Home News Technology News Google is re-branding Adwords to Google Ads. Why ?
Take Aways from the Announcement and How it will impact you and your business ?
How will these changes affect me as a user of the system ?
This morning I received an email saying Google is rebranding Google Adwords but Why ?
Google AdWords will be rebranded as Google Ads next month (24th July 2018).
Google Ads will have full range of campaign types available today, including , Display, Video & Search.
From 24th July 2018, Google Adwords name and Logo will be replaced by Google Ads Logo. Changes will be reflected in the User interface including Help Center, Billing documents, etc.
Also the support website will be moved from support.google.com/adwords to support.google.com/google-ads.
Changes to the Google Ads branding will not impact the users of the system in any way including navigation, campaign performance or reporting.
Google has restructured its advertising services, with its 18-year-old AdWords brand and DoubleClick, the adtech company acquired in 2007, consolidated under a simpler Google Ads brand.
Google claims the rebrand will make it easier for small business advertisers to connect with customers across the company's platforms, which include Search, Maps, Google Play and YouTube.
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On a rainy September evening.
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The reaction of many Austrian artists to Jörg Haider's electorial success have bemused the international Austrian artist, Gottfried Helnwein, now resident in Ireland. "I am amazed that they start now, because things were worse in the past. The former Freedom Party leader was Friedrich Peter, who spent four years in an SS company in Russia, where he was involved in exterminating Jews and Communists. That was well documented, but he would always say, 'I do not remember'."
Helnwein is an interesting quantity: a tall, earnestly cheerful, black-clad character, his face often obscured by shades and an overgrown 1970s hairstyle; a deeply moral artist who brings high craftsmanship to his gloomy, visceral drawings and huge photorealist canvases. Obsessed with images of children, often subjected to cruel medical experiment, he has long been a controversial protest artist against Nazism and repressive Catholicism in Austria and Germany, where he insists the two traditions are inextricably linked.
His earliest aktions were traumatised-looking street performances in which, say, he lay bandaged on the sidewalk, studiously ignored by passing Viennese. Yet, until the late 1970s, he had never heard of Viennese Activists, who were frequently jailed in the 1960s for self-mutilation, debauch, or portentous animal slaughters which Hermann Nitsch still enacts in his castle outside Vienna. However, in recent years, Helnwein has exhibited alongside them, and indeed the senior figure of Arnulf Rainer - for Helnwein, "probably the most important Austrian artist."
Helnwein was born in 1948 into a "Middle-middle class" Viennese home and had a strict Catholic education. "I always knew that something was really wrong, but when I asked my parents' generation any questions, I never got any answers."
The truth was that, although under Allied control until 1955, Austria was never properly denazified. In school, Helnwein learnt nothing of the mass exultation at the annexation of Austria, or the jeering Viennese crowds who watched Jews scrubbing the streets with water mixed with acid. "In school, we only heard the one thing over and over, that Austria was Victim Number One of Adolf Hitler, which of course is a joke."
He skipped school, and entered the Experimental Institute for Higher Graphic Instruction. "It was the time of the Beatles and the Stones, and everybody wanted to have a little bit longer hair, close to the ears, but not touching. But walk on the street like that, and people would scream "Hitler should come back and gas you!" This was an ordinary thing to hear, from older people, or construction workers, who would throw stones at us."
He was expelled from the institute - after painting a portrait of Hitler with his own blood - and attended the Academy of Fine Arts - "the same academy that threw Hitler out three times, probably one of the biggest mistakes ever, yeah?" Interestingly, Helnwein studied under the only professor in the Academy whose work was not abstract - Rudolf Hausner, one of the early post-war Viennese symbolist painters.
Helnwein's first exhibition at Vienna's Kunstlerhaus - watercolours of wounded children - was totally defaced by stickers which read Entartete Kunst - the Nazi term for degenerate art. His next exhibition in Modlin was confiscated by police, at the behest of the local mayor. Helnwein made a Hitler painting in oils "in the manner of Third Reich official painting, and always showed this painting with the wounded children. But more people would shake my hand, almost with tears in their eyes, saying "that (Hitler painting) is a great painting, it's about time people started painting real things like that, here's my card, please contact me." I could have sold it 100 times.
"I was once in the Academy working on a quiet Sunday. And this young guy of maybe 20 years peeked in and said, "I'm looking for the painter who painted the Führer!" The painting was leaning against the wall, and I swear, he went down on his knees in front of it, saying, "The Führer, the Führer, it's fantastic!"
Helnwein made his name through cover art for Austrian magazines, provocatively tackling issues like the appointment of Dr Heinrich Gross as Head of State Psychiatry in 1979. "In an interview, he was asked if he had killed hundreds of children in mental hospitals" - under the Nazi euthanasia programme - "and he said, 'yes it is true but at the time, it was a different reality. Today I wouldn't do it.' The guy asked him 'did you inject them?' And he said, 'no, we just mixed the poison in the food, so they weren't aware of what was going on, so they died humanely'.
"This was in one of Austria's biggest newspapers, Kurier, and there was not even one reaction. Meanwhile, 3,5000 people wrote angry letters to ORF" - Austrian State Television - "because for the first time in Austrian history, a presenter appeared without a tie. It was absurd. I thought maybe people couldn't read anymore, that was the problem. So I painted them a picture."
His photorealistic painting of a girl-child slumped in a plate of food, helped start a debate which led to Gross' resignation.
Helnwein left Austria in 1985 "because of many feelings. I was born there, all my family was there, it's my language, but I never felt Vienna was my home. Vienna has a great cultural tradition, but the atmosphere was so horrible, I felt if I continued to live there, I would either become a terrorist or die."
He settled in comparatively liberal Cologne for a decade. One piece of public art he did in 1988 - funded fully by himself, after he failed to raise sponsorship - commemorated the 50th anniversary of Kristallnacht. "Again, what amazed me was that nobody talked about it - and yet that was when the horror really started."
"I wanted to do it in front of the Dome in Cologne, but the City prevented it. But there was this little strip of land which belonged to the railways, and a guy who worked there said, 'go ahead'. I didn't want to use these historic photographs which are used too often - those mountains of corpses mean nothing anymore - so I used four metre high children's faces. I photographed children from the area, foreign children, German children, Jews, anything."
Mounted in a long billboard line, after the huge word "Selection", the children's faces were powdered in a deathly, bruised way, many with their eyes closed. That may sound subtle, but in the context of muted German Holocaust memorials, it was like a slap in the face. Despite CCTV video-cameras, someone painstakingly sliced the throats of every single child-portrait.
He rages at the later murders of children in Solingen, near Cologne, where young neo-Nazis - "16-year-oldss!" - burnt a house full of Turks: "One woman was standing in the window upstairs, holding her child and people were watching her, and she jumped down and died, but the child in her arms survived. I went to the hospital and photographed this child. Her face was destroyed, and she was not even aware that her mother was dead."
Shortly afterwards, Helnwein bought a castle outside Clonmel which he says, along with his wife, Renate and four kids, "gave me, for the first time in my life, a feeling of home". He is currently in Florida, working on a one-man show for London's Robert Sandelson Gallery, involving poignant teratological child images from an Austrian medical museum; and another one-man show at the Modernism Gallery in San Francisco.
In October, he mounts a big retrospective a the Chinese National Museum in Beijing, where he will become the first western artist to show in the Forbidden City, in the Temple of the Ancestors. "The ceilings are 50 metres high, so I want to make big children's faces. 10 metres high around the halls. I hope the censors don't find anything too shocking in that."


text:
China / Science-Tech
Man who quit his job for public good
By Yin Tao(chinadaily.com.cn)
Perhaps in many people's eyes, it is not the best time for Zeng to start business, because he is neither post-90s or 95s who have more chances to fail and start something form the beginning, nor like those in their late 30s or even elder who have accumulated lots of social experience and resources and are more likely to succeed.
"What matters is that you have a great idea and the tenacity to carry it out. The real issue here should not be when you start your business. Rather, the focus should be on how you put your ideas into practice," said Zeng.
When he launched his five-person team, the South-North Water Transfer Project initiated the open tender for the media publicity for the project from October 1 to December 31, 2014. Zeng saw it a golden opportunity to develop his business.
"My parents and friends said I was too ambitious, and they did not think my team will be able to beat other big companies," Zeng recalled. "But I don't think it is an excuse for the 'rookies' to stop challenging themselves."
"If we fail, at least our persistent efforts can narrow down the gap between my team and other rivals," Zeng said.
At first Zeng's team did research based on the material such as 100 questions on the South-North Water Transfer Project and other documentaries on the project when they were making the publicity schemes.
Zeng said if they wanted people to pay more attention to the problem of water shortage and enhance public's awareness of saving water, they have to have a good command of all-round details of the project.
Their hard work paid off. They won the bid. The 15-second publicity video created by Zeng's team was aired by the China Central Television (CCTV), China's broadcaster, for three months.
Zeng's team has gained fame among insiders since then. His team also attended some tourism fairs to sell themselves. So far, they have offered services for some Chinese provinces and foreign governments to boost their public image and promote their regional culture as well as the local tourism on the bodies and seats in Beijing buses.
Now his team has expanded to 24 members.
When asked about his future plan, Zeng said he has enrolled to pursue doctorate studies on Media Economics at Communication University of China, a cradle of China's radio and television talents and a well-known institution in the field of information communication.
"I want to equip myself with more professional knowledge, which can also help me and my team provide better service for our customers," said Zeng.
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redpajama_set_name: RedPajamaCommonCrawl


text:
A mandatory bonding service program and its effects on the perspectives of young doctors in Nepal
Bijay Tamang1 MPH, Program Director
Pradeep Kaji Poudel2 MPH, Program Coordinator
Sudip Jung Karki3 MPH, Program Coordinator
Rupesh Gautam4 MSc in Public Health, PhD Student *
*Mr Rupesh Gautam
1, 2, 3 Health and Development Society Nepal, PO Box 8975, Lalitpur, Nepal
4 School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia
RECEIVED: 1 May 2019
REVISED: 16 October 2019
Tamang B, Poudel PK, Karki SJ, Gautam R. A mandatory bonding service program and its effects on the perspectives of young doctors in Nepal. Rural and Remote Health 2020; 20: 5457. https://doi.org/10.22605/RRH5457
Introduction: To address regional differences in the distribution of health workers between rural and urban areas, the Nepal government has adopted the policy of deploying fresh medical graduates to remote areas for 2 years under a compulsory bonding service program. However, the impact of such an approach of redistribution of human resources for health is not well understood, nor is the experience of the health workers who are deployed. This study aimed to understand the experience of the medical graduates who have served under the bonding service program and suggest ways to improve the program as well as to make health service provision easier through the young doctors.
Methods: A semi-structured questionnaire-based survey was administered online to 69 young medical doctors who had worked under the bonding service program. The responses were analysed qualitatively and the findings were presented in separate pre-established domains.
Results: Most young doctors felt they were not adequately prepared for the bonding service program. Adapting to the deployed place and to the local culture was a challenge to some young doctors, which hindered their potential to serve the local community. Most found the response from the rural communities to be positive even though they faced some challenges in the beginning. While the young doctors found serving the rural communities motivating, they felt that they were limited in their capacity to provide an optimal level of health service due to limitations of infrastructure and medical equipment. They also felt that the compulsory bonding program had stunted their growth potential as medical doctors without adequately compensating them for their time and service.
Conclusion: Despite the program's noble intentions, the medical doctors who were involved with the bonding service program felt that the program had yet to address several basic needs of the doctors who were deployed for service provision. In order to motivate the doctors to work in rural areas in future after the compulsory binding has ended, the stakeholders need to address the existing gaps in policies and infrastructure.
doctors, mandatory bonding service program, human resources for health, Nepal.
Nepal is a landlocked country bordered by China to the north and India to the east, south and west. Geographically, it is divided into three regions: Mountain, Hill and Terai, each stretching from east to west across the country1,2. Nepal has a total population of 28.5 million, with an average growth rate of 1.35%3. Recently, Nepal was administratively divided into seven provinces with each province having rural municipalities (called Gaunpalika) and urban municipalities (called Nagarpalika)4,5. At present, Nepal has 263 municipalities, and 59% of its total population live in the urban areas4.
Health profile of Nepal
In recent years, Nepal has made a substantial improvement in the health outcomes of its citizens. There has been an improvement in life expectancy at birth, which increased to 70.77 years in 2017 compared with 50 years in 1981. Between 2000 and 2016, neonatal mortality fell from 39 to 21 deaths per 1000 live births, infant mortality rate declined from 64 to 32 deaths per 1000 live births and under-five mortality decreased from 91 to 39 deaths per 1000 live births. Likewise, the maternal mortality ratio decreased from 548 per 100 000 live births in 2000 to 239 in 2016 (Table 1)4. Despite these achievements, substantial inequities in health outcomes across different geographic regions and socioeconomic groups persist.
Table 1: Indicators of major health outcomes in Nepal
Health system structure
Under Nepal's Ministry of Health and Population (MoHP), there are three departments: Department of Health Services (DoHS), Department of Drug Administration and Department of Ayurveda. DoHS is responsible for delivering preventive, promotive, diagnostic and curative health services all over the country. The healthcare service points are designed as health posts to the primary health care center (PHCC) to the district, zonal, sub-regional, regional and finally to central level hospitals. Female health care volunteers, primary health care outreach clinics and expanded program for immunization outreach clinics are other programs designed to provide healthcare services down to the grassroots community level (Table 2).
Table 2: Healthcare facilities under Department of Health Services6
According to the human resource for health (HRH) assessment conducted in 2013, there were 54 177 health workers in the country in total. Doctor-to-population ratio was 0.17 doctors per 1000 population, and health workers (including doctors, nurses and midwives)-to-population ratio was 0.67 per 1000 population7,8. The health workers-to-population ratio was significantly less than WHO's recommended ratio of 2.3 doctors, nurses and midwives per 1000 population, which is calculated based on requirements for skilled attendance at birth and immunization9. Only 4% were doctors among the total health workers. Out of the total, 39% were working in the private sector7. Table 3 shows that 71% of the total sanctioned posts were filled in the public/government health facilities. PHCCs (78%) and health posts (72%) were more likely to have sanctioned positions filled than district (64%), zonal and higher level hospitals (69%).
Table 3: Percentages of government sanctioned posts filled, by background characteristics10
Policies and programs on human resources for health in Nepal
The government of Nepal promulgated the Health Service Act 1997 to manage human resources for health, which states that in order to be eligible for promotion health workers must have worked in a remote area for at least 2 years, and such health workers are prioritized in nomination for scholarship and training opportunities. The districts of Nepal are categorized into levels of remoteness (in the Devanagari alphabet they are named as ka, kha, ga, gha, nga, respectively, in the order of classification (Appendix I). For villages in remote districts, health workers also receive a remote allowance as a financial incentive for taking up a job in a remote area.
A comprehensive framework of policies, strategies and plans such as Nepal Health Policy 1991, Second Long Term Health Plan (1997–2017), Nepal Human Resource for Health Strategy (2003–2017) and Nepal Health Service Act was formulated to address the issues pertaining to human resources for health11-14. In 2010, MoHP established the country coordination and facilitation mechanism and developed the HRH Strategic Plan 2011–2015 to acknowledge the HRH-related problems15. Similarly, the Nepal Health Sector Strategy (NHSS) 2015–2020 and Nepal Health Sector Strategy Implementation Plan (NHSS-IP) 2016–2021 have also been issued16,17.
In a bid to improve access of the Nepali citizens coming from historically disadvantaged socioeconomic, gender, regional and ethnic groups to medical education/profession, and thereby also to diversify the HRH workforce of the country, reservation quotas have been put in place by the government. The reservation quotas thus allocated are 33% for women, 25% for economically or socially disadvantaged groups, 2% for individuals with a disability, 27% for indigenous groups (janajati), 9% for the relatively disadvantaged groups (dalit) and 4% for those from the remote areas18. These reservation quotas are implemented to ensure that eligible Nepali citizens from the said groups get the allocated percentage of total places at the medical schools in order to pursue medical or dental education. The remaining places are then allocated to all other Nepali citizens who do not meet any of those reservation criteria. The selections of successful candidates are made based on their academic merits and performance in medical entrance examinations.
In addition to setting up the reservation quotas for pursuing medical education, the government started a 2-year bonding service program in 2004, especially targeting the rural areas, as an additional effort to manage HRH workforce distribution in the country. Under the current provisions, private medical schools owned by a Nepali citizen must reserve 10% of seats whereas medical schools in Nepal owned by non-citizens must reserve 20% of seats of each session for the free education of students19,20. The expenses of educating the students selected for scholarships from the Ministry of Education are a part of the medical schools' general operating budgets. In return for scholarships (such as free medical or dental education), medical/dental doctors have to serve in the assigned rural places for 2 years following their graduation. The Ministry of Education provides the graduation certificate and DoHS under MoHP assigns the place for such rural postings. The certificate is not issued by Nepal Medical Council unless the 2 years bonding service program is completed13,18.
Issues surrounding Nepalese human resources for health
Inadequate numbers of qualified skilled HRH workforce is one of the most critical constraints for achieving the Sustainable Development Goals for health and other health-related indicators. Inadequate numbers of skilled health workers in remote and rural regions is a serious and worldwide problem but it affects low- and middle-income countries such as Nepal even more severely21. According to WHO, the Sustainable Development Goals index threshold of 4.45 skilled health workers (physicians and nurses/midwives) per 1000 population is needed to meet health needs, which was previously 2.3 skilled health workers per 1000 population calculated based on requirements for skilled attendance at birth and immunization9,22. However, availability of health workers in Nepal is significantly lower than that threshold with 0.67 health workers (doctors, nurses and midwives) per 1000 population. Furthermore, only 0.17 doctors are available per 1000 population. Doctors in Nepal are unevenly distributed with 60% of doctors living in urban areas, resulting in critical shortages in rural and remote areas of the country7,20.
The unequal distribution of doctors in the rural parts of Nepal has been a challenging and longstanding problem for the government. Therefore, the government has been prioritizing the deployment of doctors as well as all other health workers in remote and rural parts simultaneously through the National Health Sector Strategies I (2004–2010), II (2010–2015) and III (2015–2020)7,12,15-17. Consequently, the number of doctors has been successively improving, from 12 194 registered doctors in 2010 to 20 192 in 2018, but there is still a shortage of doctors and specialists in rural areas7,23,24. One of the major problems for Nepal is the 'brain drain' of qualified medical doctors, with more than 500 doctors emigrating each year, making it difficult for the country to maintain that growth8.
A variety of interventions have been applied to different categories of the HRH workforce to address the geographical imbalance in their distribution in Nepal, such as financial incentives, better opportunity for postgraduate studies and a bonding service program7,16,25,26. One of the main interventional steps taken by the Nepal government to address the shortage of doctors and to improve the services provided by the public health centers in remote parts of Nepal is the 2-year rural bonding service program, aimed at doctors who have completed their undergraduate medical degree with a government scholarship15. Further, a 5-year bonding service program has been started for those doctors who have completed their medical/dental specialist degree with a government scholarship27.
The areas to which doctors are sent are generally rural, underdeveloped and deficient in infrastructure, professional development opportunities and personal/family amenities. These are settings that do not attract doctors under the current circumstances23,28,29. Lack of well-equipped health centers, weak support supervision and guidance to enhance skills and limited opportunities for career development prevent recent graduates doctors from taking up rural positions, and those who do face many problems due to insufficient equipment, personal and professional development options and geographical constraints23,28,29.
Studying the bonding service program
The government is using the bonding service program as a way to deploy doctors to prevent them from emigrating and to address the lack of doctors in many geographically challenging rural areas, but the challenges, outcomes and impacts of this exposure on the deployed doctors has hardly been researched8. Therefore, understanding the experience and perception of the doctors who have been deployed in rural parts is a notable issue that the government needs to address since they are the lynchpin of the program. The effects of the program are dependent on the deployed doctors' attitude, performance and his/her reaction towards the program. Further, if the problems in the rural service are not addressed, the doctors who are forced to work in the rural areas for some period might end up migrating to urban areas, or to foreign countries out of frustration in the longer run, which further adds to the loss in the numbers of qualified health workers.
Effective human resource management strategies, plans and policies are needed for appropriate distribution and deployment of HRH workforce to ensure community access to health services and better health outcomes. Therefore, continuous periodic assessments and revision of health policies and interventions are required to maintain relevance to the changing context and to acknowledge the new challenges21. It is very important for policymakers to have an understanding and knowledge of the effectiveness and impact of a policy intervention.
It is therefore essential to closely examine the challenges, outcomes and impacts surrounding BSP to analyze the current situation and discuss the program in the light of experiences of those who are directly influenced by the program. Since no contextual and evidence-based study has been conducted yet on the bonding service program in Nepal following its implementation, and the government is preparing to implement a 5-year bonding service program for doctors after the completion of post-graduation, the findings of this study could provide some insights to the policymakers into the experiences of the deployed doctors, and take their needs and expectations into account for a successful implementation of the program.
The current study had the following objectives:
Explore the overall experience of recent medical graduates deployed in Nepal's rural areas under the bonding service program.
Assess the medical graduates' perception of the bonding service program under which they were deployed.
Understand the challenges faced by the medical graduates working under the bonding service program and identify ways to address those challenges.
For this exploratory qualitative research, a semi-structured questionnaire (Appendix II) was prepared and circulated using the online survey platform Survey Monkey between June and July 2018. The survey link was circulated in the professional networks of the first author (BT) using his Facebook timeline as well as two Facebook groups of Nepali medical doctors and Nepali dentists. Four posts each were made about the survey to the Facebook group Doctors Society of Nepal and Dentists of Nepal. These two groups are among the biggest Facebook groups of Nepali medical doctors and dentists. Likewise, two posts were made from the Facebook timeline of the first author (BT). That Facebook post was further shared by four Facebook friends of the author to their own timelines.
The survey information sheet as well as the social media post clearly explained the purpose of the survey, its target population and the voluntary nature of participation. The survey was conducted among the doctors who had completed their medical/dental education (MBBS or BDS) with a Nepal Government Scholarship Program and were obligated to work in the bonding service program for 2 years. Doctors who studied in private funding were excluded because they are not obligated to take part in the bonding service program following graduation.
The survey link was placed online on 30 June 2018 and the last survey entry was received on 17 July 2018. Thereafter, the collected data was downloaded from the online survey platform and transferred to a Word document where the responses were categorized under the pre-established analysis domains. Even though the responses were quantitatively analysed to some extent, more focus was given to qualitative synthesis, documenting the experience of the respondents rather than numbers. It was done both because of a small sample size as well as the overall purpose of the study.
The language used in the survey form was English and the responses were also received in English. The medical education in Nepal is primarily taught using English textbooks, and all the exams are also conducted in English. Almost all of the formal written medical communications among Nepali medical and dental professionals take place in English. Therefore, language was not considered to be an issue among the medical graduates who had completed their medical education in English.
Ethics approval for this study was obtained from the Research Ethics Committee of the Royal Tropical Institute, Amsterdam, The Netherlands. Participation in the survey was entirely voluntary and the potential respondents were informed that they were free to leave the survey at any time if they wished to do so. Respondents accessed the survey link through social media and anonymously completed the survey. Anonymity was maintained throughout the survey process – the researcher knew only how many people accessed the link and how many completed the survey and had no access to the name or social media handle/username of the person who accessed the link.
Between 30 June 2018 (when the survey went online) and 17 July 2018 (when the last entry was received), 69 unique entries were received, all of which were completed entries. Even though the survey was kept open, no further entry was received after 17 July 2018 despite several reminding social media posts made by the primary author for participation. Out of the 69 doctors who completed the survey, 72% had already completed their 2-year bonding service program while 28% were still working under their agreement.
As mentioned, the findings have been categorized into pre-established domains for an organized and systematic presentation of the study findings.
Figure 1: Volume and trend of completed survey entries from the day the survey went online
Domain 1: Preparation for rural service and realities of assigned locations
Respondents exclaimed that they were not provided any training prior to being assigned to the rural areas through the bonding service program. When a doctor is assigned to a PHCC, he or she is supposed to manage the administrative issues of the institution along with treating the patients. Government-employed permanent doctors are provided training, before being deployed to the workplace, on administrative issues and working conditions in the rural place. However, no such training was found to have been provided to the temporary doctors deployed under the program.
In addition to the training on handling of administrative duties, the respondents were also asked about orientation to the local conditions of the place to which they were deployed as a part of preparation for the rural service. Ninety five percent of the respondents were assigned to locations other than their own home districts, which meant they were not familiar with the local conditions. Furthermore, no orientation was provided to help them prepare for the living conditions and other practical realities of working in these rural areas.
Subsequently, once they were deployed, 53% of the respondents reported that they had found it very difficult adjusting to the appointed place because of the general living environment pertaining to housing, food, transportation, communication, electricity and water. Housing was ranked highest with regards to the adaptation problem by 80% of respondents, followed by food, transportation, communication, electricity and access to clean water.
In addition to the personal challenges faced due to lack of basic amenities in the rural locations, the respondents realized that poor infrastructure and inadequate to absent medical equipment created further professional challenges.
The major problems mentioned about work-related issues were the lack of infrastructure and consumables such as medicines, local anesthesia, injections, and gloves, which were supplied very late, contributing to their shortage most of the time. Likewise, dental surgeons were posted in hospitals but there were very limited instruments they needed to provide service. Most medical/dental equipment was lacking.
Proper sterilization was not available in many health centers and, because of that, the young doctors argued that they had to work in a risky environment. Along with the inadequacy or absence of medical equipment and consumable medical goods, problems related to basic infrastructure of the health centers were also mentioned by the doctors. For example, the number of rooms for service provision were not enough and doctors had to work in congested working areas with no space whatsoever for protecting patient privacy.
Difficulties related to administrative working environment were also mentioned. In some health centers, the junior doctors felt that other permanent government health workers including senior doctors treated them poorly. This kind of treatment and lack of cooperation towards the young doctors who had just set foot into the medical profession had reportedly affected their working environment adversely.
About one-third of the respondents (32%) argued that the mere presence of doctors without proper infrastructure and essential facilities would not achieve the purpose of bonding service.
One respondent summed up their perception of the realities in the assigned locations:
Politicians only wanted to show to their electorates that they are concerned about the health of the people. Therefore, this program was started, but without enough preparation. As a result, the infrastructure is not up to the mark in the majority of the health centers. This bonding service program must not just be implemented to serve the vested political interests of politicians but to actually benefit the rural Nepali people.
Adapting to the culture
Nepal is a multicultural and multilingual country with a lot of traditional beliefs and practices continuing to persist in the rural areas where these young medical graduates are deployed. About one in three respondents (34%) found it difficult adapting to the local culture and about a quarter (26%) of the respondents noted some difficulty understanding the language. Conversely, almost 31% of the respondents reported that they did not feel any difficulty regarding cultural practices, traditional beliefs and/or languages.
On the other hand, gender-related issues such as female doctors being treated with low respect by the staff members, and patients preferring male doctors to female doctors for treatment regardless of the levels of expertise, were reported by eight doctors.
Slightly less than 1 in 10 doctors (9%) reported having faced difficulties continually during their 2-year posting. Some of the reasons reported behind such difficulties were discrimination by the community based on the doctor's ethnicity, and lack of security. If complications arose in some cases, doctors were blamed for the complications by the patient's relatives, which posed security risks to the doctors. As a result of such threats and lack of security, some doctors reported feeling vulnerable in their working areas.
Response from the community
In terms of response from the community to the newly- assigned doctors, 48% of respondents felt that the local communities were kind and welcoming right from the beginning of their posting and the doctors did not feel any kind of difficulty related to the community in their work.
A total of 44% of the respondents initially felt that there were problems of recognition and the response from the community was not very positive but, with time, the response became excellent. The respondents felt that local people initially believed the newly assigned doctors were mere learners with poor knowledge and skills on treatment. As a result, the local people doubted the treatment of the new doctors:
People were a bit skeptical towards a new doctor in the beginning. However, after continuous interactions, counseling and treatment, they were found to be comfortable with the doctor, and satisfied with the service.
However, this experience was not shared by all young doctors and it varied with the locations they were posted to. For example, many communities in the semi-urban areas preferred experienced doctors and expected medical treatments that were on par with the service quality of specialized tertiary centers. Continual unfavorable treatment by the community throughout their service period was reported by about 1 in 10 doctors (9%):
People doubt young and newly appointed doctors. There have been several instances when patients came and asked who the senior-most doctor in the center was, and when they saw a young doctor, they showed hesitation in consulting the doctor.
Motivating factors in rural service
One of the primary motivating factors stated by most doctors while working in the rural areas under the bonding service program was they felt they were really serving the needy and underserved people, who were deprived of modern medical facilities, services and had poor levels of awareness.
One of the respondents exclaimed:
I realized that I had the ability to treat the patients suffering from health problems who were otherwise not able to seek solutions to their woes. It motivated me to be aware of the most needy people, about their life conditions, and make them disease free. This power to help them survive and bring smile on their faces after they got their treatment after 1 or 2 days of journey to the health centre completely on foot gave me a feeling of satisfaction and happiness.
About 43% of the respondents (29/67) reported that the rural exposure gave them an opportunity to experience the real Nepal. They also reported feeling they had done some service to the nation with this rural placement. Other motivating factors were that they got extensive exposure to several disease conditions. Likewise, they also reported having received love and respect/recognition from the community people, which further enriched their motivation. Some additional motivation factors were rural allowances, opportunities for training and preparation time for the postgraduate exam.
Personal and professional benefits, and drawbacks
The respondent doctors said they had experienced both benefits and drawbacks of the bonding service program in their personal and professional lives. On perception regarding personal and professional development, doctors found that the bonding service program had provided them an opportunity to get the first-hand experience of living in rural areas of Nepal, which are very different from cities where most of these doctors grew up and pursued their education. Some doctors found that BSP had enhanced their communication skills, broadened their exposure and knowledge, taught them to work under the conditions of limited resources, and helped them understand the government health system of Nepal. It had also reportedly helped them become capable in handling various critical circumstances that were encountered during the service, where they were sometimes all on their own.
Despite some personal and professional benefits, 80% of the doctors expressed that the bonding service program had hindered them from joining the postgraduate studies for 2 years. Some places where they were deployed offered exposure to only a few specific diseases and they had to work with very limited resources, infrastructure and equipment in most places. These aspects of working had resulted in less exposure to different disease scenarios along with less exposure to advanced equipment and procedures. Similarly, 20% of the respondents reported that they were deprived of continual medical/dental education, which they felt inhibited their continuous professional development. Likewise, most doctors posted to primary healthcare centers mentioned not having had any opportunity of guidance from senior doctors. As a result, they felt stuck with the knowledge they already possessed, with no room to emulate their seniors and grow technically and professionally. On the contrary, the doctors posted in district or zonal hospitals did not report having faced such problems.
Perceptions of program usefulness to health system and serving doctors
Mixed responses were received concerning the perception of usefulness of the bonding service program for the health system as well as the serving doctors. Thirty four percent of respondents felt that the health system had not improved even with the implementation of the bonding service. They felt it had instead ruined their practice because of the lack of proper equipment and proper guidance.
One respondent commented:
I do not think BSP [bonding service program] has helped the system get any better than it was before. Thanks to the lack of instruments, we cannot even offer 10% of our total services. To make the situation better, infrastructure and minimum equipment must be made available in the health care centers.
The remaining 66% of the respondents believed that the health system had improved due to the bonding service program even though they have had to face many challenges. Although most of the respondents were not satisfied with their situation under the bonding service program, they expressed that at least the doctors' presence had been made possible in rural areas where doctors would otherwise hardly want to go. They felt that, despite the shortages of equipment and medical facilities, many rural communities were getting better treatment in their local health centers and were referred with better diagnosis to higher levels if the local centers could not offer appropriate treatment locally.
Willingness to work in rural areas in future
Despite the disappointing experiences of the bonding service program, 70% of the respondents commented that they would like to work in rural areas in future but with improved working conditions. The remaining 30% of the respondents said that they would never want to work again in rural areas in future.
The bonding service program for recruiting doctors in the remote and rural parts of Nepal started in 2004 but the program has never been studied in relation to its effectiveness. Therefore there is a paucity of information on how well the program has been implemented in Nepal. The government presumes that scholarships have helped the graduates attain medical/dental education free of cost, and thus the graduate doctors who have completed their education under the government scholarship are indebted to the country. The deployment of those graduates under the bonding service program, according to the government, is a way of paying back some of that debt through service in mostly rural areas. However, there is almost no evidence available on how the graduate doctors themselves deployed in that manner perceive the program. As major program stakeholders, the young graduate doctors' perception of the program is important to gain understanding on how this program is being run, to identify the strengths and weaknesses of its implementation and to make the required adjustments. This study aimed to fulfil that purpose of gaining understanding of the young graduate doctors' perception of the bonding service program.
The study found that the majority of doctors deployed under BSP were dissatisfied with the program because of poor infrastructure, lack of proper accommodation, poor transportation system, and lack of basic facilities such as electricity and water in the rural areas where they were deployed. Gender issues such as discriminating cultural practices between male and female doctors were also reported by some young doctors.
Another constraint reported by the doctors working in rural areas was isolation, both personally and professionally. In professional terms, the doctors under the bonding service program are generally posted in the primary health centers. The senior doctors are essential for guiding new doctors, and also for managing some complicated procedures or cases. The absence of senior doctors or colleagues who can advise the young doctors and can provide mentorship was reported to be hampering their crucial period of learning. Likewise, the young doctors were posted to areas that were geographically, culturally, ethnically and linguistically very different from the places where these doctors grew up and received their medical education. On top of that, they were not provided any kind of professional or cultural training before being deployed to the rural locations, which meant they could not prepare themselves for the situations that were to come as a part of their daily working lives. As a result, this sometimes led to a shock and caused difficulties in personal and professional adjustment.
Challenges faced by the doctors
Literature shows that dissatisfaction is expressed by doctors to bonding service programs everywhere. The main reasons for dissatisfaction are lack of infrastructure, equipment and medicines followed by lack of proper accommodation, lack of transportation, lack of electricity and water30-35. Studies of compulsory service program in South Africa, show that 64% of doctors found themselves to have developed professionally in terms of gaining confidence during their service but they did not improve their clinical skills as there were no supervisors36. In Ecuador and Turkey, similar conditions were faced by the doctors after the implementation of the bonding service program33,37. In Kerala, India, dissatisfaction with the 3-year bonding service culminated into a strike as a result of which it was later reduced to 1 year30. A similar situation is brewing in the Nepalese medical fraternity against the 5-year bonding service program following the postgraduate medical/dental degree. Several studies concluded that there should be an additional support system and incentive mechanism in place along with the compulsory service program to support the doctors who are deployed under such bonding service schemes31,34,38-40.
Both positive and negative responses from the community were reported by doctors worldwide. In South Africa for example, the services from doctors were valued as a compulsory service program and it was found to have brought positive changes in community health status40. Similarly, in India, people in the communities were happy to see a doctor nearby, in the absence of whom they had to travel a long distance41,42. In Ecuador and South Africa, the community responses were not as enthusiastic as expected. Problems of not accepting the newly assigned doctors by the community for the treatment were observed because people in the communities thought that the new doctors are learners and perform experimental treatments on them. Similar problems were noted by the doctors in Nepal in the present study. However, in the long run, the problem was found to have been solved after interactions between doctors and communities40-42. Similar was the finding in the present study where most doctors reported that people in the communities started appreciating their work in the long run and in most cases their relationships with the community became much better.
Human rights and bonded service programs
In Thailand, controversy arose about whether it is ethically acceptable to force recently graduated young doctors to go to remote places, which could demoralize them35. There is also an ongoing discussion worldwide on the human rights of doctors to migrate wherever they wish to43. Although the government clearly states the provision of the obligatory service and also that they have the right to deploy the doctors after investing in their education, it still does not supersede the basic human rights of the doctors to migrate44.
Effectiveness of bonded service programs
Arguably, it can be said that the bonded service program has been successful in addressing the problem of unavailability of doctors at the primary healthcare levels in rural areas of Nepal. At the same time, the children of those Nepalis who are otherwise unable to pay the expensive medical tuition fees are getting an opportunity to become medical doctors and dentists. However, it is difficult to prove the program's effectiveness and impact on population health. This is because the population health outcomes do not necessarily depend only on doctors' availability but also on the availability and services of many other categories of health workers.
Absolute indicators were not methodically determined before and after the implementation of the bonded service program. Therefore, assessing the program effectiveness remains a technically difficult task. Similarly, it is difficult to judge the cause and effect relationship because out of the numerous factors that influence HRH, the bonded service program epitomizes only one factor. Different types of compulsory service programs have been practiced in different parts of the world. Nonetheless, in most cases, those compulsory service programs are not formally evaluated due to lack of funds, shortage of expertise to evaluate and a lack of mandate to do so. From what is understood, it is clear that although explicit information is not gathered, the compulsory service programs can be implemented and sustained over a long period, even without enthusiastic support.
Recommendations for improving the bonding service program
On the basis of this study, the authors make the following recommendations:
Manage the workplaces with better provision of infrastructure and medical equipment followed by proper laboratory facility for diagnosis.
Increase the number of allocated doctor seats for the government health centers and use permanent doctors to provide service rather than using temporary intervention mechanisms to solve the perennial problem of the health system.
Increase salary structure for the doctors sent through the bonded service program because doctors working in the private sectors are paid far better than the doctors working in rural areas.
Create career security for doctors so that the doctors won't have to stay idle after the completion of bonding service program.
Implement the plan of first posting doctors to semi-rural areas where they can receive guidance from the existing senior doctors. They could then gradually be posted to more rural areas after a certain period so that they do not get overwhelmed right from the beginning, culminating into a negative perception towards the whole program.
This study was based on the perception of a limited number of doctors who voluntarily participated in an online survey. Likewise, the study was based on a short, self-administered questionnaire. As a result, the responses could not be explored to the same extent as for in-depth interviews. As there were no cross-questions, the depth in the responses might have been limited.
The bonded service program was believed to be an appropriate intervention strategy in 2004 by the Nepal government to address the uneven distribution of doctors between rural and urban areas. This program was envisaged under the pretext that there were few medical schools in the country, tuition fees of medical education were too high as a result of which only children of wealthy families could become medical doctors. Therefore, the government decided to offer medical education to the children of Nepali citizens from low- and middle-income families by providing scholarships. Despite the good intentions behind the program, some inherent programmatic and logistic problems exist in the program that need to be addressed for its effective implementation.
Some of the programmatic problems revealed in this study are:
assigning doctors to locations that are not only very far away from home but are also very different culturally and linguistically
undue political influence in posting doctors who are related to the politically powerful people in relatively easier locations
systematic disparities in pay and/or other government facilities between permanent health workers and the temporary doctors deployed under the program
poor health infrastructure and inadequate medical equipment in rural areas
lack of mentors in health centers where these doctors are deployed
lack of personal security in case something goes wrong unintentionally while providing a health service.
Similarly, there are some logistic problems such as provision of appropriate housing facilities, transportation, clean water, electricity and communication at the health facilities where the doctors are deployed.
In the current context of Nepal, deploying around 400 doctors in the rural areas every year seems to partly solve the problem of shortage of doctors in rural parts of the country. Nevertheless, there is a massive production of doctors, at the rate of 2000 doctors per year in the country. If the production of doctors increases at a similar rate and the government does not think of absorbing these doctors into the government health system as permanent staff members, it might give rise to a situation where on one hand there are more doctors than positions available in the government and private health sector combined and, on the other hand, the disappointed doctors are continuously deployed unevenly as temporary government health service providers in places that they do not like, with hampered chances of further education and no job security after the end of the bonding service program. Therefore, the government has to identify other possible interventions that are contextually relevant rather than continue using the services of the temporary doctors who are bound by the conditions of the bonded service program.
The success or failure of the bonded service program depends on how all of these influencing factors are addressed according to the changed context from the time when the program was first envisaged. It can also be said that a single approach to address HRH inadequacy carries the risk of being ineffective because, as also found by this study, multiple factors influence the doctors' willingness to be involved in rural health service. Therefore, the bonded service program should aim to serve the purpose of convincing the doctors to not only work wherever they are required to for a bound period of time in the rural areas but instead to become the real champions of rural health service – even in future ,when they are not forced by any government rural service bonds. That depends on the willingness of the government to tackle the constraints that are making not only BSP but also the overall rural health service unattractive to a considerable proportion of young doctors.
1 Ministry of Health and Population. Annual report of Department of Health Services 2073/74 (2016/17). Kathmandu: Ministry of Health and Population, 2017.
2 Government of Nepal and Central Bureau of Statistics. A compendium of National Statistical System of Nepal, Kathmandu. Government of Nepal and Central Bureau of Statistics, 2017.
3 Government of Nepal and Central Bureau of Statistics. National Population and Housing Census 2011 (Population Projection 2011–2031). Kathmandu: Government of Nepal and Central Bureau of Statistics, 2014.
4 Ministry of Health, New Era, and ICF International. Nepal demographic Health Survey-2016. Kathmandu: Ministry of Health, New Era, and ICF International, 2017.
5 Government of Nepal. The Constitution of Nepal. Kathmandu: Government of Kathmandu, 2015.
6 Ministry of Health and Population. Department of health services annual report 2016/2017. Kathmandu: Ministry of Health and Population, 2017.
7 Ministry of Health and Population. Human resource for health Nepal country profile. Kathmandu: Ministry of Health and Population, 2013.
8 International Labour Organization. Migration of health workers from Nepal. Kathmandu: International Labour Organization, 2017.
9 World Health Organization. Health Workforce requirements for universal health coverage and the sustainable development goals. Geneva: World Health Organization, 2016.
10 Ministry of Health, New Era, and ICF International. Nepal Health Facility Survey 2015. Kathmandu: Ministry of Health, New Era, and ICF International, 2015.
11 Ministry of Health. Nepal Health Sector Programme Implementation Plan (2004–2009). Kathmandu: Ministry of Health, 2004.
12 Ministry of Health. Strategic plan for human resource for health 2003–2017. Kathmandu: Ministry of Health, 2003.
13 Ministry of Health and Population. Nepal Health Service Act, 1997. Kathmandu: Ministry of Health and Population, 1997.
14 Ministry of Health. Health sector strategy : an agenda for reform health sector strategy. Kathmandu: Ministry of Health, 2004.
15 Global Health Workforce Alliance. Human Resources for Health Strategic Plan 2011–2015 Draft. Kathmandu: Global Health Workforce Alliance, 2012.
16 Ministry of Health and Population. Nepal Health Sector Strategy 2015–2020. Kathmandu: Ministry of Health and Population, 2015.
17 Ministry of Health. Nepal Health Sector Strategy Implementation Plan 2016–2021. Kathmandu: Ministry of Health, 2012.
18 Government of Nepal. Scholarship rules, 2060 (2003). Kathmandu: Government of Nepal, 2003.
19 Huntington I, Shrestha S, Reich NG, Hagopian A. Career intentions of medical students in the setting of Nepal's rapidly expanding private medical education system. Health Policy Plan 2012; 27(5): 417-428. https://doi.org/10.1093/heapol/czr052 PMid:21880690
20 Shankar P. Attracting and retaining doctors in rural Nepal. Rural and Remote Health 2010; 10(1420): 1638. Available: http://www.rrh.org.au/journal/article/1638 (Accessed 29 December 2019).
21 World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: World Health Organization, 2010.
22 World Health Organization. Working together for health. Geneva: World Health Organization, 2006.
23 Henderson LN, Tulloch J. Incentives for retaining and motivating health workers in Pacific and Asian countries. Human Resources for Health 2008; 6(1): 18. https://doi.org/10.1186/1478-4491-6-18 PMid:18793436
24 Ministry of Health. Annual progress report of Health Sector Government of Nepal 2015/2016. Kathmandu: Ministry of Health, 2017.
25 RTI International. Assessment of health system performance in Nepal. Kathmandu: RTI International, 2010.
26 European Union and The Britain Nepal Medical Trust. Human resources for health in Nepal analysis of policies and practices. Kathmandu: European Union and The Britain Nepal Medical Trust, 2012.
27 Government of Nepal. Scholarship management and operating procedure – Draft 1. Kathmandu: Government of Nepal, 2018.
28 Magar A. Human resources for health in Nepal. Journal of Nepal Health Research Council 2013; 11(2): 1-2.
29 Nepal Public Health Foundation. Situational analysis of human resource for health in public and private sectors in Nepal. Kathmandu: Nepal Public Health Foundation, 2011.
30 Barnighausen T, Bloom DE. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions. Human Resources for Health 2009; 7(1): 52. https://doi.org/10.1186/1478-4491-7-52 PMid:19558682
31 Capstick S, Beresford R, Gray A. Effects of a compulsory externship on student perspectives and implications for workforce shortage. Australian Journal of Rural Health 2008; 16(3): 150-155. https://doi.org/10.1111/j.1440-1584.2008.00965.x PMid:18471185
32 Homedes N, Ugalde A. Human resources: the Cinderella of health sector reform in Latin America. Human Resources for Health 2005; 3(1): 1. https://doi.org/10.1186/1478-4491-3-1 PMid:15659241
33 Cavender A, Albán M. Compulsory medical service in Ecuador: the physician's perspective. Social Science & Medicine 1998; 47(12): 1937-1946. https://doi.org/10.1016/S0277-9536(98)00335-9
34 Wibulpolprasert S, Pengpaibon P. Integrated strategies to tackle the inequitable distribution of doctors in Thailand: four decades of experience. Human Resources for Health 2003; 1(1): 12. https://doi.org/10.1186/1478-4491-1-12 PMid:14641940
35 Wiwanitkit V. Mandatory rural service for health care workers in Thailand. Rural and Remote Health 2011; 11(1): 1583. Available: http://www.rrh.org.au/journal/article/1583 (Accessed 29 November 2019).
36 Reid SJ. Compulsory community service for doctors in South Africa – an evaluation of the first year. South African Medical Journal 2001; 91(4): 329-336.
37 Mollahaliloglu S, Aydogan U, Kosdak M, Oncul HG, Dilmen U. The views of new graduate physicians about compulsory service in Turkey. Medical Journal of Islamic World Academy of Sciences 2012; 20(4): 140-145.
38 Dolea C, Stormont L, Braichet J-M. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of World Health Organization 2010; 88(5): 379-85. https://doi.org/10.2471/BLT.09.070607 PMid:20461133
39 Gwynne K, Lincoln M. Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review. Australian Health Review 2017; 41: 234-238. https://doi.org/10.1071/AH15241 PMid:27209274
40 Ditlopo P, Blaauw D, Bidwell P, Thomas S. Analyzing the implementation of the rural allowance in hospitals in North West Province, South Africa. Journal of Public Health Policy 2011; 32(S1): S80-S93. https://doi.org/10.1057/jphp.2011.28 PMid:21730996
41 Sangale S, Sankhe L, Rajguru, C, Zodpey S. Compulsory rural service – a step towards achieving universal health coverage? South East Asian Journal of Medical Education 2014; 8(2): 2-7.
42 Shroff Z, Murthy S, Rao K. Attracting doctors to rural areas: a case study of the post-graduate seat reservation scheme in Andhra Pradesh. Indian Journal of Community Medicine 2013; 38(1): 27. https://doi.org/10.4103/0970-0218.106624 PMid:23559700
43 Awases M, Gbary A, Nyoni J, Chatora R. Migration of health professionals in six countries: a synthesis report. Brazzaville: World Health Organization Regional Office for Africa, 2004.
44 Stilwell B, Diallo K, Zurn P, Dal Poz MR, Adams O, Buchan J. Developing evidence-based ethical policies on the migration of health workers: Conceptual and practical challenges. Human Resources for Health 2003; 1(1): 8. https://doi.org/10.1186/1478-4491-1-8 PMid:14613524
45 Harris D, Wales J, Jones H, Rana T, Chitrakar LR. Human resources for health in Nepal. The politics of access in remote areas. Kathmandu: Overseas Development Institute, 2013.
appendix I:
Classification of district by remoteness in Nepal45
appendix II:
Survey questionnaire


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India-US to sign mega defence deals during Trump's visit; trade deal not on cards
The much-anticipated trade deal between India and the US is not on the cards during President Donald Trump's visit. Even though the much-anticipated trade deal between India and the US is not on the cards during President Donald Trump's visit, New Delhi is pulling out all the stops to make the American leader's two-day maiden […]
US President Donald Trump (R) speaks with Indian Prime Minister Narendra Modi during a bilateral meeting on the sideline of the 31st Association of Southeast Asian Nations (ASEAN) Summit in Manila on November 13, 2017. World leaders are in the Philippines' capital for two days of summits. / AFP PHOTO / JIM WATSON
The much-anticipated trade deal between India and the US is not on the cards during President Donald Trump's visit.
Even though the much-anticipated trade deal between India and the US is not on the cards during President Donald Trump's visit, New Delhi is pulling out all the stops to make the American leader's two-day maiden trip to India on 24-25 February a truly memorable event.
Foreign Secretary Harsh Vardhan Shringla today said this would be the first stand-alone visit by a US President to India and would have three legs: Ahmedabad, Agra, and New Delhi. "We expect several senior members of the US Cabinet to accompany the President," he said. This would be the fifth time that Prime Minister Narendra Modi would be meeting President Trump during the past five months.
"Relationship with the US has evolved into one of our most consequential relationships today. It is a strategic partnership based on shared values and geared towards the 21st century," Shringla said.
The two sides would hold talks on defence, counter-terrorism, people-to-people contacts, energy, and regional issues. Sources said the trade deal would not be inked during the trip as the two countries did not want to rush into it. "The trade deal is certainly not stuck but we don't want to rush into it. Trade issues are complicated. We wish to have a win-win deal for both sides," he added. The Minister of Commerce and his US counterpart have decided to engage in further talks.
Sources, however, confirmed that certain defence deals would be signed during Trump's visit. Talks on defence pacts were in an advanced stage between the two sides.
Asked if Kashmir could be raised during Trump's visit, sources said, "We have come a long way. There is a great amount of recognition on that". The issue was not a major factor in Indo-US ties though some would keep raising it, they added.
It is learnt that Prime Minister Modi will personally receive President Trump and First Lady Melania when 'Air Force One' touches down in Ahmedabad on 24 February around noon.
From the Sardar Vallabhbhai Patel International Airport, the two leaders will hold a 22-km road-show, with people lined up both sides of the streets of Ahmedabad to welcome the US President.
The road-show will culminate at the grand Motera Stadium, the world's largest Cricket Stadium, with a stopover at Sabarmati Ashram, also known as Gandhi Ashram, where the leaders will spend about 15 minutes.
At the Motera Stadium, the US President will speak at "Namaste Trump" event with close to 1.25 lakh people in attendance. There will also be cultural performances for the dignitaries. Bollywood celebrities are also expected to attend the event. "The Ahmedabad event will have few parallels. It will be similar to the 'Howdy Modi' event held in Houston in September last year," sources said.
Modi will host lunch for the American leader and the other dignitaries. The US President and the First Lady will then depart for Agra around 4 p.m. After spending about 30-45 minutes touring the monument, they will depart for New Delhi.
On 25 February, official engagements will begin with a ceremonial reception at the Rashtrapati Bhavan at 10.00 a.m. The couple will be welcomed by President Ram Nath Kovind and Prime Minister Modi. Trump will inspect the Guard of Honour after which he will be introduced to the Indian delegation.
Around noon, President Trump will go into official talks with Modi at the Hyderabad House. They will have a one-on-one meeting, followed by delegation-level talks. The talks will end with a joint press statement by the two sides.
At around 3 p.m., the President and his delegation will move to the US Embassy for a CEOs' round-table with business honchos from both countries, aimed at increasing economic cooperation.
Soon after the state banquet, the American delegation will leave for the airport and depart from New Delhi.
Defence deal
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text:
Sash Locks
Five Lever Sash Locks
Willenhall 5 lever Sash Lock M3 (2 Inch)
Brand: Willenhall
Available Keyed-Alike at a great price, the Willenhall M3 5 Lever Mortice Sash Lock comes in just one size of 50 mm with a 32mm backset. It is available in a brass and Satin Chrome Finish. Ideally suited when the door stile is too narrow to allow a standard 64 or 76 mm case size. Used mostly in French Doors Operation Deadbolt is locked or unlocked... Read more »
50mm Case - Polished Brass Finish
50mm Case - Stainless Steel Finish
50mm Case - Stainless Steel Finish - Keyed Alike
50mm Case - Polished Brass Finish - Keyed Alike
You May Also Need You May Also Need
Rebate Kit - 13mm - Brass
Rebate Kit - 13mm - Chrome
Available Keyed-Alike at a great price, the Willenhall M3 5 Lever Mortice Sash Lock comes in just one size of 50 mm with a 32mm backset. It is available in a brass and Satin Chrome Finish. Ideally suited when the door stile is too narrow to allow a standard 64 or 76 mm case size. Used mostly in French Doors
Deadbolt is locked or unlocked by key from either side
Reversible latchbolt withdrawn by lever handle from either side.
- Ideal for doors with narrow stiles (Glazed and French Doors)
Don't forget about the door handles either! To view our full range of door handles, please click the link: Door Furniture
How to measure door rebates - LocksOnline exclusive how to video.
Manufacturer Asec, Union
Keys Supplied 2
Finish Polished Brass, Satin Chrome
Keyed KD
Case Depth 50mm
Case Finish Black
Case Height 108mm
Centres 57mm
Differs 1,000
Follower 8mm
Forend Finish Polished Brass, Stainless Steel
Forend Length 165mm
Handing Reversible
Mechanism 5 Lever
Hi, guys. My name is Darrel and I am head of the tech team here at LocksOnline.co.uk. Thanks for taking some time to tune in and have a look at one of our product review videos.
And today we are talking about the Willenhall M3 Five Lever narrow style sash lock. That's designed to go primarily on doors where the locking style, that's the part of the timber where the lock goes into, the locking style is quite narrow. And, of course, the beauty is that this particular type of lock is that the case depth there is only two inches, okay. So, it's really great for French doors where you're opening outward, etc. or where you've got sets of doors, etc. Again, as I've mentioned, where the locking style is quite narrow,
It's five lever. So it's the minimum security that you would expect these days on final exit doors. It's not British standard. It can't be British standard because basically there is not enough bolt throw these days in this size of lock case to allow the bolt to come out to comply with the British standard. So that is quite well worth knowing about. It's only available in a brass finish, as you can see.
So let's get a few measurements and it will hopefully help you to determine as to whether this is the actual lock that you need for your door. So the actual size of the actual case depth there, as you can see, is 50mm. The case height is 105mm there. The backset, which is the distance from the leading edge to the centre of where you put the key into, is only 32, 33mm. The PZ measurement, and that's the measurement from the keyhole to the centre of the follower, that measurement is 55, 56mm. The actual fore end width is 25mm and the fore end height there is just a smidgen over 152mm.
It comes as standard with a full box strike, as you can see there. Therefore, that's obviously going to be a lot better than just having a plate. You've got a little bit more security in regards to box strike. And, it also comes as standard with two keys. Now, we can key these alike for you. So if you wanted a group of these all on the same key, we can do that. We can key them alike for you. That's not a problem at all.
So there you go, guys. It's the Willenhall lock. It's the M3. It's the five lever sash lock available now on LocksOnline.co.uk.
Listen, if you need a bit more information or you want a bit more advice, by all means, pop a call over to us. Use email or you can use our live chat on our website, and that allows you to talk to us directly through the working day. You can talk to me or any of the guys. We'd love to hear from you and, more importantly, we'd love to see you as a customer. So, from me, Darrel, and all of here at the LocksOnline team, take care. We'll catch up with you real soon. Take care. Bye-bye now.
Union L2370 Mortice Nightlatch (2D2 Series)


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Saint Antony the Younger (, 78511 November 865) was a Byzantine military officer who became a monk and saint. He is commemorated by the Eastern Orthodox Church on 1 December.

Biography
Saint Antony was born John Echimos (Ἰωάννης Ἔχιμος) at Phossaton near Jerusalem in 785. His parents were Photeinos and Irene, and he had at least a brother named David and a sister named Theodoule.

According to his hagiography, as a child he was brought to the hermit John, who foretold his future. When his mother died in , he and his siblings left Palestine for Attaleia. There he entered imperial service, probably in the Byzantine navy. In 821 or 822 he was promoted to ek prosopou (deputy governor) of the Cibyrrhaeot Theme. He held the post until 825, although he may have been promoted to thematic governor (strategos) in the meantime. He participated in the suppression of the rebellion of Thomas the Slav in 822–823, then spent ten months in Constantinople in 823–824, before returning to his theme and leading the repulsion of an Arab attack on either Attaleia or Syllaion.

In 825, just as he was about to be married, he was secretly tonsured by the stylite monk Eustratios, and adopted the monastic name Antony. Joined by his servant Theodore, he spent some time at Amorion, before moving on to Pylae and Nicaea, and thence to the Agauron or Pandemos Monastery on the Bithynian Olympus. His hagiography claims that during these journeys he was repeatedly rescued from need in miraculous manner.  In 829 or 830 he was tried on the orders of Emperor Theophilos by the epi ton deeseon Stephen for his persecution of Thomas the Slav's adherents after the end of his rebellion, and was imprisoned for five months at Constantinople. After being whipped, he was released, and returned to Agauron. Sometime later (Raymond Janin places this between 837 and 843) he went to Briles, where he lived in a chapel dedicated to Saint Panteleimon. He then spent some time in the Monastery of Heraclius at Kios, returned to Agauron until 842, and then went again to the Monastery of Heraclius until 848, when he moved to the metochion of All Saints in Constantinople.

In  he cured Petronas, the uncle of Emperor Michael III, who became his disciple. The two had a very close relationship, and Antony is said to have prophesied Petronas' great victory over the Arabs in 863 at the Battle of Lalakaon. In that year, he moved to Ephesus, before returning to Constantinople in 865, spending the final days until his death on 11 November in the Monastery of Leo the Deacon.

He is commemorated by the Eastern Orthodox Church on 11 November and 1 December.

Hagiography
His hagiography was a disciple who visited Antony shortly before the latter's death. Preserved in several manuscripts, is a valuable historical source as it is "rich in information about Byzantine medical services, every-day life, law, and the administrative system" (A. Kazhdan).

References

Sources

785 births
865 deaths
9th-century Byzantine military personnel
9th-century Byzantine monks
9th-century Christian saints
Byzantine admirals
Governors of the Cibyrrhaeot Theme
Byzantine people of the Arab–Byzantine wars
Byzantine prisoners and detainees
Byzantine saints of the Eastern Orthodox Church
Saints from the Holy Land

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Q: How to check whether a numpy.array exists or not ? Truth testing value for numpy array? While developing a class that uses numpy.array, I'd like to construct this array at one stage, and later check whether it exists in order to manipulate it, or construct it at a later stage (pseudo-code below). How could I check that this array exists ?
For any basic object, I use : if my_object: # do something which uses the truth value testing, but for numpy the truth value testing checks whether any or all elements of the array is present, so if my_array: # do something gives the error The truth value of an array with more than one element is ambiguous. Use a.any() or a.all().
At the moment, the only working turn-around is to call isinstance(my_array,numpy.ndarray), but I think this is not really convenient (especially because some librairies like sklearn can turn numpy array to scipy.sparse objects for instance).
The pseudo-code to illustrate what I'd like to do :

def compute_my_array(self, ...):
   # long job here
   return my_array

def new_computation(self, my_array = None, ...):
   if not my_array: # if my_array does not exist, compute it ...
      my_array = compute_my_array(self, ...)
   do_something_else_with_my_array(my_array) # ... otherwise use it

For the moment the only way I found to check whether my_array exists is to use
   if not isinstance(my_array, numpy.ndarray):
      my_array = compute_my_array(my_array)

Is there any other (perhaps better) ways to do that check ?

A: Just change your default to return an empty array, and then check if there's anything in the array
def new_computation(self, my_array = np.zeros((1,)), ...):
   if not my_array.any(): # if my_array has no nonzero data, compute it ...
      my_array = compute_my_array(self, ...)
   do_something_else_with_my_array(my_array) # ... otherwise use it

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I left the busy and humid streets of Bangkok for Phuket. I needed the sea, sun, and fresh air to welcome me before my 25th birthday. I started planning my birthday get away months before and I was freezing cold in Toronto. I was feeling miserable and I wanted to be totally selfish and travel for a month. I somehow made it happen but not without a lot of skepticism from friends and family on how I was going to survive. I have to admit, I was scared but at the same time the excitement took over me and I tried to just enjoy everything.
It only took me an hour to get to paradise from Bangkok.
My first order of business was going to the beach and enjoying a nice cocktail. I walked from one end of the beach to another and got severely sunburned. I was a lobster!
The beach in Phuket is gorgeous! I rented a sunbed for 200 Baht for the whole day. I bought some street food to munch on and grabbed drinks at a nearby sand bar. I did not move for hours. I just wanted to relax and enjoy the beach.
The best decision I made was staying at a much quieter side of Phuket. My hotel was close to the beach and restaurants. I only have to walk for a couple of minutes to enjoy great food.
At night, I enjoyed drinking a lot of Mai Tai's and eating a lot of different seafoods. I love love eating seafood and I had the freshest fish, mussels, etc in Thailand. It was heaven for me until I got allergies! Anti-histamine to the rescue. I am never leaving home without it.
A lot of the restaurants have fresh seafood in containers with lots of ice on display so you can pick and choose your meal. You can have it cook any way you want. I don't know how I even managed to order food while my servers were speaking Thai to me.
I will have more food photos soon and more stories from Thailand.
Men in speedos...YEAH baby. ;) hehe.
I love that photo of the tourist parachuting, how cool that would be, and also scary for me haha.
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