Treatment and Outcomes of Paediatric Asthma in New Zealand

Treatment and Outcomes of Paediatric Asthma in New Zealand Inequities are present in the prevalence, treatment and outcomes of paediatric asthma in New Zealand (NZ). A sound body of literature and research confirms these inequities, and associates them with various axes, including socioeconomic status (SES) and ethnicity. A conceptual framework, Williams model, is proposed to explain how basic and surface causal factors have resulted in such inequities in paediatric asthma in NZ. Finally, this essay articulates two evidence-based interventions which have been devised with one potent aim: to reduce the unfair disparities in the health status for different population groups. Asthma can affect people of any age, yet is much more common in children than adults. On one hand, studies have suggested that the prevalence of paediatric asthma is similar between Maori and non-Maori (Holt Beasley, 2002). Conversely, there is evidence that Maori boys and girls are 1.5 times as likely to be taking medication for asthma than non-Maori boys and girls (Ministry of Health, 2008). Yet, medicated asthma as a proxy for paediatric asthma prevalence may not be desirable as it fails to include those who should be medicated but are not currently due to barriers such as cost, access and education. This may have the effect of underestimating the true ethnic disparities. However, using asthma symptoms as a better indicator of asthma prevalence, evidence from the ISAAC study (2004) conclude that there are, in fact, significant ethnic variations; that the prevalence of recent wheeze is higher in Maori than in non-Maori children, and is lower for Pacific children than for other eth nic groups. These finding are consistent with an earlier study on paediatric asthma prevalence in New Zealand, suggesting that the pattern of interethnic differences have persisted over time (Pattermore et al., 2004). Perhaps the greatest difference in the prevalence of paediatric asthma between ethnic groups is the presence of more severe symptoms among Maori and Pacific children when compared with Europen children. Both Maori and Pacific children had symptoms suggesting more severe asthma; findings from the ISAAC study (2004) indicated that they reported a higher frequency of wheeze disturbing sleep reported than Europeans. Moreover, Maori and Pacific children are hospitalised more frequently and require more days off school as a result of their asthma than their European counterparts (Pattermore et al., 2004). Although asthma admissions among all children in NZ have remained relatively stable over the last decade, this not the case for all ethnicities (Craig, Jackson Han, 2007). NZ European children have experienced a steady decline for hospital admission rates due to asthma, but this decreasing trend is not the case for Maori and Pacific children, of whom Metcalf (2004) found asthma hospitali sation rates for children under 5 to be four times more likely than that of NZ Europeans. Similar ethnic disparities in hospital admission rates for asthma have also been recognised in the United Kingdom, where children of African and South Asian origins have an increased risk of hospitalisation when compared with the majority European population (Netuveli et al., 2005). Furthermore, it seems worth noting that hospital admissions for Maori compared to non-Maori are not distributed equally: a geographical analysis found the difference in asthma hospitalisation rates between Maori and non-Maori to be more significant in rural areas than in urban areas, despite the fact there was no consistent association between rurality and the prevalence of paediatric asthma (Netuveli). As asthma is a chronic disease with no cure, the goal of asthma treatment is, instead, to control its symptoms. There are two key areas in asthma management: self-management (by the caregivers of children) through asthma education and knowledge; and management via medication. In a trial of a community-based asthma education clinic, Kolbe, Garrett, Vamos and Rea (1994) reported greater improvements in asthma knowledge among European than Maori or Pacific participants. A more recent study found that, compared to children of the European ethnic group, Maori and Pacific children with asthma received less asthma education and medication, had lower levels of parental asthma knowledge, had more problems with accessing appropriate asthma care, and were less likely to have an action plan (Crengle, Robinson, Grant Arroll, 2005). Thus, it can be inferred that ethnic inequities in asthma education and self-management have been maintained throughout the years. Despite medication being a critical component of effective asthma management, studies have shown that Maori and Pacific children with severe morbidity may be less likely to receive preventative medications than NZ European children (Crengle et al.). Where reliever medications bring immediate, short-term relief for acute asthma attacks (an indicator of poor asthma control), preventers (or inhaled corticosteroids) prevent symptoms from occurring and is used in the long-term management of asthma (Asher Byrnes, 2006). The ratio of reliever to preventer use is higher in Maori and Pacific than European children, implying a disproportionate burden; that despite a higher prevalence of asthma symptoms, Maori and Pacific children are more likely to have sub-optimal asthma control. (â€Å"Asthma and chronic cough†, 2008). Death from asthma remains a relatively uncommon event, and most are largely preventable. Yet, ethnic inequities are also present: Maori are four times more likely to die from asthma than non-Maori. Asthma deaths in Maori are higher than non-Maori for every age-group, including children from 0 to 14 years old (Asher Byrnes, 2006). There have been many studies attempting to evaluate the relationship between SES and paediatric asthma in NZ; yet, evidence is conflicting on such an association. In terms of prevalence, the Dunedin Multidisciplinary Health and Development Study (1990) argue that the SES of families has no impact on the prevalence of childhood asthma. There are many studies, however, that demonstrate that socioeconomic disadvantage adversely affects asthma severity and management. Damp, cold and mouldy environments are probably more frequent in houses of families with lower SES, and there is some evidence of a dose-response relationship with more severe asthma occurring with increasing dampness level (Butler, Williams, Tukuitonga Paterson, 2003). Moreover, due to such barriers as cost and location, children of lower SES families have less frequent use of asthma medication and less regular contact with medical practitioners, which, in turn, results in higher rates of asthma-related hospital admission s (Mitchell, et al. , 1989). It is important to note that evidence exists to show higher proportions of Maori and Pacific ethnic groups living in more deprived socioeconomic decile areas with poorer housing, having household incomes of less than $40,000, and having caregivers with no high school qualification (Butler et al., 2003). If the gradient of increasing severity in asthma morbidity is steeper for Maori and Pacific children than Europeans, it seems likely that this could also be a manifestation of the influence of socioeconomic deprivation on childhood asthma. Socioeconomic deprivation is therefore is not only more common, but has a stronger effect on health for Maori and Pacific Islanders. Why, then, should such inequities be identified and addressed? Health inequities are, by definition, differences which are unfair, avoidable, and amenable to intervention. The basic human right to health guaranteed under the international human rights law affirms health – the highest attainable state of physical and mental health – as a fundamental human right; as a resource which allows everyone, including children, to achieve their fullest potential (United Nations, 2009). Ought such potential to be hindered by less than favourabe health outcomes due to familial socioeconomic status or the ethnic group to which a child belongs to is a breach of human rights and is simply unjust. Thus, dealing with childhood asthma inequities is, for Maori and Pacific children in particular, reflective of their high need due to an unacceptable contravention of rights. Morever, it is important to address Maori and non-Maori inequities because, as tangata whenua, Maori are indigenous to NZ. Kingis (2007) report states that the Treaty of Waitaingi has a role in protecting the interests of Maori, and it is, undoubtedly, not in their interests to be disadvantaged in health. There is therefore a strong ethical imperative, on the basis of both human and indigenous rights, for addressing inequities in the prevalence, treatment and outcomes of paediatric asthma in NZ. Williams (1997, adapted) model conceptualises the determinants of inequities as being of two kinds: basic causes and surface causes. It makes explicit the key drivers of inequities in the prevalence, treatment and outcomes of paediatric asthma in NZ; as in, what has created, and maintains, the inequities between ethnic and socioeconomic groups. These are referred to as the basic causes, or those factors which necessitate alteration to fundamentally create changes in population health outcomes and therefore address inequities (Williams). Surface causes are also related to the outcome but, where basic causes remain, modifying surface factors alone will not result in subsequent changes in the outcome; that is, health inequities persist (Williams). As can be seen with paediatric asthma, ethnicity is strongly associated with SES in NZ. Yet, both ethnicity and SES are not independent factors; they have themselves been shaped by underlying basic causal forces. Inequities in the distribution of prevalence, morbidity and mortality of paediatric asthma seems to resonate with an undervaluing of Maori and Pacific lives and health in NZ. Using Williams model, this undervaluing of Maori and Pacific people, and subsequent inequity, is deeply rooted in our colonial history (for Maori) and economic recession (for Pacific Islanders), as well as the scourge of institutional racism. Churchill (1996) argues that colonisation is based on the dehumanisation of indigenous people. Central to colonisation is the belief among colonisers of their superiority and the creation of a new history, with indigenous Maori knowledge relabelled as myths, the traditional landscape renamed, and land alienation. On the other hand, the economic downturn from the 19 70s to early 1980s, which coincided with the significant arrival of Pacific peoples to NZ, resulted in a shortage of jobs and a tightening of immigration policy (Dunsford et al., 2011). Pacific paoples were now labelled as overstayers, which culminated in the infamous dawn raids (Dunsford et al.). Both indigenous Maori and Pacific migrants became ethnic groups defined by exclusion and marginalisation, which has been embedded in NZ society (thus, institutionalied racism). In other words, they have been removed from a sense of place and belonging which is an entitlement of all New Zealanders. The effects of the basic causal forces introduced unnecessary challenges and has led to disparities in the social status of Maori and Pacific peoples when compared with Europeans. This is manifested in the distribution of socioeconomic deprivation, where Maori and Pacific peoples are overrpresented in the most deprived areas (Mare, Mawson Timmins, 2001). This is largely the result of the inequitable distribution of socioeconomic factors stemming from the basic causes; that is, below average educational attainment, high rates of unemployment and reduction of income among Maori and Pacific Islanders. Ethnicity, deprivation and social status all give rise to what Williams model labels as the surface causes. The amalgamation of low socioeconomic status alongside less than favourable desterminants of health and being marginalised has exacerbated to produce a quagmire in which inequities in health are a given for many Maori and Pacfic peoples. This provides part of the explanation of the inequities in the prevalence, treatment and outcomes in paediatric asthma, as Maori and Pacific peoples are less likely to have routine visits to their GP, access to regular preventive medication, and to live in sufficient housing (therefore more susceptible to house dust mites and damp envrionments) – all of which seem to be due to cost constraints (Pattermore et al., 2004). However, this is unlikely to explain the full picture, as poor outcomes are also evident for children aged under six, in whom the provision of care is free of charge. Thus, other surface causes could be a lack of cultural ly appropriate services as well as differences in the quality of care received (Rumball-Smith, 2009). Next in the causal pathway of Williams model is biological processes, where the cumulative impacts of the basic and surface causal factors together with social status manifest themselves as diseases, such as asthma, via the notion of embodiment (Williams, 1997, adapted). In the case of paediatric asthma, the immune responses of Maori and Pacific childrens may be compromised, making them more susceptible to complications in their already vulnerable health (as Maori and Pacific children with asthma are more likely to suffer more severe symptoms). These biological processes, in turn, determine health status (health, morbidity and mortality) and where we all sit on the spectrum. The issue with paediatric asthma is that many children are on the wrong end of the spectrum, and too many of these children are of Maori and Pacific ethnic groups. One way in which inequities in the prevalence, treatment and outcome of paediatric asthma has been addressed is through housing improvement intervention programmes in NZ, such as the randomised controlled trial examining the effects of improvements in housing on the symptoms of asthma. Parents of children in the intervention group allocated a non-polluting, more effective replacement heater in their homes reported fewer days of school, and fewer visits to the doctor and pharmacist for asthma (Howden-Chapman et al., 2008). Through increasing warmth, and reducing dampness and mould in households, housing intervention programmes directly improve the health status of all children with asthma. Moreover, fuel poverty is common in NZ; as in, unaffordable fuel and unsafe heating are a significant issue for many families, especially for Maori and Pacific peoples in whom higher rates of paediatric asthma prevalence, severity, hospitalisation and mortality occur (Asher Byrnes, 2006). Thus, int erventions of this kind, which prioritise socioeconomically disadvantaged communities and poorer quality housing (where there are a higher proportion of Maori and Pacific families), have the potential to reduce not only inequities in health status among ethnic groups, but also the inequitable distribution of adequate housing, a key social determinant of health. After the Maori asthma review (1991), which contended that improving outcomes from asthma among Maori required promotion techniques that incorporated Maori visions and values, a trial of an asthma action plan was devised and undertaken by Maori from Wairarapa with the aim of increasing interactions between Maori community groups and the health sector, reducing inequities between Maori and non-Maori, and improving asthma in the Maori community. Over a period of six months, Maori with asthma were educated in asthma control, seen at marae-based asthma clinics, and were provided with credit card sized asthma action plans (Beasley et al., 1993). In addition to improvements in asthma morbidity (via improvements in asthma control), the programme was found to have benefits extending beyond the effects of asthma, including greater cultural affirmation and increased access to other healthcare services among the Maori community. These successes were largely due to the involvement of the Maori c ommunity in the programme. For Maori, by Maori interventions target the surface causes of Williams model, which identified a lack of culturally appropriate care as a driver of inequities in paediatric asthma. Moreover, there is international evidence to show that similar interventions for other minority ethnic groups have also had beneficial effects (La Roche, Koinis-Mitchell Gualdron, 2006). By taking into account the needs of groups which have historically been margnalised in NZ society, these interventions allow for a more culturally meaningful engagement with regard to the experience of asthma, and serves to reduce inequities in the differential access and receipt of quality care among Maori and Pacific peoples. There is a myriad of evidence to suggest that ethnicity and SES are intrinsically linked to the inequities in the prevalance, severity, hospitalisation rates and mortality with regards to childhood asthma in NZ. Williams model may explain this relationship: the negative effects of colonisation, the economic recession and institutional racism, especially on the key determinants of health, impact differentially on population groups, resulting in the disparities in outcomes of asthma among Maori and Pacific children when compared to their European counterparts. Based on this discussion, it can be seen that approaches to develop strategies need to both prioritise those with the greatest need as well as proceed in partnership with Maori and Pacific peoples in order to address the inequities in childhood asthma in NZ.

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“Trifles”

Angel Parrett Professor Muller English 106/ Drama Essay 15 May 2006 Drama Essay Trifles Trifles, Susan Glaspell’s play written in 1916, reveal concerns of women living in a male dominated society. Glaspell communicates the role that women were expected to play in late 19th century society and the harm that can come of it to women, as well as men. The feminist agenda of Trifles was made obvious, in order to portray the lives of all women who live oppressed under male domination. John and Minnie Wright are two main characters who are never seen; however provide the incident for the play.In this play women are against men, Minnie against her husband, Mrs. Hale and Mrs. Peters against their husband’s, as well as men in general. The men are arrogant and insensitive, while the women are sympathetic, as well as understanding and forgive Minnie for the murder of her husband. Trifles clearly addresses gender issues, emphasizing the oppression of women who lose their identity aft er marriage. This is depicted in the interactions between Mrs. Hale, the male characters, and Mrs. Peters. The play takes place in Mr. and Mrs. Wright’s abandon farm house, which is located down a hollow out of view from the road (1006).The setting is lonely and cold, which signifies Minnie Wright’s feelings (lonely) and describes John Wright’s character (cold). Mrs. Hale, the Wright’s neighbor states, â€Å"I’ve never liked this place. Maybe because it’s down in a hollow and you don’t see the road† (1006). This leads the reader to believe that Minnie was lonely and isolated. Mrs. Hale also states, â€Å"†¦. he was a hard man, just to pass the time of day with him (shivers). Like a raw wind that gets to the bone. † This statement was describing a character trait of Mr. Wright; he was thought of as cold.Again Mrs. Hale makes another statement in regards to Mrs. Wright’s surroundings saying, â€Å"It never see med a very cheerful place† (1003). All of these statements speak of how unpleasant Minnie’s surroundings were and signify oppression. Mrs. Hale goes on throughout the play remembering Mrs. Wright as Minnie Foster, who she was before her marriage to John Wright. For example she states â€Å"I heard she used to wear pretty clothes and be lively, when she was Minnie Foster, one of the town girls singing in the choir. † (1004). Glaspell uses past tense when describing Minnie’s character prior to marriage. Glaspell also compares Minnie to a bird, something that is carefree.This is stated by Mrs. Hale, â€Å"†¦. she was kind of like a bird herself – real sweet and pretty, but kind of timid and –fluttery. How she did change. † (1006). This statement signifies Minnie’s character prior to her marriage and states that she did change after marriage. The description of Minnie’s character prior to her marriage is positive; the ch ange after marriage has a negative connotation. Again Glaspell uses past tense when describing Minnie in a positive light.Toward the end of the play Mrs. Hale is still remembering how happy Mrs. Wright was as Minnie Foster, prior to marriage. She states to Mrs. Peters, â€Å"I wish you’d seen Minnie Foster when she wore a white dress with blue ribbons and stood up there in the choir and sang. † (1008). Glaspell uses vivid description such as the white dress and blue ribbons to paint a picture of how happy Mrs. Wright was before marriage. The color white signifies purity and brightness, it is a happy color. Both colors white and blue are used in our countries flag, which symbolizes freedom. The change in Minnie did not occur until she was married. She was no longer seen as bright and happy. Her happiness changed to loneliness. She lived in isolation on a farm down in a hollow out of site.It is obvious that Mrs. Hale was sensitive to Mrs. Wright’s character. Mrs. Hale knew Mrs. Wright as Minnie Foster. Knowing Minnie before marriage made her transformation from Minnie Foster to Mrs. Wright very noticeable to Mrs. Hale. However the male characters in the play had no recognition of any change in Mrs. Wright’s character. The male’s arrogance and insensitive attitudes toward women hinder their ability to gather evidence that ties Mrs. Wright to the murder of her husband. At the beginning of the play Mr. Hale acknowledges the males attitudes toward women without knowing. For example he states, â€Å"†¦.I didn’t know as what his wife wanted made much difference to John. † (1001). This clearly signifies the male’s insensitivity to women. This statement that Mr. Hale made referring to John and how he does not care what his wife wanted or did not want does not even trigger the question, how was Mrs. Wright treated by her husband? Women were clearly not has important as the men. The men disregard women’s opinions and don’t give a thought to women’s needs or wants. Mr. Hale was speaking of John, Mrs. Wright’s dead husband in the above example; however Mr. Hale also expresses his insensitivity and arrogant attitude toward women.Mr. Hale states, â€Å"Well women are used to worrying over trifles. † (1003). Trifles something that is small, of no consequence, this is how Mr. Hale thinks of women. The things women are concerned with are of no importance, they are petty. This is an obvious illustration of the men’s arrogant and insensitive attitudes toward women. Mr. Hale was not the only male character who demonstrated arrogance and insensitivity toward women. The Sheriff who was investigating Mr. Wright’s murder also demonstrated arrogance and insensitivity, hindering his ability to tie Mrs. Wright to the murder.The sheriff states, â€Å"Held for murder and worrying about preserves. † (1003). This signifies how he feels that women worry ov er trifles, as stated by Mr. Hale. He insinuates that even when a woman is put in a very hard situation, she only worries over little insignificant things that are of no importance. It does not occur to the sheriff that Mrs. Wright would be worrying about the outcome of her future. This demonstrates his arrogance as well as his insensitivity. The county attorney who is also investigating the murder of Mrs. Wright’s husband adds to the male’s arrogant and insensitive attitudes.Toward the end of the play the county attorney states, â€Å"For that matter a sheriff’s wife is married to the law. †(1008). This statement contributes to the arrogant, insensitive male attitudes toward women. Again the men feel that they are the only ones of importance. This demonstrates male domination in the relation between husband and wife. Women no longer have their own identity after marriage; they are identified by their husband’s. Glaspell also uses the titles of the characters to portray this. All of the male characters in the play are identified by first and last name or career itle, (John Wright or Sheriff etc. ) which stresses importance. The women are identified by their husband’s last name only, except for Minnie (Minnie Foster) when Mrs. Hale is remembering her before marriage.Mrs. Peters, the sheriff’s wife has accepted her identity loss and taken on her husband’s as her own. Throughout the play she only identifies with her husband, which demonstrates that she no longer has her own identity. During the scene when the men are going through Mrs. Wright’s kitchen cabinets and criticizing her domestic skills, Mrs. Hale defends Mrs. Wright. However Mrs. Peters agrees with the men. Mrs. Peters states, â€Å"Of course it’s no more than their duty. † This is one of the first scenes in which Mrs. Peters demonstrates that she has given up her own identity and taken on her husband’s, the sheriff. Th e men including, the sheriff, Mrs. Peters husband, are suppose to be investigating Mr. Wright’s murder, instead they are concerned with domestics. It is wrong for the men to be criticizing Mrs. Wright over things that don’t pertain to the investigation. The men are not doing their duty, which is to be investigating the murder; they are more concerned with the facts pertaining to Mrs. Wright being a good homemaker.Because of their insensitivity toward women, they do not even give a thought as to why the house was in disarray, which would have given them the evidence they needed to prove Mrs. Wright did murder her husband, because she was oppressed. Mrs. Hale acknowledges that the men are not doing their duty, however Mrs. Peters fails to see this. During the investigation Mrs. Hale and Mrs. Peters find a half finished quilt that Mrs. Wright was making. This was a key piece of evidence due to the way she was piecing it together; she was knotting it, just like the knot in the rope that was used to choke the life out of Mr. Wright.However the sheriff just made a sarcastic comment toward the quilt, which all the men laughed at. Mrs. Hale was upset at the criticism, however Mrs. Peters stated, â€Å"Of course they’ve got awful important things on their minds. † (1005). Again Mrs. Peters defends her husband, the sheriff, not realizing if he were doing his job he would take everything in the home seriously. Due to his arrogant and insensitive attitude he passes up a crucial part of evidence. His doe s not even question that the quilt would link Mrs. Wright to the murder.His mentality when he sees Mrs. Hale and Peters looking at the quilt to see how Mrs. Wright was going to piece it together is that they are women worrying over trifles. Mrs. Peters has become so accepting of being less important than her husband, that she does not take any offense to how he views women. It is as if she views men thinking less of women, their duty. Toward the end of the play Mrs. Peters is brought to the realization that she has accepted her husband’s identity and no longer has her own. She describes Mrs. Wright’s life as stillness, subdued with no future advancement.In conversation with Mrs. Hale, Mrs. Peters states, â€Å"I know what stillness is. † (1008). Here she is recognizing that Mrs. Wright was oppressed, living dominated by Mr. Wright. However she goes on to say â€Å"I know what stillness is. The law has got to punish crime, Mrs. Hale. † (1008). This demonstrates that she does acknowledge the life Mrs. Wright was living, however she still defends her husbands identity, rather than her own as an oppressed women living under male domination. Despite her feelings she still tries to reinforce the identity of her husband the sheriff, which society has cast on women. It does not occur to Mrs. Peters until the end of the play the she is only thought of as the sheriff’s wife, not a person with her o wn identity.The county attorney states â€Å"for that matter a sheriff’s wife is married to the law. Ever think of it that way, Mrs. Peters? † Mrs. Peters replies â€Å"Not – just that way. † (1008). She did not have much of a reply regarding the county attorney’s question. This signifies that the realization was just brought to her attention, she was so accepting of males arrogant and insensitive attitudes toward women, that she did not realize that her own identity had been lost. The title, Trifles reflects how men viewed women in the late 19th century. Women were viewed as something small, unimportant, and of no consequence.This arrogant and insensitive attitude caused the men of the play to be clueless in their investigation of Mr. Wright’s murder. The women discovered the clues of the murder among what the men looked at as insignificant, women’s work. The feminist strategy was not only used to portray women who live under male do mination and oppression, but also as a message from women to men. It is a call for women to use their perceived powerlessness as a tool to manipulate the system, and a warning to men that a system where one segment of the population dominates and oppresses another cannot and will not be tolerated forever (hongik).Glaspell successfully portrayed the message. We have come a long way since the late 19th century in regards to the way men view women. Gender roles have definitely under gone major transformations. Unlike Mrs. Wright women no longer have to lose their own identity after marriage. Women are accepted for their own identity and are expected to have their own identity even after marriage. These gender roles are becoming more and more encouraged with every generation. We are all now free like the bird Glaspell compares Minnie Foster to before her marriage; we can have opportunities that are adventurous and the boundaries are wide. â€Å"Trifles† Angel Parrett Professor Muller English 106/ Drama Essay 15 May 2006 Drama Essay Trifles Trifles, Susan Glaspell’s play written in 1916, reveal concerns of women living in a male dominated society. Glaspell communicates the role that women were expected to play in late 19th century society and the harm that can come of it to women, as well as men. The feminist agenda of Trifles was made obvious, in order to portray the lives of all women who live oppressed under male domination. John and Minnie Wright are two main characters who are never seen; however provide the incident for the play.In this play women are against men, Minnie against her husband, Mrs. Hale and Mrs. Peters against their husband’s, as well as men in general. The men are arrogant and insensitive, while the women are sympathetic, as well as understanding and forgive Minnie for the murder of her husband. Trifles clearly addresses gender issues, emphasizing the oppression of women who lose their identity aft er marriage. This is depicted in the interactions between Mrs. Hale, the male characters, and Mrs. Peters. The play takes place in Mr. and Mrs. Wright’s abandon farm house, which is located down a hollow out of view from the road (1006).The setting is lonely and cold, which signifies Minnie Wright’s feelings (lonely) and describes John Wright’s character (cold). Mrs. Hale, the Wright’s neighbor states, â€Å"I’ve never liked this place. Maybe because it’s down in a hollow and you don’t see the road† (1006). This leads the reader to believe that Minnie was lonely and isolated. Mrs. Hale also states, â€Å"†¦. he was a hard man, just to pass the time of day with him (shivers). Like a raw wind that gets to the bone. † This statement was describing a character trait of Mr. Wright; he was thought of as cold.Again Mrs. Hale makes another statement in regards to Mrs. Wright’s surroundings saying, â€Å"It never see med a very cheerful place† (1003). All of these statements speak of how unpleasant Minnie’s surroundings were and signify oppression. Mrs. Hale goes on throughout the play remembering Mrs. Wright as Minnie Foster, who she was before her marriage to John Wright. For example she states â€Å"I heard she used to wear pretty clothes and be lively, when she was Minnie Foster, one of the town girls singing in the choir. † (1004). Glaspell uses past tense when describing Minnie’s character prior to marriage. Glaspell also compares Minnie to a bird, something that is carefree.This is stated by Mrs. Hale, â€Å"†¦. she was kind of like a bird herself – real sweet and pretty, but kind of timid and –fluttery. How she did change. † (1006). This statement signifies Minnie’s character prior to her marriage and states that she did change after marriage. The description of Minnie’s character prior to her marriage is positive; the ch ange after marriage has a negative connotation. Again Glaspell uses past tense when describing Minnie in a positive light.Toward the end of the play Mrs. Hale is still remembering how happy Mrs. Wright was as Minnie Foster, prior to marriage. She states to Mrs. Peters, â€Å"I wish you’d seen Minnie Foster when she wore a white dress with blue ribbons and stood up there in the choir and sang. † (1008). Glaspell uses vivid description such as the white dress and blue ribbons to paint a picture of how happy Mrs. Wright was before marriage. The color white signifies purity and brightness, it is a happy color. Both colors white and blue are used in our countries flag, which symbolizes freedom. The change in Minnie did not occur until she was married. She was no longer seen as bright and happy. Her happiness changed to loneliness. She lived in isolation on a farm down in a hollow out of site.It is obvious that Mrs. Hale was sensitive to Mrs. Wright’s character. Mrs. Hale knew Mrs. Wright as Minnie Foster. Knowing Minnie before marriage made her transformation from Minnie Foster to Mrs. Wright very noticeable to Mrs. Hale. However the male characters in the play had no recognition of any change in Mrs. Wright’s character. The male’s arrogance and insensitive attitudes toward women hinder their ability to gather evidence that ties Mrs. Wright to the murder of her husband. At the beginning of the play Mr. Hale acknowledges the males attitudes toward women without knowing. For example he states, â€Å"†¦.I didn’t know as what his wife wanted made much difference to John. † (1001). This clearly signifies the male’s insensitivity to women. This statement that Mr. Hale made referring to John and how he does not care what his wife wanted or did not want does not even trigger the question, how was Mrs. Wright treated by her husband? Women were clearly not has important as the men. The men disregard women’s opinions and don’t give a thought to women’s needs or wants. Mr. Hale was speaking of John, Mrs. Wright’s dead husband in the above example; however Mr. Hale also expresses his insensitivity and arrogant attitude toward women.Mr. Hale states, â€Å"Well women are used to worrying over trifles. † (1003). Trifles something that is small, of no consequence, this is how Mr. Hale thinks of women. The things women are concerned with are of no importance, they are petty. This is an obvious illustration of the men’s arrogant and insensitive attitudes toward women. Mr. Hale was not the only male character who demonstrated arrogance and insensitivity toward women. The Sheriff who was investigating Mr. Wright’s murder also demonstrated arrogance and insensitivity, hindering his ability to tie Mrs. Wright to the murder.The sheriff states, â€Å"Held for murder and worrying about preserves. † (1003). This signifies how he feels that women worry ov er trifles, as stated by Mr. Hale. He insinuates that even when a woman is put in a very hard situation, she only worries over little insignificant things that are of no importance. It does not occur to the sheriff that Mrs. Wright would be worrying about the outcome of her future. This demonstrates his arrogance as well as his insensitivity. The county attorney who is also investigating the murder of Mrs. Wright’s husband adds to the male’s arrogant and insensitive attitudes.Toward the end of the play the county attorney states, â€Å"For that matter a sheriff’s wife is married to the law. †(1008). This statement contributes to the arrogant, insensitive male attitudes toward women. Again the men feel that they are the only ones of importance. This demonstrates male domination in the relation between husband and wife. Women no longer have their own identity after marriage; they are identified by their husband’s. Glaspell also uses the titles of the characters to portray this. All of the male characters in the play are identified by first and last name or career itle, (John Wright or Sheriff etc. ) which stresses importance. The women are identified by their husband’s last name only, except for Minnie (Minnie Foster) when Mrs. Hale is remembering her before marriage.Mrs. Peters, the sheriff’s wife has accepted her identity loss and taken on her husband’s as her own. Throughout the play she only identifies with her husband, which demonstrates that she no longer has her own identity. During the scene when the men are going through Mrs. Wright’s kitchen cabinets and criticizing her domestic skills, Mrs. Hale defends Mrs. Wright. However Mrs. Peters agrees with the men. Mrs. Peters states, â€Å"Of course it’s no more than their duty. † This is one of the first scenes in which Mrs. Peters demonstrates that she has given up her own identity and taken on her husband’s, the sheriff. Th e men including, the sheriff, Mrs. Peters husband, are suppose to be investigating Mr. Wright’s murder, instead they are concerned with domestics. It is wrong for the men to be criticizing Mrs. Wright over things that don’t pertain to the investigation. The men are not doing their duty, which is to be investigating the murder; they are more concerned with the facts pertaining to Mrs. Wright being a good homemaker.Because of their insensitivity toward women, they do not even give a thought as to why the house was in disarray, which would have given them the evidence they needed to prove Mrs. Wright did murder her husband, because she was oppressed. Mrs. Hale acknowledges that the men are not doing their duty, however Mrs. Peters fails to see this. During the investigation Mrs. Hale and Mrs. Peters find a half finished quilt that Mrs. Wright was making. This was a key piece of evidence due to the way she was piecing it together; she was knotting it, just like the knot in the rope that was used to choke the life out of Mr. Wright.However the sheriff just made a sarcastic comment toward the quilt, which all the men laughed at. Mrs. Hale was upset at the criticism, however Mrs. Peters stated, â€Å"Of course they’ve got awful important things on their minds. † (1005). Again Mrs. Peters defends her husband, the sheriff, not realizing if he were doing his job he would take everything in the home seriously. Due to his arrogant and insensitive attitude he passes up a crucial part of evidence. His doe s not even question that the quilt would link Mrs. Wright to the murder.His mentality when he sees Mrs. Hale and Peters looking at the quilt to see how Mrs. Wright was going to piece it together is that they are women worrying over trifles. Mrs. Peters has become so accepting of being less important than her husband, that she does not take any offense to how he views women. It is as if she views men thinking less of women, their duty. Toward the end of the play Mrs. Peters is brought to the realization that she has accepted her husband’s identity and no longer has her own. She describes Mrs. Wright’s life as stillness, subdued with no future advancement.In conversation with Mrs. Hale, Mrs. Peters states, â€Å"I know what stillness is. † (1008). Here she is recognizing that Mrs. Wright was oppressed, living dominated by Mr. Wright. However she goes on to say â€Å"I know what stillness is. The law has got to punish crime, Mrs. Hale. † (1008). This demonstrates that she does acknowledge the life Mrs. Wright was living, however she still defends her husbands identity, rather than her own as an oppressed women living under male domination. Despite her feelings she still tries to reinforce the identity of her husband the sheriff, which society has cast on women. It does not occur to Mrs. Peters until the end of the play the she is only thought of as the sheriff’s wife, not a person with her o wn identity.The county attorney states â€Å"for that matter a sheriff’s wife is married to the law. Ever think of it that way, Mrs. Peters? † Mrs. Peters replies â€Å"Not – just that way. † (1008). She did not have much of a reply regarding the county attorney’s question. This signifies that the realization was just brought to her attention, she was so accepting of males arrogant and insensitive attitudes toward women, that she did not realize that her own identity had been lost. The title, Trifles reflects how men viewed women in the late 19th century. Women were viewed as something small, unimportant, and of no consequence.This arrogant and insensitive attitude caused the men of the play to be clueless in their investigation of Mr. Wright’s murder. The women discovered the clues of the murder among what the men looked at as insignificant, women’s work. The feminist strategy was not only used to portray women who live under male do mination and oppression, but also as a message from women to men. It is a call for women to use their perceived powerlessness as a tool to manipulate the system, and a warning to men that a system where one segment of the population dominates and oppresses another cannot and will not be tolerated forever (hongik).Glaspell successfully portrayed the message. We have come a long way since the late 19th century in regards to the way men view women. Gender roles have definitely under gone major transformations. Unlike Mrs. Wright women no longer have to lose their own identity after marriage. Women are accepted for their own identity and are expected to have their own identity even after marriage. These gender roles are becoming more and more encouraged with every generation. We are all now free like the bird Glaspell compares Minnie Foster to before her marriage; we can have opportunities that are adventurous and the boundaries are wide.

Proposal for the Relocation of an Office - 919 Words

RFP Request 1. Introduction 3 1.1 Purpose of Solicitation 3 1.2 Proposed Form of Contract 3 2. Description of Work 3 2.1 Statement of Work 3 3. Proposal Requirements 3 3.1 Technical Proposal 3 3.11 Designated Project Manager 3 3.12 Qualifications of Professional Personnel 3 3.13 References 4 3.14 Subcontracts 4 3.15 Methodology 4 3.16 Conflicts of Interest 4 4. Contractor Selection 4 4.1 Technical Proposal Review 4 4.2 Opening of Cost Proposal 4 4.3 Post Award Audit of Cost Proposal 4 5. General Information 4 5.1 Proposal Submittal Instructions 4 5.2 Late Submittal 4 5.3Modification or Withdrawal of Proposals 4 5.4 Public Opening of Cost Proposals 5 5.5 Property Rights 5 5.6 Debriefing 5 5.7 Confidentiality 5 5.8 Inquiries 5 5.9 Notification of Right to Protest 5 6. Attachments 5 6.1 Sample Cost Proposal 5 Schedule of rates 5 6.2 Evaluation Criteria for Technical Proposal 6 6.3 Accounting and Auditing Guidelines 6 6.4 Standard Agreement Proposed Agreement Language 6 Introduction 1.1 Purpose of Solicitation The purpose of this solicitation is to acquire proposal for the relocation of an office headquarters. This proposal must include everything that is necessary to relocate the office furniture, equipment, and all related items to their new location and set up the new office in a functional manner. 1.2 Proposed Form of Contract Interested parties should submit any fixed-rate costs as well as hourly ratesShow MoreRelatedEvaluation Of The Revitalization Project1591 Words   |  7 Pages6,000-seat performance venue to a previously approved development plan consisting of retail, office, hotel and residential space (Hollywood). 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