The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns

The virtual simulation of child sexual abuse: Online gameworld users’ views, understanding and responses to sexual ageplay.

This paper explores cultural understandings of virtual sexual ageplay in the online world of Second Life. Online sexual ageplay is the virtual simulation of child abuse by consensual adults operating in-world with child computer characters (avatars). Second Life is primarily governed by Community Standards which rely on residents (the users of Second Life) to recognise sexual ageplay and report it, which requires an appreciation of how residents view, understand and construct sexual ageplay. The research presented drew on 12 months of resident blog posts referring to sexual ageplay: 263 total, with 91 residents. The analysis of this talk explores the cultural understandings of this banned behaviour and beliefs about the nature of Second Life which underpin residents’ likelihood to report sexual ageplay and so comply with the Community Standards. In considering these issues the paper is able to highlight issues regarding the unique cultural position of abuse against children and key concerns which underpin the reporting behaviour of residents. Key considerations relate to defining online sexual activity, child avatars; the moral status of ‘reporters’, and sexual ageplay as a form of edgeplay; belief in the harmfulness of sexual ageplay and its relationship to real world behaviours