Sunday, January 26, 2020

Prevalence Of Diabetes Mellitus Health And Social Care Essay

Prevalence Of Diabetes Mellitus Health And Social Care Essay INTRODUCTION DIABETES MELLITUS Diabetes is a syndrome that is caused by a relative or an absolute lack of insulin. It is characterized by symptomatic glucose intolerance as well as alterations in lipid and protein metabolism. Over the long term, these metabolic abnormalities, particularly hyperglycemia, contribute to the development of complications such as retinopathy, nephropathy and neuropathy. Approximately 5% to 10% of the diagnosed diabetic population has type 1 diabetes mellitus (Koda-Kimble et al., 2005). Most of the diabetic patients have type 2 diabetes mellitus, a heterogeneous disorder that is characterized by obesity, ÃŽ ²-cell dysfunction, resistance to insulin action, and increased hepatic glucose production. 1.2 PREVALENCE OF DIABETES MELLITUS Diabetes Mellitus is a chronic disease and is no longer an epidemic that can be ignored. It is confirmed that diabetes is increasing rapidly in every parts of the world (IDF, 2009). The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 (Wild et al., 2004). In South-East Asia region, the number of people with diabetes will reach 101.0 million by year 2030 which show an increase of 72.1% compared to 58.7 million in year 2010 (IDF, 2009). While in Western Pacific region, the number of people with diabetes will reach 112.8 million people by year 2030 compared to 76.7 million people in year 2010, which show an increase of 47.0%. WHO predicts that in Asia and Australia region the prevalence of diabetic will reach 190.5 million in year 2030 (WHO, 2004). Similarly in Malaysia, the diabetes epidemic shows an increase trend over the years. The number of people with diabetes will increase to 2.74 million by year 2025 compared to 1.53 million in year 2007. The national prevalence of diabetes was estimated to be 12.3% in year 2025 (IDF, 2009). Approximately 1.2 million people in Malaysia have diabetes and more than half of them are not aware of it. The third National Health and Morbidity Survey (NHMS III) shows that there was an increasing trend in prevalence with age; from 2 percent in the 18-19 years old to an alarming prevalence ranging between 20.8 to 26.2 percent among those 50-64 years old. Those with primary education or less have a higher prevalence. The national prevalence of known and newly diagnosed diabetes above 30 years old rose from 8.3 percent in NHMS II to 14.9 percent in NHMS III. This shows that the prevalence of diabetes has increased by 80 percent over a decade with an average of 8 percent per year. The diabetes in Malaysia has almost doubled in magnitude over the last decade (NHMSIII, 2006). The main factors that contribute towards the increase in the risk of diabetes are socioeconomic influences, BMI, effects of urbanization, and familial aggregation. In socioeconomic influences, it shows that lower educational status and the lack of health care facilities in the rural areas delay the diagnosis of diabetes. More than 70% of diabetes subjects in India remain undiagnosed in rural area (Deo et al., 2006). Moreover, this study also observed that people of the lower socioeconomic status had lower BMI. Furthermore, urbanization leads to unhealthy lifestyle changes which affect the metabolic changes. The high prevalence of diabetes also found associated with increasing family history of diabetes. High prevalence of diabetes in the first degree relatives which is commonly seen in Asian Indians (Deo et al., 2006). A comparative epidemiology study was conducted among Japanese immigrants in United States living around Hawaii and Los Angeles and among Japanese living in Hiroshima. Results showed that the Japanese who lives in United States are in higher prevalence of getting diabetes compared to the Japanese in Hiroshima due to the westernized lifestyle (Hara et al., 2004). 1.3 COMPLICATIONS OF DIABETES MELLITUS Uncontrolled diabetes mellitus will leads to multiple complications. In Malaysia, only 6.1% among the 30 49 year age groups of diabetes mellitus patients were under control. This reflects the lack of concern for risks and complications among the young patients. A total of 1 in 4 diabetics in the 30-39 age group already show complications of the disease (Chua, 2006). Moreover, patients with uncontrolled diabetes mellitus, regardless of the type of diabetes, exhibit significantly increased odds of surgical and systemic complications, higher mortality and increased length of stay during hospitalization (Marchant et al., 2009). Individuals with pre-diabetes, undiagnosed type 2 diabetes, and long-lasting type 2 diabetes are at high risk of all complications of macrovascular disease, coronary heart disease (CHD), stroke, and peripheral vascular disease (Laakso, 2010). Moreover, M Lgaakso also indicates that more than 70% of type 2 diabetes patients die of cardiovascular causes. Hence, the epidemic of type 2 diabetes followed by an epidemic of diabetes-related cardiovascular diseases (CVD). Diabetes patients present a two to four time greater risk for coronary artery disease (CAD) than non-diabetes individuals (Protopsaltis et al., 2004). The data obtained from UKPDS 23 indicated that for each 1% increment of HbA1c there was a 1.11-fold increased risk of CAD, whereas for each 1-mmol/l increment in LDL concentration, there was a 1.57-fold increased risk. A study carried out among African American with diabetes showed that the major risk factors such as hypercholesterolemia, hypertension and smoking are important determinants of CVD in African Americans with diabetes. Moreover, other blood markers of hemostasis or inflammatory response and elevated serum creatinine proved to be CVD risk factors in African Americans with diabetes (Adeniyi et al., 2002). Retinopathy is the most common microvascular complication of diabetes, which results in blindness for over 10,000 people with diabetes per year (Fong et al., 2004). A study done among Australian population showed that the prevalence of retinopathy was 21.9% among known type 2 diabetes and 6.2% in those newly diagnosed type 2 diabetes. Generally, 15.3% of diabetes patients have retinopathy (Tapp et al., 2003). A prospective cohort study showed that the presence of diabetic retinopathy was associated with a two-fold higher risk of incident CHD events and a three-fold higher risk of fatal CHD (Cheung et al., 2007). Hence, the microvascular diseases do play a role in the pathogenesis of CHD in diabetes. Amputation is one of the major complications that should be taken into consideration among diabetes patients. Diabetes is the cause of 50 % of all the non-traumatic amputations in the United States. Among all the diabetic amputations, 24 % amputations are the toe, 5.8 % are mid foot, 38 % are below the knee, and 21.4 % are above the knee, and the remaining 10 % include the hip, pelvis, knee and other sites (Levin, 2002). One study reported an 8 % increase in amputations from 61 of 10,000 patients with diabetes in 1990 to 66 of 10,000 patients with diabetes in 1995. After diabetic patients undergo amputation, their risk of developing a foot ulcer or of requiring a second amputation increases dramatically. A total of 50 % of patients with diabetes die within 5 years after amputation (Peters et al., 2001). In Malaysia, among 203 patients that underwent amputation, 66 % of the patients were diabetics and amputations performed were related to diabetic foot conditions. Among them, 17.2 % patients underwent above knee amputation, 32.8 % underwent below knee amputation and 50 % underwent local foot amputation. About 59 % patients underwent amputation due to diabetic complication were less than 60 years old (Yusof et al., 2007). A study done involving Korean type 2 diabetic patients showed that the HbA1c is significantly associated with carotid plaque and peripheral arterial disease (PAD) (Choi et al., 2010). A cross sectional study was conducted, and it shows that the glycemic control was poor with 53.6% of the patients having HbA1c above 8% and 24% of them had microalbuminuria (Chan et al., 2005). 1.4 MANAGEMENT OF DIABETES MELLITUS 1.4.1 Controlling Glycemic Level Tight control of blood glucose levels offers primary and secondary prevention for the development of diabetic kidney disease (Stanton, 2008). By lowering glycated hemoglobin value to 6.5% or less, a 10% relative reduction was observed in the combined outcome of major macrovascular and microvascular events. Moreover, there was also a 21% relative reduction in nephropathy (Patel et al., 2008). A study carried out in the United Kingdom showed that intensive blood glucose control in type 2 diabetes patients significantly increased the cost of treatment, but the cost of complication was reduced and increased the time free of complication (Gray et al., 2000). Although good controlling on blood glucose will benefit the diabetes patients, the potential benefits of glycemic control must be balanced against factors that either preempt benefits (limited life expectancy, comorbid disease) or increase risk (severe hypoglycemia, weight gain) (Woolf et al., 2000). 1.4.2 Pharmacological Treatment According to the Malaysian Clinical Practice Guidelines Management of Type 2 Diabetes Mellitus 4th Edition (2009), the first line therapy for oral agent is Metformin, while other oral agents are acceptable as alternatives. However, usage of Thiazolidinediones (TZDs) has been found to have greater durability in glycemic control compared to Metformin and Sulphonylurea (SU). Currently there are five classes of oral hypoglycemic agents, which include ÃŽ ±-glucosidase inhibitors (AGIs), Biguanides, Dipeptidyl petptidase-4 (DPP-4) inhibitors, Insulin Secretagogues (Sulphonylurea and Non-Sulphonylurea / Meglitnides) and Thiazolidinediones (TZDs). Factors that are taken into consideration when selecting the treatment include the patients clinical characteristics, such as degree of hyperglycemia, weight and renal function (Walker and Whittlesea, 2007). Scheen and Lefebvre (1998) suggested that the selection of oral antihyperglycemic agents as first-line drugs or combination therapy should be based on both pharmacological properties of the compound (efficacy and safety) and the clinical characteristics of the patient (stage of disease, body weight). Furthermore, each antihyperglycemic agent may also be combined with insulin therapy to improve glycemic control after secondary failure to oral treatment. A systemic review on the effectiveness and safety of oral antihyperglycemic agents showed that most oral agents improved glycemic control to the same degree as sulfonylureas, though nateglinide and ÃŽ ±-glucosidase inhibitors may have slightly weaker effect (Bolen et al., 2007). Other than that, this review also showed that most agents other than metformin increased body weight by 1 to 5 kg. In terms of safety, sulphonylureas and repaglinides were associated with greater risk for hypoglycemia, thiazolidinediones with greater risk for heart failure and metformin with greater risk for gastrointestinal problems. Another systemic review and meta analysis on the effect of oral hypoglycemic agents on HbA1c levels showed that most OHAs lowered HbA1c levels by 0.5 to 1.25 % whereas thiazolidinediones and sulfonylureas lowered HbA1c levels by 1.0 to 1.25 % (Sherifali et al., 2010). This review also concluded that the benefit of initiating an OHA is most apparent within the first 4 to 6 months . A meta analysis on comparison of different drugs as add-on treatment to metformin in type 2 diabetes showed that sulphonylureas, ÃŽ ±-glucosidase inhibitors and thiazolidinediones induced reduction of HbA1c of 0.85, 0.61 and 0.42 respectively (Monami et al., 2007). In direct comparisons, sulphonylureas induced a greater reduction of HbA1c than thiazolidinediones. For the treatment with ÃŽ ±-glucosidase inhibitors (AGIs) acarbose, a meta-analysis showed favourable trends towards risk reduction for myocardial infarction and any cardiovascular event (Hanefeld et al., 2004). The meta-analysis also revealed that acarbose treatment also significantly improved glycemic control, triglyceride levels, body weight and systolic blood pressure. 1.4.3 Non Pharmacological Treatment Exercise Exercise plays an important therapeutic role in the management of type 2 diabetes and usually is prescribed along with dietary therapy and pharmacologic therapy. The benefits of exercise are observed through the lowering of blood glucose concentration during and after exercise (Najim, 2008). Physical activities are able to reduce the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes mellitus by 58% (Sigal et al., 2006). There is evidence that showed the relation between the exercise and the HbA1c level, where exercise training reduced HbA1c by an amount that should decrease the risk of diabetic complications (Boule et al., 2001). b. Dietary Control Obesity and weight gain contributes to the development of diabetes. The impact of obesity will put the diabetic patients on risk of coronary heart disease (CHD) (Anderson et al., 2003). Hence, decreasing the weight will decrease the risk for developing diabetes. Despite that, glycemic control also will be well controlled. A meta-analysis on restricted-carbohydrate diets in type 2 diabetic patients showed that there is an improvement in HbA1c, fasting glucose, and some lipid fractions (triglycerides) with lower carbohydrate-content diets (Kirk et al., 2008). A study conducted to assess the effects of high dietary fiber intake in type 2 diabetic patient shows that high intake of dietary fiber, particularly the soluble type, improves glycemic control, decreases hyperinsulinemia and also lowers plasma lipid concentrations (Chandalia et al., 2000). The Malaysian Clinical Practice Guidelines for Management of Type 2 Diabetes Mellitus 4th Edition (2009) suggests that a balanced diet consist ing of 50-60% (Carbohydrate), 15-20% (Protein) and 25-30% (Fats) are encouraged. However, these recommendations must be individualized based on glucose and lipid goals. 1.5 MANAGEMENT OF CHRONIC DISEASES IN PRIMARY HEALTH CARE In United States, there is an estimated of 99 million Americans living with a chronic illness. This becomes one of the major challenges faced by the U.S. health care system today and in the future. However, the defining features of primary care which includes continuity, coordination and comprehensiveness, are well suited to the care of chronic illness (Rothman and Wagner, 2003). In the WHOs World Health Report 2008: Primary Health Care Now More Than Ever shows that the primary-care team becomes the mediator between the community and the other levels of the health system, helping people navigating through the maze of health services and mobilizing the support of other facilities by referring patients or calling on the support of specialized services (WHO, 2008). Evidence has shown that with a better primary care, especially coordination of care could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions (Wolff et al., 2002). In Thailand, the patient satisfaction toward primary care units has improved when compared to public hospitals out-patients-department. An evolutionary change, as the patients in Thailand started to have confidence in local facilities such as primary care units for monitoring of chronic diseases (Pongsupap et al., 2005). 1.5.1 The Management of Chronic Diseases in Primary Health Care Centers in Malaysia Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. Preliminary data from Malaysian Non-Communicable Disease (NCD) Surveillance 2005/06 estimated that approximately 11.6 million Malaysian adults aged 25-64 years were having at least one risk factor for chronic diseases and only about 3% did not have any risk factor. (Ramli and Taher, 2008). A study carried in an urban primary health care setting in Sarawak shows that the poor glycemic control (HbA1c > 7.5%) is about 38%. Wong and Rahimah (2004) suggested that reasonable glycemic control can be achieved in the primary health care setting in Sarawak. A study was carried out to evaluate the status of diabetes care and prevalence of diabetic complications among the diabetic patients in primary private health care Malaysia. Majority of diabetic patients treated at the primary care level were not satisfactorily controlled and were associated with a high prevalence of complications (Mafauzy, 2005). Hence, there is a need on putting on more efforts in order to achieve clinical targets. 1.6 MEDICATION ADHERENCE A literature review showed that the adherence rates for patients with type 2 diabetes have ranged from 65 % to 85% for OHA and 60 % to 80 % for insulin (Kenreigh and Wagner, 2005). A survey was done in the United States to assess medication adherence, knowledge of therapeutic goals and goal attainment for adult patient with diabetic. The result showed that 48 % of patients were medication non-adherent and most frequently reported reasons for non-adherence were forgetfulness (34 %) and too expensive (14 %). This study also shows that the patients at HbA1c goal were more adherent than patients not at goal (Whitley et al., 2006). A study was carried out by Tan and Judy, on self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. The result showed that only 53 % subjects scored below 50 % in their diabetes-related knowledge, subjects with medication non-adherence, 46 % tended to have higher fasting blood glucose levels and only 15 % of the subjects practiced SMBG (Tan and Judy, 2008). Patients which non adherent to the drug regimen was found to be at higher risk of hospitalization. The study on this showed that patients with type 2 diabetes mellitus who did not obtained at least 80% of their antihyperglycemic medications across a year were at a higher risk of hospitalization in the following year (Lau and Nau, 2004). 1.6.1 Factor Affecting Non-Adherence in Diabetes Mellitus Drug non-adherence is a major concern in patient management, especially in individuals with diabetes, which makes the glycemic control difficult to attain. Adisa et al. (2009) stated that the commonly cited intentional nonadherence practice included dose omission, 70.2%. Almost 50 % respondents were fed up with daily ingestion of drugs and 19.8% of the respondents stated that it was inconvenient to take the medications outside. Furthermore, forgetfulness (49.6%) and high cost of medication (35.5%) were also reasons for non adherence. Another factor that influenced the non adherence were patient-related factors (96%) and health care system-related factors (79%) (Ratsep et al., 2007). Ratsep et al. stated that the patient-related factors include patients awareness regarding diabetes and its complications, patients motivation to change their lifestyle, non-compliance with medical regimen, patients financial problems and their non-attendance. Health care system-related factors include th e lack of special diabetes education for nurses, underfunding and an inadequate number of patients educational materials. 1.7 PHARMACISTS INTERVENTION Health coaching which relies on frequent contact and ongoing intervention has emerged in recent years as part of disease management initiatives (Melko et al., 2010). This has been promoted as an effective method for improving health outcomes and patient compliance with medication. A pilot study done by Melko et al. (2010) has shown that health coaching combined with tools do increased medication adherence. In United States, the adherence to OHA therapy ranged from 36 to 93 % in patients remaining on treatment for 6 to 24 months. Electronic monitoring identified poor compliers for interventions that improved adherence,61 to 79 % (Cramer, 2004). A study has shown that, HbA1c levels decreased significantly in the intervention group after the 4th month and remained lower than in the control group until the 12th month (Scain et al., 2009). Moreover, a decreased of HbA1c by 0.16% was observed with each 10% increased in drug adherence (Schectman et al., 2001). With every 1 % reduction in updated mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes, 21 % for deaths related to diabetes, 14 % for myocardial infarction and 37 % for microvascular complications (Stratton et al., 2000). A review of the literature on the role of pharmacists indicates that there is a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially focusing in providing patient education (Lindenmeyer et al., 2006). A study on Latino patients with uncontrolled diabetes (Hemogloblin A1c ≠¥ 8.0%) showed that intervention from the pharmacist and health promoter team management of uncontrolled diabetes appears to be a feasible approach in order to improve the medication management (Gerber et al., 2009). Marcio Machado and his team found that there is a significant reduction in HbA1c levels in the pharmacists intervention group but not in the control group which is without pharmacists intervention (Machado et al., 2007). In the journal which discussed the role of pharmaceutical care in diabetes management, there were evidences suggesting that the pharmacists efforts in optimizing the pharmacotherapy can prove a valuable component in community-based multi disciplinary diabetes care (Davis et al., 2005). A meta analysis carried out by Conn et al. (2009) which investigated the effectiveness of interventions to improve medication adherence in older adults suggests that interventions increase medication adherence in older adults. The types of interventions include pill count, electronic medication -event monitoring device (MEMS), diabetes education, medication counseling, monitoring and insulin initiation and/or adjustments. In comparison of MEMS and pill count, MEMS data resulted in different numbers and types of recommendations than pill counts (Matsuyama et al., 1993). Hence, the pharmacists then could make specific recommendation regarding patient educations. A Cochrane review stated that almost all of the interventions that were effective for long term care were complex, which include combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up and supportive care (Haynes et al., 2008). However, there is no conclusion about the effectiveness of the interventions that could lead to large improvement in adherence and treatment outcomes. An earlier meta analysis of studies conducted reported that chronic disease patients including those with diabetes and hypertension, as well as cancer patients and those with mental health problems benefited from interventions such as prescription refills, pill counts and electronic monitoring (Roter et al., 1998). 1.8 RESEARCH OBJECTIVES The primary health care settings play an important role in primary steps in order to prevent the development of chronic diseases. In Malaysia, there were a number of people who have chronic diseases that received treatment in the primary health care settings. Hence, research should be carried out in order to assess the medication adherence among diabetic patients in the primary care settings in order to achieve better therapeutic outcome. 1.8.1 General Objective To assess the impact of pharmacist counseling on medication adherence among the diabetic patients in primary care centre 1.8.2 Specific Objectives To assess patients blood glucose level and knowledge, before and after counseling. To evaluate patients medication adherence, before and after intervention. To correlate the medication adherence with counseling.

Saturday, January 18, 2020

Mark Mathabane’s Kaffir Boy Essay

Racial Discrimination, has already been a long term phenomenon, in existent in almost all societies in different eras and civilization. The idea of discrimination is inevitable. Considering that such discrimination creates social structure as regards what is expected of everybody in a society and what is due to them. However, sometimes this social structure is abused, beyond its limit. People who belong to a higher status quo would definitely do whatever it takes to keep it. To illustrate, colonizers who had way better technology, combat powers and knowledge as compared to areas being colonized, would come to these new conquests are superiors. They would then take the locals as slaves and ravish on the wealth that they have to offer. In their own place, these locals become discriminated and unwanted. In return, locals would do whatever it takes to associate themselves with the colonizers, by looking like them, being friends with them, working for them, or marrying people of their kind. And it always seems that it is the right thing to do. When the British came to South Africa, this is exactly what happened. Mark Mathabane’s Kaffir Boy, tells a real story of a man who chose to fight a different battle to combat discrimination and inequality. While most of his relatives act as freedom fighters, he came to America to educate himself and to excel in a sport he loves. His success has given so much inspiration. His story as depicted in his book will take us with him as he reveals the horrors of his past. Mark Mathabane lived in a country, wherein racial divide, for most of its early years seemed to be the only thing that defines them. South Africa, a country nestled in the continent of Africa, was once invaded by white colonizers too. And they have proven that they came there to stay. In a country such as South Africa, a nation so unique as compared to other nations in the African continent. South Africa can be considered as diverse in a special way, because it is the only African country that has Caucasians as locals. Originally dominated by black Americans, South Africa is now a melting pot of two cultures. Analysis It had never occurred to me that though the two were different as night and day, as separate as east and -west, they had everything to do with each other; that one could not be without the other (94) This statement from Johannes best explains the struggles of Mathabane. In summary it explains how the two dominant races in South Africa has tried to isolate each group against each other, by means of creating physical division such as creating boundaries and naming certain places as black or white territory. Whites are in a way regarded more superior because they are more literate as well. The government also used formal means to strengthen the divide by creating laws such as prohibiting mix marriages, and creating policies in the education system that seems to favor a specific race. Overall, it was almost the generally accepted norm, to- categorize, discriminate. Kaffir Boy, is a tale about Mark Mathabane’s life growing up in South Africa, just outside of Johannesburg. Mark Mathabane lives in the town of Alexandra during industrial colonialism period with his parents, five sisters and a brother. He talks about how he experienced brutality and starvation from the Peri Urban, an Apartheid police group in South Africa. Growing up very poor, he dreamt of having a better life for him and his family. He often questioned the prejudices happening around him and has decided to take the course of his destiny in his own hands. As a young boy, he struggled with his identity. He wonders which religion he should practice, which country or class he should belong. There is so much craving for autonomy that at a young age he began resenting his parents’ religious and tribal heritage and eventually decided to leave Africa. Believing that religion, specifically Christianity was used wrongfully by different groups and races, he eventually rejected it. He believes that government used it to claim that God had given whites the divine right to rule over blacks; the black churches misused it by demanding money from Africans who were already destitute; and black churches further misused it by resigning themselves to the idea that this was their â€Å"lot† in life, God’s will for black men and women (36). Mathabane also recalled how apartheid made use of tribalism as form of torture against Africans. He believes that his father, allowed himself to be controlled by superstitions, Relatively mature for his age, he reiterates his independence by doing what he pleases with his life. For Mathabane, the Christian God is bias in favor of the whites and is oblivious to the African’s pain. Although he recognizes its legitimacy as sign of respect for her mother’s faith, he still rejects it the way he rejects tribalism and African superstition. For him, submitting to any specific belief or religion is synonymous with compromising his free will. In page 208 of the book he further on states African â€Å"superstition† and tribal culture were not for him. His scorn for his father lay in the fact that his father clung to values which had â€Å"outlived† their â€Å"usefulness,† values which discriminated against him while he attempted to function within the white man’s world (208). â€Å"What Mathabane did accept, though it took some trial and error, was his mother’s understanding that education would lead him to a better life. Learning English, he decided, was the â€Å"crucial key† to unlocking the doors of the white world (193). The books that white people read led to the â€Å"power† they had over black people (254). Mathabane eventually decided that literacy was a necessary element in the liberation struggle. How can the illiterate function, he wondered, in a world ruled by signs (201) Books had taught him about places where he could be â€Å"free to think and feel the way I want, instead of the way apartheid wants† (254). He then realizes that he needs to make important decisions in order to make his dreams come true. Thinking that South Africa has nothing much to offer, at least for a poor black African boy like him, he decided to try his luck with American Universities. As he begins to plot his future, his tennis abilities begin to progress faster and better. Being an avid fan of Arthur Ashe, he takes his wins and losses as if his own. The achievements of his â€Å"idol† encourages him to do better every single day. From black state competitions, he started joining the more prestigious white state competitions. His participation in white state competitions led to his banning from joining black state competitions. At this point, he feels as if his progress in his craft takes him away from the things he loved the most. Luckily, Mark later on leaves for the United States as a university scholar, through the help of a famous American tennis player and other white donors. Conclusion â€Å"Deep within me,I knew that I could never really leave South Africa or Alexandra. I was Alexandra, I was South Africa†¦ † (348). This goes to show that despite of all the successes, the author looks back in his roots. At first, his move out of Africa was just his way of â€Å"escaping† the endless circle of failed dreams and lack of opportunities. But his absence in his country makes him reaffirm his identity, and gives him the opportunity, to finally appreciate what his past has to offer for his present and for his future. This book tells a very dark story filled with pain, sadness and loneliness on most of its chapters, but it also provides a strong foundation for the readers to further understand the plight of the narrator. The journey he took was not only of hope, but rather, a journey of rediscovery. How can the illiterate function, he wondered, in a world ruled by signs (201)? The books had taught him and transported him to places where he could be â€Å"free to think and feel the way I want, instead of the way apartheid wants† (254). Why burn the only thing that taught one to believe in the future, to fight for one’s right to live in freedom and dignity? † (285). Here reaffirms his conclusion as we experiences Soweto riots, which was triggered by resentment over the government’s ruling that African education system be taught it Afrikaans instead of English. Upon witnessing the library burn down he inquired for enlightenment from one of his peers, who mentioned that the burning is for the destruction of all the traces of white oppression in the Bantu Education system. The struggles in his youth, leads him to think that literacy is the key to success. by learning English, he will be given better opportunities, the same as the whites. According to the author, literacy has given the whites so much edge and power over the black Africans. Having an education will somehow even out the playing field. Literacy for Mathabane is so important, that for him this will eventually lead them to be liberated from all their struggles. In the end, we really have no control over our government, over the people around us, and over norms and traditions we grew up with. But we do have full control over our perspective, our feelings and destiny. And this is precisely what Mathabane did. He took charge of his own future. This book inspires me to examine the choices I have made as a young person, at the same time, it makes me wonder whether the previous steps I have taken in life will take me closer to my aspirations or take me farther. But then, it makes me think deeper not just about my ambitions, but what I really want to contribute to my society in the end. This book serves as a wake up call. In a society wherein we are given so much opportunity, it seems as if we are left with no excuses not to excel. Reference: Mark Mathabane, 1998, Kaffir Boy, Simon & Schuster Adult Publishing Group

Friday, January 10, 2020

Describe the fieldwork and research you would undertake in order to investigate why some urban areas are in need of rebranding

When investigating why some urban areas need rebranding I would use a range of both primary and secondary data to see what the environmental, economic and social needs for rebranding were. Primary fieldwork I would complete whilst in the area would include: land use surveys, EQS’s, questionnaires, perception surveys, an index of decay and I would also take photos of the area. By using a wide range of primary fieldwork I would be able to see why the area needs rebranding in a range of ways. When completing a land use survey I would use systematic sampling as I would visit every 5th property then make notes on what the property was being used for used for or what service it provided. By completing a land use survey I would be able to see what services there are in the local area and I would also be able to see what state of repair the buildings are in. An EQS allows me to look at the environmental needs of an area as when completing it I am assessing the buildings, traffic, open space and gardens and the general quality of the area. To complete and EQS I would walk around the area and rate each quality on a scale of +2, high, to -2, very poor. Another way of assessing the environmental needs of rebranding is through an index of decay, this would involve walking round the area an assessing the physical conditions of buildings within the area and rating them. This would show the needs of rebranding as if the area is in a state of disrepair then people may not be attracted to the area so the cycle of deprivation continues. To complete both the EQS and index of decay I would use stratified sampling as we already knew something about the area. Opinion based primary fieldwork I would complete whilst investigating the needs of an area includes questionnaires and perception surveys. To complete the questionnaire I would use random sampling to ensure my results reflected a wide range of opinions. Questionnaires would provide me with people’s opinion of the area and can be used to show why rebranding needs to happen. If their opinion suggests that there are a lot of improvements that could be made to the area or that it is lacking services or transport infrastructure then this shows there is a need to rebrand. Questionnaires don’t only show the social needs for rebranding but can show the economic and environmental needs as well, it all depends on what they questions ask. A perception survey also reflects people’s opinions of the area; again I would use random sampling to gain a wide range of results. Perception surveys would allow me to quickly collect people’s opinions as they include close questions. The results would provide me with opinions on the area and also information about improvements people in the area wanted to see. The final piece of primary fieldwork I would complete whilst in the area would be taking pictures, I would take pictures to try and capture the area socially, economically and environmentally. By taking a range of pictures I would be able to see if the results from my surveys fitted what my pictures show. This would help when investigating the needs of rebranding as it would provide visual representation of the area and when comparing the results to an area that has been rebranded the needs would become obvious quickly. Also when investigating the needs of rebranding I would complete secondary research to see if it supports the findings from my primary research. However when using secondary data I would have to be careful that the information was up to date and wasn’t biased. I would use a range of sources to provide me with secondary data such as census data, checkmyfile, crime data, economic activity and government profiles. I would research census data to see how many people in the area are unemployed this would show the economic needs of rebranding. The census data would also provide me with information about the social needs of an area as the census data includes information about education and health care provision in an area. Checkmyfile would also back up the information from the census data as it gives information about unemployment and also gives information about the social demographic of the area. This would help when investigating the needs of rebranding as it could show that the demographic is a certain way because of a poor service provision. Crime data would show the social needs for rebranding as it would show if there are high levels of crime in the area and would give an indication as to how safe the area was. If the results showed there was high crime in the area and the community didn’t feel very safe this would suggest there was a need for rebranding. Economic activity would provide me with information about the local areas economy and where people spent money in the local area. This would help to show the needs of rebranding as if there were few services in the area then there wouldn’t be much spending, it would also show if there was a lot of business in the area. The final piece of secondary data I would research to investigate the needs of rebranding would be government profiles of the are this would provide me with a whole range of social, environmental and economic indicators. When investigating the need for rebranding it is essential that I compare the results from my fieldwork and research to the results of an area that has experienced rebranding so I can look at the differences which would be where the main needs would lie.

Thursday, January 2, 2020

Technology Planning Perceived Educational Technology...

Technology Planning PERCEIVED EDUCATIONAL TECHNOLOGY NEEDS SURVEY Adapted from Ted Wesley - National Center for Technology Planning (www.nctp.com) and Alan November of November Learning While performing your duties: 1. Do you ever, or often, think, â€Å"There must be an easier way to do this?† If so, please list and describe as many of the things or situations as you can to which this statement would apply: 1. †¦to provide homework assignments to students. 2. †¦.to complete the class worksheet that provides what topics were covered and progress made. 3. †¦to complete attendance sheets. 4. †¦complete periodic assessments to determine English class level. 5. †¦communicate with the director of the program. 2. Do you ever, or often, think, â€Å"I could do this faster if only...† If so, please list and describe as many of the things or situations as you can to which this statement would apply: 1. †¦the director would use email or text instead of calling on the phone. 2. ...a computer was available in the classroom with projection capabilities. 3. †¦proper materials were available. Either a book for each student or extra copies of pages discussed on a given day or an online version of the book. 4. †¦there was better communication between ELL teachers and administration. 5. †¦students were assigned to the right level in the program. 3. Do you ever, or often, think, â€Å"I wish I had a helper to help me do...† If so, please list and describe as many of the things or situations as you can toShow MoreRelatedThe Explosion Of Technology On The Education Scene1667 Words   |  7 PagesDefinition of key Terminology/Background The explosion of technology on the education scene in the past few decades has been enormous. Toward the end of 20th century, one of the most frequent suggestions educational leaders made for improving schools was the integration of technology into teaching and learning processes (Henson, 2010, p.63). Mercelle (2000) defined ICT as â€Å"complex and heterogeneous set of good applications and services used for producing, distributing, processing and transformingRead MoreTechnology Efficient1592 Words   |  7 PagesTechnology Getting Efficient Technology affects our society significantly today. It has become an integral part in our life by bringing so much benefits and downsides. 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