Rohingya Refugees Health Problems and Health Seeking

Rohingya Refugees Health Problems and Health Seeking Title: HEALTH PROBLEMS HEALTH CARE SEEKING BEHAVIOR OF ROHINGYA REFUGEES Abstract Background:  Rohingya refugees are the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. In this study the main aim to find out the health problems health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patients physical, emotional, perceptions, attitudes and environmental health problems and to bring out health care seeking behavior of refugees. Methodology: This was a cross-sectional study. Total 149 samples were selected conveniently for this study from the refugee camps. Data was collected by using mixed type of questionnaire. Descriptive statistic was used for data analysis which focused through table, pie chart and bar chart. Results: The finding of the study showed that 45.6% participants had multiple problems followed by 16.8% participants had other specific problems like muscul oskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems, among the participants 11.4% had this problem, 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation hygiene problems. Among the participants the middle age people had mostly health problems, 68.4% age range between 15-59 years. The study showed that, only 16.1% participants were satisfied with the quality of service they received, among the participants 37.6% participants said that they were need better services such as more laboratory test, radiological imaging, more medicine more doctors. Conclusion:  It is clear that refugee peoples suffered from lots of health problems, because there living condition, environmental situation not similar like an independent nations, from being their expectation there was not sufficient enough medicine other services were avai lable, they deserve better services. Keywords:Health problems, Rohingya refugee, Health seeking behaviour, Bangladesh. Introduction: Rohingyas are an ethnic, linguistic and religious minority group of Northern Rakhine State (NRS) of Myanmar. Myanmar government categorized them as illegal immigrants from Bangladesh and excluded them from citizenship and basic human rights (1). From 1991-1992 a mass exodus of more than 250,000 Rohingya refugees fled persecution in the Union of Myanmar and arrived in Bangladesh, living in temporary camps and completely dependent on outside support from the United Nations (UN), the Government of Bangladesh (GOB) and numerous non-governmental organizations (NGOs) (2,3,4). Globally, the total population of refugees is about 9.9 million. The general health status of refugees in various countries is reported to be poor with malnutrition being the major health problem due to lack of access to sufficient food and nutrient intakes. Other health problems among refugees include mental illnesses, intestinal parasites, hepatitis B, tuberculosis, sexually transmitted diseases, HIV/ AIDS, malaria and anemia (2, 5). Infants and young children are often the earliest and most frequent victims of violence, disease, and malnutrition which accompany population displacement and refugee outflows. Rohingyas are spending long period of time in Bangladesh as refugees My life is over. All I want is for my children to have a chance at a better life. Two generations of the Rohingya have said this. The vast majority of their community suffers the same neglect and lack of opportunity that their parents faced at present, there are no specific services available to refugee children with special needs or disabilities. With regards to cases of sexual exploitation of children, there have been reports and cases of refugee minors (females) being harassed, abused or raped by local villagers. A survey found that out of 508 children of under 5 years of age, 65% were anemic and therefore, chronically malnourished (4, 6, 7). Rohingya is a generic term referring to the Sunni Muslim inhabitants of Arakan , the historical name of a Myanmar border region which has a long history of isolation from the rest of the country. It is thought that the Rohingya are of mixed ancestry, tracing their origins both to outsiders (Arabs, Moors, Turks, Persians, Moguls and Pathans) and to local Bengali and Rakhine. They speak a version of Chittagonian, a regional dialect of Bengali which is also used extensively throughout south-eastern Bangladesh (8). Syrian refugees are in need of basic services such as shelter, nutrition, education, medication and health care services. Approximately 1.4 million Syrian refugees are children and the United Nations Childrens Fund has reported that these children are at risk of being a lost generation. Syrian refugees are enduring daily challenges to physical and mental survival. In addition to the extreme needs for physical and nutritional interventions, mental health professionals recognize the urgent need for counseling services based on widespread documented report s of refugees (9, 10). Three meals a day are served in camps, but refugees are not satisfied with the quality of what is served. There are occasional cases of food intoxication. Refugees are not allowed to cook their food in tents because of the risk of fire. Out of camps, the nutritional status of refugees is mostly bad, only limited number of them can have 3 meals a day. In general, they feed on bread and vegetables. A survey conducted at a provincial centre found, among women in the age group 15-49, iron (by 50%) and B12 vitamin deficiency (by 46%) (11). Some of the countries in the region (notably Pakistan, Bangladesh, and Nepal) are host to refugee and displaced populations from neighbouring states, a circumstance that in itself merits attention since it has the potential to cause major political unrest (12). Bangladesh is surrounded by a high HIV prevalence neighboring country at southern part, Myanmar. Teknaf is a small town in the Chittagong Division at the southern tip of B angladesh, separated from Myanmar on the eastern side by the river Naf. This border area is unique for many reasons, including the history of the tens of thousands of refugees that are currently living in squalid conditions on the Bangladeshi side (13). A 19 years old refugee at Nayapara camp sayed that I was born in Burma, but the Burmese government says I dont belong there. I grew up in Bangladesh, but the Bangladesh government says I cannot stay here. As a Rohingya, I feel I am caught between a crocodile and a snake (14). The population of Bangladesh is growing at approximately the rate of l.59 percent per annum the percentage of urban population is 27% while that of rural is 73%. Bangladeshs population growth rate was among the highest in the world in the 1960s and 1970s, when the country swelled from 65 to 110 million (15). The Rohingya refugee problem has been a longstanding issue and involves the question of an ethnic minoritys identity. The Rohingyas are an ethnic minority group in the northern Arakan (currently Rakhine) state of Myanmar. Commonly known as Muslim Arakanese, the Rohingyas trace their historical roots in the Arakan region from the eleventh century to 1962 (16). Hundreds more Rohingya have been the victims of torture, arbitrary detention, rape, and other forms of serious physical and mental harm. Whether confined to the three townships in northern Rakhine State or to one of dozens of internally displaced persons camps throughout the state, Rohingya have been deprived of freedom of movement and access to food, clean drinking water, sanitation, medical care, work opportunities, and education (17). There is no domestic law in Bangladesh to regulate the administration of refugee affairs or to guarantee refugee rights. New refugees have difficulties accessing health care, their health proble ms may worsen with time.5 Social isolation and disconnection have been shown to contribute to premature death among members of isolated communities (18). In refugee camps medical services are mostly crippled, there is no examination and with the exception of some community health centers (RHU) there is no pregnant women and infant monitoring either, since family planning services for refugees are not available, there are unwanted births and increase in infant mortality, women additionally face risks of gender discrimination, sexual violence, early marriage and miscarriage and birth complications (19). The government of Bangladesh welcomed the Rohingyas and made substantial efforts to accommodate them but the GOB had clearly maintained from the beginning that asylum for the refugees was temporary and encouraged their immediate return, of the original 20 refugee camps that were constructed in 1992 in south -western Bangladesh, among them only two are remain near Nayapara refugee camp at Teknaf and Kutupalong refugee camp near Ukhia, giving shelter to 21,621 refugees, Kutupalong camp officially houses 8,216 refugees and Nayapara 13,405 a s of December 2001(20). Methods: Study Place: The study was conducted at the refugee camp in Coxs Bazar in Bangladesh. Data Collection, Management Analysis The data was collect from the refugee camp in Coxs Bazar in Bangladesh through a standard mixed type questionnaire. The study was conducted at the Nayapara refugee camp at teknaf in Coxs Bazar. About 149 samples were collected from July 2016 to October 2016 in Nayapara refugee camp. After collecting the data analysis is done by SPSS (Statistical Package of Social Science) software version 16.0. Ethical consideration A research proposal was submitted to the public health department of ASA University for approval and the proposal was approved by the faculty members and gave permission initially from the supervisor of the research project and from the academic coordinator before conducting the study. The necessary information has been approved by the ethical committee of public health department and was permitted to do this research. Also the necessary permission was taken from the Camp In charge (CIC), health coordinator medical team leader of the refugee health unit (RHU). The participants were explained about the purpose and goal of the study before collecting data from the participants. Pseudonyms were used in the notes, transcripts and throughout the study. It was ensured to the participants that the entire field notes, transcripts and all the necessary information was kept in a locker to maintain confidentiality and all information was destroyed after completion of the study. The participant s were also assured that their comments will not affect them about any bad thing. Result: Table 1: Distribution of demographic variables among the respondents (n=149) Demographic Variable Gender Gender Frequency Percent Male Female 67 82 45 55 Age Age Frequency Percent 01-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 06 10 14 35 29 23 18 10 2 1 1 4.0 6.7 9.3 23.5 19.5 15.4 12.1 6.7 1.4 0.7 0.7 Educational Status Educational level Frequency Percent Illiterate Literate 112 37 75.2 24.8 Marital Status Marital Status Frequency Percent Married Unmarried Widow 105 20 24 70.5 13.4 16.1 Occupations of the Participants Occupation Frequency Percent Fisher Man 1 .7 Agriculture 3 2.0 Driver 2 1.3 Day laborer 11 7.4 unemployed 42 28.2 Housewife 61 40.9 Student 13 8.7 other (Specify) 16 10.7 Among 149 participants 82 (55%) were female and 67 (45%) were male. Female were predominantly higher than male. Mean age of the participants was 45.52 ( ±19.28) years, mode was 35. The range is 100 with minimum age 02 years and maximum 102 years. Among the participants the higher numbers of the participants were at the age of 35 years and the numbers were 13 (8.7%). The number of à ¢Ã¢â‚¬ °Ã‚ ¤ 18 years were 15 (10.1%), à ¢Ã¢â‚¬ °Ã‚ ¤60 years were 102 (68.4%) and à ¢Ã¢â‚¬ °Ã‚ ¥60 were 32 (21.5%). Majority of the participants were illiterate the numbers were 112 (75.2%) and 37 (24.8%) participants were literate those who complete their primary education. Majority of the participants were married the numbers were 105 (70.5%) followed by those who are widow the numbers were 24 (16.1%) and 20 (13.4%) participants were married. Nuclear family were 76 (51%) whereas 72 (49.0%) participants were in extended family. Among total particepants housewife were 61(40.9%), Unemployed were 42 (28.2%), others 16 (10.7%), student 13(8.7%), Day labour 11(7.4%), Agriculture 3(2%) Driver2 (1.3%) and Fisher man1 (.7%). Figure -1: Health problems among the participants (n=149)    In this study 149 participants are gathered as sample, where there mean is 7.39 with standard deviation ( ± 3.28), median 9.0 and the mode was 10. Out of the 149 participants, 68 participants (45.6%) were had multiple problems followed by those had other specific problems 25 participants (16.8%) like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems among 17 participants (11.4%) had this problem, 16 (10.7%) participants had hypertension, 9 (6%) had respiratory tract infection, 5 (3.4%) had nutrition deficiency, 7 (4.75%) had diabetes mellitus and 2 (1.3%) had sanitation hygiene problems. Table 2: Type of health care and health care receive organization (n=149) Type of health care Frequency Percentage Medicine Counseling Laboratory test Referral Nothing Multiple Services 82 2 5 5 6 49 55.0 1.3 3.4 3.4 4.0 32.9 Health care receive organization Frequency Percentage Refugee Health unit (RHU) 75 50.3 Handicap International (HI) 1 0.7 Others 6 4.0 Multiple Organizations (RHU, HI, ACF, RTMI) 67 45 In this study among the 149 participants, 82 (55%) participants took medicine from RHU, 49 (32.9%) received multiple services like medicine, referral, laboratory test others, 5 (3.4%) received both laboratory test referral to other organizations 6 (4%) participants said that they didnt received any treatment from health center And majority of the participants said that they receive health services from RHU, the number was 75 (50.3%) followed by they received health services from multiple organizations like RHU, HI, ACF RTMI and 6 (4%) said that they receive services from others like MSF, health complexes. Table 3: Health care services that meet the demands and the reason for not fulfill the demands (n=149) Health care services that meet the demands Frequency Percent Yes 17 11.4 No 45 30.2 Sometimes 87 58.4 Reason that not fulfill the demands Frequency Percent Not enough medicine supply in the camps 47 31.4 Narrow space in health unit 5 3.4 Lack of doctors 25 16.8 Other 5 3.4 Not enough medicine Lack of doctors 50 33.6 Among the 149 participants, only 11.4% (n=17) participants said they have enough health services to meet their needs, 58.4% (n=87) said that sometimes they have enough health services to meet their needs and 30.2% (n=45) said that they have not enough health services to meet their needs and majority of the participants said they didnt meet needs because there is a lack of medicine supply doctors in the camps the number was 50 (33.6%) and 47 (31.4%) patients said that they didnt meet needs because there is a lack of medicine supply in camps. Figure 2: Expectation among the participants (n=149) Among the 149 participants, 56 (37.6%) participants said that they were need better services, majority of the participants said that they need multiple services includes more laboratory test, radiological imaging, more medicine more doctors, 17 (11.4%) participants said that they need more medicine and 3 (2%) said that they require more referral, laboratory test radiological imaging. Figure 3: Satisfaction level among the participants (n=149) Among the 149 participants, only 16.1% (n=24) participants were satisfied with the quality of service received, 56.4% (n=84) said that they were sometimes satisfied after received services and 27.5% (n=41) said that they were not satisfied after received services. Discussion: The result of this study showed that 45.6% participants were had multiple problems followed by 16.8% participants had other specific problems like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection is the leading individual health problems, among the participants 11.4% had this problem, 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation hygiene problems during the course of the study and also in this study it was found that among the participants the mean age of the participants was 45.52 ( ±19.28) years. The range is 100 with minimum age 02 years and maximum 102 years. Among the participants the higher numbers of the participants were at the age of 35 years 8.7%. The numbers of à ¢Ã¢â‚¬ °Ã‚ ¤ 18 years were 10.1%, à ¢Ã¢â‚¬ °Ã‚ ¤60 years were 68.4% and à ¢Ã¢â‚¬ °Ã‚ ¥60 were 21.5%, the middle age people had mostly health problems. ÃÆ'-nen C e t al stated that health problems among refugees were frequently seen mostly at the early childhood in adult aged problems, a community based study was carried out by Turkish medical association stated that 25.0%   children had sleeping disorder at the of below 18 years 24.0% have adult persons with the same problems (22). The study showed that, majority of the participants said that they receive health services from RHU, the number was 75 (50.3%) followed by they received health services from multiple organizations like RHU, HI, ACF RTMI and 6 (4%) said that they receive services from others like MSF, health complexes. The study showed that, only 16.1% participants were satisfied with the quality of service they received, 56.4% said that they were sometimes satisfied after received services and 27.5% said that they were not satisfied after received services, Among the 149 participants, 32.9% participants said that they were not satisfied because there is a lack of medicine supply in RHU, 13.4% participants were not satisfied because there is a lack of qualified doctor in RHU 38.9% participants stated that in RHU there is a lack of budget, lack of doctor, lack of medicine supply, lack of referral to other organization in timely, not gave proper medicine treatment lack of serial maintain during medicine collection thats why they were not satisfied. Conclusion From the above discussion it can be said that Rohingya refugees are not having rights to live as human being. Considering the importance of nationality crisis of the Rohingya and problems associated with these following steps can be taken: Supplies of adequate Medicine, Increase Doctors and Nurse, Modernized treatment, Increase Childcare hospital, Decrease pollution, Mass awareness of life threatening disease. Acknowledgement: Author acknowledges the Kauvery Research Group for necessary support. Funding: Self funded Conflict of Interest: None References: Azad A, Jasmin F. Durable solutions to the protracted refugee situation: The case of Rohingyas in Bangladesh. J Indian Res. 2013;1(4):25-35. Teng TS, Zalilah MS. Nutritional status of rohingya children in kuala lumpur. Malaysian J Med Heal Sci. 2011;7(1):41-9. The Rohingya Refugee Situation in Bangladesh Evan Coutts American International School / Dhaka Senior Project 2005. 2013;1-37. UNHCR WFP. Report of the WFP-UNHCR Joint Assessment Mission, Bangladesh. Assessment. 2010;(June). Kemmer TM, Bovill ME, Kongsomboon W, Hansch SJ, Geisler KL, Cheney C, et al. Iron deficiency is unacceptably high in refugee children from Burma. J Nutr. 2003;133(12):4143-9 Department of Sociology University of Dhaka Nationality crisis and Rights of Rohingya Refugee Childrenà ¢Ã¢â€š ¬Ã‚ ¯: A Sociological Analysis of Children s Rights in Bangladesh. 2014;2011-2. UNHCR. Bangladesh: Analysis of Gaps in the Protection of Rohingya Refugees. 2007;(May). Kiragu Angela Li Rosi Tim Morris E. UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES States of denial A review of UNHCRs response to the protracted situation of stateless Rohingya refugees in Bangladesh. 2011;(December). Karaman MA, Ricard RJ. Meeting the Mental Health Needs of Syrian Refugees in Turkey. 2016;6(4):318-27. Eastern M, Studies S. OrtadoÄÅ ¸uStratejiÃÅ'†¡k AraÃ…Å ¸tirmalarMerkeziÃÅ'†¡ Center for Middle Eastern Strategic Studies. 2015. TTB. War, Migration and Health; Experience of Turkey. Red Cross. Children affected by armed conflict (CABAC). 2000;(September):48-51. Gazi R, Mercer A, Wansom T, Kabir H, Saha NC, Azim T. An assessment of vulnerability to HIV infection of boatmen in Teknaf, Bangladesh. Confl Health. 2008;2:5. Holland MSF, Fronti S, March H. 10 Years for the Rohingya Refugees in Bangladeshà ¢Ã¢â€š ¬Ã‚ ¯: Past , Present and Future. 2002;(March):1-45. Socio-economic and family planning aspects of rural people in Bangladeshà ¢Ã¢â€š ¬Ã‚ ¯: A case study of Comilla District. 2014;6(10):348580. Farzana KF. Music and Artistic Artefacts: Symbols of Rohingya Identity and Everyday Resistance in Borderlands. Austrian J South East Asian Stud [Internet]. 2011;4(2):215-36. Genocide IS, In O. Persecution of the Rohingya Muslimsà ¢Ã¢â€š ¬Ã‚ ¯: Persecution of the Rohingya Muslims. 2015;(October). Herald M. Refugee Health- Research Barriers to access to health care for newly resettled Refugee Health Research. 2006;185(11). Sharara SL, Kanj SS. War and infectious diseases: challenges of the Syrian civil war. PLoS Pathog. 2014;10(10):e1004438. Cheung S. Migration control and the solutions impasse in South and Southeast Asia: Implications from the Rohingya experience. J Refug Stud. 2012;25(1):50-70. AFAD. Population influx from Syria to Turkey life in Turkey as a Syrian guest. 2014. 2014;(1):152. ÃÆ'-nen C, Gà ¼neÃ…Å ¸ G, Tà ¼reme A, AÄÅ ¸aà § P. Depression and Anxiety Case among in Syrians that Live in a Refugee Camp. The Journal of Academic Social Science. 2014;2(6):223-30.

Safety Program Development

Effective evaluation of the safety program. Increase employers and employees' involvement in worksheet hazard assessment and control by 25%. Reduce accident rate by 25% Pages Appendix 01 â€Å"Safety & health program responsibilities† Appendix 02 â€Å"Job Safety Analysis OSHA)† 12 Appendix 03 â€Å"Sample form for correction tracking† 15 Appendix 04 â€Å"Rout cause analysis† 18 I. Chapter 01 : Management & Employee involvement The overall safety in a workplace is a responsibility of both the employers and employees. The employers need to work together with their employees toward safety improvements.Management must encourage employees' involvement in improving safety. Employees need to inform and communicate with management to what is needed to be done to improve safety. L. A. Being a visible management and taking charge Management must prove their commitment and detection toward achieving a safer environment for their workers. Management musts make thems elves visible by being out there in the working area inspecting how to improve safety. Getting where you can be seen: Be visible when taking parts in any operation in order to be more aware of the working environment and the employees.This way the workers feel appreciated and aware of management good intentions for improving safety. This method can be done formally or informally depending on management participation levels. 0 Being Accessible: Employees need to have chances to communicate to management when necessary without going through complicated procedures. The employers must give the employees an easy two way communication process for reporting situations, comments or any work related issue regarding safety. Sacrificing or cutting authority to obtain accessibility between management and workers is not necessary.Adequate accessibility is as simple as having an open door policy or skipping large formal meeting. Being an example: When rules and regulation are issue management sho uld be the first to follow it showing the workers their participation and dedication. Rules must apply to everyone in the workplace with no exception. Following rules can be as simple as wearing safety equipment, such as, safety glasses. Taking charge: Management must be clear on what is required by their workers. Rules, regulations and polices must be officially stated and written in a clear easy to understand language.In addition, rules and regulation must be enforced with no exception. Management must follow on safety processes and make sure that individuals are performing their responsibilities. Management must not neglect employee involvement regarding safety issues. Workers are the first to be exposed to potential hazards. Workers are the ones who understand what must be done to reduce hazards associate with working procedures. Management need to encourage and increase worker precipitations, making them more aware of their safety roles and expectations.Employees can help manag ement in safety issues by: Participating in Joint labor-management committees and other advisory or specific purpose committees. Conducting site inspections. Analyzing routine hazards in each step of a Job and/or a process and preparing safe work practices or controls or eliminate or reduce exposure. Developing and revising the site safety and health rules. Providing program and presentations at safety and health meetings. Training of both current and newly haired employees. Conducting accident or incident investigations.Management can increase employees' precipitation in safety by: Showing workers management's detection to make the workplace safer and healthier. Adequate leadership from management that leads to employees' commitment. Management must not refuse any worker involvement; get as many help as you can. Reward and recognize workers for their efforts and accomplishments in achieving safety or following rules. Be clear on want you need workers to do (good communication). Giv e workers the resources necessary to perform the Job with the adequate training. Show your seriousness in their work toward safety.II. Chapter 02: Supervision and responsibility to the safety program All personal and acknowledge and understand their responsibilities toward safety. The employer has a responsibility to his/her workers, making sure that they are not exposed to any potential hazards and work in a safe environment. In addition, employers must clearly communicate with workers about their responsibilities toward safety, making ere that no confusion occurs. II. A. Reviewing existing organization Management must understand and be well inform of each individual safety roles in the workplace.Employees' roles in any safety and health program can be identified by using a specific worksheet (Appendix OLL- Page 04). Organizational structure and Job titles vary from one company to the next, but they include general assignments of health responsibilities. Some examples Job titles an d job decryption include: President/owner/site manager: Establish policies – provide leadership & resources – set objectives – assign susceptibilities – hold people accountable – interact with employees – set a good example – review accident reports – provide medical programs – establish safety training programs.Safety and health director/coordinator: Maintain safety & health – familiar with safety laws – aware of all presented hazards and their preventions – evaluation of the workplace' safety – design control & preventive procedures – assist & support supervisors & employees regarding safety – communicate safety rules – review hazard reports – evaluate emergency drills. Plant superintendents/division managers/directors:Provide leadership – maintain accountability – follow up on employees' suggestions analyze the facility for potential hazards  œ follow up on periodic hazards analysis encourage reporting hazards by employees – provide the necessary PEP (Personal Protective Equipment) – maintain safety meetings – help develop emergency procedures. Supervisors: Evaluate worker's performances – encourage precipitation in safety and health programs follow up on preventive maintenance – investigate accidents – discourage short cuts follow safety rules – familiarize everyone with emergency procedures. Employees' responsibilities:Understand all safety rules – responsible for your safety and the safety of other employees – offer safety and health suggestions – get involve in safety – be aware of your responsibilities in an emergency – know where the first aid kit is – report all accidents. II. B. Assigning & determining responsibilities Corporate management roles in safety: Management is responsible to their employees for providing a working area free of any recognized hazards that can causes injury or death. Managements must establish specific goals and objectives that aim to reduce injuries caused by specific unsafe behaviors.Any safety and health program will not be able to go very far without management support. Management must hold employees accountable for their actions. This can be done by rewarding workers for following safety and taking the necessary disciplinary action when they fail to follow safety rules. Management need to obtain constant feedback for determining the effectiveness of the safety program. In addition, management must get involve in the safety program, through attention to workers, precipitation in investigations and following safety rules. The facility manager roles in safety:The facility manager must acknowledge his or her responsibilities to maintain adequate house keeping, establishing safe working procedures and making sure that employees follow them. The shape and physical condition of the facility also plays an important role in achieving safety. The facility manager must make sure that everything is in good condition, taking employees suggestions into active consideration. Workers must obtain adequate training in using PEP and machines operations. Also, the facility manger must educate the employees about the areas' safety rules and polices, making sure that they are followed correctly.The facility manager is accountable to both upper management and his or her employees. The facility mangers must also have significant involvement in communications, obtaining feedback and performing tours around the working area (formal & informal) making any necessary corrections. First line supervisor roles in safety and health: The first line supervisor has more specific goals and objectives compare to other managers. The first line supervisor has various roles regarding safety, since he or she is in first contact with the employees.He or she need to set the necessary standard or achieving safety through good housekeeping and desired safety conditions. The first line supervisor must determine the employees understanding and practice of safety rules and regulation in the work area. Effective safety training of employees and continuous observation from the first line supervisor is essential. Employees' level of safety awareness can be increased by: Setting specific working standards and following them through. Employees' precipitation in safety meeting with their superiors. Following up on safety inspection and making all the necessary corrections.Management recognizes employees' outstanding achievements toward safety. Supervisors must sincerely listen to employees' complaints and suggestions. The employer must provide an adequate Hazard (Hazard Communication Standers) to his or her employees. Information on all the chemicals in the workplace must be easily accessible to workers in case of an emergency. In addition, proper training for chemical handling, s torage and transportation is necessary as part of an ongoing process. Ill. A. Chemical overview, communication standards & hazards Chemical overview: Chemicals can be either in a solid, liquid or gaseous state.Chemicals can be found in drums, tanks, pressure vessels and process systems. Responses to spills or exposure depend on the chemical properties. Material Safety Data Sheets (MASS) and labels on the chemical containers are essential for determining how workers must respond. Hazard communication standards: Chemical handling requires adequate training before any initiations are taken. The training and education must include the following: Knowledge about Occupational Safety & Health Administration (OSHA) standards. Knowledge on all chemicals in the workplace and hazards associate with them.Informing workers of the facility written plan to deal with chemical hazards. How to use MASS and labels. How can workers protect themselves and others. Hazards: Physical Hazards: Physical haza rds includes, a sudden violent reaction involving flammable, explosive or reactive materials. Proper handling is the key to deal with physical hazards. Information from MASS can be obtained about storing, mixing or moving chemicals. Physical hazards can be identified as: Oxidized Water reactive Organic peroxide Combustible Health Hazards: Chemicals can cause adverse health effects if workers became over exposed.There are two types of health effects: Acute health effects: occurs over short periods of time due to immediate exposure, they can be minor or serious. Some examples include burning or irritation. Chronic health effects: occurs over long periods of time due to prolong exposure in small amounts. Some examples include cancer, liver disease or lead poisoning. Ill. B. Exposure limits, controlling exposure & Safety on the Job Exposure limits: Exposure limits are governmental standards indicating when overexposure occurs. PEEL – Permissible Exposure Limit: Must not be exceed ed, over an our average rookery.TTL – Threshold Limit Value: Must not be exceeded, over an our average workday. STEEL – Short-Term Exposure Limit: can be safety exposed to over 1 5-minute period. IDLE – Immediately Dangerous to Life or Health: very hazardous, must not be exposed to. Controlling exposures: There are several methods used to control exposures to chemicals. Engineering controls can be use to keep exposures below PEEL and TTL levels. Also, maintaining adequate ventilation system can reduce exposure to hazardous chemicals. When exposure can not be avoided, using proper PEP depending on the chemical is essential.PEP are used to prevent exposure through skin absorption, inhalation, ingestion and injection. Chemical safety on the Job: Identify all chemical hazards in the workplace. Know how to deal with chemical in both regular and emergency operations. Treat unknown chemical as hazardous ones. Make sure to use the appropriate PEP by looking at MASS. Ins pect your PEP before and after use. Know the workplace emergency procedures. Know location of emergency showers, first aid kits, fire extinguishers and eyewash. Always secure the exposed area and ask for help. Maintain good hygiene to prevent outside exposures. IV. Chapter 04: Lockout / DugoutThere are energies in the workplace that might be accidentally released and cause serious injuries or death. The employers, with the proper training of workers, must prevent the accidental release of these hazardous energies. This can be achieved through using lockout/dugouts. ‘V. A. What is lockout/dugout & when they must be perform What is lockout/dugout? Lockouts: The employer places a lock on any energy isolating device, making sure it cannot be removed from the closed position. Such devices include circuit breaker or valve handle. Dugout: The employer attaches a written note (warring tag) on the equipment or device that

Top Great Gatsby Literary Analysis Essay Topics Choices

Top Great Gatsby Literary Analysis Essay Topics Choices the Great Gatsby Literary Analysis Essay Topics for Dummies If you're able to understand the way the pattern occurs throughout the book and its significance, then it's going to be easy to think of an essay. In the event you're still puzzled how to compose an outline for your literary analysis paper, you might locate examples online. When you have written a suitable thesis statement, you own a direction for your paper and are all set to start the true analysis. Topics can bet that we double check our essays so that you know you will get original work every moment. These topics may be used to compose an essay or any other academic paper, and you'll be able to read them through and produce your own ideas. Tradeoff hypothesis whenever you have a narrative essay example of our site, financing 8000. To get essay online, you merely will need to fill in the application form and you'll get superior work on the desired topic. There are lots of excellent essay collections readily available on the internet. You can rely on the very best essay help online. Essay writing is a skill that you should cultivate as a way to pass your exams. The Introduction The debut of the literary analysis essay outline will set up the entire essay. If you're writing an essay on Frankenstein for the very first time, then our Frankenstein essay topics are going to be a terrific assistance for you. Browsing our essay writing samples can offer you a sense whether the standard of our essays is the quality you're looking for. The rhetorical analysis definition denotes the art of persuading other people to agree with your point. The intent of an important essay is to assess information, theories or situations. Since you may see, presenting a suitable essay is both difficult and time-taking. After grasping the meaning of what's a literary analysis essay, you must read the bit of literature in question repeatedly. It's interesting that lots of students write introduction after they've written the whole paper. Many students discover that it's quite hard to decide on the topic independently or understand how each sort of literature ought to be structured. A character analysis essay is a good way for students to genuinely become familiar with the characters in a sheet of literature. A rhetorical analysis essay is occasionally an extremely challenging undertaking for students to grasp. Tom, on the flip side, is an excellent supply of love and money that could provide her all the luxuries she needs. Gatsby's relationship with Daisy demonstrates that wealthy people today are definitely the most desirable in our society. While there are lots of undertones concerning different things about which he's unaware, the particular subject of character awareness is the principal thought of the storys plot, ultimately developing into a good theme. Figure out the way the author's worldview and individual opinions are reflected in their work. You also ought to learn some information concerning the author, it is going to enable you to understand his intentions and thoughts better. If you are fortunate enough to select the bit of literature all on your own, you want to ensure it's chosen based on your tastes and interest of the audience. Thus, this lesson will move through every one of those categories to demonstrate how to specify a rubric. Topics can change depending on your majors. Insufficient development for those necessities of the assignment.

Breast Cancer A Disease That Comes Unexpectedly Essay

Breast cancer is a disease that comes unexpectedly; many people tend to overlook the symptoms. There are different types of breast cancers that require treatments and surgery. The course of treatment varies from patient to patient because there are many factors that can contribute to a patient’s treatment plan. Once the plan is in place, there are many things that will need to be done in order to ensure that the cancer will not return. Trying to beat cancer can be a long, extraneous, and in some cases a fatal process. Its important to catch cancer at its earliest stage. Knowing the symptoms of certain cancers may just save a life. Symptoms for cancer have a very wide variety, some indicating different types of breast cancer. Some types of cancers have very specific symptoms such as breast cancer. A very common symptom for breast cancer is a cyst on the breast. â€Å"A cyst in the breast may feel like a lump, but upon examination the lump is a small, generally harmless sac filled with fluid rather than a cancerous or benign lump of cells. You may have one cyst or many cysts that appear together.† http://www.nationalbreastcancer.org/cyst-in-breast . Common symptoms for breast cancer are skin change such as swelling, redness, dimpling, change in color, or visible changes in the breast. Changes in shape of breast such as, increase in size, breast lump or thickening, change in touch, may feel hard, tender or warm; changes in nipples, such as the appearance, peeling or flaking ofShow MoreRelatedThe Struggle For Life : The Story Of A Man Who Warded Off Cancer Twice1527 Words   |  7 PagesAbdullaziz Ali The Struggle for Life: The Story Of A Man Who Warded Off Cancer Twice The two cable cars are going to and fro, loading and unloading scores of tourists. In front of the control panel, two little boys are watching the buttons and lights in amazement. Today is a special day for Curt Carrigan, as his two grandsons are visiting him at his workplace. An Ordinary Yet Special Man Carrigan, 51, is an electrical engineer, working in a cable car station. His silver hair and visible wrinklesRead MoreAbstract. Does Organic Really Matter? Advertisers Are Always1576 Words   |  7 Pagesnourishment are both receiving tests. I will go to Whole Food and a Farmer Market. The Farmer Market claims to have pesticide-free natural organic product. In addition, I will purchase non-natural organic products from Whole Foods. Organic Whole Foods unexpectedly had the least overall measures of pesticides. Does Organic Really Matter? Which store contains the least pesticides? Pesticides consist of superfluous amounts of harmful chemicals. As I travel from market to market, I will determine whichRead MoreThe Importance Of Animal Testing1883 Words   |  8 PagesAnimal Testing is Essential On the other had, some individuals deem animal testing necessary for the furthering of the medical field. There have been illnesses and diseases that have been eradicated due to animal experimenting. One such disease a vaccine that was resulted by successful experimentation on animals to combat it is the poliomyelitis vaccine Continuing, one essential aspect to consider when evaluating the similarities between humans and animals is the amount shared genes. According toRead MoreThe Immortal Life Of Henrietta Lacks2194 Words   |  9 Pagesimmortal HeLa cells’ exploitation. The research of HeLa cells has changed various areas of medical study and stepped forward scientific breakthroughs that continues today. HeLa cells were central for developing the polio vaccine; exposed secrets of breast cancer and leukemia; lead to important advances in vitro fertilization, cloning, genetic hybrids, gene mapping in virology, HIV, HPV, tuberculosis, telomerase, salmonella, live cell transport, for profit distribution of cells, scientific standards, spaceRead MoreWomen, Hair, And Cancer10628 Words   |  43 PagesChapter Three Women, Hair, and Cancer in the Media 3.1. Introducing television into the home / The Rise of the (social) Media [†¦]After going downstairs, for breakfast, Leonda picks up the remote and clicks on the TV. She â€Å"channels surfs† until she comes across a network morning show that has the stat of a big new Hollywood movie as a guest. [†¦] Later [†¦], [s]he spends the rest of the period flipping through a â€Å"women’s† magazine featuring articles- and many advertisements- on fashion, makeup, healthRead MoreEssay about Fight Club2038 Words   |  9 PagesHe finds his cure in attending support groups for the mortally afflicted. One of the first groups he attends is a testicular cancer group and discovers, through an exercise referred to as â€Å"pairing up† (to share brotherly emotion with your fellow mortally afflicted), that crying with and hugging these people makes him feel better. He, although he does not have testicular cancer, is spiritual impotent and this group allows him to fill that void in his life. He gets addicted to this, and begins att endingRead MoreA Brief Note On Increased Productivity From The Workplace Essay2039 Words   |  9 Pagesnapping is a key component in any given day. Work place napping is a natural and low cost activity to increase worker productivity and alertness. Sleep should be seen as a necessity for everyone, not a luxury. There is a big difference between unexpectedly dozing off in important work environments such as at a patient s bedside, while on a customer service phone call, transporting merchandise and while operating heavy machinery, compared to taking a planned nap in a designated area during a scheduledRead MoreGateway Drugs3897 Words   |  16 Pagesadvances in Pharmacology and in other fields of science. In the early 1500 s, Swiss physician Philippus Paracelsus pioneered in the use of minerals as drugs. He introduces many compounds of lead, mercury and other minerals in the treatment of other diseases. Gateway drugs are substances that people take which, in many cases, lead to those people taking more drugs. Alcohol and pot are the most obvious gateway drugs. Studies show that if you smoke pot, you re more likely to try things like crystalRead MoreThe 7 Doors Model for Designing Evaluating Behaviour Change Programs13191 Words   |  53 Pagesmotivation for change. Dissonance alone does not make change however. It actually blocks change unless there are feasible pathways for change and social invitations to entice/kick us out of out comfy zones - thats where the other elements of the model come in. |Definition | |Shared purpose: A vision for living, running a business or household that: | |addresses real dissatisfactions of the people you want to act; Read MoreCauses And Effect Of Allergies And Asthma3783 Words   |  16 Pagesdiversity of this ÃŽ µ gene in a focus on primate species and shed some light on the evolutionary backstory to the presence and possible function of IgE in our ancestors. In comparing the genomes of more than 40 separate species across multiple orders, an unexpectedly wide range of variation was determined for the ÃŽ µ Ig gene. Some species lack exons to make membrane-bound IgE. Some do not possess the necessary gene segments to code for the long IgE isoform, and some others allow only the formation of this long