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Asthma In South Africa

·         Asthma in the global context is the most vividly and frequent chronic disease among the people and has been observed that asthma is most prevalent among the children.
·         It is basically a non-communicable disease, which under conditions of being undiagnosed in proper stage can lead to vulnerable conditions of the health leading to death. Cough, Wheeze, shortness of breath and tight chest are symptoms of asthma and it gets worse at night. Quality of life can be affected due to asthma like exercise becomes impaired, disturbed sleep and acute attacks.
·         Moreover the medicines which are meant for this disease is somehow costly and so many of the underdeveloped countries cannot afford this medicine to buy (To et al., 2012).
·         From the recent report of Global Initiative for Asthma (GINAI), it has been understood that due to asthma, death rate among five to 45 years old is increasing and South Africa has become the fourth largest asthma attack country in world (Day & Bradshaw, 2014). Increased rate of air population is the prime cause of airflow limitation in lungs and chronic inflammation of lungs as well. 3.9 million people in South Africa is affected due to asthma, in which 1.5% dies annually.  
·         With the help of this bar chart, asthma rate in different cities of South Africa can be determined. Western Cape is suffering highly due to asthma among other cities like Eastern Cape, Gauteng, Limpopo, North West, and Northern Cape.

Rate of Asthma patients in South Africa and World
·         The chart determines the worldwide rate of asthma. Populated countries are mainly affected due to this; large numbers of vehicles are causing breathing trouble. With the help f above chart, it has been determined that Wales people are suffering hard but due to lack of proper treatment process, people recover. Besides, Russian Federation, in comparison with the number of population, date rate is quite high.  

·         This graph facilitates in understanding that mainly male are suffering from asthma as they are mainly going out of the house. For men, the danger of asthma in South Africa tops at age 80+. It slaughters men at the most minimal rate at age 10-14. At 302.2 for every 100,000 men in 2013, the pinnacle death rate for men was higher than that of females, which were 264.9 for each 100,000 women. Females are murdered at the most astounding rate from asthma in South Africa at age 80+. It was slightest lethal to females at age 10-14.

·         The South African medical journal establishes the report where between 6-10% of the adults carry this disease because of the lack of the proper treatment or being diagnosed in right condition. Also the report suggests that about 3.9 million South Africans have been suffering from asthma, among which 1.5% die per year.
·         A recent survey conducted over the school children suggested the fact that more than 20% school children have been suffering from this disease.

Causes of Asthma in South Africa

·         It has been seen that asthma is such a disease which is caused due to some common factors irrespective of any context of the country. Pollution is one of the main causes behind asthma attack; and can be occurred due to stress, urbanized lifestyle and genetically. Cross-sectional study has been conducted on this matter for identifying whether these factors are causing South African children to develop asthma.
·         Besides, scientists have researched that they are working hard on the biological explanations as well. Causes of asthma do not depend on countries, it almost same everywhere. Often it is seen that psychological factors like work pressure and depression affect immune system and endocrine system of human body (Ndlovu & Jeebhay, 2014).

·         Some of the psychological factors such as anxiety and stress also have significant impact in increasing hyper-reactivity and inflammation of airways. All these psychological changes affect psychological propensity regarding asthma. Reverse action is also seen; often asthma becomes the cause of increased anxiety and depression. One of the studies also accounted the fact that the South African kids, especially under 12 years who are presumed to have more anxiety as well as rendering to community violence has higher rates of asthma.

·         Nevertheless, a precise audit of partner ponders in high-salary nations found that not exclusively is mental anxiety a result of asthma; it likewise appears to add to onset and seriousness. If so, the mental anxieties made by urban living, group savagery and family unit destitution may contribute hazardously to the asthma load among South African youth. Along with that viral cold, allergies, pollution, sports, exercises, emotions, and wrong medication can be the cause of Asthma.
·         Moreover it has also been identified that the most of the South African have a history of genetically disorders which also leads this disease to be quite prevalent among the natives of the state.

Impact of asthma

± South Africa, being a developing country still has the record of carrying the statistics of fourth highest asthma attack rates in the world. This data quite brings the fact the reason for being attacked by the disease is almost same with that of any other country.
± But in most of the cases it has been observed that the patient suffering from asthma are not reported in right time and thereby leading to a serious condition. This is mainly because of the poor economic condition of some states or social rigidity which forbids in treatment of the disease at right time
Treatment Cost of Asthma is quite high; therefore, poor or middle class people cannot able to treat asthma. Asthma can affect adults and children socially, morally and economically as well. Often asthma attack children are sked from school to stay at home to avoid risk. Parents of other children have prejudice that asthma can be infectious disease and it can be spread by touching so they requested principle to ask that particular student for staying at home (Machingaidz & Louw, 2016). This affects their morale. However, with the government intervention, monthly expenditure on the medication of a children is almost 350, which is affordable for middle class people but not for poor people. Childhood asthma has noteworthy negative impact on the daily activities of children like gaming, schooling, education, and family life. In case of adults, they are also suffering at workplace and marital life.

Treatment for asthma

No matter whatever doctors say, asthma cannot be treated or cured completely. It can be avoided or restricted for some time but it cannot be cured. However, with the right treatments most asthmatics can able to lead normal life. Purpose of this treatment is to make the lungs or breathing tube as normal as possible. It is long-term disease and to control this
Ø  Adopt precautions for shortness of breathing and coughing
Ø  Have quick relief medicines
Ø  Maintaining good lung functions (Nkosi & Voyi, 2015)
Ø  Maintain daily activities
Ø  Do proper exercise and avoid junk foods
Ø  Avoid tensions
Ø  Constantly stay in contact with physician for proper asthma management
Ø  Develop and follow Asthma Action Plan
Lack of proper treatment
± In some cases it is also seen that the high cost of the medicines as well as their availability also hinders the treatment of the disease as the people are not financially equipped to buy them (Bradshaw et al., 2010).
± The impact of the asthma in country like South Africa can be identified by the financial disability which leads to the premature deaths.
± This scenario is quite prevalent among the children of the ethnic group.
± Moreover the socio-economic status or SES of the natives in some countries also hinders the proper treatment of the disease; thereby leading to more death rates.

Government measures to prevent asthma

± GINA Science Committee is constantly trying to bring improvement in providing treatment to patients. Medical facilities are provided to the working class people so that needy people can able to avail treatment.
± Several campaigns are organized to make people aware of living healthy life and not to smoke because prevention is better than cure.
± Initiatives are being taken by the South African government, to give awareness and proper education regarding the disease among the society (Calvert, & Burney, 2010).
± Accessible information is also being transmitted to the people so that the country can turn around from this situation.
± Moreover the availability of the medicines in the country is being distributed at a broad level now. This might lead to stop the rapid spread of the disease in the state.
± The burden of the disease asthma has been increasing over the government of the country, especially the health care houses.
± The Government of South Africa has taken few initiatives to develop the asthma care facilities in a wider perspective through identical treatment procedures.


± Therefore it can be understood that for a developing country like South Africa, asthma is capturing out to be disease which is creating the country’s maximum death rate index.
± The burden of the disease have to be better understood by the people and the government in particular, so that they can avoid the premature deaths.
± The majority of the patients in the country are low SES group which are hindering them from proper medication, hospitalization or therapy services in a controlled way. 

± Asthma has become a chronic disease among children and adult. It can be happened for several reasons like pollution, anxiety, tension etc. this cannot be treated properly and government is taking several measures to curb this problem
Chronic disease management and OTN telehomecare program (in Ontario)

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) exert tremendous pressure on individuals and community healthcare system throughout the world. In Canada, highest numbers of deaths are caused by COPD and nearly half a million Canadians are affected by HF. These chronic diseases are responsible for very high number of avoidable hospitalizations and extended medical expenditure. Telehomecare is a highly potent tool to reduce incidents of avoidable hospitalization, improve quality of life, and enhance access of people with COPD and HF to health care. Chronic diseases such as diabetes, cancer, COPD, and others, are these kind of diseases that are accompanying a person throughout their life. When a person is diagnosed with any kind of chronic disease, he/she is facing with a new situation that challenges their coping methods, and therefore causing them to constantly seek for medical support. In today’s world, specifically focusing in Canada, inadequate chronic conditions management do not only impact the chronically ill patient’s quality of care but also plays an important role in the way health care is delivered for all Canadians. As stated in CIHI “Health Care Cost Drivers: The Facts” report, “Survey data shows a stronger correlation between the presence of multiple chronic diseases and higher utilization of health services than between age and utilization.” (2011, pg.16).
To put it differently, chronic ill patient will tend to utilize health care resources more frequently than others, which in other words means increased cost in health care for both clients and the government. This paper will emphasis on how a chronic disease such as chronic obstructive pulmonary disease for example, can be more self-manageable, reduce ER visits and be more cost effective for both patients and health care providers. A program in Ontario called OTN Telehomecare may be the future solution for improving chronic diseases management across Canada. The telehomecare program, which uses technology methods to deliver the best care to a client with a Chronic disease, at home rather than in health care facilities. Giving the opportunity to patients to educate themselves about their chronic illness, allow them to learn how to monitor their vital signs, and mostly give them more independence can lead to greater health outcome in chronic disease management.
The Ontario Telemedicine Network (OTN) launched the largest Telehomecare program in Canada in 2007. The program was launched with 800 COPD and HF patients. In 2012 the program was expanded to three local health integration networks (LHIN) in North East, Toronto Central, and Central West. Till July 2015, 6,334 patients with COPD and HF in these LHINs have been referred to this program. The second phase of expansion involving more LHINs is now taking place. Each LHIN is entrusted with Telehomecare program planning and implementation and has one Community Care Access Centre (CCAC) or hospital through which the Telehomecare program can be accessed at the community level (Brown, 2013).
The twin goals of Telehomecare are to impart self-monitoring skills of treatment to patients with COPD and HF, and to improve treatment monitoring of such patients by remote health care system.  The different segments of Telehomecare are; i) informal telephonic interaction between patient or caregiver and a designated Telehomecare nurse, ii) daily updating of patient data, e.g. blood pressure, sugar level, oxygen level, etc. along with answers to questionnaire to a designated Telehomecare nurse, iii) individual care if the data are on the wrong-side of the range, iv) communication regarding patient’s health condition between Telehomecare nurse and other member of the care.

Canada’s chronic health care system is immensely pressurized due to wide prevalence of chronic obstructive pulmonary disease (COPD) and heart failure (HF). This results in avoidable hospitalization and unreasonable medical expenditure. Patients with such chronic diseases also require to be monitored as a continuous process and medicines administered accordingly.
Telehomecare has the potential to reduce number of avoidable hospitalization and medical expenditure as well. It has been seen that patients with COPD or HF can be more closely
monitored and the healthcare system can work more productively when patients are brought under remote controlled health monitoring system.

However there are certain issues with Telehomecare that need to be addressed. Studies show that there seem to be no improvement in number of hospitalization, number of days confined in hospitals, self-management skill, and risk of death. Some studies have shown increased mortality rate in patients under Telehomecare program. It has also been found that there have been instances of reluctance or refusal from patients, caregivers, Telehomecare nurses, and even physicians. Another important issue is cost and reimbursement. Telehomecare needs expensive equipment and also that telephonic consultations by physicians are not reimbursed.

( To learn about more about this paper please contact us at )

Symbolism in Lottery ( MLA STYLE )

In Shirley Jackson’s story “The Lottery” symbolism stands out to be the most important and fascinating component and makes the story worth of reading. The story itself stands out to be an exemplum than any other conventional story. The plot deals with a society so bogged down in traditions that it has become completely blind by the hypnotizing effect of so called customs and rituals which the villagers perform without any reasons and awareness. Rather they follow those traditions irrespective of the fact that they can harm the dwellers of the village. Since this is the threat that every society comes up with, this story fulfills its criteria of relevancy in part because the symbols referred in the story are partially explained. The current paper illuminates the idea of exploration of some of the significant symbols such as lottery, black box and summer that makes the story itself interesting. Also the symbolism here reflects the phenomenon that the tradition adopted in the story has destabilized the basic instinct of men to protect women. 
The most basic symbol of this story is the lottery. It indicates the aphoristic rituals and customs which jaunt our society. Those traditions are considered by author as insensible, but still they are done to follow the so called customs and belief of the society. Lottery here refers to the lottery box which symbolizes those dwellers in the village because they are the only connecting and relevant factor to the origin of lottery. For instance, Shirley states
“ The morning of June 27th was clear and sunny with the fresh warmth of a full summer day. The flowers were blossoming profusely and the grass was richly green” ( p. 291).
It has been utilized as anyone can commemorate, but is not the original lottery box. They rather believe that some fragments of the original box have been utilized to form a new one, but it is uncertain. So it can be stated that the original meaning of lottery has been abandoned by the author. The lottery here acts as allegory of village life itself which at first seems to be harmless, but then one is surprised with the restrained smiles and piles of stones.  The lottery therefore functions to be a combining force which brings the natives together as a community. So the old man Warner repeats a famous dialogue which states “Lottery in June, corn be heavy soon” ( p. 297) which is a declaration of their strong relevance with the lottery. Therefore, the lottery is more of an attraction mixed with tradition and an idea greater than obsession with the anticipated benefits.
In addition to this the black box symbolizes the physical disclosure of the dwellers’ connection to tradition. The villagers use this black box as an artifact of a primitive time to perpetuate their aggressive and merciless traditions. Like the lottery the symbol Black box also becomes obscure with unfolding of the story. Initially it will be too early to say that the treatment of the box by the villagers impersonate their thoughts on the subject concerning lottery as a whole. The old and worn out box does not upset the tradition of the villagers by replacing it. Infact it is used as artifact which is culturally as well as historically significant to the people of the village. The villagers boost confidence to the villagers to believe their customs of their forefathers; irrespective of the fact that these traditions do not contain any moral value. Even the black spot on the paper indicates that the person is marked as doomed as the spot demonstrates fate. When “ the postmaster Mr. Graves followed him carrying a three legged stool and the stool was put in the center of the square and Mr. Summers set the black box down on it” ( p. 292).
            Moreover, another interesting symbol is that of Mr. Summers. Summer suggests the season of warmth, happiness, sunlight and leisure time. Here in this story the character Mr. Summers is a character who is somehow ironic. The summertime indicates the ambiance of the village to be good.  The character of Mr. Summers indicates him a jovial man. But with the unfolding of the story, his behavior slowly changes and at the end of the story the person is seen to be stoned to death which creates an atmosphere of gloominess.  Mr. Summers occupies the central character in the story who not only brings light and warmth, but also the death and darkness. The execution method at the end of the story is not an enslaved choice. Stoning is one of the common and primitive ways of killing, but it also carries a symbolic pattern. It carries a symbolic reference from the Bible where it is depicted that many of the Christians were stoned to death. This phenomenon signifies the phenomenon of executing innocent people without any reason. The main reason for using stone as equipment for killing in past as well as in this story is that there is no single executioner. This indicates the fact that no one has to singly carry the guilt of doing the crime. So this is important to the story because it gives a clear idea of who the criminal is. This rejuvenates the fact that in this story “The Lottery”, the protagonist is not a single person, but a whole society.

In conclusion, the symbols in the story denote a feministic aspect of the author about the woman in America in 1948. This has many reasons to understand the so called abiding traditions to be just as corrupt traditions in the story. This depicts the fact that those primary traditions still exist in the society and the author somehow symbolically puts herself in a position where she is victimized.

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