Posts by Voyager

12

Are Men Cashing In On The Female Body?

by Voyager in

jw
friends

are men cashing in on the female body?

mbulawa moyo

1/13/2005 8:00:56 am (gmt +2)

Voyager

This is one of those articles that disappears after you hit the submit button. Just click on the thread. I don't know why some newspaper articles do that, when others don't. Sorry about that!

Thanks!

12

Are Men Cashing In On The Female Body?

by Voyager in

jw
friends

are men cashing in on the female body?

mbulawa moyo

1/13/2005 8:00:56 am (gmt +2)

Are men cashing in on the female body? Mbulawa Moyo 1/13/2005 8:00:56 AM (GMT +2) It was with some fascination, not altogether untinged with a little consternation bordering on trepidation, that I read and, slowly, began to digest the passage below. It is an excerpt from ?The Watchtower?, a periodical published semi-monthly by Jehovah?s Witnesses.

I quote: ?It is important that worshippers of God appreciate his view of leadership. The basic principle of headship is set out in 1 Corinthians 11:3 where it is written: ?The head of every men is the Christ; in turn, the head of a woman is the man; in turn the head of the Christ is God.?
?A man had priority in human creation. He is given priority of position over the woman. The woman was made from a rib taken from the men. she was created for the sake of the man, not the man for her sake. Therefore, the woman, in God?s arrangement, was always to be in subjection to her husband and not to usurp his authority.? (End of quote).
Well, apart from the fact that the part of the above quote dwelling on the rib nonsense makes for scientific balderdash, some of the points advanced in this so-called ?Balanced views of headship? smack of men?s ever present self-seeking patronisation of women. Over the millennia men have sought to make women permanently subservient to them making them a convenience for their comfort and rather than partners.
Men have seen nothing wrong in having several women as wives or sexual partners concurrently but have never allowed women the same rights, contemptuously referring to woman who have several sexual partners as ?whores? or prostitutes? even though they may not be demanding payment for sex with those several men in their lives.
In fact, if the truth be told men have always treated women as objects of their sexual gratification at the very best, or, at worst as servants to minister to them at the man?s beck and call.
Even worse, perhaps, is the fact that until recently men had never believed a woman could attain full adulthood. This is a view which is vividly illustrated in Nguni society (Zulu, Xhosa, Ndebele) where the women folk are referred to as ?abesintwana?. ?Umtwana? means ?a child?.
Thus, ?abesintwana? is an expression classifying women as perpetual minors or ?children? from the cradle to the grave. This is a sexist view which was manifestly both unfair and unjust quite apart from being clearly oppressive which is why over the years, women, beginning with the suffragette movement in England in the 19th century, have been fighting relentlessly for equality of the sexes.
That is equality before the law; equal educational opportunities, equal job opportunities, equal pay and so forth.
But equality is not the same thing as being ?the same?. Men and women are intrinsically different in many ways but especially physically and emotionally.
God made men physically much stronger than women which is why he made them head of the family. Not only can they command authority in the home because of their physical strength superiority but they can also protect everyone else in the home.
But God is not stupid. In his great wisdom, he levelled off the two sexes intelligently making up a beauty for what he did not give women in physical strength or with bodies so lovely they can render the strongest of men effectively a lot weaker than the weakest of women. The biblical story of Samson and Delilah clearly demonstrates this.
Using beauty of their bodies ? the lovely curves and contours or valleys and promontories they can get men to do practically anything they want. Women can have any man eat out of their hand, literally, and even get whatever money they want using only their beauty even when they have no brains at all to talk about which is precisely why women can live comfortably, all their lives, on what they earn from selling sex (their beautiful bodies) to men and never the other way round.
And yet, foolishly, in this regard, women seem unable to count their blessings.
When purely out of their own volition the more beautiful among them decide to make ? through posing half naked for photographs to advertise whatever commodities, some of their not-so-well-shaped but brainy sisters start to cry foul.
?Men are exploiting us,? they fume.
Not only is this one of the most bizarre and misguided protests anyone could even come up with. It is also to slap God in the face for having done humankind?s female species such a great favour. It is like the proverbial ?looking a gift horse in the mouth?.
Instead of being grateful to God for having favoured them so much that, in effect, they have the stronger of the two sexes by virtue of nothing else but the male-weakening beauty of their sexily voluptuous bodies, women rail against him for having so favoured them. We are being exploited by men, they complain. Exploited? Good gracious! When it is you who, in fact, is exploiting God?s free gift to your own financial advantage! Women can?t see a good thing for their incurable self-pity.
As a matter of fact I was surprised that a little while ago even members of my own journalistic fraternity could have seen it fit to waste precious time debating allegations their certain advertisements were ?sexist?.
At the Southern African Gender and Media Summit in Johannesburg recently, delegates were asked what constitutes ?sexist advertising?. Some of their views were startling to say the least. Here is a representative sample.
?It?s that picture, for instance, that shows a woman in the nude, her breasts and thighs exposed women are mainly used for such ads,? said SABC female journalist, Puleng Mokho-ane. Said another female delegate, Athaliah Molokomme: ?Pictures of women scantily dressed. I have seen an ad for cat food using the lower body of a woman. I thought it was an ad for stockings. I did not see the connection.
?The use of a woman?s curves to sell a car or anything at all is sexist. When the message being sent out is not about what the woman does or knows but about the shape of her body, it is sexist.?
Nonsense. The beauty of the female body is not only an asset of immeasurable value but also the source of immense power which has enabled women to dominate men throughout history.
To view its use in advertisement as exploitation is, to put it somewhat hyperbolically, to fail to see the wood for the trees.
It is women who are using the beauty of their bodies to economically exploit society, not the other way round.
After all, no woman has even been forced to pose for such pictures.

12

Cops---Woman "Attacks Another at Church!

by Voyager in

credit for this article goes to (debbie), at watchtower observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt.

Voyager

Elsewhere:

Would make for a pretty good (soap-opera) now wouldn't it?

Thanks!

12

Cops---Woman "Attacks Another at Church!

by Voyager in

credit for this article goes to (debbie), at watchtower observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt.

Voyager

RunningMan:

Lets Get Ready To Rumble! Tickets to the next Bathroom brawl will be sold at the next convention!

I agree RunningMan, I did get a laugh out of it to.

Thanks!

12

Cops---Woman "Attacks Another at Church!

by Voyager in

credit for this article goes to (debbie), at watchtower observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt.

Voyager

Bluesbrother:

Yep! Your probably right there Blues. Won't be finding this (experience) in the next Yearbook!

Thanks!

12

Cops---Woman "Attacks Another at Church!

by Voyager in

credit for this article goes to (debbie), at watchtower observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt.

Voyager

Friends:

If you'll click on the thread, the article is a lot more clear to read than the cut and paste.

Thanks!

12

Cops---Woman "Attacks Another at Church!

by Voyager in

credit for this article goes to (debbie), at watchtower observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt.

Voyager

Credit for this article goes to (Debbie), at Watchtower Observer.

http://www.thetimesonline.com/articles/2005/01/11/news/porter_county/29e72e50d3863f8986256f8600176fee.txt

*************************************************************************************************************

About Contact Help Advertise

Cops: Woman attacks another at church

BY KEN KOSKY
[email protected]
219.462.5151

This story ran on nwitimes.com on Tuesday, January 11, 2005 12:48 AM CST

PORTER TOWNSHIP | A Valparaiso woman was arrested on a battery charge after she was accused of attacking another woman inside the Jehovah's Witness Hall at 198 W. Division Road.

Janiene Griselle, 36, of 3602 Timberbridge Drive, Valparaiso, was taken to Porter County Jail at 10:30 a.m. Sunday. She faces a maximum of a year in prison if convicted of the battery charge. Porter County police also ordered her not to return to the church.

The victim, a 30-year-old Valparaiso woman, told police she was in the main sanctuary when she was told Griselle wanted to talk to her in the bathroom. The victim said she went to the bathroom, at which time Griselle stated she was sleeping with the victim's boyfriend.

The victim said Griselle screamed at her to leave the man alone, but the victim said she told Griselle she didn't want to discuss it at church. The victim said she tried to leave, but Griselle blocked her path and then slapped, punched and kicked her. The victim suffered scratches and a bruise before a man entered the bathroom to break it up, police said.

Police said Griselle admitted she lost her "cool" and would have to "live and learn."

If Griselle returns to the Valparaiso-area church, she faces arrest on a criminal trespass charge. Police issued a trespass warning at the request of a church elder.

10

Bloodless Intensive Care--A Case Series and Review of Jehovah's Witnesses!

by Voyager in

http://www.mwc.com/newsfeedarticle.cfm?newsid=8862 .

bloodless intensive care: a case series and review of jehovah's witnesses in icu .

Voyager

http://www.mwc.com/NewsfeedArticle.cfm?NewsID=8862

************************************************************************************************

Bloodless Intensive Care: A Case Series and Review of Jehovah's Witnesses in ICU

(Anaesthesia and Intensive Care)

SUMMARY

The objective of this study was to assess the outcome of Jehovah's Witness (JW) patients admitted to a major Australasian ICU and to review the literature regarding the management of critically ill Jehovah's Witness patients.

All Jehovah's Witness patients admitted to the ICU between January 1999 and September 2003 were identified from a prospective database. Their ICU mortality, APACHE II scores, APACHE II risk of death and ICU length of stay were compared to the general ICU population. Twenty-one (0.24%) out of 8869 patients (excluding re- admissions) admitted to the ICU over this period were Jehovah's Witness patients. Their mean APACHE II score was 14.1 (7.0), the mean APACHE II risk of death was 21.2% (16.6), and the mean nadir haemoglobin (Hb) was 80.2 g/l (36.4). Four out of 21 Jehovah's Witness patients died in ICU compared to 782 out of 8848 non- Jehovah's Witness patients (19.0% vs 8.8%, P=0.10, chis quare). The median ICU length of stay in both groups was two days (P=0.64, Wilcoxon rank sum). The lowest Hb recorded in a survivor was 23 g/ l.

Jehovah's Witness patients appear to be an uncommon patient population in a major Australasian ICU but are not over-represented when compared with their prevalence in the community. Despite similar severity of illness scores and predicted mortality to those in the general ICU population, there was a trend towards higher mortality in Jehovah's Witness patients.

Key Words: JEHOVAH'S WITNESS: bloodless medicine; bloodless surgery; intensive care; anaemia; hyperbaric oxygen; erythropoietin

For it seemed good to the Holy Ghost, and to us, to lay upon you no greater burden than these necessary things; That ye abstain ... from blood ... from which if ye keep yourselves, ye shall do well.1

This quotation formed part of a letter from the Apostles to the Gentiles in Antioch and provided the basis for one of the tenets of Charles Taze Russsell, who founded the Jehovah's Witness (JW) movement in the United States in the late nineteenth century. The estimated six million currently practising Jehovah's Witnesses believe that the Bible is literally the word of God and eschew the therapeutic use of blood and its components. Specifically, they will not accept whole blood, red blood cells, platelets, fresh frozen plasma or cryoprecipitate. The use of vaccines, organ transplantation, albumin or immunoglobulins are designated "matters of conscience" and the individual can decide whether or not to accept these therapies2. Receiving their own blood is generally acceptable only when it passes through a closed circuit in continuity with the patient, such as cardiopulmonary bypass or haemodialysis3. However, there is dissension amongst individual Jehovah's Witnesses regarding these prohibitions and some will accept blood products under certain circumstances4.

The literature concerning the management of JW patients in the intensive care unit (ICU) is limited. The objective of this study was to assess the outcomes of JW patients in ICU and to review the literature regarding the management of critically ill JW patients. Based on evidence that anaemic postoperative patients who refuse blood transfusions have a greater mortality than patients willing to accept blood transfusion5, it was hypothesised that JW patients might have both a greater ICU length of stay and higher mortality than that of other ICU patients.

MATERIALS AND METHODS

The Alfred Hospital provides the State of Victoria, Australia, with quaternary services for trauma, burns, hyperbaric medicine, and heart and lung transplantation, in addition to other tertiary care typical of a level III ICU. All JW patients admitted to the ICU between January 1999 and September 2003 were identified from a prospective database which specifically codes for Jehovah's Witnesses. A retrospective case series was established. The APACHE II scores, APACHE II risk of death, ICU length of stay and ICU mortality of these JW patients were compared to the non-JW population over the same period. Data on the patients were collected prospectively from the medical charts by trained data-collectors, except nadir haemoglobin concentrations and erythropoietin use in the JW patients, which was gathered retrospectively by the authors. Following WHO guidelines, anaemia was defined as a haemoglobin (Hb) of less than 130 g/l in men and less than 120 g/l in women.

RESULTS

The JW patients are presented in Table 1. Twenty-one JW patients (0.24%) out of a total of 8869 patients (excluding re-admissions) were admitted to ICU between January 1999 and September 2003. The mean age of the JW patients was 57.8 years (18.9) and the mean nadir haemoglobin concentration was 80.2 g/l (36.3). Twenty of the patients (95.2%) had anaemia, with the lowest recorded Hb in a survivor being 23 g/l. The mean APACHE II score was 14.1 (7.0) and the median ICU length of stay was 2 days (interquartile range 1-5). They were a heterogeneous group of patients, with the majority (12 out of 21 (57.1%)) being admitted to ICU for postoperative care.

The results comparing JW and non-JW patients are presented in Table 2. There were no statistically significant differences in APACHE II scores (14.1 vs 15.1, P=0.43, Wilcoxon rank sum), APACHE II risk of death (21.2% vs 20.9%, P=0.47, one-tailed t-test for independent samples (equality of variances was not tested; the P value was the same assuming either equal or unequal variance)) or ICU length of stay (median 2 days for both groups, P=0.64, Wilcoxon rank sum) between JW and non-JW patients. Four of the 21 JW patients died and 782 of the 8848 non-JW patients died (19.0% vs 8.8%, P=0.10, chi square). Only one of the four JW patients died solely of anaemia (patient 15). Two others died with extremely low haemoglobin concentrations that contributed to their morbidity: patient 20 died seven days after suffering a respiratory arrest on a background of severe left ventricular failure and inoperable aortic valve disease; and patient 9 died of multiorgan failure following urgent coronary bypass grafting. Patient 19 had significant pre-existing co- morbidities and died from community-acquired pneumonia. He did not have severe anaemia. None of the JW patients discharged from ICU subsequently died in hospital.

DISCUSSION

JW patients are an uncommon patient population in ICU. The largest published series of anaemic JW patients, with three hundred patients, involved twelve centres in the U.S.A. over a thirteen- year period5. It studied all hospitalized postoperative JW patients (excluding cardiac surgical patients) with a serum Hb of less than 80 g/l, irrespective of whether they were in ICU. By comparison, our series was a single centre cohort over a four-year, nine-month period and looked specifically at JW patients in ICU regardless of Hb level. Only 0.24% of the total ICU admissions in this period were JW patients. The 2001 Census of Population and Housing by the Australian Bureau of Statistics showed that there were approximately 81,100 JWs in Australia at this time, or 0.4% of the population. Thus, JW patients do not appear to be over-represented in ICU.

The small size of the cohort limits our ability to draw definitive conclusions about this patient population. Nonetheless, despite similar APACHE II scores, APACHE II risk of death and ICU length of stay, the JW patients exhibited a trend to higher mortality compared with that of the non-JW patients. Carson and co- workers5 obtained similar conclusions, demonstrating increasing mortality with decreasing Hb concentration, with mortality rising sharply in patients with a Hb of less than 50 to 60 g/l. In our series, two out of five patients (40%) died with a nadir Hb of less than 50 g/l, compared with two out of sixteen patients (12.5%) with a Hb of greater than 50 g/l. Importantly, neither series had a patient who survived a Hb of less than 20 g/l.

Eleven patients (52.3%) in our series did not receive recombinant human erythropoietin (rHuEpo). Some of these patients refused to have rHuEpo administered to them after risks and benefits were discussed. However, at this time in the ICU there was no prospective protocol for managing JW patients or for using rHuEpo and management decisions were at the discretion of the treating ICU specialist.

The trend we have observed towards higher mortality in JW patients in ICU has implications for their management. There follows a literature review on the management of JW patients in ICU, addressing general treatment issues, how to compensate for anaemia without transfusion, strategies for perioperative management and organization of health care provision.

TABLE 1

JW patients

TABLE 2

Results comparing JW patients and non-JW patients

A REVIEW OF THE MANAGEMENT OF JW PATIENTS IN ICU

General ICU Management

Managing JW patients in ICU is challenging. Optimizing the patient's oxygen delivery can be difficult, as inadequate fluid resuscitation will compromise cardiac output, whereas liberal fluid resuscitation can cause haemodilution and further falls in haemoglobin level. There are ethical and medicolegal issues concerning withholding life-saving treatment on patients unable to communicate their wishes clearly. The law in Australia regarding advanced directives is ambiguous and there have been calls for clarification of the rights of patients who refuse blood transfusions6.

New therapies havebeen developed which have yet to be fully evaluated in JW patients, such as recombinant factor VII7. The literature abounds in anecdotal reports of JW patients undergoing complex surgery or surviving profound anaemia in ICU8-11. Patient survival is often attributed to new methods of treatment, although the evidence for this is limited12,13. However, there is evidence to support a number of treatment modalities and some general recommendations can be made regarding the management of JW patients in ICU.

- As noted in the introduction, there is some variation in the blood products that JW patients will accept. Where possible, a direct and confidential discussion should be conducted with the patient and thoroughly documented14.

- Referral of the patient to a different institution that has greater expertise and experience with JW patients may be appropriate3. Whilst there are several dozen centres in the U.S.A. that promote bloodless medicine and surgery, there is only one in Australia (Kayeela Hospital, East Fremantle, Western Australia) and it does not have an ICU. A regional tertiary centre may suffice if specialized referral centres are unavailable.

- Rationalizing the frequency and volume of blood sampling is important to minimize blood loss. Two epidemiological studies of ICU patients have demonstrated similar figures for the mean volume of blood taken for testing from critically ill patients: 42.5 ml/day in one study15 and 41.1 ml/day in the other16. The more unwell the patient, the more blood that is likely to be taken. The use of minimum-volume sampling tubes should be universal in JW patients. Monitoring equipment that minimizes blood sampling, such as oximetric pulmonary artery catheters or continuous intra-arterial blood gas analysers, should be utilized if available.

- A multidisciplinary approach should be employed for any complex problems in these patients, involving all relevant specialists including a haematologist. A plan should be drawn up in advance to deal with any foreseeable complications17.

- Only senior personnel should perform procedures that carry a risk of significant blood loss.

- Minimizing oxygen requirements, with sedation, ventilation and maintenance of euthermia, may be of benefit in patients with severe anaemia9.

- Critically evaluating the need for anti-coagulant or anti- platelet therapy is important, as these may contribute to or precipitate life-threatening haemorrhage17.

Compensating for Anaemia

Erythropoietin

One regimen of recombinant human erythropoietin (rHuEpo; 40000 U once per week subcutaneously) has been shown to reduce transfusion requirements and increase haemoglobin in the critically ill18. However, the long-term effects of this approach are unknown and its utility in general ICU patients has been questioned19. It has not been adequately studied in JW patients. A trial involving forty post- operative JW patients demonstrated a faster rise in haemoglobin levels with a different regimen of rHuEpo (300 U/kg intravenously three times a week for one week, then 150 U/kg three times a week thereafter) than with placebo20. The use of rHuEpo in anaemic JW patients is regarded by many as standard treatment8. On the basis of existing evidence, all JW patients in the ICU should receive rHuEpo if they are anaemic or at risk of major blood loss.

Therapy with rHuEpo takes at least five days before a demonstrable rise in haemoglobin is evident3. Adequate stores of vitamin B12, folate and iron are essential for it to be effective. Oral iron supplementation is regarded as standard therapy14. There is little evidence contradicting this but at least one study shows benefits from intravenous iron administration in a preoperative population21 and another in a dialysis population22. Consequently, some authorities recommend administering intravenous iron once every one to two weeks17. Corwin and co-workers used an oral iron preparation for all patients, changing to intravenous iron administration only if there was an inadequate response on the basis of iron studies (defined as a transferrin saturation <20% or a decrease in serum ferritin <225 pmol/l)18.

Hyperbaric Oxygen

Whilst there is a sound physiological rationale to support the use of pulsed hyperbaric oxygen (HBO) in patients with severe anaemia to alleviate oxygen debt9, there is very little clinical evidence demonstrating a clear improvement in outcome. Treating critically ill patients with severe anaemia and consequent multiorgan failure is a challenge for any hyperbaric facility and HBO is not a practical option for many patients. However, severe anaemia is accepted as an indication for HBO by a number of expert committees23 and it should be considered for JW patients with inadequate oxygen delivery in whom other therapies have failed.

Artificial Oxygen Carriers

Artificial oxygen carriers are classified into two groups: haemoglobin-based oxygen carriers (HbOC) and perfluorocarbons (PFC). HbOCs are currently undergoing phase III trials in the U.S.A. These products obtain their haemoglobin base from one of three sources: bovine blood, outdated units of human red blood cells or from recombinant technology. Many JW patients will not accept these products, especially from human or bovine sources. Recombinant HbOCs are in development, but immune reactions to the liposomal membrane in which the haemoglobin molecule is encapsulated have proven to be problematic in animal models25.

PFCs are inert compounds with low surface tension and a huge capacity for dissolving gases. They are regarded as experimental in humans and problems with them include the need for the patient to be kept on high levels of supplemental oxygen, the induction of a flu- like illness, and platelet sequestration26.

At present, no artificial oxygen carriers are approved for human use anywhere outside South Africa17, many of them will not be acceptable to JW patients should their source become apparent, and none are easily obtainable in Australia.

Peri-operative Management

Preoperative Consultation

This is an important discussion, allowing the patient and clinician to establish what blood products, surgical and anaesthetic techniques are acceptable. Some centres have a protocol guiding this discussion, at which an anaesthetist and a haematologist are present14. When relevant, providing ICU staff with a transcript of the preoperative discussion or involving the ICU specialist directly would be valuable in planning and guiding the postoperative care of the patient.

Preoperative Erthropoietin

Many studies have demonstrated the safety and efficacy of using preoperative rHuEpo starting three to four weeks prior to surgery, although it is an expensive strategy14.

Preoperative Autologous Blood Donation

This is not acceptable to JW patients, as the blood is not kept in continuity with the patient17.

Acute-normovolaemic Haemodilution

This well-described technique involves removing blood from the patient at the beginning of the operation and replacing it with crystalloid or colloid. The blood can then be re-infused near the end of the procedure leading to a relative conservation of red blood cells and clotting factors, as any blood lost intra-operatively will be diluted. This is acceptable to JW patients as long as the blood is kept in continuity with the patient3.

Blood salvage

"Cell saver" devices are generally acceptable intra-operatively, as the blood is perceived to remain in contact with the body. Postoperative salvage, however, such as collection of blood from intercostal or mediastinal drains and re-infusion back into the patient, is generally not acceptable14.

Systemic anti-fibrinolytics

Aprotinin, aminocaproic acid and transexamic acid have all been used in the perioperative period to decrease bleeding, or in circumstances such as trauma or gastrointestinal haemorrhage. There is considerable evidence to support their use, with demonstrable reductions in blood loss27 and mortality28. The choice of agent will be dependent on drug availability, patient characteristics and the nature of the surgery. Controversy remains as to which of these is the best agent at reducing bleeding in specific circumstances29-31.

Surgical technique

Electrocautery and devices such as the Cavitational Ultrasonic Surgical Aspirator (CUSA; Valleylabs, Boulder, Colorado, U.S.A.) and the Harmonic Scalpel (Ethicon, Cincinnati, Ohio, U.S.A.) have considerably improved the surgeon's ability to rapidly achieve haemostasis17. Their efficacy obviously depends upon the surgery and the experience of the operator.

Organization

As intensive care specialists become more aware of the immunomodulating effects of blood transfusion and their potentially deleterious consequences32-34 and as evidence accumulates overturning the traditional indications for red blood cell transfusions in the critically ill35, it is conceivable that some of the strategies applied at present to JW patients in order to obviate the need for transfusion may be utilized in a wider population of critically ill patients. Bloodless medicine and surgery programs are springing up worldwide as the need for such practices increases. Co- ordination of intensive care specialists, haematologists, anaesthetists, surgeons and administrative personnel is essential in order to facilitate the smooth running of these programs12. There is a need for individual institutions to establish protocols to guide the management of patients who refuse allogeneic blood transfusions. Fundamentally, the need for these services arises from a desire on behalf of treating practitioners to respect individual autonomy. This is often a difficult task in ICU when patients cannot communicate easily.

CONCLUSIONS

Jehovah's Witnesses are uncommon in ICU but are not over- represented when compared with their prevalence in the community. Given the rarity of this patient population in ICU, we suggest that it would be prudent for referral centres \to have protocols in place to assist with management issues.

A review of the literature indicates that from the beginning of their ICU stay (and weeks in advance with elective surgery), all JW patients should have a management plan to limit blood loss by minimizing the frequency and amount of venepuncture, instituting early and definitive surgical management, and using systemic anti- fibrinolytics when relevant. The early use of rHuEpo and iron supplements may prevent the later falls in haemoglobin that become critical in selected patients.

This study found a trend towards higher mortality in JW patients compared with the rest of the ICU population. JW patients with Hb of less than 20 g/l are extremely unlikely to survive.

ACKNOWLEDGEMENTS

We are indebted to Michael Bailey of the Department of Epidemiology at Monash University for performing the statistical analysis and to Ann-Marie McKenna and Clinton Kitt for collecting data on patients.

REFERENCES

1. The Holy Bible. King James edition. Cambridge University Press. Acts 15:28-29.

2. Watchtower Bible and Tract Society. Questions from readers. Watchtowcr 2000; June 15:29-31.

3. Savarese D, Waitkus H, Stewart F, Gallery M. Bloodless medicine and surgery. Intensive Care Med 1999; 14:20-33.

4. Elder L. Why some Jehovah's Witnesses accept blood and conscientiously reject official Watchtower Society blood policy. J Med Ethics 2000; 26:375-380.

5. Carson J, Noveck H, Berlin J, Gould S. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 2002; 42:812-818.

6. Stewart C. Advanced directives, the right to die and the common law: recent problems with blood transfusions. Melb Univ Law Rev 1999; 23:161-183.

7. Hedner U, Erhardtsen E. Potential role for rFVIIa in transfusion medicine. Transfusion 2002; 42:114-124.

8. Gannon C, Napolitano L. Severe anaemia after gastrointestinal haemorrhage in a Jehovah's Witness: New treatment strategies. Crit Care Med 2002; 30:1893-1895.

9. McLoughlin P, Cope T, Harrison J. Hyperbaric oxygen therapy in the management of severe acute anaemia in a Jehovah's Witness. Anaesthesia 1999; 54:891-895.

10. Cothren C, Moore E, Offner P, Haenel J, Johnson J. Blood substitute and erythropoictin therapy in a severely injured Jehovah's Witness. N Engl J Med 2002; 346:1097-1098.

11. Moskowitz D, Perelman S, Cousineau K et al. Multidisciplinary management of a Jehovah's Witness patient for the removal of a renal cell carcinoma extending into the right atrium. Can J Anaesth 2002; 49:402-408.

12. Kickler T. Why "bloodless medicine" and how should we do it? Transfusion 2003; 43:550-551.

13. Hardy J, Belisle S, van der Linden P. Combined blood substitute and erythropoictin therapy in a severely injured Jehovah's Witness. N Engl J Med 2002; 347:696-697.

14. Marsh J, Bevan D. Haemalological care of the Jehovah's Witness patient. Br J Haematol 2002; 119:25-37.

15. Smoller B, Kruskell M. Phlebotomy for diagnostic laboratory tests in adults: Pattern of use and effect on transfusion requirements. N Engl J Med 1986; 314:1233-1235.

16. Vincent J, Baron J, Reinhart I et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288:1499-1507.

17. Goodnough L, Shander A, Spence R. Bloodless medicine: clinical care without allogeneic blood transfusion. Transfusion 2003; 43:668-676.

18. Corwin H, Gettinger A, Pearl R et al. Efficacy of recombinant human erythropoietin in critically ill patients: a randomized- controlled trial. JAMA 2002; 288:2827-2835.

19. Carson J. Should patients in intensive care units receive erythropoietin? JAMA 2002; 288:2884-2886.

20. Atabek U, Alvarez R, Pello M et al. Erythropoietin accelerates haemocrit recovery in post-surgical anaemia. Am Surg 1995; 61:74-77.

21. Rohling R, Zimmerman A, Breymann C. Intravenous versus oral iron supplementation from preoperative stimulation of hemoglobin synthesis using recombinant human erythropoietin. J Hematother Stem Cell Res 2000; 9:497-500.

22. Macdougall J, Tucker B, Thompson J, Tomson C, Baker L, Raine A. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int 1996; 50:1694-1699.

23. Cope T, Harrison J. The use of hyperbaric oxygen in the management of severe anaemia in a Jehovah's Witness. Anaesthesia 2000; 55:293-294.

24. Reid T. Hb-based oxygen carriers; are we there yet? Transfusion 2003; 43:280-287.

25. Rudolph A, Cliff R, Kwasiborski V, Neville L, Abdullah F, Rabinovici R. Liposome-encapsulated hemoglobin modulates lipopolysaccharide-induced tumor necrosis factor-α production in mice. Crit Care Med 1997; 25:460-468.

26. Klein H. The prospects for red-cell substitutes. N Engl J Med 2000; 342:1666-1668.

27. Mannucci P. Hemostatic drugs. N Engl J Mcd 1998; 339:245- 253.

28. Levi M, Cromleeche M, de Jonge E et al. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant end points. Lancet 1999; 354:1940-1947.

29. Ray M, O'Brien M. Comparison of ε-aminocaproic acid and low-dose aprotinin in cardiopulmonary bypass: efficiency, safety and cost. Ann Thorac Surg 2001; 71:838-843.

30. Casati V, Guzzon D, Oppizzi M et al. Transexamic acid compared with high-dose aprotinin in primary elective heart operations: effects on perioperative bleeding and allogeneic transfusions. J Thorac Cardiovasc Surg 2000; 120:520-527.

31. Morgan G, Mikhail M, Murray M. Clinical Anesthesiology, 3rd Ed. McGraw Hill 2002:450.

32. Kirkley S. Proposed mechanisms of transfusion-induced immunomodulation. Clin Diagn Lab Immunol 1999; 6:652-657.

33. Vanvakas E, Blajchman M. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood 2001; 97:1180-1195.

34. Ghio M, Ottonello L, Contini P et al. Transforming growth factor-β^sub 1^ in supernatants from stored red blood cells inhibits neutrophil locomotion. Blood 2003; 102:1100-1107.

35. Hebert P, Wells G, Blajchman M et al. A multicentre, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340:409-417.

G. MACLAREN*, M. ANDERSON[dagger]

Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria

* M.B., B.S., F.J.F.I.C.M., F.R.A.C.P., Former Senior Registrar.

[dagger] M.B., Ch.B., F.A.N.Z.C.A., F.J.F.I.C.M., Staff Specialist.

Address for correspondence: Dr M. Anderson, Intensive Care Unit, The Alfred Hospital, Commercial Rd, Melbourne, Vic. 3004.

Accepted for publication on July 12, 2004.

Copyright Australian Society of Anaesthetists Dec 2004

9

link from society website "donate to disaster relief"

by core in

https://www.jwgift.org/main.asp?page=0

not sure if this has been noted here before but the uk jw donations website has a link described as " click here to donate to disaster relief.

who gets this then and what disaster will it benefit - bandwagon anyone ?.

Voyager

Does the Watchtower meet these Guidelines? If not, then (Don't Donate)! I still have (not) seen ONE WORD of this tragic event even mentioned on their website !

http://www.cidi.org/donate.htm http://www.cidi.org/donate.htm

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Guidelines for Appropriate
International Disaster Donations

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Kreyol
بالعربي (Arabic)
فارسي (Farsi)

Corporate Considerations

Monetary Contributions to Established Relief Agencies are Always the Most Useful Response to Disasters: Financial contributions allow professional relief organizations to purchase exactly what is most urgently needed by disaster victims and to pay for the transportation necessary to distribute those supplies. Unlike in-kind donations, cash donations entail no transportation cost. In addition, cash donations allow relief supplies to be purchased at locations as near to the disaster site as possible. Supplies, particularly food, can almost always be purchased locally - even in famine situations. This approach has the triple advantage of stimulating local economies (providing employment, generating cash flow), ensuring that supplies arrive as quickly as possible and reducing transport and storage costs. Cash contributions to established legitimate relief agencies are always considerably more beneficial than the donation of commodities.

Confirm There is a Need for All Items Being Collected.: Do not make assumptions about the needs of disaster victims. Exactly what is needed can be confirmed by checking with an established relief organization that has personnel working on-site. Do not send what is not needed; unneeded commodities compete with priority relief items for transportation and storage. Organizations that receive in-kind relief donations can help this process by clearly communicating what items are required (in what size, type, etc.) as well as clearly stating what items or services are NOT needed. Please remember, certain foods, particularly in famine situations, can make victims ill. In most cases, donations of canned goods are not appropriate. The collection of bottled water is highly inefficient. It is important to have an accurate analysis of need before determining response.

Deliver Items Only to Organizations having Local Distribution Capacity: Distributing relief supplies requires personnel and financial resources within the affected country. To efficiently distribute relief commodities, staff, warehouses, trucks and communications equipment are required. It is not enough to gather supplies and send them to an affected region; a sound partnership with a reliable local agency having transport and management capacity is mandatory.

Donate Only to Organizations having the Ability to Transport Collected Items to the Affected Region: Immediately after a disaster, many local organizations will spontaneously begin collecting miscellaneous items for use in disaster relief. However, at the time that these collections are begun, agency officials will not have thought about to whom, or how, the items will be sent. It is not unusual for community and civic groups to have collected several thousands of pounds of relief supplies only to find that they do not know whom to send the supplies to and that they do not have viable transportation options for shipping the goods. At this juncture, it is often advisable for those collecting the goods to auction them off locally, converting commodities into cash to be applied to the relief effort.

Never Assume the U.S. Government or any Relief Agency Will Transport Unsolicited Relief Items Free of Charge: It is important to make arrangements for the transportation before collecting any kind of material donations. Never assume that the government or any relief agency will transport donations free of charge (or even for a fee). In the majority of cases, the collecting agency will be responsible for paying commercial rates for the transportation and warehousing of items gathered.

Volunteer Opportunities for Disaster Relief are Extremely Limited: Volunteers without prior disaster relief experience are generally not selected for relief assignments. Candidates with the greatest chance of being selected have fluency in the language of the disaster-stricken area, prior disaster relief experience, and expertise in technical fields such as medicine, communications logistics, water/sanitation engineering. In many cases, these professionals are already available in-country. Most agencies will require at least ten years of experience, as well as several years of experience working overseas. It is not unusual to request that volunteers make a commitment to spend at least three months working on a particular disaster. Most offers of another body to drive trucks, set up tents, and feed children are not accepted. Keep in mind that once a relief agency accepts a volunteer, they are responsible for the volunteer's well-being -i.e., food, shelter, health and security. Resources are strained during a disaster, and another person without the necessary technical skills and experience can often be a considerable burden to an ongoing relief effort.; *****************************************************************

Never (assume) anything when it comes to the Watchtower. And never take them for granted. There are too many (victims) out here already, due to the Watchtower Society.

Does the Watchtower (CLEARLY COMMUNICATE) to the public, as to how much money they are going to give for the relief efforts? Do you know how much money the Watchtower gave for the (LAST) disaster? If you do, will you please (scan) us a copy? If not, could it be because the Watchtower only used (some) of their disaster relief donations for the disaster victims, and kept the rest for (PRINTING) purposes?

Would you really want to donate to an organization that seems to be only concerned about the (Jehovah's Witness) victims, and does not have enough respect for the rest of the victims to even mention something about the disaster on their website? Does (Love Thy Neighbor), only apply for Jehovah's Witnesses?

11

Godly Obedience in 2005

by truthseeker in

jw
friends

yep, "godly obedience" is the theme for this years district convention.. you know the wts will be hot on obedience this year.. expect more wt articles asking for money (as obedience to jehovah), asking for more pioneers and elders, and making this a matter of obedience.. it's getting worse.. at the meeting this week, a whole 25 minutes was taken up on what to do regarding accomodation at the district convention.. brother zealous said if we're not obedient to the instructions that the faithful slave has given us, we undermine the hard work the society puts in to arrange these provisions.. godley obedience means we will attend all three days at our convention.. .

this cult makes me sick.

everything is about jehovah; jesus just does not figure in anything, unless they feel the need to quote a scripture or something.. .

Voyager

truthseeker:

Absolutely right truthseeker. Accommodations are big business and because some areas are lacking the JWs move on to another area. One news article said that due to a (lack) of accommodations there was a (huge) loss with the JWs. It went from 64,000 JWs to a scheduled 16,000 JWs.

Its at the bottom of this thread: http://www.13wmaz.com/news/top_stories.aspx?storyid=9851

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After several canceled meetings with city leaders, Marshall says that process is at a standstill.

Marshall told Eyewitness News because of its lack of accommodations, the Centreplex has lost business.

She says they've gone from serving 64,000 Jehovah's Witness delegates in 2003, to a scheduled 16,000 in 2005.

Marshall says for three years in a row, the group opted to use the Gwinnett Civic Center in Atlanta.