sábado, 15 de enero de 2011

Anatomy of a School Crisis

Anatomy of a School Crisis

Angel Valentin for The New York Times; David Goldman for The New York Times
José Maldonado-Rivera, the founding principal of Columbia Secondary school, and a newspaper clipping showing Nicole Suriel, 12-year-old student drowned on a day trip to a Long Island beach.
THE auditorium at Columbia Secondary School was packed one evening last month. In the balcony, students held placards calling for the return of Dr. M — the founding principal, José Maldonado-Rivera, who had been dismissed the day before. Below, parents spilled over into standing room. One rose to speak in favor of the dismissal, only to be shouted down. Another rebuked the acting principal for reading from notes.
David Goldman for The New York Times
In June, Lucille Camp and her daughter Phoenix, 9, visited a memorial at Columbia Secondary for Nicole Suriel, 12, who drowned on a field trip to a Long Island beach.
At a school where close to half of the students come from Spanish-speaking homes, the fact that there was no designated translator fanned the flames. As the administrators spoke in English, the crowd grew increasingly restive. Finally, a woman stood and delivered a rapid-fire tirade in Spanish. “She’s not very happy about the situation,” translated Roxana Bosch, the school’s associate director of admissions and parent relations. The shorthand would have been laughable, if emotions had not been running so high.
Dr. Maldonado-Rivera, the charismatic and controversial head of Columbia, a four-year-old selective school in Harlem, had weathered an investigation last summer into the drowning of a sixth grader on a field trip to a Long Island beach. Now, just as the school seemed to be regaining its footing after that tragedy, its leader had been dismissed for having what city officials called “an inappropriate financial relationship” with the school’s former parent coordinator, Monica Marin-Reyes. Ms. Marin-Reyes had baby-sat for Dr. Maldonado-Rivera’s son without charging, and later lived, rent-free, in his apartment; that they are now in a romantic relationship added spice to the reports splashed across the news media.
The school was a high-profile startup with backing from Columbia University. Its students performed well on state tests, and its teachers earned accolades from education watchdogs. Its mission was to wed two of the highest aspirations of the public school system — excellence and equality of opportunity — in a combined middle school and high school devoted to science, math and engineering, where the children of new immigrants living in Washington Heights would share classrooms with the children of university professors. The school was supposed to be “part of this brand-new world,” as one parent put it. How had it become engulfed by tumult instead?
Conversations with more than two dozen parents, current and former teachers and students, as well as with Dr. Maldonado-Rivera, Ms. Marin-Reyes and Andrew Stillman, the assistant principal at the time of the drowning, show that there were always fissures underlying the strong statistics at Columbia. The episode exposed them, and acted like a kaleidoscope that — depending on how it was turned — revealed radically different perspectives. Turn it one way, and the principal was a visionary brought low by Department of Education bureaucrats; turn it another, and he was a dangerous autocrat whose disdain for the rules finally caught up with him.
Throughout its history, the school had faced financial challenges — partly because Dr. Maldonado-Rivera, who had never taught in a New York City public school, never mind run one, was caught off guard by a drop in city funding; and partly because of its ambitious program, including a rich range of experiential learning adventures each June.
Open houses for potential students have been packed, and each year the school gets hundreds more applications than it has seats. But annual teacher turnover has run as high as 40 percent, and on a 2009-10 Department of Education survey, 70 percent of the teachers responding disagreed with the statements “The principal is an effective manager who makes the school run smoothly” and “I trust the principal at his or her word.”
The School Leadership Team, a group of parents and faculty that is supposed to help shape Columbia’s development, grew increasingly divided, participants said: differing over discipline, supervision and, ultimately, over the very idea of whether students from vastly different backgrounds could succeed in the same accelerated curriculum.
“José has a very spontaneous leadership style,” was how Mr. Stillman, now a teacher at the school, put it. “He didn’t manage the school like a bureaucrat.”
“He’s a Svengali,” said Ruth Margeson, whose son is an eighth grader. “He can weave a web, and you can get stuck in it.”
IN the beginning, parents remember, Dr. Maldonado-Rivera issued a simple yet profound invitation: “Come build a school with me.”
Columbia Secondary started with the bold goal of drawing a student body that mirrored the racially diverse population of Upper Manhattan, while maintaining a selectivity and curriculum that would challenge the best schools in the city. Most of New York’s elite public schools enroll few black and Hispanic students (5 percent at Stuyvesant High School, 11 percent at Bronx Science), and there are also high-performing schools likeFrederick Douglass Academy in Harlem where fewer than 1 percent of the students are white.
At the middle-school level, Columbia is open to children who live or attended elementary school north of 96th Street. To get in, students must get a 3 or a 4 (out of a possible 4) on the state’s English Language Arts and math exams in fourth grade, and then compete on an essay test. Black and Hispanic families of Harlem and Washington Heights felt as if the school was opening a door that had long been shut. The mostly white and middle-class families of the Upper West Side found the marriage of racially mixed classes and high expectations appealing.
Todd Heisler/The New York Times
Andrew Stillman, the assistant principal then and a teacher now, said critics of the principal exploited the tragedy.
Susan Farley for The New York Times
Chance Nalley, a math teacher, left the school in the summer.
From the beginning, Dr. Maldonado-Rivera, a passionate educator with a Ph.D. in science education who had most recently been working in private schools in Puerto Rico, had grand plans: Before classes even began, he told parents he was writing a book about the school. One recalled thinking, “If José can deliver on 60 or 70 percent of what he says he’ll do, it will be a good experience.” The principal read every entrance exam, called each of the families whose children had been accepted the first year and freely handed out his cellphone number.
Opening in 2006 with 96 sixth graders, in part of an old school building, Columbia was intimate and exciting. At potluck dinners, families mingled. In engineering class, children built catapults and had a marshmallow-shooting contest. Among the electives were things like outdoor survival skills — the school got a permit to start a fire in the snow in nearby Morningside Park.
If it seemed that they were making things up on the fly, that was all right. “We all knew that when we signed up,” said Christine Stute, whose son was part of that first class. “And I think the group of people that decided to sign up was a special kind of group because they were willing to take these risks.”
The capstone to the year was the June J-Term, when students would fan out on field assignments, studying a single subject in depth. Dr. Maldonado-Rivera took about two dozen to Puerto Rico, a trip that Malaga Baldi, who went along with her daughter, remembers as “outrageous, fantastic.” They camped in a rain forest, visited a banana plantation, went snorkeling, and sloshed through swamps; the children would be up until 10 p.m. working on PowerPoint presentations or journal entries.
The next year, Ms. Baldi chaperoned another J-Term journey, where students studied science at the University of Maine’s Orono campus, then hiked and biked in Acadia National Park. “There was one boy who’d never ridden a bike before, and Chance taught him how to bike in three hours,” Ms. Baldi said of Chance Nalley, a teacher who led the trip. “It still brings tears to my eyes. I felt so privileged to be there. It was spiritual and really, really wonderful.”
ALONG with its name, Columbia University gives the school $100,000 a year, a quarter of it to buttress the principal’s salary, the rest to pay people to teach electives, among other things. Most of the rest of the school’s budget comes from the Department of Education — and with it, the thicket of rules known as the Chancellor’s Regulations, which Dr. Maldonado-Rivera quickly found burdensome. In the private school world, he said, “I had equipped an entire middle school in one week with a credit card.” Now, even ordering tables and chairs “took weeks and we had to argue with people less competent than us, people who’d never run a school.”
“I can’t spend 10 hours ordering a chair,” he said. “I’m not built for that.”
Columbia added a grade each year, which meant hiring a new crop of teachers and developing new curriculum. And each year the school took over a little more space in the West 123rd Street building it shared with another school (a site the university had promised on its new Manhattanville campus kept receding into the future). It was an enormous, exhausting undertaking; many staff members, from Dr. Maldonado-Rivera down, worked 12-hour days and frequent Saturdays.
Plans would be made and then changed; an example involved education in Spanish. The school pledges to produce bilingual students, but instruction has veered from one approach to another. First, Spanish classes taught native speakers and nonspeakers together. When that proved unwieldy, only native speakers got Spanish instruction. Then the nonspeakers started using Rosetta Stone language programs on computers, while the native speakers had a teacher. Now, all students again have a teacher, with different level classes.
One of the reasons for such changes in direction was money. In its first year, Columbia got about $10,000 per pupil from the city, the systemwide average. The next fall, it received about $6,300, because its students did not qualify for certain money earmarked for low performers. Dr. Maldonado-Rivera said the cut took him by surprise, and that he had to drop one of the two Spanish teachers he had planned to hire.

But to some people, the shifting approaches felt like chaos. “There was a general administrative disorder that characterized the school,” said one parent who worked closely with the administration and, like many of those interviewed, spoke on the condition of anonymity for fear of adversely affecting his child’s education.
This parent told a story encapsulating all he felt was good — and bad — about the principal’s management style. Dr. Maldonado-Rivera did not think highly of the city’s substitute teachers, so when a teacher was absent, a colleague filled in — sometimes Dr. Maldonado-Rivera himself. In one science class, he led a lesson on the atom.
“Gathering six children in the center of the room he said: ‘O.K., you’re the nucleus. Stand in the middle, and hug each other tightly,’ ” the parent explained. “And then to another group he said: ‘You, you’re electrons. Run around randomly. And you, you’re the charge, so jump to the outside.’ It was a tremendous lesson.”
But in the front office, the parent said, “all kinds of things weren’t getting done.”
Relationships between teachers and administrators were increasingly strained.
“His philosophy was just go, just do it,” said Dana Ligocki, a social studies teacher who quit in the middle of last school year. “It doesn’t matter if we’re doing things well, but it matters if we do a lot of things. I started to see that that was his way of being a leader. And then safety gets cut or curriculum gets cut.”
Dr. Maldonado-Rivera said that some teachers left for personal reasons, and that others could not live up to his high expectations.
“It’s a very ambitious school with a high intellectual demand,” he said. “We don’t need to apologize for having high standards for teachers. I’d ask myself, ‘Would I want my son to be learning science or math with this teacher?’ And if it’s not something I would want, then that’s something I would need to fix.”
COLUMBIA parents were supposed to be partners in their children’s education, and the school’s diversity was a big draw. But those active in the School Leadership Team and the parent association  tended to be disproportionately white and professional.
“In terms of actually doing the everyday work, the numbers of Hispanics is very limited, ” said Victor Acosta, one of the active Hispanic parents, whose daughter, a ninth grader now, was in the founding class. “There’s no tradition of volunteering in the schools in the first generation. You send your kids to school and the school takes care of it.”
By the school’s third year, meetings — and follow-up e-mails — had become increasingly contentious, participants said. (Dr. Maldonado-Rivera said that it was “not a functional entity.”) Some questioned whether the electives taught by college students or parents were appropriately supervised. Some protested discipline procedures — children were sometimes asked to apologize before the whole school for misbehavior, a process one parent likened to “public shaming,” and Dr. Maldonado-Rivera once held the whole seventh grade after school for 40 minutes because some children had been acting up in the hallways. Parents and teachers pushed for a guidance counselor; Dr. Maldonado-Rivera said the school did not need — and could not afford — one.
Perhaps the biggest debate came over academics. Some students scored as high as 90 on the entrance exam, but the mean was a 28. Once in, all faced the same accelerated curriculum. Some soared; others sank. At one point last school year, a third of the seventh grade was on academic probation.

Struggling students were tutored after school, pulled out of electives, kept behind in the classroom during J-Term. Some were counseled out — Dr. Maldonado-Rivera said there was 8 to 10 percent attrition for academic reasons each year. “Sometimes,” Mr. Stillman said, “you end up cutting your losses.”
Some parents and teachers proposed establishing different levels of classes to accommodate the achievement range. But Dr. Maldonado-Rivera refused to compromise his vision of a school where all children learned together at the highest levels. “If part of your philosophy is a commitment to strength in diversity,” he said, “then you have a commitment to not tracking.”
Critics complained that the principals’ vision blinded him to reality and that he was more interested in branding the school as “world class” than dealing with its problems. “It wasn’t working, but he didn’t see it as needing to be fixed,” said Ms. Margeson, the parent with a boy in eighth grade.
At an established school, many of those debates would have been over. But Columbia’s culture was up for grabs. Who would define it? Who made the rules?
THEN, on June 22, 12-year-old Nicole Suriel drowned in a riptide in Long Beach.
A city investigation found that no regulations were broken on the beach that day, though it did fault Columbia for not having proper permission slips for the trip and suggested that the school could have done better. “There was a lack of adequate planning by the principal and assistant principal,” the report said, “a failure to provide a sufficient number of adults to supervise the children at the beach, and poor judgment by the teacher in charge, who either failed to realize that there were no lifeguards on duty or failed to recognize the additional danger presented by their absence.”
The teacher who had been the main chaperone was fired, and Mr. Stillman stepped down as assistant principal. Dr. Maldonado-Rivera said he had offered to resign if it would save their jobs, and then was put on probation. He was adamant that his decisions had not contributed to the drowning. “The systems of risk management that we had in place were way beyond anything that the D.O.E. required,” he said.
But — in a turn of the kaleidoscope — a significant number of others at the school saw things differently. A faculty group led by Mr. Nalley, the teacher who had helped a student learn to ride a bike, went to the union arguing that the drowning had been “part of a pattern of negligence at the school,” said a member of the group, Ms. Ligocki, the social studies teacher. When the investigator’s report did not go that far, Mr. Nalley, the union representative at Columbia, protested the findings publicly and then told city officials about the principal’s relationship with Ms. Marin-Reyes.
A group of the principal’s supporters also went to education officials, to deny any improprieties between Dr. Maldonado-Rivera and Ms. Marin-Reyes, which, in an odd twist, ended up spurring the investigation.
Mr. Nalley declined to be interviewed. Instead, he e-mailed an excerpt from a report on the Columbia Space Shuttle disaster: “Hubris refers to an exaggerated pride or self-confidence that turns into arrogance. It results from excessive admiration of oneself, a series of previous successes, uncritical acceptance of accolades and a belief that one is exempt from the rules. In the end, hubris is eventually rewarded with disaster and comeuppance.”
Mr. Stillman said Dr. Maldonado-Rivera’s critics exploited the tragedy. In a moment of great emotional turmoil, “each person read into the situation their private critiques of José,” he said.
“It became part of the institutional politics to correlate the drowning with a pattern of risk-taking.”


As September drew nearer, the principal raced to hire new teachers — seven, or about half the faculty, including Mr. Nalley, had departed by midsummer. Dr. Maldonado-Rivera said his intention had been “to save the school, rebuild the boat and go back out.”

ON Nov. 30, Dr. Maldonado-Rivera was in a meeting when someone from the superintendent’s office handed him a letter saying he was fired. It seemed “surreal,” he said, not least because he had been assured that he would get off with “a hit on the chin.”
Dr. Maldonado said a call he made to the chancellor’s cellphone went unreturned. The students were eating lunch, and Dr. Maldonado-Rivera had them moved to the gym.
“I wanted to speak to my children,” he said. “I wanted to explain to them what was going on.”
But the superintendent warned him not to, the principal said, “or I would be removed by a police officer.”
Instead, the students were given the news in small groups; some teachers just handed them each letters announcing the firing.
“Some students started to cry,” said Kiambra Griffin, a ninth grader, who quickly created aFacebook page — Bring Back Dr. José Maldonado-Rivera to Columbia Secondary School — though she had the feeling that it would be futile.
Natalie Ravitz, a spokeswoman for the Education Department, said in an e-mail that officials had considered “the full history and scope” of the principal’s conduct and found “repeated, serious failures in judgment and violations of our regulations.” She added: “As much as we understand that this is emotional for the Columbia Secondary community, we cannot turn a blind eye to his record.”
Neither Dr. Maldonado-Rivera nor Ms. Marin-Reyes denied the facts in the report, except to say that their relationship did not become romantic until the summer. “I thought for a conflict of interest money had to be exchanged,” Dr. Maldonado-Rivera said.
A week after the firing, there was another parents’ meeting, this time drawing about 50 people. Things proceeded calmly as the interim acting principal, Gary Biester, a longtime math teacher and administrator, spoke with a translator by his side.
Damaris Solis Padilla, whose daughter is in the ninth grade, said that she thought Dr. Maldonado-Rivera’s firing had been unfair, but that she was ready to move on. “We’ve got to have a school that still can run and thrive and be all the good things it’s supposed to be, despite this one person leaving,” she said. “When the leader leaves, the families are really important, because we’re the ones that stay.”

Nigeria’s Promise, Africa’s Hope

OP-ED CONTRIBUTOR

Nigeria’s Promise, Africa’s Hope

AFRICA has endured a tortured history of political instability and religious, racial and ethnic strife. In order to understand this bewildering, beautiful continent — and to grasp the complexity that is my home country, Nigeria, Africa’s most populous nation — I think it is absolutely important that we examine the story of African people.

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In my mind, there are two parts to the story of the African peoples ... the rain beating us obviously goes back at least half a millennium. And what is happening in Africa today is a result of what has been going on for 400 or 500 years, from the “discovery” of Africa by Europe, through the period of darkness that engulfed the continent during the trans-Atlantic slave trade and through the Berlin Conference of 1885. That controversial gathering of the leading European powers, which precipitated the “scramble for Africa,” we all know took place without African consultation or representation. It created new boundaries in ancient kingdoms, and nation-states resulting in disjointed, inexplicable, tension-prone countries today.
During the colonial period, struggles were fought, exhaustingly, on so many fronts — for equality, for justice, for freedom — by politicians, intellectuals and common folk alike. At the end of the day, when the liberty was won, we found that we had not sufficiently reckoned with one incredibly important fact: If you take someone who has not really been in charge of himself for 300 years and tell him, “O.K., you are now free,” he will not know where to begin.
This is how I see the chaos in Africa today and the absence of logic in what we’re doing. Africa’s postcolonial disposition is the result of a people who have lost the habit of ruling themselves, forgotten their traditional way of thinking, embracing and engaging the world without sufficient preparation. We have also had difficulty running the systems foisted upon us at the dawn of independence by our colonial masters. We are like the man in the Igbo proverb who does not know where the rain began to beat him and so cannot say where he dried his body.
People don’t like this particular analysis, because it looks as if we want to place the blame on someone else. Let me be clear, because I have inadvertently developed a reputation (some of my friends say one I relish) as a provocateur: because the West has had a long but uneven engagement with Africa, it is imperative that it also play an important role in forging solutions to Africa’s myriad problems. This will require good will and concerted effort on the part of all those who share the weight of Africa’s historical albatross.
In Nigeria, in the years before we finally gained independence in 1960, we had no doubt about where we were going: we were going to inherit freedom; that was all that mattered. The possibilities for us were endless, or so it seemed. Nigeria was enveloped by a certain assurance of an unbridled destiny, by an overwhelming excitement about life’s promise, without any knowledge of providence’s intended destination.
While the much-vaunted day of independence arrived to much fanfare, it rapidly became a faded memory. The years flew past. By 1966, Nigeria was called a cesspool of corruption and misrule. Public servants helped themselves freely to the nation’s wealth. Elections were blatantly rigged. The national census was outrageously stage-managed to give certain ethnic groups more power; judges and magistrates were manipulated by the politicians in power. The politicians themselves were corrupted by foreign business interests.
The political situation deteriorated rapidly and Nigeria was quickly consumed by civil war. The belligerents were an aggrieved people in the southeast of the nation, the Biafrans, who found themselves fleeing pogroms and persecution at the hands of the determined government of the Federal Republic of Nigeria, which had been armed to the teeth by some of the major international powers. My fellow Biafrans spent nearly three years fighting for a cause, fighting for freedom. But all that collapsed and Biafra stood defeated.
It had been a very bitter experience that led to the hostilities in the first place. And the big powers got involved in prolonging it. You see, we, the little people of the world, are constantly expendable. The big powers can play their games, even if millions perish in the process. And perish they did. In the end, more than a million people (and possibly as many as three million), mainly children, died either in the fighting or from starvation because of the Nigerian government’s economic blockade.

After the civil war, we saw a “unified” Nigeria saddled with an even more insidious reality. We were plagued by a home-grown enemy: the political ineptitude, mediocrity, indiscipline, ethnic bigotry and corruption of the ruling class. Compounding the situation was the fact that Nigeria was now awash in oil boom petrodollars. The country’s young, affable head of state, Gen. Yakubu Gowon, ever so cocksure following his civil war victory, was proclaiming to the entire planet that Nigeria had more money than it knew what to do with. A new era of great decadence and decline was born. It continues to this day.
What can Nigeria do to live up the promise of its postcolonial dream? First, we will have to find a way to do away with the present system of political godfatherism. This archaic practice allows a relative handful of wealthy men — many of them half-baked, poorly educated thugs — to sponsor their chosen candidates and push them right through to the desired political position, bribing, threatening and, on occasion, murdering any opposition in the process. We will have to make sure that the electoral body overseeing elections is run by widely respected and competent officials, chosen by a nonpartisan group free of governmental influence or interference.
And we have to find a way to open up the political process to every Nigerian. Today, we have a system where only those individuals who can pay an exorbitant application fee and finance a political campaign can vie for the presidency. It would not surprise any close observer to discover that in this inane system, the same unsavory characters who have destroyed the country and looted the treasury are the ones able to run for the presidency.
But we must also remember that restoring democratic systems alone will not, overnight, make the country a success. Let me borrow from the history of the Igbo ethnic group. The Igbo have long been a very democratic people. They express a strong anti-monarchy sentiment with the common name Ezebuilo, which translates to “a king is an enemy.”
There is no doubt that they experienced the highhandedness of kings, so they decided that a king cannot be a trusted friend of the people without checks and balances. And they tried all kinds of arrangements to whittle down the menace of those with the will to power, because such people exist in large numbers in every society. So the Igbo created all kinds of titles which cost very much to acquire. In the end, the aspirant to titles becomes impoverished in the process and ends up with very little. So that individual begins again, and by the time his life is over, he has a lot of prestige, but very little power.
This is not a time to bemoan all the challenges ahead. It is a time to work at developing, nurturing and sustaining democracy. But we also must realize that we need patience and cannot expect instant miracles. Building a nation is not something a people do in one regime, in a few years, even. The Chinese had their chance to emerge as the leading nation in the world in the Middle Ages, but were consumed by interethnic political posturing and wars, and had to wait another 500 years for another chance. America did not arrive at its much admired democracy overnight. When President Abraham Lincoln famously defined democracy as “the government of the people, by the people, for the people” he was drawing upon classical thought and at least 100 years of American rigorous intellectual reflection on the matter.
Sustaining democracy in Nigeria will require more than just free elections. It will also mean ending a system in which corruption is not just tolerated, but widely encouraged and hugely profitable. It is estimated that about $400 billion has been pilfered from Nigeria’s treasury since independence. One needs to stop for a moment to wrap one’s mind around that incredible figure. It is larger than the annual gross domestic products of Norway and Sweden. This theft of national funds is one of the factors essentially making it impossible for Nigeria to succeed. Nigerians alone are not responsible. We all know that the corrupt cabal of Nigerians has friends abroad who not only help it move the billions abroad but also shield the perpetrators from persecution.

Many analysts see a direct link between crude oil and the corruption in Nigeria, that creating a system to prevent politicians from having access to petrodollars is needed to reduce large-scale corruption. For most people, the solution is straightforward: if you commit a crime, you should be brought to book. But in a country like Nigeria, where there are no easy fixes, one must examine the issue of accountability, which has to be a strong component of the fight against corruption.
Some feel that a strong executive should be the one to hold people accountable. But if the president has all the power and resources of the country in his control, and he is also the one who selects who should be probed or not, clearly we will have an uneven system where those who are favored by the emperor have free rein to loot the treasury.
Nigeria’s story has not been, entirely, one long, unrelieved history of despair. At the midcentury mark of the state’s existence, Nigerians have begun to ask themselves the hard questions. How does the state of anarchy become reversed? What measures can be taken to prevent corrupt candidates from recycling themselves into positions of leadership? Young Nigerians have often come to me desperately seeking solutions to several conundrums: How do we begin to solve these problems in Nigeria where the structures are present but there is no accountability?
ONE initial step is to change the nation’s Official Secrets Act. Incredible as it may seem, it is illegal in Nigeria to publish official government data and statistics — including accounts spent by or accruing to the government. This, simply, is inconsistent with the spirit and practice of democracy. There is now a freedom of information bill before the National Assembly that would end this unacceptable state of affairs. It should be passed, free from any modifications that would render it ineffectual, and assented to by President Goodluck Jonathan. This can and should be achieved before the presidential election in April.
In the end, I foresee that the Nigerian solution will come in stages. First we have to nurture and strengthen our democratic institutions — and strive for the freest and fairest elections possible. That will place the true candidates of the people in office. Within the fabric of a democracy, a free press can thrive and a strong justice system can flourish. The checks and balances we have spoken about and the laws needed to curb corruption will then naturally find a footing.
And there has to be the development of a new patriotic consciousness, not one simply based on the well-worn notions of the “Unity of Nigeria” or “Faith in Nigeria” often touted by our corrupt leaders; but one based on an awareness of the responsibility of leaders to the led and disseminated by civil society, schools and intellectuals. It is from this kind of environment that a leader, humbled by the trust placed upon him by the people, will emerge, willing to use the power given to him for the good of the people.
Chinua Achebe, a professor at Brown University, is the author of “Things Fall Apart.

Detección, evaluación y manejo de la anemia preoperatoria en los pacientes ortopédicos quirúrgicos electivos: Guía NATA

Detección, evaluación y manejo de la anemia preoperatoria en los pacientes ortopédicos quirúrgicos electivos: Guía NATA
Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines.
Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, Fergusson DA, Gombotz H, Habler O, Monk TG, Ozier Y, Slappendel R, Szpalski M.
Department of Pathology and Medicine, Stanford University School of Medicine, Pasteur Dr., Stanford, CA 94305, USA. ltgoodno@stanford.edu
Br J Anaesth. 2011 Jan;106(1):13-22.
 

Abstract
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes
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Anestesiología y Medicina del Dolor