Collaborative practice in Australian maternity settings Focus on rural and remote practice - Free Essay Example

Sample details Pages: 9 Words: 2705 Downloads: 10 Date added: 2017/06/26 Category Medicine Essay Type Essay any type Did you like this example? In the context of maternity care, collaboration is defined as a shared partnership between a birthing woman, midwives, doctors and other members of a multidisciplinary team (National Health Medical Research Council, 2010). Collaborative practice is based on the philosophy that multidisciplinary teams can deliver care superior to that which could be provided by any one profession alone (National Health Medical Research Council, 2010). Indeed, there is evidence to suggest that collaborative maternity practice does improve outcomes for women, including both clinical outcomes and consumer satisfaction with care (Hastie Fahy, 2011). Don’t waste time! Our writers will create an original "Collaborative practice in Australian maternity settings: Focus on rural and remote practice" essay for you Create order Collaborative practice is particularly important in Australian rural and remote maternity settings, which are characterised by fragmented, discontinuous care provision (Downe et al., 2010). As such, both the Code of Ethics for Midwives in Australia (for midwives and obstetric nurses) and the Collaborative Maternity Care Statement (for obstetricians and other doctors) require that a collaborative model of care be adopted in Australian maternity settings. However, inconsistencies between and among midwives and doctors about the definition of collaboration, and subsequent ineffective collaborative practice, remain key causes of adverse outcomes in maternity settings in Australia (Hastie Fahy, 2011; Heatley Kruske, 2011). This paper provides a critical analysis of collaborative practice in Australian rural and remote maternity settings. Rural and remote maternity care in Australia It is estimated that one-third of birthing women in Australia live outside of major metropolitan centres à ¢Ã¢â€š ¬Ã¢â‚¬Å" defined for the purpose of this paper as rural and remote regions (National Health Medical Research Council, 2010). However, the number of facilities offering maternity care to women in these regions is just 156 and declining (2007 estimate) (Australian Government Department of Health, 2011). Australian research suggests that the decreasing number of rural and remote maternity services is resulting in more women having high-risk, unplanned and unassisted births outside of medicalised maternity services (Francis et al., 2012; McLelland et al., 2013); indeed, one recent study drew a direct correlation between these two factors (Kildea et al., 2015). Additionally, statistics suggest that both maternal and neonatal perinatal mortality rates in Australia are highest in rural and remote regions (Australian Government Department of Health, 2011). High perinatal m ortality rates and lack of services in rural and remote communities mean that many rural and remote women are transferred to metropolitan centres, often mandatorily, for birth (Josif et al., 2014). This system has resulted in fragmented, discontinuous care for many rural and remote women à ¢Ã¢â€š ¬Ã¢â‚¬Å" which is itself a poor outcome (National Health Medical Research Council, 2010; Sandall et al., 2015). Many women find such models of care to be significantly disempowering, which again may result in poorer outcomes (Josif et al., 2014). Indeed, many women, and particularly Aboriginal women, may resist engaging with medicalised maternity services to avoid being transferred off-country for birth (Josif et al., 2014). Furthermore, those women who are transferred off-country for birth bear a significant financial, social and cultural burden (Dunbar, 2011; Evans et al., 2011; Hoang Le, 2013). Australian maternity services reform In response to these issues, in 2009 the Australian government commenced a major reform of maternity care. This reform included attempts to shift maternity services provided to rural and remote women to more collaborative, continuous, community-centred models (Francis et al., 2012). These new models of care require midwives to work collaboratively with general practitioners, obstetricians and rural doctors to care for a rural or remote woman in her own community to the greatest extent possible (McIntyre et al., 2012a). Evidence suggests that rural and remote women desire to be cared for in their local communities provided the maternity services offered are safe (Hoang Le, 2013). Indeed, there is evidence to suggest that women, and particularly Aboriginal women, who birth within their communities have an increased likelihood of positive outcomes (Commonwealth of Australia, 2009). However, the National Guidance on Collaborative Maternity Care, which resulted from the government refo rms, notes there are a number of unique and significant challenges to achieving collaborative practice in rural and remote community settings (National Health Medical Research Council, 2010). Collaborative care in Australian maternity settings à ¢Ã¢â€š ¬Ã¢â‚¬Å" challenges and complexities The fundamental aim of collaborative services in Australia is the provision of woman-centred care, where women are empowered to be active partners in the provision of their care (National Health Medical Research Council, 2010). It is well-established that the delivery of woman-centred care in a maternity setting produces the best outcomes, in terms of both clinical outcomes and consumer satisfaction with care (Pairman et al., 2006). In a recent Australian study, Jenkins et al. (2015) suggest that collaboration is fundamental in the achievement of woman-centred care in rural and remote settings in terms of continuity of care à ¢Ã¢â€š ¬Ã¢â‚¬Å" including consistency in communication between care providers à ¢Ã¢â€š ¬Ã¢â‚¬Å" across often vast geographical regions. However, conflicting definitions and interpretations of the concept of woman-centred care between midwives and doctors are a key barrier to achieving collaborative practice in Australian maternity settings (Lane, 2006). The se problems are magnified in rural and remote settings, where transfers of care between midwives and doctors often occur abruptly when women are transported off-country to deliver (Lane, 2012). Differences in understandings of the concept of woman-centred care between midwives and doctors à ¢Ã¢â€š ¬Ã¢â‚¬Å" and, therefore, impairments to effective collaboration à ¢Ã¢â€š ¬Ã¢â‚¬Å" are underpinned by midwives and doctors differing perceptions of risk in childbirth. Indeed, a study by Beasley et al. (2012) identified incompatible perceptions of best-practice strategies to mitigate risk as the key factor underpinning the lack of collaborative practice between midwives and doctors in Australian maternity settings. Whilst midwives focus on normalcy, wellness and physiology in birth, doctors place an emphasis on intervention à ¢Ã¢â€š ¬Ã¢â‚¬Å" both valid approaches to risk mitigation in birth, but fundamentally contradictory (Lane, 2006; Beasley et al. 2012; Downe et al., 2010; Lane 200 6). These differing philosophies of care have resulted in increasing tensions in maternity settings, and this has been exacerbated by sensationalist media reporting, particularly following the Senate Inquiries into Media Reform of 2008/09 (Beasley et al., 2012). The concept of risk is particularly important in rural and remote settings, given the decision to transfer a woman off-country is often made on the basis of risk. The reforms to the Australian maternity system à ¢Ã¢â€š ¬Ã¢â‚¬Å" including the introduction of the Nurses and Midwives Act 2009 à ¢Ã¢â€š ¬Ã¢â‚¬Å" have resulted in significant increases to midwives scope of practice and autonomy (National Health Medical Research Council, 2010; Beasley et al., 2012). This is particularly important in rural settings, where midwives are often required to be specialist generalists with a diverse suite of clinical skills (Gleeson, 2015). However, this expansion in midwives scope has further challenged the achievement of collaborati ve practice in Australian maternity settings. Tensions have occurred because doctors often perceive themselves to be solely accountable for the outcomes of maternity care and, therefore, legally vulnerable when practicing under midwifery-led models of care focusing in risk-mitigation strategies to which they may be unaccustomed or opposed (Lane, 2006; Beasley et al., 2012). These issues are particularly obvious in rural and remote maternity settings, where the referral of the care of birthing women by midwives to doctors may occur primarily during obstetric emergencies. Doctors in Australia have been particularly vocal about the fact that there is poor evidence to support the safety of midwifery-led models of care, including in rural and remote maternity settings (Boxall Flitcroft, 2007). The expansion in midwives scope of practice has also challenged the achievement of collaborative practice in Australian maternity settings in other ways. Australian research suggests doctors fe ar the expansion of midwives scope will result in them becoming redundant in, and therefore, excluded from maternity settings, and that a decline in clinical outcomes will result (Lane, 2012). As noted by Barclay and Tracy (2010), despite the recent increases to midwives scope of practice, both midwives and doctors continue to have a distinct scope in terms of caring for a birthing woman and both remain legally bound to practice within this scope. However, many doctors continue to oppose the reforms to the maternity system on the basis of changes in midwives scope à ¢Ã¢â€š ¬Ã¢â‚¬Å" and also because these reforms may not be evidence based, may fail to meet the needs of women (and particularly the unique needs of rural and remote women), and are driven by service providers rather than consumers (Boxall Flitcroft, 2007; McIntyre et al., 2012b; Hoang Le, 2013). Again, doctors opposition to changes in midwives scope significantly impairs the achievement of collaborative practice in Au stralian maternity settings. These issues are further complicated by the fact that Commonwealth law now requires midwives practicing in Australia to have collaborative arrangements with a medical practitioner if they are to receive Medicare-provider status (Barclay Tracy, 2010). This particularly affects private-practice midwives practicing in rural and remote areas of Australia. However, as noted by Lane (2012), such legislation à ¢Ã¢â€š ¬Ã¢â‚¬Å" which effectively forces midwives and doctors into a collaborative relationship à ¢Ã¢â€š ¬Ã¢â‚¬Å" is fundamentally inconsistent with the concept of collaboration as a professional relationship based on equity, trust and respect. Further, these reforms impose collaboration and compel midwives and doctors to form collaborative relationships are unworkable in many rural and remote maternity settings. Often, midwives practicing in these settings work with doctors who are fly-in fly-out locums, who are on temporary placements or who are l ocated in regional centres many hundreds of kilometres away, making the establishment of genuine collaborative relationships a highly complex process (Barclay Tracy, 2010). Collaborative care in Australian maternity settings à ¢Ã¢â€š ¬Ã¢â‚¬Å" opportunities and achievement Despite these significant issues, however, research suggests that collaboration can be achieved in Australian rural and remote maternity settings. The first step in achieving collaboration in this context is for both midwives and doctors to undergo a shift in perception with regards to each others professional roles and boundaries (Lane, 2006; McIntyre et al., 2012a). This will particularly involve doctors increasing acceptance of midwives expanding role in rural and remote maternity care provision. Rural and remote maternity services in particular provide positive examples of midwifery-led models of maternity care providing maternity services which are both safe and effective (McIntyre et al., 2012a); indeed, one study concludes that shared but midwifery-led models are the best way to achieve continuity of care in rural and remote maternity settings (Francis et al., 2012). Therefore, evidence from these models may be used to bolster doctors confidence in the efficacy of midwifery- led approaches to maternity care. However, for this to be achieved, incompatibilities in care philosophies between midwives and doctors must be overcome. This may commence with midwives and doctors recognising that both professions share the same basic goal of achieving the best outcomes for women (Lane, 2006). Communication is also fundamental to the achievement of collaborative practice in Australian maternity settings (National Health Medical Research Council, 2010). Indeed, Lane (2012) notes that effective communication between midwives and doctors is one of the minimal conditions which must be met if collaborative practice in maternity settings is to be achieved. However, there are a range of barriers to effective communication between midwives and doctors in rural and remote maternity settings, the most significant of which is geographical distance. Telehealth, which involves the use of telecommunication technologies to facilitate communication between clinicians à ¢Ã¢â€š ¬Ã¢â‚¬Å" and particularly those who care for priority consumers such as mothers and babies à ¢Ã¢â€š ¬Ã¢â‚¬Å" in geographically diverse regions of Australia may be useful in promoting collaborative practice in rural and remote maternity settings (Australian Nursing Federation 2013). The National Health Medical Research Council (2010) also identifies written documentation à ¢Ã¢â€š ¬Ã¢â‚¬Å" including pregnancy records, care pathways and a transfer / retrieval plan à ¢Ã¢â€š ¬Ã¢â‚¬Å" to be important in fostering collaborative practice in in rural and remote maternity settings. Collaboration, or practice based on a shared partnership between a birthing woman, midwives, doctors and other members of a multidisciplinary team, results in improves outcomes for birthing women. As such, codes of practice for both midwives and doctors in Australia require that collaborative practice be utilised in Australian maternity settings. Research evidence suggests that due to the unique challenges posed by rural and remote maternity settings in Australia, collaborative practice is particularly important in this context. However, in Australia in general à ¢Ã¢â€š ¬Ã¢â‚¬Å" and in rural and remote maternity settings in particular à ¢Ã¢â€š ¬Ã¢â‚¬Å" collaborative practice is both lacking and challenging to achieve. This paper has provided a critical analysis of collaborative practice, with a particular focus on Australian rural and remote maternity settings. It has concluded that whilst it may be challenging to achieve, collaboration in Australian rural and remote maternity settings can à ¢Ã¢â€š ¬Ã¢â‚¬Å" and, indeed, should à ¢Ã¢â€š ¬Ã¢â‚¬Å" be achieved in order to promote the best outcomes for birthing women in these regions. References Australian Government Department of Health, (2011), Provision of Maternity Care, accessed 02 October 2015, https://www.health.gov.au/internet/publications/publishing.nsf/Content/pacd-maternityservicesplan-toc~pacd-maternityservicesplan-chapter3#Rural%20and%20remote%20services Australian Nursing Federation, (2013), Telehealth standards: Registered midwives, accessed 02 October 2015, https://crana.org.au/files/pdfs/Telehealth_Standards_Registered_Midwives.pdf Barclay, L Tracy, SK, (2010), Legally binding midwives to doctors is not collaboration, Women Birth, vol. 23, no. 1, pp. 1-2. Beasley, S, Ford, N, Tracy, SK Welsh, AW, (2012), Collaboration in maternity care is achievable and practical, Australia New Zealand Journal of Obstetrics Gynaecology, vol. 52, no.6, 576-581. Boxall, AM Flitcroft, K, (2007), From little things, big things grow: A local approach to system-wide maternity services reform in the absence of definitive evidence, Australia New Zealand Health P olicy, vol. 4, no. 1, p. 18. Commonwealth of Australia, (2009), Improving Maternity Services in Australia: The Report of the Maternity Services Review, accessed 02 October 2015, https://www.health.gov.au/internet/main/publishing.nsf/content/624EF4BED503DB5BCA257BF0001DC83C/$File/Improving%20Maternity%20Services%20in%20Australia%20-%20The%20Report%20of%20the%20Maternity%20Services%20Review.pdf Downe, S, Finlayson, K Fleming, A, (2010), Creating a collaborative culture in maternity care, Journal of Midwifery Womens Health, vol. 55, no. 3, pp. 250-254. Dunbar, T, (2011), Aboriginal peoples experiences of health and family services in the Northern Territory, International Journal of Critical Indigenous Studies, vol. 4, no. 2, pp. 2-16. Evans, R, Veitch, C, Hays, R, Clark, M Larkins, S, (2011), Rural maternity care and health policy: Parents experiences, Australian Journal of Rural Health, vol. 19, no. 6, pp. 306-311. Francis, K, McLeod, M, McIntyre, M, Mills, J, M iles, M Bradley, A (2012), Australian rural maternity services: Creating a future or putting the last nail in the coffin?, Australian Journal of Rural Health, vol. 20, no. 5, pp. 281-284. Gleeson, G (2015), Contemporary midwifery education focusing on maternal emergency skills in remote and isolated areas, Australian Nursing Midwifery Journal, vol. 22, no. 11, p. 48. Hastie, C Fahy, K (2011), Interprofessional collaboration in delivery suite: A qualitative study, Women Birth, no. 24, vol. 2, pp. 72-79. Heatley, M Kruske, S (2011), Defining collaboration in Australian maternity care, Women Birth, no. 24, vol. 2, pp. 53-57. Hoang, H Le, Q (2013), Comprehensive picture of rural womens needs in maternity care in Tasmania, Australia, Australian Journal of Rural Health, vol. 21, pp. 197-202. Jenkins, MG, Ford, JB, Todd, AL, Forsyth, R, Morris, J Roberts, CL (2015), Womens views about maternity care: How do women conceptualise the process of continuity?, Midwifery, v ol. 31, no. 1, pp. 25-30. Josif, CM, Barclay, L, Kruske, S Kildea, S (2014), No more strangers: Investigating the experience of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women in northern Australia, Midwifery, vol. 30, no. 3, pp. 317-323. Kildea, S, McGhie, AC, Ghao, Y, Rumbold, A Rolfe, M (2015), Babies born before arrival to hospital and maternity unit closures in Queensland and Australia, Women Birth, vol. 28, no. 3, pp. 236-245. Lane, K (2006), The plasticity of professional boundaries: A case study of collaborative care in maternity services, Health Sociology Review, vol. 15, no. 4, pp. 341-352. Lane, K (2012), When is collaboration not collaboration? When its militarized, Women Birth, vol. 25, no. 1, pp. 29-38. McIntyre, M, Francis, K Champan, Y (2012a), The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care, Midwifery, vol. 28, no. 3, pp. 298-305. McIntyre, M, Francis, K Chapman, Y (2012b), Primary maternity care reform: Whose influence is driving the change?, Midwifery, vol. 28, no. 5, pp. 705-711. McLelland, G, McKenna, L Archer, F (2013), No fixed place of birth: Unplanned BBAs in Victoria, Australia, Midwifery, vol. 29, no. 1, pp. 19-25. National Health and Medical Research Council (2010), National Guidance on Collaborative Maternity Care, accessed 02 October 2015, https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/CP124.pdf Pairman, S, Pincombe, J, Thorogood, C Tracy, S (2006), Midwifery: Preparation for Practice, Churchill Livingstone Elsevier, Sydney. Sandall, J, Soltani, H, Gates, S, Shennan, A Declan, D (2015), Midwife-led continuity models versus other models of care for childbearing women, Cochrane Database of Systematic Reviews, accessed 02 October 2015, https://onlinelibrary.wiley.com.ezp01.library.qut.edu.au/doi/10.1002/14651858.CD004667.pub4/abstract

Speech Analysis Gettysburg Address - 1006 Words

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Assisi Essay Example For Students

Assisi Essay Critical Evaluation-AssisiA poem that I have been studying recently is Assisi by Norman McCaig, which I found very interesting to read because it made a statement which relates to our world today even though the poem was wrote about thirty or forty years ago. The poem has lots of ideas including effective figures of speech, good choice of words, important images and irony. The statement that McCaig makes is, where ever there is great wealth it always exists along side great poverty. The poem is set in Assisi in Italy around the 1970s were all the rich tourists are coming in hundreds from all different countries far and wide to see the frescoes painted by Giotto in Assisis huge cathedral. McCaig mainly focuses on the dwarf outside of the three-tier cathedral built in honour of St. Francis. McCaig then proceeds to the priest guiding the tourists around the cathedral telling them the history of Giottos frescoes and how they individually teach people the goodness of God and the suffering of his son. McCaig uses effective littery techniques to describe the tourists and to describe the dwarf. He then goes on to explain that the tourists are not studying the frescoes and are just there to boast about being there. Then he goes on to tell of the dwarfs voice when he says Grazie for the money one of the tourists have given to him outside the cathedral. McCaig uses juxtaposition by situating the dwarf outside of the huge three tier cathedral. McCaig also refers to the dwarf as a ruined temple. By saying this he creates a huge contrast between the dwarf and the cathedral, he also uses irony to compare the dwarf to St. Francis were he says: Outside the three tiers of churches built in honour of St. Francis, brother of thepoor, talker with birds, over whomhe had the advantage of not being dead yet. This is saying that the dwarf had an advantage over one group of people, the dead. I think that it was a good idea to situate the dwarf outside the huge cathedral and create the image of a great, strong, beautifully designed building standing over a small, weak, deformed person. McCaig gives the reader a graphic description of the dwarf in both stanzas 1 and 3 where he uses many littery techniques to describe the dwarf. In stanza 1 he uses alliteration, simile and metaphor to give the reader a graphic view of the dwarfs deformed body: The dwarf with his hands on backwardssat, slumped like a half-filled sackon tiny twisted legs from whichsawdust might run. He uses alliteration to say things like, sat slumped and tiny twisted, these two pieces of text give a good view of the dwarfs way of sitting and his little weak legs. The simile used is, Slumped like a half-filled sack. This tells me that the dwarf had no strength to keep himself up straight and every time he sat down his back got closer to the ground. McCaig also uses a metaphor to tell you of the dwarfs legs, Tiny twisted legs from which sawdust might run. Here he is speaking about the dwarf as if he was an old teddy bear, he is saying that his legs are so worn out that sawdust might run from them, this is what happened to the teddy bears in the late 19th centaury, they were filled with sawdust and if they wore away the sawdust would run out. In stanza 3 McCaig called the dwarf a ruined temple., this gives the image of the dwarf who is battered and bruised and over the years he has begun to rot since no one has been looking after him. McCaig says this because the dwarf has been living around the huge cathedral for many years and is now wearing away. McCaig goes on to give more details of the dwarfs appearance:whose eyes,wept pus, whose back was higher than his head, whose lopsided mouthAll of these properties of the dwarf are very brutal, McCaig says this to make the reader feel pity for the dwarf but surprisingly McCaig goes on to tell how the dwarf had a voice as sweet as a childs: Said Grazie in a voice as sweet as a childs when she speaks to her mother. .u58165c95f71c5ac26f9b8b66d6631235 , .u58165c95f71c5ac26f9b8b66d6631235 .postImageUrl , .u58165c95f71c5ac26f9b8b66d6631235 .centered-text-area { min-height: 80px; position: relative; } .u58165c95f71c5ac26f9b8b66d6631235 , .u58165c95f71c5ac26f9b8b66d6631235:hover , .u58165c95f71c5ac26f9b8b66d6631235:visited , .u58165c95f71c5ac26f9b8b66d6631235:active { border:0!important; } .u58165c95f71c5ac26f9b8b66d6631235 .clearfix:after { content: ""; display: table; clear: both; } .u58165c95f71c5ac26f9b8b66d6631235 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u58165c95f71c5ac26f9b8b66d6631235:active , .u58165c95f71c5ac26f9b8b66d6631235:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u58165c95f71c5ac26f9b8b66d6631235 .centered-text-area { width: 100%; position: relative ; } .u58165c95f71c5ac26f9b8b66d6631235 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u58165c95f71c5ac26f9b8b66d6631235 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u58165c95f71c5ac26f9b8b66d6631235 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u58165c95f71c5ac26f9b8b66d6631235:hover .ctaButton { background-color: #34495E!important; } .u58165c95f71c5ac26f9b8b66d6631235 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u58165c95f71c5ac26f9b8b66d6631235 .u58165c95f71c5ac26f9b8b66d6631235-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u58165c95f71c5ac26f9b8b66d6631235:after { content: ""; display: block; clear: both; } READ: Profession for Women EssayI think McCaig does this to give the reader an element of surprise by giving the dwarf such a sweet voice when the reader would expect a rough, deep voice, McCaig uses very good figures of speech in these both stanzas describing the dwarf. In stanza 3 there is an extended metaphor comparing the tourists to hens:A rush of tourists, clucking contentedly, fluttered after him as he scattered the grain of the word. McCaig uses this metaphor to show that the tourists are rushing after the priest because he is spreading the word of God, he compares the tourists to hens who are following the farmer as if he is scattering grain. This also shows that the tourists did not pay much attention to Giottos frescoes which told stories of God. This leads to the tourists devaluing the life and work of Christ. I think that McCaig has made a very clear image of the tourists and that he makes very good use of the metaphor by extending it. Throughout the poem there is the use of irony and sarcasm, the first piece of irony used is in stanza 1 were he compared the three tier cathedral built in honour of St. Francis to the little deformed dwarf. The next piece of irony is in stanza 2 were McCaig tells us that the priest is spending his time guiding rich tourists round the cathedral showing of Giottos frescoes instead of spending time with the people who need it most. The next and last piece of irony I will highlight is in stanza 3 were the dwarf is sitting outside the cathedral which was built to friend the poor begging. This is a good littery technique used by McCaig were he compares the cathedral which was supposedly built for the poor to the poor dwarf who is begging to the rich tourists. McCaig then goes on to use sarcasm when he compares the dwarf to St. Francis and says: He had the advantage of not being dead yet. This is true but the dwarf has nothing to live for and would most probably want to be dead. I think tha t these two techniques which were used by McCaig were really useful in describing the scenes he is trying to show the reader of the poem. In stanza 3 McCaig gives the reader the one and only experience of the dwarfs voice, from the way McCaig has vividly described the dwarf you would expect him to have a rough, deep voice but it is not:Whose lopsided mouth said Grazie in a voice as sweet as a childs when she speaks to her mother or a birds when it spoke to St. Francis. Once again McCaig bring St. Francis into the poemby comparing one of the birds voice when it spoke to St. Francis to the dwarfs voice as he says Grazie. This shows that McCaig is a good writer because he can use so many littery techniques to create a poem of this class. I have chosen a poem and studied it carefully, identified the littery techniques used. I looked at such ideas as effective figures of speech, choice of words, important images, irony. I have also showed how the poet has made the social comment:Where ever there is great wealth it always exists along side great poverty. Words/ Pages : 2,094 / 24