,450 consultations in religious missions facilities versus 129,569 at government health centers in the northwest region. In other words, there is a two fold increase in the utilization of nonprofit facilities. That data attest to the low utilization of public health care services and implies that the quality of health services delivered is inferior in the public sector and, therefore, less sought. The evidence from the northwest province suggests a steady decline in health care provision by public facilities. The share of the government in both health centers and hospital consultations fell from 72.9% in 1989 to 50.1% in 1995 while the share of mission consultations increased from 25.5% to 47% and the private sectors from 1.6% to 2.9%. The bed occupancy rate in hospitals fell from 45% in 1985 to 23% in 1996. Therefore, it becomes apparent that many patients clearly demonstrated preference for health services offered by nonprofit organizations and for profit establishments instead of those offered in the public sector. Such utilization factors underscore the failure of the PHCS in providing efficient health services.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In fact, the poor, for whom public services are primarily intended, incur overall financial losses when using public health facilities. First, they must travel long distances to receive uncertain and inconsistent medical attention. Second, added to the time wasted on the road to reach health centers, they have to wait long hours to receive inadequate and inappropriate care or no care at all. The opportunity cost in terms of income loss and hours of labor is high compared to the quality of life improvement they might have gained. This prevents many low-income patients from utilizing public health facilities unless their diseases are in a well-advanced state and require immediate attention.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   According to the 1995 household-survey, 14.8% of health providers were traditional healers, 43.8% of consultations took place in public facilities, and 56.2% took place in private facilities– though 50% more expensive. There is a clear decrease in the utilization of public health facilities over private health clinics. The decaying public health care buildings, major components of the health care infrastructure, and the lack of competent health workers actually send negative messages to patients who, therefore, prefer to obtain appropriate care at higher costs at private institutions for those who can afford it. Table 2-7 further illustrates the low level of government health spending relative to private spending and household spending.    There is a grave degeneration of medical ethics in several public health facilities. Often, under qualified health workers perform specialized services they have not been trained for. In some hospitals, nurses are performing surgeries, delivering anesthesia and prescribing medicines. In other health facilities, the record of services provided is inaccurate and patients’ files are non-existent.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The overall number of health care personnel in public health care facilities has decreased against a background of a growing population, resulting in a gap between the health services demand and the supply in the whole territory and an underutilization of public medical services. Underutilization promotes wastage in health care resources and inefficiency (low utilization) while favoring the development of over-crowding in other health units, which in itself prevents proper and adequate delivery of healthcare to patients. Moreover, the vast regional imbalances between the distribution of health care facilities and health care workers exacerbate the problem of underutilization of public health care facilities. Equity: Health Disparities Across the Nation There are significant differences in the state of health and the access to care between the poor and low-income households and the non-poor, as well as between urban and rural inhabitants. Most people turn to formal health services in cases of illness. Among those who have declared themselves ill in 2001, 3/4 was able to seek consultation at a formal health centers, versus 1/4 in informal facilities. Formal health centers are more frequently visited by the non-poor and informal facilities by the poor. It appears that non-poor seek medical help more often than the poor maybe due to superior financial capacity.    Another indicator of discrepancy between poor, non-poor, rural and urban residents is the vaccination rate. Thus, the immunization rate for non-poor children is better than that for poor children and children are better protected in cities than in rural areas. Table 2-5 reports inequality in the rate of consultation in formal and informal facilities between poor and non-poor in rural and urban areas. From that table, it appears that both income groups allocate similar budgets for health expenditure. However, the average health expenditure among the rural and poor residents is three times less than that of non-poor and urban dwellers. Thus, lower spending for health care services is reflected in the lower consultation rate of non-poor which is indicative of their health status. Thus, the infant (12 to 23 months) immunization rate for poor in rural areas was 66.9% and 53.1% for poor in urban areas while it was 89.5 for non-poor in rural areas and 70.2% for non-poor in urban areas.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Finally, the non-poor have to travel slightly lower distances to receive medical care than the poor which in turn increases their access to health services. According to regional health map data, 54% of people live less than five kilometers from an integrated health center. This average figure, however, conceals wide regional disparities, ranging from 43% of people living less than five kilometers from an integrated health center in the province of Adamaoua to 78% of people living less than five kilometers from an integrated health center in the Littoral province. Moreover, the household survey statement notes that rural people must travel five times farther than urban dwellers to reach the nearest health facility. Even more striking, 98.9% of the people who must travel 6 km to a health facility live in the countryside, indicating the serious problem of rural access to appropriate health care services.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Table 2-5 shows the division of health spending in urban areas (Douala, Yaounde, and other towns) and in rural areas. From this table, it is obvious that urban dwellers spend more on health care than rural dwellers mainly due to higher income since households in cities spend on average $34 on health care versus $16.7 on average on health care, which is about half of what urban dwellers spend on healthcare. Though government spending seems to be significantly higher in comparison to direct foreign aid and religious mission share of health spending, it must be emphasized that an increasing share of MOPH budget is financed through foreign financial donations (Table 1-3).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Table 2-8 is a perfect illustration of the lack of equity in the distribution of health services (whether in formal or informal facilities) among the different population groups in Cameroon.    From Table 2-8, it appears that annual average health spending per capita is three times higher in urban than in rural areas (39,00 CFAF vs. 13, 000 CFAF) and four times higher among the non-poor than it is among the poor (32,000 CFAF Vs 6,900 CFAF). Yet the cost of health services rose nearly three times as fast as the average inflation rate over the last five years by some 70% (13,000 CFAF to 22,00 CFAF), which led to a considerable decrease in the demand for health services, especially for the poor whose utilization of health services declined. References Adamolekun, L. (Ed.). (1999). Public Administration in Africa: Main Issues and Selected Country Studies. Boulder, CO: Westview Press. McKinney, J. B., & Howard, L. C. (1998). Public Administration: Balancing Power and Accountability (2nd ed.). Westport, CT: Praeger Publishers. Vine, V. T. (1971). The Cameroon Federal Republic. Ithaca, NY: Cornell University Press.