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Available from: the reproductive tract just prior to antibiotic spray buy 250 mg sumycin otc and during menstruation shot of antibiotics for sinus infection discount sumycin 500mg mastercard, Module two Menstrual hygiene – getting started Part of Menstrual hygiene matters; A resource for improving menstrual hygiene around the world antimicrobial activity of xylitol cheap sumycin 500mg on-line, written by Sarah House virus scan software sumycin 500 mg cheap, Therese Mahon this module will cover antibiotic resistant upper respiratory infection effective sumycin 500 mg. International • Undertaking advocacy on menstrual hygiene and dissemination of good practice. The table also hygiene considerations into their guidance and identifes some of the factors that need to be considered professional training, with a requirement to co-ordinate for effective co-ordination and collaboration between (and and communicate across sectors. WaterAid to menstrual hygiene realised this was an area of hygiene that had to be addressed. These discussions exposed the myths and misconceptions around menstruation and gave confidence to even the most silent women. Giving women and girls support, information and facilities for menstrual hygiene management can empower them and enable them to contribute more in society. A • As the head of the household who controls the fnances, mother said, “My husband expects me to look after to ensure female family members can afford appropriate my daughters. No special attention is paid • As professional engineers, social development to their wives in terms of money, food materials and specialists, managers or medical professionals, workload. Girls and women have been known to have been so desperate for sanitary products that they have traded sex or favours with men to be able to obtain them (refer to Module 3. He proposed a fundraising football tournament, and that I was going to bleed every month until I become too old. With the money, the group bought 1, 000 sets 10 of sanitary towels and over a month gave them to 500 girls in more than ten schools in slums across Nairobi. With their advice, he came up with a plan, “After our meeting, I invited Amina Khatum from Char Bramgacha to come to my village to speak about menstrual hygiene. Because Amina is from a village that is very close to ours, some of the Nural Islam working with his female colleagues to promote women knew her. What is budgeted for will depend on the focus of the Possible budget items include: programme, but be careful not to overlook elements that will be essential to ensure the quality of the programmes and Preparing staff and partners engage the women and girls in the programme’s design and • Staffing for the menstrual hygiene elements of the feedback. In development contexts, the issue gender disparities are stark this will be even more of sustainability of access to the products should be a key crucial if women and girls are to be able to engage consideration. The costs can be limited if menstrual hygiene is integrated into existing the following example from Tanzania highlights the costs training programmes or regular meetings. The piloting of will leak on their school clothes and be embarrassed and the distribution of the book has teased by other school children, particularly boys. Module three Menstrual hygiene – sanitary protection materials and disposal Part of Menstrual hygiene matters; A resource for improving menstrual hygiene around the world, written by Sarah House, Therese Mahon and Sue Cavill (2012). Programme considerations when choosing which sanitary materials to One of the women told the group that she had never 1 used a pad until she visited her daughter in the city support and had no other form of sanitary protection with her. Toilet paper or tissues • Easily available in the local • Loses strength when wet and can fall apart. It is not yet in commercial production but eforts are being made to make this happen. It also includes a range of soft materials that can be inserted into the pad holders, the number depending on how heavy the fow is. A tampon is a form of sanitary protection that is inserted into the vagina by the woman or girl and soaks up the blood before it comes out of the body. The applicator is a double tube that is used to push the tampon into place and is thrown away after insertion. It comes in diferent sizes and is inserted into the vagina to catch the menstrual blood. Produced by: Duet, ReProtect Inc (Photo: S House) the Duet menstrual cup (pictured left) is currently undergoing regulatory approval (2011). Panties, pants, knickers, underwear Period pants Produced in: China, purchased in Japan Underwear with a thin rubber lining fxed internally where leakage can occur. They are used in conjunction with other products, such as pads or tampons, and provide an additional level of protection. To resolve this, a cardboard doll wearing the napkin was developed as a demonstration model. Large-scale commercially Formal registration of the commercial company in the country in which it is based, produced sanitary pads and also all countries to which the product is to be exported. Monitoring and follow-up support: • Regular follow-up support to the group for the initial few years after establishment. They have learned this through the challenges they faced assisting women’s self-help groups to become self-sustaining. Even when packaged for delivery at the level of the primary health centre, the commodity is lightweight but bulky, needing adequate space which is free of moisture and pests/rodents. It will be stored at the sub-centre or at a place rented for this particular purpose, if the space in the Sub-Centre is insufcient. Step 9: these funds will be used for meeting the costs of transportation from block to sub-centre and then to the village and rental to store the sanitary napkins at the sub-centre level if required. Step 10: the balance fund, if any after meeting the above costs, will be returned to the District Health Society through the block. They also make direct sales to end users, which they achieve by partnering with community health volunteers or promoters and village health teams, but this is a smaller-scale initiative. Huru started in 2008 in Mukuru, a slum area of Nairobi, • Review and feedback to districts on monthly as a project to produce and distribute re-usable sanitary monitoring reports. The kits are distributed at schools as part of • Estimate sub-centre requirement of sanitary an ‘edutainment’ programme that provides information napkins and consolidate for block. Huru expects to have distributed kits to some 15, 000 • Monthly meetings to review programme schoolgirls throughout Kenya. Sanitary pad mapping, ZanaAfrica24 Organisation ZanaAfrica Activities and purpose Mapping distribution of sanitary pads in Kenya: this is part of the monitoring mechanism for the Kenya National Sanitary Towels Campaign (2006) to help ensure accountability, transparency and equity in distribution. This has also led to 5, 000 distribution individuals being newly trained in health and hygiene education and business skills. Step 2 – Soak the soiled material in a solution of one part household chlorine to nine parts water for at least 20 minutes. To ensure there is enough soap in the water, make sure there are a lot of bubbles when you stir and shake the water with your hand. Step 3 – While wearing gloves or plastic sheeting, wash the soiled material as you would normally, with soap and water, and rinse well. Repeated infections lead to more serious reproductive tract infections, making them more vulnerable to other health issues. All of these issues pose • Those who operate the waste chain (both adults and challenges for washing, drying and storing sanitary children) should be provided with protective equipment, materials. The huge number of sanitary pads typically used by • Disposal into a regular waste management collection women in their lifetime has signifcant implications for and disposal system. It also has an impact on the sustainability of supply, such as in Disposal of sanitary products into latrines emergency situations. Disposal can actually involve a number Potential problems with this method of disposal can be: of steps in the waste disposal chain, particularly when a • If the latrine is a pour fush, the pads can easily block woman or girl is in a school or other public place where the fushing system. Once a latrine is full, it can no longer fulfl its function to provide safe, hygienic and dignifed sanitation for its owners. A small adaption can be made by adding an external pipe to direct the urine into the ground rather than exposing it and blood to the environment. Some stand alone away from the latrine and other smaller incinerators are attached to the latrine block – this solves discreet collection and transfer issues and prevents embarrassment. Girls’ latrines with an integral incinerator, Tamil Nadu, India Disposal shoot inside the latrine Fire grill inside incinerator External view of the latrine and incin erator (All photos: Ministry of Rural Development, Government of India) Refer to Toolkit 3. The programme is working Community channels can be particularly important to reach in 68 upazilas (districts) in low-lying areas and the girls who don’t attend school. Top right: Not disposing of used sanitary materials hygienically can dirty the environment. Opposite: Safe disposal of used sanitary napkins in an appropriate place can prevent environmental waste problems. The most important step in establishing access to affordable and appropriate sanitary materials is the involvement of women and girls in the selection process, and in the design and planning of interventions. Water, sanitation and hygiene facilities in the household As the women and girls in a household may not control the family fnances, men and boys may need to be engaged to help improve the water, sanitation and hygiene situation at household level. Trials were also undertaken to distribute the girls’ menstrual hygiene book at scale, to every girl in the last three years of primary school across four districts of Tanzania. Somewhat There is some smell and/or some sign of fecal matter and/or some flies and/or Clean some litter. Not Clean There is a strong smell and/or presence fecal matter and/or a significant fly problem and/or a large amount of litter. Dustbin 1 Is there dustbin available for disposal of napkins in Yes No the toilet Note that menstrual hygiene interventions are needed in both primary and secondary schools, because girls can start their period at primary school age. For example, girls may be taught the undertaken in Africa and Asia to supply commercially biology of the process without learning how they will feel produced disposable or re-usable pads to girls in school or how they should look after themselves. Features of menstrual hygiene-friendly schools Menstrual hygiene-friendly infrastructure: available and there is somewhere to wash and dry • Separate latrines are available for boys and girls, and sanitary cloths. None of the three schools had soap available for of the problematic schools was toilet paper available at hand-washing in the toilets. Facilities for girls to wash and dry sanitary cloths or re-usable pads, privately and hygienically, are also needed, so they don’t have to dry their cloths or re-usable pads in front of others or worry about them going missing. Lifesaving measure – Girls and women may have a place to wash, dry or dispose of them. The main clusters (or sectors, where the cluster approach is not being applied) with responsibilities for • Emergency responses often have to be made very menstrual hygiene in emergency responses are likely to be: quickly and meet a variety of needs. The water, sanitation and hygiene • Dealing with sensitive issues in emergency contexts sector currently appears best placed to take responsibility for can sometimes be easier, as women and girls are meeting the immediate menstrual hygiene needs of women outside their normal environment. In most cases, female staff are best placed to talk to women and girls, although male staff can take an organisational role, helping to plan questions and review results and feedback. Cluster and cross-cluster meetings can provide a useful forum for this where they are functioning well. Popular media (drama, songs, street theatre, dance, etc) might also be effective in this instance. Relevant guidance note (9) Menstrual hygiene: Provision must be made for discreet laundering or disposal of menstrual hygiene materials. The location or facilities in central, accessible and well-lit areas with good visibility of the surrounding area can contribute to ensuring the safety of users. Excreta disposal Excreta disposal Relevant key indicators 108 standard 2 – Toilets are appropriately designed, built and located to meet the following Appropriate and requirements: adequate toilet • They can be used safely by all sections of the population, including children, facilities older people, pregnant women and persons with disabilities.

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Before you meet with school staff virus 7 characteristics of life cheap sumycin 500mg mastercard, it can be helpful to 999 bacteria what is 01 discount sumycin 250mg without a prescription take some time to bacteria in urine culture buy sumycin 500mg without prescription organize what you know about your child treatment for dogs eyes buy discount sumycin 500mg on line. Date: Child’s Name: Date of Birth: Brothers’ and Sisters’ Names: Names and types of pets: Medical conditions bacterial vagainal infection order sumycin american express, medications, and side effects that teachers and school personnel need to be aware of. It may be helpful to make tabs to divide the papers into categories that best meet your needs. Date: In person Phone Call Notes: Follow up needed Describe what and when: Follow up completed You do not need to wait for a formal progress report to communicate with your child’s teachers. By checking progress reports and asking questions, you may be able to catch when your child is struggling early. It is recommended that you talk to your child’s teacher or receive a written progress report at least every four weeks. It may be helpful to track your child’s progress using the Student Progress Mini Summaries form on the next page. Fill in the date you received the information about progress toward each goal, circle the source of that information, and note the name of the source. To bring your records up to date, look at the report cards and the progress reports for the past two years. If your child is not progressing, use the problem solving information beginning on page 67. Date: Source: Progress Report Report Card Staff: Goal: Meeting expectations or benchmarks Yes No Additional Comments: 69 Probblem Solving You canc use the worksheetw ono the next pagep to keepp a list of thee interventioons and suppports provided to your child. The problemp solvving processs within a muulti tiered syystem of suppoorts is designed to help children maaster the areeas they are having troubble with, whetther the trouuble is acadeemic or behaavioral. This framework guides educcational servvices for alll children, thhose receiving general educatione annd those receiving excepptional studeent educaation servicees. Whenn your child is not makinng progress iti is helpful tto revisit thee questions ffound on paages 71–73 with your child’s teachhers or the problemp solvving team. Photo courteesy of: iStockphotoo/Thinkstock 71 Problem Solving Record At Progress Grade School Intervention or Support Date By Whom Yes or No or Home Grade = the grade. Is my child the only one struggling with this issue (or topic), or is this a problem for a larger group of students Is there someone else or a team of people that should be helping us to help my child If this is a unique problem for my child, what additional assistance will they receive Once additional help begins for your child and you start meeting to review the evidence about whether your child is progressing or not, these are some additional questions you may want to ask: If your child is making progress, ask the following questions: 1. Is my child making enough progress to close the gap between their performance and their classmates’ performance Are we going to keep the same level of support for them, or will we increase or decrease the help If we try something new, will it be added to what we are already doing or replace what we are already doing to help my child Is there someone else — or a team of people — at the school that needs to be helping us help my child Will you help me know what types of things I can do at home to help my child in school Each report may include many recommendations, and it is not always appropriate to use them all at once, because it can be overwhelming to your child or their teachers. It is more helpful to prioritize the recommendations based on what is most important for your child in the immediate future as well as the vision that you and your child have for what they want to do after public school. If youur child had an independdent educatiional evaluation, revieww each reportt and identiffy and recordr the reecommendaations in the same way aas for the public school eevaluations. For reecommendaations that are not beingg used, or that are not sccheduled to be used, wrrite downn the explanation providded for not usingu or scheeduling the rrecommended service. If you have received noo explanationn and the recommendattion is not beeing used orr scheduled to be used, you should ask questioons. Your goal iis to get a reeason for noot using a reecommendattion that maakes sense too you or to gget an assuraance that thhere has beenb a scheddule established to use the recommeendation. When you have a concern it is important to refer to what you know about how your child learns best, the information from the problem solving team you have worked with, the levels of support your child has received, and the evaluations that have been done. Transition planning focuses on plans and dreams you and your child have for the future. If your child is 14 or older, answer the following questions, in addition to the questions on pages 55–56, prior to meeting with school personnel. If not, is there a way to help them learn about the types of work or volunteer opportunities Local Contacts Director, Exceptional Student Education (Find contact information at data. State Contacts Some of these organizations have local chapters or are part of a national organization. Agency for Persons with Disabilities Autism Society of Florida 4030 Esplanade Way, Suite 380 P. Feel free to ask about the meaning of words used to describe your child or your child’s education. It is helpful to make sure that everyone involved has the same understanding of important terms. Academic—Having to do with school subjects such as reading, writing, math, social studies, and science. Access Points—Academic expectations written specifically for students with significant cognitive disabilities. As part of the Next Generation Sunshine State Standards, access points reflect the essence or core intent of the standards that apply to all students in the same grade, but at reduced levels of complexity. Accommodation—A different way of doing something that takes into account a student’s disability. For example, when a student with a visual impairment studies by listening to a recording of a textbook, the student is using an accommodation. Accommodations do not change the requirements of a course or the standards the student must meet. In Florida, administrative law judges are employed by the Division of Administrative Hearings within the Florida Department of Management Services. The administrative law judge cannot know the student or be a friend or relative of the family. The rights of the parent of a student with a disability transfer to the student when the student reaches the age of majority. In Florida, this is 18 years of age, unless the student has been declared incompetent under state law or has a guardian advocate who has been appointed to make educational decisions. For example, age appropriate books for a teenager are different than age appropriate books for a seven year old, even if the teenager reads on a second grade level. Assessment—A way of collecting information about what a student knows and can do and what a student still needs to learn. Assessments may include giving tests, observing the student, and looking at the student’s portfolio or work samples. Assistive Technology Device—Equipment that helps a person with a disability maintain, increase, or improve their ability to do something. Assistive Technology Service—A service that directly helps a person with a disability select, buy, or use an assistive technology device. This includes evaluating assistive technology needs; purchasing equipment; selecting, fitting, and repairing equipment; and training the person, family, teachers, employers, and others in the use of the equipment. Autism Spectrum Disorder—A person who has an autism spectrum disorder has trouble communicating and interacting with others. In order to qualify for programs and services for students with autism spectrum disorder, a student must meet all the requirements listed in the Florida State Board of Education Rules. This includes a change from a more restrictive placement to a less restrictive placement, or vice versa. Compensatory Services—Services that a school district provides to a student in order to make up for services not provided in the past. Complaint—A parent’s formal written claim that a school district has violated a law related to the education of students with disabilities. School records are confidential, so they may only be read or used by school staff, parents, and others who are allowed by law to see them. Consent—A parent’s permission to let the school take an action that affects their child’s education. Courses of Study—The types of courses a student plans to take in order to reach their measurable postsecondary goals. If a student is suspended for three days in October, five days in January, and two days in May, the student has been suspended for 10 cumulative days. Daily Living Skills—Skills necessary to take care of one’s personal needs as independently as possible. In order to qualify for programs and services for students who are deaf or hard of hearing, a student must meet all the requirements listed in the Florida State Board of Education Rules. In order to qualify for programs and services for students with developmental delays, a student must meet all the requirements listed in the Florida State Board of Education Rules. In order to qualify for programs and services for students who have dual sensory impairments, a student must meet all the requirements listed in the Florida State Board of Education Rules. Eligibility Criteria—The requirements a child must meet to qualify for each exceptionality category (program). The eligibility criteria for each exceptionality category are listed in the Florida State Board of Education Rules. To qualify, the student must meet the requirements listed in the Florida State Board of Education Rules. Emotional—Having to do with feelings and the way one responds to and expresses feelings. In order to qualify for programs and services for students who have emotional or behavioral disabilities, a student must meet all the requirements listed in the Florida State Board of Education Rules. These are not technical skills but social and behavioral skills that help a person work well with others, communicate with others, follow directions, be on time for work, etc.

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Twenty-three of 28 women interviewed were met with two Serbian men antibiotics for uti in diabetics order genuine sumycin line, who took us accompanied throughout their travel by the trafficker or to antibiotics for sinus infection azithromycin buy discount sumycin 500mg Belgrade antibiotic resistance is ancient buy 500mg sumycin free shipping, by car antibiotic essentials 2015 buy sumycin discount, to antibiotic list of names sumycin 250 mg a house where I an agent in the smuggling chain. Of the women who met some other Russian, Moldavian were accompanied, eight stated they travelled with the and Romanian women. One allowed to leave the house without woman from Ukraine, for example, reported how police being accompanied by their pimp, or complicit with the traffickers escorted her and two other their pimps’ friends. Romania to Italy the trip to get to Europe is very high Eleven respondents specifically reported having witnessed risk and full of danger. Respondents recounted sale who work at the borders can demand prices ranging from for 700 to 15, 975 (Euros). And you are forced to do whatever they the main financial transactions generally take place ask you if you want to go on, because during this phase, as the woman is made aware of her going back would be worse. The debts and repayment obligations, or her “debts” are Nigerian border is terrible, but I have transferred to another trafficker or employer, and she is faced the worst situation along effectively “sold. You have almost Romania en route to the United Kingdom, gave a arrived in Spain and you would really detailed account of a journey that took her through do anything at that point. And, you also Serbia, Macedonia, Albania, Italy, and Belgium, during have to consider that if you try to run which she was sold on three different occasions. I have heard of girls who did not want to go on, but the Three women reported having been “purchased” at ones who paid for the trip did not let auction-like settings, 18, 19. I humanising process further disassembles a woman’s heard that one of them was killed and sense of self and self-worth. It is beyond the scope of this report to review the range of trade arrangements Five women were provided with documents and made by traffickers. These women were often accompanied is important in the health context is the very act of women to the departure point and met at the designated being bought and sold and the severe physical and destination by the trafficker or a relative of the trafficker. In a majority of trafficking cases, the arrangements for Only two women reported receiving any medical and process of travel are used to put women in a attention during this stage following sexual abuse or situation of “debt-bondage. Women quickly learn that obedience is debts off before they can leave their work and obtain the safest option. As discussed further in the Destination stage chapter, debts rarely decrease, making it difficult Sergey took me to his apartment in or impossible for women ever to be released from Milan, were I met another Albanian indentured servitude. I tried to leave They took me away to a flat [in Tirana] from that place once I understood his where they kept me for two months. I tried to escape once, but and sexually abused me in order to they followed me and forced me to force me. The man who I think bought me I was hospitalised for about 3 months, wanted sex and if I refused he raped me. The Marja, man who bought me would rape me and Albania to Italy when I would try to refuse, he would send another man down to beat me. He Traffickers are known to rape girls who are virgins at put a love bite on my neck to remind me. The these extreme and life-threatening forms of violence back of my neck was bleeding from are meant to show women the price of disobedience. They told me forced to submit to the demands of traffickers in order “Don’t scream or we will kill you. I became pregnant trafficker’s initial violence or threats is to make the [while in the house]. Forced dependence is a but they guarded me while I was [at the key feature of captor-captive relationships. Fourteen women reported resulting from pain, disease, fatigue and having been confined, raped, or beaten once or several starvation. Several induced by unrelenting uncertainty and specified that they were abused after having been told of the threat of death, pain and non-release their future work in prostitution and having refused. Because 41 Travel and transit stage captors control resources for alleviating the travel and transit stage is probably the period for this dreaded state, captives develop a which it is most challenging to develop intervention dependency on their captors for relief. Women are often under close surveillance, the result is clearly a negative impact regularly on the move, and may not yet recognise that on self esteem and lessened conscious they are in danger and need help. However, like the pre efforts to retain pre-captivity identity, departure period, the travel and transit period can offer group support and initiate covert action opportunities to provide vital information to women. Embassies and consulates may serve the psychotherapist working with trafficked women for same purpose. First, essential, even potentially life-saving information that the woman is forced into “extreme survival conditions” could be made available while she is in transit. Without time to rest, the woman is debilitated and unable to consider her options or contemplate self-defence strategies. Concluding remarks the travel and transit period can be as unthreatening as a plane ride or short boat trip, or it can involve mortal dangers that can disable or kill a woman, such as crossing rapidly flowing rivers, war zones, or treacherous mountains under armed guard. For many women this period took an enormous toll physically, psychologically and emotionally. The effects of traumatic events on memory and recall that occur during this time are important later when women are asked to recount people, places, and times of events for legal or other purposes, as well as for their psychological health. In particular, the consequences of this trauma should be recognised when police seek testimony from women who have been trafficked. Women may have difficulty offering details of their experience and may have inconsistencies in their statements and gaps where they are unable to describe what happened to them. It is not unusual for memory lapses to cause unwarranted doubts about a woman’s veracity. Paper presented at the International Conference on Migration, Culture & Crime, Israel. Working paper for the Center for Migration and Development, Working Paper Series, Princeton University. Combating the trafficking in children and their exploitation in prostitution and other intolerable forms of child labour in Mekong Basin countries. Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress. Responding to the health needs of trafficked women, Fieldwork preparation workshop report. Sexuality, reproductive health and violence: Experiences of migrants from Burma in Thailand. If the value of those services as reasonably assessed is not applied toward the liquidation of the debt or the length or nature of those services are not respectively limited or defined. London: London School of Hygiene & Tropical Medicine and World Health Organization. Trafficking in women personal, psychological and social problems in (non)-united Europe. They told my face was bloody, they still took me me, ‘Don’t scream or we will kill you. Women reported broken bones, the destination stage is the period that a woman is put contusions, head and neck trauma, dental problems, to work and her labour is exploited. The destination loss of consciousness, headaches, high fevers, stage encompasses the forms of abuse associated with 1 dermatological problems. For most women in this study, danger and unhealthy weight loss, gastrointestinal problems, and violence pervaded both their work and personal lives in complications from abortions. The majority of injuries and illnesses reported by the forms of risk and abuse, on the one hand, and the women were the result of physical and sexual abuse. As corresponding range of health consequences, on the discussed below, women were beaten, raped, and other hand, can be roughly divided into nine broad deprived of sleep, food, and other basic necessities, categories (Figure 3): leading to fatigue, weight loss, and vulnerability to infection. When Katrina information provided by women who had been finally collapsed she was taken to an emergency service, trafficked. During the destination stage most women encounter multiple forms of risk and abuse that reinforce and Women who are trafficked are also injured trying to exacerbate each another in ways that increase morbidity. For example, a Ukrainian women fell two the medical and the social aspects of this panoply of stories after having tied towels together to form a rope. Other women describe being beaten after framework influences how she contextualises abuse and asking clients for help to escape. Finally, research on other forms of violence against this chapter looks at the different forms of abuse, women highlights that certain chronic pains and associated heath risks and key aspects of health service illnesses—such as idiopathic pelvic pain and irritable delivery during the destination stage. One officer cited a case of women who had been complaints–are likely to be the indirect result of brutally beaten, and, so that the contusions would be less physical, sexual, or psychological abuse inflicted by visible, the perpetrators then forced them to sit in an ice traffickers, owners, and clients. One young respondent from Laos but never in the face because they trafficked to Thailand, explained, for example, “One girl, didn’t want to ruin the merchandise. I was Women were asked whether anyone had intentionally very scared and started crying. The second week I could not bear the pain any more and I agreed Of the respondents who were willing to offer more to accept the client. Anyway, after eight detailed descriptions of abuse, women reported having days of torture, I thought I will accept been hit, kicked, punched, struck with objects, burned, the job to save my life. Women also described being might be able to seek help from the deprived of food and held in solitary confinement as client. Two respondents specifically noted that story and asked for help the clients told beatings were carried out in such a way as to avoid the employer and I was beaten harder making the injuries visible. Ani, Over half the respondents associated headaches and other Laos to Thailand pains, such as pain in the legs and lower back with the violence they endured. One respondent, a domestic Perpetrators of abuse included trafficking agents, worker, was beaten about the head and neck with a employers, boyfriend-pimps, and clients. As a result, she continues to has noted cases of sexual and physical abuse by law have chronic headaches and loses consciousness one to enforcement officials, 12, 13 and members of the armed two times daily. One recent Respondents explained that violence and punishments study looking at the “demand side” of the most common were inflicted as a response to perceived disobedience, to forms of exploitation of trafficked women and children force them to have or sell sex, when they had not earned proposes that those who exploit child labourers, domestic enough money, and when customers complained about workers, or sex workers frequently “cloak what is an them. After fleeing an abusive father, one woman exploitative labour relation behind fictive kinship or some trafficked to Belgrade explained, “We were beaten if we other form of paternalism. If he found any tips, we were beaten and the of perpetrators and the links to Mafia and organised money was taken away” [Anna, Ukraine to Yugoslavia]. In 2000 the Italian Ministry of Interior reported that 168 foreign prostitutes had been 3. Alexandra, Ukraine to Belgium In other accounts of extreme violence, law enforcement officials interviewed recounted cases of women who had In addition to beatings and rape, perpetrators punished been kept in cold baths for hours, burnt with cigarettes, women by depriving them of basic elements of survival 46 the health risks and consequences of trafficking in women and adolescents. In the trafficking context, risks to reproductive and One respondent who physically collapsed from hunger sexual health generally result from sexual abuse and and required hospitalisation explained: coercion. All of the women in this study, including three domestic workers, reported having been sexually abused I was not fed, was beaten and was and coerced into involuntary sex acts. Sexual abuse and locked in the bathroom till nightIt non-consensual sex acts included vaginal rape, forced lasted more than two weeks and when anal or oral sex, forced unprotected sex, gang rape, sex the ambulance driver came, he told the without lubricants, sex during menstruation, and sex mistress that I lost consciousness due accompanied by violent or degrading rituals. Tamara, Women who were forced to sell sex reported having Ukraine to Turkey been raped by traffickers, pimps, acquaintances of traffickers and pimps, and clients. Two domestic Malnutrition and unhealthy weight loss were common workers employed as nannies and housekeepers, problems caused, in part, by food deprivation and poor described being raped repeatedly by their employers and nutrition. One was violently raped, anally raped, animals, not given enough to eat and what they were forced into unprotected sex, and subjected to other acts given was not fresh or nutritious.

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There are wide geographical variations across the country in terms of resources allocated to safe antibiotics for acne during pregnancy discount sumycin 250 mg overnight delivery training in Home Sharing antibiotics and probiotics purchase sumycin now. Hours dedicated to virus 34 compression order generic sumycin from india training ranges from six (6) hours in total antibiotic resistance issues purchase sumycin 500 mg, up to infection you can get from hospitals order sumycin 250 mg with mastercard a maximum of nine (9) days if one was to avail of every course offered by an organisation. It is noteworthy to mention that training is facilitated primarily in group sessions but smaller schemes tend to provide individualised training on site. The social worker involved in Home Sharing tends to be the person who co-ordinates the training module. Manual and Patient Handling refresher training should be carried out every three years. Updating skills and knowledge of the area of disability, policy changes and national culture changes should be carried out every year. Recommended case load for Home Sharing Home Sharing as a model of respite and full time support is available to people with intellectual disability currently delivered through twenty one (21) service providers across Ireland with st st approximately 3m (for the period 1 January 2015 – 31 December 2015) paid in allowances to Home Sharing families (excluding staff costs and contributions paid by the person with intellectual disability). The quantum of service being delivered nationally for the same period st st (1 January 2015 – 31 December 2015) for the allowances paid is 12, 962 day sessions and 75, 672 overnight stays. There are anomalies throughout the country in terms of how this service has developed over the years. Given the scale and geographical spread of this service it is not adequately resourced to meet the current and projected demand for the service and this needs significant investment. Therefore, the National Expert Group proposes the following structure as an appropriate infrastructure to support the existing service and to also serve as a blueprint for Home Sharing to further develop in line with national and international best practice. There is a considerable resource required in the setting up of placements with a Home Sharing family. There is also a significant amount of contact and liaising between both the natural family and the Home Sharing family including information sharing, facilitating introductory visits and ensuring for example that all equipment is in place in advance of the placement proceeding. Prior to this stage, it is important to note the background work that is required to get Home Sharing families ready and approved to facilitate placements such as completing the training and assessment processes. Any commissioning organisation will need to front load resources to achieve this level of service as it will take time to build up to their required level of service. The social work post in certain Home Sharing schemes will need to be set at a Team Leader grade when the social worker is responsible for a large number of Home Sharing families. A senior grade is essential considering the level of responsibility and risk associated with overseeing community based services such as Home Sharing. Home Sharing Short Breaks families are home sharing families that provide placements to one or more individuals for day, evening and overnight breaks. They provide placements to a variety of individuals from one day, evening or night every second month up to 6-8 per month. Although the family have a general agreement or contract with the commissioning organisation, they are not under a formal contract to provide a particular amount of sessions per month. Home Sharing Contract Families are contracted by the commissioning organisation to provide a set number of sessions per month to a number of individuals with higher levels of need for up to 10|16|20 nights or sessions per month. Contract family placements require a considerable amount of support and organising due to the level of needs of the guests, in particular the Level 2 and 3 guests which are usually the majority of the placements matched with contract families. Home Sharing Shared Living families provide a full-time placement to the person with intellectual disability. These placements require considerable support, supervision and contact with the commissioning organisation as the person with intellectual disability is living with them on a full time basis. Shared living families take responsibility for the person’s needs in addition 54 to their daily living and care needs. If a scheme develops and expands to more than one of the three types of Home Sharing (Short Breaks / Contract Families / Shared Living) such as in the example given in Figure 5, an overall Manager/Principal Social Worker or equivalent will need to be appointed to have an overall collective accountability for the scheme and the substantial amount of Home Sharing and full time placements that are being provided for. The Home Sharing team provides the majority of support to Home Sharing families via the Home Sharing link social worker and the co-ordinator with the support of the clerical administrative role. The co-ordinator will have regular contact with Home Sharing families regarding training, scheduling and allowance payments. The link social worker will be in contact with the Home Sharing family on a regular basis to supervise and provide support for placements in addition to assessing the Home Sharing family’s capacity for Home Sharing on an ongoing basis. The work involved in a Home Sharing service requires staff to be able to work flexibly and be able to respond to crisis needs on a regular basis. It is vital to ensure that safeguarding children and vulnerable adults within Home Sharing services are managed appropriately and overseen by appropriately qualified and trained staff. Staff working as part of a Home Sharing service needs to be flexible to meet the needs of the service. For example, the majority of home visits as part of a Home Sharing assessment will need to be conducted in the potential Home Sharing family’s home during the evening time. The Home Sharing training course will also need to be delivered during evenings and weekends to accommodate families. Flexibility and crisis intervention models of working will be required of staff in ensuring that needs are met in the event of emergencies and unplanned eventualities with placements. It is imperative that safeguarding is an underlying theme throughout all areas of Home Sharing services. Figure 5 does not include the resource required organisationally from Key workers, casework social workers and other relevant staff members such as multi-disciplinary teams, day service staff and others as required. Sean requires assistance w ith all aspects of his personal care and is doubly incontinent. M ost Sean is a 14 year old boy w ho avails of Hom e Sharing w ith tw o fam ilies. In total, last stay in hospital w here Sean becam e very unw ell and needed to be Sean avails of 16 nights per m onth Hom e Sharing eight nights w ith a placed on life support. Dad is not involved w ith Sean’s health can deteriorate quite rapidly and he requires round the clock Sean and does notprovide any supportto the fam ily. Despite Sean’s socialorfam ily supportand she has a diagnosis ofdepression and anxiety. M um describes both Hom e Sharing fam ilies as her ‘rocks’ and she They have built up a great relationship w ith Sean and his fam ily and their does notknow w hatshe w ould do w ithoutthem. W ithoutthe supportshe ow n children are very fond of him and look forw ard to his Hom e Sharing and herson receive from Hom e Sharing M um acknow ledgesthatshe w ould visits. Sean receives an be unable to m anage and Sean w ould m ost likely be in a full tim e individualised service through Hom e Sharing asboth Hom e Sharing fam ilies residential placem ent. M um has built up a w onderful relationship w ith are very attuned and vigilant regarding Sean’s health care needs and both Hom e Sharing fam ilies and they are very supportive tow ards her. They are flexible in term s of their Sean is very m uch included in allfam ily activities and socialactivities by scheduling and have often provided Hom e Sharing for Sean w hen he is both Hom e Sharing fam ilies. Allfeedback from the naturalfam ily and both quite illand m um isunable to care forhim oratvery shortnotice ifm um is Hom e Sharing fam ilies indicate thatSean seem s very happy w ith his Hom e feeling unw ell. Both Hom e Sharing fam ilies have needed to seek m edical Sharing placem entsand he hassettled in very w ellw ith both Hom e Sharing care and attention for Sean on occasions and have stayed w ith him fam ilies. O ver the years, the num ber of Hom e Sharing sessions has overnight if adm itted to hospitaland they have often provided 24 hour increased in response to the changing needs of Sean and his fam ily. The flexibility ofHom e Sharing allow s us Sean has a num ber of m edical conditions and diagnoses of intellectual to be m ore responsive to Sean and hisfam ily’sneedsw hen necessary. Sean is prescribed various m edications and both his Hom e Sharing fam ilies are kept up to date regarding changes to his m edications or dosages. Sean also experiences seizures and he is prescribed BuccalM idazolam w hich ism edication to be adm inistered in the 58 9. Conclusion Home Sharing as a model of service provision to people with intellectual disability has been in operation in Ireland since the mid 1980s. The service has developed over the years in response to alternatives to centre based respite and residential care (community and institutional). There have been developments in Home Sharing within some intellectual disability organisations however, this is inconsistent nationally. In some areas Home Sharing has developed positively over the last ten years in response to service providers offering alternatives to traditional models of centre based respite and residential group home living for people with intellectual disability. While acknowledging Home Sharing as a progressive model of support there is however, no current legislation underpinning the regulation of Home Sharing in Ireland. This is essential in supporting a consistent level of service and standards nationally. There is an inequity in the protection afforded to children with intellectual disability who are in Home Sharing arrangements on a full time basis but are not under the protection of a care order. What has emerged over the life time of this working project on Home Sharing in Ireland is that there is a very limited monitoring and management resource allocated to Home Sharing nationally and as such there remains a significant risk to the 853 people who are currently in receipt of this service. Notwithstanding these obstacles the National Expert Group advocates for the continued development of Home Sharing services as the evidence both nationally and internationally shows that this type of service provision is an individualised, person-centred and inclusive model of service as it supports people with intellectual disability to receive support with regular families in the community. A commitment is also required to further develop Home Sharing in line with chapter eight (8) of this report. This also includes people with intellectual disability who are in State care and are reaching adulthood and require Home Sharing. An appropriately resourced staffing infrastructure to be put in place with immediate effect to manage, monitor and safeguard the current Home Sharing placements that are in operation throughout Ireland in line with Figure 5 contained in this report. This should include a multi-annual investment until the existing quantum of Home Sharing service provision is appropriately resourced. In addition, a standardised retainer allowance 60 of 10, 000 per annum to be paid to Home Sharing ‘Shared Living’ families providing full time support to a person with intellectual disability. For Home Sharing ‘Contract’ families a pro rata retainer allowance to be paid as outlined in section 5. The national lead will inform the service planning process and progress with the further development of Home Sharing services in Ireland. The term ‘Home Sharing’ to be the recognised umbrella term nationally when referring to people with intellectual disability in Home Sharing arrangements. Home Sharing to be subdivided into three categories of ‘Short Breaks’, ‘Contract Families’ and ‘Shared Living’. These include detailed guidance on training, safeguarding, vetting and assessments of Home Sharing families in addition to providing clear guidance on the processes required for efficient, effective and safe practice. Given the anomalies and differences in allowances paid by service providers throughout the country the National Expert Group recommends that allowances paid to Home Sharing families for Home Sharing are in keeping with Chapter 5 of this report. Existing Irish legislation needs to be amended to include Home Sharing as a model of service provision to people with intellectual disability. The Health Act (2005) should be amended to incorporate regulations for the safe and proper discharge of Home Sharing. Section 192 (b) of the Finance Act (2005) to be amended to reflect the equivalent protection to the Home Sharing scheme as provided for Foster Carers in relation to fostering allowances. Contract Families Pilot Scheme 07-09: Galway: Brothers of Charity Services Galway and Ability West Galway. Home Sharing Regulations for People with Intellectual Disability Part 1 – Preliminary Provisions the Minister for Health, in exercise of the powers conferred on him/her by Section 10 (2) of the Health (Nursing Homes) Act, 1990 (No. These Regulations may be cited as the Home Sharing Regulations for People with Intellectual Disability.