Homeschooling Essay Example | Topics and Well Written Essays - 2500 words

Homeschooling - Essay Example According to Green and Dempsey home school parents’ beliefs about the values, content, adequacy, and methods of public school education appear to be implicated less strongly in their decisions.† (Green & Dempsey) Home schooling is considered to be the process by which children are educated at home alone without studying in a class with other students. It is a response to many weaknesses that many parents have detected in the public education system. Home-schooling is an option for parents who wish to provide their children with a different learning environment than that which exists in public schools. It is also an alternative for those families who are unable, for practical or personal reasons, to comply with the regulations of a public school. Therefore, as Chris Lubienski mentions, home schooling may be defined as â€Å"a flight from modern American school.† The present trend is based on various factors which motivate parents to choose home schooling as an option for giving education to their children. This form of schooling provides better family bonding and socialization with the family members as most students are studying within the home environment and in close knit set up with the other family members and siblings. The flexibility of choosing the most productive time for schooling activities is also very encouraging. If there may be a family event or some family function, the study time can be adjusted accordingly. In the present times with good connection and internet and online information, it is easy to get information and use it for study purpose. The online information provide good platform for research and guidance with regard to school curriculum. Many schools and forums also have information related to home schooling. The present trend can also be said to lay foundation for the future trend, which will make the information easy task for the parents as well as for children who are home schooled. In the 1960’s and 1970’s lot of research

Islam Essay Example | Topics and Well Written Essays - 500 words - 10

Islam - Essay Example The focus in the paper "Islam" is on present day problems that can be solved by focussing on the spiritual democracy where only powerful minority or only majority is not to do with the whole system rather every individual is important in the whole fabric of the system of world and what is in it, that is implied in the rhythmic and systematic rituals of pilgrimage. As pilgrimage is having rituals like staying and camping, revolving, running and throwing stones at evil symbol, and to refrain from every evil and to be oriented only towards inner self and to behave in a good way, in the same way the whole practice of life is actually symbolic of the essence of the will and faith of ours which can best be polished by bringing the sense of equality, solidarity, spiritual purity and freedom seen during the pilgrimages in Makkah. The nation making process can also be considered that how people can best be amalgamated and disciplined by making them warmly spiritual at heart. It brings one to ponder about the ideal state which may be the most peaceful, rhythmic, systematic and spiritually and physically healthy of which rituals of the pilgrimage may be referred as symbolic. Pilgrimage is the pillar of Islam which gives support to the religion of peace by establishing the bonds of sisterhood and brotherhood in order to bring equality, solidarity and freedom from intruding, underestimating and horrible activities from others, that is all implied in the whole journey which is done during the pilgrimage and all activities as well.

Development in Accounting and Corporate reporting Essay

Development in Accounting and Corporate reporting - Essay Example This paper examines these developments and other issues that may have impacted in the development of accounting. It is important to understand the historical background of any subject such as accounting. Understanding accounting background and how it has developed is essential in understanding the past, and leads to a better understanding of the present practices. Understanding the historical background of accounting discipline, trends and practices that could have led to its current status facilitates better understanding of the profession. It is only through evaluation of the historical developments of the subject that people may appreciate accounting as it is today and its significance in the society, in organizations or other areas of application. Moreover, understanding the historical background enhances a better understanding of the objectives of the accounting theory and what the subject intended to achieve. In other words, a problem is better solved by understanding the objectives at the initial stages of a process. Furthermore, understanding the historical background of the subject al lows people to delve deep into understanding social, economic and political events and the significance of the subject in shaping these issues. For instance, as the article illustrates, there is a debate on whether accounting was a social construction, based on how accounting influences the society. Considering that there lacks a universal understanding of the accounting theory, the theory may be best understood by investigating the use of data, which people relate to accounting practices. Understanding such practices and how they relate to use of accounting data will lead to credible links on what accounting theory might mean, and how it has evolved over time to what it is today, as well as its impact on the social, economic and political

Leadership in Nursing Essay Example | Topics and Well Written Essays - 3000 words

Leadership in Nursing - Essay Example Hence the nursing needs for the elderly have become an issue of growing concern in Hong Kong. Traditionally, the care of the sick is considered to be the moral duty of their family members among the Chinese. Hence, being cared for by nurses, who are strangers, "places the Chinese people in somewhat of a paradoxical situation" (Pang et al., cited in Smith & Tang 2004, p.18). Therefore, the success of nursing care depends also on the nurse's ability to act as a surrogate family member. With increasing health issues of the elderly and their near-total dependence on healthcare facilities, private nursing homes are increasing in demand for the confinement of the elderly with deteriorating health issues like cerebrovascular accidents, fractures such as hip fractures, congestive heart failure, chronic obstructive airways disease, dementia, parkinsonism, etc. The government has funded three forms of residential care, with the aged homes providing assistance with activities of daily living, C&A homes providing personal attention and some nursing care, and infirmaries providing more intensive nursing care with medical supervision (Bartlett & Phillips 1995, p.238). Though several measures have been undertaken to increase the number of residential care homes, the availability of such care homes unfortunately still fall short of demand. This places increasing responsibility on the available nursing care personnel. According to a study done by Leung et al... Though several measures have been undertaken to increase the number of residential care homes, the availability of such care homes unfortunately still fall short of demand. This places increasing responsibility on the available nursing care personnel. According to a study done by Leung et al. (2000, p.65) from a random sample of private nursing homes in Hong Kong East region, increasing number of bedridden or chairbound patients, increasing dependency for basic activities of daily living, increasing problems of incontinence of bowel and/or bladder, increasing use of supporting devices, aggravating problems of bedsore, etc. lead to more hospitalizations and specialist out-patient clinic visits. Unfortunately the incidences of re-hospitalizations of these patients with recurrences of the same disease conditions have been gaining in frequency recently. "Frail elderly patients are shuffled back and forth between acute care, non-acute care, old age homes and the community" (Derrick 1998, p.1). This situation calls for a highly efficient and totally effective nursing care system. This report studies the scenario in a private nursing home in Hong Kong. The scenario is analysed for the effectiveness of the nursing care rendered by the present nursing team, its leadership style, and its advantages and disadvantages. Also studied are the different leadership styles and concepts that are applicable to this context. New strategies for improving the situation are developed, and appropriate leadership skills are recommended that suit these strategies. 2. Context I work as intern in a nursing team handling 100 inhabitants of a private nursing home in Hong Kong. The average age of the group is

Values and Meaning of Attending College Essay Example | Topics and Well Written Essays - 750 words

Values and Meaning of Attending College - Essay Example In contrast to an individualist purpose for attending college, Boyer believes the college has an obligation to teach â€Å"a more coherent view of knowledge and a more integrated life† (Steltenpohl & J. Shipton, 1995, p. 18). In addition, he warns that we must be â€Å"mindful of the consequences of selfishness† (p. 18). Boyer does not provide a defense of individualism, even though he says it is â€Å"necessary† (p. 18). Instead, Boyer relies only on his defense of community in making his case for two essential goals. The problem is that Boyer does not actually believe in individualism when he claims colleges have an obligation (or duty) to enforce this idea of a more â€Å"coherent† or â€Å"integrated† life. A perspective that believes in individuals to develop their own views on knowledge or life would advocate for an obligation or duty for colleges to present knowledge to students and to allow them to form their own judgments. The purpose, or g oal, of college is not to give students a passage, but rather to present facts and objective information. A â€Å"passage† sounds inherently biased toward whatever values the college seeks to supply their students with. While this kind of education—such as that provided by Christian private colleges—has a demand, but that demand is specific and does not represent the general purpose of college. Indeed, having students personally powered and committed to the common good is potentially valuable, but not if that commitment undermines their autonomy. The result of Boyer’s perspective is clearly laid out by Perkinson in his essay â€Å"The Educated Person: A Changing Ideal,† specifically in his treatment of John Dewey and socialization (Steltenpohl & J. Shipton, 1995, p. 36). Dewey and pragmatist philosophers advocated schools as tools for producing intelligent decision-makers in a participant democracy. In reality, what this meant was that loyal citize ns coming out of public schools were not â€Å"leaders, but functionaries† (p. 36). Everyone coming out of schools was equipped with common values, beliefs, and attitudes serving the American status quo. Economically, every child was prepared to accept his or her role as a cog in a production system. This is the logical result of the kind of solution that Boyer seeks by telling colleges that they have an obligation to teach their students how to be members of a community. However, Boyer and Dewey have been influential enough to change American education at their core. One can see this influence even in our Brandman catalog, which withholds degrees from students who have not completed the sometimes-irrelevant education requirements. The opposite perspective—that we ought to be honoring the role of the individual in education—is borne out by Whitehead in â€Å"Universities and their Function† (Steltenpohl & J. Shipton, 1995, p. 38). Whitehead locates the â €Å"proper function of a university† in â€Å"the imaginative acquisition of knowledge† (p. 39). Imagination is an individual ability and does not depend on a community. When one looks around a college classroom, one does not see a group of people engaged in the attempt to better their community through the process of learning. While Boyer would think this is a problem, Whitehead is more concerned with whether individuals are involved in an imaginative acquisition of knowledge. The imaginative pursuit of knowledge, one would suspect, might lead to an individual developing his own

Alcoholic Beverage Essay Example for Free

Alcoholic Beverage Essay Alcoholism is a chronic problem that includes difficulty in controlling drinking, having to drink consistently to get physical independence, being preoccupied with alcohol, and continually using alcohol regardless of problems it causes (Brick, 2004). Alcohol should not be legal in U. S. because it is impacts negatively on health, family, community and on a person’s education. Alcohol drinking is like taking a drug. It is a form of drug addiction and drug abuse. Alcoholism is a worldwide problem that affects many people. Drinking alcohol has negative short and long term effects. Alcoholism has been associated with adverse effects on health, family, community, and education (Marshall, 2000). However, the effects on a person depends on particular factors such as how often and how much alcohol is taken, a person’s age, gender, when a person begun drinking and how long they have been drinking, their health, and family history (Begleiter amp; Kissin, 1996). It is in this regard that alcohol should not be legal in the United States. Alcohol is addictive, and people become addicts end up spending a lot of money on alcohol. It means that when they spend all the money they have on alcohol, they forget their families, and are not able to support the community in anyway. Some resort to stealing to sustain their drinking habit. Alcohol addicts sometimes engage in robbery acts to get the money for drinks. Community becomes at risk of destruction with excessive alcohol consumption allowed. When many people engage in excessive consumption of alcohol, education becomes at risk. People drop out of school, and illiteracy level increase in the community. In addition, the progress and development of any community depends on the health of its people. Therefore, when alcohol puts the health of its members at risk, community suffers in the long run. Alcohol affects both female and male differently. Men who consume alcohol, daily have an increased risk of health risks. Such men can experience cancer and heart disease in the long-term and low energy to sexual difficulties in the short-term (Brick, 2004). Men are more likely to suffer from liver cirrhosis, and have higher chances of being diagnosed with high blood pressure. Nearly 26. 6% of deaths among men of between 16 and 24 years old can be attributed to alcohol consumption. Men tend to be more dependent of alcohol (Marshall, 2000). Drinking too much alcohol damages a person’s body organs such as liver, brain, stomach, heart,and intestines. Brain is adversely affected because the brain cells die leading to loss of memory, learning difficulties, brain disorders, confusion, and problems with attention (Blane amp; Leonard, 1999). Liver is highly affected because of the great possibility of developing cancer in the liver, throat and mouth. The stomach may also acquire ulcers. Long-term drinking has also been linked to stroke and heart failure. The nervous system can also experience damage leading to behavioral and physical problems (Dasgupta, 2011). These problems affect health, family, community, and education in the long-term because of expenses associated with alcohol consumption, and possible treatment measures. Alcohol poses many effects on the body such as fertility. It reduces levels of testosterone. As a result, it could decline sperm quantity and quality, and lead to loss of libido. Alcohol is toxic to the testicles, and affects hormones. It could hamper production of sperms, hinder them from developing properly, and slow their movement towards the egg. Alcohol can also limit the liver from metabolizing vitamin A properly. It also depresses the nervous system, and could result in difficulty in getting and keeping erection (Peters, 2008). Many young adults do not realize that alcohol has a fattening effect. Alcohol can reduce the amount of fat that the body burns for energy. The human body makes several attempts to eliminate alcohol 1 / 3 very fast as it cannot remain in the body for storage. The process takes priority over nutrient absorption and burning of fat. In the long-term, there could be a serious damage in the appearance. Other effects include loss of hair in the body, breast enlargement, and withering of testicles (Dasgupta, 2011). Alcohol has also been associated with worsening of skin disorders such as rosacae. Rosacae skin disorder is responsible for expansion of blood vessels in the face making it redder. Heavy drinking can cause the appearance of pus spots and red bumps. It has also been linked to inflammation, pain and swelling in the joints. The effect is common among men of between 30 and 60 years old (Hannigan, Spear, Spear amp; Goodlett, 1999). As mentioned earlier, heavy drinking increases the chances of heart disease, liver damage, bone disease, cancer, anxiety and depression, and type II diabetes. Heavy consumption of alcohol also caused inflammation on the pancreas and irritates stomach. These effects indirectly affect family, community and education (Peters, 2008). Women are not safe from alcohol either. The body of women takes much time to process alcohol compared to men. Women feel more effects of alcohol than men even when they drink the same amount. The fertility of women is at risk with heavy consumption of alcohol. Women are high risk of acquiring breast cancer, and adverse impacts of the menopause. Women are advised in several studies to avoid alcohol when trying to have a baby. Alcohol disrupts menstrual cycle in women, and limits their chances of conceiving. These are bad effects on the body, and not good for family and community in general. Therefore, alcohol should not be legal in the United States (Hannigan, Spear, Spear amp; Goodlett, 1999). While drinking less alcohol may make one look good, heavy consumption causes bad skin, tired eyes, and weight gain for both female and male. It also interferes with people’s sleep. Heavy consumers of alcohol often wake up and feel like they have not had enough rest. Alcohol dehydrates the body and skin. It deprives the skin of certain vital nutrients and vitamins. Hence, it is not good for health. Alcohol is also responsible for much divorce among couples due to fights in the family, and lack of finances for family upkeep (Dasgupta, 2011). Alcohol is depressant. It means that alcohol calms people down, and slows down some body organs. With only 0. 05% level of blood-alcohol, a person begins getting dulled judgment, and his or her inhibitions get released. They then become clumsy and start having slurred speech with only a 0. 10% blood-alcohol level. At 0. 30% level of blood-alcohol, one nearly becomes unconscious. Any addition after that becomes extremely dangerous since at 0. 45%, one can get into a coma. Brain shuts down from 0. 70% and stop controlling the heart, breathing, and one may end up dead. Other short-term effects include blurred vision, blackouts and insomnia. These can lead to injuries, accidents, and even death. Drinking alcohol also causes hangover in the next morning, which is associated with nausea, headaches, heartburn, fatigue, thirst, and dizziness. There are many side effects of alcohol (Peters, 2008). Conclusion In conclusion, consumption of alcohol should be reconsidered in U. S because of its adverse effects on health, family, community, and education. Alcohol should only be taken when necessary. The side effects are adverse and continue to destroy people across the world. Therefore, alcohol should not be legal in the United States because it is impacts negatively on health, family, community and on a person’s education. References Begleiter, H. , amp; Kissin, B. (1996). The pharmacology of alcohol and alcohol dependence. New York: Oxford University Press. Blane, H. T. , amp; Leonard, K. E. (1999). Psychological theories of drinking and alcoholism. New York [u. a. : Guilford Press. Brick, J. (2004). Handbook of the medical consequences of alcohol and drug abuse. New York: Haworth Press. Dasgupta, A. (2011).

Improving Eye Care In Rural India Communications Essay

Improving Eye Care In Rural India Communications Essay CATARACT refers to the clouding of the lens in the human eye, affecting vision. In the developing world, cataract is the cause for blindness in nearly half the blind population i.e. 50% of the recorded number of blindness cases. While problems of inaccessibility continue to plague many parts of the developing world nearly two-thirds of the population in many developing countries are unable to access quality medical resources infrastructure primarily because quality medical care or eye care in this case is still urban-centric all hope is not lost yet. In India too, where 90% of the cases are treatable, most Indians lack access to quality eye care. In the early 1990s, the country was home to a third of the worlds blind people and here too cataract blindness was the major cause in most cases. The World Bank decided to step in and help the Indian government deal with the problem, spending $144.8 million between 1994 and 2002 on the Cataract Blindness Control Project under which 15.3 million eye surgeries were performed. The World Bank-funded project was largely implemented in northern India and it helped reduce the incidence of cataract, in the states that were covered under this project, by half. But India is a very big country and it definitely needs a more sustainable approach to dealing with cataract blindness given that it has a sizeable ageing population. One such approach is the Aravind Eye Care System, a three-decade old campaign that has been fighting cataract blindness predominantly in the southern Indian state of Tamil Nad u. Working in the same direction is the L V Prasdad Eye Institue, operating from the neighbouring state of Andhra Pradesh. Both Aravind and LVPEI, setup in the mid 1970s and the mid 1980s respectively, have been focused on taking quality eye care to the rural masses from the very beginning, most of it free of cost. In the larger context, this paper discusses how private entrepreneurship is taking quality Eye Care to the rural masses in India. This paper will discuss the Eye Care delivery model aimed at fighting Cataract Blindness in the context of the Culture-Centered Approach (CCA). The Culture-Centered Approach advoates greater engagment with the local culture, â€Å"through dialogues with community members†, to ensure â€Å"equitable† and â€Å"accessible† healthcare across communities (Dutta-Bergman, 2004a, 2004b; Dutta and Basu 2007 as quoted in Dutta, 2008). Furthermore, this paper will use the Extended Technology-Community-Management (TCM) model (Chib Komathi, 2008) to explain the intersections between technology, community and the management of information communication technologies (ICT) in the context of the CCA and the Eye Care delivery model adopted by the private healthcare players i.e. the non-governmental organisations (NGOs). According to the TCM model (Lee Chib, 2008), the intersection of ICT characteristics of technology, along with the dimensions of software and hardware, project management dimensions of financial requirements, the regulatory environment, and stakeholder involvement, along with local community participation â€Å"will ultimately lead to sustainable ICTD interventions.† Culture-Centered Approach Globalisation has led to an increasing realisation that the Biomedical[6] model of healthcare is limited in scope when engaging in issues of global health (Dutta, 2008). Furthermore, Dutta (2008) says that many societies now feel the need to â€Å"open up the spaces of health communication to the voices of cultural communities† i.e. there is now greater awarness of the need for better engagement with marginalised communities. Culture is dynamic. That culture has an important role to play in health communication is better understood today. But this concept began attracting widespread attention only in the early 1980s, especially in the U.S. when healthcare practitioners felt a need to adopt multiple strategies to address the health-related issues of a multicultural population (Dutta, 208). â€Å"This helped question the universalist assumptions of various health communication programs† aimed at the developing nations and the so called third-world nations   (Dutta, 2008). The Culture-Centered Approach was born out of the need to oppose the dominant approach of health communication, located within the Biomedical model, where health is treated as a â€Å"universal concept based on Eurocentric[7] understandings of health-related issues, disease and the treatment of diseases† (Dutta, 2008). According to Dutta (2008), the CCA is a better alternative to understanding health communication because it is a â€Å"value-centered† approach. The CCA is built on the notion that the â€Å"meanings of health† cannot be universal because they are ingrained within cultural contextsm, he argues.  Ã‚   The CCA has its roots in three key concepts i.e. ‘structure, ‘agency and ‘culture. The term ‘culture refers to the local context within which so called health meanings are created and dealt with. ‘Structure encompasses food, shelter, medical services and transportational services that are all vital to the overall healthcare of various members of a community. ‘Agency points to the â€Å"capacity of cultural members† to negotiate the structures within which they live. It must be noted that ‘structure, ‘agency and ‘culture and entwined and they do not operate in isolation. Dutta (2008), in his book Communicating Health, further elaborates that the CCA throws light on how the dominant healthcare ideology serves the needs of those in power. Powerful members of society create conditions of marginalistaion. Therefore the focus of the CCA lies in the study of the intersections between ‘structure, ‘agency and ‘culture in the context of marginalised communities. To understand better the problems faced by the marginalised, the CCA advocates the healthcare practitioners engage in dialogues with members of the concerned community. Each community has its own set of stories to share and this is vital to understanding the local culture. The CCA also aims to document resistance, of any kind, to dominant ideologies as this helps strengthen the case of the CCA against the dominant healthcare model. The CCA, according to Dutta (2008), provides sufficient scope to study physician-patient relationships, in a bid to ultimately improve the healthcare deli very model. Adopting the CCA is just half your problem solved; the integration of the CCA with the Extended TCM model completes the picture.   The Extended TCM Model The TCM model (Lee Chib, 2008) argues that the larger question of social sustainability depends on both local relevance and institutional support. The TCM Model proposes that the intersection of ICT characteristics of technology, along with the dimensions of software and hardware, project management dimensions of financial requirements, the regulatory environment, and stakeholder involvement, along with local community participation, will ultimately lead to sustainable ICTD interventions (See Figure 1.1). The TCM model was further revised. Community was subdivided to include: modes of ownership of ICT investments and profits; training of community users both in the use and in technology management; and the basic needs of the community. Furthermore, Sustainability was also subdivided into financial and social (see Figure 1.2). Chib Komathi (2009) found that the TCM Model was inadequate as it could not examine the critical issue of vulnerability. Therefore, their study improved on this inadequacy by adding crucial factors and variables relating to vulnerability. They extended the TCM model, and called it the Extended Technology-Community-Management (Extended TCM) model (see Figure1.3).  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This new framework on ICT planning accounts for community involvement, the management components, the overall design of technologies such as telemedicine or tele-consultation, and evaluation of existing vulnerabilities in the community where these technologies are implemented. It identifies four dimensions of vulnerabilities influencing technology implementation among the rural poor: economic vulnerability, informational vulnerability, physiological/psychological vulnerability, and socio-cultural vulnerability. Chib Komathi (2009) further explain each dimension of vulnerability: Physiological and psychological vulnerabilities refer to the physical and mental well-being of an affected person, or a specific community. Informational vulnerability deals with the access to and availability of information within affected communities. Informational resources include personal documents, books and critical data, opinion leaders and professional experts,. The lack of such resources affects the capabilities of people who are dependent on them. In a rural setting, informational vulnerability is further augmented by the low literacy levels and lack of pertinent â€Å"technological skills necessary to enable the learning and processing of information.† The economic vulnerability is sparked off by the loss of livelihood i.e. a loss of activities that otherwise financially support households and sustain economic growth in a rural setting. The socio-cultural vulnerability of communities is determine d by â€Å"the structure and values of a given society that define human relationships in communities.† Hierarchies in any society (gender, race, religion, caste, age and class egalitarianism within communities) or a community often dictate access to resources and assets, and the decision-making power of people. Cataract Blindness in India At the outset, one has to understand the sufferings of the blind in India, in a rural setting blindness, irrespective of the cause, results in a loss of livelihood for an individual. In rural India, like elsewhere, this would translate into one less earning member in the family, making the blind person a burden to his/her family. This leads to a loss of dignity and status in the family. In effect, blind people in rural India, like in many other societies, are marginalized. Enter Aravind and LVPEI, who continue to strive to help blind people in rural India and empower them by giving them back their sight. There are many causes of blindness, like Diabetes for instance. But Cataract is one of the leading causes of blindness in the developing world. Records in India show that Cataract is the most significant cause of blindness in the country (Nirmalan et al. 2002 Murthy et al. 2001).Cataract, reports say, is responsible for 50 to 80 per cent of the bilaterally blind (Thulsiraj et al. 2003 Thulsiraj et al. 2002).The elderly are more at risk of developing Cataract. India aims to eliminate needless blindness by 2020 in line with ‘Vision 2020: the right to sight initiative, launched jointly by the World Health Organisation (WHO) and the International Agency for Prevention of Blindness (IAPB). Many organisations worldwide are also working in the direction of eliminating needless blindness (Foster, 2001). The government in India and the World Bank launched the Cataract Blindness Control Project in seven states across India in 1994.From close to 1.2 million cataract surgeries a year in the 1980s (Minassian Mehra 1990), Cataract surgical output tripled to 3.9 million per year by 2003 (Jose, 2003). In 2004, World Health Organization (WHO) data showed that there was a 25 per cent decrease in blindness prevalence in India (Resnikoff et al. 2004) the reason(s) could be the increase in Cataract surgeries countrywide. But there is a larger problem here, that of population growth. The aged population in India (those aged over 60 years) population which stood at 56 million people in the year 1991 is expected to double by the year 2016 (Kumar, 1997). This ‘greying of Indias population only suggests that the number of people ‘at-risk of developing Cataract is constantly on the rises. In the larger sense, this paper aims to show how private entrepreneurship in India is taking quality eye care to the rural masses in that country. This paper aimed to discuss the same through two case studies, that of the Aravind Eye Care system as well as the L V Prasad Eye Institute (LVPEI). Unfortunately, email correspondence with LVPEI failed to elicit responses from this organization. Given the limitations of this study, including time constraints, this paper will explain the Aravind Eye Care system in the context of rural Eye Care in India and the fight against Cataract Blindness all this within the framework of the CCA. Furthermore, this paper will critique the business model of NGOs like Aravind in the context of the Extended TCM model, including whether for-profit organisations are using the rural masses to support their business model. In particular, what is the role of the healthcare provider in this case disseminate knowledge to the grass-roots or live-off their healthcare delivery model? Aravind Eye Care Dr. G. Venkataswamy had a very simple vision when he first setup Aravind Eye Care in 1976: â€Å"Eradicate needless blindness at least in Tamil Nadu, his home state, if not in the entire nation of India.† Aravind began as an 11-bed private clinic in the founders brothers house in the southern Indian city of Madurai. Today, the Aravind Eye Hospital (AEH) at Madurai is a 1,500 bed hospital.   In addition to Madurai, there are four more AEHs in Tamil Nadu (Aravind.org) with a combined total of over 3,500 beds. By 2003 the Aravind Eye Care System as we know it today was up and running. The System continues to operate under the aegis of a nonprofit trust named the Govel Trust it comprises of a manufacturing facility (for manufacturing synthetic lenses, sutures, and pharmaceuticals related to eye care); eye hospitals; education and training (graduate institute of ophthalmology); research facilities (complete with an eye bank);) and a center for community outreach programs (Prahlad, 2004). A typical day at Aravind now has doctors performing about 1,000 surgeries including free surgeries; 5-6 outreach camps in rural areas where about 1,500 people are examined and close to 300 people are brought to an AEH for eye surgery (TED, 2009). How does Aravind do it? The organisation has setup ‘vision centers or clinics in remote villages, fitted with basic eye care equipment. Each clinic is manned by an ophthalmic assistant and â€Å"these clinics perform basic examinations; prescribe corrective lenses and treat minor ailments.† If an eye ailment can be cured by the application of eye drops, these clinics are equipped to do so.   For more complicated cases, such as Cataract Blindness, the patient consults an ophthalmologist based at an AEH in a nearby city via the videoconferencing route. If the patient needs corrective surgery, he/she is asked to hop onto a bus waiting outside the ‘vision centre that takes them to the nearest Aravind base hospital. The patients are operated upon the following day; they spend a day in post-operative care and then take a bus back to their villages all free of cost (Laks, 2009).[8] But it wasnt all gung-ho in the beginning; more hard work than anything else. There was no specific Outreach team. Everyone in the pool was asked to participate in Outreach programme. â€Å"In the beginning (in 1976-77) Dr. V and a small team would visit villages and conduct eye screening camps. Those who required Cataract surgery would then be advised to visit the base hospital for surgery. But Dr .V found that a majority of those advised to undergo surgery would dropout, owing to socio-economic factors like fear of surgery; lack of trust on restoration of sight; no money to spend for transport, food and post operative medical care and (their) resistance to western medicine,† according to the head of Outreach activities at Aravind, R. Meenakshi Sundaram in his email response to my queries. These barriers were gradually addressed through various strategies. â€Å"We decided to involve village chiefs and local organizations to take ownership of the Outreach programmes, in terms of identifying the right location for the Eye Camp and providing the required support facilities. Their help was key to community mobilization. We organized a team to standardize the quality in Eye Care service delivery. Furthermore, Dr. V focussed his attention on building hospitals like ones home where we normally expect basic culture and values,† said Mr. Sundaram. â€Å"Fear of surgery was a common barrier in addition to other factors. Perhaps the acceptance for surgery was low in the beginning. But it was constantly explained at the community level whenever camps were organized as the programme aims to serve people at large. Particularly, in the year 1992 the Intra Ocular Lens (IOL) was introduced and the rural community did not believe in having a ‘foreign particle in their eyes. We came across a lot of myths. Those issues were addressed thru counselling,† added Mr. Sundaram. Realizing the impact of counselling, a cadre was developed within the System in 1992 and seven counsellors were trained in the first batch of counsellors training. They were given a basic orientation about common eye problems with a special focus on IEC. ‘Patient counsellors i.e. patients who had undergone eye surgery were asked to help the Outreach team. â€Å"They played their role in explaining eye problems in the local language and tried to help others realize the consequences of failing to accept surgery. Considering the myths, a real IOL was used as education material to help the rural folk understand the concept of the IOL,† Mr Sundaram said. The number of counsellors has steadily risen ever since and stands at 179 at present. How is the Aravind Eye Care System possible? Financial self-sustainability was the primary focus from day one at Aravind. Initially, the organization was given a grant by the government to help subsidize the treatment costs for eye camp patients (Prahlad, 2004) and the Govel Trust also pledged properties to raise money from banks in the early days. Prahlad (2004) states that the Madurai AEH, the first, was always self-supporting as far as recurring expenditures were concerned. Within the first five years of operation, the Madurai AEH had accumulated surplus revenues for further development and for the construction of four other hospitals in the Tamil Nadu state. He adds that over the years, the patient revenues generated from its five hospitals located in five cities finance the Aravind Eye Care System to a great extent. Furthermore, Aravind has also taken to the management-contract route and it manages two hospitals outside of its home-state. While city folk are charged market rates for each consultancy and for surgery, patients in remote villages pay just Rs. 20 for three consultancies or SGD 0.60. (TED, 2009). Those who can afford to pay, the urban folk who visit Aravinds hospitals in urban locations on their own, do not get discounted rates. Such a system of cross-subsidies ensures that only 45 percent pay while the rest are not charged at all i.e. about five out of every 10 patients examined at Aravind can be provided free eye care, including eye surgery (TED, 2009). A cross-subsidising financial model is not the only mantra[9] to Aravinds success. Having been in the business of delivering quality Eye Care for over three decades now, the System is well-positioned to leverage on the Aravind brand-name to attract donations. Over the years, the organization has received international recognition for its work and this includes the 2008 Gates Award for Global Health, and this years Conrad N. Hilton Humanitarian Prize that carries a US$1.5 million cash award. Last but not the least is the money that flows into Aravind in the form of specific project-funding. One such sponsor is the London-based ‘Seeing Is Believing (SiB) Trust, a collaboration between Standard Chartered Bank and the International Agency for Prevention of Blindness (IAPB). Since 2003, ‘Seeing is Believing has grown from a staff initiative to raise enough money to fund a cataract operation for each member of the Bank to a US$40 million global community initiative. I wrote to Standard Chartered Bank (SCB) asking them why they decided to partner with Aravind and LVPEI. â€Å"LV Prasad Eye Institute, Hyderabad, as well as Aravind Eye Hospital are premier eye care institutes in the country.   India has a vast geographic spread and both these institutions work in different geographic zones of the country.   LVPEI is prominent in the south-eastern states of the country while Aravind is prominent in the southern states of India,† said Pratima Harite, Manager (Sustainability), Corporate Affairs- India in her email response to my queries. The rationale behind the India Consortium Project is the ‘vision centre concept that a significant proportion of eye problems corrected or detected at the primary care level has substantial savings to the individual and to the communities.   â€Å"Based on the success of LVPEIs Vision Centre model, the India Consortium Project proposed scaling up the development of Vision Centres in a co-ordinated matter in six states across the country.   For this, LVPEI sought support from four key implementing partners premier eye care institutions themselves across the country,† added Ms. Harite. Singapores Temasek Foundation (TF) part-funds SiB activities in India, particularly in capacity building i.e. in enhancing the training component of the SiB programme. Is this a viable business model? Aravind has perfected the model over the last three decades. They have the technology, behind the video consultation, in place â€Å"a low-cost wireless long-distance network (WiLDNet)† put together by the Technology and Infrastructure for Emerging Regions (TIER) research group at the University of California, Berkeley, California, USA.[10] This was done to overcome the issue of zero internet connectivity or slow connections that do not support video consultations in remote villages (Laks, 2009). In 2004, a mobile van with satellite connectivity was introduced to facilitate Tele-Consultations. The Indian Space Research Organisations (ISRO)[11] help was sought to this extent. The ‘vision centres can easily communicate with the base hospital (some 30 to 40 kms.) via satellite. These ‘vision centres effectively address the issue of accessibility, affordability and availability of quality Eye Care. â€Å"A series of centres were started across the Tamil Nadu state. Each base hospital is connected with a group of vision centres. At present, we have 10 ‘vision centres that operate on WiFi. The rest run on BSNL[12] broadband connections,† Mr Sundaram said. Aravind has the delivery system in place. A sound understanding of the local culture that in many cases is averse to western medicine and where modern-day medicine is not the first and only option to treat any disease or ailment. Why would a villager trust a doctor who drives down one fine morning and says he would like to operate upon them? Aravind begins by appointing a volunteer group for each community; some of these volunteers are further trained to serve as ophthalmic assistants and even as nurses in Aravinds hospitals. In a rural setting, rural folk trust their friends, neighbors, and their own people first. It is about creating ownership to the problem, like Mr. Sundaram said, and then partnering with the community to solve the problem. Aravinds financial results for the year 2008-09 were healthy. It raked in (income) US$22 million and spent (expenditure and depreciation) US$ 13 million.[13] Discussion That Aravind and other NGOs working in a similar direction, like LVPEI for instance, use the Culture-Centered Approach, as elaborated by Dutta (2008), in delivering quality eye care to rural India is quite clear. Aravind, in particular, has successfully integrated the CCA with the Technology-Communication-Management (TCM) model, as elaborated by Lee Chib (2008) to create a sustainable model for Eye Care delivery. ‘Accessibility and ‘affordability are the key factors in such healthcare models. In taking this route, one has to ensure that the technologies chosen for the job are cost-effective and easy to implement because capital expenditure and operational expenditure do play a vital role in determining the cost of healthcare services. Aravind has been able to keep the cost of Eye Care delivery considerable low consistently for many years now. Critics argue that organizations like Aravind are feeding-off their model. At this point, it is important to understand the ground-realities. In India, the divide between the urban ‘haves, and the rural ‘have-nots is only getting wider with each passing year. According to UN projections released 2008, India would urbanize at a much slower rate than China and have, by 2050, 45% of its population still living in rural areas (Lederer, 2008). The Government in India is not doing enough to address the plethora of health issues that plague [the various regions and communities in] the country. The flagship scheme to improve healthcare services in rural India, the National Rural Health Mission    launched in 2005 as a seven-year programme has many of its goals yet to be achieved, and the government is now considering extending it to 2015, according to recent media reports. Despite many a government claims and many a government schemes several villages in states across India co ntinue to depend on the private sector for quality healthcare or in this case Eye Care. Given this situation, Aravind and LVPEIs work in the direction of providing affordable Eye Care and free eye surgeries to five out of every ten patients they examine is a commendable feat.   A second question raised in this study is, what is the role of the healthcare provider in this case disseminate knowledge to the grass-roots or live-off their healthcare delivery model? Aravind is doing its part in disseminating knowledge to the grass-roots. Most ophthalmic assistants who man the ‘vision centers are community members trained by Aravind. But one has to understand that the act of knowledge dissemination in a remote rural setting has its challenges i.e. tackling illiteracy, basic awareness among others and these challenges cannot be addressed in just a few years. The India Consortium Project, sponsored by SCB and Temasek Foundation, set a target to set up 40 ‘vision centres by 2010. So far, 32 ‘vision centres are operational and the remaining will be operational this year, according to Ms. Harite.   On the flip side, a study by Murthy et al. (2008) argues that the goals of the ‘Vision 2020: the right to sight initiative to eliminate Cataract blindness in India by the year 2020 may not be achieved. But this should not deter those working in this direction. Both the public and the private sector must continue to fight Cataract Blindness because that is the only way to tackle the problem at hand. Last but not the least, this study recommends that NGOs operating in the healthcare space look at both the CCA and the TCM model to ensure better service delivery. References Chib, A. Komathi, A.L.E. (2009). Extending the Technology-Community-Management Model to Disaster Recovery: Assessing Vulnerability in Rural Asia. Submitted to ICTD 2009. Dutta, M. J. (2008). Communicating Health. Polity Press, Cambridge, U.K. Foster A. (2001).Cataract and Vision 2020 the right to sight initiative. British Journal Ophthalmology, 85, 635-639. Jose R, Bachani D. (2003). Performance of cataract surgery between April 2002 and March 2003. NPCB-India;2:2. Kumar S. (1997). Alarm sounded over Greying of Indias population. Lancet, 350, 271 Lee, S., Chib, A. (2008). Wireless initiatives for connecting rural areas: Developing a framework. In N. Carpentier B. De Cleen (Eds.), Participationand media production. Critical reflections on content creation. ICA 2007Conference Theme Book (pp. 113-128). Newcastle, UK: Cambridge Scholars Publishing. Lederer, E.M. (2008). Mint. Retrieved April 16, 2010, from http://www.livemint.com/2008/02/27231012/Half-the-world8217s-populat.html Laks, R. (2009). Videoconferencing and Low-cost Wireless Networks Improve Vision in Rural India. Comminit.com. Retrieved April16, 2010, from http://www.comminit.com/en/node/301452/307 Minassian DC, Mehra V. (1990). 3.8 Million blinded by cataract each year: Projections from the first epidemiological study of incidence of cataract blindness in India. Br J Ophthalmol, 4, 341-3. Murthy GV, Gupta S, Ellwein LB, Munoz SR, Bachani D, Dada VK. (2001). A Population-based Eye Survey of Older Adults in a Rural District of Rajasthan: I, Central Vision Impairment, Blindness and Cataract Surgery. Ophthalmology, 108,679-85. Nirmalan PK, Thulasiraj RD, Maneksha V, Rahmathullah R, Ramakrishnan R, Padmavathi A,et al. (2002). A population based eye survey of older adults in Tirunelveli district of south India: Blindness, cataract surgery and visual outcomes. Br J Ophthalmol, 86, 505-12. Prahlad, C. K. (2004). The Fortune at the Bottom of the Pyramid. Wharton School Publishing, Pennsylvanial, U.S. Resnikoff S, Pascolini D, Etyaale D, Kocur I, Pararajasegaram R, Pokharel GP,et al. (2004). Global data on visual impairment in the year 2002. Bull WHO, 82, 844-51. TED. (2009). Thulasiraj Ravilla: How low cost eye care can be world class. Retrieved April 16, 2010, from http://www.ted.com/talks/lang/eng/thulasiraj_ravilla_how_low_cost_eye_care_can_be_worl