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Emergency medicine is a new specialty in the Caribbean. With the development of specialist training over the past 20 years, the issues of quality assurance and governance have become more prominent. The purpose of this paper is to explore the successes and challenges of implementing systems of quality assurance in this unique environment, highlighting issues peculiar to the Caribbean setting.

This paper is a review of current practice in the emergency departments (ED) of the four major teaching hospitals of the University of the West Indies. Information was gathered through interviews with key stakeholders (including the respective ED residency directors, senior residents and senior nursing and administrative staff), review of departmental protocols and guidelines and reviews of current published and unpublished literature.

Examples of good practice were identified in all six components of the clinical governance framework (clinical audit, clinical effectiveness, research and development, openness, risk management and education and training). Challenges to implementation of quality management included an underdeveloped quality culture, inadequate data collection, poor incentives for improvement and high external pressures, including staff shortages, departmental crowding and lack of public empowerment.

This is the first published work on clinical governance and quality assurance in emergency medicine in the Caribbean. This paper gives an insight into the unique opportunities and challenges in the area of quality management and clinical governance in the developing world, and suggests ways forward with regard to more effective implementation of quality initiatives in under-resourced jurisdictions.

Profiles the development of the project IWW/Earth First Local 1, a group which brought loggers and environmentalists together in an attempt to combine labour and ecology issues. Describes anarchosyndicalist ideas that formed the basis of this alliance, suggesting that these have some merit for present day ecologists. Considers the common ground shared by labour and ecology movements and presents some learnings from the project for future mainstream environmental policies.

This paper will challenge normative disaster studies and practice by arguing that thriving communities require the pursuit of imperfection and solidarity. The authors use Lewis Carroll’s Looking-Glass World as a lens to critique both how disasters are understood, and how disaster researchers and practitioners operate, within a climate-change affected world where cultural, political and historical constructs are constantly shifting.

The paper will undertake an analysis of both disasters and disaster studies, using this unique (and satirical) critical lens, looking at the unfolding of systemic mistakes, oppressions and mal-development that are revealed in contemporary disasters, that were once the critiques of Lewis Carroll’s Victorian-era England. It shows how disaster “resilience-building” can actually be a mechanism for continuing the status quo, and how persistent colonizing institutions and systems can be in reproducing themselves.

The authors argue the liberation of disaster studies as a process of challenging the doctrines and paradigms that have been created and given meaning by those in power – particularly white, Western/Northern/Eurocentric, male power. They suggest how researchers and practitioners might view disasters – and their own praxis – Through the Looking Glass in an effort to better understand the power, domination and violence of the status quo, but also as a means of creating a vision for something better, arguing that liberation is possible through community-led action grounded in love, solidarity, difference and interconnection.

The paper uses a novel conceptual lens as a way to challenge researchers and practitioners to avoid the utopic trap that wishes to achieve homogenized perfection and instead find an “imperfect” and complex adaptation that moves toward justice. Considering this idea through satire and literary criticism will lend support to empirical research that makes a similar case using data.

A unifying theme apparent at this year's Symposium was the need for balance when lifting the veil of bank secrecy: (1) the need to protect civil liberties versus the need to fight crime; (2) the bank's need to balance its role as policeman while furthering its commercial objectives; (3) the necessity of weighing international cooperation against the awareness that individual nations jealously guard their own legislative regime; (4) the dichotomy of technology that serves both to protect and penetrate secrecy; (5) the balance required when investigating crimes.