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Home Croakey projects Croakey longreads Join the Gathering of Kindness in creating a better health system: a recommended LongRead
Participants at the Gathering of Kindness
Join the Gathering of Kindness in creating a better health system: a recommended LongRead
Editor: Melissa SweetAuthor: Lea McInerneyon: May 29, 2016 In: Croakey longreads, Healthcare and health reform
The damaging problem of bullying in healthcare features regularly in the news and on social media, most recently thanks to discussions yesterday at the AMA national conference in Canberra (check #amanc16) and to a new anti-bullying program at Royal Melbourne Hospital.
How different might our health system be if it was based upon kindness, trust and respect?
Earlier this year, a group of people with diverse expertise and experiences of the health system came together in Victoria to imagine just such a system.
The Gathering of Kindness was a unique opportunity for sharing stories, for listening and reflecting, and for creative discussions. Perhaps it will also come to be seen as a pivotal step for a fledgling movement for social change, reports writer and consultant Lea McInerney in a special Croakey LongRead.
Lea McInerney writes:
It's a chilly morning and mist is hanging low over Macedon's nearby mountains on the first morning of the two-day Gathering of Kindness. As I get off the train I spot three other people looking for someone. The organisers have arranged a lift for us to Duneira, a heritage house and gardens where the event will take place.
Lea McInerney
Soon we're in a car with our driver, Sharee, one of the event's many volunteers. She quickly puts us at ease and we introduce ourselves: psychologist, social worker, doctor, government policy officer, and myself, reporting for Croakey.
We're all a bit sniffy, noses cold from the sudden chill. Sharee points to a box of tissues sitting on the console. "It's colder up here in the mountains," she says. "I thought you might need these." Gratefully, we each grab one.
Two acts of kindness already and the show hasn't even started yet.
When the organisers offered Croakey a scholarship place at this very first gathering of its kind, I must admit to feeling a bit sceptical. The promo said, "We're inviting you to re-imagine a healthcare system that has kindness, trust and respect as core components." It brought to mind Gandhi's reply when someone asked him what he thought about western civilisation: "I think it would be a good idea."
I've been both inside and outside the healthcare system. In the early 1980s, I registered as a nurse and specialised in palliative care, first in hospitals, then with people in their homes. I left a clinical management role in the 1990s and became a health policy analyst, then worked in organisation development.
I've been a client of health services and have cared for family members with serious illnesses. I've encountered kindness and meanness, care and carelessness, clarity and confusion. We all want things to be better, but when your hopes have flown high then crashed to the ground a few times, you go in a little warily.
"This will be two days where we design something that doesn't yet exist. It will take courage, imagination, thoughtfulness, humour and cooperation." So the invitation promised.
The organisers, healthcare entrepreneur Mary Freer and hospital-based doctor Cath Crock, had been talking together for some time about the increasing problem of workplace bullying in healthcare. Mary is the person behind Change Day, a social movement that encourages people to commit to making a single change that will bring better health outcomes in their work, while Cath has been involved in developments in patient-centred care for many years and was awarded a Churchill Fellowship to study practices overseas in 2010.
Both women were aware that bullying was likely to be a problem not only for the staff affected, but for the people they were caring for too. They talked it over with futurist Peter Ellyard who encouraged them to flip it on its head. Rather than try to get to the bottom of the problem, why not go straight to a preferred alternative. Not "How do we end bullying?" but "How do we create kindness?"
Around the same time, the Victorian Attorney-General's Office had been conducting an audit of data from three reviews of bullying in healthcare settings. The findings were alarming – the incidence of bullying was high, it was poorly dealt with, many workers were caught up in an escalating cycle of poor behaviour, and they had little confidence that anything could be done about it. The audit concluded that stronger leadership and sustained commitment was required from health sector leaders to make things better.
The Victorian Health Minister Jill Hennessey is now overseeing a wide-ranging strategy within her department to create a culture that supports both patient and staff safety. Last year she approached Mary to see if Change Day 2016 would do something on bullying. Mary proposed the Gathering of Kindness and the minister was supportive, offering a small grant to get things rolling. Another early supporter was the Victorian Managed Insurance Authority, which provides risk advice and insurance services for state government departments, hospitals, health centres and community services.
Mary and Cath gathered together a large group of volunteers – the budget was too small to hire an events manager – and in late March found themselves welcoming 100 people from Australia, New Zealand, Ireland and the UK to Macedon.
Sharee leads us from the car park to the booking-in table and cups of tea and coffee set up on the patio outside the historic home. People are rugged up in coats and scarves, mingling and talking, shyly with strangers, relief on their faces when they meet someone they know.
Welcoming participants
While I'm standing there warming my hands with my coffee cup, I meet the executive director of nursing (DON) of a hospital in Sydney who becomes my 'go to' person for the current state of play in hospitals. We're both about the same vintage and while I left the profession 20 years ago, she's had a varied nursing career in the UK and in several Australian states.
We dive straight into the topic. Is it worse now than in the past?
She tells me about a student nurse who recently had her first experience of giving a patient an injection. The senior nurse had given her no time to prepare and it was much more stressful than it needed to be. "She just threw me into it", the student said. If staff aren't nurtured, the executive DON says, they can't nurture patients.
I tell her I remember working with a senior nurse I'll call Beth, during my first year as a registered nurse in a hospital. Beth was always grumpy and bossy, and was the trigger for the first self-help book I ever bought, Dealing with Difficult People. I don't know if what she was doing was bullying – we didn't really use that language back then – but her behaviour wasn't kindly and it was certainly persistent.
A bell rings and it's time to make our way to the marquee on the lawns. Inside are large round tables close together, nine or ten seats at each. We settle in.
Mary and Cath are up the front and welcome us all. "If you've ever been to a conference," Mary says, "forget all that now. This is an un-conference."
More on that shortly, but first Mary-Anne Thomas, the local state member for Macedon, and Parliamentary Secretary for Health and Human Services, opens the gathering, after acknowledging the Wurundjeri people. She touches on the magnitude of the challenge and quotes Rosie Batty who, when a journalist questioned whether violence against women would ever end, said that you must believe change can happen, that it's possible.
The un-conference starts off in an un-conference-like way with a performance of a play. Called Hear Me, it was written by Alan Hopgood in collaboration with the Australian Institute for Patient and Family Centred Care. It's now been performed over 100 times in healthcare settings in Australia and New Zealand, and seen by around 7,000 people. (If Hopgood's name rings a distant bell that's because he was Wally in Prisoner and Jack Lassiter in Neighbours.)
The play deals with the aftermath of a young woman's death in hospital after she was given the wrong medication. It's hard to watch – a heartbroken mother, an arrogant physician, a devastated junior doctor, a nurse who doesn't want to rock the boat, and a CEO trying to find a way through. (Watch a selection from the play at the end of this article).
The message that comes across at the end of the play – how critical it is to properly listen to people, patients and their families in particular – will come up time and time again during the conference.
When I was in my 20s, I worked in a small country hospital for a while. I nursed an old man who had advanced cancer. He'd had treatment in the city then returned to his hometown for care. His prognosis wasn't good.
One day, as I was fixing his pillows, he said something that made me realise he didn't really understand what was wrong with him, and how serious it was. Either no one had spoken to him about his condition or, just as possibly, somebody had when he'd been in the city hospital, but he hadn't been able to take it in at the time.
In those days, in that place anyway, only doctors were allowed to talk with a patient about their diagnosis. I asked the doctor if he could talk to the man, let him know what was happening. We were standing in the corridor a little way down from the man's room. The doctor said something along the lines of, "There's no point in telling him, he doesn't know what's best for himself and there's nothing that can be done anyway."
I knew it was wrong, but I didn't feel I could override the doctor's orders. The dying man, who I can still picture, was one of the reasons I headed to London to study oncology and palliative care. There had to be a more respectful way.
This is what I remembered, as I watched the play.
When it finished, Cath and the actors invited people from the floor (or, more correctly, the grass) to offer their responses.
Someone quoted a state health minister who says the experts of the health system are at both ends of the stethoscope. Another suggested that we underestimate the skills required to have difficult conversations, whether that's with a staff member or with a patient. Someone else's take on it was that, too often, the individual agendas of health professionals step in over the real purpose of what they're actually there to do.
A more personal response came from a philosopher who had recently been a patient. She was in hospital for a long time and said the nurses and doctors were fabulous and very attentive. The thing that bothered her though was the design of the hospital – the physical design as well as the systems, which she could see were often inefficient.
Because hospitals seem so concerned about safety these days, she said, patients are constantly being seen by different health professionals, and this gets tiring. She was also troubled by seeing elderly patients left on commodes for a long time, adding that obviously resources, and the lack of them, have a profound impact.
The fate of the junior doctor in the play isn't pretty – she abandons her career, a not uncommon situation – and this triggered passionate discussion about the pressures on staff, young doctors in particular, and how easy it is for their confidence to be shattered.
A doctor now in his 50s spoke about how as a junior doctor under supervision, he'd administered the wrong dose of a drug to a patient who died. He observed that mistakes at the beginning of your career tend to be through lack of experience, while mistakes by more experienced doctors often come from being too busy and missing things.
In response, another older doctor talked about how inherently unhealthy the health system is, saying that the three words he's heard over and over during his career are "Who needs sleep?" He added that we all know that people work best when they're rested and fed and comfortable. The whole profession, he was starting to think, works in a zombie state.
Someone else said it's important to recognise that health workers will get things wrong sometimes, that it's better for the system to recognise this and build a culture of learning, rather than a culture of pretending that mistakes are never made, and coming down heavily on people when they are.
At this point I was starting to see the value of focusing on creating a positive culture of kindness, rather than trying to solve every individual problem.
Different people were canvassing causes: lack of resources, lack of leadership, inadequate management skills, poor role modelling, the way nurses and doctors interact, individualism, faulty systems, and more. It felt overwhelming. At the same time, many of the personal anecdotes were harrowing and were touching raw nerves for some. It looked like the two days might teeter between war stories and impassioned opinions about single fixes.
Perhaps sensing that, someone turned to the question of whether you can you teach kindness, to which Mary invited the philosopher to respond. She said she's not convinced you can, that it's a trait of character inculcated from a young age.
Mary then brought in a neuroscientist. His take on it is that kindness is contagious among humans because we're a highly social species. We're born helpless, we have to be fed and cleaned by at least one other human being at great cost financially and emotionally to them. If there was no compassion, he said, there'd be no next generation.
However, there's another dynamic that can undermine this, and that's often at play among professional groups – an unconscious agenda to maintain the status quo. If anything changes, he added, they lose the power they hold, and that's a big problem to have to work around.
The play and subsequent discussions helped to set the tone for this event being different to business as usual. No keynote addresses, no individual speakers, not even any PowerPoint presentations.
Instead, there were Story Starters – an artist, surgeon, physician, philosopher, musician, futurist, entrepreneur, neuroscientist, actor, lawyer, patient advocate, former patient, politician, academic, video producer – who kicked-off what were called Open Conversations.
Four or five Story Starters would kick off a session by each telling a story based on themes like "Where have you met kindness and can we increase the likelihood of that meeting?" and "Kindness in strange places". Mary or Cath would then open up the discussion to the whole gathering. The message was, if you want to join in any time, just do.
In a marquee of 100 people that could be a recipe for chaos. But from where I sat at the back, it seemed to work well, people listening intently, those doing the talking not hanging onto the microphone for too long.
In between the Story Starter sessions were Creative Clusters – small group discussions, where people met in groups of eight to ten dotted around the gardens (sunblock helpfully provided), and talked about their experiences of both bullying and kindness.
As I listened to the stories, I heard a few different angles on kindness coming through – it's contextual, it's important to consciously put people at the centre, that staff are people too, that listening is powerful. There were also lots of stories about acts of kindness that people had found very moving.
Kindness in context
What is kindness and do we all have the same picture of it in our minds?
As it turns out, probably not. Someone brought up the Christian teaching of "Do unto others as you would have done to you" and this opened up a discussion about different cultural ideas of kindness.
Sometimes there's a mismatch between the intention of the person being kind and what's actually needed by the person who is the object of a kind act. A doctor gave an example of not helping a man in a wheelchair struggle for ten minutes to get through a door, because he'd realised the man wanted to learn how to do it for himself.
Then there's the question of how do we be kind when it's a tough environment and other people aren't being kind? In response, someone quoted Abraham Lincoln: "I do not like that man. I must get to know him better."
A surgeon, an Iraqi man who arrived in Australia by boat 17 years ago and was held in a detention centre in the desert for a time, talked about how non-English speaking people can sometimes come across as rude. He said he went to a very good school in Iraq and was taught English, but instead of learning how to say, "May I please have a glass of water", they learned to say, "I want water." He said it took him ten years in Australia to learn to say, "May I please have the scalpel?" He added that he is married to a Russian woman and that when she speaks English she can sound abrupt.
The neuroscientist expanded on his earlier stories about kindness and compassion being central to how we've survived as a species. He talked about a recent discovery in neuroscience of 'mirror neurons', a cluster of neurons in the brain that seem to have a role in how we engage with others.
He touched on it at the gathering and later explained it like this in an email:
Each person is a mirror of their environment which is then in turn mirrored by their own behaviour. This underlies the powerful phenomenon of social contagion – that information, ideas, and behaviours including kindness can spread through networks of people the way that infectious diseases do. For this reason, giving and receiving kindness can have a contagious effect … Unfortunately, social contagion also applies to negative emotions. In this way, anger and rage and the behaviours they may generate, such as rudeness and aggression, are also socially contagious." (Prof William T O'Connor, Limerick University)
People at the centre
In the discussion in the big marquee after one of the Open Conversations, an Aboriginal Elder told the gathering a little of her story and her people. She grew up on a river bank in regional Victoria and there were hard times, she said, "but you learn things along the way and it shapes you."
She talked about the racism that is an everyday experience for her people. Many go into hospital very sick, but come out early because they're not treated well. Recently, she had major surgery herself and experienced rudeness from staff generally, and nurses ignoring her requests for help.
She reminded the gathering of the different sorts of knowledge people have, pointing out that some people learn things in universities and become experts on different subjects, but that when they're interacting with her community, often they know "shit all" – because they haven't lived there and connected with people. Often, she said, non-Indigenous people don't understand or appreciate a person's spirit and how it's part of their story.
In one of the Creative Clusters, outside in the warm sunshine, the executive DON said she loves her job because of its explicit focus on patient-centred care. The CEO is totally committed to it and every decision, from senior management responsibilities through to individual patient care, is expected to be in line with it.
At every executive meeting they have a current patient story, where they look at what's going well, what could be done better, and what support staff might need for that. She visits the wards regularly and talks with the nurses, asking similar questions – what's going well, what's not, what help do they need?
Staff are constantly reminded of the behaviour expected of them. If people act in ways that aren't in line with the hospital's values, then they're called up on that. It's important, she said, to have the courage to call out inappropriate behaviour at the time it happens. People will always push boundaries, but it's important to make it within the limits of values and expected behaviour. She finished her description of her workplace saying it's a very nurturing environment, focused on both patients and staff.
Another woman who works in arts in health talked about a major art gallery where she worked for a while. The CEO held a meeting where every member of staff was present – curators, cleaners, security, everyone. The curators looked at the cleaners, a question on their faces as if to say, why are they here? The CEO began the meeting by saying everyone is critical for the work – without the security people the artworks would be stolen, without the cleaners it wouldn't be a nice place for people to visit, without the artwork, no visitors.
One of the Story Starters had breast cancer as a young woman and now regularly gives talks to healthcare workers. A question she often puts to them is, "Do you see the person behind the disease – do you see their story?" She mentioned a book called The Wounded Storyteller that encourages you to see an unwell person as a story with a life. She thinks we've lost that now that we have CT scans and myriad ways of testing people.
In her experience, what most people want is medical treatment and for the health professionals to 'show up', to bear witness to their suffering. She suggested that we may not be able to solve this in our current healthcare facilities, and might need to find new spaces where we can be vulnerable and find a window into our own souls. She doesn't think it's ever found in the bureaucracy or in checklists.
Staff are people too
The Iraqi surgeon who was held in a detention centre spoke about the paradox of hardship and suffering, of how it shapes you and, depending on how you respond to it, how it can make or break you.
The neuroscientist picked up on this and talked about the work of Viktor Frankl, a neurologist and psychiatrist who was a prisoner in Auschwitz during the war.
Amid the squalor and hardship, he noticed that some people retained their dignity and were consistently kind and courteous, while others seemed to give up. In time, he came to see a distinct difference between the two groups: those who remained kind had a sense of meaning or purpose for their life beyond the camp, while the others didn't.
Frankl found that while it's hard to continue to be kind in an environment where kindness is rejected, if you have a purpose, it's protective. Alluding to Harry Potter, the neuroscientist said it was like a magic cloak that protects you from bullies and catastrophes.
If you have a lot of people in workplaces who feel 'stuck' in their jobs, he said, that can affect the way they feel at work which flows onto the way they treat the people they care for. If you're doing something you love doing, you'll be happy.
You must find out what you love doing, he said, adding that humans probably shouldn't stay in the same job all their lives, as they can end up feeling trapped – although he acknowledged that family, mortgages and various other commitments mean making a move can require a lot of courage.
During morning tea on the first day I met a woman who works in a hospital and whose role is 'spiritual care', also known as pastoral care. She mentioned chart-reading versus storytelling. Chart-reading is when a health professional gleans what's going on for the patient from the chart at the end of the bed. Storytelling is what most patients would prefer – to tell their story to the people looking after them, and have them respond to that.
She's observed that many health workers, when interviewing patients or clients, have a 'checklist' approach, working their way through questions on a list. They often miss cues like a particular tone of voice or a fleeting expression that could lead to deeper, more relevant, questions. She pointed out that even just in general conversation, we're often getting our own reply ready rather than listening properly to what the other person is saying.
In between sessions, I heard a story from a young doctor about an old man he assessed in casualty one day. He suspected a particular medical condition and was running a series of clinical tests. One of them involved asking the man to smile, to see whether a bleed on the brain had affected the symmetry of his face.
Expressionless, the old man replied that he couldn't smile. "Why not?" the doctor asked. "Because I have nothing to smile about." The doctor picked up on that and asked him a deeper question. It turned out that the man's dog had died some months before and that he lived alone and had no family. He was still grieving and possibly depressed.
The doctor spent longer at the bedside and read through the man's old case-notes before making a referral to community support. Later the doctor was criticised for taking too long with patients. He knew that picking up and acting on this patient's cue, which only took another twenty minutes, would both help the man recover and prevent him getting caught up in a cycle of emergency visits, at significant cost to the healthcare system.
Acts of kindness, small and large
One of the Story Starters told a story about a senior doctor who'd had a medical emergency and nearly died in hospital. His symptoms were complicated and it took a while for a correct diagnosis to be made. Finally doctors worked out he had an internal bleed and needed emergency surgery.
Later, when he'd recovered, the doctor said the thing that brought him to tears – in a good way – was when he was about to go under the anaesthetic and realised a nurse was there beside him with her hand gently on his arm. He saw it as an expression of deep kindness and it moved him enormously. Often, it's the simple things.
The spiritual carer said members of her team make it a regular practice to keep an eye out for people in the corridors and other open areas of the hospital who might be lost.
A purpose built hospital can be an act of kindness. The politician spoke about a hospital she visited in Oslo that was built with the intention of making everyone there feel good to be a part of it. She said it's set out like a street with lots of light, and there are visual art works and also a stage where there's a performance every lunchtime. A small bridge is built out from the wards, and patients and staff can easily come out to watch.
We were given a glimpse of what that might be like when after lunch each day, pianist Tony Gould gave a short concert in the music room of the old house.
He's been closely involved with the HUSH music project, which involves musicians composing music specifically for people in hospital. So far there are 15 CDs, composed by the likes of Paul Grabowsky, Slava and Leonard Grigoryan, and the Tasmanian Symphony Orchestra.
Before playing, Tony talked about the care that goes into the compositions. The music's simple, but not simplistic, and not too loud or bright. There are many minor keys, but not too many. The intention is to calm people, not make them edgy.
The music room was full, standing room only, the sun shining in through the windows. As the first song finished there was a second or two of silence, people lost in their own reveries, then grateful applause.
Each piece was a gentle mix of quiet and bubbly, like water flowing along a creek. I can imagine how good it would feel to be working with it playing in the background, or if you were ill and feeling vulnerable.
Gathering up the threads
Towards the end of the first day, Mary and Cath invited everyone to start clarifying what they'd like to create out of these two days. After a wild ride of a discussion facilitated by Mary, seven specific areas emerged, among them the assumptions we make about kindness, building an evidence-base, the potential ripple effects of individuals consciously fostering small acts of kindness, and the scope for large transformational strategies.
The next day, each area was assigned its own Creative Cluster and people worked on the one they were most interested in and documented their ideas.
In another process, ten participants worked on 20 questions on kindness, recording their responses on an electronic meeting system called Zing, organised by Max Dumais, another of the gathering's volunteers. One person who took part, a consumer representative, said it was a really efficient and transparent way to collect a lot of ideas from different perspectives.
Seated around a large table, each with a keyboard in front of them, they'd listen as Max called out the questions, typing in their initial 'top-of-mind' responses. These automatically went up onto a screen above them, which was divided into two halves. In the lower half, there were ten numbered boxes, one for each person, and in the upper half, a cumulative list of everyone's ideas. As people typed their ideas in, they went into their own box, and then when they pressed 'Enter', the responses would 'zing' into the collective box. It meant that every perspective was captured and could be seen by everyone, and was available for later deeper consideration.
All the ideas from the different processes are being compiled into a report and will be available here.
As the two days drew to a close, Mary spoke about how we all have the capacity to help make enormous change and create a kind respectful culture in healthcare. She cautioned people to avoid creating an 'us and them' mentality towards people who use bullying behaviour, quoting Abraham Joshua Heschel who said "Few are guilty, all are responsible." This is our collective responsibility, Mary said.
Focusing on the positive, someone suggested, will need a shift from automatically saying "the system is unkind, we need to fix it" to instead saying "let's find the kindness already there and nurture it".
Someone who works in the field of appreciative inquiry said humans tend to not notice what's working well, and we frequently slip into the negative.
The executive DON agreed, adding that throughout her career she's often experienced staff on the wards finding it difficult to identify what's going well, instead slipping quickly into all the problems that have to be 'fixed'. She has to keep refocusing them, and finds it makes a big difference when they start talking instead about the positives they can build on and use to overcome the problems.
On the train back to Melbourne at the end of the second day, one of my fellow travellers, an academic and patient advocate, put the outcomes of the gathering into context in a way that seems realistic and reasonable.
She sees it as a fledgling movement and for now it's important, she said, "to let things be little, until they start to grow for themselves."
A week later, I spoke to both Mary and Cath by phone to see how they felt it had gone, and where to next. Mary said she was particularly pleased to see such a will and appetite to think and talk about a better future – at the same time acknowledging the difficulties and the pain people have experienced in their workplaces.
She loves the "What is it I can do now?" question and where she can see it leading. Smaller gatherings are already happening in Melbourne, Sydney and Canberra, and expanding to include people beyond those at the original gathering.
And was she disappointed by anything? Mary said she deliberately didn't allow herself to feel disappointed. Often when you finish an event, she said, you do a post-mortem, and dwell on what you wished you'd done differently. This time, she decided to take inspiration from Asian-American cellist Yo-Yo Ma, who said, "It's not about proving anything. It's about sharing something."
Mary said, "We shared conversations, as respectfully, transparently and openly as possible. You always wish you achieved more, wish there was more than 24 hours in a day. But this is just the beginning."
For Cath, a highlight was seeing the effect from taking a deliberate focus on kindness. She feels it's important because you're never going to get to the bottom of bad behaviour – we've all got a bad story to tell and it's not necessarily helpful to keep going over them.
She and Mary had talked about whether to put on the play because of the negativity in it, but decided it was important to let people see, experience and feel those difficult aspects and acknowledge them, then begin to move on to a preferred alternative.
They knew it could be very Pollyanniaish to just say, "Let's all be nice". You've got to acknowledge that other stuff, Cath said, because it is really bad. But rather than blaming the department or CEO or manager above you, we need to move beyond blame and all make this shift, bit by bit, into a big movement.
Mary and Cath will put their heads together in the coming weeks and be in touch with the group through different media. "There'll be another conversation and we don't know what it is yet," Mary said. She's confident something incredible will happen. "We're up for the surprise."
In the meantime, I'll leave the last word for now with the executive DON: "It's time to see kindness as a strength."
• Lea McInerney is a meeting and workshop facilitator, strategic planner and organisation development consultant, with a background in healthcare and community services. She also writes narrative essays, articles and poetry, and her work has been published in Griffith Review, The Age, Cordite Poetry Review, Meanjin Quarterly, Southerly and Australian Poetry Anthology 2015. She lives in Melbourne. Follow her on Twitter – @leamcinerney – and see her previous LongRead at Croakey (first published in Griffith Review): A long and dreamy read about letting go into death.
• Warm thanks from Croakey to Mary Freer, Cath Crock and the Gathering of Kindness for providing a complementary registration to Croakey and Lea McInerney to attend the event, as well as to Lea for her probono contribution in writing this for Croakey.
• For more information – see the Gathering of Kindness website.
• Listen to this broadcast by ABC Radio National's The Spirit of Things.
• See photographs from the event.
Watch highlights of the play, Hear Me.
Tags: LongRead. kindnesssocial innovation
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text:
Bulnes este un oraș și comună din provincia Ñuble, regiunea Bío Bío, Chile, cu o populație de 20.763 locuitori (2012) și o suprafață de 425,4 km2.

Referințe

Legături externe

Localități din Chile
Comune din Chile
Orașe din Chile

redpajama_set_name: RedPajamaWikipedia


You can trust Bay Vac & Pedal to provide you with reliable, quality vacuum repair services. Our repair specialists have over 30 years of experience in the vacuum industry, and a wealth of knowledge when it comes to vacuum machines. You can trust our team to successfully complete any vacuum repair and answer any questions you may have.
As a locally owned and operated business, we guarantee reliable, quality services. We stand behind our work, and want our customers to experience a standard of customer service that is hard to come by.
Come visit us or contact us for more information on our vacuum repair services. You can bring your vacuum to our store, and let the service team know you need a repair. If you are unsure what type of repair is needed, bring your vacuum to our store and we will take a look at it and provide you with our honest opinion and profession recommendation.
Remember, we offer free estimates on all vacuum repairs! Contact us today for more information on our vacuum selection and quality, reliable vacuum repair services.
Our goal at Bay Vac & Pedal is to save good people from bad vacuums.
Bob and the people from Bay Vac and Pedal come HIGHLY recommended by my family. You will not find a more Honest, Ethical, Down to Earth, Qualified store for vacs and bikes. We have purchased both a high end vacuum cleaner (Lindhaus) for our home, and a midrange mountain bike for my daughter. We have been extremely satisfied by their customer service and treatment: before and after the sale. I was treated as well as a ""just shopping"" passer by as I was when I came in for purchasing, and as well as when I have a question or problem to solve. I have been cycling for over 20 years and am very pleased with thier line of product, and the quality of products offered. They are also very accommodating. It it adds to their credit, we live 500 miles away (Green Bay WI area), and shop when we are visiting family in the area. We have found their prices not only reasonable – but on the bike, we saved $100 compared to the similar model that was offered in our area by the ""bigger"" bike stores. Bob and his guys have our business for as long as they like. We highly recommend them – hands down!
This business is one of the few that still believe in great customer service. They are very knowledgeable about vacuums and do everything to make sure you have what you need when you leave. I will recommend this place to everyone.
Very sweet couple that owns the shop, extremely knowledgeable in their business. It did take a little bit longer than I was hoping to get done but in all fairness they had to order parts. My vacuum didn't even run this well when I first bought it!!!!
Wonderful people to work with! Bob has years of experience at expert repair. I wouldn't take my vacuum anywhere else!
We are glad to see Bay Vac is back in business. It is a much needed business in Bay City, where you can buy a quality vacuum and always get expert, honest service.
Bay Vac is the only place to buy vacuums! Product & Service is the best!


KidVid Tournament 2010 Champion: Brian Vogan's "That's How a Pumpkin Grows"
Posted in Brian Vogan, KidVid Tournament 2010.
Posted in Brian Vogan, Caspar Babypants (Chris Ballew), KidVid Tournament 2010, Seattle.
April 5, 2010 by Stefan Shepherd.
The other semi-final matchup of KidVid Tournament 2010 is an all-Seattle affair. (We've had a number of those this year.) It features the Leadbelly Regional winner Recess Monkey and their "Marshmallow Farm" video from Field Trip -- the video defeated the Not-Its in an epic Round 2 Seattle-based matchup. That video's going up against the Woody Guthrie Regional winner Brian Vogan and "That's How a Pumpkin Grows" from his Little Songs album -- it defeated a Readeez video in Round 2.
Posted in Brian Vogan, KidVid Tournament 2010, Recess Monkey.
April 1, 2010 by Stefan Shepherd.
Posted in Caspar Babypants (Chris Ballew), Debbie and Friends, KidVid Tournament 2010.
The other second round matchup of KidVid Tournament 2010 today is the Woody Guthrie Regional final featuring Brian Vogan's "That's How a Pumpkin Grows" from his Little Songs CD against "Counting for Pleasure" from Readeez' Volume 2 DVD (and Songeez CD).
Posted in Brian Vogan, KidVid Tournament 2010, Readeez.
March 31, 2010 by Stefan Shepherd.
Posted in KidVid Tournament 2010, Not-Its, The, Recess Monkey.


text:
(Archive)
Prof. James R. Cordy , School of Computing, Queen's University at Kingston, Canada
A Program Understanding Theory of Software Complexity
25.11.2015 (Wednesday) , 10:00 - 11:30
TU Dresden, Room 205, Werner-Hartmann-Building , Nöthnitzer Str. 66 , 01187 Dresden
Many complexity metrics have been proposed to help predict the cost and effort of producing new software systems. However, more than 80% of the effort associated with a software project is not in its initial development, but rather in its evolution and maintenance. Existing complexity metrics have been shown to be more or less isomorphic to simple code size, and are of little help in predicting potential maintenance effort, other than observing that bigger systems require more work.
In this talk I will step back and ask the question "what makes software maintenance difficult?" Beginning with a reminder of the limitations of programmers as human beings and drawing from observations from software maintenance research, we will explore the known and unknown causes of difficulty in software maintenance in search of a feature-based metric that can capture what really makes maintenance hard.
Surprisingly, we will discover that it all boils down to one thing: there is no problem in software maintenance that cannot be made worse by another level of indirection. Based on this observation, I will conclude with a concrete proposal for a new kind of feature-based software complexity metric, and demonstrate its application to estimating the complexity of "make"-based build systems.
Dr. Cordy received his BSc in computer science and mathematics from the University of Toronto in 1973 and his MSc in computer science in 1976. After serving several years as chief programmer and senior research associate at the Computer Systems Research Institute of the University of Toronto, he returned to school and received his PhD from the University of Toronto in 1986. Following ten years at Queen's University he left to found Legasys Corporation in 1995 where he was vice president and chief research officer until his return to Queen's in 2001.
Dr. Cordy is a past member and chair of the Natural Sciences and Engineering Research Council of Canada (NSERC) grant selection committee in Computing and Information Science, a recent distinguished scientist member of the NSERC E.W.R. Steacie Awards Committee and an emeritus member of the International Federation for Information Processing (IFIP) Working Group 2.4, "software implementation technology." He is a registered professional engineer, a Senior Member of the IEEE, a Distinguished Scientist member of the Association for Computing Machinery and an IBM Visiting Scientist and Faculty Fellow.
Prof. Cordy recently served as program co-chair of the IEEE 2002 and 2008 International Conference on Source Code Analysis and Manipulation (SCAM), the IEEE 2005 International Workshop on Program Comprehension (IWPC 2005) and the IBM 2005 Centre for Advanced Studies Conference (CASCON 2005). He served as industrial co-chair of the IEEE 2002, 2004 and 2005 International Conference on Software Maintenance (ICSM ), as co-organizer of the Dagstuhl International Seminar on Transformation Techniques in Software Engineering (2005), and as program chair of the IEEE 4th International Conference on Computer Languages (ICCL'92). He serves on the program committees of numerous conferences and workshops in software systems and languages, on the editorial board of several journals, books and special issues, and as session chair at many conferences.
In 1990-91 Dr. Cordy was invited to be guest researcher at GMD (now part of the Fraunhofer Institute), the German National Institute for Computer Science, in Karlsruhe, Germany, and in 2004-05 he was again invited as guest researcher, at the Automated Reasoning Systems Division of ITC-IRST, the Provincial Center for Scientific and Technological Research in Trento, Italy. Since 2013, Dr. Cordy is one of five cfaed Grand Professors.

redpajama_set_name: RedPajamaCommonCrawl


Choose Wild-Rye for that perfect fit and performance when biking or skiing!
Josh sits down with Wild-Rye co-founder Katy Hover-Smoot. Wild-Rye is a brand that is dedicated to lifting up a long overlooked category of outdoor goods, women's bike and ski apparel. After achieving her PHD and flirting with a career in academia, Katy began to swiftly change paths and chase her desire to immerse herself in the outdoor sport industry. Since then, she's had the opportunity to work with some fantastic mentors in the outdoor industry giving her the boost to turned her attention towards building Wild-Rye and seriously strengthening an often ignored (but not for long!) category: clothing specifically geared towards athletic women.
The company that helped Katy get her footing in the industry: Specialized Bicycle Components Inc.
What is Wild Rye all about?
How did you decided to dive into this kind of business?
What was it like taking the first steps in starting Wild-Rye?
Do you specifically focus on biking and skiing to stay a four season company?
What is it like working remotely?
How does Wild Rye stand apart from other soft good companies?
What was the prototyping process like for Wild Rye?
Did you have any mentors that helped you build Wild Rye?
What has been some of the hardest parts about starting Wild Rye?
What has the growth been like since you started?
Where did you guys come up with your name?
What are some of your biggest fears in regards to Wild Rye?
What have been some of the biggest mistakes that you've made in regards to Wild Rye?
Where do you see Wild-Rye headed into the future?
What's the best part about running Wild-Rye?


text:
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Residential & Commercial remodeling contractor providing reasonable pricing, on all services.
url: http://ercontractors.yolasite.com/
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text:
ACCEPTED

#### According to
Index Fungorum

#### Published in
Fl. berol. (Berlin) 2: 139 (1824)

#### Original name
Fusarium oxysporum f. oxysporum

### Remarks
null

redpajama_set_name: RedPajamaGithub