Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Projecte WebSat

El marc d'aquest projecte és el servei d' atenció tècnica d'un dels distribuïdors d'una coneguda marca d'ofimàtica i electrònica domèstica. Un dels processos de negoci consisteix en la reparació d'aquesta mena d'equips.

MDMA attenuates THC withdrawal syndrome in mice

3, 4-Methylenedioxymethamphetamine (MDMA) and cannabis are widely abused illicit drugs that are frequently consumed in combination. Interactions between these two drugs have been reported in several pharmacological responses observed in animals, such as body temperature, anxiety, cognition and reward. However, the interaction between MDMA and cannabis in addictive processes such as physical dependence has not been elucidated yet. In this study, the effects of acute and chronic MDMA were evaluated on the behavioral manifestations of Δ9-tetrahydrocannabinol (THC) abstinence in mice. THC withdrawal syndrome was precipitated by injecting the cannabinoid antagonist rimonabant (10 mg/kg, i.p.) in mice chronically treated with THC, and receiving MDMA (2.5, 5 and 10 mg/kg i.p.) or saline just before the withdrawal induction or chronically after the THC administration. Both, chronic and acute MDMA decreased in a dose-dependent manner the severity of THC withdrawal. In vivo microdialysis experiments showed that acute MDMA (5 mg/kg, i.p.) administration increased extracellular serotonin levels in the prefrontal cortex, but not dopamine levels in the nucleus accumbens. Our results also indicate that the attenuation of THC abstinence symptoms was not due to a direct interaction between rimonabant and MDMA nor to the result of the locomotor stimulating effects of MDMA. The modulation of the cannabinoid withdrawal syndrome by acute or chronic MDMA suggests a possible mechanism to explain the associated consumption of these two drugs in humans.

High School Review Summary, 2005

A status report identifying technical assistance, policies, and promising practices to facilitate high school improvement statewide.

Iowa Gender Wage Study, 1999

In 1993, Iowa Workforce Development (then the Department of Employment Services) conducted a survey to determine if there was a gender gap in wages paid. The results of that survey indicated that women were paid 68 cents per dollar paid to males. We felt a need to determine if this relationship of wages paid to each gender has changed since the 1993 study. In 1999, the Commission on the Status of Women requested that Iowa Workforce Development conduct research to update the 1993 information. A survey, cosponsored by the Commission on the Status of Women and Iowa Workforce Development, was conducted in 1999. The results of the survey showed that women earned 73 percent of what men earned when both jobs were considered. (The survey asked respondents to provide information on a primary job and a secondary job.) The ratio for the primary job was 72 percent, while the ratio for the secondary job was 85 percent. Additional survey results detail the types of jobs respondents had, the types of companies for which they worked and the education and experience levels. All of these characteristics can contribute to these ratios. While the large influx of women into the labor force may be over, it is still important to look at such information to determine if future action is needed. We present these results with that goal in mind. We are indebted to those Iowans, female and male, who voluntarily completed the survey. This study was completed under the general direction of Judy Erickson. The report was written by Shazada Khan, Teresa Wageman, Ann Wagner, and Yvonne Younes with administrative and technical assistance from Michael Blank, Margaret Lee and Gary Wilson. The Iowa State University Statistical Lab provided sampling advice, data entry and coding and data analysis.

Hidraulica Agricola e Desenvolvimento Rural - Estudos e Projetos - Relatorio Detalhado Integrador e Critico da Actividades Profissional

on agricultural hydraulics and rural development has been the main activity of the author in the last two decades. A large part of the professional career was devoted to studies and design of hydraulic infrastructures for the establishment of irrigation in Portugal. The recent years of his professional career focused on the internationalization of consulting services by drafting general plans, technical advises, design projects, training and specialized technical assistance to farmers and technicians. Angola and Cape Verde have been the stage of action. The present document was written with two main objectives: to obtain a Master of Science degree and to share with the community some relevant aspects of author’s work experience. The document was structured to emphasize three major units: the agricultural hydraulics, rural development and studies and projects. For these units were selected groups of activities considered relevant to the author's career: Alqueva Multi-Purpose Scheme, Rehabilitation and Modernization of Hydro-agricultural Schemes, Other Studies and Projects, Master Plans and Reports and Agriculture and Rural Development. In every activity is highlighted the aspects considered most important and which reflect the author's experience.

Iowa Climate Change Advisory Council Final Report 2008.

On April 27, 2007, Iowa Governor Chet Culver signed Senate File 485, a bill related to greenhouse gas emissions. Part of this bill created the Iowa Climate Change Advisory Council (ICCAC), which consists of 23 governor-appointed members from various stakeholder groups, and 4 nonvoting, ex officio members from the General Assembly. ICCAC’s immediate responsibilities included submitting a proposal to the Governor and General Assembly that addresses policies, cost-effective strategies, and multiple scenarios designed to reduce statewide greenhouse gas emissions. Further, a preliminary report was submitted in January 2008, with a final proposal submitted in December 2008. In the Final Report, the Council presents two scenarios designed to reduce statewide greenhouse gas emissions by 50% and 90% from a 2005 baseline by the year 2050. For the 50% reduction by 2050, the Council recommends approximately a 1% reduction by 2012 and an 11% reduction by 2020. For the 90% reduction scenario, the Council recommends a 3% reduction by 2012 and a 22% reduction 2020. These interim targets were based on a simple extrapolation assuming a linear rate of reduction between now and 2050. In providing these scenarios for your consideration, ICCAC approved 56 policy options from a large number of possibilities. There are more than enough options to reach the interim and final emission targets in both the 50% and 90% reduction scenarios. Direct costs and cost savings of these policy options were also evaluated with the help of The Center for Climate Strategies, who facilitated the process and provided technical assistance throughout the entire process, and who developed the Iowa Greenhouse Gas Emissions Inventory and Forecast in close consultation with the Iowa Department of Natural Resources (IDNR) and many Council and Sub-Committee members. About half of the policy options presented in this report will not only reduce GHG emissions but are highly cost-effective and will save Iowans money. Still other options may require significant investment but will create jobs, stimulate energy independence, and advance future regional or federal GHG programs.

Descripció de la tipologia d'usuaris derivats al servei de Teràpia Ocupacional Domiciliària a la comarca d'Osona: estudi descriptiu preliminar

Introducció Aquest treball, aborda l'atenció domiciliaria a les persones amb dependència des de la perspectiva de la teràpia ocupacional a la comarca d’Osona. Conèixer aquesta tipologia de persones i la seva problemàtica, ha de servir per adaptar les infraestructures d’aquests serveis a fi de donar millor resposta a les seves necessitats. Objectiu Descriure la tipologia d'usuaris que es deriven al servei de Teràpia Ocupacional Domiciliària a la comarca d'Osona Metodologia S'ha realitzat un estudi descriptiu preliminar d'una mostra (n=65) de usuaris de la base de dades del Banc D'ajudes Tècniques (BAT Osona) del Consell Comarcal d'Osona. En aquest estudi s'han analitzat les variables de sexe, edat, nivell funcional, diagnòstic, situació familiar, agents derivadors, motius de derivació i problemàtica principal detectada. Resultats S'indica un perfil femení de la mostra (72,09%), amb una mitjana d'edat de 74,41 anys. A nivell funcional, la mitjana de puntuació ha estat de 65 punts en l'Ìndex de Barthel, en persones amb patologia osteoarticular en el 18,60% dels casos. La situació familiar situa un perfil compartit de persones que viuen en família (41,86%) o soles (39,53%). En les derivacions al servei, el 58,13% dels casos es fa des dels Ajuntaments i per dificultats en el quarto de bany (46,51%). La problemàtica més detectada en aquests domicilis és la dificultat per l'accés a la banyera (67,40%). Conclusió Aquests resultats ens indiquen una clara tipologia de persones que s’han d’atendre i unes problemàtiques en la seva vivenda que provoquen serioses dificultats de desenvolupament funciona. Es precís, en futures investigacions acotar encara més aquets perfils i problemàtiques a fi de precisar les estratègies d’intervenció i optimitzar millor aquest tipus de recursos.

Public Employees Leadership Institute, August 2011

The mission of the Iowa Local Technical Assistance Program (LTAP) at the Institute for Transportation (InTrans) is to foster a safe, efficient, and environmentally-sound transportation system by improving skills and knowledge of local transportation providers through training, technical assistance, and technology transfer, thus improving the quality of life for Iowans.

Long-Term Community Recovery Strategy, Waverly, IA, December 2008

Long-Term Community Recovery Targeted Technical Assistance Strategy is an outcome of the coordinated effort of the city, Rebuild Iowa Office and Federal Emergency Management Agency Emergency Support Function. In partnership with City officials and RIO and informed by community outreach efforts, provided Targeted Technical Assistance to the community. This support helped the community identify and provide visibility to recovery issues, needs and opportunities that when addressed can result in a more effective long-term recovery for the community.

Long-Term Community Recovery Strategy, Iowa City, IA, December 2008

Long-Term Community Recovery Targeted Technical Assistance Strategy is an outcome of the coordinated effort of the city, Rebuild Iowa Office and Federal Emergency Management Agency Emergency Support Function. In partnership with City officials and RIO and informed by community outreach efforts, provided Targeted Technical Assistance to the community. This support helped the community identify and provide visibility to recovery issues, needs and opportunities that when addressed can result in a more effective long-term recovery for the community.

Long-Term Community Recovery Strategy, New Hartford, IA, December 2008

Long-Term Community Recovery Targeted Technical Assistance Strategy is an outcome of the coordinated effort of the city, Rebuild Iowa Office and Federal Emergency Management Agency Emergency Support Function. In partnership with City officials and RIO and informed by community outreach efforts, provided Targeted Technical Assistance to the community. This support helped the community identify and provide visibility to recovery issues, needs and opportunities that when addressed can result in a more effective long-term recovery for the community.

Long-Term Community Recovery Strategy, Palo, IA, December 2008

Long-Term Community Recovery Targeted Technical Assistance Strategy is an outcome of the coordinated effort of the city, Rebuild Iowa Office and Federal Emergency Management Agency Emergency Support Function. In partnership with City officials and RIO and informed by community outreach efforts, provided Targeted Technical Assistance to the community. This support helped the community identify and provide visibility to recovery issues, needs and opportunities that when addressed can result in a more effective long-term recovery for the community.

Governor's Office of Drug Control Policy Five-Year Strategic Plan July 1, 2003-June 30, 2008

The Office of the Drug Policy Coordinator is established in Chapter 80E of the Code of Iowa. The Coordinator directs the Governor’s Office of Drug Control Policy; coordinates and monitors all statewide counter-drug efforts, substance abuse treatment grants and programs, and substance abuse prevention and education programs; and engages in other related activities involving the Departments of public safety, corrections, education, public health, and human services. The coordinator assists in the development of local and community strategies to fight substance abuse, including local law enforcement, education, and treatment activities. The Drug Policy Coordinator serves as chairperson to the Drug Policy Advisory Council. The council includes the directors of the departments of corrections, education, public health, public safety, human services, division of criminal and juvenile justice planning, and human rights. The Council also consists of a prosecuting attorney, substance abuse treatment specialist, substance abuse prevention specialist, substance abuse treatment program director, judge, and one representative each from the Iowa Association of Chiefs of Police and Peace Officers, the Iowa State Police Association, and the Iowa State Sheriff’s and Deputies’ Association. Council members are appointed by the Governor and confirmed by the Senate. The council makes policy recommendations related to substance abuse education, prevention, and treatment, and drug enforcement. The Council and the Coordinator oversee the development and implementation of a comprehensive State of Iowa Drug Control Strategy. The Office of Drug Control Policy administers federal grant programs to improve the criminal justice system by supporting drug enforcement, substance abuse prevention and offender treatment programs across the state. The ODCP prepares and submits the Iowa Drug and Violent Crime Control Strategy to the U.S. Department of Justice, with recommendations from the Drug Policy Advisory Council. The ODCP also provides program and fiscal technical assistance to state and local agencies, as well as program evaluation and grants management.

Annual Report Of the State Geologist, March 2012

What we do: Since 1892, the Iowa Geological and Water Survey (IGWS) has provided earth, water, and mapping science to all Iowans. We collect and interpret information on subsurface geologic conditions, groundwater and surface water quantity and quality, and the natural and built features of our landscape. This information is critical for: Predicting the future availability of economic water supplies and mineral resources. Assuring proper function of waste disposal facilities. Delineation of geologic hazards that may jeopardize property and public safety. Assessing trends and providing protection of water quality and soil resources. Applied technical assistance for economic development and environmental stewardship. Our goal: Providing the tools for good decision making to assure the long-term vitality of Iowa’s communities, businesses, and quality of life. Information and technical assistance are provided through web-based databases, comprehensive Geographic Information System (GIS) tools, predictive groundwater models, and watershed assessments and improvement grants. The key service we provide is direct assistance from our technical staff, working with Iowans to overcome real-world challenges. This report describes the basic functions of IGWS program areas and highlights major activities and accomplishments during calendar year 2011. More information on IGWS is available at http://www.igsb.uiowa.edu/.