Reflections on the e-learning platform initiative

I started this blog in July 2013 to document my learning and reflection throughout a period dedicated to supporting a group of Tanzanian organizations.  The project began in 2012 to see how to establish a mobile-optimized ePlatform for health workers in Tanzania, accessible through PC, tablet, and smart phone,  with an offline version accessible through android.

Planning – a slow job!

Almost three years have passed, and it’s time to sit back and reflect a little. The concept to date has been developed through a process of listening to people from more than 100 organizations and finding ways to build their input into what aims to be an initiative that helps everyone involved in the human resources for health landscape to better achieve their goals – not necessarily to be the best project ever – the icing on the cake – rather to be the yeast that makes the cake rise.  Almost three years have been spent building solid relationships with core organizations who were selected to be the ‘’founding partners’’. Countless discussions have taken place about the specific roles of each organization, the importance of inclusive and generous leadership from the coordinating organization, the absolute imperative of ensuring that everything we do is fully aligned with the strategies of the government, the need to look beyond the space where each organization works in order to build synergies with a whole range of other ministries, sectors and people who can help us to build a useful virtual learning community for all people who care about health and know what its like to be a health worker in Tanzania.

 

The work of preparing project documents, budgets, consortium agreements, beta versions of the eplatform, mockups of sample courses, local buy-in, senior level engagement and commitment of key consortium members – much of this has been done, and further updates will be on a new blog which will be established (‘’holding’’ blog at https://synergiesinhealth.wordpress.com/).

So with this post, I am now closing this blog – and now is the time to reflect on what has been learnt to date.

Shortly before going to catch my plane, the other day, a wise woman asked the question …”has all this time and effort been worth it, what have you or the people you have been working with actually learnt?’’

This is a question that I have spent the last couple of days thinking about – because if nothing has been learnt, then really, what would have been the point?

So here below are my thoughts so far on the learning which has taken place along the journey that began when I first got involved with Tanzania through my work at the Global Health Workforce Alliance.

A‘’good idea’’ is like a seed

1. I have learnt that a ‘’good idea’’ is like a seed. The tree that grows bears no resemblance to the seed – but without the seed, there can be no tree. I would say that the idea that resulted from time working at GHWA and the 2 initial missions to Tanzania as GHWA staff member, could account for approximately 1% of the project as it now stands. Without an idea, a project will not materialize, but the gap between having an idea and actually converting this to a real initiative is massive.

Good partnerships are based on trust

2. I have learnt that solid partnerships are built on mutual respect and trust, and are not built with organizations but with people. Building trust takes time and is not something that can be rushed.  It demands sincerity, patience and a willingness to understand others’ concerns. It requires honest efforts to see different perspectives and a willingness to at least try to help address challenges specific to each context. I have learnt that  it is not a weakness to admit to mistakes as long as there is an accompanying openness to acknowledging when things are not perfect, and a sustained desire to make improvements. I have learnt that people working in different organizations and environments have particular constraints they must deal with, and a good partner will make efforts to be empathetic and try to help to overcome obstacles so that workable solutions can be found.

People make a difference

3. I have learnt that there are a lot of people who really want to make a difference to help find sustainable solutions for causes they really care about. I have been privileged to meet a fair share of such amazing professionals living and working in Tanzania, Switzerland, Ireland, Japan, USA, UK, Spain, Argentina, Nigeria, France, Russian federation, Kuwait, China, Azerbaijan, Scotland, Denmark, India, Portugal and plenty of other places, who have given of their time generously and have shared with me their considerable knowledge and insights and have on many occasions gone out of their way to open doors to help our project move another baby step forward.

Meaningful use of technology – a game changer

4. I have learnt that technology is amazing and holds incredible potential for changing our world. I have also learnt that real change can come about not through devices, but by chosing to use them meaningfully – technology is an enabler of positive change. I have learnt that many lessons can be learnt from the patterns of usage of technology in countries who enjoy high speed wifi and who have already reached the status of information society, and these lessons can be invaluable in the exciting project of shaping technology adoption in countries who are taking their first steps into the digital age. I have learnt to believe that the road ahead is clear and that sooner than we think, the majority of people even in least developing countries will have access to the internet and if harnessed properly , we can be at a game changing moment in the history of development.

Perseverence in ensuring high standards

5. I have learnt that perseverance is needed to achieve ambitious goals. I have learnt that when standards slip, there is sometimes a need to remind ourselves that if the objective is to have a gold standard project, then delivering something that is silver standard is just not good enough. The ability to have sometimes tough conversations, I believe, is linked to having a foundation of a good relationship where all concerned understand that harsh words are sometimes needed to keep things on track, but trust that there is no intended meanness or self interest behind such words, but rather a deep and shared interest in finding the best solutions for a project which will benefit everyone.

Locally-owned solutions: the ultimate objective

6. Finally, I have learnt to believe that when people with a shared interest and passion come together with a common purpose, and are supported to collaboratively identify their own solutions,  the possibilities for success are simply boundless.

So – has it been worth it? It’s been a long road so far – it’s been a road full of potholes, ups and downs, slow and difficult at times, but with plenty of inspiring and wonderful moments, and always travelled in great company.

What lies ahead? Only time will tell – but hopefully something amazing!

How can we bring an ePlatform to life?

Photo Credit to UCA.edu Outreach and Engagment Program

I have just come back from my sixth visit to Tanzania where over the past year I have been supporting BMAF – the Benjamin William Mkapa HIV/AIDS Foundation – to develop an initiative aimed at launching an ePlatform for people working in the national health ecosystem. Earlier this week, we held a consultation with 18 organizations to get input and we will proceed with a soft launch by mid 2015 of a Moodle site which will carry learning resources aimed at educating people on relevant policies and research findings, non-medical continuous professional development, and sharing of best practices for scale up. The platform will also be used as a one-stop shop to store a searchable repository of documents and to map the many health-related events planned in Tanzania.

Working closely with BMAF, TTCIH and other health organizations in Tanzania, I presented the initiative to more than 40 organizations in the past week, including the MOH-led technical working group, the professional health associations who are already involved in this initiative, and several national and international civil society organizations, private sector and donor stakeholders. The response overall was positive and the vast majority of people, including the Ministry of Communication, Science and Technology, agreed that the time is right for such an initiative. The platform aims to become a space where people not only access information but where the community also actively engages, discusses and learns from each other. Over the past week, many people were curious to know how engagement actually happens, so while my personal experience is slightly different to what will be involved in managing a platform for an entire health ecosystem (approx. 65,000 people!), the concept is the same, so I would like to share.

The Nuts and Bolts of Community Engagement

During my time at the Global Health Workforce Alliance (GHWA), I led the development of the first ePlatform. The challenge was to convert an outdated excel file of organizations, of which very little was known, to an engaged community of professionals working in the area of human resources for health. Working with smart, motivated, digital-native interns, and a great IT developer, we designed a space which had three main objectives – to allow people to share information, to network with others in the community, and to collaborate on various issues.

We made something like 400 phone calls to people we had never had contact with, sent countless personal emails, held several information webinars and kept following up to support users, asking if they were happy with the platform, and inviting them to suggest how we might make the ePlatform more useful and relevant. Buy-in at the Secretariat level was secured through an initial training session which everyone was required to attend to learn how to use the different tools and to discuss how to incorporate the ePlatform into their work. Several people at the secretariat were persuaded to add their voice to digital skills building screencasts which were posted on the platform.

a screenshot of the GHWA community eplatform

We initiated a ‘featured member’ section which highlighted a particular health worker issue each month – told through the experience of a nominated person, with targeted outreach to relevant organizations to enrich the discussions on the platform, and lots of back and forth to ensure the featured member was comfortable with the tools.

After 8 months of intensive outreach and engagement, we had 698 people from more than 500 organizations in 91 countries, who had made 6,228 visits to the platform, sharing169 contributions to 64 blog discussions; 334 people who had watched at least one of the 34 videos, and posted 21 events.

The platform is still going strong with 1,021 members and vibrant community discussions which are being used for a public consultation to inform the global strategy on human resources for health, share the work of a range of organizations and get to know people working in the area of human resources for health.

I would love to hear from your experiences in setting up successful community engagement eplatforms. Any additional comments are very welcome and more ideas on how to really ensure that an ePlatform reflects a vibrant community and doesn’t just become another repository of static information that nobody accesses.

Being part of a virtual community

Becoming an active member of an online community can be something we dread or don’t know how to approach – even when we understand and believe in the benefits of collaboration!

In my case, I think I subconsciously rank activities in relation to my comfort level – e.g. reading updates, listening to podcasts, accessing reading material online is convenient, entertaining and easy. I enjoy the variety in the format of content and value the flexibility – that I can access them whenever and wherever etc. Furthermore, I feel safe because my role in using these resources is similar to what is expected of a student in a behaviourist model which I grew up with – more-or-less passive and invisible – getting on with things myself.

 

 

In relation to the discussion forums,from the moment I started being involved in online communities, I enjoyed reading what other people posted, but actually participating is something I have had to work hard at. Contributing in the behaviourist model is safe – because the knowledge has already been classified as ‘right’ or ‘wrong’ by the expert, so anyone who studies the material can enter a Q&A session, knowing more or less how the contribution will be received. Contributing in a learning community is somewhat of a leap into the unknown, which requires much more bravery – there is no guarantee that what we write will be accepted by the group, and let’s face it, most people do not like to be challenged publicly.  

“Understanding the implications of one’s online presence as part of practice, learning, and life in general, is a new skill to be acquired.” (Costa 2011, p.81). I believe good online students need to learn how to establish their social presence. For students to do this confidently there needs to be an accepted code of conduct which everyone accepts and understands and constructive support and guidance by the moderator to ensure learning happens. This is a delicate and difficult task. A discussion where everyone agrees with each other through politeness may end up being not so interesting, but how do we learn effective ways of challenging each other constructively to achieve those higher learning objectives that we all want? What do you think?

Community engagment at its best for Easter celebrations

From the plaza de San Roque we look on as one of the many Semana Santa processions painstakingly winds its way down the steep, twisty, cobbled hill from the high town back to its church of origin after a 12 hour circuit.

An outburst of cheers comes from a bar across the way – and equally loud groans of disappointment come from another – Madrid had scored against Barcelona in the final of the Copa del Rey – football teams based many hundreds of miles away from the viewers, but an irrelevant detail to lovers of the game.

Up the hill, we barely see the feet of some 40 men underneath the float, who are testing their strength, skill and team work to get the precious (and heavy) cargo down the hill in one piece – the gold-adorned float on which the virgin is gloriously seated.

A group of men in immaculate pressed suits, adorned with a variety of medals and religious chains are shouting commands to the feet, guiding them round the bends from the front – a job bearing huge responsibility and requiring supremely precise instructions.

Behind the float comes the band, playing the marches, and other Semana Santa music. These musicians have been practicing all year for this moment. They have lived, prayed and played together all of their lives – no conductor is needed to keep them together as they set the pace for the feet that rely on the beat of the music to move forward together. Behind the musicians, come the Nazarenos in their long tunics and high cone hats, covering everything except their eyes. The crucifix-bearing penitents follow. Then the rest – pious religious types (a couple with blind folds) and some mothers, carrying jackets and drinks for the child Nazarenos who need an extra hand to see them through the entire route.

Another shout from the bars as Barca score this time. Children add to the happy din, running around with a variety of plastic toys bought from the vendors who have set up their stands around the town. Groups of teens hang around in their going out clothes. The bars are packed – people eating, drinking, laughing, chatting  – being part of the event.

Spectators line the street as the procession continues. Some bless themselves as the virgin passes, some call out ‘’guapa!!’’, others give thumbs up to a trumpeter or drummer they know in the procession – and others still are just standing chatting.

The football fans raise the roof as Gareth Bales scores a last minute wonder goal to win the Copa del Rey for Real Madrid.

It’s a spectacular scene from the bottom of the hill – the float – illuminated by a hundred giant candles – crawling down the hill against the back drop of the floodlit castle, the musicians, nazarenos,  the throngs of people, the football fans, the kids, the teens – they all blend wonderfully together in this celebration –because this is not just about religion. This could be the most incredibly well choreographed piece of street theatre in the world –  but it’s not. There’s no director here, or producer, casting director or technical team – this is just a community being itself at Easter – the whole town is on the street, together, and every man, woman and child has the role of their own choosing. Everything and everyone has a part in this production – the pious, the musicians, the football fans, the ice cream eaters, the ones who are just there for the party. The result is something that could never be stage managed – its too complex. This can only be achieved when an entire town pulls together because they want to.

This time the procession guys take the lead, next month will be the turn of the dancers to take the lead when the Feria will take over the town, In July and August, the horsey guys will take the lead for the beach races. And the whole town will get behind each event and raise each one to the level of Spectacular – this is not only about religion, not only about dancing, not only about horses, not only about music – this is about people pulling together to respect their shared values and traditions. Each has their preference, the event that they feel passionate about – but each celebration is based on mutual respect and massive engagement. This is community engagement at its absolute best. This is what happens when people share values and purpose, when they pull together and each plays their part.

Happy Easter 2014 from Sanlucar de Barrameda!!

Is there a need to re-assess the way feedback is currently perceived in education?

While we are seeing a shift in the way teaching and learning is carried out – towards more collaborative and participative approaches – it would seem that there has been no parallel shift in relation to formative assessment and feedback.  In the same way as behaviourist pedagogical approaches positioned the teacher as the expert, giving textbook knowledge to students, it seems that the current approach to giving feedback is also largely a transmission process, where the teacher marks the students’ work as right or wrong – without serious engagement of the students.

Lately, I have been reading up on the notion of self-regulated learners, and to be honest, I find it really compelling. Of course, for this to happen, there is a need for greater educational literacy on the part of students in order for them to understand the purpose of feedback and their potential role in the process. This idea of applying a constructivist approach to feedback, I believe, would be empowering and beneficial to students.

Feedback skills in the workplace

In most work situations, there is a certain amount of teamwork involved – where different view points must be discussed and taken into consideration in order to move forward – call it input, comments, whatever – this is basically feedback. Mainstreaming peer feedback in education to the point that this would be seen as a skill is a win-win for me.

How to provide feedback to thousands of learners?

I am working on a project which proposes to offer courses to thousands of  health workers through a mobile optimized learning platform in Sub Saharan Africa. Though the project envisages capacity building of a number of professional association staff members to be ‘champions’ on the platform, we already know for sure, that there will be minimal possibilities to give in-depth, personalized feedback to each learner. For our project, it will be crucial to train learners to be effective members of a digital learning community. Learners will need to be supported to attain the necessary skills in order to understand their role as a learner within a socio constructivist system – and this will include playing an active part in giving feedback to peers.

Currently, for our project, we envisage that there will be a number of self assessments, multiple choice tests, generic feedback using a variety of media, and peer based evaluations – all of which will be saved to the learners’ portfolio and will be taken into account at the end of each course when awarding certification.  Much of the success of the platform will depend on finding ways to provide adequate support to learners so that they feel part of a learning community, become self regulating insofar as possible, and provide useful feedback so that everyone can benefit from shared knowledge and experience. It is quite a challenge – all ideas welcome!

In search of the perfect e-learning experience

A couple of years ago I did an online course on innovative collaboration for development. New content was uploaded every Friday and I had to do an assignment each week, which was graded by the course leader. There
was a discussion forum, but contribution was not mandatory and only a few people posted random thoughts over the duration of the course. I never felt part of a community of learners though I didn’t really expect this – my expectation was to learn about what tools were out there and how they could be used. Despite the minimal student support and lack of engagement with my peers, I found the course was efficiently managed and it fulfilled my need for ‘’knowledge acquisition’’ on an issue I was interested in learning about.

 E-learning: a cheaper substitute for schools?

The experience very much reinforced my belief that e-learning is an adequate and convenient substitute for ‘’real’’ classroom-based learning for people who may not have time or money to get a better bricks-and-mortar-based learning experience.

Applying my knowledge

Shortly after completing that course, I started developing a concept which included post-training learning programmes for health workers in Tanzania. I initially proposed a blended learning approach, which would combine residential courses with e-learning modules . I firmly believed that incorporating  e-learning components would offer huge cost savings, without which, courses on the scale we were proposing  would not be possible  – and I felt that people would go along with the e-part because it was being supplemented by superior in-situ training.

Change of opinion

Over the course of my M.Sc. in Blended and Online Education courses, I have been studying social constructivist pedagogy; exploring the many varied and exciting  features of Moodle and other virtual learning environments (VLEs); discussing with a host of people working in diverse organizations and trawling the internet and other resources to find evidence and examples of what is feasible for 21^st Century learners.

I am now a firm believer in the possibilities of fully online learning activities, particularly for my current objective of creating more knowledgeable and empowered professional learning communities (PLCs). I have dropped the notion of ‘’sweetening’’ online learning programmes with in-situ courses, not because of the (very real) cost effectiveness, but because I genuinely believe that with appropriate pedagogical approaches, the course objectives will be achieved just as well, if not better.

It’s not only about the course

However, just as traditional universities and training institutions need to build classrooms from bricks-and-mortar to connect with
their learners, I believe  e-learning developers need to build their communities in order for learners to engage – ‘’build the course and they will come’’ is not true!!

Prerequisites for successful digital learning experiences

In my opinion, this challenge can be achieved through age-old partnership building, and engaging champions who will drive things forward. Culturally appropriate learner-centred course development, adaptation of courses for locally available tools and technology, appropriately designed learning resources and activities based on sound socio-constructivist approaches, and support for digital learners to teach them how to use the tools and how to really participate in digital courses to achieve higher order learning – I am convinced that these are all prerequisites for successful digital learning experiences.

The yeast to make the cake rise!

Technology, and platforms such as Moodle can be like the ‘’electricity’’ that enable our efforts to be plugged in, achieving the required scale to tackle the massive challenges in  supporting communities of health workers, teachers and other professionals to become empowered, engaged and motivated life-long learners who learn from experts and from each other and become part of bigger conversations that they would normally not have access to.

Any comments would be very welcome, whether  you agree or disagree with this post – thanks!

Is There a Doctor on Board?

I flew back from Dar Es Salaam on Saturday night on the KLM flight. The 9 hour flight was pretty much as usual until about 50 minutes before the scheduled arrival time. A man, in his sixties, I would say, who had been on a trekking holiday with his daughter suddenly collapsed. The air hostess called for a doctor and about 5 arrived to the place where the man was lying still on the floor (probably a high number of doctors explained by this being somewhat of an “aid route”). They asked for a ventilation balloon which was promptly brought in addition to a defibrillator and stethoscope by the KLM staff. They got to work calmly and professionally and set about quickly giving the man CPR. They worked together to keep the man alive until we made a medical emergency landing in Amsterdam about 35 minutes later when the Dutch paramedics came on board with an ambulance outside on the runway. As someone who is acutely aware of the global shortage of health workers, (according to recent report by the Global Health Workforce Alliance there will be a worldwide gap of 12.9 million in the coming decades) it was an unexpected, up close and personal experience  which only served to reinforce my belief that shortages of health workers affect us all. Health is all of our business and we need to actively seek out our role in ensuring that our leaders plan for enough trained, supported and motivated health workers – you never know where or when you will need one. Sincere thanks to the doctors involved and the KLM staff – you were great!

E-learning: much more than tools

The proliferation of discussion boards, online communities, e-learning modules, and m-learning programmes in recent years is quite incredible. There are so many tools and gadgets scrambling to outshine each other in terms of the more and better features they offer.

It is easy to see why everyone is so excited about incorporating technology to community engagement and education activities – the potential advantages are massive. In so many cases, however, I believe that the focus has been a bit too much on the logistical possibilities or “affordances” provided by technology  and not enough attention to the pedagogical advantages which can be provided by virtual learning environments (VLEs).  The techies are everywhere but the pedagogues are very quiet.  But this is about education. Only with the increased involvement of pedagogues can we fully enable VLEs  to be used for large -scale learning and engagement. Professional educators can help ensure that VLEs deliver valid learning options in their own right,  affording opportunities to empower learning communities for  collaborative co-construction of knowledge  in a way which more traditional classes  do not always allow.

The techies have already blown our minds with statistics on how technology makes it possible to reach more people at a lower per capita cost, to reach people in remote areas, to provide flexibility for people who may be too busy to attend regular classes in a particular geographic location, to get quantifiable data on users more easily etc. etc. However, unless the pedagogical affordances related to issues such as engagement, action, collaborative-learning or information-generation are also understood and accepted, the potential opportunities may be lost leading to a sense of fatigue by potential users who are being asked to sign up to multiple snazzy-looking platforms for no real value in return (how many people sign up to courses only because they are low cost and flexible?).

Elearning or mlearning is not just about putting up content. It is about engaging learners with content and with each other to generate information which will be relevant and valuable to the whole learning community. Digital pedagogical strategies must be employed in designing programmes to achieve this, Equally important is to communicate the pedagogical benefits to students and participants and educate them on how to function confidently and effectively in a dynamic learning community empowered through a socio-constructivist approach– it is potentially so exciting but  it needs to be better understood (which can be achieved only with greater collaboration between technologists and pedagogues working together).

Presenting learning courses as technical platforms that mainly offer logistical and access advantages while under-representing the critical pedagogical foundations will make it difficult if not impossible to get beyond using e- and m-learning modules just for dry content repository and administrative tasks (which is quite common on many platforms today).

Bottom line – is positioning tech-learning modules as a mere flexible, low cost alternative to more expensive classroom-based education underselling the whole concept?

Ageing (part 4): Enjoying the golden years in the sun

What really struck me during this trip to Sanlucar, was the number of elderly people around the town.
They were definitely in the majority at the morning market – some being helped by their carers, others going about their business independently. Walking through the town, I couldn’t help noticing the high numbers of golden oldies sitting outside cafeterias enjoying a coffee (or if the time was right a cerveza and a tapita), being pushed around in their wheelchairs provided by the town hall, or motoring independently in their mobility scooters.

On the beach, I regularly saw a senior or someone with some kind of disability being brought out of the water to the showers in a specially adapted water chair with paddles, helped by the young guys and girls from the civil protection unit. Others parked their wheelchairs in shaded huts, reading the newspaper in the biblioplaya (the beach library), or took part in the aqua aerobics class in the water in front of one of the chiringuitos (beach bars). Who needs golden years city, I think, when the whole world can just be adapted for people with special needs.

Dependent on the dependency law

I started discussing with some people involved in caring for the elderly, who painted a picture which is a little grimmer than the impression I have built up. There is a lot of talk about the reform of the ley de dependencia – a law that was passed in 2006, when the public coffers were full, aimed at ensuring the needs of people with special needs related to  illness or age would be addressed. Practically all of what I saw in Sanlucar, it seems, was achieved during this period when there was a will to build a more inclusive society and money to pay for it.  Footpaths in the centre of town were adapted for the wheelchairs which were made available to anyone who needed one, ramps were built almost everywhere, several gimnasios de la calle were built around town and on the wonderful paseo maritimo (beach promenade), next to the cycling path. Allowances were paid to care givers who would spend a few hours a week with old people in their homes- doing a bit of cleaning, cooking, chatting and of course an excursion to the morning market etc etc. Now however, Spain is one of the economies strapped for cash and it looks like all of these initiatives will soon be a thing of the past.

It seems such a pity to lose the benefits of the ley de dependencia and all the progressive measures put in place during the boom years. To me, as an onlooker, and having spoken to many people who enjoyed the investment in the city, it looks like it was a success. They managed to make practically the whole town accessible to everyone of all ages, mainstreaming old age and disability!

The Florida of Europe

Instead of putting a stop to this and viewing it as a luxury which is only possible in the good times, surely it should be recognised as proof that it is possible to create a society where everyone’s needs are considered –  a golden opportunity to do the right thing, providing inclusive care for our seniors and vulnerable members of society  as part of our social responsibility to look after everyone – and encourage others to enjoy it as well.  Luis Garicano recently proposed some legislative changes to make Spain the Florida of Europe in a fedablog post. Seeing the old people around Sanlucar this summer, I would say it is definitely worth considering …great place, great weather, fantastic food, would surely appeal to many seniors if appropriate healthcare were also available….creating plenty of employment in the process . I would definitely spend several months a year there in my old age…though I think I will continue with my Chinese classes just in case, and head for Yanda if there are no suitable options closer to home!

Ageing (part 3): “To see what is right and not to do it is want of courage”

During my recent trip to Beijing I saw an ad on TV for Yanda International Health city. It showed footage of  the ‘Golden Age Health Nursing Center’ situated in a glitzy-looking complex just 30 km outside Beijing catering  for  12,000 over-60’s.

      I looked up the website and marvelled at  photos of men and women in their 70’s and 80’s doing tai chi, dancing and all sorts of fun-looking activities that I wouldn’t normally have associated with residents of a nursing home.

             I contacted the center to request a visit,  explaining that I had never come across anything of this scale before and was interested to know how it worked. The administrator clarified that the nursing center is indeed being developed as a 12,000 bed complex, but the development is in the early phase and to date only 2,000 are available. This was still a lot bigger than any nursing homes I had come across before, so I very happily accepted the offer of a tour of the complex the following day.

My birthday buddies – celebrating on 19 June!

                     I began the visit at 8 am on Saturday morning starting off with a tour of the various accommodation options for residents, which include independent, semi-assisted or assisted living space, depending on the individual’s  level of mobility and state of general health.  Everything seemed as advertised on TV – the onsite college, the vast games room, the onsite restaurants and all the other services on offer. Though it was early, there were people around – including some kids splashing about in the pool which is open to visiting families at weekends. We went to one of the nurses’ stations with high-tech monitoring equipment and they told me about the future plans to make further use of new technologies to enable a certain amount of self-care for residents. Care draws from western medical techniques as well as traditional Chinese medicine and is very much based on the holistic view that  all needs must be catered for – dietary, social, physical, intellectual, and spiritual (theres a church, mosque and temple on site).

                            What appealed to me about the golden age nursing home were the possibilities offered by such a large-scale initiative, There are many nursing homes and sheltered accommodation schemes in Europe but they generally cater for no more than 100 people, and logically cannot provide facilities  such as those  on offer in a place the size of Yanda.  I also liked the focus of Yanda as a place to actually enjoy the golden years – not as a last resort for people who have no one to look after them.

Do we need bigger facilities to cater for more people?

                           In my native Ireland, it is estimated that by 2021, the number of people aged 65+ in need of residential long term care will rise by 12,270 – an increase of 59% since 2006. Increased demand for this type of care will rise similarly all across Europe. How can these people be catered for with currently available facilities?

                          Do we need to update our thinking on care for the elderly and find more and better solutions to ensure enough appropriate, caring, compassionate, and fun environments where we can be sure the golden years are actually enjoyed?

                           Making size one of the criteria for new facility development could also allow for greater variety of activities and interests, greater opportunities to meet like minded peers, and a greater sense of community which may not necessarily be achievable in a 100 bed  facility where death is constantly lurking in the next bed or the room down the corridor.

Do you have to be rich to grow old with dignity?

                          This Yanda facility is  targeting wealthy locals and foreigners – but is it a model  for everyone, achieved perhaps through public private partnerships?

                             Did Confucius intend that  harmony should be achieved through strict regulation, clinging to century-old practices, forcing young people to tailor their lives around obligations to their ageing parents ? Or did he intend that people should be open  and courageous in adapting practices and updating views to continually seek optimal solutions for all in a changing world?