Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

Poverty and Ethnicity in Northern Ireland: An Evidence Review

This report provides an overview of the research evidence on the relationship between poverty and ethnicity in Northern Ireland. After a period of increasing ethnic diversity, the review was concerned with understanding how issues of poverty affect people from different minority ethnic communities and their ability to access and secure good outcomes from key services. A comprehensive literature review and focus groups with people from the Roma, Somali, Chinese and Polish communities, and with local stakeholders, provide the basis for the report. The report discusses: • how new migrants have joined long-standing communities of people from minority ethnic groups; • how the policy framework to address racial inequalities in Northern Ireland is relatively new; • how people from minority ethnic groups experience low incomes and access services; and • how the legacy of conflict in the region may affect minority ethnic groups.

Routledge International Handbook of Rural Studies.:Understanding the association between rural ethnicity and inequalities

Rural areas are facing demographic transformation. Some localities have experienced significant levels of (internal and international) immigration in recent decades. In other rural places, a shifting minority: majority ratio (arising mainly from increased minority fertility and decreases in the majority population) is altering the rural landscape. It is this context of increasingly diverse rural societies that frames this chapter. It begins by examining inequalities arising from ethnicity in a rural context. The review proceeds by identifying how different factors, including recent patterns of international migration and historical legacies of ethnic diversity, intertwine to produce multi-cultural rural areas. First of all an overview of the significance of the ‘ethnic’ label is presented, recognizing its limitations and also its usefulness. Having established this context the chapter proceeds by highlighting the way in which rural ethnic inequalities are measured and also the particular challenges of measuring rural poverty. The processes that produce inequalities among ethnic groups are examined, with particular attention on migration and space and place, but mindful of historical legacies along with economic transformations and associated recent migration patterns. Finally, the conclusion of the chapter highlights gaps and identifies areas for future research agendas.

Difference, Diversity and Difficulty: Problems in Adult Peace Education in Northern Ireland

The peace process in Northern Ireland has been hailed, variously, as the successful resolution to one of the world's most intractable conflicts, and as a failed attempt to reconcile the conflciting claims of the two main ethnonationalist communities. At both these points, and at every other point along the continuum, recognition is given to the centrality of education. This article looks at the role played by adult learning, and contrasts two fundamentally different apporaoches. In one, Enlightenment assumptions about the power of knowledge to dispel prejudice have run alongside attempts to create a world of shared values; in the other, a postmodern acceptance of different cultures has accompnaied a peace process that builds upon ethnic diistinctions. As with the Dayton Accord and with other peace agreements brokered with international assistance, the consociational model of governance has been chosen for Northern Ireland in order to create a political equilibrium between the unionists and nationalists. Such a political framework reverses the direction of previous integrationist educational policies in favour of a celebration of difference, an approach that is fraught with difficulties.

Recognising Ecological Contexts of Diverse Ethnic Groups: Experiences of British-Indian Adult Children of Divorce

The process of divorce as a family change process including outcomes and consequences has received considerable research attention in the western context. However, the experience of divorce for children within specific ethnic contexts has been rather limited leading to poor planning and practice provision with diverse families. By drawing upon an empirical qualitative study of British Indian adult children, this paper will make a case for recognising diverse needs within specific historical, socio-cultural and developmental contexts. There is a need to acknowledge these contexts in policy design to establish practice that is flexible, accessible and relevant to the needs of different and diverse communities. Results indicate that areas of impact may be similar to those identified by other studies within the literature review. However, the experiences, expressions, implications and larger consequences of impact are located within specific socio-cultural contexts. In support of this, major findings of the study (outlined below) will be discussed - Context: patriarchy, stigma, immigration; Impact: economic, social, emotional, career/education, physical; Coping: psychological strategies, physical strategies, social strategies, sources of support.

Negotiating Territoriality and Diversity: Young People’s Encounters in Northern Ireland Divided Communities

Neighborhoods across the globe are becoming increasingly ‘divers’, yet we still find their urban encounters reproduced through negotiating differences that escalates moods of social inequality and spatial imbalances. Research on ethnic division also stresses the spatial aspects of their production as shared urban spaces are mostly signified in the literature as ethnic ‘enclaves’. Territoriality and place attachment, in this sense, has a wide impact on the people’s everyday encounters while experiencing segregation. These historical narratives have produced communities that exhibit high levels of intracommunity relations and localized networking. This article investigates how youngster generations in Northern Ireland perceive, accept and respond to their differences, or perhaps how they act against it, to push the boundaries towards more diversity. In fact, the spatial and temporal encounters that occur among one community and the ‘Other’ signify a sort of negotiations and being more constructive about the future. The argument maintains that territoriality and place attachment has a wide impact on the young people’s everyday experiences. The empirical study shows how individuals and community groups position and identify themselves under the impact of social segregation. Building on social identity theories, I explain how people in Derry have established their own sense of belonging, of who they are, based on their group memberships which eventually became an important source of pride and self-esteem.

Supporting an ethnic minority woman's choice for pain relief in labour: a reflection

Despite professional expectations for midwives to provide care to women that is founded in equality and recognises diversity (Nursing and Midwifery Council, 2015), women from ethnic minority populations consistently suggest that they are not heard (Briscoe and Lavender, 2009; Tobin et al, 2014). This article reflects upon a situation where a Portuguese woman with limited English speaking ability was denied access to epidural anaesthesia as the midwife felt that she could not give valid consent to the procedure without the presence of an interpreter. The midwife’s role within this situation will be reflected upon and implications for midwifery practice identified.

Balancing cultural diversity and social cohesion in education: The potential of shared education in divided contexts

This article considers how the education systems of divided societies have been shaped in response to the experience of ethnic and religious conflict. The analysis identifies two competing priorities in such contexts – the development of social cohesion and the protection of cultural, ethnic and religious identities - and explores how these may be reconciled through a model of ‘shared education’. Drawing on research evidence and recent experience of shared education in relation to Northern Ireland, the Former Yugoslav Republic of Macedonia and Cyprus, we reflect on the advantages and challenges of this model in areas experiencing conflict and division.

Effect of habitat fragmentation on levels and patterns of genetic diversity in natural populations of the peat moss Polytrichum commune

Peat bogs represent unique ecosystems that are under particular threat from fragmentation due to peat harvesting, with only 38% of the original peatland in Europe remaining intact and unaffected by peat cutting, drainage and silviculture. In this study, we have used microsatellite markers to determine levels and patterns of genetic diversity in both cut and uncut natural populations of the peat moss Polytrichum commune. Overall diversity levels suggest that there is more genetic variation present than had previously been assumed for bryophytes. Despite this, diversity values from completely cut bogs were found to be lower than those from uncut peatlands (average 0.729 versus 0.880). In addition, the genetic diversity was more highly structured in the cut populations, further suggesting that genetic drift is already affecting genetic diversity in peat bogs subjected to fragmentation.

The religious content of ethnic identities

The religious dimensions of ethnic identities have been under-theorized. In contemporary industrial societies there is a tendency to characterize religiously demarcated groups as 'really' ethnic.This article suggests that the religious content of ethnic boundaries may be more important than might initially be assumed. A religious identification may have specific religious content and assumptions that may cause it to operate in different ways from other identities. Even if identities do not seem primarily religious per se, they may have latent religious dimensions that can become reactivated. Whilst identity conflicts and other social struggles may stimulate the return of the religious, once reactivated, the religious dimensions of identity may take on a logic of their own.Therefore, the article argues that in many contexts there is a two-way relationship between religion and ethnicity. Each can stimulate the other, rather than religion simply playing a supporting role to the ethnic centrepiece.