QWHN NEWS - MARCH 2004

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Annual Report 2004

 

Below you will find a copy of the main stories that appeared in the March 2004 edition of the QWHN News. The topic for this edition was "Why Women's Health?"

 

A PERENNIAL WEED? QUESTIONING WOMEN'S HEALTH

By Dr Dorothy Broom

Some questions just never go away. But more than thirty years after the first edition of Our Bodies, Ourselves, perhaps it is not impertinent to ask again: why (still) women’s health?  A number of contributions to this issue of the Newsletter come from women working directly in service provision or policy areas, and they speak from their on-the-job experience. As an academic, I am a bit removed from the action, and I lack the authority they have acquired from years of practice. In any event, there would be no value in my reiterating what they might say; instead, I offer a kind of political history of the question itself. Who has raised it? What does it mean to ask this? What kinds of answers have been generated, and what differences might our answers make? Overall, this commentary aims more to elaborate the question than to answer it, a task I am happy to leave to others, including all the readers of this Newsletter!

For anyone who thinks the question ‘Why Women’s Health?’ is novel, a review of events over the last three decades should dispel that impression.  The advent of the renascent women’s movement in the late 1960s and early ‘70s quickly put women’s health on the agenda, and that development became highly visible when Australia’s first feminist women’s community health centre was launched in Leichhardt on International Women’s Day 1974.  The women who founded Leichhardt effectively staked out the territory in their application for initial funding. They assumed that the answer to the question was compelling, an assumption that appeared to be confirmed by their quick success in attracting funding from the Commonwealth Community Health Program.

But a number of dissenting voices were soon audible, coming from parts of the medical profession and conservative lobby groups who opposed the kind of autonomy – for both clients and workers – that the centre was striving to establish.  Opponents rightly forecast a revolution in reproductive rights, an explosion of women’s health information assembled by and for women, and a sea-change in women’s expectations of doctors and other service providers.  Indeed, those are exactly what the women’s health movement was striving to achieve; the difference is that feminists define such changes as progress, whereas some others were fearful of reproductive rights and empowered consumers, especially women consumers!

Stimulated by community-based initiatives, governments gradually began to take an active role. A Victorian Women’s Health Policy Working Party published a brief discussion paper titled Why Women’s   Health? in 1985 which canvassed  issues  that were already receiving the attention of women  in  consciousness-raising and activist groups. The discussion paper highlighted the social and economic foundations of health and illness, ‘the second shift’ of unpaid household work (including unpaid health care), the medicalisation of women’s lives, reproductive health problems, sexual assault, and the over-prescription   of   minor  tranquillisers, among other concerns. These were understood to contribute to women’s distinctive illness profile, and to signal deficiencies in mainstream health services.  Consequently, policies, programs and services were needed that would improve women’s health not just through clinical treatment but also by addressing the underlying conditions that eroded women’s health.

When the political climate was right, the issues moved onto the national political stage. As had happened in Victoria, a similar array of questions and concerns was raised in the consultations leading to the 1989 National Women’s Health Policy. The Policy was the first of its kind in the world, and articulates a set of principles that embed it in the social view of health and in other national and international initiatives.  To the surprise of some (who had, perhaps, given little thought to the realities of women’s lives), it identified violence, and occupational health and safety among seven major women’s health issues, as well as more predictable concerns such as reproductive health and sexuality, and emotional and mental health. It also enumerated five action areas, including improving women’s participation in health decisions at all levels from the personal to state and national policy-making.  Funding was never particularly bountiful, but it gave a significant boost to voluntary labour and limited state-based funding, enabling the expansion of women’s health centres and other activities designed to implement the Policy.  In addition, the National Cervix Screening program and Breastscreen improved access to services for early detection of women’s cancers, and the longitudinal Women’s Health Australia survey began collecting data on three large cohorts of women in 1996.

Research and publishing activity has blossomed in the decades, and there are now a number of scholarly journals that specialise in women’s health, as well as a significantly increased representation of articles on women’s health in a range of other medical and social science periodicals. Feminist journals include studies of health matters, and book publishers have apparently seen both popular and academic sales potential in the topic. Medical education is being broadened to include not only more on women, but different content material, and novel ways of teaching that improve student doctor’s interpersonal skills and social understanding as well as their technical knowledge. It would seem that women’s health has become an answer, not a question.

Yet after thirty years of activity and advocacy, the question is still being asked: why women’s health? But it can be engaged from (at least) two quite different perspectives.  On the one hand, we can ask why women’s health? That is, why should we focus on health rather than on some other priority such as justice, employment, or childcare. In response, one could point out that we actually want action on all those issues, not only on health; but that well-being is fundamental to everything else in life. Furthermore, health encompasses many aspects of women’s lives, not simply the diseases that might be listed at hospital admission.

Additionally, the question is still sometimes raised by people who are hostile or simply ignorant of the work of the women’s health sector. They ask why women’s health, perhaps followed by an assertion that women have had more than our share of the resources and now it is ‘men’s turn’. The suggestion – occasionally explicit – is that men’s health is ‘actually’ worse than women’s, or even that women or the women’s movement are somehow to blame for men’s health problems. Although the wording is the same, this is a very different question: one that requires an entirely different response. An adequate answer to this question calls not for facts, figures and reports, but for a deep healing of rifts, resentments and losses: a healing between women and men, among women and within each woman herself.  I wish I knew how women can advance that healing without, in the process, relegating to obscurity our own legitimate claims, giving up the precious and hard-won gains of the late 20th century. Perhaps we need to keep constantly re-asking and devising responses for both versions of our perennial question.

Dorothy H. Broom, PhD, FASSA

Senior Fellow, National Centre for  Epidemiology & Population Health

The Australian National University

 

CHILDREN BY CHOICE

Children by Choice provide a good example of the necessity to retain specialist women’s health services. Our service focuses on the needs of women who are experiencing unplanned pregnancy, which (to state the obvious) is a health issue particular to women. Though a woman may choose to involve her partner, family or friends, the decision whether to continue an unplanned pregnancy or terminate an unwanted pregnancy ultimately rests with her.

 Clients who access our service are looking for a women-centred and women-staffed organisation. They find this approach less threatening in comparison to a mixed gender environment, and are able to be more open and forthcoming in their discussions with our counsellors.

 Not all women experiencing unplanned pregnancy require or seek our services. They may have a supportive general practitioner (male or female) who is able to provide the information and referral details that they are seeking. However, unfortunately Children by Choice continue to receive complaints from women about inappropriate handling of unplanned pregnancy by general practitioners. Some general practitioners are judgmental and impose their moral values on the situation, and/or may refuse to provide referrals for all options, and/or pressure a woman to choose one option over another. This experience can be extremely distressing for women.

At Children by Choice, we regard the woman as an expert in her own life. We see our role as:

·    - Resourcing women with up-to-date and accurate information to enable them to make an informed decision;

- Providing counselling services that assist and empower women to make their own decision around unplanned pregnancy.

This role is crucial to enable many women to deal with, and positively resolve, their experience of unplanned pregnancy.

 

Children by Choice provide a Queensland-wide counselling, information and education service on issues relating to unplanned pregnancy. Please call on 07 3357 5377 or Freecall 1800 177 725 (outside Brisbane).

 Cait Calcutt, Coordinator, Children by Choice in Brisbane

 

WOMEN AND DOMESTIC VIOLENCE: Issues Impacting on Women's Health and Well-Being

The experience of domestic violence leaves many women with poor health outcomes. The health issues most consistently reported by women are the effects of  physical, sexual and emotional/psychological abuse, all of which have a detrimental effect on women’s health.

The consequences of the violence extend well beyond the time women spend in the abusive relationship. After leaving the violent relationship women talk about the loss of ‘sense of self’ and of the struggle to achieve a state of good  mental and emotional health and well-being.

It is commonly recognised that most victims of physical abuse do not  report their injuries to health professionals, because of threats and fear. Women are conditioned by society to keep the abuse a secret, and often blame themselves for the abuse. This attitude can be a barrier to seeking effective health-care. Poor physical health can limit a woman’s capacity to actively participate in day-to-day life, including parenting.

Sexual abuse may be associated with physical abuse or threats of physical abuse to the woman or her children. Sexual abuse can have on-going effects to women’s health. They may suffer from guilt, shame, depression, anxiety, feelings of worthlessness, fear of being alone and fear of men and sex. These health issues associated with sexual abuse could develop into long-term mental health problems such as major depression and substance abuse.

Verbal abuse too, affects women emotionally and psychologically. It is the hidden kind of violence, which doesn’t leave evidence comparable to the bruises of physical abuse. It can be just as painful, and recovery can be difficult because the woman may have lost self-esteem and confidence. Health professionals need to be alert for indications of the effects of violence even when it is not the presenting problem.

Domestic violence is a major health issue which doesn’t discriminate, it crosses all boundaries.  It creates an on-going challenge to health systems, as well as individuals and communities. A collaborative approach from health and welfare services is vital in assisting victims to recover from the effects of living with domestic violence. Clearly, networking, information sharing and partnerships between different services, creates new possibilities for social change.

Jennie Black and Leonie Johnson

North Queensland Domestic Violence Resource Service

 

FOCUS ON WOMEN'S EMOTIONAL AND MENTAL HEALTH

Fifteen years after the handing down of the National Women’s Health Policy – Advancing Women’s Health in Australia – there is still a particular need for women’s health education.  The seven priority health issues for women identified in this document remain as issues for women and are addressed at varying levels with various strategies by each of the Queensland Women’s Health Centres.

A focus for West Moreton Women’s Health is women’s emotional and mental health and we are developing various programs to address this issue.  Two of these are our rural program and a Group Oriented Interpersonal Therapy for Women With Postpartum Depression.

A series of community consultations held in September – October 2003 highlighted the social isolation still being experienced by some women in the rural shires in the West Moreton District.  Rural Women’s Groups having both social and education components were identified as an effective strategy to address this isolation.  With groups in two of the three rural shires having ceased operation in the previous twelve months, our Rural Community Development Worker concentrated on reinvigorating the profile of this service in these communities and establishing new groups for women.  Information sessions addressing such issues as assertiveness and communication, back care, use of natural medicines and reiki are being offered and numbers in excess of 100 women across the three shires are attending groups each month.  In an effort to further unite rural women, we are hosting an International Women’s Day lunch in Glamorganvale to be attended by women across six rural groups.

Maternal mood and maternal mood disorders in the postpartum period have a significant influence on children’s development and long-term outcomes.  This effect is almost certainly mediated by the disturbance to the maternal-infant attachment relationship as a result of depression or anxiety in the mother.  A review of a UK postnatal depression support group (2001) identified the value of the group and indicated an average four point improvement on the Edinburgh Post Natal Depression Scale.  With very limited services in the West Moreton District for women with mild to moderate maternal mood disorders, West Moreton Women’s Health in collaboration with Child Health Services have developed a group oriented interpersonal therapy program for women.  The group will commence in late February and we look forward to the results which will be available in June.  The group is based on a program developed by Tresillian Family Care and uses a relationship-focused and strengths based approach to therapy grounded in a systems theory.  The eight week therapy group will be followed up by an ongoing support group – another lack within this district for many years.

Cathy North, West Moreton Women’s Health, Ipswich

 

CANCER INFO ON LINE

Recent surveys show that 40 to 50 percent of patients access medical information via the internet and that this information affects their choice of treatment. As well as the ‘professional’ websites, patients access information on non-profit breast cancer organisation’s websites (Internet and information on breast cancer: an overview. E. Santoro. Breast 2003; (12): 424 - 431).

One in three of Australia’s five million regular net-users search for health information online. Three quarters of these ask their doctors questions based on information they have found online, according to a survey by AC Nielsen. Internet use among females rose to 70 per cent in 2003, from 41 per cent in 2000.

In recognition of the growing role of the internet in providing information to both patients and health practitioners the National Breast Cancer Centre launched its new website portal in October 2003. The aim of the portal is to provide the latest, evidence-based information on breast and ovarian cancer.

The portal contains the following sites:

www.breasthealth.com.au - the new consumer website of the National Breast Cancer Centre containing comprehensive breast cancer information in a consumer-friendly format. This website is a joint venture with the Macquarie Bank Foundation.

www.nbcc.org.au – contains information about the organisation and its resources, programs and services.

www.nbcc.org.au/bestpractice - the National Breast Cancer Centre’s website for health professionals involved in caring for women with breast cancer. It contains information such as clinical guidelines, training information, conference details and images.

www.myparentscancer.com.au - a site for teenagers who have a parent with cancer. The site aims to help families communicate about cancer by giving teenagers information and advice when they need it, and by helping them understand the emotions they may be experiencing. The site was developed in consultation with CanTeen Australia.

www.breasthealth.com.au/boysdocry - a dedicated section of the National Breast Cancer Centre’s consumer site addresses the information needs for men on how to cope and offer better support when a  woman they love has breast cancer.

www.ovariancancer.com.au - the website from the National Breast Cancer Centre’s Ovarian Cancer Program. The site  contains information about ovarian cancer for consumer and health professionals.

For     more     information     on      the NBCC’s  e-communications, contact Lisa Robinson, via email at  lisa.robinson@nbcc.org.au  or phone   (02) 9036 3053.

Source: Breastfax—A Bulletin of National Breast Cancer Centre

 

FACTORS AFFECTING WOMEN'S HEALTH

Many factors - biological, social, cultural, environmental and economic - influence women's health status, their need for health services and their ability to access appropriate services. In particular women's health needs stem from the fact that:

·          Women are more socially disadvantaged than men in terms of poverty, education and power. Socially disadvantaged people are more likely to become ill.

·          Women are more likely to use health services because of their role as carers of children, older people, disabled people and the extra strain this places on their health.

·          Women have particular sexual and reproductive health needs in pregnancy, childbirth and menopause.

Due to gender inequality women are treated differently than men both in society generally resulting for example in violence against women and sexual assault and within the health system where women complain that their health problems are not treated seriously by health professionals or that they are inappropriately prescribed tranquillisers.

 

Source: Women’s Health NSW website

www.whnsw.asn.au

 

TOWNSVILLE WOMEN'S HEALTH SERVICE

The Women’s Health Service which is part of the service delivery of the Women’s Centre, 50-52 Patrick Street Aitkenvale are currently facilitating the following groups weekly:

·          Women’s Self Group

·          Eating Issues Support Group

·          Older Women’s Network

In addition to our weekly groups we are also involved in this year’s International Women’s Day celebration March and Rally with the theme, “Women of Strength, Surviving, Thriving, Challenging -  That’s How We Make a Difference”.  The march  will commence at 4.30pm from Anzac park and progress along the Strand to Strand park where the rally will begin at 5.00pm. Our IWD Coordinator for 2004, Ms Karen Phillips has her finger on the pulse of all activities and preparations are well under way.

On 10 March the Women’s Health Promotion Worker  Penny Jansen and Sexual Assault Counsellor Carol Olsen-Bull along with  Jeanie Brook, Dalrymple Shire Worker and Stephanie Whelan, Charter Data will be facilitating a half day information and activity day on a range of issues and topics for women at Ravenswood.  Other such days are planned for Pentland and Greenvale.

We are currently in the preparation stages to facilitate workshops for women at the Townsville Correctional Centre in both Residential and Secure on specific topics such as Menopause, Contraception, Sexual health,  Breast self-examination and International Women’s Day.

For information, support and counselling on Women’s Health issues contact the Women’s Centre at 50-52 Patrick Street, Aitkenvale or phone on 4775 7555.

Penny Jansen, North Queensland Combined Women’s Services, Townsville

 

EXPLORING THE EXPERIENCES, BELIEFS AND VALUES OF LESBIANS

Marg Piggott is a student at Swinburne University in Melbourne and is completing an honours degree in psychology. She is currently completing research on the impact of growing up as a woman and a  lesbian in an homophobic and woman-devaluing society.

“The purpose of the research,” Marg explains, “is to highlight to health professionals that our development as women and lesbians results in experiences that are unique to us which can have an  important impact upon our wellbeing.”

Marg is trying to obtain information from as many lesbians in as many  countries as possible and would really appreciate it if you would complete a brief survey online.

The survey is anonymous and open to all lesbians over the age of 18. It takes about 30 minutes to complete. If you would like to know the results of the research, copies will be available after the research is completed. If you would like to help in attempting to improve health services to lesbians please contact Senior Researcher, Dr. B. Findlay via email at bfindlay@swin.edu.au or,  Marg Piggott, also via email at margpiggott@ozemail.com.au for information on being involved.

 

BEAUTY AND HEALTH

Dr Sheila Jeffreys is a founding member of the Coalition Against Trafficking in Women, Australia. She is an Associate Professor in the Department of Political Science at the University of Melbourne where she teaches sexual politics, lesbian politics and international feminist politics. She is the author of five books on the history and politics of sexuality including The Idea of Prostitution and Unpacking Queer Politics, 2003. She is completing her sixth book: Beauty and Misogyny: Harmful cultural practices in the west. This book argues that western beauty practices need to be understood in UN terms of harmful cultural practices and these are defined as harmful to the health of women and girls. She makes the following important points in regards to “Why Women’s Health?”…

Women's health in relation to prostitution: post-traumatic stress disorder (ptsd), sexually transmitted infections affecting fertility and problems with reproductive system often for life. Also cuts and abrasions in sado-masochism prostitution.

Effects of violence in prostitution and outside prostitution on women's health mentally and physically.

Women's health in relation to beauty practices such as: Problems with mobility from high heel and other unsuitable shoes which can lead to women's having great difficulty walking in later life, especially if they have foot surgery to prettify feet or undo the damage, bunions, hammer toes. Also knee problems related to the shoes.

Problems relating to cosmetics e.g. bse (Mad Cow Disease) in animal products and coal tar in lipstick (women ingest 4 pounds weight of lipstick a year if worn daily and it is pretty toxic).

Problems with cosmetic surgery. Health damage from labiaplasty (getting more common), breast implants and botox.  Apparently the paralysis from botox can become permanent.

Problems with shaving hair off include painful bumps and in-grown hairs (apparently).

The health problems related to piercing, cutting (in private and in 'studios') and tattooing are well known.

There are other health concerns relating to the sexual practices now required of women as result of pornography. Problems of cuts and tears to body etc.

Problems for mental wellbeing for women of having to see porn with partners or having to live in a sexualised environment i.e ads, tv, magazines that portray women as prostituted, pornographised.

 

BRISBANE WOMEN'S HEALTH NETWORK

In response to a recognised need to make the best use of available opportunities for women in the metropolitan area of Brisbane, representatives from various agencies formed the Brisbane Women’s Health Network (BWHN) with the following aims: To share information about women’s health educational opportunities available in the general community, to maximise women’s access to health promotion activities, to avoid duplication of events, to identify areas of collaboration. To assist with these outcomes, a website for BWHN has been established and can be accessed via the Women’s Health Queensland Wide (WHQW) website.  This site can be found at www.womhealth.org.au/BWHN.htm Meetings are held every second month at Women’s Health Queensland Wide, situated at 165 Gregory Terrace, Spring Hill.  In addition to WHQW, current BWHN members include organisations such as those representing cancer prevention and screening, fertility control, a children’s and teenager’s service, alternative birthing, older women, endometriosis, arthritis and osteoporosis and other State Government women’s services.

     BWHN members are interested in hearing from other organisational representatives who would like to join the group, or to come along to inform members of their services, or make suggestions for improving services to women in the metropolitan area.

    For more information about the Network, please   phone   either   Jan Roberts on (07) 3636 1839,  or  Kathy Faulkner on (07) 3839 9962 from Monday to Thursday.

 

"WHY WOMEN'S HEALTH?""

We asked our members and others to make comment on the question "Why Women's Health?" Following are the responses we received:

 

“Women have gender specific conditions and disorders that deserve recognition and attention in their own right. Women experience their health issues and health care differently. Women frequently receive health care services differently. There are very many instances in the literature (and in medical practice) where men's perspectives are taken and promoted as the norm and women's views are negated, dismissed or ignored. The global and national health statistics on morbidity and mortality attest to women's differential indices that deserve specific attention. 

It has been a long hard road over many decades for women's health to rise to the surface of society's and health professions' consciousness, so we must not  allow it to fall back into the shadows.”

Professor Carol Morse, Adult Development & Ageing, Victorian University, Melbourne

 

“Women, like myself, newly settled in isolated areas can be confronted with all sorts of problems in relation to managing their own health.  In addition to geographic dislocation and all the stress that can cause, there is also a lack of information and services available.

Luckily, some isolated communities have very dedicated women’s health networks, but there will always be the perennial problem of a short fall in specialist gynaecological and obstetric services available for isolated women. This often leaves women in a precarious position in a time of crisis. Networking and a focus on women’s health can only strengthen and improve this situation.”

Sue Fitzsimmons, Tieri

 

"Because we are awesome, wondrous, vital individuals!  It is our innate right to be healthy and to express that health in any way we chose.  The only limits we have are the ones we impose on ourselves.  Don’t settle for anything less than optimum!  It is not “normal” to have headaches or PMT or “growing pains” or high blood pressure.  Inside each one of us is that wisdom to know what is naturally normal, naturally right!  Learn to listen again!”

Dr Anne Jensen, Chiropractor, Townsville

 

“In Indigenous communities: Women are the ones who take the responsibility to attend the health centres and clinics. When they attend they nearly always have a child or children with them. Women are open to information and education. When a woman attends for a well-women's check, the staff have an opportunity to pick up early pregnancies detection and early antenatal care, education and possibility of better neonatal outcomes, cervical changes precursors to CA, early onset chronic disease path, early management and intervention. Also, DV issues, infertility and STIs. These last two bring the men into the equation with consultation re infertility and contact tracing re STIs with men in community. Contact tracing for STIs brings another set of women and so on it goes.”

Sandra McElligott, Remote WH Educator, Alice Springs

 

“A special focus on Women's Health is imperative because women often neglect their own health and wellbeing to make sure their children get the medical care they need.  In areas where bulk-billing is no longer available and families cannot afford to pay for visits to the doctor and buy medicines on top of that, most mothers put aside their own health problems in favour of their children.

The special focus on women's health by Women's Health Centres enables women to access medical information free.”

Beverley McEwen, Brisbane

 

“In the remote areas of Australia, women are looked upon as the strength of the family and the heartland. The old saying ‘she’ll be alright, she just needs a good sleep’ is all too often heard. It is always the women who are there to attend to the health needs of everyone, even the animals.  But, in such situations, nobody bothers to consider the special health needs of women: exhaustion, isolation, depression and, in far too many cases, physical injuries caused by domestic violence.

The availability of specified Women’s Health Services in the remote areas are few and far between. When the family attends remote health clinics and the Royal Flying Doctor Service, time is of the essence, which usually results in the mother not expressing her problems. She thinks, ‘I will leave it till next time’, which usually never comes. The Government needs to address this urgent issue by providing more specified Women’s Health Services to rural, remote and isolated areas of our heartland.”

Sandy Kelly, Coen – Cape York

 

“Yes, a much needed focus indeed on the topic of Women’s Health. I speak in particular of women in like services that offer counseling for women and children affected by domestic and family violence. Thankfully, our service’s Management Committee strongly supports management and staff by encouraging a duty of self care as we approach 2004. Effective Team Building, developing unity and support for and of each other is highly recommended in our environment. It is therefore an essential ingredient, that supports a team as well as valued clients. I wish all good health and strength of spirit, as we endeavour to strive forth with enthusiasm amidst our passions to assist all of our clients and our colleagues.”

Rikki Kemp,The Domestic Violence Resource Service (Mackay & Region)

 

“A comment made by my 17 year old niece recently made me realise the importance of a strong focus on the health and wellbeing of women of all ages. She told me that it is common knowledge these days that in any given high school class, there will always be a couple of girls with eating disorders. When I asked her what she, her friends or the teachers are doing about this situation she informed me that they do nothing, they just ignore it because they feel there is nothing they can do about it.

In my opinion, this is totally unacceptable. A stronger focus on Women’s Health issues would ensure that appropriate information and help was available to these teenagers who, in my view, are screaming out for help.

Name and Address Withheld

 

“Many survivors of sexual abuse have spent years disconnecting from their bodies; refusing to know their bodies and being ashamed of them as a result of sexual violence.  For these reasons they have not come to know their bodies in the way health professionals urge - the concept of 'listening' to our bodies; knowing the terrain of our bodies, their rhythm etc is not possible on various levels for those with violated and wounded bodies.  For many survivors, issues such as the breast examination; pap smears; bowel and abdominal problems can go unchecked for years.  Even visiting a dentist and having one's mouth probed can be difficult.  Health campaigns and health focus on proactive medical health and preventative measures that require women to 'know' their bodies is very, very difficult for survivors.”

 Dr. S. Caroline Taylor, Post Doctoral Research Fellow, University of Ballarat

 

 

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  "Risk! Risk anything! Care no more for the opinions of others...Act for yourself. Face the truth." Katherine Mansfield (1888-1923) New Zealand/British writer.
 

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