Even though most of the supermarkets across the country have pulled Erin Farm products off their shelves, some of them said they will continue to support the company once they rectify the problem and try to re-build customer confidence. Erin Farm Meat Packers Ltd had shutdown its processing plant and recalled a batch of infected meat products recently after the Ministry of Health’s Food and Drug Division identified the lysteria monocytogenes bacteria in a batch of Erin Farm’s chicken franks, spiced ham and turkey. Checks with supermarkets across the country yesterday revealed that most of them had pulled the products off the shelf but others were willing to give them a second chance.

One of them, Tru Valu’s Long Circular Manager, Anthony Akow said Erin took all the pre-cautions that were necessary including a total clean-up. “They handled the situation with good tact and when they are ready to sell again, we will continue to support them,” he said.
“We always had a good relationship with Erin and we would like to maintain that,” Akow added. Kumar Maharaj, CEO of Maharaj West Side Supermarket, Arima said even though his customers are afraid to buy Erin’s products, he appealed to consumers to give them a second chance. “Erin has always been a high quality product and in fact, it is one of the highest quality in local meat products. I don’t feel we should just wash our hands off them like that but give them a second chance,” said Maharaj. “I really think it was a genuine problem and human error and I will be willing to support them once again when they have sorted out the problem,” he added. Rohan Sinanan of Food Master, Tunapuna also gave his support to Erin. “From day one they handled the situation well and I think it is just a matter of re-building customer confidence,” he said. Sinanan felt Erin just needs time to sort out the problem. “But once they sort it out, we will be willing to support them again in the future,” he said.

A Sunday Newsday Investigation

Medical practitioners across TT can soon expect more litigation charges of malpractice against them as attorneys reveal that there are several cases of medical negligence which are now under consideration for possible court action. Sometimes people do not even know that negligence may have been involved in the loss of a loved one. Even if they suspect they do not know where to turn. Doctors support, protect and cover-up for each other. The saying that doctors’ mistakes are quickly buried is no joke. There have been reports of patients entering a hospital for one type of operation only to end up losing a limb or some healthy organ. What do they do? What can they do?

Civil litigation is usually beyond their means and attorneys are calling on Government to establish a panel of independent medical practitioners to review complaints and recommendations for compensation for people seeking justice, against what they believe is medical malpractice. Doctors are covered by insurance but this insurance is very high and the premiums range from $7,000 to $30,000 per year. The highest insurance premiums are in the field of Obstetrics and Gyanecology, while the lowest are in the field of Special Internal Medicine. Insurance companies try to cover the costs which arise from a lawsuit. Attorney-at-law Anand Ramlogan disclosed that he had about 17 cases of medical negligence before him, some of which are pending. Attorney-at-law Nyree Alfonso said she too had quite a few cases which are currently being investigated. Several other attorneys confirmed that they were considering handling a few cases but indicated they could not discuss them due to confidentiality and privacy of their clients.

Sunday Newsday began a check with attorneys when several people called to say they were pursuing legal action against the State’s public medical health institutions or private clinics for negligence. Over the past few years, there have been reports of mothers losing babies and relatives threatening health institutions for medical negligence following incidents of “bad treatment.” Last week, a daily newspaper reported that the infant mortality rate at the San Fernando General Hospital is 22-24 per 1,000. According to the report, the figure is calculated from the number of newborn deaths, still-births and babies who die within the first month of life. One couple, Sean and Lauren Hobson of Morvant said they are pursuing legal action after their baby son suffered brain damage (cerebral palsy) while receiving medical attention at a private medical institution.

The Hobsons said they believe the complication occurred at the institution but the child’s condition improved and they described themselves lucky that they were able to get treatment at the Port-of-Spain General Hospital. A woman recently filed a lawsuit against a doctor for  medical negligence and special and aggravated damages. Last week, Newsday reported another case in which a widow sued the Mount Hope Medical Hospital after her husband allegedly came to the health institution to have a tooth abscess drained but died after the condition developed into a pulmonary infection, deep vein thrombosis and later to pulmonary infarction thromboembolism. Last month, there was an increased incidence of Entero-bacter bacteria which was responsible for infections in ten babies at the Mt Hope Women’s Hospital. In a Newsday article, Saturday September 13, Health Minister Colm Imbert said an investigation had been launch-ed to determine if the bacteria were caused by insanitatry conditions at the Unit.

Ramlogan, the most out-spoken of the attorneys said that the public is not aware of how many of these “negligent” cases occur and heard about them only when they were published in newspapers. “One expects a certain level of health care and when they feel they have been wronged they feel a need to get justice, which is why so many more people are now filing for litigation,” said Ramlogan. He lamented that in TT, while we do have very competent medical practitioners, the standard of health care delivery has dropped because of a failure in the administrative policies and politics of the day. “It is just sheer mal-administration and the top officials are just playing musical chairs with health care and it is filtering down into the system,” he said. Ramlogan said in one of the cases he is investigating, a woman of Tacarigua gave birth to a still-born male baby on September 23, 2001.

She claimed that she was given “bad treatment” by the nurses stating that they were “hostile and unprofessional.” The woman’s doctor had instructed her to go to the Mount Hope Clinic and let the doctors induce labour. The nurses reportedly told her: “You should have stayed home until the baby ready,” (even though the doctor had instructed her to have the labour induced). The woman told Ramlogan that when she started having labour pains, she was told to sit on a wheel-chair. In the meantime, she was in severe pain and even though the baby was already coming out, the nurses said: “Do not push.”

She told the nurses she was not pushing and she needed help because she was beginning to feel the baby’s head in her chest. By the time the doctor/s attended to her, the baby had already suffocated in her womb. Ramlogan is also investigating the death of a boy from Petit Valley, who was admitted for an operation to remove an extra finger on his hand but died after it was amputated. How could such a thing happen? That’s what Ramlogan wants to find out. Ramlogan said there were many medical negligence cases but not all may result in legal action since doctors were unwilling or reluctant to give evidence. “Therefore, the injustice is against the poor and often times go unnoticed,” he said.

Patients should not have to go to court

Health Minister Colm Imbert said plans are underway to repeal the Medical Board Act in order to accommodate investigations into cases of medical negligence. The comment came in the wake of information that a number of  litigation cases for medical negligence were before lawyers. Former Health Minister Dr Fuad Khan, a Urologist by profession, revealed that the highest number of medical negligence cases occur in the area of Obstetrics and Gynaecology. Second is Urology and the third highest is Orthopedics (surgery of bones and joints). Dr Khan challenged Health Minister Colm Imbert to introduce the UK/US “Medical Surgical Audit” system across the board; in all health institutions, both public and private. He suggested that it should be part of the “Health Services Quality Act” which willl serve as a tool to oversee the malpractices of doctors and provide solutions to improve health care as is done in the UK.

In an interview, Imbert said once the Medical Board Act is repealed, accommodations would be made to introduce a panel to investigate complaints so that the “aggrieved” persons could take action, rather than go through the court. He felt court action was not the desired route since it could be long and drawn-out and could take a number of years. “Sometimes a person can be disadvantaged if the person passes through a kangaroo court system and the case can go on for a number of years, even until the person dies,” said Imbert. “That is very unsatisfactory,” he added. He explained that was why he had to change the Medical Board Act in the first place, because the Board had informed him there were no proper systems to investigate medical matters and they did not have the powers to do so. He said once the Act is repealed and accommodations put in place, Govern-ment would also be able to introduce an Audit system similar to what exists in the UK and in the US. Dr Khan said a lot of negligent cases are never made public and the cases which are now being heard about are just a “drop in the bucket” of what actually takes place.

Dr Colin Furlonge president of the Medical Professionals Association of TT (MPATT) pointed out that there are thousands of doctors in this country. “If you multiply that by the number of interactions per day and further multiply that by the number of interactions for the year, the number of litigation cases we are now seeing is a very small percentage in comparison to the number of interactions,” he said. Dr Furlonge pointed out that furthermore, litigation for medical negligence occurs all over the world. Defending his position as a Union leader, however, he said most times the cases have been found to be fair and that the people often felt that they were “badly represented by their legal representation.” One of the lawyers investigating such cases, attorney-at-law Nyree Alfonso, responding to this statement said: “At least we know our clients will not die on us.” Dr Khan lamented that there was no structure of internationally accepted medical procedures in TT. Providing a few suggestions, he said there needs to be a system in which medical practitioners can record all advice and be able to request any investigation.

As a matter of fact, he said he is considering establishing a private firm in which patients can access information and advice in cases where they feel they have been wronged. He said the health care system has deteriorated because of a lack of proper standards and procedures. Dr Khan noted as an example, the fact that there are medical practitioners who claim to be trained doctors when in fact they are not – quacks. He described an example in which patients’ requests for radiological investigations take as many as six months. “That is another form of medical negligence,” he said.
Another problem he said is when senior medical consultants palm off their work on junior doctors.

He said a number of negligence cases also occur at the Accident and Emergency Department because junior doctors are the ones who usually attend to patients. “If they are not trained enough and you can’t get it right, then one can expect litigation charges,” said Dr Khan. “The food for medical litigation is when the infrastructure for proper procedures is not right.” As a matter of fact, the attorneys and medical practitioners who spoke to Sunday Newsday, believe there will be a lot more litigation charges to come since they were “suspicious” about the qualifications of the foreign doctors who have been hired by Government to address the shortage problem in TT.

 

Former Health Minister Dr Fuad Khan has called on Health Minister Colm Imbert to introduce a “Medical Surgical/Clinical Audit” as practised in the UK. What is a Medical Audit? According to a Sunday Newsday research, a Medical Audit is the assessment by peer review of the medical care provided by the medical profession to the patient. A Clinical Audit is a multi-disciplinary assessment of the total care of patients by all health personnel. Auditing is intended to be a dynamic process, leading to improved patient care.

The principle functions of Audits are:
*to encourage the improvement of clinical practice
*educate all members of the clinical team
*raise the overall quality of clinical care
*enable the comparison of the provision and outcome of surgical care with current best practice
*provide peer comparison
During an Audit the medical professionals choose a topic, agree on certain standards, observe current practice, assess conformity to standards and intervene to promote change and observe practice again.

“Hello!  I’m calling from Remand Yard.  When you come bring some chicken and chips.” The caller is not a Prisons Officer but one of the many prisoners who have cellphones in their cells at the Port-of-Spain State Prison, at Golden Grove, at the Maximum Security Prison, Carrera and in the Tobago Prison. Police and Prison officials are trying to determine how these cellphones are getting into the nation’s prison cells, and who is responsible. Telephone calls from cellphones, sources said, are being made from inside cells to people on the outside and it is believed that some persons are making money out of it. A senior official told Sunday Newsday that a prisoner recently contacted “one of his boys” from a cellphone. The individual who was contacted by cell phone was told to get information on the whereabouts of a State witness who has been granted immunity in exchange for his testimony in a murder and kidnapping matter.
    
A State witness was found dead recently and it is believed his death was ordered by a prisoner using a cellphone. Sunday Newsday was reliably informed that several cellphones have been confiscated by prison officials in recent times. Sources told Sunday Newsday that a cellphone found in one of the prisons was traced to a woman identified as Rachael McMorrash-Howell of LP#33 Upper St Barb’s Road, St Barb’s.  The number was 779-4413. However, the person who lives at that address is Rachael Marrast-Howell, a temporary clerk typist at the Port-of-Spain General Hospital (PoSGH). The names were close enough but Marrast-Howell’s cellphone number was different. The 26-year-old woman was baffled when Sunday Newsday asked her about the particular cellphone. “Not me.  That is not my cellphone number,” she said.  “This is very strange and there must be some kind of scam and this is scaring me,” she added. Marrast-Howell said she purchased a cellphone for her husband on her name sometime between 1998/1999. The number was 751-9014, but it was stolen on August 24. 

That phone, she said, was in her maiden name, Rachael Marrast, and even so, she said her husband’s stolen phone does not have the same number as the one found in the Prison. Three days (August 27) after her husband’s cellphone was stolen, Marrast-Howell said she made a report to TSTT and was baffled when told that there was no information in TSTT’s system as to the ownership of her husband’s cellphone. After the report was made, Marrast-Howell said information was taken by TSTT and typed on a computer. Sunday Newsday called the numbers of both the stolen phone and the one found in the prison. They are both prepaid. The stolen phone rang out of service, while a recording came up on the one that was found in the prison. After the recording came on the phone found in the prison, a man’s voice then came on, but his name was not easily identifiable. Sources have speculated that the information on Marrast-Howell’s name was somehow transferred to the one found in the prison.

Rachael Howell’s current cellphone is connected to the same St Barb’s address, TSTT’s records show. Asked to explain the apparent mix-up with the names, Rae Ann Harper-Walters, TSTT’s Corporate Communications Manager  said that it is quite possible during a transaction with a customer that a Customer Service Representative could have made a mistake. But Marrast-Howell told Sunday Newsday that her identification card was taken then to get the correct spelling of her name. With respect to the missing information on Marrast-Howell’s husband’s cellphone, Harper-Walters said she has to discuss that matter with TSTT’s Chief Executive Officer, Sam Martin. President of the Prisons Association Claudius Gulston said in an interview on Thursday that they are “vigorously pursuing” the matter of cellphones getting into prisons. Gulston told Sunday Newsday that more than five cellphones have been removed from the Port-of-Spain State Prison in recent times. He could not, however, say how many had been found at the Golden Grove, Maximum Security Prison, Carrera and Tobago Prisons.

“We are trying to find out how those cellphones are coming in,” Gulston said. He added that some of the cellphones are found between prisoners’ belongings in either the Remand Yard, Condemned Section or the area for ordinary convicts. “It could be anybody and ‘no’ I don’t want to assume whether or not prison officers are responsible,” Gulston continued. Maybe, Gulston said, the cellphones are being thrown over walls, and he said there is a definite need to work harder to find the source of the problem. Gulston asked the Prison Administration to come up with answers that could help find those responsible. Acting Commissioner of Prisons Carlo McHoney said if he knew the culprits, he would definitely put a stop to it. “If we knew and didn’t stop it, it means that we are lying down on the job,” McHoney said. He could not say how many cellphones have been found so far. Asked if he felt prison officers were responsible, McHoney replied: “I can’t say ‘yes’ or ‘no’ and I can’t put my head on a block for anyone. It will not be fair for me to cast any aspersions on any of my prison officers.” Saying the matter is of great concern, the acting Prisons chief said when cellphones are found in prison cells they do what needs to be done including confiscation. McHoney did not want to say what else prison authorities do, but pointed out that “other action” will be taken based on investigations, and that those caught with cellphones would be dealt with under the Prison Services rules and regulations.

Calypsonian Roy Lewis, 56, known in the calypso world as “Mystic Prowler” died yesterday while travelling in a taxi. He reportedly suffered a massive heart attack. Reports revealed that around 3.30 pm, Lewis of Almond Drive, Morvant, boarded a taxi at Morvant Junction and asked to be taken to D’Abadie where he planned to visit a female friend. Reports revealed that on reaching San Juan, Lewis began gasping for breath and collapsed in the taxi. The driver of the car drove the vehicle to the San Juan Sub Station where police officers alerted a District Medical Officer. Titus Lewis, son of the dead calypsonian was contacted; he went to the scene where he identified the body of his father. Lewis won the calypso monarch in 1998, and was recently employed at Mas Camp Pub as an entertainer.

AN INTER-SCHOOL gang-war ended up in blood shed on Friday, after a brawl broke out among pupils attending a football match at the Ato Boldon Stadium, at Couva, resulting in at least five students having to seek medical attention. Police have detained two school boys, ages 16 and 17, in connection with the incident. The fracas started at the stadium grounds and ended up in the health centre where the injured pupils had gone to seek medical attention, and was followed by other pupils.

Police sources told Sunday Newsday that the incident stemmed from an on-going impasse among pupils of schools in Freeport and Mac Bean, Couva. Some 2,000 students attending schools in Marabella, Couva, Freeport and Chaguanas, had attended the opening of the Central Division Intercol Football at Ato Boldon stadium, on Friday. The drama unfolded around 5.35 pm, shortly after the last game was played. Reports stated that there was a confrontation among the gangs, which led to a scuffle. The fighting continued to Isaac Junction, Couva, where several students were stabbed with knifes, others beaten and their chains ripped off their necks. As the injured pupils made their way to the health centre, they were followed by the gangs who stormed into the health centre and dealt them ( the injured children) several blows about their bodies. When the officers of the Couva Police Station responded they had to call for reinforcement to control the situation. Eyewitnesses said during the game several pupils, including girls, were seen drinking and smoking on the grounds.

SOUTHERN DIVISION police are investigating the circumstances surrounding the death of a five-month-old baby girl yesterday. Tiny Tia Hosein’s lifeless body was discovered on a makeshift bed at her Marabella home, by her mother, Seema Hosein, around 1.30 pm yesterday. Hosein told police that around 1 pm, she fed her baby and left her sleeping on a bed. She said when she checked on the infant a half-an-hour later she found that the baby’s body was cold and stiff. Hosein told the police that her baby was not suffering from any illness, but did have physical contact with her brother-in-law who had died from tuberculosis a few months ago.

Residents of Sea Lots, Port-of-Spain are literally “upset” about the stench they have had to endure over the past few months since the Barana Seafood Processors came into their community. Over the past four or five months, residents have shown their dissatisfaction in the form of protests, bearing placards and calling on the authorities to do something to ease their discomfort. The latest occurred on Wednesday when Port-of-Spain South MP Eric Williams attended an opening ceremony for a nursery school in the area adopted by none other than the same Barana Company which the residents are complaining about. The school is located a few metres away from the National Fisheries compound. The residents want to know how anyone could set up a school for young children with a stench like that.

During a visit to the area, Sunday Newsday was told that several parents are complaining that their children were suffering from asthmatic conditions. A check in the area revealed that the residents are justified in their complaints. When the taxi-driver approached the front of National Fisheries, we both found ourselves gagging with the full blast of the putrid stench. If I had to describe the odour I would say “the severe, fresh scent of rotting fish with a sour and acid edge and raw sewage combined.” “Now I understand what the fuss is about,” I sputtered, the taxi-driver shaking his head in agreement, not even able to respond right away. A resident for about 50 years Grace Radellant was eager to speak to Sunday Newsday. She was the same person who made the most “noise” on the opening day of the Sea Lots Nursery School. “The scent started about four or five months after Barana moved in here. We protested many times by blocking the road. We went to the Ministry of Environment, we spoke to our MP, but to date we still get problems with the stench and this thing smelling really bad,” she said. Radellant added: “Barana say they adopt the school but they are not doing anything to help the children because they are getting the stench first.”

The resident disclosed that a lot of the children have asthma, a complaint they never had before. She said she too has been experiencing a lot of coughing lately and cannot sleep well at night. “You have to put on the fan all day, all night, you have to buy spray and spray your house and lock up. Sometimes when you are eating and that stench hits you, your stomach upset, some people vomit, you have to leave your food and go,” said Radellant. In a statement Gary Aboud Secretary of the environmental group, Fishermen and Friends of the Sea (FFOS), called on Environment Minister Rennie Dumas to appoint a qualified task force to report to the nation on remedies and costs of regulating what he described as “deadly toxic burning” at the Beetham Garbage Dump and at the “equally nauseating Barana rotten fish recycling scheme.” He accused the Sewage and Waste Management Company Limited (SWMCOL) of neglecting and mismanaging the POS Dump.

Aboud provided a list of the likely “disastrous effects” of the stench, among them:
* Excessive chronic respiratory and other diseases of the area residents.
* Pollution of our Gulf of Paria and coastal waters by heavy metal toxic ooze.
* Air pollution and smog throughout Port-of-Spain and the environs.
* Pollution of the land as hazardous materials seep and the soil becomes saturated with them.
* A shameful Port of Call for cruise ships which are greeted with polluted waters and a nauseating stench.
Environment Minister, Rennie Dumas said he had no idea that the FFOS had made a call for the appointment of a Task Force. Staying clear from commenting on the issue, he said there was someone in his Ministry who was in charge of the matter and referred us to speak with him.
Corporate Communications Officer of the Environmental Management Authority, Neil Parsanlal told Sunday Newsday that the Authority was working together with Barana on the matter. He said the Company wants to know why Barana was being singled out since there are other companies which share the National Fisheries compound.

Social activists told the Government to “keep it real” at a National Consultation on Social Development at Crowne Plaza on Friday. Some 150 participants from a broad cross-section of society related their concerns about the views of a Ministry of Social Development working paper covering social issues as diverse as health, HIV/AIDS, gender, ethnicity, crime, family life and poverty alleviation. Setting the tone for the event was dramatist Hal Greaves, portraying a miserable fellow afraid to seek social assistance. He warned participants: “Sometimes when people come to help, it is as if they are throwing it for fowl, as though we are less than human.

It’s not easy for people to come and ask for help; what words do we use? Sometimes they make it sound as if it is in a book…and I’m not in the book. It’s not ‘paper,’ it’s not ‘issues,’ it’s people.”   While participants generally appreciated the chance to share their concerns, they expressed a mixed attitude to the working paper distilled for them from several previous focus-groups and mini-consultations. From the floor Verna St Rose Greaves declared: “Our problem is in implementation. What else do we need to know about vagrancy and homelessness before we can do something about it? Let’s talk about who’s going to do it, how and when. The time is now!” An ex-patriate male, recently returned from the United States where he said he was daily tracked by someone wanting to throw him and his children in jail, said: “Trinidad and Tobago is not the worst place in the world. Just outside Yale University are all the problems we in TT have, in their boldest and brashest forms.”

Other speakers said the working paper was too idealistic and bureaucratic. One man said: “The language of the document is precise but unclear. It varies from being very loose to being ‘technocratese.’” Sharon Bradshaw of the Caribbean Conference of Churches observed: “If you ask the wrong questions at the beginning, you’ll get the wrong answers.” Former Minister of Health Dr Emanuel Hosein used sarcasm to call for  a more realistic paper to be presented. He derided: “Let’s build a road to Tobago.” A young woman recently returned from the United States echoed that call, saying: “I’m not here to deal with all these bells and whistles.” But one man concluded that while he had some misgivings about the document, he would prefer to have it than have no document at all. Making specific suggestions, mood consultant Dr Robert Moultrie wished the consultation would more emphasise the creating of peace and harmony in our society, saying we must stop denying that negative anger was holding all of us back. “There should be a Ministry to deal with negative anger. We should address the impaired parent-child relationships of which we have an epidemic in Trinidad and Tobago,” he said.”

Many speakers tried to put the consultation into context emphasising what they saw as the most important external factors. Gregory Sloane-Seale of the YMCA warned that worldwide, the privatisation of public services like health, water, and prisons, had destroyed the social fabric of many countries. Academic Dr Winston Suite echoed the earlier warning by Prime Minister Patrick Manning that 24-hour television rarely portrayed our culture. He said, “We want to be somebody else. We don’t know who we are.” Suite recounted that in the 1970s people had ignored a rise in school-dropouts, whom he described as mostly young African males, some of whom  were now criminals. He warned that our sociologists must avoid the errors of our teachers who had switched schooling from “education” to “training.” A Mr Regis noted the coming oil/gas boom but lamented: “Why in the face of such abundance can’t I dare to imagine this vision will be achievable?” Just before lunch a Maloney woman admonished participants. Relating her recent trauma when confronted by several young bandits who kept repeating to her “We not afraid to die, we not afraid to die!,” she quoted scripture to warn: “Without a vision a people perish.” Earlier at the seminar Minister of Social Development Mustapha Abdul-Hamid said all contributions would be taken into account, and that consultation would be ongoing.

President of the Trinidad and Tobago Unified Teachers Association(TTUTA) Trevor Oliver has called on parents nationwide to spend more quality time with their children and underscored the need for parental supervision. Oliver spoke to Sunday Newsday yesterday following a fracas among some schoolgirls at the National Library on Friday evening. It was reported that scores of secondary school students came under police scrutiny after a fight between two schoolgirls raised security fears. According to reports, the two students were not arrested but were counselled about their behaviour. The female constable was said to have told them to “keep the peace.” However, a worker at the library reportedly claimed that one of the girls had a knife and was stopped by officers “just in time from stabbing the other girl.”

Central police station, where the girls were taken for counselling, did not reveal any information about the schoolgirls including which schools they attended. Oliver said he had not received a report but said he was concerned about the frequent incidents which occurred among students at the Library. He lamented that this a disadvantage to the students who really want to learn and access the Library for genuine purposes. He said TTUTA was willing to meet with library officials and discuss possible solutions to help alleviate the problem. “But you know, it is not just us nor the police. The National Library needs the support of the entire community,” said Oliver. He said the most important support of course, must come from the home — the parents. According to Oliver, a report showed that the most well-behaved students come from homes where there is strong parental support and supervision. “Only a parent who is well attuned to his/her children will know what they are taking to school in their bags,” he said. “We need to re-build family values in the home so children will have better values,” Oliver reiterated. The TTUTA president advised parents that when they spend quality time with their children, they will be able to know what is happening in their lives and therefore, exercise more control.