Republic of Ireland’s Primary Care Strategy: An Analysis

Republic of Ireland’s Primary Care Strategy: An Analysis Primary Care Strategy Introduction â€Å"Primary care is the first point of contact that people have with the health and personal social services.†[1] This means that primary care must be sufficiently well developed to be able to address the most complex and diverse range of health-related challenges and problems that will manifest in healthcare service provision, and make the most of opportunities to promote health and reduce morbidity, across the general population in specific target groups. This essay will explore the Republic of Ireland’s primary care strategy in relation to key goals and targets, and also examine some elements of the strategy in terms of a SWOT analysis. Specific reference will be made to the role of the Specialist Public Health Nurse/Health Visitor Role. Main Body Primary Care can be defined as â€Å"first contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system.†[2] Primary care is about the provision of information, diagnosis, treatment, referral and support for the majority of people who access healthcare services for the first time, and the strategic concerns of primary are related to accessibility, provision of short and long-term care which meets the needs of the population, assessment of those needs, and coordination of services to meet those needs[3]. This has many implications for the provision of healthcare services and the management of increasingly scarce resources. However, it is evident from the literature that in most locations, primary healthcare services still have a long way to go in meeting the goals of primary healthcare itself, particularly in relation to improving integration of services and reorienting services to a person-centred model, rather than a disease-centred model. Primary healthcare is viewed as a means of reducing the use of and demand for overall healthcare services by acting as a gatekeeper for secondary healthcare, and as a means of primary prevention of healthcare problems and disease, particularly in high risk groups of the population, but there is ongoing evidence and debate within the academic literature that there are continuing issues about the lack of egalitarian access to such services and ongoing questions about the ways in which they are provided[4]. It is considered by some that the decisions which govern the design and delivery of primary care services are potentially more based on political drivers than true patient need[5]. Similarly, the gateway function of the primary care service in determining which patients have access to acute care (or secondary care) services may not be based on individual need, but on other factors, such as political, social and even personal factors, including prejudices on the part of healthcare professionals[6]. The primary care strategy, if it provides strong guidance which leads to strong leadership, and perhaps enhances management of care through the use of agreed care pathways which guide decision making, might help eradicate some of these factors. Making the person-centred care model central will also help to remove some of the barriers to egalitarian service provision[7]. However, one of the challenges of the Republic of Ireland model is the fact that two thirds of patients in primary care must pay for their care, which would mean that despite the focus on removing inequalities in access, there continue to be challenges for providing equality of acces s[8]. One of the strengths of the primary care strategy is the focus on improving interprofessional working and communications, as a means of streamlining use of services and preventing doubling up or overlap of services[9]. Improving interprofessional working at the primary care level is one thing, but the strategy also needs to ensure that the intersection between primary and secondary care is properly managed, and that patients moving from acute care settings into community settings continue to have a streamlined, person-centred model of care applied, with good continuity of care[10]. However, there is also a need for the provision of strong leadership, which supports the implementation of the changes associated with this re-orientation of primary care in Ireland, and which supports new ways of working and helps to break down the barriers between the professions[11], [12]. This is where the role of the Health Visitor can be examined in a little more detail, in relation to realising some of the goals of the Primary Care Strategy, and in addressing some of the challenges of this. It has long been the case that Health Visitors work across professional boundaries, and work closely with a range of other health professionals, because within the community, specialist and generic roles are equally required in supporting individual patient need[13]. The interprofessional interface is perhaps one of the most fundamental elements of the work of the Health Visitor, but at the same time is perhaps not given enough attention or credit in terms of the impact that Health Visitors have in the prevention of illness and public health sectors of primary healthcare[14], [15]. The Public Health focus of the primary care strategy is inherent in much of the rhetoric it contains, particularly as it expressly cites the potential for preventive strategies to reduce overall healthcare resource use[16]. It is here that the Health Visitor’s role perhaps has the greatest scope, and should be more strongly underlined, as this is a great resource for change. Research shows that the role of the health visitor is paramount and unparalleled, in reducing risk related behaviours, improving health outcomes, promoting healthy lifestyles and engaging in the more challenging areas of the health/social car interface[17], [18], [19]. However, there is also some evidence to suggest that nurses and, in particular, health visitors, have a key role to play in expanding and delivering the public health dimension of primary care[20]. In particular, the development of improved partnerships in health and social care may be made possible through the role of such nurses, who have the broader community knowledge as well as specialist knowledge of key areas of public health[21]. These partnerships can be developed with a focus on the quality of care provision, not just the identification of need[22], [23], [24]. However, managing the development of improved partnerships, and achieving the goals of the Strategy, is going to be challenging during the transition period, and there may be a degree of uncertainty over roles and boundaries[25]. It might be that Health Visitors are in a prime position to provide the leadership required during such a time. Conclusions and Recommendations. Below is a summary of a brief SWOT analysis of the primary care strategy and isome of its potential implications. Table 1 SWOT analysis of Primary Care (with Reference to the Republic of Ireland Primary Health Strategy[26]) This shows that while there are issues with weaknesses and threats, many of these are the kind that have been present within the primary arena for some time, and it will take good leadership, and good use of existing skills and resources, to achieve the goals of the strategy. While the primary care focus for healthcare services is laudable, there is still the overwhelming need for good resourcing, more clarity about provision, and clear guidance on how to move forward to achieve these goals. Making use of existing roles, such as that of the Health Visitor, whose work crosses the intersections of care at so many points in the primary care sector, could improve quality of care, reduce the impact of the change and transition, and also set standards for the future to increase interprofessional communication and partnership. Certainly it should not be assumed that the strategy will eradicate all the existing problems about the provision of primary care in Ireland, and those problems must still be addressed in future provision[30]. References 213615 Allen, P. (2000) Accountability for clinical governance: developing collective responsibility for quality in primary care. British Medical Journal 321: 608–611. Barlow, J., Davis, H., McIntosh, E. et al (2007) Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation Archives of Disease in Childhood 92 229-233. Campbell, S.M., Roland, M.O., Middleton, E. and Reeves, D. (2005) Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study. BMJ 12;331(7525):1121 Carr, S.M. (2007) Leading change in public health – factors that inhibit and facilitate energizing the process. PrimaryHealth Care Research and Development. 8 207-215. Chavasse, J. (1998) Policy as an influence on public health nuse education in the Republic of Ireland. Journal of Advanced Nursing 28 (1) 172-177. Chavasse, J. (1995) Public Health Nursing in the Republic of Ireland. Nursing Review 14 (1) 4-8. Currie, G. and Suhomlinova, O. (2006) The Impact of Institutional Forces Upon Knowledge Sharing in the UK NHS: The Triumph of Professional Power and the Inconsistency of Policy. Public Administration 84 (1) 1-30. Department of Health and Children (2001) Primary Care: a New Direction. Available from: http://www.dohc.ie/publications/pdf/primcare.pdf?direct=1 Accessed 10-11-08. Douglas, F., van Teijlingen, E., Torrance, N. et al (2006) Promoting physical activity inprimary care settings: health visitors’ and practice nurses’ views and experiences. Journal of Advanced Nursing 55 (2) 159-168. Dunnion, M.E. Kelly, B. (2005) From the emergency department to home Journal of Clinical Nursing 14 776-785. Ewles, L. (2005). Key Topics in Public Health. London. Churchill Livingstone. Jackson, C., Coe, A., Cheater, F.M. and Wroe, S. (2007) Specialist health visitor-led weight management intervention in primary care: exploratory evaluation Journal of Advanced Nursing 58 (1) 23-34. Lordan, G. (2007) What determines a patient’s treatment? Evidence from out of hours primary care co-op data in the Republic of Ireland. Health Care Management and Science 10 283-292. McGregor, P., Nolan, A., Nolan, B. and O’Neill, C. (2007) A comparison of GP visiting in Northern Ireland and the Republic of Ireland. ESRI Working Ppaper Avaialble from www.esri.ie Accessed 10-11-08. McMurray, R. and Chester, F. (2003) Partnerships for health: expanding the public health nursing role within PCTs. Primary Health Care Research and Development4 57-65. Masterson, A. (2002) Cross-boundary working: a macro-political analysis of the impact on professional roles. Journal of Clinical Nursing 11 331-339. Mitchell, P.S., Schaad, D.C, Odegard, P.S. Ballweg, R.A. (2006) Working across the boundaries of health professions disciplines in education, research and service: the University of Washington experience. Academic Medicine 81 (10) 891-896. O’Dowd, A. (2005) Uncertainty over reorganisation is destabilising primary care. BMJ331 1164 Price, B. (2006) Exploring person-centred care. Nursing Standard 20 (50) 49-56. Rummery, K. and Coleman, A. (2001) Primary health and social care services in the UK: progress towards partnership? Social Science Medicine 56 (8) 1773-1782 Stanley, D., Reed, J. Brown, S. (1999) Older people, care management and interprofessional practice. Journal of Interprofessional Care 13 (3) 229-237. Starfield, B. (1994) Is primary care essential The Lancet 344 1129-1133. Thomas, P., Graffy, J., Wallace, P. (2006) How Primary Care Networks Can Help Integrate Academic and Service Initiatives in Primary Care Annals of Family Medicine 4:235-239. Vernon, S., Ross, F. Gould, M.A. (2000) Assessment of older people: politics and practice in primary care. Journal of Advanced Nursing 31 (2) 282-287. Watkins, D., Edwards, J. Gastrell, P. eds. (2003). Community Health Nursing: Frameworks for Practice. 2nd ed. p.35. London, Baillià ¨re Tindall. 1 Footnotes [1] Department of Health and Children (2001) p 7. [2] Starfield, B. (1994) [3] Starfield (ibid) [4] Vernon, S., Ross, F. Gould, M.A. (2000) [5] Vernon (ibid) [6] Starfield (ibid). [7] Price, B. (2006) [8] McGregor, P., Nolan, A., Nolan, B. and O’Neill, C. (2007) [9] Stanley, D., Reed, J. Brown, S. (1999) [10] Dunnion, M.E. Kelly, B. (2005) [11] Carr, S.M. (2007) [12] Currie, G. and Suhomlinova, O. (2006) [13] Watkins, D., Edwards, J. Gastrell, P. eds. (2003). [14] Ewles, L. (2005). [15] Jackson, C., Coe, A., Cheater, F.M. and Wroe, S. (2007) [16] Department of Health and Children (ibid). [17] Barlow, J., Davis, H., McIntosh, E. et al (2007) [18] McMurray, R. and Chester, F. (2003) [19] Douglas, F., van Teijlingen, E., Torrance, N. et al (2006) [20] McMurray (ibid) [21] McMurray (ibid) [22] Allen, P. (2000) [23] Campbell, S.M., Roland, M.O., Middleton, E. and Reeves, D. (2005) [24] Rummery, K. and Coleman, A. (2001) [25] O’Dowd, A. (2005) [26] Department of Health and Children (ibid). [27] Masterson, A. (2002) [28] Mitchell, P.S., Schaad, D.C, Odegard, P.S. Ballweg, R.A. (2006). [29] Thomas, P., Graffy, J., Wallace, P. (2006) [30] Lordan, G. (2007)

John Proctor in The Crucible :: Essay on The Crucible

Crucible Paper The Puritans had many values that everyone must know and completely obey. One of those values is to know, and obey the Ten Commandments. The Ten Commandments were one of the most important things for all Puritans to know and obey, because without them there would be no order. For a Puritan not to know his Commandments by heart was nearly unheard of seeing how the Commandments are the basic rules for them. Although almost all of the Puritans knew the Commandments there were a few who didn’t know them all by heart. John Proctor was one of these who didn’t know them all by heart. Its not just the fact that he didn’t know them all by heart that lets him fit into the category of not being a good Puritan because he lacks the Puritan characteristic of knowing and obeying the Ten Commandments. One way he shows that he doesn’t obey the Ten Commandments is the fact the he rarely attends church anymore. This is breaking one of the Ten Commandments, ‘Th ou shall remember the Sabbath Day and keep it Holy’ this Commandment states that on every Sunday you must attend church. Yet John doesn’t, which isn’t following what he should do. Another example of not obeying the Commandments is by having an affair with Abigail, who was his housekeeper and who happened to be eleven at the time. In committing this act he directly disobeyed the Commandment ‘Thou shall not commit adultery’. This Commandment states that when one is married to someone they should only be active among themselves. The finally way John shows that he is not a good Puritan is by not knowing all the Commandments when asked to say them by Mr. Hale. John says them all but adultery. These three things made John Proctor ‘an unworthy Christian’ by Puritan standards. When John was asked to repeat the Ten Commandments by Mr. Hale he was off to a good start but he forgot adultery completely and said one twice (page 63-64). This shows Mr. Hale that in fact John doesn’t know the Commandments, which means he is not a good Puritan. The reason for Mr. Hale’s presents at Proctor’s house was because Elizabeth Proctor, John’s wife, was accused of witchcraft early that day at court. Hale didn’t come representing the courts, but purely to gain knowledge of the people of Salem so that he may gain knowledge of how to get rid of the Devil if he truly is in Salem.

A Literature Analysis Essay

Joyce Carol Oates attributes the creation of â€Å"Where Are You Going? Where Have You Been? † to Bob Dylan’s â€Å"It’s All Over Now, Baby Blue† and the article she read â€Å"about a killer in the American Southwest†, she also considered â€Å"the legends and folk songs connected with the subject of â€Å"Death and the Maiden†Ã¢â‚¬â„¢ when creating this story (Latta 1). Oates was well known for writing about â€Å"the spiritual, sexual, and intellectual decline of modern American society† writing about such issues as suicide, rape and murder (eNotes. com, sect.2). Oates was also interested in exploring the various aspects of adolescence through her writing (Schwartz, 1). Critics have widely argued over the influences of â€Å"Where Are You Going? Where Have You Been? † and the true identity of Arnold Friend. Little attention has been given to the music incorporated into the story and the obvious similarities of the antagonist, Arnold Friend to legendary singer, Bob Dylan. This essay will explore Bob Dylan’s musical influence on â€Å"Where Are You Going? Where Have You Been? † by interpreting the song, â€Å"It’s All Over Now, Baby Blue† and the similarities between the two as well as identifying physical characteristic similarities between Dylan and Friend. Oates dedicated this story to Bob Dylan; which gives interpreters of this story just cause to assume Dylan’s music during the 1960s greatly influenced the characters and scenes of â€Å"Where Are You Going? Where Have You Been? † Critics however do not agree as to who Arnold Friend represents. Most critics feel that Arnold represents the devil and evil, such as Joyce Wegs’ and Marie Urbanski who argue that Arnold is evil and his outward appearance represents the devil. Some critics however feel that Arnold represents a religious or cultural savior (Jordan). It is unrealistic to think that Arnold Friend is any savior such as Mike Tierce and John Michael Crafton suggest in â€Å"Connie’s Tambourine Man: A New Reading of Arnold Friend† (Jordan). It seems most likely that Arnold is a creation of Oates which had the appearance of Bob Dylan because she was inspired by him which many critics have already noted. Another argument made by a small portion of critics is that Arnold didn’t really exist but was rather a figment of Connie’s imagination such as McConnell states in â€Å"Connie’s Tambourine Man: A New Reading of Arnold Friend† where he writes, â€Å"Connie is the framer, the story creator—and the diabolic traces in her fiction frighten her not because they are the manifestations of an outside evil but because they are the symbolic extrapolations of her own psyche† (1). There is no reason to think that Connie, a fifteen year old girl would imagine such a threatening older person. When Connie daydreams, she thinks of â€Å"the caresses of love† and boys such as the one she met the night before Arnold Friend showed up at the door. Connie daydreamed about â€Å"how nice [the boy] had been†, and Connie continues thinking of how sweet being with this boy had been. She related her experience to be like the movies and the way it was â€Å"promised in songs† (339). Connie was a young girl living her life according to the music, and she would not have daydreamed something as threatening and terrifying as Arnold Friend. While critics may disagree to what Arnold represents; there is significant evidence that Arnold was created to look, but not necessarily be, Bob Dylan. Arnold Friend’s physical description is that of Bob Dylan’s appearance in the 1960s. Oates makes reference to the radio DJ, Bobby King, which is in â€Å"reference to â€Å"Bobby† Dylan, the â€Å"king† of rock-and-roll† (McConnell, 1). McConnell also supports the theory that Arnold looks like Bob Dylan, with his â€Å"shaggy, shabby black hair that looked crazy as a wig,† (Oates, 340) his â€Å"long and hawk-like nose,† (Oates, 342) and his unshaven face. Arnold also had â€Å"big and white† teeth, his lashes, â€Å"thick and black as if painted with a black tar-like material† (Oates, 344) and his size, â€Å"only an inch or so taller† (Oates, 341) than Connie are all characteristic of Bob Dylan. Arnold â€Å"spoke in a fast, bright monotone† voice which â€Å"is also ‘suggestive of Dylan, especially since he speaks’ â€Å"in a simple lilting voice, exactly as if he were reciting the words to a song†Ã¢â‚¬â„¢ (Oates, 342) (McConnell, 1). When Connie became suspicious of his age, before she realized the danger she was in, small clues confirmed her feelings that he was indeed an older man. He used a mix of slang â€Å"as if he were running through all the expressions he’d learned but was no longer sure which of them was in style†. Arnold used his lyrical voice and pieces of lyrics from songs to confuse, comfort and then scare Connie. Connie recognized many of the lyrics used. Michael Kapper accurately portrays the influence of music in Connie’s life. Kapper writes, Rock’n’roll music is a constant presence in Connie’s life. At the drive-in, the background music is â€Å"something to depend on† (Oates, 337), and on Sunday afternoon, with no drive-in and no boys around, the music itself gives Connie joy. This omnipresence is even noteworthy in the music’s absence (1). It is important to decipher the similarities between â€Å"Where Are You Going? Where Have You Been? † and Bob Dylan’s â€Å"It’s All Over Now, Baby Blue†. While there are several other songs that are similar to the overall theme of Oates’ story, â€Å"It’s All Over Now, Baby Blue† has substantial similarities and support from several critics. The reoccurring lyric in â€Å"It’s All Over Now, Baby Blue† (Dylan) is â€Å"†¦it’s all over now†. Arnold Friend spends the majority of the time at Connie’s house explaining to her that her life as she knows it is over; at the end he says â€Å"it’s all over for you here, so come out† (349). Connie and her friend were very trusting and unaware of the consequences of their actions. Connie and friend risked crossing the highway to be able to act like adults, and â€Å"†¦listen to the music that made everything so good† (337). Dylan sings of the risks of living on the edge in â€Å"It’s all Over Now, Baby Blue†, warning that â€Å"the highway is for gamblers, better use your sense† (7). Connie gambles with her life both by crossing a busy highway and by trusting people she does not know. Arnold tells Connie that her time in her home was over, telling Connie, â€Å"†¦they don’t know anything about you and never did and honey you’re better than them because not a one of them would have done this for you† (Oates, 350). Arnold also makes himself look as if he is a saint saving Connie from her family who does not understand her. This is also present in â€Å"It’s All Over Now, Baby Blue†, where Dylan sings â€Å"look out the saints are comin’ through† (5). Dylan sings that â€Å"The carpet, too, is moving under you† (17), this must be what Connie felt when she realized Arnold was a â€Å"forty-year-old baby† (Oates, 344) and when she realized that she would not see her mother or sleep in her bed again. In the final few verses of Dylan’s song it states; â€Å"leave your stepping stones behind, something calls for you. Forget the dead you’ve left, they will not follow you† (19. 20). Oates’ story echoes Dylan’s song. Connie is leaving her home where she has learned and grown such as stepping stones and she will never see her family again; whether she dies or must stay with Arnold Friend against her will is personal interpretation. Arnold Friend however made it clear that she would not return. It is evident from the wealth of literary analyses that Joyce Carol Oates’ story â€Å"Where Are You Going? Where Have You Been? † will continue to have mixed interpretations of its characters, influence and overall theme. It is undeniable however, from Oates’ dedication of the story to Bob Dylan and the overwhelming similarities of â€Å"It’s All Over Now, Baby Blue† to Oates’ story that both the story and Oates was heavily influenced by Bob Dylan visible in both the antagonist’s characteristics, the choice of words and the overall importance of music to the characters and theme of the story. References â€Å"It’s All Over Now, Baby Blue†. Lyrics. Sony NY BMG Music Entertainment. (2007). 31 August 2007 Jordan, Tonia. â€Å"Who Is Arnold Friend? † Ezinearticles. com. (2006). 1 September 2007 Kapper, Michael, C. â€Å"A Virgin in the Backseat Smoking Hash: Joyce Carol Oates’s â€Å"Where are You Going, Where Have You Been? † The Joyce Carol Oates Papers. (1996). 1 September 2007 Latta, Alan, D. â€Å"Spinell and Connie: Joyce Carol Oates Re-Imagining Thomas Mann? † Connotations 9. 3 (1999/2000): 316-29. 31 August 2007. < ht tp://www. uni-tuebingen. de/uni/nec/latta93. htm> McConnell, Leigh. â€Å"Connie’s Tambourine Man†. Blog. (2007). 31 August 2007. http://conniestambourineman. blogspot. com/2007/07/connies-tambourine-man. html â€Å"Oates, Joyce Carol: INTRODUCTION. † Short Story Criticism. Ed. Joseph Palmisano Project Editor. Vol. 70. Gale Group, Inc. , 2004. eNotes. com. 2006. 30 Aug, 2007 oates-joyce-carol> Schwartz, Aaron. The Story â€Å"Where Are You Going, Where Have You Been? † by Joyce Carol Oates. Ezinearticles. com. (2007). 30 August 2007 http://ezinearticles. com/? The-Story-Where-Are-You-Going,-Where-Have-You-Been? -by-Joyce-Carol-Oates&id=324443 Showalter, Elaine. â€Å"Where Are You Going, Where Have You Been? â€Å". Rutgers UP: New Jersey. (1994). 30 August 2007 http://jco. usfca. edu/where. html

Helen Keller, Deaf and Blind Spokesperson and Activist

Helen Keller, Deaf and Blind Spokesperson and Activist Helen Adams Keller (June 27, 1880–June 1, 1968) was a groundbreaking exemplar and advocate for the blind and deaf communities. Blind and deaf from a nearly fatal illness at 19 months old, Helen Keller made a dramatic breakthrough at the age of 6 when she learned to communicate with the help of her teacher, Annie Sullivan. Keller went on to live an illustrious public life, inspiring people with disabilities and fundraising, giving speeches, and writing as a humanitarian activist. Fast Facts: Helen Keller Known For:  Blind and deaf from infancy, Helen Keller is known for her emergence from isolation, with the help of her teacher Annie Sullivan, and for a career of public service and humanitarian activism.Born:  June 27, 1880 in Tuscumbia, AlabamaParents: Captain Arthur Keller and Kate Adams KellerDied:  June 1, 1968 in Easton ConnecticutEducation: Home tutoring with Annie Sullivan, Perkins Institute for the Blind, Wright-Humason School for the Deaf, studies with Sarah Fuller  at the  Horace Mann School for the Deaf, The Cambridge School for Young Ladies, Radcliffe College  of  Harvard UniversityPublished Works: The Story of My Life,  The World I Live In,  Out of the Dark, My Religion,  Light in My Darkness, Midstream: My Later LifeAwards and Honors:  Theodore Roosevelt  Distinguished Service Medal in 1936, Presidential Medal of Freedom in 1964, election to the Womens Hall of Fame in 1965, an honorary Academy Award in 1955 (as the inspiration for the documentary about her life), countless honorary degreesNotable Quote: The best and most beautiful things in the world cannot be seen, nor touched ... but are felt in the heart. Early Childhood Helen Keller was born on June 27, 1880, in Tuscumbia, Alabama to Captain Arthur Keller and Kate Adams Keller. Captain Keller was a cotton farmer and newspaper editor and had served in the Confederate Army during the Civil War. Kate Keller, 20 years his junior, had been born in the South, but had roots in Massachusetts and was related to founding father John Adams. Helen was a healthy child until she became seriously ill at 19 months. Stricken with an illness that her doctor called brain fever, Helen was not expected to survive. The crisis was over after several days, to the great relief of the Kellers. However, they soon learned that Helen had not emerged from the illness unscathed. She was left blind and deaf. Historians believe that Helen had contracted either scarlet fever or meningitis. The Wild Childhood Years Frustrated by her inability to express herself, Helen Keller frequently threw tantrums that included breaking dishes and even slapping and biting family members. When Helen, at age 6, tipped over the cradle holding her baby sister, Helens parents knew something had to be done. Well-meaning friends suggested that she be institutionalized, but Helens mother resisted that notion. Soon after the incident with the cradle, Kate Keller read a book by Charles Dickens about the education of Laura Bridgman. Laura was a deaf-blind girl who had been taught to communicate by the director of the Perkins Institute for the Blind in Boston. For the first time, the Kellers felt hopeful that Helen could be helped as well. The Guidance of Alexander Graham Bell During a visit to a Baltimore eye doctor in 1886, the Kellers received the same verdict they had heard before. Nothing could be done to restore Helens eyesight. The doctor, however, advised the Kellers that Helen might benefit from a visit with the famous inventor Alexander Graham Bell in Washington, D.C. Bells mother and wife were deaf and he had devoted himself to improving life for the deaf, inventing several assistive devices for them. Bell and Helen Keller got along very well and would later develop a lifelong friendship. Bell suggested that the Kellers write to the director of the Perkins Institute for the Blind, where Laura Bridgman, now an adult, still resided. The director wrote the Kellers back, with the name of a teacher for Helen: Annie Sullivan. Annie Sullivan Arrives Helen Kellers new teacher had also lived through difficult times. Annie Sullivan had lost her mother to tuberculosis when she was 8. Unable to care for his children, her father sent Annie and her younger brother Jimmie to live in the poorhouse in 1876. They shared quarters with criminals, prostitutes, and the mentally ill. Young Jimmie died of a weak hip ailment only three months after their arrival, leaving Annie grief-stricken. Adding to her misery, Annie was gradually losing her vision to trachoma, an eye disease. Although not completely blind, Annie had very poor vision and would be plagued with eye problems for the rest of her life. When she was 14, Annie begged visiting officials to send her to school. She was lucky, for they agreed to take her out of the poorhouse and send her to the Perkins Institute. Annie had a lot of catching up to do. She learned to read and write, then later learned braille and the manual alphabet (a system of hand signs used by the deaf). After graduating first in her class, Annie was given the job that would determine the course of her life: teacher to Helen Keller. Without any formal training to teach a deaf-blind child, 20-year-old Annie Sullivan arrived at the Keller home on March 3, 1887. It was a day that Helen Keller later referred to as my souls birthday. A Battle of Wills Teacher and pupil were both very strong-willed and frequently clashed. One of the first of these battles revolved around Helens behavior at the dinner table, where she roamed freely and grabbed food from the plates of others. Dismissing the family from the room, Annie locked herself in with Helen. Hours of struggle ensued, during which Annie insisted Helen eat with a spoon and sit in her chair. In order to distance Helen from her parents, who gave in to her every demand, Annie proposed that she and Helen move out of the house temporarily. They spent about two weeks in the annex, a small house on the Keller property. Annie knew that if she could teach Helen self-control, Helen would be more receptive to learning. Helen fought Annie on every front, from getting dressed and eating to going to bed at night. Eventually, Helen resigned herself to the situation, becoming calmer and more cooperative. Now the teaching could begin. Annie constantly spelled words into Helens hand, using the manual alphabet to name the items she handed to Helen. Helen seemed intrigued but did not yet realize that what they were doing was more than a game. Helen Kellers Breakthrough On the morning of April 5, 1887, Annie Sullivan and Helen Keller were outside at the water pump, filling a mug with water. Annie pumped the water over Helens hand while repeatedly spelling â€Å"w-a-t-e-r† into her hand. Helen suddenly dropped the mug. As Annie later described it, a new light came into her face. She understood. All the way back to the house, Helen touched objects and Annie spelled their names into her hand. Before the day was over, Helen had learned 30 new words. It was just the beginning of a very long process, but a door had been opened for Helen. Annie also taught her how to write and how to read braille. By the end of that summer, Helen had learned more than 600 words.   Annie Sullivan sent regular reports on Helen Kellers progress to the director of the Perkins Institute. On a visit to the Perkins Institute in 1888, Helen met other blind children for the first time. She returned to Perkins the following year and stayed for several months of study. High School Years Helen Keller dreamed of attending college and was determined to get into Radcliffe, a womens university in Cambridge, Massachusetts. However, she would first need to complete high school. Helen attended a high school for the deaf in New York City, then later transferred to a school in Cambridge. She had her tuition and living expenses paid for by wealthy benefactors. Keeping up with school work challenged both Helen and Annie. Copies of books in braille were rarely available, requiring that Annie read the books, then spell them into Helens hand. Helen would then type out notes using her braille typewriter. It was a grueling process. Helen withdrew from the school after two years, completing her studies with a private tutor. She gained admission to Radcliffe in 1900, making her the first deaf-blind person to attend college. Life as a Coed College was somewhat disappointing for Helen Keller. She was unable to form friendships both because of her limitations and the fact that she lived off campus, which further isolated her. The rigorous routine continued, in which Annie worked at least as much as Helen. As a result, Annie suffered severe eyestrain. Helen found the courses very difficult and struggled to keep up with her workload. Although she detested math, Helen did enjoy English classes and received praise for her writing. Before long, she would be doing plenty of writing. Editors from Ladies Home Journal offered Helen $3,000, an enormous sum at the time, to write a series of articles about her life. Overwhelmed by the task of writing the articles, Helen admitted she needed help. Friends introduced her to John Macy, an editor and English teacher at Harvard. Macy quickly learned the manual alphabet and began to work with Helen on editing her work. Certain that Helens articles could successfully be turned into a book, Macy negotiated a deal with a publisher and The Story of My Life was published in 1903 when Helen was only 22 years old. Helen graduated from Radcliffe with honors in June 1904. Annie Sullivan Marries John Macy John Macy remained friends with Helen and Annie after the books publication. He found himself falling in love with Annie Sullivan, although she was 11 years his senior. Annie had feelings for him as well, but wouldnt accept his proposal until he assured her that Helen would always have a place in their home. They were married in May 1905 and the trio moved into a farmhouse in Massachusetts. The pleasant farmhouse was reminiscent of the home Helen had grown up in. Macy arranged a system of ropes out in the yard so that Helen could safely take walks by herself. Soon, Helen was at work on her second memoir, The World I Live In, with John Macy as her editor. By all accounts, although Helen and Macy were close in age and spent a lot of time together, they were never more than friends. An active member of the Socialist Party, John Macy encouraged Helen to read books on socialist and communist theory. Helen joined the Socialist Party in 1909 and she also supported the womens suffrage movement. Helens third book, a series of essays defending her political views, did poorly. Worried about their dwindling funds, Helen and Annie decided to go on a lecture tour. Helen and Annie Go on the Road Helen had taken speaking lessons over the years and had made some progress, but only those closest to her could understand her speech. Annie would need to interpret Helens speech for the audience. Another concern was Helens appearance. She was very attractive and always well dressed, but her eyes were obviously abnormal. Unbeknownst to the public, Helen had her eyes surgically removed and replaced by prosthetic ones prior to the start of the tour in 1913. Prior to this, Annie made certain that the photographs were always taken of Helens right profile because her left eye protruded and was obviously blind, whereas Helen appeared almost normal on the right side. The tour appearances consisted of a well-scripted routine. Annie spoke about her years with Helen and then Helen spoke, only to have Annie interpret what she had said. At the end, they took questions from the audience. The tour was successful, but exhausting for Annie. After taking a break, they went back on tour two more times. Annies marriage suffered from the strain as well. She and John Macy separated permanently in 1914. Helen and Annie hired a new assistant, Polly Thomson, in 1915, in an effort to relieve Annie of some of her duties. Helen Finds Love In 1916, the women hired Peter Fagan as a secretary to accompany them on their tour while Polly was out of town. After the tour, Annie became seriously ill and was diagnosed with tuberculosis. While Polly took Annie to a rest home in Lake Placid, plans were made for Helen to join her mother and sister Mildred in Alabama. For a brief time, Helen and Peter were alone together at the farmhouse, where Peter confessed his love for Helen and asked her to marry him. The couple tried to keep their plans a secret, but when they traveled to Boston to obtain a marriage license, the press obtained a copy of the license and published a story about Helens engagement. Kate Keller was furious and brought Helen back to Alabama with her. Although Helen was 36 years old at the time, her family was very protective of her and disapproved of any romantic relationship. Several times, Peter attempted to reunite with Helen, but her family would not let him near her. At one point, Mildreds husband threatened Peter with a gun if he did not get off his property. Helen and Peter were never together again. Later in life, Helen described the relationship as her little island of joy surrounded by dark waters. The World of Showbiz Annie recovered from her illness, which had been misdiagnosed as tuberculosis, and returned home. With their financial difficulties mounting, Helen, Annie, and Polly sold their house and moved to Forest Hills, New York in 1917. Helen received an offer to star in a film about her life, which she readily accepted. The 1920 movie, Deliverance, was absurdly melodramatic and did poorly at the box office. In dire need of a steady income, Helen and Annie, now 40 and 54 respectively, next turned to vaudeville. They reprised their act from the lecture tour, but this time they did it in glitzy costumes and full stage makeup, alongside various dancers and comedians. Helen enjoyed the theater, but Annie found it vulgar. The money, however, was very good and they stayed in vaudeville until 1924. American Foundation for the Blind That same year, Helen became involved with an organization that would employ her for much of the rest of her life. The newly-formed American Foundation for the Blind (AFB) sought a spokesperson and Helen seemed the perfect candidate. Helen Keller drew crowds whenever she spoke in public and became very successful at raising money for the organization. Helen also convinced Congress to approve more funding for books printed in braille. Taking time off from her duties at the AFB in 1927, Helen began work on another memoir, Midstream, which she completed with the help of an editor. Losing Teacher and Polly Annie Sullivans health deteriorated over several years time. She became completely blind and could no longer travel, leaving both women entirely reliant on Polly. Annie Sullivan died in October 1936 at the age of 70. Helen was devastated to have lost the woman whom she had known only as Teacher, and who had given so much to her. After the funeral, Helen and Polly took a trip to Scotland to visit Pollys family. Returning home to a life without Annie was difficult for Helen. Life was made easier when Helen learned that she would be taken care of financially for life by the AFB, which built a new home for her in Connecticut. Helen continued her travels around the world through the 1940s and 1950s accompanied by Polly, but the women, now in their 70s, began to tire of travel. In 1957, Polly suffered a severe stroke. She survived, but had brain damage and could no longer function as Helens assistant. Two caretakers were hired to come and live with Helen and Polly. In 1960, after spending 46 years of her life with Helen, Polly Thomson died. Later Years Helen Keller settled into a quieter life, enjoying visits from friends and her daily martini before dinner. In 1960, she was intrigued to learn of a new play on Broadway that told the dramatic story of her early days with Annie Sullivan. The Miracle Worker was a smash hit and was made into an equally popular movie in 1962. Death Strong and healthy all of her life, Helen became frail in her 80s. She suffered a stroke in 1961 and developed diabetes. On June 1, 1968, Helen Keller died in her home at the age of 87 following a heart attack. Her funeral service, held at the National Cathedral in Washington, D.C., was attended by 1,200 mourners. Legacy Helen Keller was a groundbreaker in her personal and public lives. Becoming a writer and lecturer with Annie while blind and deaf was an enormous accomplishment. Helen Keller was the first deaf-blind individual to earn a college degree. She was an advocate for communities of people with disabilities in many ways, raising awareness through her lecture circuits and books and raising funds for the American Foundation for the Blind. Her political work included helping to found the American Civil Liberties Union and advocacy for increased funding for braille books and for womens suffrage. She met with every U.S. president from  Grover Cleveland to Lyndon Johnson. While she was still alive, in 1964, Helen received the highest honor awarded to a U.S. citizen, the Presidential Medal of Freedom, from President Lyndon Johnson. Helen Keller remains a source of inspiration to all people for her enormous courage overcoming the obstacles of being both deaf and blind and for her ensuing life of humanitarian selfless service. Sources: Herrmann, Dorothy. Helen Keller: A Life. University of Chicago Press, 1998. Keller, Helen. Midstream: My Later Life. Nabu Press, 2011.

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