We spend our time in one of four ways, depending on the two factors that define an activity: urgent and important. Urgent means it requires immediate attention. Urgent things act on us and are usually visible. For example, a ringing phone is urgent. Important things, on the other hand, have to do with results. It contributes to our mission, values, and high-priority goals. We react to urgent matters. Important matters that are not urgent require more initiative, more proactivity.
The Habit 3 Covey talks about is the prioritization of tasks. Covey describes the importance of keeping your priority things on the top. He explains that you should be able to identify the tasks that are important and prioritize them above all. With so much happening around in your surroundings, there are chances that you miss the important ones. This is why it is vital that you create a list of high-priority tasks and cater to them according to their importance.
First Things First
This is how this switch in context, giving priority to the three characteristics over the four noble truths, has come to dominate modern Buddhism. The common pattern is that when modern authors explain right view, which the Buddha equated with seeing things in terms of the four noble truths, the discussion quickly switches from the four noble truths to the three characteristics to explain why clinging leads to suffering. Clinging is no longer directly equated with suffering; instead, it causes suffering because it assumes permanence and essence in impermanent things.
3. Clinging comes from the mistaken view that there can be such a thing as long-term happiness. But because all things are fleeting, there is no such thing. Pleasures, like pains, simply come and go. When you can resign yourself to this fact, you can open to the spacious wisdom of non-clinging, equanimous and accepting, as you place no vain expectations on the fleeting show of life.
For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program.
Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries.
To address this issue in Kampala, in 2008, we conducted a pilot study on the burden of injury seen by lay people and designed and implemented a context-appropriate course on prehospital trauma care for lay first-responders based on the World Health Organization's recommendations that lay first-responders should be the first step towards developing formal emergency medical services in settings without a formal prehospital system [7], [8], [9].
Since the initial training, we prospectively followed this cohort to assess the effectiveness of our training program at six months. We hypothesized that participants would retain knowledge of first-aid learned during the training course, use the skills and kit frequently and feel more empowered to provide emergency services. We also measured the costs and cost-effectiveness of scaling up this program to cover the city of Kampala based on the methods outlined in the Disease Control Priorities Project, 2nd edition (DCP2) [9].
Our training program, previously described in detail [10], was conducted in Kampala (population: 1.2 million) [11] and consisted of a day-long modified basic first-aid course on trauma and a free basic first-aid kit for each participant. Participants had been selected through convenience sampling from a 20 square mile catchment area around Mulago Hospital. The course curriculum was adapted from prior models by local stakeholders. The core curriculum included universal precautions, scene management, external compression for haemorrhage control, basic airway control, recovery position, safe lifting and transportation of injured victims, splinting fractures and triage. After the course, each participant received a first-aid kit assembled using locally available materials and instructions on restocking the kit.
Cross-sectional surveys and fund of knowledge tests were conducted immediately before and after training and at three and six months. We collected data on the frequency and types of aid provided, supply use, barriers to providing aid, perceived utility of the course and kit and self-reported confidence in giving first-aid. Fund of knowledge tests consisted of five questions covering each core skill area. Data collection instruments were designed in English and Luganda and pilot-tested twice in Kampala before use by study personnel. Structured one-on-one interviews were used at study onset. Self-administered questionnaires were used at three months and mobile phone surveys at six months for logistical reasons. A half-day refresher session was conducted at three months.
Institutional Review Board approvals were obtained from the University of California, San Francisco, Mulago Hospital and the Uganda National Council of Science and Technology. Informed consent to participate in the study was obtained from all trainees. Throughout this study, participants received no financial incentive to perform first aid in the field, or to complete encounter records. Nominal stipends were given on training days to replace lost income.
Our study thus fills these critical needs. Despite a substantial burden of injury in Uganda, Kampala, its largest city, has no formal prehospital emergency system. We found that lay people can effectively retain knowledge of prehospital trauma care learned through a context-appropriate first-aid course for at least six months. Trainees found this basic intervention useful and after the training, were able to more confidently deploy these new skills. Our findings suggest that police may be the ideal first-responders in Kampala given their higher knowledge retention and skills and supply use compared with other trainees. Their established communication and transportation networks are also an advantage. However, appropriate recognition for such services will be critical to dissuade any incentive to charge informal fees for services. This study also showed shorter times from injury to hospital arrival, although this compares two different datasets; our prospectively collected encounter records and the hospital trauma registry. Nonetheless, the findings suggest that delivery of prehospital care did not delay access to care.
This study can be compared with others' experiences in developing prehospital systems in resource-constrained settings. In urban Ghana, truck drivers who completed a similar context-appropriate first-aid course showed a significant increase in skill use at 10 months based on response rate of 28% [18]. However, trainees assembled first-aid kits at their own expense and at 10 months, only 27% of trainees carried materials useful for universal precautions such as gloves or plastic bags. Our study conducted more in-depth and periodic assessments of participants' fund of knowledge and use of free first-aid kits.
Our cost and cost-effectiveness analyses must be interpreted with caution, even though sensitivity analyses were used. Estimates of the number of lay first-responders needed for Kampala and their potential impact on mortality were determined based on work primarily in a conflict-affected setting. By comparison, a decreased incidence of trauma and associated frequency of skill use in urban Kampala may have led to an overestimate of the cost-effectiveness.
Despite study limitations, many areas for further research exist. Better methods are needed to measure the impact of training lay first-responders on trauma morbidity and mortality. While we established the need for a simple first-aid kit for effective provision of prehospital care, mechanisms to ensure restocking of kits also need to be determined. Facility-based records could more accurately measure economic burden and may help determine the accuracy of our projections.
In conclusion, a lay first-responder training program is a practical and effective first-step towards developing a formal emergency system in Uganda. It is likely to be very cost-effective in this setting. Establishing and scaling up this intervention with in Kampala should be a key priority for Ugandan policy-makers. Incorporating emergency services into the essential package of health care would critically address the disproportionate global injury burden shouldered by the poor. Results of this program could be useful in other resource-constrained settings that lack emergency medical systems.
For example, when Gandhi first started leading people, he was shy and a really bad and constantly nervous public speaker. But his vision of a society in which all people are equal made it easy to decide and practice speaking every chance he got, in spite of his fear, and become the person he needed to be to make his vision a reality.
Put first things first and we get second things thrown in: put second things first & we lose both first and second things. We never get, say, even the sensual pleasure of food at its best when we are being greedy.2
After a bit of a lengthy Prologue, Ghost of Tsushima will finally give you a horse and open the gates for you to explore a very large region of the game. There's a lot you can do, from side quests, to tracking down collectibles like Singing Crickets to exploring points of interest like Pillars of Honor - but make before you get too lost, make sure to prioritize doing these things first. 2ff7e9595c
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