Research into Truancy: Causes and Effects

Research into Truancy: Causes and Effects Introductory orientation Truancy is about learners who have not been attending school regularly as required by the school, parents and even the authorities. Truant behavior is a problem for the individual, the family, the school and society in general. Free and compulsory education is recognized as a basic entitlement under international standards, including the United Nations Universal Declaration of Human Rights (1948), the Convention of the Rights of the Child (1989) and the European Convention on Human Rights (1950). With the right to free education and the obligation corresponding to this right observed and enforced through a national emphasis on school attendance, The National Statistic Office (Malta) states that in the 2004/2005 scholastic year the figure for school absenteeism accounted for 7.7% of the total number of school days in the reference period or an overall absence rate of 9.2 absent days per pupil that for boys being 10.0 days per pupil and for girls 8.4 days per pupil. As a teacher this makes me fretful about students missing school as this can be associated with subsequent emotional and psychosocial problems in early adulthood and is a predictor of multiple problems (Fogelman and Hibbert, 1990). Truancy may have both short and long term effects on society. There is evidence that truancy is linked to delinquent behaviour and juvenile crime (Collins, 1998; Reid, 1999). According to Jones (1996), ‘Absenteeism is a sign of trouble that often leads to lower academic skills and grades, delinquency, and dropouts. Studies have shown that high school dropouts are twice as likely to be unemployed and on welfare, and overall, tend to be facing a more difficult life than their graduating counterparts. Jones (1996; p.128), All members who form part of any educational institution cannot allow these students to give up on themselves. We as a modern, fast developing society, we cannot afford to let them surrender. It is clearly far less expensive to educate them than pay for a lifetime of welfare and all of the deprivations that welfare represents. These are ominous issues, which imply that the number of students who skip school is rising and that school absenteeism is a new generations behaviour that is today a dramatic social phenomenon. This proposal drafts the intent to investigate and explore realities of how truancy manifests with Maltese youth and also explore the psychosocial world of truants in Maltese schools. Problem Analysis The Pre-Scientific Problem awareness As a supply teacher for these past five years, I have witnessed incidences of truancy in the period 2006 to 2009. One of the common truancy reducation measures used was to lock the school gates during lessons and breaks and open them after school hours (my personal exsperience). Despite the limited impact on truancy reducation, the approach of locking gates is still common and evident in some secondary schools. I found locked gates while visiting some of the schools. Gangsters, to control late coming and to stop learners from dodging classes, locked gates to prevent trespassing, sepecially. Exploring the problem Incidence and nature of truancy Malta Since 1946 education has been compulsory for all children between six to fourteen years and extended to the age of 16 by the Education Act (Malta) of 1971. Maltese law imposes a duty on parents to ensure that their children of compulsory school age receive appropriate education, whether through attendance at a state or independent school. If they fail to do so, without any reasonable excuse and if found guilty, they are liable to a fine not exceeding in previous currency one Maltese Lira (equivalent to â‚ ¬2.33) for each day during which the offence continues, unless the parent fails to give a good and sufficient explanation within three days from the date he or she receives a notice from the Director of Education (Malta Education Act 1988). From January 2001 up to December 2002 there were 8,903 arraignments before the local tribunals in connection with school absenteeism (Grech, 2002). This figure represents only the number of students who were absent from school without a valid reason on more than three occasions in the time frame of a month. It is a known fact that there are a number of students that systematically plan three days off from school each month, just for the sake that they use their monthly absence allowance and knowing that in this way their parents would not receive a citation. Surveys show that the overall absence rate between 25th September 2000 to 31st March 2001 stood at 10.5 days per pupil (NSO Malta, 2001). This figure reveals an increase of 5.2% over 1999/2000 scholastic year (NSO Malta, 2001). Thus it shows that during this period, 657,604 pupil days were lost to absenteeism and authorised absence due to sickness. Indeed, the Clark Report (2005) shows concern for the increase in unauthorised absenteeism with parental consent, particularly in state secondary schools which cater, in the main, for a student population coming from a working- class background. Family problems, psychological problems, illnesses, school phobia and bullying have, significantly, been indicated by the Clark focus group to be the topmost reasons contributing to school avoidance. Some Overseas Countries Most of the research conducted abroad seems to provide information regarding the nature and extent of truancy in secondary schools. Results of a study conducted at a school in London from 1985 to 1987 revealed that 70% of the sampled pupils admitted truanting during the three-year period (Stoll, 1990:22). In the study that involved nine secondary schools, 66% of the 765 fifth year pupils admitted truanting (ibid). Figures on truancy in 150 English secondary schools revealed that 31% of pupils in years 10 and 11 admitted that they played truant or skipped lessons (OKeefe Stoll, 1995:12). Gray and Jesson (1990:25) report about the major national survey results of truancy in English secondary schools. According to this study, 23% of all fifth year pupils were involved in truant behavior and they were less likely to stay on in full-time education. Furthermore, schools facing serious problems of truancy tend to be in the inner city rather than in other areas (ibid). on the other hand, Collins (1998:26) reports that absentee rates vary between schools in the London Education Authority. Munn and Johnstone (1992:4) found that out of a sample of 50 Scottish secondary schools, 18% of the pupils (11% in June and 7% in November) were classified as truants and were mostly form the senior years. These figures exclude truants within the school day, as â€Å"14 schools reported that they did not keep period attendance records† (ibid). Truancy has long been a subject for research in various parts of the USA. According to Nelson (1972:98), 64% of the 591 students surveyed identified themselves as class truants. Learners habitually play truant each day in Los Angeles, Pittsburg and Milwaukee (Black, 1996:33). Bos, Ruiters and Visscher (1992:393) found that the average rate of truancy in 36 schools in the four Dutch cities studied was 4.4% and that truancy increased with the level of the class in almost all schools. Some researchers further indicate that truancy does not necessarily mean missing the whole day of school but found that I could be in the form of missing a part of a day or particular lesson (Kilpartick, 1998:31; Reid, 1999:91). In a study conducted by Malan in South Africa (1972:144), 2,738 out of 69,908 pupils were identified by their teachers as truants. Masithela (Masithela, 1992:33) observed that learners tend to miss lessons during the first and second periods, as well as during the last give periods. The tendency of missing certain lessons towards the end of the school day shows that some form of â€Å"hidden truancy† is prevalent and that pupils can be marked present in the register but fail to attend all lessons (ibid:45). On the other hand, they may come late and be marked absent or be somewhere on the school premises not attending certain lessons or periods, but still be marked as being present on the class resisters. Factors associated with truancy Malta Truancy is about learners who have not been attending school regularly as required by the school, parents and even the authorities. Tyerman (1968) defines the term truant as the child who is absent from school purely on his or her own initiative. Gabb (1994) includes in his definition of truant, that a child who is absent with leave given by his or her parents, or who are actually kept at home by the parents. Hersov (cited in Gabb, 1994) goes still further, dividing from truants, ‘school phobics and ‘school refusers. King (2001) furthermore defines school refusal/school phobics as a difficulty to attend school due to emotional distress, especially anxiety and depression. Fenech (1991) (in an unpublished research) defines ‘absenteeism as ‘being away from lessons for any period of time and for reasons not considered as legitimate, with or without the parents knowledge (p.3). She goes on to include ‘physical presence without any attention being given to a lesson in progress [as well as] masked or selective truancy (ibid., p.3). Fenech (ad. lib.) refers to the latter as ‘skiving off specific lessons or disappearance after registration (p.3) remarking that a number of sources consider absenteeism and truancy synonymous. Sultana (1997), like Fenech (1991), defines absenteeism as ‘staying away from school for reasons not justified by the law (p. 355). However, she goes on to include other ‘less overt ways (ibid., p 355) such as what Willis (1977) calls participating in ‘informal mobility (ibid., p. 355). This includes not entering the class for lesson, intentionally staying in another class, leaving the class without permission, or staying in class without bothering to follow the lesson. Studies conducted abroad When seen from a psychological viewpoint, truancy may be symptomatic of learns who are insecure and have low academic achievement levels and low self-esteem. Lewis (1995:37) states that attendance difficulties my broadly result from a combination of â€Å"pull† and â€Å"push† factors. Pull factors are personal and social aspects that â€Å"pull† a learner out of school. The pull factors may be related to the psychological indices mentioned by Reid (2002:11), such as maladjustment, a lower general level of self-esteem and academic self concept, anxiety and lower career aspirations. Factors that â€Å"push† learners away from school include academic and classroom aspects such as inapproachability of the teaching staff, incomprehensible teaching style and inappropriate classroom management. Other factors relating to the school and the classroom include bullying, the curriculum, boring lessons (Reid, 1999:91), teachers humiliating remarks (Porteus, Clacherty, Mdiya, Pelo, Matsai, Qwabe and Donald 2000:11), poor record-keeping and school organization (Bimler Kirkland, 2001:90; Coldman, 1995:29). According to Pappas (1996:1), truancy is often symptomatic of family dysfunction, since the parents of truants tend to be permissive, undisciplined and unavailable. Some authors believe that truancy is associated with a poor socio-economic background, including poverty, poor housing and unemployment (Bell, Rosen and Dynlacht, 1994:204; Tyerman, 1958:222). Some researchers state that there is a link between truancy and delinquent behavior (Collins, 1998:38; Brown, 1998:298-299; Reid, 1999:25). Truancy differentiated from school phobia There is a need to distinguish between truancy and school phobia. The concept â€Å"school phobia† describes a learner who is unwilling to attend school and stays at home with the knowledge of parents (Wicks and Nelson, 2000:123). A learners problem often stats with a vague complaint or reluctance to attend school and progresses to total refusal to go to school. Blagg (1992:121) asserts that school phobia may be induced by fear-arousing aspects of school, such as fear of failure caused by anxiety about meeting the standards. Fear may also be related to worries about the health and welfare of parents (Blagg, 1992:123). In the other hand, a learner who plays truant misses the whole school day or lessons without the knowledge of parents or caregivers. Furthermore, a truant tends to be involved in various forms of anti social behavior (Blagg, 1992:121). Milner and Blyth (1999:18) acknowledge the difficulties involved in studying the prevalence and pattern of truancy and in comparing current and past school attendance or absence. The difficulties are partly compounded by the variations in the definition of truancy itself (Boyd, 1999:22; Gabb, 1997:2) and the multifaceted nature of truancy (Edward and Malcolm, 2001:1; Reid, 1999:17). The problems associated with studies on truancy should, however, not prevent further research from being conducted. Solutions should be found, or the cause at least eliminated, because truancy is regarded as a serious problem with socio-economic implications. A preliminary review of the literature reveals that truancy is a major problem form schools and society and a most powerful predictor of juvenile delinquent behavior (Van Petegem, 1994:272; Wiehe, 2000). Reid (2002:2) maintains that the amount of money spent on truancy reduction initiatives proves the extent of truancy. Statement of the problem Data on the extent and nature of truancy in schools are often based on information obtained from class registers. This information may be inadequate or almost incomplete and limits the understanding of the phenomenon, thus making it difficult to develop appropriate intervention strategies. More insight on how truancy manifests is needed to provide a base on which to suggest, plan and develop effective intervention strategies. Therefore, further research is needed to enable education officials, schools, parents and other professionals to manage learners with attendance difficulties more efficiently. This study serves to bridge the information gap regarding the nature of truancy and to provide a picture of the life world of truants in Secondary Schools. Aims of the Research The General Aim The aim would be to describe truancy in general as stated in the literature and to conduct an empirical study in order to determine how truancy behaviour manifests in secondary schools and what the life world of truants looks likes. The findings can then be used to inform and guide future practice. The Specific aim The aim of the study would be to gather information that will be used to guide the school (college) community namely the SMT, form teachers, subject teachers, guidance teachers and school councillors, youth workers in school and other stakeholders to help in the interventional approaches and procedures that can be used for reducing truancy. In order to realise the above aims, the following questions are set to direct the research: What is the extent and degree of truancy in terms of the frequency and number of learns involved? What are the patterns, type or nature of truancy? Where do truants go when not at school or in class? What measures are used to monitor and manage truancy? Research Method The study will comprise two methods, namely, a literature study and an empirical investigation. A study of the literature will derive information on studies about poor school attendance and procedures employed to mange or reduce truancy from books, research articles, journals and other resources. A quantitative research design will be used in the empirical investigation. This investigation aims to gather data by means of a questionnaire that will be given to learns in Form 1 and Form 2 in eight randomly selected schools, , incorporating two Junior Lyceums, two Area Secondary and two Church schools. A qualitative research design will be used with guidance teachers, counselors, youth workers, form teachers, Assistant Head of Schools and Heads of School currently working in schools. A focus group and interviews with Heads will help me to investigate what the School community is doing to combat truancy. Such data will be advantageous in that they are ‘the most adequate [tool] to capture how a person thinks of a particular domain (Goldsmiths Collage, n.d.). More over since a face to face rapport with the interviewee, it is induced to continue questioning the subject in order to confirm the hypothesis about his or her beliefs, seeking appraise any underlying meaning in the process. Demarcation of research Due to time constraints, the preset research is confined to then 8 randomly selected secondary schools in Malta. A list of all secondary schools was compiled to allow for the random selection of 8 schools, which will form part of this study. This sample was mainl cohosen on the basis of cost implicaitons and accessibility. Explanation of concepts In this section a number of concepts that are relevant to this research are defined. Truancy Reids (1999:1) asserts that the term ‘truancy is often misused and can be applied both generically and with a local meaning. In the different parts of Great Britain, truancy is known as ‘dodging, ‘skipping off, ‘mitching, ‘skiving, ‘bunking off and ‘going missing, respectively. Whitney (1994:49) defines truancy as ‘absence that has not been authorized by the school and where leave has not been given or approved. Another definition provided by Collins (1998:2), who states that truancy is about pupils who have been registed with a school but identified as not attending school when the law says they should. This definition includes absences from a particular lesson or lessons, known as ‘post-registation truancy (Gabbs, 1994:5; Stoll, 1990:23). Clark Report (2005) identify as truancy when a student is voluntarily absent or not attending school without their parents permission and often, awareness (Anglicare, Werribee Family Services 2000). Truancy is defined as unjustifiable or unexplained absence from school with attempts by the student to conceal the absenteeism. Usually the child avoids home when not at school and the parents are often unaware of the childs absence (Rollings, King, Tonge, Luk, Heyne, Ramsdell, Burdett Martin, 1999). The concept blanket truancy refers to absence from the whole school day, which is usually reflected on the class register, while post-registration truancy occurs when the learner is marked present but fails to turn up at a lesson or lessons (Stoll, 1990:23). In this research, the term ‘truancy is broadly defined as unauthorized absence from school. The definition is adopted with the assumption that absence with the knowledge and permission of the school and parents or guardians does not constitute truancy. Since the study seeks to explore the type of truancy as manifested at secondary schools, both concepts of truancy (blanket and post-registration) are relevant and will be investigated. A Truant A truant is a ‘child aged 6 17 years old who absents himself or herself form school without a legitimate reason and without permission of his or her parents or the school official (Schaefer and Millman, 1981: 335). For the purpose of this research, a truant refers to a learner who, after being registered at a school, absents himself or herself from school or lessons without a legitimate reson or permission from parents or the school official. The traditional or typical truant: Traditional truants tend to be isolated that come from an unsupportive home background, possibly with a tendency to be shy. It is likely that they will have a low self-concept, be introverted and be the citim of their social circumstances. The psychological truant: could be the school phobic (school refusal) case but more othen than this psychological truant miss school for psychological related factors such as illness, opsychomatric complaints, laziness, a fear of attending scholl for any reason (such as dislike of a teacher, a lesson, an impending confrontation or fear of bullying.) The Institutional truant: Institutional truants are more likely to indulge in ‘on the spur of the moment absences from lessons and to be selective about days or lessons to miss. Secondary School A school that admits or registers and educates learners in Form 1 Form 5 is known as a secondary school. Life World In this research, the term ‘life world refers to the psychological context this is made up of elements such as interpersonal aspects, the family, school and the broader community. According to this definition, the life world involves the personal and external world of the learner. The personal word refers to intrinsic factors. The external word is made up of the broader educational systems, the home environment and the community where the child spends his time when not at school. Relevant intervention strategies would be easier to suggest if the contextual issues related to the phenomenon under investigations are understood. Research Program The research comprises give chapters, as follows: CHAPTER 1 In this chapter, the background information in the seriousness and implication of truancy are discussed. The chapter also includes an analysis of the problem, the problem statement, aims of the study, description of the research method and definition of the concepts. CHAPTER 2 Chapter 2 entails a review of the literature on types of truancy and the causes of truancy or contributing factors in different countries, including in Malta. Different approaches that the various countries and schools use to manage truancy will also be discussed. CHAPTER 3 This chapter deals with research designs and methods. A discussion of the research problem, the aim of the empirical investigation, the research tool used in the study and the selection of the sample will be included. Details of the compilation and administration of questionnaires as well as an analysis of data will be presented. CHAPTER 4 In this chapter, the results of questionnaires will be presented. The results will be analyzed to find answers to the research questions. CHAPTER 5 The chapter entails a summary of the research finding, conclusions and recommendations. A summary of the results from the literature study and the limitation of the study will be included. Conclusion This chapter focuses on the background and analysis of the problem, as well as the aims of the study. An attempt will be made to explain the research method used, relevant concepts and planned programmes of the research. The next chapter will contain the review of the literature on the types of truancy, factors contributing to truancy behavior, the rate and extent of truancy and the strategies used to manage truancy. CHAPTER 2 TYPES OF TRUANCY, CAUSAL FACTORS AND APPROACHES USED IN THE MANAGEMENT AND REDUCTION OF TRUANCY Introduction According to Tyerman (1958:217), truancy has been a problem to all concerned with education since 1870s. Approximately 750 children were charged for truancy in England and Wales in 1954 (ibid: 220). This figure could have been an underestimation as it was based on learners who were referred to courts, and therefore represented mainly incorrigible truants (ibid). Furthermore, the figure gives a general picture of truanting children in one country only and without an indication whether it was absence from certain lessons or whole school day absence. Truancy is currently a problem in communities. In Clarks report concern was expressed about truancy among school children. Data presented in this report indicates that non-attendance exists, and has become an issue of increasing concern for schools, educational and student welfare organizations. Non-attendances viewed as being among one of the key problems facing some schools. There is increasing concern for the seemingly large number of ch ildren and young people, who are, for a range of reasons, missing out on the benefits of education and possibly on a better future (Dr. L. Galea, The Times 9th February, 2005). Non-attendance can be the beginning of countless problems for students who regularly miss out on school (Heyne, King, Tonge, Rollings, Pritchard Young,1999). The extent and nature of truancy are best understood in terms of whether it implies absence for the whole day or during a particular lesson. This chapter deals with how blanket and post-registration truancy manifest, the causal factors and various measures of reducing truancy in secondary schools. Blanket Truancy Perspectives in various countries England and Wales Normab (2001:49) states that 50,000 children play truant on a normal school day in England. The number of truants increases steadily with age and most truants are found at secondary school (ibid). This confirms past research findings about the existence of truancy in secondary school in some parts of England. Gray and Jesson (1990:25) gathered information on the incidence of truancy from the youth cohort survey of England and Wales. The result of their survey shows that 6% of final-year secondary school learners reported to have played truant for several days or weeks at a time. Malcolm, Wilson, Davidson and Kirk (2003:50) state as follows: ‘In 1999, the Audit Commission noted that at least 40,000 of the 400,000 learners absent from school are truanting. Scotland In a study done at 50 Scottish secondary schools, it was found that 30% to 33% of learners had been playing truant at least once in the survey week (Munn and Johnston, 1992:38). These schools were requested to provide both the overall attendance rate and the numbers of learners (ibid). Australia Haddon (1996:110), citing a comprehensive study conducted in Victorian secondary schools in Australia, states that 40% to 60% of learners of compulsory school age reported that they engaged in truancy. Cohen and Ryan (1998:12) state that about 10,000 learners in Tasmania play truant at least one day a week. The Netherlands The research done at 36 schools in four Dutch cities indicates that the average level of truancy at all schools was 4.4% (Bos, Ruiters and Visscher, 1992:393). The average percentage of allowed absence was 4.7%, therefore suggesting that learners in most schools are just as often absent with a valid reason as without one. United States of America It appears that truancy is a problem in American schools, although at varying levels. According to Black (1996:33), approximately 2,500 and 4,000 learners play truant on a daily basis in Pittsburg and Mulwaukee, repectively, while 300,000 of the 1.6 million students in Los Angeles are habitual truants. This shows that some learners stay absent without permission every day and that a day never goes by with a recording of 100% attendance. Truancy is so much of a concern that the Department of Education has prepared a manual that gives schools some guidelines on how to reduce it (United States Department of Education, 1996). Malta From January 2001 up to December 2002 there were 8,903 arraignments before local tribunals in connection with school absenteeism (Grech, 2002). This figure represents only the number of students who were absent from school without a valid reason on more than three occasions in the space of a month. It is a known fact that there are a number of pupils that systematically take three days off from school each month just for the sake that they use up their monthly absence allowance and knowing that in this way their parents would not receive a citation. Survey results issued by the National Statistics Office Malta on December 16, 2002 showed that overall absence rate from schools between September 25, 2000 and March 31, 20001, stood at 10.5 days per pupil. That included both absenteeism and authorized absence (such as those due to sickness). During this period, 657,604 pupil days were list to absenteeism, accounting for 8.9 per cent of the total pupil days. This reveals an increase of 5. 2 per cent over the 1999/2000 scholastic year. Absences in government schools stood at 19.12 days per pupil whereas that of government dependent (church schools) and independent private schools was 5.76 days per pupil. The rate of truancy in terms of gender Some of the overseas researchers state that there is no difference in the levels of truancy reported for males and females (Gray and Jesson, 1990:26; Haddon, 1996: 110; Smith, M., 1996:226; Stoll, 1994:36; Whitney, 1994: 59). Recent research on truancy in the seven local education authorities reports that the numbers of learners in secondary school admitting truancy was almost equal for boys and girls (Malcolm et al., 2003:31). Coldman (1995:68) also states that the variation that exists in truancy levels of males and females is slight. It is, therefore, apparent that some research are in agreement with regard to the truancy levels of male and females learners. Earlier research that was conducted in South Africa suggests that more males than females tend to play truant Coldman (1995:68) warns against making assumptions and generalisations about the existence of gender differnce in truancy levels. He argues that observed findings might result from the fact that some schools have more males than females, particularly when one is dealing with a large sample. What the above studies suggest about truancy levels of males and females is that the difference might be slight, if it does exist. Furthermore, observed diffrenences may be incfluenced by other variables, such as the enrolled number of male and female learners in a sample. Truancy rate according to the geographical location of the school Serious truancy is said to be more prevalent in inner-city secondary schools in England (Gray and Jesson, 1990:36; Stoll, 1990:23). Munn and Johnstone (1992:4) also found that the Scottish school with the highest percentage of unauthorized absence was all in the inner city. Coldman (1995:69) asserts that claims that truancy is a problem mainly experienced in inner city schools are disputable, since another survey showed that the truancy level is high even in the suburban, rural and industrial areas of England. It may therefore be purely speculation, without much supporting evidence, to suggest that inner-city school experience higher levels of truancy. Hard evidence needs to be gathered, where possible, in order to verify the claim that inner-city experience higher rates of truancy. According to some researchers, truancy levels also appear to differ from school to school, since they may be more prevalent in schools than in others (Blackm 1996:33; Bos et al., 1992:385; Gray and Jesson, 1990:26; OKeefe and Stoll, 1995:12). It is therefore apparent that the levels of truancy seem to vary from country to country, and in some cases, also in terms of geographical locations within a city or town. The literature indicates that blanket truancy is common in many secondary school and that, in some cases, learners play truant on a daily basis. The levels of blanket truancy can also vary according to regional locations within the same country. In the next section, the evidence regarding the level of post-registration truancy drawn from the literature will be discussed. Post-registration Truancy Very little information is given in the literature about national trends of post-registration truancy in countries where research on truancy was conducted. Most of the studies conducted in the United Kingdom, Australia, the United St Determinants of Health: Area of Residence Determinants of Health: Area of Residence Lisa Theaker The overall health of an individual and of communities can be defined and affected [LF1]by many factors. Circumstances and environment play a massive part in determining whether a Person or Persons can be categorised or labelled as being â€Å"Healthy†. Some of the more common of these determinants are issues such as area of residence- the affluence and prosperity of the general area, the income of the individual or family unit, the levels and standards of education available within the area, social relationships and at the most fundamental level, genetics also play a part. From a social perspective, factors such as access to good quality health services are considered to be a secondary factor and have less of an impact on the individuals’ health than the others. A person’s health is often determined by issues such as their social and economic environment, their physical environment and their general behaviours and lifestyle choices. An individual only really has control over one of these factors – the lifestyle as it is of their own choosing whether they have a healthy diet, if they smoke or drink alcohol. This too is determined to some extent by the level of social, physical and economic factors (WHO, date unknown) (Naidoo et al, 2000). Income and social status or class differences are displayed in statistics from different areas and often show direct correlation to the health of the individuals within them. A better income and â€Å"higher class† proves to be critical in better health. This is due to better quality of diet, access to education and better working environments. Studies have shown that where the greater difference in income between richer and poorer individuals exist, then this is reflected and evident in the statistics of health (Naidoo et al, 2000). Education levels at a lower standard are also linked with poor health. People with a low level of education often have low self-confidence and are found doing lesser paid yet more manual labour in health affecting environments such as factories. This also affects stress levels as well as income. The knock-on effect this produces brings inequalities such as poor housing and unsanitary living conditions in what are commonly labelled as â€Å"deprived areas†. All the factors affecting these communities have a profound effect on the health of not just the individual, but of their families also (BBC, 2008). The physical environment often impacts upon the health of families and individuals [LF2]alike, both in a domestic and workplace. Areas of residence with good quality road networks, decent acceptable housing, safe water and clean air [LF3]are statistically proven to show greater levels of better health of residents than areas with heavy industry, both now and historically. Air pollution is a major contributor to ill health, especially if the individual has an underlying or pre-existing health condition such as asthma. People who live and work in cleaner environments are often generally healthier, or display less health issues than people working within these area of heavy industry. Workers in heavier industries such as coal mining and steelworks have no control over they’re working environment, and although health protection equipment such as dust masks and ear protection are now issued as standard, this has not always been the case and generations of workers have suffered some times horrendous health issues from diseases and conditions associated with working in the dusty, noisy conditions for many years unprotected. Cases of emphysema, a lung condition where essentially the lungs are filled with dust which eventually hardens, have[LF4] affected many generations of coal miners (WHO, date unknown). Social support networks in communities are also proven to show links to improved health. Areas with community support outlets that offer help and advice with aspects covering stop smoking services, job-seeking and educational courses can encourage and offer the means to people within the community to improve themselves both mentally and physically and this has a profound effect on their health by improving their prospects and their self-esteem (WHO, date unknown). The genetic makeup of an individual can also be a major contributing factor to their health and can determine possible lifespan, overall healthiness and the possibility of developing certain illnesses. Personal behaviours of lifestyle can be influenced at an early age, where a parents input on the diet and lifestyle habits are often impressed upon children from a very early age. These attitudes are often carried into adulthood from children having witnessed the un-healthy practices of parents, and assume them to be acceptable and normal. Factors such as smoking and the consumption of alcohol are some of these. General coping skills can be witnessed by the nest [LF5]generation and can often lead to problems with their own coping mechanisms later in life (BBC News, 2008). Access to health services are a fundamental factor too. Good accessible health provision is essential for the maintenance of health within communities – whether the individual chooses to access these available services is down to their general attitudes to their own health (WHO, date unknown). Lifestyle choices such as smoking, drinking, promiscuity and a balance of healthy diet and exercise are in the hands of the individual. These choices are also determined by the levels of income and area of residence. Deprived areas, even within the same general locality and country statistically show that this is the case. For example – Calton, an area of Glasgow in Scotland, shows a distinctive rise in the mortality rates in males when compared to a more affluent area of Lenzie. A baby boy born in Calton will have an average life expectancy of 28 years less than a boy born and resident in Lenzie. This is explained by Calton simply being less affluent. The population of Calton are generally of a lower social class, and the mortality rate reflects this amongst males of comparable ages. This is not just in Scotland however, similar findings have been reported in areas of London. The life expectancy varies by 11 years from residents of affluent Hampstead to St Pancras, which is c onsidered to be less affluent (BBC News, 2008). [LF6] People from lower classes experience greater levels of sickness and ill health, whether this is from lifestyle choices or work environments (if they actually work). Work and employment levels are a very important factor to consider. The work environment determines income levels and can directly affect the health of the individual. Some work environments are considered to be â€Å"high-risk† because of accidents, hazardous materials or even stressful situations (WHO, date unknown). A very detailed and thorough discussion of determinants of health however this could be strengthened by creating greater links to the models of health. There are more factors to the determination of â€Å"Health† than reviewing and [LF7]considering the technical issues of income, employment, lifestyle and the areas where people live, although these are statistically proven to have a major impact. Many would consider that ill health of an individual comes about as a direct result of lifestyle choices and that by adequate and improves healthy lifestyle promotion campaigns, theses can make a difference and encourage the individual to make changes and be responsible for taking steps to improve their health and that of their family. This is not always the case however, when the truth maybe that the individual has little or no control over the choices to be made. This serves to strengthen the argument that ill health is not in the hands of the individual rather that its roots lie in the social and economic domain. If the means are not available to make the changes, then it is impossible to do so. It is true however that some people do make the effort to maintain their health and that of their families eve on sometimes limited income however the social environment of poor quality housing and the air around where the live prevents them from doing so. The air quality is beyond the control of anyone. These factors are major contributing issues. Regardless of the input of any health promotion campaigns and any amount of income, this cannot be changed – other than to provide the means to move their family to a less polluted environment. Ill health does not occur merely by bad luck. The imposing factors from birth and through the entirety of an individuals’ life, through to their demise are paramount to affecting how these years are spent, whether in good or bad health. Social factors such as class and ethnicity come into play when tied in with the universal factors of age and gender. The gender, ethnicity and age of the individual cannot be changed, however it is possible that the social class can be altered given the right circumstances. Environmental factors such as housing provision, and the quality and area of it are also major factors – the area of residence and the amenities that are offered there, such as leisure facilities and access to health services have an impact upon the health of the residents. Lifestyle factors such as smoking, nutrition, exercise and the psychosocial environment are also major factors. The amount of stress and worry experienced by the individual are paramount to the levels of the other factors. Smoking levels increase in stressful environments as does overeating (Naidoo et al, 2000).[LF8] References BBC News (28th August 2008) ‘Social factors key to ill health’ [online] Available at: http://www.news.bbc.co.uk/go/pr/fr/-/1/hi/health/7584056.stm [Accessed 5th April 2014] Health Poverty Action (date unknown) ‘ factors that Determine Good or Poor Health’ [online] Available at: http://www.healthpovertyaction.org/policy-and-resources/the-determinants-of-health/ [Accessed – 5th April 2014] Naidoo, J Wills, J. (2000) ‘Health Promotion – Foundations for Practice’ (2nd edition) London, UK: Harcourt Publishers Ltd World Health Organisation (date unknown) ‘Health Impact Assessment – The determinants of health’ [online] Available at: http://www.who.int/hia/evidence/doh/en/ [Accessed – 5th April 2014] Bibliography Health Poverty Action (date unknown) ‘The Cycle of Poverty Poor Health’ [online] Available at: https://www.healthpovertyaction.org/policy-and-resources/the-cycle-of-poverty-and-poor-health/ [Accessed – 5th April 2014] The College of Occupational Therapists (COT) (2013) ‘Social Determinants of Health’ [online] Available at: https://www.cot.co.uk/social-determinants-health [Accessed 5th April 2014] Very good range of sources used. [LF1]Is this the ‘Introduction’ section? [LF2]Is this the ‘Discussion of Findings’ section? [LF3]You are right but need to clarify what is meant by these i.e., give the parameters [LF4]‘has’ [LF5]‘next’ [LF6]Excellent points and use of example/source [LF7]Is this the ‘Conclusion’ section? [LF8]An excellent conclusion – very well thought out! Well done! However this should have been in report format!

Philippine Presidential Elections 2016 Essay

The 2016 presidential election is one of the most talked about topic of today. To date, just more than a year from now we will again be having our new set of national leaders. It is again the time when we can use our power to vote and elect the deserving person that will eventually rule our country. The scheduled date will be on a Monday, 9th day of March, 2016. As we all know, the incumbent president Benigno Aquino III is barred from seeking re-election pursuant to 1987 Philippine Constitution. Therefore, this election will determine the 16th President of the Philippines. In recent months, we have heard so many big names that can potentially be our next Philippine president. Two of the most prominent Filipino politicians has officially declared their candidacy over presidency, both with strong will and competitiveness. Without any surprise, the current Vice President Jejomar â€Å"Jojo† Binay of the United Nationalist Alliance (UNA), our first guy on the list, confirmed his plans of running as president during an interview back in September 2011. The longest-serving Makati City Mayor, now the Vice President of the Philippines not only created a strong political dynasty but he also realizes his colossal visions. While VP Binay effortlessly made it to the list of possible and feasible presidential candidate, our next guy, a potical rival of the former, and the current Senate Majority Leader, Sir Alan Peter Cayetano, needed to closely monitor surveys to make sure he’s still in the running and viewed by the Filipinos as a viable candidate, according to a source familiar to Cayetano. The 43-year-old Senator from the Nacionalista Party (NP) is serious about running that he has to put together a team to work on campaign preparations. In a March 2013 interview on Morning’s @ ANC he said â€Å"I want to be the president of this country. I think I can do something great for God and his people.† Among other politicians who would possibly run, one is Sen. Ferdinand â€Å"Bongbong† Marcos Jr. of Nacionalista Party.

Famous Thinkers Essay

There are many famous thinkers that have lived on this earth who have made significant changes to everyone’s lives. A couple famous thinkers stand out amongst them all. These two are Mr. Bill Gates and Reverend Dr. Martin Luther King, Jr. Their contributions society have been great and were based off of their personal, social and political environments. They had both sought to solve problems or issues that people faced and they were able to provide solutions and implement them. The solutions they provided all followed a creative process, which will be compared to each other, and their ideas will be critiqued to discuss what they could have done differently. Contributions to Society Mr. Bill Gates and Reverend Dr. Martin Luther King Jr. have both contributed to society in different ways. Bill Gates had gained immense wealth through the creation and sales of Microsoft Windows, and he is using this wealth for philanthropic reasons. The Bill and Melinda Gates Foundation contributes to societies throughout the world. Their contributions range from providing vaccines in Africa, to financial services for the poor in the United States. These contributions affect society as they provide better health by helping prevent illness and helping better the lives of those less fortunate. Reverend Dr. Martin Luther King Jr. lead the change in gaining equal civil rights for African Americans by using nonviolent civil disobedience. The Environment Mr Bill Gates and Reverend Dr. Martin Luther King Jr. lived in different environments which attributed to their creativity in solving problems or issues. Bill Gates was raised in a financially responsible family, and attended a preparatory school which allowed him to focus on computer programming. This environment allowed Bill Gates to excel in what he loved and create the Microsoft organization. Bill Gates gained enormous wealth through his creation of Microsoft, which he now uses for the Bill and Melinda Gates Foundation. Reverend Dr. Martin Luther King Jr. lived in a rough environment. He grew up where African Americans where considered a lesser person and were segregated because of their race. This eventually lead Martin Luther King Jr. to take lead in the civil rights movement, which brought him to direct the march on Washington, D.C and give his â€Å"I Have a Dream† speech. Solving Problems or Issues Mr. Bill Gates and Reverend Dr. Martin Luther King Jr. both address issues in society. Bill Gates addresses issues across the world, where Martin Luther King Jr. addresses civil rights issues in the United States. Bill Gates, through the Bill and Melinda Gates Foundation, currently aids in numerous issues throughout the world. Some of the more widely known issues are support for better education in the United States, and contributions to providing vaccinations in Africa. The issues that Bill Gates seeks to solve is poor education in the United States and to prevent disease and death in developing countries. Martin Luther King Jr. had addressed the civil rights issues to help gain equal rights for African Americans in the United States by use of nonviolent civil disobedience. Solutions The Bill and Melinda Gates foundation works through funding other non-profit organizations working towards the common goal of helping impoverished people, providing health services in developing countries, and helping better the education system in the United States. Reverend Dr. Martin Luther King Jr. had a solution to bring the people together and spread the word of equal civil rights through speech, and motivation. Martin Luther King Jr. spoke at several different venues through the United States prior to the â€Å"I Have a Dream† speech in Washington, D.C. At the â€Å"I Have a Dream† speech, over 250,000 people attended and marched, showing non-violent civil disobedience. (The Nobel Foundation, 1964). Comparing the Creative Processes Bill Gate’s creative process was very simple in the fact that he has money, and wants to do good with it. His process was to create the Bill and Melinda Gates Foundation, find non-profit organizations that share a common goal, support them financially and repeat the process. Reverend Dr. Martin Luther King Jr. had a more complex creative process, where he had to bring the African American people together and get the leaders of the United States to listen. Martin Luther King Jr. began by traveling the United States, speaking where civil rights of African Americans where being denied. Through his speeches and travel, he brought together the African American people and accomplished the goal of gaining equal civil rights (The Nobel Foundation, 1964). Critique of Ideas The Bill and Melinda Gates Foundation can take an active role in their philanthropic ideals. The foundation currently supports other non-profit organizations that work toward the foundations goals. If Bill Gates could turn the foundation around and actively work towards their goals by doing something themselves, they may achieve greater success as other organization seeking support can follow their lead. Reverend Dr. Martin Luther King Jr. should not have done anything different. His motives of showing the world that the African American people are humans too, and deserve equal civil rights was conducted in a non-violent manner and accomplished his goal to gain equal civil rights. Conclusion Mr. Bill Gates and Reverend Dr. Martin Luther King, Jr. have provided great contributions to society across the world and in the United States. Their environments helped bring about this desire to contribute as they had both sought to solve problems or issues faced by society. The solutions they provided all followed a creative process, which Bill Gates could have done a better job at and Martin Luther King Jr. couldn’t have done better. References Bill and Melinda Gates Foundation. (2013). Retrieved from http://www.gatesfoundation.org/ King, M. L. (2003). I HAVE A DREAM. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/394023549?accountid=35812. Ruggiero, V. R. (2009). The art of thinking: A guide to critical and creative thought (9th ed.). New York, NY: Pearson Longman. The Nobel Foundation. (1964). Martin Luther King Jr. – Biographical. Retrieved from http://www.nobelprize.org/nobel_prizes/peace/laureates/1964/king-bio.html

Analysis Of Candide By William Shakespeare - 1154 Words

Eric Schessler Mrs. Leavitt AP Literature and Composition August 17, 2014 Throughout Candide, there is a constant battle between pessimistic and optimistic viewpoints, both looking to find a navigable path through an uncertain and unforgiving world. In the end, the matter seems to be settled when Candide says, â€Å"I also know...that we must cultivate our garden.† (120) over Candide’s adventures, he has been beaten down, but always gotten back up, and all the while he has been lectured by people standing on either side of the optimism/pessimism divide. The conclusion he draws, and ultimately the philosophy that brings he and his companions to a peaceful existence in the end, seems to be the third way out from this battle. â€Å"We must cultivate our garden,† becomes a compromise of the two viewpoints, and provides a relief from the philosophical bickering. The stories main proponent of optimism is Candide’s philosophy mentor Pangloss, who throughout the tale, constantly espouses the same philosophical sentiment, â€Å"It is d emonstrated that things cannot be otherwise: for, since everything was made for a purpose, everything is necessarily for the best purpose.† (18) Even after being beaten, tortured, and delivered across Europe into Turkey, he is still able to believe that all is for the best, and that had not all of these things happened, neither he, Candide, or the rest of their friends be where they were (120). This philosophy is often challenged throughout the book, however, asShow MoreRelatedLiterary Criticism : The Free Encyclopedia 7351 Words   |  30 Pages(1554)[19] 17th century[edit] Simplicius Simplicissimus, by Hans Jakob Christoffel von Grimmelshausen (1668) The Adventures of Telemachus, by Franà §ois Fà ©nelon (1699) 18th century[edit] The History of Tom Jones, a Foundling, by Henry Fielding (1749)[20] Candide, by Voltaire (1759) The Life and Opinions of Tristram Shandy, Gentleman, by Laurence Sterne (1759)[20] Emile, or On Education, by Jean-Jacques Rousseau (1763) Geschichte des Agathon, by Christoph Martin Wieland (1767)—often considered the first true

Architect Company Bjarke Ingels Group ( Big ) Studio

The internationally awarded architect company Bjarke Ingels Group (BIG) Studio has been drawing headlines around the world with their impressive projects. To be known as one of the innovative architects throughout the time, founder and architect Bjarke Ingels is full with enthusiasm and ideas and making the society as the main ingredients in the design process. He views architecture as art and science of accommodating life which the architect have to make sure that the city and buildings are actually fits in the way that we want to live. (GSD, 2014) Offering such idea into architecture, the firm has established a reputation for challenging the traditional architecture approach by creating structural entities that speaking about our constantly evolving world (designboom, 2014). ‘Yes is More’ stand as a philosophy of BIG which basically an evolution from Mies Van de Rohe, a modernist architect that triggered the agenda of ‘less is more’ into their design. That is some sort of minimalist approach that is being encountered in that time however the modern building became less attractive and new evolution had to be made (Ingels, 2015). BIG tries to contribute to the societal evolution throughout their architecture. The social environmental issues are the concerns and demands from each of the project not just the aesthetic values and facades. Hedonistic Sustainability is the concept that represent the approach by BIG, making a combination of playfulness and responsibilities in

Sci 241 Week 5 - 24609 Words

( ©Reinhard/Age Fotostock America, Inc.) CHAPTER 8 CONCEPTS I I I I I I I I I Thiamin, riboï ¬â€šavin, niacin, biotin, and pantothenic acid are B vitamins needed to produce ATP from carbohydrate, fat, and protein. Vitamin B6 is important for amino acid metabolism as well as energy production. Folate is a coenzyme that is needed for cell division. Vitamin B12, only found in animal foods, is needed for nerve function and to activate folate. Vitamin C is needed to form connective tissue and acts as a watersoluble antioxidant. Vitamin A is essential for vision, and it regulates cell differentiation and growth. Vitamin D is necessary for bone health. Vitamin E is a fat-soluble antioxidant. Vitamin K is essential for blood clotting. u s t A†¦show more content†¦How can anyone have a deï ¬ ciency? Despite advances in vitamin research over the last century, millions of people around the globe still suffer from vitamin deï ¬ ciency diseases. In the United States, the plentiful and 235 236 Chapter 8 The Vitamins varied food supply make severe vitamin deï ¬ ciencies unlikely but this doesn’t mean everyone gets enough of everything all the time. Marginal deï ¬ ciencies often go unnoticed and can be mistaken for other conditions. Vitamins Are Vital to Your Health L Vitamins Organic compounds needed * in the diet in small amounts to promote and regulate the chemical reactions and processes needed for growth, reproduction, and the maintenance of health. Vitamins are essential to your health. You only need very small quantities but if you don’t get enough your body cannot function optimally. Severe deï ¬ ciencies cause debilitating diseases but even marginal intakes can cause subtle changes that affect your health today and your risk of chronic disease tomorrow. An organic substance is classiï ¬ ed as a vitamin if lack of it in the diet causes symptoms that are relieved by adding it back to the diet. The fact that the vitamins we eat in food are essential to health seems simple and obvious, but it was not always so. ForShow MoreRelatedSci/241 Week 5 Fat and Water Soluble Vitamins1222 Words   |  5 PagesFat- and Water-soluble Vitamins Vitamins are primarily classified by solubility. Some vitamins are soluble in water and others are soluble in fat. â€Å"According to The National Institute of Health, the body needs 13 vitamins for normal health.† This includes vitamins A, C, D, E, K and the B complex vitamins, thiamine, riboflavin, niacin, pantothenic acid, biotin, B6, B12 and folate. Each of these vitamins provides a variety of functions to the body which can be obtained from a well balanced dietRead MoreDiet And Exercise Analysis Presentation842 Words   |  4 PagesKyle Anderson September 19, 2014 SCI/241 Week One Goal Statement My current health and fitness is at the peak. I am a professional cyclist, I train anywhere from 10-35 hours week doing a minimum of 150 mile every week. 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It is found in Benin, Cameroon, Democratic Republic of the Congo, Ivory Coast, Gabon, GhanaRead MoreEffect Of Ginger On The Brain Of Diabetes Induced Diabetic Rats Essay7558 Words   |  31 Pageswhether the antioxidant properties of ginger has beneficial effects on the structural brain damage associated with diabetes. We investigated the observable neurodegenerative changes in the frontal cortex, dentate gyrus, and cerebellum after 4, 6, and 8 weeks of streptozotocin (STZ)-induced diabetes in rats and the effect(s) of ginger (500 mg/kg/day). Sections of frontal cortex, dentate gyrus, and cerebellum were stained with hematoxylin and eosin and examined using light microscopy. In addition, quantitativeRead MoreOsteoporosis: bone Mass7865 Words   |  32 Pagesfracture or osteoporosis are at an increased risk; the heritability of the fracture as well as low bone mineral density are relatively high, ranging from 25 to 80 percent. 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This is the highest prevalence of undernourishment for any region in the World and, with aboutRead MoreOn the Interface between Operations and Human Resources Management16889 Words   |  68 Pagesrequired expensive overtime), he zeroed in on the largest source of output loss, blocking and starving in the line (traditional OM topics). But, because he knew that the majority Manufacturing Service Operations Management  © 2003 INFORMS Vol. 5, No. 3, Summer 2003, pp. 179–202 BOUDREAU, HOPP, MCCLAIN, AND THOMAS Operations and Human Resources Management of stoppages were due to people-induced disruptions, the new manager eschewed the traditional OM focus on equipment-induced causes

Mentally disturbed Aiko

Mentally disturbed Aiko-sama of the Yano family Essay Mentally disturbed Aiko-sama of the Yano family Anguish of the family taking care of the beloved soul hovering between two worlds. A bunch of camellias Early one morning in the winter of 2003, there was a cry for help from my daughter, who was upstairs. Mother! Help me, Mother! I rushed upstairs with an uneasy premonition, my heart pounding. What I found there was a lavatory bowl full of used tissues. The culprit was standing by the bowl, looking puzzled, as if to wonder who had done such a naughty deed. She said, Someone came here, and put a bunch of camellias into this bowl, while peering worriedly into it. I do wonder who has done this! I could not blame her. I went downstairs to fetch disposable gloves and a bag, with my eyes dimmed with tears. A couple of days before, I had had an interview with a judge from the city care agency to evaluate the level of the home care services my Mother needed. I took a photograph of this situation so that it could be used to help determine such a level later. Almost in the same hour the next morning, I had to rush upstairs for the same reason. By the end of the day we had placed a sign indicating, This toilet is out of order! , on the door of the toilet. Instead, a bedside toilet was installed with a restricted amount of paper. Because of her failing memory, Mother wipes herself as long as there are tissues, forgetting that she has already done so. Several days ago she broke the disposable toilet bag into small pieces and scattered them all over the floor. As the bag was made of polymer composition, her clothes, the floor, bedding, and everything else in her room became crunchy and sticky. I called my sister, who lives in the immediate neighbourhood, for help. She soon came to my assistance, but it took hours to clean the room, and to clean Motherquot;s body. This kind of event never happens in daytime when helpers are at home. This might be another proof that famous Murphyquot;s Law is correct. The development of Motherquot;s symptoms of mental disturbance went from bad to worse. I used to ask a helper to come and take care of her while she was having her meals. One evening, a helper came to me, saying, Aiko-sama is calling you. When I went upstairs to see her, she asked me, Are you the person who is always looking after me? The helper and I looked at each other involuntarily, not knowing what she was trying to say and I couldnquot;t understand. Mother also complained that I didnquot;t give her a sleeping pill last night. She said she could not sleep well at night. This is not true; in fact, I never forget to give her a sleeping pill and to massage her shoulders and back, saying good night, before turning down the light in her room. Around that time, Motherquot;s behaviour began to ruin the health of the family, especially that of my daughter. As I had already been suffering from arrhythmia and had been taking medicine to be able to get to another world after having looked after Mother, I had been taking sleeping pills to help me to sleep deeply for a short period. While I was asleep, my daughter used to take care of Mother upstairs, and wake me up when necessary. However, Mother started suffering from sleeplessness, moving around in the room during the night. My daughter finally became immuno-suppressed and suffering from various complaints. I consulted Motherquot;s doctor about her condition and asked for a stronger pill to make my mother sleep at night. He said that he could prescribe stronger pills, but that we should not expect them to work, because, mentally disturbed people often didnquot;t respond to those drugs. My sister had already concealed a calling bell under the carpet, and I periodically went upstairs to see what Mother was doing. There were no other options open to us. Mother did not respond to the new pills as expected. She had undergone surgery for breast cancer five year ago, and shortly afterward, she had been affected by an even greater shock when our eldest brother died from stomach cancer, after his surgery had been rejected. Since that time, Mother had been suffering from a very severe trigeminal neuralgia. Soon, she had to have a trigeminal rhizotomy. Meanwhile, she had suffered many other problems, including severe haemorrhoids, diverticulitis and herpes infections. This made her unable to eat ordinary food, and she began to live on fluid meals. One Saturday afternoon, quite unexpectedly, she was suffering from an acute abdomen so I took her to a local hospital. She was diagnosed as having peritonitis and immediately taken into hospital. There was no shared ward available at that time, so she was accommodated in the best single room of the hospital. However, I soon noticed that her nurse had long red manicured nails, and moreover a shower facility in the room worked only a couple of days a week. Motherquot;s condition improved very rapidly, but, for a long period, there was almost no information about Motherquot;s medical condition from the doctor in charge. The doctor insisted that Motherquot;s abdomen was still full of pus. The hospital was fortunately very near to Funabashi Station on the Keisei Line, so my brother often made a stop there on his way home from his office. My sisters-in-law also helped me a lot, taking turns with each other to visit Mother. The doctor explained that the drug he had prescribed had performed a miracle and Mother would recover without any complications. However, we felt we had wasted too much money doing this. When Mother had acute recurrent symptoms several months later, I had no hesitation in taking her to another hospital to ask for help. Around this time, Mother began to show a strange behaviour pattern. She cut the tube of fluid delivery system with scissors, and become disorientated. She was consequently restricted in her movements, was bound with a belt to the bed during the night or to the wheel chair in the daytime. Her stamina was astonishing, and she was released from the hospital a month later. However, she had begun to show a sign that her departure was nearing with saliva dribbling from her mouth all the time. Cutting a large piece of absorbent gauze into small pieces became her only pastime, and it looked as if she was doing this in a threatening way. An agonising decision All the family buckled down to take care of Mother, with the round-the-clock assistance of many helpers. However, the number of disturbing calls to my brother or sister to complain about the current situation increased day by day, and this could have bothered them a lot. But they soon sympathized with me, and agreed to put Mother into a nursing facility. We started to find an appropriate facility for Mother with the help of a care manager, responsible for making such arrangements. As Mother has a specific digestive ailment, we had to find a hospital-type care centre. Both my friends and helpers gave me information concerning such facilities, but, some were too far away, and others too expensive. My sister made a call by chance to a nearby hospital and asked whether they could accept our mother. They replied that we would have to arrange an interview with the hospital staff first, adding that it would cost about ÂÂ ¥800,000 a month, including one-tenth of which must be paid by Mother as a recipient of services. At this point my brother stated that he must take the situation seriously now. He said that we should wait one more month, after which he would find a suitable place by one means or another. I told him that there was no time to lose and that this was a real cry for help from us. So, under the circumstances, there was no other way but to apply for an interview with the care facility. As a result, I met the staff of the hospital together with my husband and my sister. They informed us that they could offer a better price, in view of our situation, stating furthermore that the present state of affairs was very understandable and that, to prevent the condition of the family from getting worse, they would consider whether they could accept Mother soon. The room charge might furthermore be reduced by 50%. We considered this to be a most acceptable price, and completed the application form at once although we did not understand the whole system was all about. Diabetes EssayHowever, I was relieved to know that Mother had begun sleeping in the bed. I would have liked the room charge to be less expensive in view of this situation, and exchanged glances with my husband in a somewhat humourless smile. Shortly after that time, Aiko-sama awoke from her sleep, and clung on to me desperately. Letquot;s go, letquot;s go downstairs, she kept saying. She likes going by lift. A special PIN number is required to operate the lift but Aiko-sama had been playing naughty tricks, by mingling with a crowd of hospital visitors when the lift door opened. They had discovered her in various places in the hospital. The nurse said that it was fortunate she had not gone outside the hospital. She was sometimes naughty on the 4th floor. There is a sign, which says, press here on the button of the fire alarm box and she probably often pushed the button to sound a siren. Hospital should be aware that those who belong to the category of Aiko-sama like to follow written instructions. I would like to suggest that the sign on the button should say do not press especially for the patients on the 4th floor. One day, a doctor responsible for Mother told us that we should not waver between hope one minute and despair the next as regards the condition of Mother. We should understand that she is not living in this world any more. He warned us that otherwise, we would run the risk of contracting a stomach ulcer. His phrase burned into my brain. About that time, it was necessary to decide the level of care needed by Mother. The previous night, the judge had called me because she wanted to confirm something in advance. I answered various questions she asked me, and told her I would be waiting for her at the hospital the next day. On the day of evaluation, I was waiting for the judge with my husband in Motherquot;s room. She came in. Good afternoon. Are you Aikosamaquot;s husband? She asked to my husband. If this were true, my husband Koki should be over 100 years old by then. I was furious with the judge. This is MY husband! For the family of the mentally disturbed patient, a lower level judgement is beneficial, because one-tenth of the insurance burden would be less. However, this is clearly not profitable for hospitals. This system is very difficult to understand for us because it is much too complicated. Anyway, I told the judge that Mother had developed delusions the other day, and explained to her that she had said that two children were playing on her palm, and the doctor had operated on her hand. Mother also said that the operation was unsuccessful, and she has problems in her hands. The judge said that Motherquot;s condition was not so terrible. Within the day, I made a call to the Town Hall, complaining that the nursing-care manager was not aptitude for her work. Evaluation of Motherquot;s level remained the same as before at level 5. Cherry-blossom season The season for cherry-blossom viewing had come. I donquot;t know who told Mother that she would be taken to see the cherry-blossoms, but her usual request Letquot;s go downstairs changed to Letquot;s go out to see the cherry-blossoms. This could maybe have been her last chance to see them. For this reason I wanted to take her out, so one Saturday afternoon, I drove to the hospital with my husband, daughter, and my dog Kona. I asked the nurse whether I could take Mother out to see the cherry-blossoms for a while by car. She said that she would get permission from her doctor. We waited for this in Motherquot;s room. Half an hour passed, then the nurse came in seemingly irritated and said that she had been unable to contact the doctor, but that she would assume full responsibility. We took Mother out of the hospital and drove to a near-by driveway full of cherry trees. Kona remembered Mother and licked her hands. Mother also remembered Kona, and fondled the dog in the car. Whenever asked where Mother is, Kona would always go upstairs to look in the bathroom to find Mother. When Mother was at home, she used to spend most of the day there, so we cannot blame Kona for going to the bathroom to find her. Mother viewed the cherry-blossoms from the car window and whispered to herself many times, Beautiful! Beautiful! The weather was fine and we could not ask for anything more, but the windscreen seemed like a frosted glass to me. When we returned to the hospital, Mother couldnquot;t remember anything, and said, Letquot;s go out to see the cherry-blossoms. During the week, my sister took her out to see the flowers, and my brother drove her to the near-by park to see the cherry trees. Mother must have spent a pleasant week with the family seeing beautiful flowers. A few weeks later, I asked Mother what month it was then. She said she didnquot;t know. It would soon be May. As soon as I told her that, she said, Well, itquot;s the season for cherry-blossoms. Letquot;s go out and see them. Until then I had heard that taking care of mentally disturbed persons is a terrible and hard job to do. However, as Mother was able to celebrate the special occasion of her eighty-eighth birthday without any problems, I have never imagined that she suffers from such an acute dementia like this. Memory disturbance is really a strange symptom. In Motherquot;s brain, there is space for the past memories of many years ago, which come and go, but there is no space for immediate memories. She lives only at this very moment. The dot memory will never be connected to the past lines. In some sense, the family has been be saved by her symptoms, but despite this we feel very sorry about it. It was only a couple of times when Mother waved her hands saying Good bye to us when we left the hospital. At present, it is very hard to find any opportunity of leaving the hospital. Mother forgets that she went out for a walk, got on a bus to the near-by station, and asks again to do the same thing. My brother has been as patient as a saint. He takes Mother downstairs so many times until Mother gets tired and has a lie-down in the bed. Can you recognise me, Mother? Hamako? No, I am not Hamako. She seldom remembers the name of Kazuko, however, when she called my name by a miracle, I cannot help bursting into tears, and hugging her. In our house, there is a bathroom upstairs and Motherquot;s room is opposite. Every night, when I take a bath, having finished all the household jobs, I feel an indescribable sadness, finding the light of the room off all the time. I wish I could bring Mother home once more. However, I always feel myself on the horns of a dilemma. If she felt homesick, it would be a terrible pity for her. As if she had been expecting the situation that has meanwhile arisen, she called me to her bedside when she was at home. It was shortly before she became severely mentally disturbed. Kazuko, remember here are my clothes to wear when I cross the Acheron, the river of the underworld and a special coin to pay for the ferry boat. Please never forget they are here. She told me many times about this emphatically. Having been asked to look after her affairs when she is gone, it is more than I can bear to see her becoming thinner and thinner day by day. I have to prepare for that day when she flies away for eternity and comes home. May such a day be as faraway as possible.