title: The Health and Wellbeing of Homeless People: Complexities around the Provision of Primary Healthcare in New Zealand

authors: Scanlen, Anna

subjects: Homeless People

abstract: Homelessness is a pressing social issue, and people who are homeless, in particular those who sleep rough, often experience a confluence of physical and mental health issues. Health problems experienced by homeless people can be more severe than those experienced by domiciled people. Such problems can contribute to homelessness, and be exacerbated by homelessness. Previous research has found that for various reasons, primary healthcare services can be inaccessible for homeless populations. More recent research explores the growing availability of accessible, non-threatening health services targeting homeless people, with humanistic approaches to care. This thesis draws on a case study of an NGO clinic providing population-based primary healthcare to homeless and low-income people. The case study is informed by the perspectives of two groups of participants; homeless clinic patients and clinic staff. Ten semi-structured interviews were conducted with homeless clients, and six semi-structured interviews were undertaken with clinic personnel. Social representations theory informs the interpretation, analysis and discussion of the participants' conceptualisations of health and wellbeing, illness and disease, homelessness, health services and the NGO clinic. Social representations from both participant groups (micro perspectives) inform shared social representations (macro perspectives) of the NGO clinic. This determines whether participants conceptualise the clinic as an 'ideal' health service for homeless people.

NGO clinic staff responses reveal that clinic staff have a personal and professional ethos to work with people in need and those that may have been stigmatised from society. This shared ethos has shaped the development of the NGO clinic, into its current structure of a holistic, population based primary healthcare for homeless people integrated within a wider social service structure. In this setting, relationships are developed between practitioners and homeless clients to ensure homeless patients healthcare needs are met.  Also, practical needs are met as the clinic provides low-cost healthcare to homeless people within the context of an umbrella organisation that provides other much-needed social services. Collaboration is an important component to the efficacy of the NGO clinic, and meeting patient needs. However, clinic staff note that there are many dilemmas in providing healthcare to homeless people, and they can struggle to provide the service according to their vision, due to funding constraints. Nonetheless, NGO clinic personnel are committed to working with their patients, and find their jobs rewarding.

The responses from homeless clinic patients brought to mind a military metaphor, which was utilised to anchor the experiences of homeless people in a familiar concept - the military. Each homeless client that was interviewed at the NGO clinic is written about in the form of a health biography, which summarises current health issues, health histories, health related practices and conceptualisations of health. The severity of three major health issues experienced by the participants - addictions, mental health issues and foot problems - are then explored in terms of detailed perspectives from homeless participants, and clinic personnel conceptualisations of those particular health issues. Social networks are discussed as important to homeless people's health and wellbeing, particularly through resource and information sharing. The clinic setting is conceptualised by homeless participants as a caring, welcoming environment; which contrasts with some negative experiences reported by homeless participants in other health service settings.

This thesis explores the NGO clinic as a unique model for a health service that meets the various healthcare needs of homeless people. There is a need for more recognition from government organisations and policy makers of the impoverished life situations that many homeless people find themselves in - often without minimum standards of living, which jeopardises their ability to take care of their health. Appropriate health services need to be accessible to homeless people, in order for healthcare needs to be met.

text: The Health and Wellbeing of Homeless People: Complexities around the Provision of Primary Healthcare in New Zealand Homelessness is a pressing social issue, and people who are homeless, in particular those who sleep rough, often experience a confluence of physical and mental health issues. Health problems experienced by homeless people can be more severe than those experienced by domiciled people. Such problems can contribute to homelessness, and be exacerbated by homelessness. Previous research has found that for various reasons, primary healthcare services can be inaccessible for homeless populations. More recent research explores the growing availability of accessible, non-threatening health services targeting homeless people, with humanistic approaches to care. This thesis draws on a case study of an NGO clinic providing population-based primary healthcare to homeless and low-income people. The case study is informed by the perspectives of two groups of participants; homeless clinic patients and clinic staff. Ten semi-structured interviews were conducted with homeless clients, and six semi-structured interviews were undertaken with clinic personnel. Social representations theory informs the interpretation, analysis and discussion of the participants' conceptualisations of health and wellbeing, illness and disease, homelessness, health services and the NGO clinic. Social representations from both participant groups (micro perspectives) inform shared social representations (macro perspectives) of the NGO clinic. This determines whether participants conceptualise the clinic as an 'ideal' health service for homeless people.

NGO clinic staff responses reveal that clinic staff have a personal and professional ethos to work with people in need and those that may have been stigmatised from society. This shared ethos has shaped the development of the NGO clinic, into its current structure of a holistic, population based primary healthcare for homeless people integrated within a wider social service structure. In this setting, relationships are developed between practitioners and homeless clients to ensure homeless patients healthcare needs are met.  Also, practical needs are met as the clinic provides low-cost healthcare to homeless people within the context of an umbrella organisation that provides other much-needed social services. Collaboration is an important component to the efficacy of the NGO clinic, and meeting patient needs. However, clinic staff note that there are many dilemmas in providing healthcare to homeless people, and they can struggle to provide the service according to their vision, due to funding constraints. Nonetheless, NGO clinic personnel are committed to working with their patients, and find their jobs rewarding.

The responses from homeless clinic patients brought to mind a military metaphor, which was utilised to anchor the experiences of homeless people in a familiar concept - the military. Each homeless client that was interviewed at the NGO clinic is written about in the form of a health biography, which summarises current health issues, health histories, health related practices and conceptualisations of health. The severity of three major health issues experienced by the participants - addictions, mental health issues and foot problems - are then explored in terms of detailed perspectives from homeless participants, and clinic personnel conceptualisations of those particular health issues. Social networks are discussed as important to homeless people's health and wellbeing, particularly through resource and information sharing. The clinic setting is conceptualised by homeless participants as a caring, welcoming environment; which contrasts with some negative experiences reported by homeless participants in other health service settings.

This thesis explores the NGO clinic as a unique model for a health service that meets the various healthcare needs of homeless people. There is a need for more recognition from government organisations and policy makers of the impoverished life situations that many homeless people find themselves in - often without minimum standards of living, which jeopardises their ability to take care of their health. Appropriate health services need to be accessible to homeless people, in order for healthcare needs to be met.

year: 2009

title: Optimisation of non-isothermal utilities using the Unified Total Site Heat Integration method

authors: Tarighaleslami, Amir Hossein

abstract: Total Site Heat Integration is an effective method for design of large scale utility systems that serve large chemical processes, such as refineries, petrochemicals or even lower temperature chemical and process plants. Total Site Heat Integration of different chemical plants might confront batch, semi-continuous or continuous plants which are clustered into one large site. Excess heat produced from one plant could be transferred to other plants using an intermediate fluid. In this paper, Total Site optimisation of targeting utility generation and consumption for lower temperature processes, which mainly use non-isothermal utilities, is presented. The utility temperature selection optimisation applies to the recently developed Unified Total Site Heat Integration Targeting (UTST) method. The new method shows that, for low temperature processes where non-isothermal utilities are used, the supply and target temperatures of a utility is an important constraint, while for higher temperature processes, where isothermal utilities are applied, no significant change in targets from conventional Total Site are obtained. New heuristics based on UTST method with respect to non-isothermal utility temperature selection are proposed. A Kraft Pulp Mill case study has been investigated in this research, using optimised non isothermal utilities, showing a 3.6 MW increase in heat recovery, 0.87 MW decrease in shaft work generation, and $ 330,000 /y utility cost saving in the system applying the new UTST method compared to the conventional Total Site method.

text: Optimisation of non-isothermal utilities using the Unified Total Site Heat Integration method Total Site Heat Integration is an effective method for design of large scale utility systems that serve large chemical processes, such as refineries, petrochemicals or even lower temperature chemical and process plants. Total Site Heat Integration of different chemical plants might confront batch, semi-continuous or continuous plants which are clustered into one large site. Excess heat produced from one plant could be transferred to other plants using an intermediate fluid. In this paper, Total Site optimisation of targeting utility generation and consumption for lower temperature processes, which mainly use non-isothermal utilities, is presented. The utility temperature selection optimisation applies to the recently developed Unified Total Site Heat Integration Targeting (UTST) method. The new method shows that, for low temperature processes where non-isothermal utilities are used, the supply and target temperatures of a utility is an important constraint, while for higher temperature processes, where isothermal utilities are applied, no significant change in targets from conventional Total Site are obtained. New heuristics based on UTST method with respect to non-isothermal utility temperature selection are proposed. A Kraft Pulp Mill case study has been investigated in this research, using optimised non isothermal utilities, showing a 3.6 MW increase in heat recovery, 0.87 MW decrease in shaft work generation, and $ 330,000 /y utility cost saving in the system applying the new UTST method compared to the conventional Total Site method.

year: 2016

title: Kia rehe te matau, kia rehe te maui

authors: Winiata, Te Whatanui Huia

subjects: Taiaha, Maori business, maori development

abstract: The theory of applying successful military strategy to the world of business is not a new concept.  The connection between these two environments has often been explored, and works by Sun Tzu and others promote the connection between the battlefield and the boardroom.  The cut and thrust of the business realm is often likened to combat, and the guiding principles and beliefs that influence Generals and Field Commanders are in many ways identical to those of executives and Chief Executive Officers.

This thesis is interested in exploring the interconnectedness between battle and business from a Māori perspective.  In particular, this study explores the link between the Māori weapon known as the taiaha, and Māori business, in the belief that the lessons learnt from the various taiaha schools can be transferred to Māori business.  Likewise, the beliefs, principles and philosophies that are instilled within warriors while training with the taiaha have a valid place within Māori business, and when applied to the Māori business arena, have beneficial outcomes for those involved.

This study highlights fundamental taiaha principles that are applicable to the Māori business world.  These beliefs have been identified by a number of taiaha experts as well as successful Māori business operators.  The long term purpose of this thesis is to support Māori entering into business, by highlighting traditional values that are taught through the medium of taiaha, and showing how they can be applied to business.

text: Kia rehe te matau, kia rehe te maui The theory of applying successful military strategy to the world of business is not a new concept.  The connection between these two environments has often been explored, and works by Sun Tzu and others promote the connection between the battlefield and the boardroom.  The cut and thrust of the business realm is often likened to combat, and the guiding principles and beliefs that influence Generals and Field Commanders are in many ways identical to those of executives and Chief Executive Officers.

This thesis is interested in exploring the interconnectedness between battle and business from a Māori perspective.  In particular, this study explores the link between the Māori weapon known as the taiaha, and Māori business, in the belief that the lessons learnt from the various taiaha schools can be transferred to Māori business.  Likewise, the beliefs, principles and philosophies that are instilled within warriors while training with the taiaha have a valid place within Māori business, and when applied to the Māori business arena, have beneficial outcomes for those involved.

This study highlights fundamental taiaha principles that are applicable to the Māori business world.  These beliefs have been identified by a number of taiaha experts as well as successful Māori business operators.  The long term purpose of this thesis is to support Māori entering into business, by highlighting traditional values that are taught through the medium of taiaha, and showing how they can be applied to business.

year: 2013