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Urip iku urup (life is lit) by service to others: a qualitative study of frontline healthcare workers’ lived experiences providing patient care in Indonesia’s COVID-19-designated hospital
BMC Health Services Research volume 23, Article number: 262 (2023)
While COVID-19 affects every walk of human life, it especially implicates healthcare workers at the forefront of the pandemic due to their vulnerable involvement in providing first-line treatment. This study presents the lived experiences of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital, one of the severely afflicted healthcare settings wherein resource challenges, public health crisis, and political constraints intersect as policy conundrums.
Using a qualitative exploratory-descriptive approach, this study drew on thirteen in-depth, semi-structured interviews with frontline healthcare workers who have experiences providing first-line COVID-19 patient care in the COVID-19 hospital. The data analysis commenced with the verbatim transcription of the interview data, which was then subjected to a systematic thematic analysis employing hermeneutic phenomenological principles.
The exploration of the participants’ accounts reveals eight interconnected themes: facing resource scarcity and resignation; experiencing service-induced burnout due to occupational workload; encountering fears of being infected and infecting others; engaging in positivity through social connectedness; having dilemmas over healthcare rationing; developing negative emotions during patient interactions; coping through spirituality and religiosity; and embodying a life of service.
Managing healthcare in resource-limited, crisis settings presents multifaceted challenges that exceed mere structural modifications, requiring prioritized public health investment to ensure optimal patient care. Therefore, healthcare policy development and implementation should equally emphasize the well-being of frontline healthcare workers to foster sustainable healthcare delivery and achieve improved patient outcomes.
While the COVID-19 pandemic appears to be “under control” in some Western countries, with many transitioning from an acute pandemic response to a sustained management strategy, there remains a significant prevalence of infections and deaths in others, such as in Indonesia. As one of the first countries to be affected by the first wave of the pandemic and on the current list of countries where COVID-19 infections stand significantly, Indonesia has been dealing with a continued overwhelmed and overburdened healthcare system due to its substandard worker-to-patient ratio .
Despite the recent development and distribution of vaccines , Indonesia still has the highest incidence of COVID-19 in Southeast Asia, with at least 17,261 active cases recorded as of 15 October 2022 , putting pressure on frontline healthcare workers to provide care for the affected . This study contributes to improving the understanding of experiences learned from healthcare workers during the COVID-19 public health crisis, as well as to the translation of research findings into evidence-based policy and practice aimed at enhancing frontline healthcare workers’ well-being and welfare, and by extension, the global public health architecture.
COVID-19 has magnified the world’s economic geography and exacerbated existing social disparities, bringing attention to the fragile nature of global health governance. With the pandemic and its unprecedented effects, frontline healthcare workers have emerged as notable figures by delivering the very best healthcare services possible to alleviate the strains imposed on patient care [5, 6]. The pressures placed on the healthcare workforce to protect public health amid the pandemic, however, are nowhere more evident than in Indonesia. As of the confirmation of the first two cases, Jakarta continues to experience an enduring increase in confirmed COVID-19 cases. With the healthcare system in the city struggling to keep up with the rising rates of infection, the vulnerability for many COVID-19-infected population groups has created an unmanageable surge in hospital bed occupancy rates.
Amidst the intentions of averting the risk of infecting non-COVID-19 patients treated in the regular hospitals, the Indonesian government reconstructed a Jakarta apartment building in early March 2020 to accommodate the provisions of first-line hospitalizations for COVID-19 patients. Given that this emergency facility still functions as a central emergency hub for treating and caring COVID-19 patients, as well as the current COVID-19 figures in Indonesia, it is imperative to deduce implications for professionals in the healthcare sector and to share experiences learned from working in these challenging environments. In so doing, this study seeks to draw on the lived experiences and perspectives of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital.
Design and setting
This study is underpinned by an interpretivist paradigm [7, 8], whereby the insights are mainly derived from a phenomenological exploration that is not merely in the act of understanding particularities but in the system of meanings from which it is composed to the larger contextualities of the study. A qualitative exploratory-descriptive approach  further inspired the research process with a focus on exploring and describing the experiences as they were lived by frontline healthcare workers. In employing this design, the study was informed by the work of van Manen’s hermeneutic phenomenology [10,11,12,13,14,15]. The approach presupposes an attentive attunement and open-mindedness that offers rich textual information about the “human” side of a phenomenon and enables interpretation of symbolic order meanings.
With a three-month research period commencing in June 2021 and concluding in August 2021, this study took place in one of (and the largest of) Indonesia’s first-line COVID-19-designated hospitals in Jakarta. As a leading hospitalization for COVID-19 patients in Indonesia, this makeshift hospital was reconstructed in early March 2020 and is headed by a number of significant government and non-state entities, including (among others) the Indonesian military, police, ministry, and medical association. Built on a 10-hectare site with roughly 7,000 apartments in ten buildings, the hospital is one of the world’s largest COVID-19-focused hospitals with a total housing capacity of approximately 22,000.
During the pandemic in Indonesia (March 2020–as of this writing), four out of ten apartment buildings were converted into COVID-19-designated facilities, with zoning implemented to prevent cross-infection and the hospital area divided into three distinct localities: the red zone for COVID-19 patients, the yellow zone for the occupation and housing of healthcare workers, and the green zone for non-service-providing physical activities (such as sports, exercises, and recreational activities). Due to the emergency nature of the hospital and its very unusual working conditions, it is important to note that personnel service contracts are renewed on an as-needed basis, with them having the option to renew their contracts or being transferred to another COVID-19 emergency facility if so directed. At the time of the study, approximately 3,000 healthcare workers were employed in at least 25 departments located in both the yellow zone (administrative and secretarial services) and the red zone (direct patient care), and some personnel were routinely rotated monthly to other COVID-19-designated hospitals in other regions of Jakarta as part of contract renewals or military and police assignments, and others had their service contracts officially ended.
Considering that purposive sampling is meaningful within the phenomenological notion of intentionality, this study invited frontline healthcare workers (n = 13) with various levels of expertise and responsibilities who have first-hand knowledge and prior experiences of providing direct patient care in the COVID-19-focused hospital in Indonesia. A range of snowballing was also employed to identify and recruit new participants among the existing study participants’ acquaintances, thereby proceeding in locating information-rich participants through this chain-referral approach.
Eight males and five females were included in this study, with the participants aged between 21 and 30 years (n = 7), 31–40 years (n = 3), and 41–50 years (n = 3). Of the participants, there were five medical personnel (three general practitioners and two pulmonologists), two clinical psychologists, four nurses, and two dieticians. Before their services in the COVID-19-designated hospital, most participants had worked for a range of 1–10 years (n = 10), 11–20 years (n = 2), and over 20 years (n = 1), but a sizeable majority has been serving in the hospital for over 12 months (n = 7), with the remainder serving for, respectively, 1–6 months (n = 3) and 7–12 months (n = 3).
Data collection and ethical consideration
Following ethical approval from Universitas Airlangga research ethics board (Approval No. 2281/UN3.1.7/PT/2020), and with the purpose of getting rich and in-depth experiences, a semi-structured interview protocol consisting of open-ended questions, followed by probing questions, was developed to explore the participants’ lived experiences and perspectives of serving at the COVID-19-designated hospital, as well as their thoughts, concerns, and feelings.
After contacted participants clearly and freely expressed their consent to participate, the interviews were arranged with flexibility and agreement to both parties, also appropriately held in a location convenient to the participants. Before commencing the interviews, the participants were provided with an explanation of the research objectives, as well as hard copies of letters of information and informed consent to document the essential statement of agreement between two parties, with the former meant to be kept by the participants and the latter was meant for both sides.
van Manen’s phenomenological approach of being open and giving time and space for the participants to talk about their experiences was valuable in exploring insights . The in-depth, semi-structured interviews started in exploratory modes and progressed toward a more in-depth manner, with questions exploring participants’ descriptions of their sense of caring for and treating patients during the COVID-19 trajectories, recollections of patient and family encounters, experiences of working in the emergency facility hub, as well as key driving causes for service.
The interviews were audio-recorded, lasted for approximately 45–90 min, and conducted in a face-to-face format so long as adequate health protocols were adhered. Equally important, observational notes were engaged throughout the interviews, with memoing and reflexive journaling were also used afterward to support observations of participants’ behaviors, reactions, and emotions during the interviews. This journaling particularly provided an attunement of the interview moments; thus, letting the phenomena of the lived experiences and perspectives of frontline healthcare workers be disclosed.
In a dynamic process, van Manen’s analytical steps, holistic, selective, and detailed readings, led the way in exploring the participants’ experiences . The data analysis process started with a review of the interview transcripts purposefully attending to embedded meanings , with both authors reflecting and discussing data and interpretations at all levels in the analytical process in order to ensure trustworthiness of the findings. An iterative, inductive approach of analysis was used to study the transcripts which were clustered and analyzed in order to identify understanding and meaning of the material as a whole. In a process of dwelling in and distancing, which also included continuously going back and forth between clusters of meaning and the interview text as a whole, clusters were grouped into essential themes to capture the phenomenon of interest.
Indeed, as highlighted by van Manen , the process of writing and rewriting is essential because it helps researchers to transcend beyond the identification and comparison of themes to a fuller understanding of the meaning of pre-reflective experiences both within and across transcripts . Following this step, thematic reflections were described as figures of meaning to help point to possible eidetic meaning aspects of the frontline healthcare workers’ experiences, containing detailed descriptions of lived experiences with an aim of illuminating the complexity and structure of meaning and will serve as a structure in the presentation of findings.
Hearing the participants’ voices in this study enabled it to investigate as well as to explore the connections, patterns, and recurring themes that reflect the experiences of the participants as a whole. The findings of eight interconnected, essential themes were articulated by participants’ frank, pre-reflective and honest expressions and reactions in the profound sense of emotionally-attuned experiences; described in detail below. This section also presents empirical data, i.e., interview quotes from participating healthcare workers, not to provide proper proof or argumentation but as examples that amplify the nearness and presence of the frontline healthcare workers’ understanding of their experiences.
Succumbing to the system asymmetry
The participants expressed their confusion and dissatisfaction with their early interactions with the COVID-19-designated hospital, highlighting the rather non-existent system and absence of infrastructure that serves as the foundation of an emergency facility. Due to the absence of a well-established system and the inadequacy of facilities, a great level of ingenuity had to be exercised to adapt to its ever-changing emergency nature. Further, participants were concerned about the inadequacy of quality human resources in each of their departments, which affected them emotionally and induced jenuh-like emotions (getting weary of the situation). These emotions, manifested mostly as emotional exhaustion and overwhelm, were particularly present due to the strain to quickly adapt to a succession of personnel changes and their distinct work styles in a short time span, a situation likely linked to the hospital’s frequent personnel changes and constant contract renewals.
However, in addition to the feeling of jenuh, participants in leadership positions regarded the system as problematic when they had to assist and instruct new personnel, as they perceived it as impeding their previous progress. Dissatisfaction and frustration with the system was also expressed, as it necessitated further adaptations to begin anew and ingenuity to manage the system. For example, because the psychology department is led by a military member and there is a rotational command arrangement, the monthly leadership changes made senior clinical psychologists especially sensitive and frustrated when the new leadership was incompatible with their membership.
Despite these effects, participants became receptive to and attuned to the system’s inadequacies, succumbing to them either out of habitual familiarity or a sense of powerlessness. Even for nurses in the COVID-19 swabbing department, who were particularly exposed to the frightening state of encountering patients and faced greater risks in their patient encounters, this system asymmetry pertaining to institutional facilities was not only germane; it also compelled nurses to (powerlessly) concede defeat to the hospital’s flawed system.
At one time, the room for collecting COVID-19 swabs was inadequate, as there were no windows and thus no air circulation. I was really frustrated when my teammates and I sought a different room but were never provided with one, possibly due to its inaccessibility. Finally, I can only adapt; I can only ngarepin [depending on] the air conditioner and fan in the room.
Becoming subjected to burnout
As the principal treatment facility for COVID-19 patients in Indonesia, the workload experienced by those at the forefront of the pandemic is indeed unfathomable. Although most departments require workers to work in the red zone and visit patients for only eight hours before a 32-hour break, the workload during the eight-hour visit is rather demanding and even stressful.
Two participants discussed the challenging workload allotted to them as clinical psychologists, which includes counselling patients, interviewing prospective personnel, and organizing events for patients (such as webinars and fun games). During therapy sessions in particular, they often felt as if they were absorbing the patients’ negative energy owing to the immense stress of listening to many (patients’) anxieties and complaints. Despite this, both participants maintained the same caring and supportive approach to the patients: “We are here to serve patients, and they need us”, and attempted to recall the joy they experienced when patients’ conditions improved.
However, due to a different system in the swabbing department that necessitates healthcare workers to work every day from 8 a.m. to 5 p.m., two nurses described the stressful circumstances of swabbing 600–700 people in a single day. Both nurses also mentioned their exhaustion as a result of the hospital’s mass swabbing activity, which they described as: “…from morning to evening, we must swab every healthcare worker [about 3,000 people]”. They also expressed burnout, especially when swabbing challenging patients, such as those with ADHD or bodies of those who died in the ICU, leaving them emotionally and physically exhausted due to their department’s lack of human resources, but with a strong sense of duty to perform their job.
Having fears of being infected and infecting
COVID-19 was a significant source of concern for the participants, prompting them to devise a variety of precautions to reduce their risk of infection. Concerns about the new COVID-19 strain particularly prompted participants, in their own ways, to maintain their level of safety when providing care to COVID-19 patients.
In an intriguing twist, participants stated that their fears of infection stemmed from a desire to prevent infecting others; for some, this fear manifested as an unwillingness to return home. In fact, the COVID-19 hospital’s system discourages and even prohibits workers from returning home, and all participants agreed that this is a prudent policy that must be followed despite their overwhelming desire to do so. Even during the two most important religious holidays celebrated by Muslim participants, they chose not to return home for fear of contracting their families and relatives and felt bitter toward those who could return in contrast to their peculiar situations.
Notwithstanding so, even participants who were able to return home (for urgent reasons) were not necessarily welcomed by their neighborhoods, indicating that their community was not as receptive to their presence after their services in the COVID-19 hospital. In this, participants expressed feelings of exclusion from their neighbors just because they worked in the COVID-19 hospital, with them further voicing their resentment at having to morally provide care for patients who ironically stigmatized them.
My mother once prohibited me from returning home because she did not want me to become bahan omongan [the talk of the town]. I felt compelled to beg her, “Ya Allah, Ma! I will bring my COVID-19 test as proof!” I was also disappointed when my neighbors believed that working here is so terrifying... like, ‘she works in a COVID-19 hospital, she must be a carrier of the virus’, while in reality, who helps them when they are in need or do not follow to health protocols? It is us [healthcare workers].
Growing a sense of relatedness with patients
Participants, especially those who had been diagnosed with COVID-19 in the course of their service, exhibited a sense of connectedness and relatedness to their patients. Some even extended this by comparing patients in a COVID-19 hospital to those at conventional hospitals by stating that patients are essentially alone (for self-isolation purposes), and as COVID-19 hospital residents, their shared experience of being “alone and far from my family” enhanced their ability to relate with their patients.
One participant mentioned that she frequently felt irritated when she was tired or when she encountered demanding patients, but she always consoled herself with thoughts such as: “I must consider my patients’ feelings because I am sure they do not want to be like this either”. Another participant, who was particularly drawn to young children whom she described as “reminding me of my lovely children back home”, described swabbing a 14-day-old infant after the grandfather tested positive for COVID-19 as the most traumatic experience she could endure because “the baby was crying so intensely because the Dacron swab was the same as those used for adults”.
Participants with leadership and management responsibilities went even further by emulating a sense of connection with patients and instilling in their colleagues the importance of “caring for patients as if they were our family”, stating that “it is impossible for us to hate our COVID-19 patients”, despite experiencing emotional distress as a result of treating them. Participants understood that many patients may have had fears and anxieties following their initial COVID-19 diagnosis, and they felt motivated to ease their burdens. One participant continued by stating that he enjoyed conversing with his patients and joking with them to lighten their moods, especially with patients his age and the elderly because they tend to have the most negative thoughts about health deterioration and even death, and he felt obligated to share his empathy with them and foster a sense of togetherness.
Facing dilemmas with healthcare rationing
Participants expressed concerns with the arbitrariness of discretion over (especially) healthcare rationing, comparing it to “playing God without God’s power”. One general practitioner detailed how, in a single day (8-hour shift), she and her teams had to cope with five consecutive deaths, followed by the next day of dealing with the same situation and receiving reports from nurses that the consciousness of several patients had weakened. She felt as though “it was a marathon of patient deaths” and felt bad for “maybe” lacking the knowledge necessary to save her patients. Yet, as she continued to speak in a conflicting manner, “We lacked ventilators” and “All we can do is have a strong attitude and effective coping methods to cope with it”. She further sought to portray her experiences in encountering dilemmatic healthcare rationing, recounting an agonizing and awful moment during COVID-19’s second wave peak in Indonesia when she was compelled to pick which patients should be taken off ventilators.
We have a significant number of ‘ugly’ [deteriorating] patients and must choose which one should be prioritized. For example, we must determine whether a young patient and an elderly patient have comorbid conditions. Because there are so many elderly patients in the ER, if the elderly patient suffers kidney failure, hypertension, or diabetes, and the young patient is generally healthy, we must prioritize the young patient. At some point, we had to care for at least three patients at the same time, assessing their odds of survival, attempting to save them, or simply waiting and watching.
Her experiences and emotions were also shared by participants with decision-making responsibilities, such as pulmonologists, recalling a moment when they, as physicians with discretion and autonomy, had to determine which patient should be transferred to the ICU. They proceeded by stating how they felt conflicted when they were required to choose which patients to provide prescriptions to due to a shortage of availability, and how they felt remorseful that they had to “prioritize” patients with a higher chance of survival and “put aside” others with less. In the end, they expressed remorse that, despite their extensive experience and knowledge, they had yet to contribute to what they perceived to be their expectations, and particularly developed a sense of guilt when they had to eventually face the patients’ families, explaining that “breaking the news is a skill acquired the hard way”. A general practitioner with a leadership position in his department, pondered on the consequences of his colleagues’ delivery of bad news when he tried connecting it to his experience.
At times, we feel sad when the families of our patients condemn us, asking, ‘Why are you not saving my family?’ At one point, a patient’s family approached me begging for help; but, due to the hospital’s overcrowding, I suggested the family seek care elsewhere with better facilities and resources. A few days later, the family sent me a message stating, ‘Thank you for your advice. My family has died’, as if implying and persuading me that it was my fault and my cause, when I thought I had done all possible.
Developing negative emotions in patient interactions
Caregiving for sick persons entails vulnerabilities, as seen by the participants’ sentiment of not knowing what will happen next and, if they do, being unable to help. A participant who worked as a dietician in the ICU described how she was frequently confronted with the “unimaginable and unexpected” as patients’ conditions deteriorated and frequently culminated in death. She stated her sorrow and disappointment that, “A few days ago, the patient was still able to drink the milk I gave her”, as well as her anxieties and feelings of guilt that, “Maybe it was my fault; perhaps I gave the patient too little milk, or I should have increased the amount… I am afraid that the patient’s condition is a result of my administering an incorrect dose”.
As it turns out, such an experience is a collected encounter shared by the participants, including two clinical psychologists who felt burdened by the notion that they were powerless to assist a patient who attempted suicide in the building. In consequence, one psychologist even had reached the point where she sought consolation and emotional support from her colleagues, further expressing her feelings of frustration, regret, and powerlessness when she was confronted by her patient’s emotionally charged verbal remarks:
On my first visit to the red zone, I encountered a patient whose mental instability demanded transfer to another facility. The patient, whose condition was already improving and stabilizing as a result of my treatment sessions, felt misled and offended that she had to be transferred to a different institution after having been accustomed to this one. I still remember her saying, ‘Perhaps I would still be here if I had not consulted with you. I should not have consulted with you’.
But as the participants had also pointed out, they were not always in control of the patients’ care and (most of the time) had to follow on what was directed as the procedure, that there are higher levels of decision-making over which they have no control. This lack of professional autonomy affected a general practitioner, who, despite maintaining a fairly nonchalant demeanor throughout the interview, also had an emotional moment when he recalled an episode of feeling inadequate and incapable, “It turns out my scope is just this much”.
Coping through spirituality and religiosity
In light of the significant adversities faced by participants, they recognized the importance of protecting their health and well-being through positive health behaviors and micro-strategies. While all participants acknowledged the significance of pragmatic considerations during their service at the hospital, some particularly highlighted the importance of spirituality and religion as a springboard for mending and health management. One participant narrated an excellent example of both aspects:
Good people are those who can benefit others, my faith teaches. It is a tenet of my faith that I take to heart, and it is what drives me to help other people and what makes me happy while I am helping them. While it is true that we can only do so much on our own, I still think God is on our side whenever we do right. Obviously, we need to keep up our standard of healthful living. But I believe that if we act with our hearts, God will reward us with our hearts as well.
Participants concurred with the preceding narrative and emphasized the importance of conforming to the teachings of their religion when they feared contracting the virus. Likewise, participants believed that their humanitarian calling would protect them, “Insya Allah, if we maintain a high level of safety, our health will be protected, and we will not contract the virus. However, even if we contract COVID-19, we must ikhtiar [an Arabic phrase for putting effort] on how to recover in order to resume our work”.
Among the participants, one participant who is a pulmonologist with almost two decades of experiences, was possibly the most spiritually inspired by his faith. For him, since COVID-19 is indiscriminate in its infectivity, he hoped that if he understood this from a more nuanced spiritual perspective, or as he put it, “It was fated that way”, he would feel more at ease during the healing process. Even as a survivor of COVID-19 who contracted the virus twice and lost both of his parents to the virus, he could find solace in the support and religiosity of his religion, underlining the necessity of accepting that everything is predestined as fate.
Indeed, with a flurry of unfortunate events unfolding at an unprecedented speed and despite their best efforts, participants were compelled to surrender to the painful reality. Nevertheless, an interesting facet emerged from their accounts, as they found comfort in the presence of a higher power, characterized as “the act of not knowing everything but knowing that something greater exists”. Additionally, participants believed that striving to provide the best possible care to their patients while giving their utmost effort, and surrendering to a higher power, assisted them in accepting the limitations of reality and embracing the concept of “ikhlas” – the act of letting go – throughout the process. Ultimately, this brought them a sense of comfort and release from the burden of their inability to save every patient, enabling them to focus on the ones they could help.
Finding meanings in life of service
Given the excessive workload and high prevalence of burnout, it begs the question of “why” frontline healthcare workers continue to devote their lives to serving patients in the COVID-19 hospital. As it unfolds, all participants have a sense of usefulness and a desire to contribute to society in order to find purpose in their lives. For instance, a military dietician remarked that his military assignment to the emergency facility is the first time in his 20 years of service that it coincides with his passion, expressing delight that his profession can be channeled through such service.
As a soldier, I am honored and proud to have been entrusted with serving in this place in service of my nation. I am proud of myself since I believe that not everyone wants to come here and because I am prepared to take risks while others are not.
One clinical psychologist, who was highly worried and even had psychosomatic episodes after her first interaction with the hospital, shared a similar emotion and even became philosophical in her motivation, using the Javanese proverb “urip iku urup” (life is lit), stating that she “personally feels satisfaction and a warm sensation in my heart when I am able to help others”.
Two participants who identified themselves as altruistic, emphasized the need of having a sense of purpose while helping others in order to do so with sincerity and selflessness, stating that they felt “called” to serve others. One participant even put considerable attention in citing this “calling”, stating that her profession as a nurse compelled her to serve in the COVID-19 hospital, despite contracting the virus twice during her time there.
Drawing on hermeneutic phenomenological analysis, this study is offering a novel insight into frontline healthcare workers’ lived experiences and perspectives when providing patient care in Indonesia’s COVID-19-designated hospital. Further contributing to the burgeoning literature on the phenomenological studies of COVID-19, the eight overarching themes revealed by this study’s documentation of healthcare workers’ subjective constructions of their care provision experiences are reflective of concerns echoed in the literature outside of Indonesia and bring forth the overarching and ongoing healthcare issues around the world.
The highlighting of resource challenges and systemic deficiencies to which healthcare workers are subjected calls attention to the many facets of healthcare management in low-resource, crisis settings. In contrast to China amid COVID-19, for example, which deployed experienced experts to the COVID-19 battlefield , Indonesia’s COVID-19-designated hospital recruits its personnel through voluntary participation and military as well as police assignments. With the likelihood that many of its personnel are not always experts but are assigned merely because they are needed, there is a deep resignation due to (to name a few) the realization of having no control over the system, which has contributed to its high turnovers and many other manpower issues.
While the issue of human resources impacts healthcare workers in multifaceted ways, it is especially notable in terms of burnout and heavy workload, as exemplified by the instance of psychologists and nurses in the COVID-19 swabbing department. Service-induced burnout, as noted by Steel et al. , influences healthcare workers’ job satisfaction and turnover probability relative to both demanding workload and a lack of resources. However, the present study highlights the particular complexities of intersecting heterogeneous factors (e.g., high turnovers, demanding workload and burnout, and manifestations of altruism-motivated fears) and the hospital’s community quarantine policy during service contracts.
Despite adherence to the policy represents embodiments of psychological resilience  and a strong professional identity , social disconnections can affect the development of negative emotions, as in the case of healthcare workers’ resentment and disappointment over their conflicting moral obligations in the face of social discrimination and stigmatization. Yet, there are also times in which remoteness from the outside world can derive positive implications, such as healthcare workers fostering a sense of kinship and interconnectedness with patients despite not being blood-related. As seen in the study, recurrent and relational social relationship between healthcare workers and patients produces positive effects of sociality, enabling the amelioration of isolation-related negatives by relating to patients and their shared experiences.
There is, however, an obvious need to consider broader factors when discussing the interactions between healthcare workers and patients, and especially the impinging repercussions of healthcare rationing. In many ways, healthcare rationing is a “wicked problem” within which moral tensions reside at the intersections between efficacy and equity in healthcare , and its pervasiveness is at the center of COVID-19 and impacts the pandemic management from both top-down and bottom-up approaches. In the local experience of Indonesia, there are many productions of politicized tensions relative to the COVID-19 management, with the prioritization for economic interests over healthcare considerations affecting healthcare workers and their resource scarcity and challenges at (particularly) the COVID-19-designated hospital.
While the ramifications of having constrained resources and man-made capabilities have contributed to its dilemmatic healthcare rationing, it cannot be projected as the primary and sole cause when billions of Rupiahs have been allocated for the hospital. The inclusion of patients and their autonomy in terms of the ethical challenge posed by healthcare rationing also invites wider structural changes for engaging their wishes into meaningful patient care. Yet, even after “a carefully considered advance directive” , there was, in fact, blame externalization from patients’ emotion regulation reactions in what they perceive to be an unjust family member death (“…A few days later, the family sent me a message stating, ‘Thank you for your advice. My family has died.’”). To the extent that healthcare rationing is an inevitable part of clinical practice and personal coping mechanisms can be helpful, there are also many pointing to the complex constellations of politics and patients’ autonomy that affect healthcare workers’ moral dilemma and complexity.
In one narrative, the consequence of healthcare rationing evokes the emergence of negative emotions when caring for their COVID-19-infected patients, such as circulating fears of being blamed by patients for malpractice, anxieties with the what-ifs, and doubts about their professional competence. Indeed, as evidenced by Fallman et al. , healthcare workers’ deficits in reciprocity and participatory, transparent decision-making imply that patients’ circumstances and outcomes are not always or solely dependent on themselves alone, but also on asymmetrical relationships , as well as insufficient professional autonomy and systemic rigidity . Coping, consequently, becomes a prominent reparative measure for healthcare workers, with many of them citing religion and spiritual mending and healing as a primary strategy.
What is particularly emphasized with the many excerpts of religious coping is how it affords the meaning-making of finding a purpose in life through professional contributions to society. While, as noted by Wrzesniewski et al. , “The modern sense of ‘calling’ may have lost its religious connection”, they nonetheless credited it as an inspiring means for allowing individuals to enjoy their time, by describing, “Work that people feel called to do is usually seen as socially valuable – an end in itself”. In the case of healthcare workers, even at the expense where their concerns for others are at personal price (e.g., risking themselves for being infected), healthcare workers still perceive that their “other-oriented calling”  offers them with their perceived ethical ends of self-satisfaction and a sense of achievement.
In their particular expressionistic use of the Javanese proverb, “Urip iku urup” (Life is lit), healthcare workers are able to picture their moral worth based on their pronounced commitment to “calling” in caring for COVID-19 patients. In this, these fragments of calling-related professions point to derivations beyond just prosocial personality traits, altruistic attitudes, public service motivation, or other “generic” patterns of behaviors. That is, their humanitarian callings extend the perception of meaning-making in life purposes and project to navigating “profession of medicine” , within which to draw on Gustafson , “A sense of calling… can affect one’s sense of worth and well-being as a professional person not only by assuring some dignity but by nourishing and confirming the deep moral motives that lead persons to professions”. Indeed, notions of callings and service through the channeling of professions are not only about acts of which right things to do or which services benefit “the self” or “the others”, but rather indicative to framings of collective sense of morality and the impacts felt on these individuals, such as healthcare workers understanding their professional self-worth based on respective moral codes.
Study strengths, limitations, and future directions
A strength of this study rests in its hermeneutic phenomenological methodology as it enabled the opportunity to achieve a more in-depth understanding than a superficial, qualitative analysis might have provided . The analysis should not be viewed as conclusive and an absolute truth of the meaning of COVID-19 healthcare which would be out of step with the applied approach and also an illusion. The study, however, offers distinctiveness in providing insights into the perspectives and experiences of frontline healthcare workers in a COVID-19 central emergency hub, especially in contexts of resource constraint and political-institutional impediments in the Global South. While the study findings are reflective of the participants’ experiences, they cannot be extrapolated to all frontline healthcare workers in the sector; hence, the recruitment can be expanded to encompass a wider sampling base and potentially, more a more varied and nuanced spectrum of perspectives. However, it is believed that this study provides probable interpretations  that require readers to relate dialogically to the text to continue to improve understanding and expand the interpretive process, as well as to consider the relevance and transferability of the findings to other settings.
Since the hospital is largely governed by the Indonesian government and is operated by the military, there is a marked tendency to sidestep imperative but politically charged issues for fear of offending the government, including issues with healthcare workers not receiving financial compensation and facing consequences for speaking up (e.g., termination of employment). Such rendering gives avenues for future studies to include the perspectives of those from the governments in order to decipher the Indonesian politics of healthcare that has affected the grassroots levels and its broader population as to effect change and entice reform. Yet another great strength in this context is that the participants’ voices have been given a place in the article, so that they can be heard, even though the subject may be sensitive.
At the same time, the analysis and interpretation of the lived experiences and perspectives of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital has been carried out by an international collaboration between the Global South and North, with thus different preconceptions of and perspectives on healthcare infrastructure and practice. The collaboration not only brought together trustworthy perspectives, but also allowed for the exchange of critical thoughts and diverse perspectives, enabling the purveying of this article and enhancing its quality. Hence, it is hoped that this scholarly endeavour, which brings together a wealth of knowledge and interdisciplinary expertise, can be of service within and beyond the society.
The present study encapsulates the lived experiences of healthcare workers functioning in a resource-limited and challenging setting, which has far-reaching implications for future public health crisis management as well as policy refinement. Although Indonesia is in the midst of a series of transitions, ranging from demographic and epidemiological, to social, economic, and political , the reverberation of infrastructure and facility-related challenges points to Indonesia’s historic fragmentation of underinvestment in its public health system, with a variety of contributing factors such as an absence of political commitment and a predilection for reactive interventions. In this, important notes should be on increasing the focus on the public health system as equal to economic considerations and political interests, for example, by improving human resource management and its resourcing system, as well as administering appropriate mental health solutions for service-related burnout and (especially) repercussions of healthcare rationing.
Undoubtedly, prioritizing the well-being of healthcare workers offers a distinct opportunity to advance health policy by acknowledging their indispensable role in the healthcare system, enhancing their working conditions, and investing in public health systems. Such an approach can ameliorate workforce shortages and augment patient outcomes by fostering a contented and stable healthcare workforce. Moreover, placing emphasis on healthcare worker welfare can culminate in long-term cost savings by curbing burnout and turnover rates, eventually translating into greater continuity of care and improved patient outcomes. Thus, acknowledging and prioritizing healthcare worker welfare in health policy can propel sustainable and effective healthcare systems, while ensuring the safeguarding of frontline healthcare workers, who are instrumental in delivering healthcare services.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Mahendradhata Y, Andayani NLPE, Hasri ET, Arifi MD, Siahaan RGM, Solikha DA, et al. The capacity of the indonesian healthcare system to respond to COVID-19. Front Public Health Frontiers. 2021;9:887.
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The authors wish to acknowledge and thank the study participants for their generosity in sharing their experiences and perspectives.
The authors did not receive support from any organization for the submitted work.
Ethics approval and consent to participate
This study was approved by Universitas Airlangga Research Ethics Board (Approval No. 2281/UN3.1.7/PT/2020). The study was conducted in accordance with the World Medical Association Declaration of Helsinki, and all participants provided written informed consent prior to participation in the study.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Cite this article
Ningrum, A.P., Missel, M. Urip iku urup (life is lit) by service to others: a qualitative study of frontline healthcare workers’ lived experiences providing patient care in Indonesia’s COVID-19-designated hospital. BMC Health Serv Res 23, 262 (2023). https://doi.org/10.1186/s12913-023-09257-2


New submitter jpwilliams writes "Gizmag reports that researchers at Sandia National Laboratories have tested a 10-centimeter bullet that can be fired from a smooth-bore rifle to hit a laser-marked target one mile away. The bullet 'includes an optical sensor in the nose to detect a laser beam on a target. The sensor sends information to guidance and control electronics that use an algorithm in an eight-bit central processing unit to command electromagnetic actuators. These actuators steer tiny fins that guide the bullet to the target.' Interestingly, accuracy improves with targets that are further away, because 'the bullet's motions settle the longer it is in flight.'"


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Brenda teaches students of all ages and backgrounds. Piano lessons are held weekly and for 30, 45 and 60 minute sessions and parents are welcome to attend. Students learn and perform solo music from all periods and styles and often collaborate with each other in duets, duos and trios. They also collaborate with friends who sing and play other instruments. If interested in lessons, please call for an interview. Brenda is also active as a performer and often collaborates with the University of Colorado Boulder, College of Music faculty. Please see related videos and background.
Artist piano teacher – providing piano lessons in Boulder and metropolitan Denver, Colorado since 1993.
Sample video from student recitals

domain: artistic


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DJ OSO at Taverna 19!!
as DJ OSO lights up the dance floor at Friday's newest & hottest Latin night...Friday Internacional at Taverna 19!!
Project412 Performs at Absolute Salsa!!
where Project412 will bring yet another HIGH-ENERGY-LATIN-DANCE-PERFORMANCE!!
You don't wanna miss this!!
Salsa Clasica Featuring International Salsa Superstar...Magna Gopal!!
You don't wanna miss this once in a lifetime opportunity to see International Salsa Superstar Magna Gopal in action in our fine city of Pittsburgh!!
Magna will be here for social dancing, teaching & performing FRIDAY, SEPTEMBER 20th through SUNDAY, SEPTEMBER 22nd at a variety of venues.
Visit steelcitysalseros.com for tickets & details.
Official Salsa Clasica After Party hosted by Salsa412!!
as we host the Official Bachata After Party following the Steel City Salseros Saturday Super-Size Salsa Social featuring International Salsa Superstar Magna Gopal!!
The “For the Love of Bachata” invasion led by Pittsburgh Bachata Ambassador Jessica Taylor is coming out in FULL FORCE to support special guest DJ, DC DJ Yulio Gutierrez! Yes there will be Salsa and Cha-Cha-Cha, but we can’t stop the INVASION!
Meet us at Absolute Ballroom, literally around the corner, for a delicious food, amazing dancing, and a fantastic DJ!!

domain: entertainment


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Interview with the organizers of the Bazaar Berlin
A look into the Bazaar Berlin 2019, with Barbara Marbook and Mirjam PriemerNovember 14th, 2019
Bazaar Berlin is Germany’s most international fair-trade market for handicrafts, design, and natural products. Every year during November, around 500 manufacturers and retailers from more than 60 countries present their high-quality goods and exotic merchandise.
Members of Berlin Global had the opportunity to talk with the project manager, Mrs Barbara Mabrook and the PR manager, Mrs Mirjam Priemer about Bazaar Berlin 2019.
1. Please introduce a little bit about Bazaar Berlin: why did you decide to organize this multi-ethnic marketplace in Berlin, and not in another German city?
Bazaar Berlin has a very long history. It started in 1962, and in those days, this market was called “Overseas Partners for Progress”. It was started as political project by the German government right after the Wall was built to attract international people to Berlin. They founded this fair for the so-called developing countries and the German Ministry of Economy financed it. They paid for the stand, they paid for the transports of the goods and for the trip of the stand director. And it was organized by government institutions of those countries. I started working here in 1986. So, when I began, it was still like that. The idea was political, but it was not really successful because the entrepreneurs did not come by themselves, but like a state institution who were more interested in going shopping in Kurfürstendamm, actually, than doing business here. And also, we could not attract the best visitors, because all the stands were allowed were things like washing powder and handicrafts. So, when the Wall fell two years later, the money was stopped and we were divided in teams. I was in charge of the African teams during those days, and we decided to host a fair completely different from what we did before. We wanted to hold a fair open to the public where people could come, see the products and buy them directly, and everybody who participated had to pay for their stand. So, we got people who were really interested in doing business. A company here in Bazaar is sometimes only one person, but it was their own business, and we started with one single hall. It was very small in the beginning, and we developed slowly but surely. The first thing we had was a hall for Africa, which had a very practical reason at the beginning. The entrepreneurs from Africa were selling drums, the other exhibitors were complaining. So, we thought “why don’t we put all the drums together?” And we started to get a very special atmosphere like nothing else in Europe, since this is the only fair where there is an African hall, and all the people really come from Africa. So, we started thinking about other concepts. We wanted to add an ecological aspect. We started with the “Natural Living” section, and then we wanted to give a platform to young designers who have great ideas but no money and no marketing experience. So, we created the section “Art and Style”. And this section has simpler stand construction, but it is also cheaper. So, we made it possible for this kind of people to afford it. The last thing we added, it was five years ago, was the “Fair-Trade Market” which is for people who are certified fair traders, or on the way to certification. We are going to expand this section in the future and allow all the social communities to participate. And why are we doing this? Because of globalization, and because consumers are aware of what is going on, and they want objects that have a good story not a bad story. They want things that make them happy and make them feel good. It is our interest and we think that Berlin is the best place in Germany to do something like that because a lot of people think like us.
2. Why is Berlin a “good place” or a “good market” in comparison with other cities?
Because people in Berlin are more open-minded and this city is more international than other places. They have less money but more creativity. They are not so much into status symbols. Berlin is not like other cities where you have to think what to wear. I have been living here since 1982, and I do not care what I wear. I just wear what I like, and I go where I want to go. For me it is the only place in Germany to live.
3. We read on your website that this year you will have five themes: World Market, Natural Living, Art and Style, Winter at Home and Fair Trade. Can you tell us some words about each one of them?
The World Market is the root of Bazaar Berlin. It is an international exhibition about Africa, Europe, Asia and Latin America. As I said, “Natural Living” is for ecological products. “Art and Style” is for temporary design and it can be combined with ethnic aspects, but it has to be different, not traditional but modern design. The “Winter at Home” section is done with an agency we are working with who brought things to make your home nicer in the winter.
4. Bazaar Berlin tries to be socially responsible and collaborate with other organizations such as UNICEF and Mama Afrika. Which projects did you realize, or do you plan to realize with these international partners?
We just gave a free stand to UNICEF that is not our partner. But we had some projects with partners. For example, at the moment, we have two partners, one is an association in Berlin is called “Global Project Partners”. They are doing a project in Turkey with Syrian refugee women who designed beautiful things, which you can see on the ground floor. Unfortunately, this is the last year of the project. And then we have another project called the “Develop Project”, which is co-sponsored by the German government. You have to have partners in a country. We have a fashion school in Cambodia at the modern design center, we have the German partner Messe Berlin, a fashion institute in Dusseldorf, and a project in Hong Kong. Our partners can bring their work here, and we give them the stand for free. The other part of the fashion institute in Dusseldorf sends a student to teach young designers in Cambodia, and the project management in Hong Kong organizes the whole thing. They are in charge of the fair-trade certification and workshops in Cambodia for those who produce things. This project that is also in Hall 1 has been running for the past year. But we have began the process to start a new project with the same partners in Cambodia, and it will start next year.
5. Do you believe that the Bazaar Berlin fills the cultural gap between Germany and other involved countries?
Of course. People have made friends here. This morning we honored an exhibitor from Nepal who has been coming for 40 years and he told us he has made friends here. In the beginning they were business partners and now they are friends. We also get phone calls in the office asking to come back this year. People, visitors and exhibitors are all looking forward for this big event.
6. Which media do you employ to promote Bazaar Berlin?
The best media are the social media: Facebook and Instagram have been very successful. We moved a lot of work and content to social media to directly reach the audience, and it’s been very successful. You can receive a great amount of information about Berlin Bazaar on our social media and our webpage.
7. Do you think that you can improve the media you use to reach a broader audience or are you satisfied with the media that you chose?
Yes, we are pretty satisfied. Of course, there are more possibilities, so we try to get to know the background stories of the exhibitors and the products we have here. Because next to the experience of shopping here, the history and the stories are the most important things about Bazaar Berlin. In the future we will put more force into sharing these kinds of stories, with the audience and the media. These stories show exactly what Bazaar Berlin is. We have some stories on our website and on Instagram but unfortunately only in German, because visitors are 99% German. The main visitors to the Bazaar Berlin are German speaking people from Berlin and the surrounding areas. We don’t have many visitors from abroad, only exhibitors. Bazaar Berlin is a market for direct sales, where people come to buy Christmas presents and things for themselves.
8. How difficult is to organize this kind of multicultural event? Which challenges did you face?
I love this question! One of the main problems is that if you work with people from Asia and Africa, they often have VISA problems, because they are not companies. They are dealers and handicrafters and if they are new and young and they don’t have any money, the chance to get a VISA for Europe is very low. Also, it depends on the Embassy of each country so we can never predict with which country we will have a problem. For example, this year was the first time that we had problems with India and Indonesia. Africa is always difficult as well. Another problem is that if they get the VISA, but they don’t get their goods. In Ghana they shipped a 20-foot container, which is really a lot, but they just left the ship because it was not full. Although the lady had paid, they didn’t send her goods. Other goods disappear on their way. It happened from Latin America in Peru or Madrid and these people have no goods. These are the main problems we have every single year. But also, every year there is something new which makes this job so interesting. You never know what’s going to happen. It’s not really a problem of cultural mentality, it’s either political or organizational problems. In a lot of these countries their forward agencies are really bad. Its difficult for the exhibitors to ship their goods. Those who come regularly usually store their goods here in Berlin to make sure they at least have something when they come back next year. 80% of our exhibitors come back. A lot of them have been coming for 20 years.
9. Is any government or Embassy from another country in Berlin involved in the organization or promotion of Bazaar Berlin?
No, but there is one thing. There is a club of the foreign office for women; female ambassadors, wives of ambassadors and women who work in Embassies, and they have an invitation for the Friday morning every year. They will attend the Bazaar Berlin this year as well.
10. For the last question we would like to ask you to say a few words about the future of Bazaar Berlin.
There will be a Bazaar and I hope it will continue, as we have started to shift towards social issues, focusing on quality, design, and sustainability. This is the future because they cannot find a shop this big to sell and promote these kinds of products in Berlin. In Bazaar Berlin you can find things that you can’t find anywhere else, and we want more of this kind of exhibitors to come. That’s the idea of the future, and it will have a long future. It’s a big fair-trade market and it grows every year.


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domain: medical


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Download “JUMANJI,” the first taste of Azealia Banks’ upcoming mixtape, Fantastic. The tropical cut was produced by Hudson Mohawke and Nick Hook. Reports of Banks’ upcoming release dates have been wrong in the past, but as of right now Azealia stands to release her 1991 EP in June, the Fantastic mixtape later in the summer, and her debut album, Broke With Expensive Taste, in September. That’s a lot of music slated to be released in just over four months. Color us doubtful. But in any case, we have a new song now and it’s pretty bad ass. Download away:
New Azealia Banks: “JUMANJI” MP3
Raekwon, Killer Mike, Pusha T, Danny Brown, YG, Action Bronson, Young Thug, and more show up.
He also makes a quick cameo as a detective.
“Bubs” is a collaboration with PC Music’s A.G. Cook.
Another new track to follow up last week’s “A Kick To The Face.”


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Tales from the Shed - Spring 2016 Season
Preview by Lizzie Guilfoyle
TALES from the Shed, Chickenshed’s hugely popular interactive performances for children aged 0-7 years, returns to the Southgate venue for a spring run – every Friday from January 22 to March 18 at 11.30am and every Saturday from January 23 to March 19 at 10am and 11.30pm (excluding Friday, March 4 and Saturday, March 5).
Tales from the Shed takes children and performers on a theatrical journey together, meeting characters such as Can-Can the beautiful bird, and The Thing That Goes Blurgh on the way!
Each show is different, but all shows creatively help to improve literacy, numeracy and communication skills.
Tales from the Shed uses theatre driven by the children’s imaginations. Since 1996 the Tales team have collected and created numerous stories, songs and characters. These are delivered using puppets, humans and bags of energy all underpinned by the belief that children are the most creative and demanding audience and deserve proper big theatre!
The Tales from the Shed format allows the Tales team to react to the children’s thoughts, experiences and requests and to use them within the show. Which means no two shows are ever the same.
Tickets: £6, free to babies under 6 months – available from the box office on 020 8292 9222, by emailing firstname.lastname@example.org or online at www.chickenshed.org.uk
Running Time: Approximately 50 minutes to one hour.
Extra half term dates: Thursday, February 18 at 10am and 11.30am and Friday, February 19 at 10am.
Chickenshed, Chase Side, Southgate, London, N14 4PE


text: Take your dishes out to the ball game with this charming porcelain rendition of a hot dog wrapper. This life-size replica looks just like the real thing right down to folds of the wrapper. Sure to bring a smile to anyone's face, it will remind of ballparks, county fairs and big city street vendors. Fill with your favorite food or use to hold office supplies. Made in France.


text:
An audiobook is a book or text that has been recorded to be read aloud; it can also be the result of the use of speech synthesis.
The relationship to “reading” is modified by the use of hearing, rather than sight, traditionally attached to print books and e-books. Technological progress (particularly in terms of recording and sound reproduction), the desire for new products and many other qualities (saving time, mobility and physical storage space, community reading, pleasure of listening , uninhibited relationship to text for learners …) contribute to the considerable development of the audiobooks in recent years.
Easy to use, the audiobook appeals to different age and socio-professional categories, for often different or even opposing reasons: unique means for certain categories of disabled people (visually impaired for example), reading comfort for the elderly, mobility and new relationship to reading for the youngest, time saving for the active (use in transport and during household chores), pleasure of listening and conviviality …
In many countries (United States, Great Britain, Australia), the audiobook has grown rapidly in recent years, and has already won over a large audience. In 2018, the global audiobook market was valued at approximately $3.5 billion.
Because of the importance of print, it is easy to forget that originally reading was done aloud, as early as antiquity. It was not until the industrialization of book production, and especially the rise in literacy of the population, that the printed book took the place that we know today. But the oral tradition has survived, especially thanks to the children.
Listening to a book reading was a very common practice in the 19th century, which saw writers and soap operas read their works.
(“The phonograph at home reading out a novel.” From Daily Graphic (New York), 2 April 1878. Less than a year after the invention of the phonograph, this drawing offered a future vision. Novels however would remain impractical for phonographs until the 1930s.)
The first recordings of music and spoken language were made possible thanks to the invention of the phonograph in 1877 by Thomas Edison who imagined as an application to his invention “phonographic books” intended for blind people.
The audio book was first created in the 20th century for young people (stories for children, language methods for extracurriculars) and for visually impaired audiences. In addition, during the 20th century, a good number of plays and texts were read and recorded on the radio. The development of audiobooks was carried out until the 1960s which marked a certain decline probably because of the cassette format, with the exception of audio books of poetry, historical recordings or for children. Since the 1980s, the audiobook has developed again with the practice of entertainment on the go.
For decades, audiobooks have been produced exclusively by recording the human voice. Advances in speech synthesis now make it possible to produce books using this technique. Text-to-speech cannot match the human voice in expressing particular emotions or tones, but using text-to-speech results in an audiobook much faster.
The audiobook, adaptation of a book to audio medium, should not be confused with the MP3 saga, intended solely for audio medium.

domain: library


text:
The Fayetteville Arkansas ISACA Chapter and the North Arkansas IIA Chapter are pleased to announce the 2nd Annual Training Symposium.
The date of the Symposium is September 28.
Cost is $85 for members and $150 or non-members.
Be on the lookout for the newest flyer. Registration will open on August 14, 2017.

domain: geography


text:
This is an inline carousel of images and or videos of this pet.
Bruce Collie Mix Cypress, TX
- Black , White / Cream
- Coat length
- Vaccinations up to date, spayed / neutered.
- Good in a home with
- Other dogs, children, other animals. cats unknown.
My name is Bruce! I am an energetic 18 month old Collie mix who loves to run, swim, play and go on long walks! I enjoy chewing on bones, playing tug of war, being outdoors and munching on plenty of treats. I know how to sit, stay, lay down, shake and spin! If it’s sunny, I will lay down in the sun and maybe take a dip in the pool. At night I love cuddles with my blanket- and you! I’m great with other dogs and children, and love play dates. Will you be my forever play mate?

domain: pet


text:
From a Correspondent
TANGLA, October 24: Panery Police Station established in the year 1901, has completed 100 years of existence. The Kali Mandir in its premises was also built in the same year.
The preparations for the two-day centery celebration of both are going on in full swing. The two-day celebration will be held at the Panery PS premises on October 29 and October 30. A strong celebration committee has already swung into action with State Minister and Udalguri MLA Rihan Daimari as president, Tarath Kalita as working president and Panery PS OC Sohrab Ali as secretary. A press meet was held on Sunday where working president Tarath Kalita informed that preparations had almost come to an end. Kalita also informed that a budget of Rs 7 lakh had been allotted for the programme. He also said that a souvenir would be published on the occasion. Informing the media persons of the historic past of Panery Police Station established in 1901 by the British, Kalita exhorted the State Government to renovate the police station building.
Panery PS OC Sohrab Ali said, “Efforts are being made to make the celebration a colorful one and leave an ever-lasting memory for the multi-ethnic diverse population in the jurisdiction of the police station covering 70 revenue and 50 non-revenue villages along with nearly 24 tea gardens.” Ali sought co-operation and participation of people belonging to all ethnic groups, castes and creed. A multi-ethnic community cultural rally is also part of the celebration, informed Ali. He exhorted the DGP, Assam Police through the centery celebration committee for grant of an amount of Rs 10 lakh for the renovation of the police station building. The press meet was also attended by other members of the celebration committee.

domain: news


text:
Pat Robertson really misses Ronald Reagan and his leadership; so much so, he wishes that the former president would rise from the dead and lead America again.
He laughed as he said, “I wish Reagan would rise from the dead and come back, he was a great president.”
Robertson contrasted Reagan, who “just believed in America,” with President Obama, who “does not” because he was raised in a “different environment” by people who don’t love the United States.
Watch the video below:
[image via screengrab]
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text:
Sonia York-Pryce Part of CW16
This paper examines the role of dancers who extend beyond the paradigm of age and their contribution to current dialogues in the field of dance through film documentation. This project aims to make visible the older dancer through film giving new materiality and value by celebrating the older body on screen. The research seeks to investigate which is the preferred performing body, the youthful or the mature? These older dancers choose to ignore the rationale and perform which In turn could be considered inappropriate behaviour by the western dance world. There is a need for the mature dancer to be acknowledged not only for their ‘corporeal difference’ but recognition that their practice rather than their age defines them.

domain: sociology


text:
Most Popular Papers *
Merger and Acquisition Deal Brings Leveraging Synergy – An Analysis of Kotak Mahindra Bank & ING VYSYA Bank
Rashmi Ranjan Panigrahi, S. K. Biswal, and Ansuman Sahoo
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Hem Raj, K.K. Parmar, O.C. Rana, and Vikas Kumar
Pre & Post Merger Financial Performance - A Study of Selected Companies In Indian Pharmaceutical Sector
Shibashish Sahu and Swarnalata Nayak
Impact of Training Practices on Employee Productivity: A Comparative Study
Rohan Singh and Madhumita Mohanty
Greenfield Steel Projects in India - Special Case Study - Social Cost Benefit Analysis of POSCO
Malay Kumar Mohanty and Chandan Kumar Tripathy
The Effect of Benefits and Risks On E-procurement Implementation: An Exploratory Study of Swedish and Indian Firms
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* Based on the average number of full-text downloads per day since the paper was posted.
» Updated as of 01/20/21.

domain: economics


Homebuilder recognized for a record 12th consecutive year, further demonstrating the company’s leadership position in building to EPA’s highest water-efficiency standards
KB Home (NYSE: KBH) today announced that its commitment to building exceptionally water-efficient homes has again been recognized by the U.S. Environmental Protection Agency (EPA) for a record 12th consecutive year. KB Home is the first and only homebuilder to receive the WaterSense® Sustained Excellence Award, the highest level of recognition given by EPA’s WaterSense program.
This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20221019005352/en/
KB Home wins 2022 WaterSense® Sustained Excellence Award, the only national homebuilder to receive this prestigious honor. (Photo: Business Wire)
“Our award-winning partners helped people protect this precious resource by promoting WaterSense labeled products and water-efficient behaviors,” said Veronica Blette, Chief, U.S. EPA WaterSense Branch. “Saving water is particularly critical in areas impacted by drought, and KB Home’s recent announcement about building all new homes in drought-stricken Arizona, California and Nevada to the EPA’s highest water efficiency standards further demonstrates the homebuilder’s commitment to the environment and their customers.”
WaterSense, a voluntary partnership program sponsored by EPA, is both a label for water-efficient products and homes and a resource for helping consumers learn ways to save water. Since the program started in 2006, WaterSense labeled products have helped consumers and businesses save 6.4 trillion gallons of water — enough water to supply all households in the United States with water for eight months.
“KB Home is honored to be recognized by EPA for a record 12th consecutive year. KB Home was the first national builder to participate in the WaterSense program because we understood it would help our customers lower the total cost of homeownership and save this precious natural resource,” said Jeffrey Mezger, Chairman, President and Chief Executive Officer of KB Home. “This year we expanded our industry-leading commitment to water conservation as we began building all new homes in our Arizona, California and Nevada communities to EPA’s WaterSense standards.”
KB Home continues to champion the important role EPA’s WaterSense program plays in helping to lower its buyers’ monthly utility costs and minimize their carbon footprint and energy usage. To date, KB Home has built over 19,000 WaterSense labeled and Water Smart homes — more than any other homebuilder — and installed over one million WaterSense labeled fixtures. The company estimates that its homes conserve approximately 1.7 billion gallons of water annually. More recently, the homebuilder announced that every KB home built in its future Arizona, California and Nevada communities will be WaterSense® labeled, further helping homeowners in some of the most drought-stricken areas of the country.
In addition to being a leader in building water-efficient homes, KB Home is the #1 energy-efficient national homebuilder and has built over 165,000 ENERGY STAR® certified new homes, more than any other builder, delivering a level of advanced energy efficiency met by fewer than 10% of new homes built in America. The homebuilder goes beyond EPA requirements by ensuring that every ENERGY STAR certified KB home has been tested and verified by a third-party inspector to meet EPA’s strict certification standards. ENERGY STAR certified homes are, on average, up to 20% more efficient than homes constructed to current building codes, help lower the cost of ownership and are designed to be healthier, more comfortable and better for the environment than new homes without certification.
KB Home is the only national builder to have earned awards under all of EPA’s homebuilder programs, including ENERGY STAR, WaterSense and Indoor airPLUS, which focuses on indoor air quality. The company’s sustainability leadership was recognized by Newsweek®, with the company being the only homebuilder to be named to the publication’s prestigious list of America’s Most Responsible Companies two years in a row.
For more information on KB Home’s sustainability initiatives and how the company is building better homes, better communities and a better future, visit kbhome.com/sustainability.
For more information on WaterSense, visit www.epa.gov/watersense.
About KB Home
KB Home is one of the largest and most recognized homebuilders in the United States and has built over 655,000 quality homes in our more than 65-year history. Today, KB Home operates in 47 markets from coast to coast. What sets KB Home apart is the exceptional personalization we offer our homebuyers — from those buying their first home to experienced buyers — allowing them to make their home uniquely their own, at a price that fits their budget. As the leader in energy-efficient homebuilding, KB Home was the first builder to make every home it builds ENERGY STAR® certified, a standard of energy performance achieved by fewer than 10% of new homes in America and has built more ENERGY STAR certified homes than any other builder. An energy-efficient KB home helps lower the cost of ownership and is designed to be healthier, more comfortable and better for the environment than new homes without certification. We build strong, personal relationships with our customers, so they have a real partner in the homebuying process. As a result, we have the distinction of being the #1 customer-ranked national homebuilder in third-party buyer satisfaction surveys. Learn more about how we build homes built on relationships by visiting kbhome.com.
WaterSense, a partnership program sponsored by EPA, seeks to protect the future of our nation's water supply by offering consumers and businesses simple ways to use less water with water-efficient products, homes and services.
Craig LeMessurier, KB Home