A comprehensive approach to providing services to survivors of sexual and gender-based violence in Democratic Republic of Congo: addressing more than physical trauma

ABSTRACT

The eastern Democratic Republic of Congo (DRC) is impacted by a prolonged conflict and humanitarian crisis. Sexual and gender-based violence (SGBV) affects an estimated 39.7% of women and 23.6% of men in the region, and is associated with serious medical, psychological, and socio-economic outcomes for survivors and communities. IMA World Health, a faith-based non-profit organisation, implements a USAID-funded project, Ushindi, which is a collaborative effort with three national NGOs and one technical partner in response to SGBV in eastern DRC. The consortium provides a comprehensive package of services to SGBV survivors, focusing on medical, emotional, psychological, legal, and socio-economic needs.     

The Unexpected: Bionic Woman at the Millennium

Wilfred Bion's A Memoir of the Future provides a point of departure for feminist thinking about the millennium. Bion problematizes hopes for the future and associates thought with catastrophic change. Women play an unexpected role in Bion's experimental autobiography, posing provocative questions and unsettling the status quo . Since Bion has little to say about women in his clinical writings, A Memoir sheds light on his thinking and on the post-Kleinian culture of the 1970s. Book I of A Memoir depicts a class- and sex-nightmare played out between men and women, and women and women, in an age of anxiety whose setting appears to be the fascist 'pacification' of Middle England during an unspecified period. In this hallucinatory drama, all encounters are reduced to a brutal fiction of dominance and submission. The violence of the action suggests the primitive mental world of psychosis. Book II of A Memoir satirizes 'the brilliance of masculine thought' through the voices and criticisms of women. But this is the purgatorial movement of Bion's autobiography, inhabited by 'idées mères' (untransformed beta-elements) and haunted by the ghosts of Bion's traumatic war-time experience. A monstrous plot is hatched to kill primitive, fascistic Man, who retaliates and takes the female spoils. Is this the prelude to catastrophic change? Book III stages a country-house debate between different characters who represent aspects of Bion's personality, recapitulating the concerns of his later writing. The debate includes a meditation on childbirth as compared to war trauma, but Bion takes his distance from feminine intuition or common sense. Women fight on both sides of the barriers in the Bionic revolution - becoming, however, figures for the 'unexpected' and precursors of emotional upheaval. The gendering of millennial thought in Bion's Memoir provides an opportunity to scrutinize our own unthought fantasies of change.     

Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.     

New Thinking in Financial Market Regulation: Dismantling the “Split Share Structure” of Chinese Listed Companies

China’s distinctive set of stock market institutions was introduced in 1990. Among the characteristics of China’s stock markets was a strict separation between different categories of investors. Listed companies issued different categories of shares to state shareholders, domestic corporate investors, domestic individual investors, and foreign investors. By 2005, the barriers segmenting China’s stock market had been significantly relaxed. Domestic investors were allowed to purchase shares previously reserved for foreign investors, and approved foreign investors were allowed to purchase shares previously earmarked for domestic individuals. Nevertheless, a crucial barrier remained. An ongoing debate among Chinese academics, investors, and policy makers focused on how to resolve the “split share structure” (guquan fen zhi) in which a minority of shares were tradable while the majority of shares (namely those reserved for domestic corporate and state shareholders) were excluded from the market. The split share structure was blamed for distorting prices and inhibiting development of the stock market. This paper analyzes the policy adopted to address the split share structure. To what extent does this policy change reflect new thinking on the part of China’s market regulators? This paper argues that analysis of policy making in China’s capital markets can help to distinguish between two competing assessments of China’s political economy. One account sees China pursuing a gradualist strategy, slowly but steadily expanding the role of markets. Another account sees China trapped in a semi-marketized and increasingly corrupt development pattern. The implementation of the split share structure reform program provides evidence to support the gradualist account of incremental, but persistent, reform. Mary Comerford Cooper is an assistant professor in political science at the Ohio State University. Her recent research focuses on the politics of financial markets in China and Taiwan. Earlier versions of this paper were presented at the Comparative Politics Research Workshop/ Globalization, Institutions and Economic Security Workshop at Ohio State University in May 2007, and at the annual meeting of the Association for Chinese Political Studies in July 2007. I benefited greatly from the constructive and insightful comments of Bj?rn Alpermann, Melanie Barr, Jean-Marc Blanchard, Sarah Brooks, Joseph Fewsmith, Sujian Guo, Dane Imerman, Ryan Kennedy, Marcus Kurtz, Xiaoyu Pu, James Reilly, Alex Thompson, Daniel Verdier, Jianwei Wang, Alan Wiseman, Bin Yu, and an anonymous reviewer. I am also grateful for Lan Hu’s exceptional research assistance. All remaining flaws are purely my own.     

Shifting priorities at the Health Protection Branch: challenges to the regulatory process

Abstract: The Health Protection Branch (hpb ) of Health Canada has recently undergone considerable policy and organizational renewal, with numerous and broad‐ranging implications for the evaluation of drug product safety and efficacy. From a public‐health perspective, however, the criteria used to develop organizational and policy change at the hpb have provided a sub‐optimal basis for reform, due primarily to the many forms of market failure to which the regulation of pharmaceuticals is subject. For example, thepartnership andefficiency criteria that guided policy renewal have led to the transfer of important responsibilities to partners, with the potential for either a conflict of interest or inadequate information, for which the legal basis is not always clear. The resulting realignment of the hpb's roles and responsibilities may be characterized as leading to a shift from a comprehensive approach to public‐health protection to one based on strategic risk management, with responsibilities dispersed among government, industry, academia and consumers. The rebalancing of goals in the redesign of the regulatory process suggests a change in the role of the state in the context of public‐health protection and highlights issues of concern to the public interest that may not be fully recognized as deregulation occurs in other sectors of the economy. Sommaire: La Direction générale de la protection de la santé (dgps ) de Santé Canada vient de subir un vaste remaniement de politiques et d'organisation qui entraîne de nombreuses et profondes répercussions sur l'évaluation de la sûreté et de l'efficacité des produits pharmaceutiques. Cependant, du point de vue de la santé publique, les critères auxquels on a fait appel pour modifier les politiques et l'organisation de la dgps n'ont permis qu'une base de réforme sous‐optimale, à cause surtout des nom‐breux genres de défaillance du marché qui affligent la réglementation des produits pharmaceutiques. Par exemple, les critières depurtenariat etd'efficacité qui ont guidé le remaniement des politiques ont amené le transfert d'importantes responsabilites à des partenaires moyennant le risque de. conflit d'intérêts ou d'informations inadéqaates, sans pour autant assurer une base juridique Claire. On pourrait donc dire que cette réorientation des rôles et responsabilités de la dgps fait que l'on passe d'une approche globale en matière de protection de la santéà une gestion stratégique du risque, la responsabilité en étant dispersée parmi le gouvernement, l'industrie, les milieux universitaires et les consommateurs. Le rééquilibrage des objectifs dans le remaniement du processus de réglementation suggère une évolution du rôle de l'État en ce qui concerne la protection de la santé publique; il met aussi en relief des questions d'intérêt public qui n'ont peut‐être pas été reconnues alors que la déréglementation prend lieu dans d'autres secteurs économiques.     

Explaining legislators’ positions on outside income limits: Voting on honoraria ceilings in the U.S. Senate, 1981–1983

This article examines roll-call voting by members of the U.S. Senate on three proposals to limit members’ outside income in the 1980s. I find that several factors influenced legislators’ votes on outside income limits legislation (OILL). First, financial self-interest was an important constraint on members’ willingness to support OILL. Members who earned more honoraria were less likely to vote yes, but this opposition was neutralized when limits were attached to the compensating mechanism of a pay raise. Senators from poorer states were generally more likely to support honoraria limits alone but less likely to support limits linked to a pay raise, suggesting a responsiveness to constituent interests in both cases. Finally, when OILL was linked to a pay raise, electoral considerations became prominent in legislators’ vote decisions, with electorally vulnerable members less likely to vote yes.