NZ – Child support system needs to be fairer

The Government is seeking to make it easier and fairer for parents to make child support payments – but also make it harder to avoid stumping up.

Revenue Minister Peter Dunne today released a discussion document, Supporting Children, outlining wide-ranging proposals to change the system.

Parents owe about $2 billion but only about $600,000 of that is unpaid child care payments while the rest is penalties.

Mr Dunne said the scheme, which arranges financial support for the care of 210,000 children, needed to be fairer. At the moment, for example, a dad might care for a child before and after school every day but because he did not have them for 40 percent of nights (the current test) he was not considered to have shared care.

One of the options was to change the measure to a tiered system starting as low as 14 percent of nights and recognising other periods of time.

Other options around changing payments calculations included using an estimate of how much it cost to raise a child as a basis for payments, and taking the income of both parents into account – not just that of the absent parent.

Mr Dunne said most of the principal payments were made – 89 percent – but there were issues with penalties building up.

Options to tackle payment, penalties and debt included:

* making it compulsory for child support payments to be automatically deducted from salary and wages;

* reducing penalties after people made repayments for a reasonable length of time;

* providing an amnesty on penalty fees for people who pay the whole original debt;

* allowing penalties to be written off in some cases – for example, when someone is ill.

“An important part of getting the scheme right will be creating a situation where paying parents are more likely to comply with their obligations voluntarily,” Mr Dunne said.

“They are more likely to do that if they see their obligations as fair, transparent and reasonable – and not based upon some formula that seems to have no regard for their individual circumstances.”

The document also looked at tightening up on non-parents claiming child support – in some cases teens have left home and set up with people parents did not approve of but who they found they had to pay.

Mr Dunne said the scheme was introduced 18 years ago and was “outdated and sometimes unfair”.

Families were often more complex: both parents were more likely to be working and often separated fathers had a greater role caring for children than in the past.

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It was better if parents could reach their own arrangements but the scheme was a good backstop when that could not be worked out, he said.

The proposals would not please everyone but both parents had to share responsibility. Officials are trying to improve the tracking of absentee parents – about 27 percent of debtors are in Australia and 2 percent in other parts of the world.

The proposals, if adopted, would be more costly for Inland Revenue to administer.

Chief Families Commissioner Carl Davidson said parents needed support to continue to parent together as about 21 percent of households with dependent children were single-parent.

He said child support should be paid directly to the carer parent not through Inland Revenue and overseas experience showed people were more happy to pay when they saw the money going directly to their children rather than government departments.

He also said the system needed to account better for changing circumstances and flexibility around who paid what.

Every Child Counts spokeswoman Deborah Morris-Travers welcomed the proposals and said children in single parent homes were over-represented in poverty statistics.

She called on the Government to drop the domestic purposes benefit penalty for women who would not name the dad.

The discussion document will be on Inland Revenue’s website with submissions closing on October 29 and legislation would be introduced some time next year.

Labour’s Stuart Nash said National had campaigned “hysterically” on the issue and was now taking a leisurely approach to fixing problems.

http://www.stuff.co.nz/national/politics/4086847/Child-support-system-needs-to-be-fairer

UK – Work Matters: Management Focus – Boost for play

SkillsActive has come up with a three-tiered, bite-sized approach to playwork qualifications, reports Karen Faux.

Earlier this summer, SkillsActive published a report, Playwork People 4, which found that more than 40 per cent of playworkers do not have a playwork qualification. So employers who are keen to recruit more staff with specific expertise in play will doubtless welcome the launch of the Level 2, 3 and 4 Award, Certificate and Diploma in playwork, developed by SkillsActive. Candidates now have the opportunity to pursue a three-tiered approach to learning at each level.

The award represents an induction, the certificate attests that learners are ‘ready’ for work and the diploma that they are ‘competent’.

Employers told SkillsActive they needed more staff who understood the principles and values of playwork and who were committed to developing a career in this area. They said playwork qualifications needed to provide a clearer picture of the skills that had been acquired.

To ensure the new awards meet the needs of employers, SkillsActive recently undertook a full review of the playwork national occupational standards, consulting across the playwork sector – with employers, training providers and playworkers themselves.

Having developed the new qualifications with key partners, SkillsActive is confident it has created a user-friendly, bite-sized approach to learning, which could close the skills gaps. At all levels, the units were pulled together by a technical reference group and at Level 3 and 4 the units were sent to awarding bodies to be developed into qualifications. New units at Level 3 cover adventure play, play rangers and playwork for younger children.

Uzma Anglin, SkillsActive communications manager, says, ‘In response to employer feedback, we have ensured that playwork principles are contained in a specific unit, so learners can use it as a standalone qualification.’

She adds, ‘Employers will benefit because qualifications will be available in bite-sized chunks, which means staff will be able to study flexibly, to suit themselves, their employers and the settings they work in.

‘These playwork qualifications are the only ones which fully equip learners to work in out-of-school clubs, holiday playschemes, adventure playgrounds and play-based facilities for school-aged children,’ she says.

SkillsActive is in discussion with the CWDC to achieve recognition of the Level 2 Certificate and Level 3 Diploma as full and relevant for practice in early years registered settings, which would mean they will be accepted in nurseries as well as out-of-school clubs.

Level 3 will be available this October, Level 4 is due to be published by January 2011.

FURTHER INFORMATION

www.skillsactive.com/playwork/qualifications/qualifications_development

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025161/?DCMP=EMC-CONNurseryWorldUpdate

Positive Relationships: Baby room – Who cares?

The often disregarded baby room was the focus of a project on how young children are cared for, as Dr Kathy Goouch and Dr Sacha Powell explain.

There seems to be a lack of research information about the processes and practices of early childhood education and care for children from birth to three (David et al, 2003). This gap in research knowledge is particularly evident in relation to the specific field of work with babies from birth to 12 months, in varying forms of daycare.

Although the increase in maternity leave seems to have resulted in a drop in the numbers of very young babies being looked after outside the home, Unicef (2009) has reported that around 18 per cent of babies under 12 months in England are in some form of daycare provision; and this is often for a large part of the working week. Accordingly, we have focused on exactly that age group in the Baby Room Project, our latest research initiative.

USE IT OR LOSE IT

With all the advances in technology and the new use of neuro-imaging procedures, much more is now known – thanks to research by neuroscientists – about brain activity, growth and development. This is increasingly useful in informing the kinds of care and support necessary for healthy babies.

What seems to be clear from this kind of research is that babies’ brains are incredibly active and thirsty for interaction and activities – which in turn fosters further learning and brain development (David et al, 2003).

As we develop, our brains are said to work on the ‘use-it-or-lose-it’ principle (Greenfield, 2000). That is, as with any other muscle, our brains strengthen with activity or weaken without. Significantly, we now know that the brains of babies are shaped by experience.

This early stage of brain growth, from birth, and the experiences and encounters that influence it, often take place in out-of-home settings, in nurseries and daycare and in designated rooms in those settings – in other words, the baby room.

The practitioners working with the babies in their care have a huge professional responsibility to do so in loving and appropriate ways. Yet in our research we have found that those practitioners are often overlooked in relation to support and professional-development opportunities.

NATTERING ON THE NING

In our project, we are working with a small group of local baby room practitioners to look at what they are doing with babies and to understand why they might be practising in particular ways in their settings. This group comes together for development sessions, but has also agreed to observations being carried out and to short films being made of its interactions with babies.

As the project progresses, discussions about, for example, sleep or nappy-changing practices have become lively and engaging. To further help the practitioners swap ideas and question their own and others’ ways of working, we have provided them with a netbook and created a social networking site (or ‘Ning’) for them to chat online to each other.

A key feature of this project is to provide opportunities for our colleagues working in baby rooms not only to look inward at their own practice but also to look outward and around, for ideas, affirmation, challenge and research evidence.

SHANGHAI SYNERGY

The project is providing a mass of interesting data, but to support our own knowledge development – and hopefully to provide a practitioner network link there – we have also been able to visit Shanghai, China, to look at some innovative family support practices with parents, grandparents and babies in a family centre that opened in 2005.

We took with us film of one of our settings and information about the project and its Ning to share with our Chinese colleagues. In turn, we were offered unlimited access to the family centre, with and without families, and to some in-service seminars with practitioners across the region.

Seeking out other examples of practice from elsewhere in the world is enormously useful, as it helps us reflect on similarities and differences and also on why we practise in the way that we do. For example, with the new emphasis on the use of toys and resources made from natural materials, our colleagues in Shanghai were interested in the fact that colour seemed to be missing from the baby rooms.

This kind of practitioner reflection provides the perfect opportunity to question our motives and the rationale for developments that sometimes emerge from research and sometimes from other influences.

Opportunities to observe and learn from colleagues across international borders are rare, but when they occur there is much to ponder, for example in relation to cultural and policy differences. With our colleagues in the project’s nurseries, the Shanghai experience is one we are hoping to frequently revisit via the video material – but also to build upon when we arrange a reciprocal visit to our own settings in the near future.

STAND BACK AND REFLECT

Our Baby Room Project is nearing the end of its year-long funding and we are beginning to analyse and report on the findings. The most significant element of our learning is that the project has confirmed that while we know that practitioners working in nurseries find it difficult to access professional development during the working week, those in baby rooms seem to be, and feel themselves to be, a completely overlooked community.

Baby room practitioners, in common with all of those caring for young children, work extremely hard and for long hours. In some very small nurseries there may be one adult caring alone for three babies for most of the working day – an enormous mental and physical challenge.

Opportunities to stand back and reflect on practice are extremely rare and indeed frequently non-existent. And yet this sort of reflection is crucial to professional development, to careful consideration of all elements of practice, to the questioning of routines and to the professional engagement of practitioners in their everyday responsibilities.

One of the practitioners in our project talked about how it had helped her to ‘helicopter above’ the work she did with babies to better see what was happening and why. Another spoke about how it had caused her to think about the ‘good babies’ and how little time she perhaps gave them compared to others who were more demanding in a number of ways.

A member of the group raised the point that parents, mothers, were handing over to them the ‘most precious thing in their world’ and what a huge responsibility it was. Some practitioners talked about parents who were worried that the practitioner was too young to trust with their babies and how that made the practitioner feel.

On our Ning, the social network site, many practitioners have described ‘A day in the life of a baby room practitioner’ and compared and contrasted routines and rituals; someone wryly commented that everybody had to do the same things and yet they did them differently.

Conversations have begun on the Ning about the storage of breast milk, observations and the demands of record keeping, sleep routines, child protection and practitioner protection. Links to other useful sites are facilitated through the Ning and everyone can contribute to the discussions and has equal access.

One thing we have learned is the enormous need for this group to talk to one another – to share understandings and worries, to tell how constraints can be overcome, to gain a perspective on the demands of policy, parents, managers, local authorities and Ofsted – all with a stake in the success of baby rooms.

Significantly, we have learned how important it is for our project group to feel the enormous importance of the professional responsibility they hold. We believe that it is through access to professional development programmes, properly designed and managed to allow practice, research and policy to be effectively mediated and considered, that baby room practice can achieve the high status it deserves.

Dr Kathy Goouch is senior lecturer in education and Dr Sacha Powell is a principal research fellow in the department of educational research, Canterbury Christ Church University. The Baby Room Project was funded by the Esmee Fairbairn Foundation.

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025160/?DCMP=EMC-CONNurseryWorldUpdate

Enabling Environments: Creativity – The Midas Touch

The Midas Touch Project, a Liverpool-based transformative learning programme for very young children and their families and carers, aims to enhance children’s and adults’ sense of awe and wonder in their everyday lives. Using recycled, ‘ordinary’ objects as tools of play, work and learning, the Midas Touch programme uncovers the unusual within the usual, the strange in the familiar and the beauty within the unsuspecting.

Its approach relies on the metamorphosis of recycled, discarded and ‘worthless’ objects, their incorporation into challenging learning experiences and the documentation of children’s learning for its affects and effects.

Midas Touch is based on an innovative project called REmida, based in the north Italian city of Reggio Emilia, whereby an early years practitioner (pedagogista) and an artist (atelierista) work collaboratively in different ways to enhance children’s learning and promote the idea that waste materials can be resources. The Midas Touch team also wanted to adapt some key principles from the Reggio Emilia approach when rolling out its programme. These include:

Children must have some control over the direction of their learning
Children must be able to learn through experiences of touching, moving, listening, seeing, hearing
Children have a relationship with other children and with material items in the world that children must be allowed to explore
Give children endless ways to express themselves.
Another vital factor of Midas Touch is the role of the adult, whether that be a practitioner or a parent/carer. The role of the adult within Midas Touch is to be the listener, the observer and a compass.

Through Midas Touch, children are able to explore interests via processes, but this does not necessarily lead to an end product. The adult can listen to children’s interests, views and opinions and act as a compass by guiding their learning through appropriate questions, which will not impose the adult’s own views and opinions, but extend the child’s learning.

There is no hierarchy within Midas Touch; it is an opportunity for the practitioner and the child to go on a learning journey together that will lead to the opportunity to engage in sustained shared thinking. This gives the adult a better understanding of the children in their care by clarifying children’s interests, opinions and schemas of play – which will in turn help to better support a child’s learning.

CONSIDERED DECISIONS

Midas Touch was set up as a four-week pilot this March in St Helens, Merseyside, with the hope of becoming a sustainable resource eventually. Seven different settings across St Helens, including children’s centres, private day nurseries and nursery and reception classes, attended the project on a weekly basis.

All decisions were made after consultation with Warwickshire’s Enviro Arts Vision for Education (Weave) in Leamington Spa, House of Objects Creative Recycling in North Tyneside and, most importantly, the children and families in the St Helens area.

Funding the pilot was an initiative named Find Your Talent, a national scheme to encourage children and young people to participate in cultural activities, both in and out of school. The Liverpool City Region pilot is one of ten that was run nationally to support education settings, children and young people to participate in their local cultural offer.

I was seconded as an early years consultant for this project from my role as early years professional at Thatto Heath Children’s Centre, St Helens. I had been involved with this project and Find Your Talent from the very early stages.

During the project, I took responsibility for the early years practice and ensured that the experience was open-ended and creative for all the children involved. I advised, supported and worked alongside the artist and co-delivered sessions to the children. I also gave advice and set out the essential outcomes of the project for children’s centres and schools, based on local priorities.

The rest of the team consisted of:

Nick Owen, project leader. Nick is responsible for driving the project forward, managing the budget and timescales and championing the project. He liaised with press and marketing teams and the recycling department of the council, with support from the Find Your Talent co-ordinator for St Helens. Nick is director of Gloucester-based sports and cultural body, Aspire Trust.

Claire Weetman, project manager. Visual artist Claire supports Nick in managing and driving the project forward. She co-ordinated the participation of schools and children’s centres, with support from the Find Your Talent area co-ordinator, Nicola Clarke. She was also instrumental in readying the venue for the project delivery.

Michiko Fujii, artist. Michiko worked with me to develop creative opportunities for the children. She collaborated with Claire to source suitable materials and was responsible for the preparation of the materials prior to use.

ESSENTIAL REFLECTION

Planning, reflection and documentation were essential elements of the four-week pilot project, as well as linking this all back to the EYFS. Each week there was a loose theme within our planning, relating to the objects used. These four themes were: plastics; wood and metal; natural materials; and blacks and whites.

However, the majority of the planning was emergent and reflective, looking at observations and reflections from the previous week. This meant that we introduced materials to extend learning and interests, such as a variety of mark-making media and real tools.

All sessions covered the themes and areas of learning of the EYFS in a holistic way and activities were all child-led. Children’s learning was observed and documented in various ways, such as taking photographs, recording videos and making written observations. This documentation was used to enhance learning opportunities while at the Midas Touch, but was also made into books and wall displays to share with children, parents/carers, practitioners and the wider community.

Practitioner and parent/carer feedback about the Midas Touch project included the following comments:

What have you noticed? ‘Children really had to THINK to solve problems to make what they wanted.’
What have you learnt? ‘Why do we spend lots of money on expensive resources and things such as dressing-up clothes when children have such vivid imaginations and are so creative? Practitioners and parents/carers need to see this project to realise the importance of developing their children’s skills in this way.’
‘Everyday materials + Freedom = Learning.’
What was important? ‘Not to have any preconceived ideas. The children’s imaginations take us on a wonderful journey.’ ‘To step back and offer support where required. To know when to be quiet. Allowing children to be children and show individual talents.’
Our partnership with St Helens Council will continue and our next step is to resource a feasibility study to identify a local venue and management structure to enable the centre to become a long-term initiative for children in St Helens and Merseyside.

I feel strongly that this opportunity for learning has been irreplacable for the children who were part of the Midas Touch. It is a place where each individual child’s interests take them on a journey, free from boundaries – a place where a sheet of material can lead to the most imaginative role-play I have ever observed, where a plastic bottle can be transformed into a musical instrument and where children are free to truly explore play with real objects and real tools, free from any pre-conceived ideas.

Laura Grindley was formerly early years professional for Thatto Heath Children’s Centre, St Helens, Merseyside and is now senior children’s development and learning officer for Whiston Area Children’s Centres.

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025156/?DCMP=EMC-CONNurseryWorldUpdate

UK – Government urged to rethink school starting age

Educational experts are urging the Government to rethink the age at which children start school, to close the gap between summer-born children and older peers.

Tim Oates, of Cambridge Assessment, which published a review of research into birthdate effects last year, believes that the school starting age should be based around the development of ‘executive function’ in children, the ability to monitor, plan and reflect, which typically occurs at around the age of four-and-a-half.

Mr Oates said, ‘The gap in attainment between summer-born and autumn-born children is a function of their being young for their year group. The evidence points to there being a spurt in the development of executive function at around the age of four-and-a-half. If you push down the onset of intensive formal education too far, some children will not develop this capacity and struggle with the demands of formal schooling.’

His views were backed by a new review of birthdate effects on education and school policy, published by the Department for Education in July. This found that the gap between the number of autumn-born children and those born in August who achieved a good level of development in the EYFS profiles is 24 percentage points. This gap falls to eight percentage points at Key Stage 2 and six percentage points between autumn-born and summer-born children who achieve five or more grades A*-C at GCSE.

Summer-born children were found to be significantly more likely to be identified as having a special educational need than older classmates. The most disproportionate SENs in summer-born children are moderate and specific learning difficulties, speech, language and communication needs and ‘unclassified’ needs.

The study found that gaps in attainment were only due to summer-born children being comparatively younger at the time they were assessed, not to how old they were when they started school.

A spokesperson for the DfE said, ‘We are still considering policy on summer-born children. In the meantime, from September 2011, all local authorities will be required to offer children a place in Reception from the September following the child’s fourth birthday. Parents will continue to have a choice on whether to defer and, if so, can continue to access 15 hours’ free nursery education from a range of providers.’

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025135/?DCMP=EMC-CONNurseryWorldUpdate

UK – Ofsted to issue accident guidance

Following a successful appeal by a nursery owner, Ofsted is planning to issue precise guidance on what constitutes a ’serious’ accident requiring notification.

The owner of a Yorkshire setting had been given notice to improve by Ofsted because she did not notify child protection agencies when a child fell and cut her lip.

The dispute between Ofsted and Granby House Nurseries, which has four settings in Rotherham and Worksop, has prompted the inspectorate to publish new guidance for nurseries on what should be regarded as a serious accident.

The guidance is expected to be sent to providers in the autumn. The notice to improve has been removed from the nursery’s Ofsted report.

The child, who fell while walking inside the Wickersley nursery, Rotherham, went to hospital for the cut to her lip, which required stitches. The incident was reported to Ofsted, but while an inspector concluded that the accident could not have been avoided, she said that the nursery should have informed child protection agencies, as it is an EYFS requirement to report serious accidents or injuries to children in its care.

Jo Gray (pictured), owner of Granby House, said that the EYFS guidance does not define what a serious accident or injury is.

Ms Gray complained to Ofsted after speaking to Rotherham Safeguarding Unit, which advised her it was not general practice to contact it in such situations. In a letter dated 25 August, Ofsted notified Ms Gray her complaint had been upheld.

The letter said, ‘Arrangements have been put in place to devise a factsheet for staff and providers on what is a serious accident, and for any where referrals are to be made to child protection agencies.’

It added, ‘There is no clear guidance or clear definition in the EYFS of what is a serious accident or when they should be referred to child protection agencies. There was no reference to possible child protection concerns in the regulatory inspector’s report and she did not discuss this with you. Therefore, this aspect of your concern is upheld and the outcome summary report is to be updated to reflect that no further action is required and there was no breach in the EYFS Welfare requirements.’

Ms Gray said, ‘I hope that, following my complaint, there will be detailed guidance issued as to what constitutes a serious accident to ensure providers don’t go through the same ordeal we have. Now we have had this notice to improve removed, we can carry on doing what we do best: providing quality care for all our children.’

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025134/?DCMP=EMC-CONNurseryWorldUpdate

UK – ‘Don’t change the EYFS’, practitioners say

There is ‘overwhelming’ support among most early years practitioners for the EYFS framework, new Government research by the Institute of Education suggests.

The study commissioned by the DCSF and published by the current Government, was carried out to find out the views all those working with the framework throughout the children’s workforce, ahead of a planned review of the EYFS this year.

In July children’s minister Sarah Teather announced a review of the EYFS led by Dame Clare Tickell.

The report, Practitioners’ Experiences of the Early Years Foundation Stage, concluded that there was ‘overwhelming satisfaction with the current requirements,’ but noted that there were criticisms of the framework’s implementation.

It added, ‘The majority of respondents would like to see only minor changes in the EYFS, and would prefer “no change” to radical change in the current requirements.

Many of the dissatisfactions expressed by practitioner groups stem from the implementation of the EYFS rather the documentation itself, which is widely viewed as embodying the beliefs, principles and practices to which most practitioners adhere.’

The areas of learning were found to be ‘generally appropriate’ but there was some criticism of the levels set for the early learning goals for Communication, Language and Literacy and the Problem-solving, Reasoning and Numeracy goals.

The report said, ‘Both teachers and headteachers disliked the strong emphasis on emergent literacy and numeracy (CLL, PSRN) and felt that these goals tended to be pursued at the expense of personal, social and emotional development.’

Practitioners also said that they found that the need for assessments against the EYFS Profile, were ‘increasingly problematic’ in Reception ‘and practitioners attempt to map children’s individual developmental trajectories on to a scale which many practitioners regard as ill-founded, illogical or inappropriate’.

The research took place during the first 18 months of the framework, between September 2008 and March 2010 and involved 190 attending focus groups and subsequent one-to-one interviews with 42 practitioners.

A Government consultation was launched in August, inviting nurseries, childminders, parents and all those working with the EYFS to contribute to their views on the framework to feed into the review. The consultation closes at the end of the month.

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025260/?DCMP=EMC-CONNurseryWorldUpdate

NZ – Safety a burning issue

Firefighters, the Rodney District Council and ACC have teamed up to make Rodney safer for children for this week’s Safety New Zealand Week.

Rodney fire services visited childcare providers around the district to present information packs to children and their parents on home safety.

The pack contains pamphlets on hot water and fire safety, home safety tips, Firewise balloons and stickers, as well as discount vouchers for smoke detectors.

Children under the age of five have the highest incidence of burns of all types, Silverdale station senior officer Vaughan Mackereth says. Between the years 2004 to 2008, an average of 1100 children annually have been admitted to hospitals with burns.

Around half of the patients were between the ages of one and two, who were victims of hot water or hot liquid spillage.

Young skin burns quicker and deeper at a lower temperature than adult skin.

ACC is encouraging people to make one simple change during the week to make their homes safer.

Visit www.homesafety.co.nz for information and a quiz on how you can make your home a safer.

http://www.stuff.co.nz/auckland/local-news/rodney-times/4084315/Safety-a-burning-issue

Childhood obesity is rising rapidly in Mumbai: Dr Sanjay Borude

On Monday, Dongri resident Nazir Abdul Ahmad Rehman, 53, left his 100-sq metre tenement for the first time in five years. He underwent a three-hour-long bariatric surgery, which will finally enable him to lead a normal life. Dr Sanjay Borude of Breach Candy hospital, who performed the surgery successfully on Rehman, spoke to DNA on the growing obesity problem in the city.

Borude is the former vice president of Obesity Surgery Society of India and is currently the Asia-Pacific representative, International Federation of Surgery for Obesity.

Rehman, at 190 kilos, has not been able to walk for a long time. Post surgery, how soon will he experience noticeable weight-loss?
He will be able to go for a routine walk six months after the surgery. In six months, he will reduce almost 40 kilograms.

What is the success rate of bariatric surgery?
I have been performing this surgery for the past ten years, and have operated on more than 1,000 patients. I have not seen a single mortality in this procedure. However, there is a risk involved of less than 1%, due to some complication that may occur.

Who is an eligible candidate for obesity surgery?
People with a body mass index (BMI) of more than 37.5 due to weight are eligible for this surgery. I see a lot of female patients who come for this surgery before marriage. I have performed more than 40-50 surgeries on patients of marriageable age and post surgery their lives have changed.

Is childhood obesity on the rise?
In a city like Mumbai, childhood obesity is rising rapidly. My youngest patient is a 14-year-old who weighs 120kg. But after the surgery, he weighs 80-85 kg. Now, after increasing awareness about surgery as an option to lose weight, more and more parents are approaching the hospital with queries. I see a lot of teenagers between 14 and 18 years who are morbidly obese. Some of these children are also diabetic.

How many days of hospital stay is required post surgery? What kind of surgeries are available for obesity?
There are two options available for obesity surgery: Sleeve gastrectomy and gastric bypass. Sleeve gastrectomy is a restrictive form of weight-loss surgery in which approximately 85% of the stomach is removed, leaving a cylindrical or sleeve-shaped stomach. This has a capacity ranging from about 60 to 150cc. The removal of the major part of the stomach results in virtual elimination of ghrelin hormones which stimulate hunger. As the new stomach continues to function normally, there are far fewer restrictions on the food which patients can consume after surgery, though the quantity of food eaten will be considerably reduced.

What kind of tests are done before weight-loss surgery?
Certain basic tests are done prior to surgery: A complete blood count (CBC), urinalysis, and a chemistry panel, which gives a readout of about 20 blood chemistry values. Often a glucose tolerance test is done to evaluate for diabetes, which is very common in overweight persons. All barring the very young will have to get a chest X-ray and an electrocardiogram done. Women may have to go for a vaginal ultrasound to look for abnormalities of the ovaries or uterus.

http://www.dnaindia.com/mumbai/interview_childhood-obesity-is-rising-rapidly-in-mumbai-dr-sanjay-borude_1432334

Politics is killing the world’s children

I recently met a woman called Opa, in a tiny village a few hours inland from Madang on the east coast of Papua New Guinea. World Vision had trained her as a birth attendant, but her fellow-trainee had died and she said she was now unable to attend to all of the community’s birthing needs. I looked around at the group of nursing mothers and asked how many had children who had died. Hands shot up, and the uniform reply was ”plenty”.

By contrast, the average pregnant Australian woman – if there is such a thing as an ”average” pregnancy – could expect to see a midwife at least half a dozen times over nine months, as well as a doctor or a gynaecologist if she needed to. Under-five child deaths are almost unheard of, particularly deaths from preventable diseases.

This is not the case in many parts of the world. The tragic, preventable deaths of 9 million children every year is one of the world’s largest problems, and this week it has landed on Melbourne’s doorstep, where a UN health conference is under way at the Melbourne Conference Centre.

The conference, entitled Advance Global Health – Achieve the Millennium Development Goals, brings together more than 300 non-governmental organisations from more than 70 countries. Some 1500 delegates are exploring the challenges of meeting the Millennium Development Goals (MDGs) – the world’s blueprint for halving global poverty by 2015.

It is the beginning of a last ditch effort to get Millennium Development Goals 4 and 5 back on track for their 2015 target. The goals’ aim to slash child and maternal mortality rates. But despite some recent successes, there are still millions of mothers losing their children to preventable diseases before they turn five.

Melbourne was chosen to host the conference – only the third time it has been held away from New York — because the city is without peer in the field of child health. Melbourne is home to the Burnet Institute, the Nossal Institute, and the Royal Children’s Hospital – some of the world’s leading thinkers on saving children’s lives. It is also home to many of Australia’s leading charities in this field.

The knowledge these organisations can share is vital in combating this tragic situation. But the reality is that agencies like World Vision can’t turn back the tide on child mortality rates unless governments in both developing and developed countries start lifting their weight: overall global donor aid for maternal, newborn and child health accounts for only 3 per cent of global aid.

At present, there is no shortage of high-level declarations and commitments from donor countries, but in practice donor pledges on health have become a debased currency. It is politics, not poverty, that is killing the world’s children.

Only three weeks after the Melbourne meeting, the world’s leaders will gather at the UN General Assembly in New York to review progress towards the MDGs. There they have the opportunity to restore momentum to the fight on preventable child deaths.

At a global level, rich countries need to increase their commitment to health from the current level of $US16 billion a year to $US42.5 billion by 2015 if they’re to meet the health MDGs in all developing countries. To put this funding requirement in context, it is equivalent to just 4 per cent of the fiscal stimulus package announced by the G20 for 2009.

But it’s not just about aid volume. We also need to get smarter about how we spend our aid dollars on health. For example, a lot of the political energy and donor funding in recent years has been directed towards vertical programs to address specific diseases – particularly HIV, tuberculosis and malaria. These efforts have often yielded significant results – not least the more than 4 million people who are now receiving antiretroviral treatment for HIV and AIDS – and need to be sustained.

Yet at the same time, key causes of child deaths such as undernutrition, poor sanitation and lack of hygiene have been woefully neglected. For example, despite undernutrition being a factor in over a third of all child deaths, in 2007 donors allocated just 1.5 per cent of aid for health to nutrition. We have failed to prioritise family care within communities, reflecting the fact that in poor countries most antenatal, postnatal and child care activities take place in the community rather than a hospital.

This Melbourne conference is a critical moment for the world to set the fight against poverty back on track so we do not fail the world’s most vulnerable people. With the MDG end-date only five years away, the care of pregnant women in Victoria should already be a right shared by women the world over. Sadly for women like Opa though, until developed countries start demonstrating genuine political will to solve this problem, such care remains the domain of a privileged few.

Tim Costello is chief executive of World Vision.

http://www.smh.com.au/opinion/contributors/politics-is-killing-the-worlds-children-20100901-14n0z.html