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6 “Rural” Health in Modern Southeast Asia / Atsuko Naono

Tim Harper Indiana University Press ePub

6   “Rural” Health in Modern Southeast Asia

Atsuko Naono


Over the course of the past century in Southeast Asia, the term “rural” received sometimes sporadic and sometimes considerable attention from colonial governments, postcolonial governments, and international and private organizations concerned with health—such as the League of Nations Health Organization (LNHO), the Rockefeller Foundation, the World Health Organization (WHO), and other non-governmental organizations (NGOs). When and how rural medicine began to be viewed differently from urban medicine, when colonial doctors began to see the medicine differently in rural space and urban space, and when the idea that the village was a place where health was dealt with differently from anywhere else, however, are all questions that have hardly been dealt with directly in the literature on the history of medicine in Southeast Asia. Government records do not make the task any easier. Colonial and postcolonial medical reports are rich in statistics on rural and urban areas, but this terminology is rarely defined. While we might easily define Bangkok, Jakarta, Manila, Saigon, or Singapore as urban areas, in the colonial period, just as today, no single definition of what a rural area constitutes has been agreed upon. During the colonial period, the government authorities identified the village as the major unit of rural society, giving the village an importance and attributing to it administrative functions that it probably never had. These views influenced scholarship on Southeast Asia into the 1980s. It has been only recently that scholars have tried to understand rural Southeast Asia from the inside.1

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CHAPTER FOUR Organizational Theory

Jan J. Nyberg University Press of Colorado ePub

This chapter examines organizational theory. While some of the theory is anything but caring, it is our goal to see through Watson’s (1985) “new lens” and try to apply caring to the organizational literature. Organizational theory is a huge body of literature; we will deal with the parts of it that have influenced my thinking about nursing administration. Other people may chose other parts of organizational theory, but they are not necessarily interested in the caring theory specifically. After a rather critical review of bureaucracy, I will introduce you to some of the more caring authors I have found.

No one can really say when organizations began. Jackson et al. (1986) view the history of organizations as originating thousands of years ago when people organized for protection, food gathering, and building shelters. These authors believe that humans have a tendency toward organizing—that it is a part of instinct and evolutionary growth. Certainly, humans seem to want to organize. We work in organizations, we worship in organizations, we play in organizations. Some people seem to be “joiners” more than others, but no one is totally uninfluenced by some organization. Our biggest forms of organization are governments, which have been around since recorded history. Certainly, there are good and bad things about organizations, but Jackson et al. remind us that in the establishment of organization, individuals must be willing to agree to the establishment and adherence to rules. By forming group goals and preventing chaos, each member has to perform certain functions and refrain from untoward behaviors that might be detrimental to the group. So, organizing is a “mixed bag.” It can be very helpful, but it requires some loss of individual freedom. Morgan (1986) agrees with that premise and believes that the imposition of rules can lead to the diminishment of creativity and freedom for the soul. In health care, nurses’ jobs vary in freedom and domination. Traditionally, hospital nursing has been very structured, and many nurses feel the sense of domination. Many hospitals are now experimenting with new structures that would give nurses more freedom in their jobs. Other job settings, such as home care, are less structured.

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CHAPTER EIGHT. Psychoanalytic observations on five cases of right perisylvian damage: failure of mourning

Karen Kaplan-Solms Karnac Books ePub

In the previous three chapters, we considered psychoanalytic observations on patients who sustained damage to different parts of the left perisylvian region of the brain. In this chapter, we summarize the very different presentations of patients who sustained equivalent damage on the opposite side of the brain: in the perisylvian region of the right cerebral hemisphere (Fig. 8-1). In all of the cases to be described in this chapter, the damage in question was caused by cerebrovascular accidents in the distribution of the right middle cerebral artery.

In analysing these cases, we will proceed somewhat deeper beneath the surface of conscious awareness than was necessary in our analyses of the previous three cases (chapters five, six, and seven). This is because, as the reader will soon see, damage to the right perisylvian region of the brain produces far more profound disturbances of personality, emotion, and motivation than does equivalent damage on the left-hand side of the brain. This, in turn, reveals that the metapsychological functions of the right perisylvian convexity involve somewhat deeper levels of ego organization than did those of the equivalent region of the left hemisphere. We hope in this chapter to begin to demonstrate how the method that we are recommending in this book can be used, not only to gain an understanding of the neural correlates of our psychoanalytic model of the mind, but also to make a psychoanalytic contribution to contemporary neuropsychology. If the fundamental mental mechanisms that underlie the surface phenomenology of human personality, motivation, and emotion are indeed inaccessible to simple behavioural observation due to the dynamic resistances that Freud described, then it certainly follows that these mechanisms cannot be adequately characterized and understood by conventional neuropsychological research techniques, which do not take account of the mental processes that occur beneath those resistances.

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Chapter 5: Confidentiality

Michele Mathes Sigma Theta Tau International ePub

As a nurse, you have many professional responsibilities that are spelled out in the standards and guidelines for practice. So far, this book has compared and contrasted your legal duties and your ethical duties, which are equally important pillars in professional practice. Issues related to patient confidentiality and privacy, like most areas of healthcare practice, involve legal and ethical obligations.

This chapter explores your ethical and legal duties with respect to confidentiality and privacy. The ethical obligation to not disclose information about patients reaches back nearly 2,500 years, to the time of Hippocrates, whose oath requires the physician to pledge that “what I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about” (Tyson, 2001).

NOTE Hippocrates, a Greek physician born in 460 B.C., still influences healthcare worldwide because of the ethical standards he espoused. Much of what we know about Hippocrates is derived from others’ writings.

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2 Ethical Decision-Making: A Framework for Understanding and Resolving Mental Health Dilemmas

Connie M. Ulrich Sigma Theta Tau International ePub

–Marna S. Barrett, PhD

Clinical Associate Professor of Psychology in Psychiatry University of Pennsylvania Perelman School of Medicine

• Ethical dilemmas are inherently troublesome, primarily because they involve at least two competing yet equally “right” choices rather than a right versus wrong choice.

• Distinct from other branches of medicine, psychiatry raises unique challenges for ethical decision-making. Only in mental health are we asked to determine a person’s competence, restrict a person’s right to self-determination, participate in legal decisions about a person’s culpability, and engage with society in a reciprocal relationship of influence.

• Ethical principles such as autonomy, beneficence, nonmaleficence, fidelity, justice, and empathy are ideals to which we strive. Although useful for understanding the complexities of a dilemma, they are not sufficient for problem resolution.

• A framework for ethical decision-making is imperative for developing a consistent and effective personal standard for resolving ethical dilemmas. Key elements of such a framework include identifying and clarifying the issue, determining whether the situation is a “right versus wrong” or a “right versus right” dilemma, evaluating the principles involved, creating a “trilemma,” weighing benefits and burdens, consulting, considering possible outcomes, making document decisions, and reviewing and reflecting on the process.

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