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Mother Of All Myths That Only Mums Mother

Looking for the perfect gift for Mother’s Day? Forget the dust buster. It’s a myth buster.

Motherhood is a fertile breeding ground for myths. Take the myth implicit in Bill Heffernan’s recent comments about Julia Gillard: that women who don’t give birth are “barren”. When we put this myth into the myth buster, we find that there are many reasons that women don’t have children. Calling these women “barren” denies the rich and fruitful relationships that many women nurture with children – you don’t need ‘your own kids’ to mother.

When people talk about mothering the way Bill Heffernan does, they perpetuate the myth that motherhood is defined by biology, breast feeding and “buckets of nappies”. This limited definition of motherhood assumes that ‘mothering’ is exclusive to biological mothers. It ignores the fact that women without children can also be good mothers and that there are many ways to mother.

There are many other myths around motherhood that we should feed to the myth-buster. Take these old favourites: “only women who give birth are mothers”; “children can only have one mum”; “there is no substitute for a mother’s love” and, the mother of all myths, “that only biological mothers are ‘real’ mothers”.

When the myth buster does its work we see that lots of women mother children – adoptive mothers, step mothers, social mothers, foster mothers, ‘aunties’, friends, neighbours, nannies, and so do some men. It is simply not true that all this mothering is second best or that these contributions to raising a child are less real or less motherly.

A child can have many mothers. In fact, there are many days when many, many mothers are needed – to get the kids to footy or netball training, to prepare dinner and get to the dentist on time, to make costumes for drama club, to drive kids to music lessons and parties, to take a turn with the wheel-chair, the shopping trolley or the pram, to help with maths homework, to remove nits from hair and dispense first aid to the guinea pig.

From childhood to adulthood, lots of people provide mothering in the form of sex education, learning to drive, mentoring about responsible drinking. They also share tears, reveal secrets and provide hugs and support children through the rites of passage. Yes, it takes a village. The myth that only mothers mother denies the important way that women without children can and do contribute to childrens’ lives.

With so many women mothering, why limit Mother’s Day lunch to only one mum? Every Mother’s Day, a lot of women who mother miss out because the traditional celebration of Mother’s day excludes women without children. This exclusiveness can make Mother’s Day a sad day for some women. However, by expanding our view of mothering, and by moving an apostrophe, we can share the celebration and make it a Mothers’ Day.

By acknowledging that mothering doesn’t just come from mothers, we provide opportunities to welcome more women to Mothers’ Day lunch and, in some families, we might also welcome a man or two to the celebration.

It is not only women who benefit from motherhood myth-busting. There are some children who feel sad on Mother’s Day because it focuses on the notion of ‘real’ mums. Kids who do not know their biological mothers, or cannot be with them, may not feel like joining in. However, if we acknowledge that there are lots of ways to mother and place less emphasis on biological definitions of mothering, we could make the lives of some kids happier. If we expand our rules about who is a mother, we might find that more children can enjoy the Mothers’ Day stall at school.

This Mothers’ Day, lets put all the myths in the myth buster and buy a toaster for Philomena for taking kids to the footy, a perfume gift pack for Auriol for all her school holiday baking, gardening gloves for Tina for telling the kids a bed-time story and chrysanthemums for Julia Gillard for caring about the future of work for kids.

This Mothers’ Day, the myth buster is the perfect gift for people who want to share the ritual of breakfast in bed. Perhaps we should send one to Bill.

The Australian May 11 2007

Behind the numbers

Letter, The Age

The federal government cut payments to aged care by $1.2 billion over four to help curb a predicted blowout in costs. Aged care providers are predictably are up in arms. Unfortunately, government subsidies often serves the interests of the providers more than residents.

Under the current arrangements, the providers do their own assessments of residents. When a resident is reclassified as requiring a higher level of care, the provider receives more money from the federal government. However, staffing levels rarely change nor are extra services provided to the resident. One in eight claims are reportedly incorrect.

The Aged Care Funding Instrument is based on residents’ level of care rather than ‘restorative care’.  There is no financial incentive for providers to introduce services such as strength training or lifestyle programs that would improve residents’ quality of life.

The funding of aged care homes requires greater scrutiny and transparency to ensure the best possible care for frail, elderly people.

Sarah Russell, Northcote

Relatives bear load

Letter, The Age

Sarah Russell’s article (“We’re neglecting our ageing population”, Comment, 18/4) describes many of the serious shortcomings evident to anyone who has experienced the emotional turmoil of placing a loved one into institutional care.

Mecwacare’s Noel Miller Centre in Glen Iris is a case in point. In the high-care facility, significant cutbacks in staff numbers along with general management disengagement from resident service delivery is of great concern to those who visit daily, some twice daily. All too often relatives have to help with tasks from feeding, bathing and room cleaning because staff are too pressed. Management too often does not see what actually occurs in residents’ rooms and common areas – preferring to remain in their offices.

Curiously, Mecwacare, a not-for-profit organisation, recorded a net profit of $3.9 million for the year ended June 30, 2015, and bought a new head office in Malvern and added six aged care homes to its portfolio.

Neither the board nor the executive of Mecwacare has explained why growing the portfolio of buildings and Mecwa facilities should take precedence over the care and welfare of those already living in their facilities – especially in their high-care units.

 John Simpson, former resident relative – Mecwacare

Pain is real, not a myth

Letter, The Age

It is tragic that older people commit suicide (The Age, 17/1). The National Coronial Inquiry Service estimates that two people over the age of 80 are taking their lives every week. The most common method is hanging.

Ian Hickie suggests older people commit suicide because of myths and negative stereotypes about ageing, pain relief, hospitals and how the health system treats elderly people. Are these myths?

Recently, an elderly woman living in an aged care home died in excruciating pain because no one was suitably qualified on the night shift to administer the prescribed morphine. The woman’s daughter was so traumatised she could not remain at her mother’s bedside to hold her hand.

We do not need motherhood statements about healthy ageing. We need political action to ensure older Australians are valued and receive the quality of health care that they deserve.

 

Sarah Russell, Northcote

 

Our elderly need homes, not warehousing

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Language  shapes our sense of place. Residential aged care facilities are places that our most vulnerable older people call home; the home that will, for most, be their last place on earth. The term “facility” dehumanises aged care. Facilities are built to perform functions in the most efficient manner. In contrast, a home is a welcoming place, where friends and family drop in for a cuppa or a chat,   and, if we need help, assist us around the house, the garden or even with dressing.

Since the 1990s successive governments have failed to heed the forecasts of demographers on population ageing. Now with the need for housing and care options exceeding the capacity of families and communities, an investment boom is taking place. Private equity firms, foreign investors and superannuation and property real estate investment trusts are entering the residential aged care market in larger numbers. And they are building larger facilities.

According to the Australian Institute of Health and Welfare, half of all residential aged care facilities had more than 60 places in 2014 compared with 28per cent a decade ago. Increasingly built on reclaimed industrial land, aged care facilities now serve as places to warehouse our parents and grandparents,  removed from daily community life.

The Aged Care Financing Authority estimates the residential aged care sector requires $31 billion of investment over the next decade. Handy if this can come from private funds. To attract investors, the Productivity Commission recommends a competitive market with reduced regulation. In a recent letter to the editor (8/1), the chief executive of the Aged Care Guild listed “infrastructure, technology, and training and consumer choice” as the improvements “unleashed” on the sector. Care was not mentioned.

Using language of facilities, scale efficiencies, corporatised operations and the generation of better margins enables investors, industry bodies and politicians to respond in solely economic terms, forgetting they are building a home where care is provided for us, our parents and grandparents.

Policies seeking to improve care are bureaucratic and largely meaningless because they are based on the language of business facilities. While we need strong standards and monitoring of aged care services, we equally need to change the prevailing view of ageing, and what it means to provide a home and care.

We need to include the broader moral view on the question of how  we, as a community, can create an age-friendly environment for all.

We hold deeply negative attitudes to ageing, lumping together all  older people as  a drain on the economy, separating them from the life span, and pitting them against the young for resources. Fearful of our own mortality, frailness and dependence on others, we stigmatise older people. While we respect those who can take care of themselves, or who are “not a bother to anyone”, those who are frail and needing care are not accorded the same respect. This equates to a failure to recognise our parents and grandparents as full human beings. Within aged care, these social views of old people as worthless and unproductive are  reflected and magnified when faced with the daily reality of frail human bodies. When we treat people as “other”, when the stereotypes structure policies and culture, we treat people carelessly.

We need a moral approach to the care of older people based on kindness. We need to recognise in older people an inner life much like ours; complex, full of memories, filled with desires, passions and vitality even if their bodies and minds are no longer as agile. There is a significance to late life. It has purpose. Its meanings need to be seen and celebrated.

We need to shift our view of frail, older people to include the recognition of their contribution to our nation’s prosperity over the whole of their lives. We need to value the contribution people who need care can, and do, make to the lives of others.

Everyone is responsible for the culture of ageing. We need effective leadership from governments, the private sector, businesses, families, community members and older people themselves. We need to create places where we can live the end of our lives as part of the community, in homes where we receive care with respect and kindness. Our sense of belonging is deeply rooted to our sense of place and purpose. We have a moral responsibility to create age-friendly places for all.

Dr Kathleen Brasher is a member of the WHO strategic advisory committee for the Global Network of Age Friendly Communities

 

 

Entrenched sexism in surgery

For decades, the Royal Australasian College of Surgeons turned a blind eye to the entrenched sexist culture within surgery. After recent publicity, they have finally opened their eyes. They can no longer deny sexist surgeons operate within hospitals around Australia.

The college appointed a group of independent experts – Rob Knowles, Helen Szoke, Graeme Campbell, Cathy Ferguson, Joanna Flynn, Judith Potter and Ken Lay – to advise them on what should be done.

The first thing was to determine the extent of the problem. Was it just a few rogue sexist surgeons? Or is sexism pervasive within surgery?

The Expert Advisory Group found sexism is commonplace in surgery. A survey found 49% of fellows, trainees and international medical graduates were subjected to “discrimination, bullying or sexual harassment.”

The large number of victims comes as no surprise to those of us who have worked in a hospital. Hospitals operate on a hierarchical structure with surgeons positioned at the top of the pecking order. They call the shots.

Sexist surgeons do not leave their bullying behaviour at the operating theatre door. They bully other health care professionals and patients. They also take their bullying behaviour home.

Sexist surgeons have a strong sense of entitlement. They are in command, both at work and home. Not surprisingly, the expert committee found protagonists had a lack of insight about their bullying and sexist behaviour. This lack of insight into their internalised misogyny will make changing their behaviour difficult.

The expert committee noted that sexist behaviour has negative implications for patient care. I recently observed a senior surgeon disagree with a colleague about a female patient’s analgesia. The surgeon spoke very loudly whilst the patient lay quietly in her bed. Afterwards, the patient was very distressed. She asked me if the surgeon wanted “to euthanise me?”

I later asked the surgeon not to talk about the patient within her earshot. I explained how upset she was about the altercation at her bedside. He stormed off, shouting: “I will not listen to this.”

The Expert Advisory Group found “known bullies” are untouchable. Bullying among surgeons has become normalised as a culturally accepted behaviour. Perpetrators are more likely to be promoted than held to account.

Most surgical departments have at least a few bullies. It is likely that these bullies are well known to the hospital’s management. Yet, despite legal obligations to provide a safe workplace, hospital managers rarely reprimand surgeons for their sexist behaviour.

The demonstrable lack of consequences for perpetrators encourages some surgeons to continue to abuse their power. Hospital managers may be reluctant to take action on badly behaved surgeons for a range of reasons. They may fear the financial and reputational consequences. Hospitals fear both publicity and litigation.

There is an expectation among some senior surgeons that junior trainees should endure the same training circumstances as those in place when they trained. Trainee surgeons do not complain for fear of being seen as weak or unsuitable for surgery. They fear being black-balled.

Those who have the courage to complain risk career suicide. Sometimes a surgical career is over before it starts.

The expert committee also identified “bystander silence” as a serious problem. Within a culture of fear and reprisal, colleagues who witness bullying, discrimination and sexual harassment are rarely prepared to complain. They see no point in making a complaint.

Complaint processes protect the status quo. The person responsible for dealing with complaints is often a close colleague of the person who is being complained about. Not surprisingly, complaints often hit a brick wall.

The college has responded to the current toxic professional culture within surgery with a 21-page action plan. The document “Building Respect, Improving Patient Safety: RACS Action Plan on Discrimination, Bullying and Sexual harassment in the Practice of Surgery” claims to show “RACS’ commitment to dealing with unacceptable behaviours; strengthening surgical education and training; and reshaping the culture of surgery on foundations of collaboration and respect”.

The action plan is difficult to read, let alone understand. It is replete with weasel words. Phrases create an impression that a meaningful statement has been made, when only a vague or ambiguous claim has been communicated.

According to the current President of the Royal Australasian College of Surgeons: “We must make it safe for victims and bystanders to speak up. There must be clear consequences for those whose behaviour is unacceptable.” Unlike the action plan, his statement is clear.

The Royal Australasian College of Surgeons plans to provide education in countering discrimination, bullying and sexual harassment. Once again, the onus is on the victim to take action. However, with better complaints mechanisms, perhaps the victims will now get justice.

The college also plans to change the way surgeons are trained. Current surgical training arrangements provide disincentives for doctors seeking work-life balance to join the surgical profession. The current arrangements favour those without family commitments or with partners who have less demanding careers.

They aim to embrace diversity and foster gender equity. However, simply bringing females into the surgical boys club will not change this culture. Changing the toxic culture among surgeons requires structural change.

Respect living wills

Letter, The Age

I arrived at an aged care facility recently to find a fire truck, 2 Mobile Intensive Care Unit Ambulances (MICA), a paramedic motorcycle and an ordinary ambulance. The flashing lights heralded the death of a 94-year-old resident. The nurse in charge had dialled 000 despite explicit written instructions that the resident not be resuscitated. Residents of aged care facilities are encouraged to make living wills. These advance directives allow residents and their families to state their wishes for end-of-life medical care. These living wills are meaningless unless health care professionals respect our wishes.

Sarah Russell, Northcote

Too quick to prescribe

pills

Letter, The Age

I am the medical power of attorney of my 91-year-old mother, who lives in an aged-care facility. She was recently reviewed by a psychogeriatrician, who prescribed a new drug to slow down the progression of Mum’s dementia, despite the fact her dementia is progressing slowly without this drug. Instead, I prescribed lifestyle intervention, such as outings and conversation, to improve Mum’s quality of life.

Another doctor was concerned my mother was taking a diuretic without a potassium supplement. I explained that she ate several bananas a week, because they are her favourite fruit. Surely, this is preferable to taking a drug.

Last Saturday, my mother had a fall. The doctor was sure she had not fractured her ribs, but still ordered an X-ray. The only treatment for a fractured rib is rest and analgesia. I cancelled the X-ray and instead prescribed trips to the park in a wheelchair and The Age crossword. With burgeoning healthcare costs, I call on all medical doctors to ask: is that drug or medical test really necessary?

Sarah Russell, Northcote