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Moving forward together

By Hilary Graham-Smith, NZNO Associate Professional Services Manager

This article was first published in Kai Tiaki Nursing New Zealand, October 2018

The past 12 months have taken a toll on all of us, in various ways. A malaise has hung over NZNO and its members; it has been a bit like the winter bug that keeps recurring, only the symptoms are not snuffles, coughing or headaches. At first, the symptoms were mild – anxiety tinged with optimism and hope tinged with despair. But as time went on, they worsened and manifested, for some, as anger, bitterness, cynicism and hostility. For others, there was sadness, disbelief and disquiet.

The maelstrom that has been the district health board (DHB) multi-employer collective agreement (MECA) negotiations, which began in 2017, has left many of us feeling bruised, and wondering what has become of our great profession. As I reflect on this question, other even more difficult ones creep into my head – how do we move forward from this? How do we rebuild trust between and among members, and between members and NZNO?

Staff had had enough

There is no doubt nurses and health care assistants working in our hospitals had had enough – enough of working short-staffed, shift after shift after shift; enough of working extra and/or double shifts; enough of not having their qualifications, expertise and commitment recognised in their pay packets; and enough of putting themselves and their patients at risk, because of all of these things.

There is no doubt trust and confidence in care capacity demand management (CCDM) to deliver a solution had evaporated and, to be fair, is it any wonder? After 10 years, progress on implementation was still glacial. Work analyses and full-time equivalent (FTE) calculations, while providing evidence of the need for more staff, went unheeded. Yes, we know why, but is that really an excuse?

As the negotiations continued, the tension increased, both inside and outside NZNO. The advocates and the negotiating team continued working hard to achieve a result that would go some way to satisfying members, but to no avail, so members voted to strike. Right there was the signal that nurses, midwives and health-care assistants were not going to be easily appeased.

As the first strike day (5 July) loomed, we threw ourselves into planning for the delivery of life preserving services (LPS). For most of us, this was a first, the learning curve was steep. The pace was demanding – days, nights, weekends of work. Anxiety about getting it right was high, but then came a brief reprieve. NZNO was harangued about calling off the first strike day, but that wasn’t done lightly or on a whim. Bargaining had resumed and, under the law, a strike cannot take place while the parties are in bargaining.

To those who still hold a grudge against NZNO about that, perhaps acquainting themselves with the rules that govern bargaining before unleashing their anger would have been more professional. Remember how much we love to say we are an evidence-based profession?

Of course, the stone-throwing started long before the strike. Some members (and non-members) took to social media to rain down abuse on NZNO and on individual staff. For many of us in the profession, that behaviour was the wellspring of deep sadness. What has the profession come to, we asked ourselves and each other as, day after day, the insults, name-calling, ill-informed commentary and blatant lies spewed forth from various Facebook pages.

Caution by NZNO and DHBs

In this fraught context, work on LPS continued in preparation for the second strike on July 12. Again, there are rules that determine how this work is done. If, on strike day, there were more staff than usual, that was about NZNO and the DHBs being cautious – nobody wanted the day to be compromised by tragedy or disaster.

The strike went ahead, a resounding success, some would say – street marches, flag-waving, public support, media coverage – and finally a result.

So what now? Perhaps it is time for a look in the collective mirror. As a profession that espouses critical thinking, compassion, empathy and communication as key to who we are, it begs the question: Are those the values that looked back at us from Facebook?

The preferable course is that we move forward together. We have achieved some excellent outcomes. Together, we can reboot CCDM to ensure workplaces are staffed safely and we can work toward 100 per cent employment in a nurse-entry-to-practice/specialist-practice programme for all new graduate nurses. We can also begin to implement NZNO’s Strategy for Nursing and, in doing so, effect real change for the profession.

We would do well to heed the words of American essayist, cartoonist and humourist, James Thurber: “Let us not look back in anger or forward in fear, but around in awareness.”


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Pacific migrant workers not the solution for aged care staffing

By Eseta Finau,
Board Member and Pacific Nurses Section Chair,
New Zealand Nurses Organisation

Rather than dignify recent foolish comments made by media presenters about Pacific nations, I would like to address an issue to do with Pacific people made a little earlier this month.

The World Bank has suggested that the shortage of aged care workers looming here and in Australia could be solved by welcoming young employees from Pacific countries. The Bank’s reasoning seems to be that New Zealand has too many older people and Pacific nations have too many young people – so it’s a marriage made in Heaven.

But what may seem so simple a solution on paper to the World Bank, and to others who have echoed such calls in the media, may not be any real solution in the long run.

In New Zealand, aged care workers often have poor wages and conditions so the workforce is mostly made up of skilled migrants who are willing to work for lower pay in their struggle to get by. They do have some training and skills and they are dedicated and hard-working. There’s no doubt they do an incredible job despite poor conditions, and that may well be because many are from cultures that especially respect and care for the elderly.

But the reality is we need more registered and enrolled nurses as well as the best skilled but less-qualified aged care workers. In other words, we need to take a ‘whole workforce’ approach rather than an ill-informed ethnic-centred approach. The World Bank’s short-sighted suggestion will do nothing to improve workforce development and staffing polices in aged care for the future because it is not ‘whole workforce’.

It’s also insulting and patronising to Pacific young people. As a Tongan woman, Tongan nurse, mother, auntie, sister and grandmother – and as a New Zealand-based advocate for Pacific people – I am prompted to ask, is accepting a poorly paid job that very few want to do all we think our young people are good for?

Instead we should be welcoming Pacific young people – alongside young Māori and any young person wanting a challenging and rewarding career – into the nursing profession through training and appropriate qualifications.

At the same time we should be increasing pay rates and improving working conditions to make aged care work more attractive to all. This would stop many qualified and experienced people leaving the sector to work where pay and conditions are better. It would also mean the aged care workers left behind to take up the slack get the sort of remuneration and working conditions they deserve.

That’s a solution that will afford dignity to young Pacific migrants, to aged care workers generally, and to the elderly themselves. It may also help ensure that those of us approaching old age are cared for with the respect and professionalism we deserve when our time in aged care comes along.

Let’s get real, aged care deserves more investment in workforce development and safe staffing, and Pacific aged care workers deserve better respect from the commentators on the World Bank’s report.


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CE Memo Musa – speech to NZNO 2018 AGM

Note: Due to time constraints, CE Memo Musa gave an abridged version of this speech at the AGM, agreeing to release the full speech online later.

Wednesday 19 September 2018

Tēnā koutou, Tēnā koutou, Tēnā koutou katoa

I am Memo Musa, Chief Executive of NZNO Tōpūtanga Tapuhi Kai Tiaki O Aotearoa, and it is my pleasure to welcome you all here once more to NZNO’s 25th AGM, and to the conference tomorrow if you will also be attending there.

As usual I would like to acknowledge the Board, Te Poari and the Membership Committee.

I would like to thank our exhibitors and sponsors for both the AGM today and the conference tomorrow, and especially UnionPlus, our major sponsor.

The theme of tomorrow’s conference is ‘Health is a human right – optimising nursing to make it happen’, and I want to talk about the past financial year with that in mind because that theme encapsulates the very reason we exist as an organisation.

We are here to support nurses, midwives, students, nurses and care workers as they advocate for wellbeing and access to healthcare as a fundamental human right of the people they work with. In my opinion there is no other profession that connects with people at their most vulnerable time the way nursing does.

But I want to take this thinking a step further just for today by saying that health is a human right for nurses too – and professional wellbeing is part of that.

For your wellbeing you have the right to be equipped to provide excellent care. You have the right to be educated and skilled. You have the right to have a healthy workplace with empowering policies and where working conditions and staffing levels are safe.

And, perhaps most essential to your wellbeing, you have the right to be recognised for what you do – to be valued and fairly paid.

I can’t think of a better way to expand on the conference theme on the role of NZNO than what I have just said. You are there to stand up for the people in your communities. We are here to stand up for you.

I will come back to this as I cover some of the important developments and achievements of the year, which was an extremely complex one. It was an election year, and the year we started bargaining. But if you look at the submissions we wrote; the campaigns we ran; the publications we produced; the media attention we generated; and the bargaining we conducted – the work outputs and the achievements have been truly phenomenal. And we have also bucked the trend in that we are the only union in New Zealand to have grown its membership.

We can be very proud of the successes which will help ensure that nurses and their rights to health and wellbeing are upheld, respected and supported.

And we have the right to celebrate our successes. Last year in my AGM report I said we do not celebrate enough of our successes, and that we are highly critical of our shortcomings to the point that it overshadows the good things – and the progress we are making. I would like to restate that it is vital that as an organisation for nurses we celebrate the successes and the work we have done together and collectively. To build power we must act in SOLIDARITY, because doing so will further build the power of the profession and NZNO.

So what have we done? I will cherry-pick a few highlights from the annual report, which you can all read at your leisure. That means there will be a lot of things I don’t mention and that should not be seen as diminishing their importance in any way.

If we look at the strategic objective of improved health outcomes, a highlight would have to be the official launching of the NZNO Strategy for nursing in March. This is just one of seven major publications we produced this year. Others included a report on our 2017 Nation Student Nurse Survey and a national Diabetes Nursing Knowledge and Skills Framework. We also published Listening with my Heart, a book of poems by New Zealand nurses. This book, which has already almost sold out, was part of our project to increase the visibility of nurses.

Our own and collaborative projects in the area of improving health outcomes included supporting people living with and beyond cancer, working with the Women’s Health College to get menstrual management products funded for young women, and working with ACC and the Health Quality and Safety Committee to reduce surgical site infections.

In terms of our strategic objective that nurses have the right to be skilled, we have continued with many professional development initiatives – for example, we held 184 professional forums attended by 5780 people throughout the year (6414 people if we also include medico legal forums). And particular effort was made to make these forums available in rural as well as main centres because nurses, midwives and health care workers everywhere have the right to be skilled – even if they don’t live in the main centres.

To support nurses’ right to be part of a strong workforce we have continued to strengthen nursing workforce planning, sustainability and leadership through our journals and publications as well as through various awards.

To be an effective as an organisation in strengthening the workforce (yet another strategic objective and nurses’ right) we made 27 submissions to government and related agencies on a range of nursing-related, professional, regulatory, employment and health issues. We have been vocal about the underemployment of graduate nurses to politicians and in the media about this and many other matters affecting the nursing workforce.

The End of Life Choice Bill submission is just one example – in it we asked for guidelines to help nurses understand their rights and the legal and ethical consequences for them around end of life choices.

Other activities included:

  • a review of NZNO position statements and standards documents developed by colleges and sections
  • a submission (and oral presentation) on the Abortion Law Reform Bill
  • a submission on the tax review which included the views of Te Rūnanga with a focus on reducing inequities; increasing excise tax on alcohol and tobacco and introducing a tax on sugar sweetened foods and beverages.

In terms of membership, we grew to include 50,708 members this year, up from 48,444 last year. This was an increase of 4.7 percent that continues the rising trend in membership numbers over the last 10 years.

We are especially pleased that our youth membership has grown by about 25 percent.

More members means increased need for support, and at this point I would like to acknowledge the daily toils of MSC, our membership support centre. They work at the coalface to support our members’ right to wellbeing in both their practice and work environment. This year we had an average of 770 calls per week. That’s about 150 per day, or 17 for every hour our help line is open. And on top of that there are the 1000s of emailed requests for support.

Our medico-legal team dealt with 282 new medico-legal cases this year involving 354 member which has helped ensure our members enjoy the right to good legal advice and fair representation when required. The advice given covered a wide range of areas from coroner’s cases, Nursing Council and Midwifery Council inquiries, Health and Disability Commissioner complaints, police inquiries and many more.

In addition our medico-legal lawyers provided legal advice in relation to the constitution and privacy, and presented at various internal and external seminars, which we have already mentioned.

In terms of employment law we dealt with 23 members’ cases over matters such as personal grievances, wages arrears, disputes and contracts.

Our organisers and professional nurse advisors also carry a massive workload that needs to be acknowledged. Their activities included representing on matters relating to negotiation on collective agreements, responding to change management proposals, organising delegates and their structures, and participating in campaigns to support nurses’, midwives’ and care workers’ rights to fairness and equity.

Most frequently the work of organisers and professional nurse advisors involved issues of pay, collective agreement interpretation and disciplinary issues.

One campaign that I would particularly like to highlight was pay equity. As an organisation whose members are nearly all employed in historically female dominated occupations, we are committed to achieving 100 percent pay equity for all our members. This is, of course, another fundamental human right that nurses should enjoy.

NZNO developed a pay equity strategy aimed at achieving a settlement in the DHB sector. As you are no doubt aware that was achieved.

Altogether NZNO negotiated around 33 collective agreements during the year and pay equity was included in the negotiations around the DHB MECA. As part of this work NZNO launched the Health Needs Nursing campaign to raise public understanding of the nursing and midwifery crisis. We believe this was very successful.

We have continued to be very active in the media and our credibility and effectiveness as an authority on health and nursing matters is increasing. We have issued at least one media release a week (sometimes many more) and we have received regular coverage in print, online and on radio and television.

Sometimes this has been in collaboration with other organisations. Our work with the PSA for example, saw a united front and significant media visibility. We jointly produced an open letter on health funding and we were at Parliament with the PSA on Budget Day where they had cardboard cut-outs of health care workers, which resulted in a number of NZNO representatives being interviewed on TV3 and TVNZ

The announcement of the Caregivers Equal Pay settlement was made jointly with the PSA and E tū and such collaboration with other unions has meant that all groups gained media coverage and were able to “own the wins” together.

Other themes we were active in the media about include proposed restructuring of senior nurse positions at DHBs, parking and safety concerns for staff travelling to and from work and workplace safety in mental health settings.

There were 11 issues of our monthly magazine Kai Tiaki, and each was published with a particular theme. The magazine is well-read and distributed, with 46,500 copies being printed in March. Its Facebook page continues to grow with some stories reaching 41,000 readers or more.

There is so much more going on within the organisation and many more activities and achievements I could tell you about, but perhaps this representative sample of how NZNO has worked to support the rights of nurses, midwives and care workers is sufficient for now.

However, I would be remiss not to mention finances. Our total income for the year was 21.4m and we had an expenditure of 21.7m. However, after tax and adjustments we finished the year with a surplus of $182,419. This means that, financially, we remain in a very healthy position to continue working to support those rights.

I would like to place on record my sincere appreciation of the work our staff have done on your behalf during the past year. I thank you too as delegates and members for the many volunteer hours you have put into NZNO’s work in the last year. To the Board and Management thank you for supporting me to work with you and for providing leadership.

Solidarity forever,
Solidarity forever,
Solidarity forever,
For the union makes us strong.

No reira tēnā koutou, tēnā koutou, tēnā koutou, tēnā koutou katoa.


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Celebrating the International Day of the Midwife

On Thursday 3rd May midwives from Aotearoa took to the streets in a National Day of Action. Why? Like nurses, midwives are fed up with the chronic under-funding of the maternity system. Despite having launched a Pay Equity claim with the high court in 2015 midwives have largely been ignored. In the spirit of good faith the claim was taken out of court and into mediation where a new funding model (co-designed by the College of Midwives and the MoH) was agreed on. But it is waiting to be given the green light because it will involve a significant increase in funding.

Thursday saw the culmination of a two-month long campaign to raise awareness of the issues for midwives, particularly the Lead Maternity Carers (LMCs). Charlie Ferris, an LMC from Southland started the “Dear David” campaign after being told by her accountant that her business was just not sustainable. A breakdown of costs revealed that despite working up to 80hrs a week, Charlie was earning just $7.45/hr. And she isn’t alone. One analysis of LMC work has put the average hourly rate for an urban midwife at $12.80 and $7.23 for rural practice – that’s less that half the minimum wage!

After marching through the streets of Wellington we arrived at Parliament grounds where a petition with over 13,000 signatures was presented to the Minister of Health, David Clark. We heard from a line-up of speakers including Associate Minister of Health and Minister for Women, Julie-Ann Genter. A bound book of Facebook posts was also presented, and we were assured that our impassioned pleas had “been heard”.

In New Zealand there are two arms of the midwifery workforce, the LMCs and the DHB employed ‘core’ midwives. We have a symbiotic relationship and when one arm is under stress the other arm is called upon to carry the extra load. LMCs are on-call 24/7, have no sick pay or annual leave and their travel is not billable. Effectively it’s like being a contractor but without any ability to adjust your fees. Core midwives are paid under the DHB MECA and are represented by either NZNO or MERAS. It is my opinion that the lack of industrial voice for LMCs has resulted in the situation we have now where pay and conditions have become untenable. LMCs are leaving the profession in droves and our world-class maternity system is in crisis.

There is important mahi to be done in the DHB space as well. Midwives are specialists in maternity care and undertake a four-year degree programme. Despite functioning as autonomous practitioners who have the legal authority to prescribe, diagnose and discharge we are not remunerated as such and so feel very under-valued! I am hopeful that the pay equity process which forms a key component of our NZNO MECA claim will address these disparities.

As for funding the new co-design model, well that depends on how much gets dished out in what feels like the very long-awaited budget.

This International Midwives Day will go down in history as the year we midwives stood together, LMC and core, united and impassioned in our love for our work and our belief in delivering a quality service for the people of Aotearoa.

In solidarity
Sarah Gilbertson (Midwife, NZNO delegate)


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Matariki a time to reflect

Over recent years I along with many others have a renewed appreciation for Matariki.  Celebrating Matariki or Puanga is increasingly popular, with many people braving the brisk mid-winter evening to go out and celebrate under the canvas of the stars, paying tribute to Matariki.

Matariki literally means the ‘eyes of god’ (mata ariki) or ‘little eyes’ (mata riki) although we celebrate in the evenings, Matariki for many of us in Aotearoa the Matariki stars are only visible at dawn before they get overpowered by the days light.

Traditionally the brightness of these stars were considered an indication of the how good the coming growing season ahead would be. The brighter the stars the warmer the new growing season and therefore the more productive the crops would be.

The rise of Matariki signals the Māori New Year, an important time for family to gather to acknowledge those who had passed away, reflecting on the past year and celebrate the future ahead.  It is a time to acknowledge and let go of the past and focus on the good

Planning for the year ahead is really good practice and a time to check in with yourself.  My Kaumātua the late Matua Bill Sterling and the late Aunty Vera Morgan would always say “Look after yourself, if you are not well then you can’t give time, energy or care to those around us, this is a time for you to check in with your wellbeing”.  These are such important words and really imperative, especially for those whose work revolves around caring, supporting and working with others.

For those of you that have never participated in  Matariki or Puanga, I encourage you to participate, or even take some time out under the evening stars take some time for yourself, reflect and re energise,

I personally wish you a wonderful Matariki and encourage you to look around you and up to the sky and give yourself some time to heal and nurture yourself and families and to prepare for the new season.

 

Kia kaha

Kerri Nuku

Kaiwhakahaere

NZNO


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If health is a winner on Budget Day we are all better off

kerri-grant-tppa

It’s Budget week. All eyes are on Finance Minister Grant Robertson, and what the government’s first budget has shaped up like. Our eyes of course are primarily on what it means for health.

Kiwis see the need: A third of people think that health should be the top priority on Thursday, according to the last 1 News Colmar Brunton poll. The reasons aren’t hard to find. DHB deficits, crumbling hospital infrastructure and the mental health crisis and health workforce dissatisfaction have made the headlines for months.

A decade of severe underfunding of our public health services has meant our health system has failed to keep pace with our growing community need, the demands of an ageing population and ageing workforce, and increased costs of providing services.

The health system itself is now sick, and needs to be nursed back to health. This is the number one message to the Government from the New Zealand Nurses Organisation on Budget Day. It’s why we’re rallying around the country.

But “health needs nursing” in more ways than one. The nursing team is the largest workforce in health. We are the dedicated, skilled professionals who are with you from the moment you’re born until your last breath.

It is concerning however that this year the rhetoric has been about the “competing demands” on the government, and about expectations that are not likely to be met in a year of spending.

Prime Minister Jacinda Ardern has said: “It is as important for us to make sure we meet the competing needs that we have around strong services for health and education as it is to also make sure that we keep the books in good shape, that we are ready for any economic shocks”

While the threat of another earthquake or two is making the government cautious, is it really a case of balancing health against the economy?

World Health Organisation Director General Dr Tedros Adhanom stated recently that, “Governments see health as a cost to be contained…This is wrong. Health is an investment to be nurtured.”

In 2016, we took part in a meeting in Geneva to advise the United Nations High-Level Commission on Health, Employment and Economic Growth and here is an extract from its statement:

“The returns on investment in health are estimated to be 9 to 1. One extra year of life expectancy has been shown to raise GDP per capita by about 4 percent.”

“Investments in the health system also have multiplier effects that enhance inclusive economic growth, including via the creation of decent jobs. Targeted investment in health systems, including in the health workforce, promotes economic growth.”

Evidently investing in health makes us all better off.

Rebuilding a quality public health system includes investment in the health workforce. To enhance the health and wellbeing of all peoples in Aotearoa/New Zealand and to lift our economy, adequate and safe staffing levels in our health services, healthy shift rostering, access to study leave for professional development and full employment of new graduate nurses are vital ingredients. This will attract students to the profession and retain those already in it. It also leads to a happier, healthier workplace that will also relieve some of the bullying that can occur.

Fair pay, which appropriately recognises our skills and qualifications, naturally also attracts and retains nurses, midwives and healthcare assistants.

The health and wellbeing of New Zealanders also depends on other factors surrounding the healthcare system, like having liveable incomes, warm and affordable housing, equitable access to education, nutritious food, and a healthy environment. Therefore NZNO is also assessing Budget 2018 for policies in the social sector and environment that support health and wellbeing.

Tomorrow we will see whether the government has decided to make a sufficient investment in health. We hope for the sake of the health and wellbeing of the population and the nursing workforce especially that it does, if not in one go then we want to see a clear roadmap to recovery of the public health system and workforce itself. As shown in the placards at rallies around the country: The healthcare team needs to be well to keep others well.

Finance Minister Grant Robertson has hinted that come Thursday, “Health and Education will get long overdue boosts to their capital and operating funding to deal with cost pressures.”

For all our sakes, the boost must be big enough, and soon.

President, Grant Brookes and Kaiwhakahaere Kerri Nuku.

 


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Proud to nurse

 

 

Registered Nurse Freya Head

 

Yesterday I stood tall at the New Zealand Nurses Organisation press conference in Wellington to be part of the public announcement that the 27,000 strong DHB nurse, midwife and health care assistant workforce had rejected once again the DHB offer for the new collective agreement that included a 2% pay increase this year and next. We are simply worth more, deserve more and need more.

We know that the public health service is creaking with the strain of high demand, more complexities of an aging population and suffering in a climate of funding neglect but we also are a workforce that needs looking after so that we can look after others.

A decade of severe underfunding of our public hospitals has taken its toll on everyone and I feel nurses wear the brunt of this in their everyday lives. We are picking up extra shifts and staying later than we should, missing meal breaks, toilet breaks and going home broken, only to put ourselves back together and do it all over again the next day. We are stretched to our absolute capacity and beyond. This is not sustainable and frankly, not fair.

So yes all of this can’t be fixed immediately with a money tree but we do think a better offer can be achieved. We have waited for a long time for a pay boost, as have others, but we cannot wait any longer, we need it now.

Nurses are beyond stressed and this takes its toll on our health, on our families and our personal relationships. It takes its toll in our working relationships with our colleagues and then those in our care also start to feel this pressure and this is just not acceptable to us.

I used to say to my friends “How about a nursing degree, nursing is fantastic.” I am just not saying that anymore. It is not fantastic at the moment.

Nursing can be a rewarding and great career but not when you are burnt out, expected to do more with less and the prospect of actually getting adequate pay to keep up with the cost of living is no where near in sight.

I go home after shifts and wake up in the middle of the night, worried that perhaps those in my charge won’t actually get the medical attention and support they need. I ask myself “How is this the new ‘norm’? Is this acceptable?” and the answer is no, it’s not.

I feel it is time for the government to pull its socks up and face this head on.

We need to attract and retain our great nursing workforce and the meagre crumbs of percentage increases that barely meet inflation just aren’t good enough anymore.

No nurse would look forward to a strike and many will be stressed with the notion of leaving hospitals in a crisis situation and understaffed. We will have a week of action and we really are planning to garner public support for a pay rise.

Too long have we kept the faith, waiting to be recognised and for our pleas to be heard. Too long have we listened to the promises of a better tomorrow for that day to never come. We need action now. Not in a few years or ten years. Now.