| Nepal's Health Situation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nepal is a country of 28 million people located between China and India. Its remoteness, mountains, lack of infrastructure, and land-locked status pose extreme barriers to development. Its per capita income is USD $218 and the vast majority of people are subsistence farmers. From 1996-2006, Maoist rebels fought a civil war against the Nepal government, a democracy with a House of Representatives. Nepal's maternal mortality ratio (MMR) of 539/100,000 births ranks among the highest in the world. (In comparison, Sri Lanka's MMR is 94, while the United States' is just 8). Life expectancy is 55 years. Diseases of pregnant women, children, infections, and malnutrition account for two thirds of Nepal's illnesses. The government manages a system of curative and public health institutions that span a vast country, where travel must often be on foot. The Ministry of Health and Population (MoHP) is the central body responsible for health planning, implementation, and evaluation. The Ministry is also responsible for zonal and regional hospitals. The Department of Health Services under the Ministry is responsible for providing health services at district levels and below. Local village committees handle delivery of health services at the district levels and below through local health facilities, which are District Hospitals, Primary Health Care Centres, Health Posts and Sub-Health Posts. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Health Service Facilities (public and private)
Source: Nepal Strategic Plan for Human Resources for Health, 2003 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The Nepal Government's National Health Policy (1991), Second Long-term Plan (1997-2017), and the Tenth 5-Year Health Plan (2002-7) all give highest priority to extending the health care system to the poor, rural, marginalized and most vulnerable in the population. Special attention is to be focused on maternal-child health, infectious diseases and outpatient care. In approaching these problems, the Health Sector Reform Strategy of 2004 also emphasized the concepts of "decentralization" and "public-private partnerships".
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| 1978 saw the establishment of Nepal's Institute of Medicine (IoM) whose mission was to create a cadre of health care workers for the whole country. The IoM sought to recruit students from all over Nepal and train them in a way that would encourage their return to rural facilities. This met with modest, though not sustained, success. IoM's Tribuvan University Teaching Hospital (TUTH) remained Nepal's only medical college until the 1990's, when local medical education underwent a virtual explosion. Now in 2006, Nepal has 13 medical colleges, 40 nursing campuses, and 125 campuses for mid-level health care workers. This proliferation, however, has not trickled down to rural areas where the need is greatest. A large proportion of high level health care workers (doctors and nurses) leave Nepal to study and then work overseas. Today, well over 50% of IoM's doctor graduates head for the U.S. There is still a gaping disparity in the quality of health care access offered in urban and rural areas. While Kathmandu has 98 doctors for every 100,000 people, rural Nepal averages just 2.5 per 100,000 – and in many of its 75 districts, there is no doctor. Many approved government posts of all levels of health care worker are unfilled. One indication of unmet need: For the whole of Nepal, 13% of all deliveries are conducted by trained personnel; and for the poorest fifth of the population (mainly rural) the number is just 3%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Monday, November 5, 2007
Health Needs of Nepal
Sending Dr.'s to Remoteness
Nepal's health care system is crying out for change
A man walked up and asked me to see his son. A seven-year-old and his father had carried him eight hours down from the hills.
The boy had two weeks of fever and a tender bulge on the left side of his neck. The father showed me a paper from previous Hospital written the day before: 'Refer to higher centre for treatment'.
In fact, all the boy had was a skin abscess and he just needed minor surgery. Unfortunately, no anesthesia or pain relief medicine was available. The incision into his neck, though successful, was very painful. He had to be held down, his crying filling the hallway. As we were cleaning up, we watched the grateful father laying his son on the porch outside the hospital to warm him in the winter sun.
In towns and villages across Nepal, scenes like these play out every day. There is a hospital building and some staff, but they cannot provide even basic care. Women giving birth, children with broken arms and legs, people with burns, fever, and pain, all crying out for change in Nepal's health care system.
Nepal's health officials work against huge obstacles to provide comprehensive health care in remote places with a limited budget, and in the face of political turmoil. While the health infrastructure is generally adequate the big problem is assuring that staff are on duty, have competent skills, and are caring.
Only 18 percent of Nepali women who deliver babies have a trained health worker in attendance, and for the poorest parts of the country it is less than five percent. Every day 12 Nepali women die at childbirth.
In the last ten years Nepal has seen tremendous growth in medical colleges and the annual production of new doctors will soon cross 1,000. We now have over 40 nursing campuses. Each year, the 125 separate medical institutes under CTEVT produce over 4,000 new health assistants, nurse midwives, and community medical assistants. Where do they all go? Why are rural Nepalis still without health care?
We need a paradigm shift in our thinking about health care in Nepal in three fundamental areas:
1 Provide quality care to the greatest number
Are we aiming for highest quality care for a few or quality care for many? The Health Ministry is now creating posts for health care workers who can cover much wider areas of the country. For example, while a specialist anesthesia doctor is unlikely to ever venture into the hospitals of Panchtar, Baglung or Dandheldura there are now Anesthesia Assistants in each of those places, enabling operations to be conducted. Similarly, the SBA (skilled birth attendant) program trains not just doctors but multiple levels of health workers, nurses and ANMs to conduct safe deliveries.
2 Support health care workers in the field
Why do doctors, nurses and mid-level health workers refuse to stay in rural hospitals? First, there is a strong pull to migrate. In one of Nepal's premier medical colleges last year, over half of its graduating class of doctors left to train in the United States. Of them, 95 percent of will not return. In the past five years nurses have joined doctors in this mighty exodus. And who can blame them? A staff nurse will earn 10 times more in England than in Nepal.
Those who stay need to be taken care of while they work in difficult circumstances. Increasingly, local committees are starting to manage rural hospitals, sometimes with excellent results. Several factors help in keeping health workers happy and productive. These are the 5 C's:
• Communication: Enable the hospital to use the internet, including telemedicine facility.
• Continuing Medical Education: Provide professional nourishment for staff growth.
• Connection with a higher hospital: Create a link with staff in another, regional center.
• Community management: Hospital staff do better when they are managed locally.
• Children's education: Unless their kids are looked after, the staff will soon move away.
There is no shortage of health care workers in Nepal, the problem is persuading them to stay where they are needed the most.
3 Build beyond MBBS
I am a doctor, and I have trained young doctors in Nepal for the last 20 years. Doctors are certainly needed in Nepal but they are not a remedy to all of our problems. In medicine experience sometimes counts even more than fine training. I know of experienced health assistants who can diagnose a patient better than most new doctors. And ANMs are far more skillful at delivering babies.
The captain of the rural health care team should be an MD General Practice doctor. Across Nepal, we have seen these all-rounders transform local health care systems. An MDGP can do operations, deliver babies, take care of kids and adults and has administrative training. We must train more MDGPs and get 2-3 of them to work in each district hospital as a team.
Let's re-examine our guiding principles, test them against available evidence and build on this strong foundation. Only then will we begin to hear less crying in the countryside.
“My heart came home.”
Nursing at 7,000 Feet
Caring for patients in a Himalayan village hospital has forever changed the outlook of two UBC School of Nursing grads.
Julia Iwama and Christine Fantuz spent five weeks, ending in February this year, at the TEAM Hospital in Dadeldhura, in Western Nepal. The facility is perched on a mountain ridge at an altitude of almost 7,000 feet. It has 36 beds, treats 250 outpatients daily and serves a surrounding population of 1.5 million people. Nursing staff deliver approximately 100 babies every month.
"Sometimes, there are not enough hands to catch all the babies," says Iwama, who recalls one busy birthing night when the hospital security guard had to help deliver babies.
The students encountered both injuries and conditions unique to the area. A common scenario was women -- including heavily pregnant women -- falling out of trees as they gathered leaves to feed herd animals. They also treated the serious complications of local healers' interventions such as packing an injury with dung. They dealt with daily power outages, scarce equipment, some poor-quality medications and temperatures barely above freezing.
Also, providing care within a vastly different culture was challenging.
"I delivered a baby girl and the mother told me to throw it in a bucket," says Fantuz. "Women are devalued in Nepal and it was so hard to see women also devaluing their own daughters."
A highlight for her was donating two units of blood, carrying the bags into the operating room, and administering the blood to a patient to help save her life.
In addition to patient care, the pair was involved in ward management. A surgical team from Kathmandhu came to the small hospital for a week dedicated to performing as many surgeries as possible, meaning staff had to accommodate and co-ordinate care for 286 in-patients with only a few dozen beds.
When they weren't working, the duo spent time in Dumada, a neighbouring community of about 300 villagers, sharing meals, singing and hiking.
Both women say the experience helped them focus on what's most important for the patient and the value of "just being present." Iwama, who also worked at the hospital in 2006, stresses the importance of understanding Nepal's health-care issues in the context of people's -- especially women's -- daily life. "They want their stories told, and not just to be a statistic."
"What I'll remember is that even with so many differences, people are similar -- they want to be loved, to be touched and cared for," says Fantuz, a former registered massage therapist who is working toward a critical care nursing specialty and plans to work as an intensive care nurse.
Iwama will return to the hospital this Fall to work there indefinitely. "This experience affirmed for me where I want to be in life," she says. "My heart came home."
DADELDHURA HOSPITAL
Located in the far-west, this hospital is planned to be rebuilt over the next couple of years and to take on a training role for middle grade staff. Dadeldhura is currently being managed by HDCS and TEAM Nepal with the expectation that a formal agreement for HDCS to manage the hospital will be signed soon.
Friday, October 26, 2007
Leopard vs Vista
Leopard vs Vista
The Mac is on a roll. Apple Inc.'s perennially praised but slow-selling Macintosh computers have surged in popularity in the past few years, with sales growing much faster than the overall PC market, especially in the U.S. By some measures, Mac laptops are now approaching a 20% share of U.S. noncorporate sales, up from the low single digits where they once seemed stuck.
| Personal Technology columnist Walt Mossberg says the new operating system keeps Apple ahead of Microsoft, but it's not revolutionary, with only a handful of core novelties. (Oct. 25) |
There are several reasons for this, including the security problems in the dominant Windows platform from Microsoft; spillover from Apple's blistering success with its iPod music players; the fact that Macs can now run Windows programs; and Apple's highly successful chain of company-owned retail stores.
But another key factor has been the Mac operating system, called OS X, which came out in 2001. It has proved to be as powerful and versatile for mainstream consumers as Windows, yet easier to use and more secure. And Apple has upgraded OS X far more rapidly than Microsoft Inc. has upgraded Windows, bringing out major new releases roughly every 18 months, while Microsoft struggled for more than five years to produce the latest Windows iteration, Vista, which came out in January.
On Friday evening, Apple will release yet another new version of OS X, called Leopard, to replace the current version, known as Tiger. I've been testing Leopard, and while it is an evolutionary, not a revolutionary, release, I believe it builds on Apple's quality advantage over Windows. In my view, Leopard is better and faster than Vista, with a set of new features that make Macs even easier to use.
VOTE
![[Go to Question of the Day.]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_vLK_v71h_pfPVnE95QLb8nPeOstq7oAF4FWjhlY8XfTzMjuI5vUMuDyQ0OdyO5_AoAYg7Wbz4ocTHyTVzR0vhTrmEbHnopS_8KwtW2GqTwucGXeM64EE8oDmIBRfHVhUanqVsIttwzw1o=s0-d)
How likely is it that your next home-computer purchase will be an Apple rather than a PC? Cast your vote in the Question of the Day.
Leopard will come preinstalled on all new Macs. It can also be purchased for $129 as an upgrade to existing Macs that, depending on configuration, can be as many as six years old. Unlike Vista, which is sold in four noncorporate upgrade versions ranging from a $100 stripped-down "basic" edition to a $259 deluxe "ultimate" edition, there's only one version of Leopard. It includes all the features, from those aimed at novices to those aimed at power users.
For me, the marquee features in Leopard are a new function called Time Machine that automatically backs up your entire computer in the background; two new methods, called Cover Flow and Quick Look, for rapidly viewing the contents of files without opening any programs; and new techniques that allow you to access the files in, and to remotely control, other computers on your network or connected over the Internet with a few clicks and no technical expertise.
![[Spot Check]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_t0KjjIyhwp6HFtdUPWRKBlvj1_6ms5I4sC34fb_KvbORQKkXoWRDHHHpiIpMSd7jcZgubFNxn05divENbBFxJizSXxi_eSHDi2uYQ4ux_LN7yxWHpMlMO3Lq57NqNPXX6wwknytrLgLW3dXO0-H2Pb0HM=s0-d)
Plus, Apple's free software for running Windows on a Mac, called Boot Camp, which was formerly an add-on users had to download and install, is now built right into the operating system. And, in my tests, the third-party Fusion program for running Windows and Mac programs simultaneously continued to work fine in Leopard.
I did notice a few drawbacks, but they were minor. The menu bar is now translucent, which can make it hard to see the items it contains if your desktop picture has dark areas at the top. The new folder icons are dull and flat and less attractive than Vista's or their predecessors on the Mac. While Time Machine can perform backups over a network, the backup destination can only be a hard disk connected to a Mac running Leopard. And, on the Web, I ran into one site where the fonts on part of the page were illegible, a problem Apple says is known and rare and that I expect it will fix.
While Apple claims the new system includes more than 300 new features, there is nothing on the list that could be considered startling or a major breakthrough. Some of Leopard's features are unique, but many others -- such as backing up data and quickly viewing files -- have been available on both Windows and the Mac via third-party programs or hard-to-find geeky methods buried in the operating systems. Leopard has made them easy to find and use.
When I upgraded my personal iMac desktop to Leopard, it took less than an hour, and after the process was complete, all my programs, including the Mac version of Microsoft Office, the Firefox Web browser and Adobe Reader, worked rapidly and fine. I was still able to run Windows XP via Fusion. And my previous installation of Boot Camp, which turns the iMac into a speedy, full-fledged Vista machine after a reboot, worked perfectly. All my Vista programs and files continued to function properly.
![[Ptech]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_v0dfddkq94ohPls6y41Me11o5MvnnVpGGWpmDRffaACV9lTmgFahPoieqNK8NNw6kl0ZAUn7AFdOsTYqrFpamI8id3BMZOm-EjNsBHtBebk5NfsAmAy75aHey6N5FvNUkgePumCymEhdxI3ho1qwxqPg=s0-d) |
| With Cover Flow, users get a visual preview of a computer's files without having to open programs. |
In fact, every piece of software and hardware I tried on two Leopard-equipped Macs -- a loaned laptop from Apple and my own upgraded iMac -- worked fine, exhibiting none of the compatibility problems that continue to plague Vista. My old Hewlett-Packard inkjet printer, for which Vista lacks the proper software, worked instantly in Leopard, even over the network. And, unlike with Vista, it was able to print on both sides of the page. I popped my old Verizon cellphone modem card into the test Leopard laptop and it worked, too, with no software installation or tweaking.
Leopard felt about as fast as Tiger, and it started up much faster than Vista in my tests. I compared a MacBook Pro laptop with Leopard preinstalled to a Sony Vaio laptop with Vista preinstalled. Even though I had cleared out all of the useless trial software Sony had placed on the Vaio, it still started up painfully slowly compared with the Leopard laptop.
It took the Vista machine nearly two minutes to perform a cold start and be ready to run, including connecting to my wireless network. The Leopard laptop was up, running and connected to the network in 38 seconds. In a test of restarting the two laptops after they had been running an email program, a Web browser and a word processor, the Sony with Vista took three minutes and 29 seconds, while the Apple running Leopard took one minute and five seconds.
Here's a rundown of some of Leopard's key features. Much more detailed information is available at apple.com/macosx.
File management: Apple's Finder, the equivalent of Explorer in Windows, now offers two new ways to quickly see what your files contain. You can still view them as icons or lists. But you can also use Cover Flow, the same system Apple uses in iTunes and on the iPhone to display album covers for music. In Leopard, a large preview of each file you select appears above the list of files in a folder, and you can rapidly scroll through these icons. These previews are live, and their contents can be viewed without opening the program that is normally needed to display them.
![[Leopard]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_s6VHrBJ5HR26_BPYgllSOpetlwXSwnvUj7S7kGMyQOf7OnYxn3fR5IisXcDjCKUNkxOeG7e_AdmeQQ5C41h6JcoP0yfACJ0Yk6r3DlTpoob2-NjZkV8tqw02qxcf6vd5rls66bQUzgugL98-p-V78UbH8u=s0-d) |
| Time Machine backs up files. |
For instance, if the file is a video, you can just click on it, and it will play. If it's a multipage PDF file, you can click on it, and arrows will appear allowing you to flip through the pages.
An even better and deeper look can be obtained using a feature called Quick Look. Just hit the space bar or click on a toolbar icon, and a preview of any selected file zooms out. You can even view multiple sheets in an Excel file via Quick Look without launching Excel.
Another quick new way to see your files is available in the Dock, the Mac's equivalent of the Windows Task Bar. Here, any folder you place on the right side of the dock will display its contents, after a single click, either as a grid of icons displaying miniversions of the file or as a "fan," or arc, of such icons. These special Dock folders are called "Stacks." Leopard includes one by default that is the destination for everything you download from the Internet, so your desktop will no longer get cluttered with downloads,
Time Machine: This built-in feature will continuously back up all of the contents of your Mac to either an external hard drive directly connected to the computer, or to a hard disk connected to another Mac running Leopard that's on your network. The initial backup, in my tests, took all night, but after that, the system updates the backups hourly and I didn't notice any slowdown during the process.
To recover any file you deleted, you simply click on the Time Machine icon, and you are taken to a view that shows file folders -- or your email or address book or photo collection -- in a stack of windows that appear to go on infinitely. You click on an arrow and the stack of windows zooms until you arrive at the last view in which the missing file existed. Then, you click "restore," and the file is recovered in your normal desktop view. You can also restore whole folders, groups of files, or even an entire hard disk.
Shared computers: In Leopard, any computer that has been set to be shared on your network shows up on the left side of every Finder window. Click on it, and you can access whatever folders have been shared on those machines. Depending on the remote computer's security settings, you may first have to enter a user name and password. It's the simplest method I've ever seen for accessing other computers on a network. And it works with Windows PCs as well as Macs. When I first turned on the Leopard laptop in my office, it immediately found a shared folder on my colleague's old Dell running Windows XP. She hadn't even remembered sharing the folder, which contained files from 2003.
You can copy or move files to and from these shared computers, or view their contents with Cover Flow and Quick Look, or open them in programs on your own computer.
If you are a member of Apple's optional .Mac service, which costs $100 a year, you can use a feature called "Back to My Mac," which can access your Macs from thousands of miles away over the Internet. However, this feature works only over certain kinds of routers (not all of them Apple's) and, as my router didn't qualify, I couldn't test it.
Remote control: For any Mac in your shared-computers list for which you have permission, you can take over the screen by simply clicking on a button called "Share Screen." You can also remotely control distant Macs over the Internet using Apple's built-in iChat instant messaging program, as long as you have permission and the Macs are running Leopard.
![[ptech]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_v0nsGudrq9qRWommEyWRhonYeGCsxHdAj9y3qo-1gIEqAZtPZzP5_zlgcWah9Frtq3OY7sCtYRDZFB2XfkBMyjze6imvHCjOXtEuA4iVmYLmGacqoUFk8jAy7uHElF43P-EV0l0tp2U0fy8h0PBn6SFpk=s0-d) |
| Stacks displays the files in folders in the dock. |
iChat: Apple now allows you to use its instant messaging program with Google Talk as well as AOL's AIM service, and you can set up a video chat in which you can present a slide show or display a document. You can also add special backgrounds that can make it look as though you're someplace else, like Paris. In my tests, this even worked with someone on the other end using a Windows XP computer running the latest version of AIM.
Spaces: In order to cut down desktop clutter, Leopard lets you set up as many as 16 different desktops that can run simultaneously, with different programs open in each. You switch among these desktops by using keyboard commands or a menu.
For instance, you might have your iPhoto and iTunes running in one "space," or desktop, your Web browser and email program in another, and Windows XP in another.
Leopard isn't a must-have for current Mac owners, but it adds a lot of value. For new Mac buyers, it makes switching even more attractive.
Email me at mossberg@wsj.com. Find all my columns and videos online free at the new All Things Digital web site, http://walt.allthingsd.com.
Friday, October 19, 2007
Getting into Ivy
Get Your Kid into an Ivy Michele Hernandez boasts that 95% of her teenage clients are accepted by their first-choice school। Her price: As much as $40,000 a student As I listened to my 8th period English teacher drone on for the third time about how Finny, a character in A Separate Peace, was indeed the main character although he was not the narrator, it finally dawned on me that this was not the exciting world of high school that I had hoped for।
This is how Andrew Garza began an essay in his application to Haverford College। It was a 1,200-word piece that established him as an intellectually curious young man। It was crafted to appeal specifically to the admissions officers at the small liberal arts school. And it was the idea of his high-priced college admissions coach, Michele A. Hernandez. Garza attended a private school in Switzerland, and that worried Hernandez: She thought he might appear to be a privileged teenager without much substance. So she advised him to write about why he had left his public high school in suburban New Jersey. "We had to make it seem like he didn't want to be around so many rich kids. We spun a whole story about him taking the initiative to leave in order to broaden his experience," Hernandez says. "It was his initiative. But he wouldn't have written about it."Today Andrew is a senior at Haverford, studying sociology and economics. His father, John, paid Hernandez $18,000 for 18 months' worth of advice. "It is a lot of money," says Garza, a manager at Abitibi-Consolidated (
ABY ) in New York। "But if you look at it as an investment, it's not a bad one।"A DIVISIVE FIGUREHernandez may well be the most expensive college coach in America, charging as much as $40,000 to get a student into an elite college. As one of this fast-growing industry's most visible practitioners, she uses methods that are publicly scorned by rivals but are nonetheless becoming part of the profession's standard operating procedures. She is a divisive figure in an already controversial field, regularly drawing condemnation from admissions officers who say she is selling advantage to people who least need it.If the notoriety sometimes bothers her, Hernandez is not about to let on. To her critics, she says: "I'd be an idiot to charge half of what I can. Parents can always hire a lesser person." That might sound arrogant, but she is clearly proud of turning her one-woman operation, Hernandez College Consulting, into what amounts to a luxury brand. Her clients, mostly people of some means and great ambition, rave about the personal service: the regular phone calls to their kids (you have to go above and beyond); the academic help (read the book Poetic Meter and Poetic Form); the "brand" positioning (classics would be a great angle); the advice about which colleges to consider and where not to bother; the hours she devotes to each application.Despite being asked to pay fees that are as much as 10 times higher than average, these well-intentioned, well-heeled parents keep calling. And calling. Since she started seven years ago, Hernandez, who is 40, says she has worked with some 150 students, 95% of whom, she claims, were accepted at their first choice of college. She hints that among them have been the progeny of chief executives, financiers, billionaires.Hiring help is not the privilege of only the wealthy, of course. According to the Independent Educational Consultants Assn., 22% of first-year students at private colleges—perhaps as many as 58,000 kids—had worked with some kind of consultant.THE INSIDE SCOOPBut few of the 4,000 independent college counselors now scattered around the country can match Hernandez' influence or earning power. Early on, she began offering college-admissions counseling for students in eighth grade—yes, eighth grade—an approach that is becoming more common. Since 2005, she has run application boot camps in Manhattan and Santa Monica, Calif., which this summer cost $9,500 and are sure to attract imitators. Hernandez says she earned almost $1 million last year. She drives a BMW convertible. And she just moved near Middlebury, Vt., where she and her husband own 117 acres on Snake Mountain.What makes her own story so compelling is that Hernandez is an insider-turned-outcast. A former admissions officer at Dartmouth College, she dared to reveal secrets of the opaque selection process in her book, A Is for Admission: The Insider's Guide to Getting Into the Ivy League and Other Top Colleges, and then to build a thriving business that helps people game the system. As she says to parents: "You don't want to pay $180,000 for some piddling school when, by spending a little extra, your kid could get into Yale." She insinuates herself so deeply into her students' lives and is so unabashed about her money-making that she has come to be regarded either as operating at the leading edge of her profession or its cynical extreme.Hernandez had been out of college for four years when she returned to her alma mater, Dartmouth, as an assistant director of admissions in 1993. It was a job of convenience (she had married a professor there, Jorge Hernandez) and one for which she was eminently qualified but temperamentally unsuited.Hernandez speaks twice as fast as most people, reads as if it were a competitive sport, and is forceful, opinionated, and stubborn. These traits were not always appreciated by her colleagues. At one point, the dean of admissions, Karl Furstenberg, reprimanded her for not being more deliberate in her evaluations. Hernandez had been a valedictorian of her high school in Armonk, N.Y., graduated Phi Beta Kappa from college, earned a master's degree in English and comparative literature from Columbia University, and was exasperated by the criticism. She still is. "I thought he should bow in my direction for working so hard."Hernandez began keeping a journal, chronicling what she regarded as the essential workings of the selection process. It wasn't revenge or ambition, she says, that motivated her to turn her notes into a book, though later she would be accused of both. It was indignation: She believed Ivy League schools weren't being truthful about how they reviewed students' applications. "We were forced to misrepresent things," she says. "Parents kept asking if there was an equation we used. There was." Privately, the schools referred to it as the Academic Index, a formula based on test scores and academic standing used to rank applicants. "It was the secret everyone in admissions knew," Hernandez recalls. "But we couldn't tell parents that. It bothered me."The promise of the first inside account of what seemed to be an unpredictable process, along with expert advice about how students can distinguish themselves in their applications, was irresistible to publishers. After a bidding war, Hernandez received a $450,000 advance from Warner Books. One condition of her contract was that she tell no one about the book, not even at Dartmouth where she was still employed. "I felt bad for Karl because I knew the book would get a lot of attention, and it would look bad for him," says Hernandez. "But I was very complimentary toward Dartmouth."While she was working on the book, her husband was denied tenure, an event that has come to confuse the circumstances of her eventual departure from Dartmouth in May, 1997. Five months later, A Is for Admission was published. "This book is not aimed at guaranteeing admission to an Ivy League school," she wrote in the introduction. "However, it will teach you how to maximize your chances and show you how to present yourself in the best possible light." At the time, Furstenberg told The Chronicle of Higher Education that the book was a betrayal of trust: "It offers only a glib, superficial look at college admissions. It plays into some of the paranoia and anxiety that surround this process, and in that sense is a disservice." (Neither he nor anyone at Dartmouth would comment for this story.)The book was a success and became Hernandez' most effective advertisement when she went into college consulting full-time in 2000. It gave her name recognition—so much so that even after her divorce in 2001 from Jorge she continued to use his surname. And it helped establish her bona fides among parents, many of whom are inclined, as she is, to regard admission to the top schools as a high-stakes game that should be played using any advantage.Those well-meaning, chronically striving parents were comfortable hiring expensive experts. Their eager-to-please kids were accustomed to being hovered over. The conditions were ideal for Hernandez. Already, a few high-priced, high-impact counselors had begun to assert themselves, not oblivious to the disapproval of educators but unconcerned all the same. Among them was Katherine Cohen, an Ivy League graduate once employed part-time by Yale to read applications, who had founded IvyWise in 1998. When Hernandez first heard about her, Cohen was asking $28,995 for her two-year platinum package. "I realized she was making a living doing this," Hernandez says. "I increased my price after that."She would soon have a few more credentials that could help attract clients. She wrote two other books: The Middle School Years: Achieving the Best Education for Your Child, Grades 5-8 and Acing the College Application: How to Maximize Your Chances for Admission to the College of Your Choice. And she earned a quickie doctorate in education from Nova Southeastern University in Florida, where she had moved in 1998. About that degree she is candid: "It's kind of crappy compared to my other ones. But I figured it would be good to have. I am a doctor. It gives me some credibility."Families pay Hernandez as much as they do because she promises not just substitute parenting but parenting in the extreme. She selects classes for students, reviews their homework, and prods them to make an impression on teachers. She checks on the students' grades, scores, rankings. She tells parents when to hire tutors and then makes sure the kids do the extra work. She vets their vacation schedules. She plans their summers. And through it all, she is always available to contend with the college angst that can consume whole families. Parents value her confidence; kids, mostly, appreciate her enthusiasm.From the beginning, Hernandez pledged all that work would be invisible. Like her peers, she operates in stealth, mindful that if admissions officers find out a student was coached they will regard the application with suspicion. Hernandez rarely speaks with high school counselors. She never calls a college on a student's behalf. And she is especially careful not to leave any fingerprints on the application essays, even as she edits seven, eight, sometimes 10 drafts. "But I'm not afraid of admissions officers," she says. "If they could tell, how would I be so successful?"Admissions officers, of course, have little respect for the work of Hernandez and other consultants. "I believe that most of the funds expended on independent counselors are simply wasted," Jeffrey Brenzel, the dean of admissions at Yale, wrote in an e-mail. "We do not believe they have much, if any, effect on who we accept."Hernandez' apparent success depends, too, on how well she manages the expectations of the kids and their parents. She says nearly all of her students are accepted to the school they most want to attend. But in many cases, she strongly suggests which college would be a reasonable first choice. She calls that strategizing. First she writes a 12-to-18 page report for each new student, based on transcripts, test scores, and other accomplishments, that gives the likelihood of their gaining admission to the schools they are interested in. "I have written: 'You have 0% chance of getting into Harvard early decision. Don't apply,'" she says. "People pay for accuracy. I know exactly what it takes to get into Harvard." Her apparent candor serves another purpose, too: Such an assessment makes it unlikely that she will fail.When she begins working with kids already in their junior year of high school, she is naturally a bit constrained in what she can advise after that initial evaluation. "At that age, they have what they have," she says. When John Garza contacted Hernandez in January, 2002, Andrew already knew he wanted to attend Haverford. Hernandez told him it would be a reach. Then she started suggesting ways he could fashion himself into a more attractive applicant.Over the next year, as she does with most of her clients, she worked with him by e-mail and over the phone, occasionally in person. She helped him navigate the International Baccalaureate curriculum, advising him to sign up for classes that U.S. colleges would recognize as difficult. She directed his interests. "I helped in ways that would look good and let him be true to himself," she says. Early in his junior year, Andrew had become involved with Habitat for Humanity, though his contributions were modest. Hernandez talked to him about the importance of leadership: In his senior year, he served as president of the local chapter. She encouraged him to make a bigger impact: He helped raise $4,000 to build homes in Kyrgyzstan and Hungary by expanding the organization's sandwich-making business on campus.Then she suggested he write his main application essay about something else altogether. "The Habitat for Humanity theme, the tug on your heartstrings, sounded too common," says Andrew. So he tried another topic that would reveal more about his intellectual enthusiasms: how running helped him understand the existentialist philosophy he was reading about. "She gave me specific suggestions about the essay to form one cogent image of who I am," says Andrew.Crafting that singular, convincing portrait of the student is central to Hernandez' approach. She considers sentimental pursuits a distraction and those done out of obligation misguided. So it went with Ben Selznick, who started to work with Hernandez in the spring of 2002 when he was a junior. His father, David, a tax attorney in Armonk, N.Y., paid $16,500 for about a year's worth of advice. "We had a very motivated son who wanted to attend a top university," he says. "We wanted to give him every opportunity we could."Ben was a talented drummer, and Hernandez told him to concentrate on his music. He recalls conversations about his schedule: "I was on the track team and she asked: 'Are you going to be a track star?' So I quit and got a job as a drum teacher at a local music school." She put the kibosh on plans to be a camp counselor, too; instead he spent several weeks that summer at the Berklee College of Music in Boston.During his senior year, Ben joined a couple of singing groups, took more music classes, and completed an independent study in composition. "A lot of it came from me realizing that music could be a good way to pitch myself," he says. At Hernandez' suggestion, he visited Dartmouth. It became his first choice. Hernandez then told him to apply early decision, which is binding. (Almost all of her clients apply early somewhere because the acceptance rate is higher than during regular admission.)He applied as a music major. Ben had been uncertain about how to frame his main essay until Hernandez advised him to write about the experience of listening to his favorite piece of classical music, Wagner's Tannhäuser Overture, and its influence on his own creative process. Ben was accepted to Dartmouth. He graduated in May with a degree in religious studies and is now working as a paralegal at a law firm outside of Boston.Andrew and Ben were typical Hernandez clients: bright, eager, and just months away from applying to college. Before long, though, she began to promote her services for younger kids. Hiring Hernandez to work with 14-year-olds became a more tempting proposition for parents as they watched the acceptance rates at elite schools drop. By 2004 she was signing up a new eighth- or ninth-grade student almost every month. She had also moved to Portland, Ore., remarried, given birth to her second child, and begun calling herself "America's Premiere College Consultant."FINDING THE 'SELLING POINT'What sets Hernandez apart these days is the intensity with which she extends into adolescence the Brand Me imperative. Her approach with these students depends on sussing out and then encouraging their own inclinations. If someone says she likes photography, Hernandez might suggest she take photos of the homeless, then mount an exhibit as a way to raise money. "A kid wouldn't come up with that idea on their own," she says. "They don't know what colleges are looking for." Hernandez advised a student working on a nanotechnology project to e-mail famous scientists and compile the exchanges into a book. "If you did that, I guarantee you'd get into any school," she said to the girl. To another student who enjoys studying Latin, Hernandez suggested learning Greek over the summer, too: "It's a great selling point." When a ninth-grade boy said he might be interested in his school's tech club, she told him: "You can take it over and take it in a new direction."Today, Hernandez has 80 clients. And yet, unlike Cohen of IvyWise, who now has a staff of 15 providing help with applications for nursery school on up, Hernandez is still on her own, answering every phone call, sending every e-mail. She doesn't want to manage employees and, in any case, doesn't believe her knowledge can be transferred or replicated. That, of course, places a natural limit on her business. In 2005 she hadn't yet reached it but was close enough that she began looking for other ways to expand her operation. She soon came up with an idea that would again be derided by educators and embraced by parents.Hernandez and Mimi Doe, a parenting expert with whom she had just written the book, Don't Worry, You'll Get In: 100 Winning Tips for Stress-Free College Admissions, announced their first application boot camp. It was a $7,800, four-day summer program for students about to enter their senior year. Doe and Hernandez promised they would leave with completed applications and a strategy for where to seek admission.All 15 spaces for the New York seminar, held at the luxury Kitano hotel, were snapped up in weeks. In the summers of 2006 and 2007, Hernandez and Doe raised the price, first to $8,200 and then to $9,500, and still filled one session in Manhattan and another at the Shutters Hotel in Santa Monica. Next year they may hire others to help edit the essays so they can open the program to more students. They will charge $12,500.But is it worth it? There is no way to verify her claims. Even Andrew and Ben, who respect her expertise and dedication, express some ambivalence. "I would like to think that I would have gotten in anyway," says Andrew. "But the reality is, you never know. I think Michele eliminated the risk that I wouldn't get in." Ben, mulling over his college experience in the months after graduation, puts it this way: "I'm thankful to Michele. I didn't think she was indispensable, though. Could I have done it myself? Maybe. Could I have gone somewhere else and been happy? Yes."Certainly, plenty of kids delight in the opportunities consultants like Hernandez make available to them. Many thrive under high expectations; others aren't undone by the sacrifices called for. Ben, for example, has no regrets about following Hernandez' advice, even if it meant giving up the camaraderie of the track team and summer camp. Andrew's experience led to a job with Habitat in Mexico for one year before he began Haverford. And during college vacations, he worked with microlending programs in Latin America.But, in general, the intense pressure to succeed is a big reason the incidence of anxiety, depression, and drug use is as high among children of the affluent as it is among children of the inner city, according to Columbia University psychologist Suniya S. Luthar. "Young people perceive that their whole lives are building to this moment of applications, rejections, acceptances. They see it as either you make it or you are doomed to a second-class existence," she says. Even those who do get into top schools may suffer the consequences of their success. Barry Schwartz, a psychology professor at Swarthmore College, says: "Those who excel enough to get into Harvard or Stanford are likely to be less inspired students once that goal has been achieved."Set aside for the moment the concerns of the affluent, though. There is another fear about expensive counselors such as Hernandez: that they help distort an educational system that can already leave the less privileged at a disadvantage. As Ben says, "It's so not a level playing field to start with, and then you go beyond. I just told friends it was my dad's idea to hire her."Hernandez, meanwhile, is finding new ways to extend her brand. She and Doe have created a virtual boot camp ($2,999). They have put together a 60-page book, Set Yourself Apart: The Ultimate Guide to Top High School Summer Programs ($189). They have a partnership with two SAT tutors who on Hernandez' Web site offer five hours of help over the phone ($1,600). And Hernandez and Doe are hoping to link up with a travel consultant, someone who could plan family trips to visit colleges. "That will be like Ralph Lauren's Purple Label," Hernandez says. "It won't be for everybody."
This is how Andrew Garza began an essay in his application to Haverford College। It was a 1,200-word piece that established him as an intellectually curious young man। It was crafted to appeal specifically to the admissions officers at the small liberal arts school. And it was the idea of his high-priced college admissions coach, Michele A. Hernandez. Garza attended a private school in Switzerland, and that worried Hernandez: She thought he might appear to be a privileged teenager without much substance. So she advised him to write about why he had left his public high school in suburban New Jersey. "We had to make it seem like he didn't want to be around so many rich kids. We spun a whole story about him taking the initiative to leave in order to broaden his experience," Hernandez says. "It was his initiative. But he wouldn't have written about it."Today Andrew is a senior at Haverford, studying sociology and economics. His father, John, paid Hernandez $18,000 for 18 months' worth of advice. "It is a lot of money," says Garza, a manager at Abitibi-Consolidated (
ABY ) in New York। "But if you look at it as an investment, it's not a bad one।"A DIVISIVE FIGUREHernandez may well be the most expensive college coach in America, charging as much as $40,000 to get a student into an elite college. As one of this fast-growing industry's most visible practitioners, she uses methods that are publicly scorned by rivals but are nonetheless becoming part of the profession's standard operating procedures. She is a divisive figure in an already controversial field, regularly drawing condemnation from admissions officers who say she is selling advantage to people who least need it.If the notoriety sometimes bothers her, Hernandez is not about to let on. To her critics, she says: "I'd be an idiot to charge half of what I can. Parents can always hire a lesser person." That might sound arrogant, but she is clearly proud of turning her one-woman operation, Hernandez College Consulting, into what amounts to a luxury brand. Her clients, mostly people of some means and great ambition, rave about the personal service: the regular phone calls to their kids (you have to go above and beyond); the academic help (read the book Poetic Meter and Poetic Form); the "brand" positioning (classics would be a great angle); the advice about which colleges to consider and where not to bother; the hours she devotes to each application.Despite being asked to pay fees that are as much as 10 times higher than average, these well-intentioned, well-heeled parents keep calling. And calling. Since she started seven years ago, Hernandez, who is 40, says she has worked with some 150 students, 95% of whom, she claims, were accepted at their first choice of college. She hints that among them have been the progeny of chief executives, financiers, billionaires.Hiring help is not the privilege of only the wealthy, of course. According to the Independent Educational Consultants Assn., 22% of first-year students at private colleges—perhaps as many as 58,000 kids—had worked with some kind of consultant.THE INSIDE SCOOPBut few of the 4,000 independent college counselors now scattered around the country can match Hernandez' influence or earning power. Early on, she began offering college-admissions counseling for students in eighth grade—yes, eighth grade—an approach that is becoming more common. Since 2005, she has run application boot camps in Manhattan and Santa Monica, Calif., which this summer cost $9,500 and are sure to attract imitators. Hernandez says she earned almost $1 million last year. She drives a BMW convertible. And she just moved near Middlebury, Vt., where she and her husband own 117 acres on Snake Mountain.What makes her own story so compelling is that Hernandez is an insider-turned-outcast. A former admissions officer at Dartmouth College, she dared to reveal secrets of the opaque selection process in her book, A Is for Admission: The Insider's Guide to Getting Into the Ivy League and Other Top Colleges, and then to build a thriving business that helps people game the system. As she says to parents: "You don't want to pay $180,000 for some piddling school when, by spending a little extra, your kid could get into Yale." She insinuates herself so deeply into her students' lives and is so unabashed about her money-making that she has come to be regarded either as operating at the leading edge of her profession or its cynical extreme.Hernandez had been out of college for four years when she returned to her alma mater, Dartmouth, as an assistant director of admissions in 1993. It was a job of convenience (she had married a professor there, Jorge Hernandez) and one for which she was eminently qualified but temperamentally unsuited.Hernandez speaks twice as fast as most people, reads as if it were a competitive sport, and is forceful, opinionated, and stubborn. These traits were not always appreciated by her colleagues. At one point, the dean of admissions, Karl Furstenberg, reprimanded her for not being more deliberate in her evaluations. Hernandez had been a valedictorian of her high school in Armonk, N.Y., graduated Phi Beta Kappa from college, earned a master's degree in English and comparative literature from Columbia University, and was exasperated by the criticism. She still is. "I thought he should bow in my direction for working so hard."Hernandez began keeping a journal, chronicling what she regarded as the essential workings of the selection process. It wasn't revenge or ambition, she says, that motivated her to turn her notes into a book, though later she would be accused of both. It was indignation: She believed Ivy League schools weren't being truthful about how they reviewed students' applications. "We were forced to misrepresent things," she says. "Parents kept asking if there was an equation we used. There was." Privately, the schools referred to it as the Academic Index, a formula based on test scores and academic standing used to rank applicants. "It was the secret everyone in admissions knew," Hernandez recalls. "But we couldn't tell parents that. It bothered me."The promise of the first inside account of what seemed to be an unpredictable process, along with expert advice about how students can distinguish themselves in their applications, was irresistible to publishers. After a bidding war, Hernandez received a $450,000 advance from Warner Books. One condition of her contract was that she tell no one about the book, not even at Dartmouth where she was still employed. "I felt bad for Karl because I knew the book would get a lot of attention, and it would look bad for him," says Hernandez. "But I was very complimentary toward Dartmouth."While she was working on the book, her husband was denied tenure, an event that has come to confuse the circumstances of her eventual departure from Dartmouth in May, 1997. Five months later, A Is for Admission was published. "This book is not aimed at guaranteeing admission to an Ivy League school," she wrote in the introduction. "However, it will teach you how to maximize your chances and show you how to present yourself in the best possible light." At the time, Furstenberg told The Chronicle of Higher Education that the book was a betrayal of trust: "It offers only a glib, superficial look at college admissions. It plays into some of the paranoia and anxiety that surround this process, and in that sense is a disservice." (Neither he nor anyone at Dartmouth would comment for this story.)The book was a success and became Hernandez' most effective advertisement when she went into college consulting full-time in 2000. It gave her name recognition—so much so that even after her divorce in 2001 from Jorge she continued to use his surname. And it helped establish her bona fides among parents, many of whom are inclined, as she is, to regard admission to the top schools as a high-stakes game that should be played using any advantage.Those well-meaning, chronically striving parents were comfortable hiring expensive experts. Their eager-to-please kids were accustomed to being hovered over. The conditions were ideal for Hernandez. Already, a few high-priced, high-impact counselors had begun to assert themselves, not oblivious to the disapproval of educators but unconcerned all the same. Among them was Katherine Cohen, an Ivy League graduate once employed part-time by Yale to read applications, who had founded IvyWise in 1998. When Hernandez first heard about her, Cohen was asking $28,995 for her two-year platinum package. "I realized she was making a living doing this," Hernandez says. "I increased my price after that."She would soon have a few more credentials that could help attract clients. She wrote two other books: The Middle School Years: Achieving the Best Education for Your Child, Grades 5-8 and Acing the College Application: How to Maximize Your Chances for Admission to the College of Your Choice. And she earned a quickie doctorate in education from Nova Southeastern University in Florida, where she had moved in 1998. About that degree she is candid: "It's kind of crappy compared to my other ones. But I figured it would be good to have. I am a doctor. It gives me some credibility."Families pay Hernandez as much as they do because she promises not just substitute parenting but parenting in the extreme. She selects classes for students, reviews their homework, and prods them to make an impression on teachers. She checks on the students' grades, scores, rankings. She tells parents when to hire tutors and then makes sure the kids do the extra work. She vets their vacation schedules. She plans their summers. And through it all, she is always available to contend with the college angst that can consume whole families. Parents value her confidence; kids, mostly, appreciate her enthusiasm.From the beginning, Hernandez pledged all that work would be invisible. Like her peers, she operates in stealth, mindful that if admissions officers find out a student was coached they will regard the application with suspicion. Hernandez rarely speaks with high school counselors. She never calls a college on a student's behalf. And she is especially careful not to leave any fingerprints on the application essays, even as she edits seven, eight, sometimes 10 drafts. "But I'm not afraid of admissions officers," she says. "If they could tell, how would I be so successful?"Admissions officers, of course, have little respect for the work of Hernandez and other consultants. "I believe that most of the funds expended on independent counselors are simply wasted," Jeffrey Brenzel, the dean of admissions at Yale, wrote in an e-mail. "We do not believe they have much, if any, effect on who we accept."Hernandez' apparent success depends, too, on how well she manages the expectations of the kids and their parents. She says nearly all of her students are accepted to the school they most want to attend. But in many cases, she strongly suggests which college would be a reasonable first choice. She calls that strategizing. First she writes a 12-to-18 page report for each new student, based on transcripts, test scores, and other accomplishments, that gives the likelihood of their gaining admission to the schools they are interested in. "I have written: 'You have 0% chance of getting into Harvard early decision. Don't apply,'" she says. "People pay for accuracy. I know exactly what it takes to get into Harvard." Her apparent candor serves another purpose, too: Such an assessment makes it unlikely that she will fail.When she begins working with kids already in their junior year of high school, she is naturally a bit constrained in what she can advise after that initial evaluation. "At that age, they have what they have," she says. When John Garza contacted Hernandez in January, 2002, Andrew already knew he wanted to attend Haverford. Hernandez told him it would be a reach. Then she started suggesting ways he could fashion himself into a more attractive applicant.Over the next year, as she does with most of her clients, she worked with him by e-mail and over the phone, occasionally in person. She helped him navigate the International Baccalaureate curriculum, advising him to sign up for classes that U.S. colleges would recognize as difficult. She directed his interests. "I helped in ways that would look good and let him be true to himself," she says. Early in his junior year, Andrew had become involved with Habitat for Humanity, though his contributions were modest. Hernandez talked to him about the importance of leadership: In his senior year, he served as president of the local chapter. She encouraged him to make a bigger impact: He helped raise $4,000 to build homes in Kyrgyzstan and Hungary by expanding the organization's sandwich-making business on campus.Then she suggested he write his main application essay about something else altogether. "The Habitat for Humanity theme, the tug on your heartstrings, sounded too common," says Andrew. So he tried another topic that would reveal more about his intellectual enthusiasms: how running helped him understand the existentialist philosophy he was reading about. "She gave me specific suggestions about the essay to form one cogent image of who I am," says Andrew.Crafting that singular, convincing portrait of the student is central to Hernandez' approach. She considers sentimental pursuits a distraction and those done out of obligation misguided. So it went with Ben Selznick, who started to work with Hernandez in the spring of 2002 when he was a junior. His father, David, a tax attorney in Armonk, N.Y., paid $16,500 for about a year's worth of advice. "We had a very motivated son who wanted to attend a top university," he says. "We wanted to give him every opportunity we could."Ben was a talented drummer, and Hernandez told him to concentrate on his music. He recalls conversations about his schedule: "I was on the track team and she asked: 'Are you going to be a track star?' So I quit and got a job as a drum teacher at a local music school." She put the kibosh on plans to be a camp counselor, too; instead he spent several weeks that summer at the Berklee College of Music in Boston.During his senior year, Ben joined a couple of singing groups, took more music classes, and completed an independent study in composition. "A lot of it came from me realizing that music could be a good way to pitch myself," he says. At Hernandez' suggestion, he visited Dartmouth. It became his first choice. Hernandez then told him to apply early decision, which is binding. (Almost all of her clients apply early somewhere because the acceptance rate is higher than during regular admission.)He applied as a music major. Ben had been uncertain about how to frame his main essay until Hernandez advised him to write about the experience of listening to his favorite piece of classical music, Wagner's Tannhäuser Overture, and its influence on his own creative process. Ben was accepted to Dartmouth. He graduated in May with a degree in religious studies and is now working as a paralegal at a law firm outside of Boston.Andrew and Ben were typical Hernandez clients: bright, eager, and just months away from applying to college. Before long, though, she began to promote her services for younger kids. Hiring Hernandez to work with 14-year-olds became a more tempting proposition for parents as they watched the acceptance rates at elite schools drop. By 2004 she was signing up a new eighth- or ninth-grade student almost every month. She had also moved to Portland, Ore., remarried, given birth to her second child, and begun calling herself "America's Premiere College Consultant."FINDING THE 'SELLING POINT'What sets Hernandez apart these days is the intensity with which she extends into adolescence the Brand Me imperative. Her approach with these students depends on sussing out and then encouraging their own inclinations. If someone says she likes photography, Hernandez might suggest she take photos of the homeless, then mount an exhibit as a way to raise money. "A kid wouldn't come up with that idea on their own," she says. "They don't know what colleges are looking for." Hernandez advised a student working on a nanotechnology project to e-mail famous scientists and compile the exchanges into a book. "If you did that, I guarantee you'd get into any school," she said to the girl. To another student who enjoys studying Latin, Hernandez suggested learning Greek over the summer, too: "It's a great selling point." When a ninth-grade boy said he might be interested in his school's tech club, she told him: "You can take it over and take it in a new direction."Today, Hernandez has 80 clients. And yet, unlike Cohen of IvyWise, who now has a staff of 15 providing help with applications for nursery school on up, Hernandez is still on her own, answering every phone call, sending every e-mail. She doesn't want to manage employees and, in any case, doesn't believe her knowledge can be transferred or replicated. That, of course, places a natural limit on her business. In 2005 she hadn't yet reached it but was close enough that she began looking for other ways to expand her operation. She soon came up with an idea that would again be derided by educators and embraced by parents.Hernandez and Mimi Doe, a parenting expert with whom she had just written the book, Don't Worry, You'll Get In: 100 Winning Tips for Stress-Free College Admissions, announced their first application boot camp. It was a $7,800, four-day summer program for students about to enter their senior year. Doe and Hernandez promised they would leave with completed applications and a strategy for where to seek admission.All 15 spaces for the New York seminar, held at the luxury Kitano hotel, were snapped up in weeks. In the summers of 2006 and 2007, Hernandez and Doe raised the price, first to $8,200 and then to $9,500, and still filled one session in Manhattan and another at the Shutters Hotel in Santa Monica. Next year they may hire others to help edit the essays so they can open the program to more students. They will charge $12,500.But is it worth it? There is no way to verify her claims. Even Andrew and Ben, who respect her expertise and dedication, express some ambivalence. "I would like to think that I would have gotten in anyway," says Andrew. "But the reality is, you never know. I think Michele eliminated the risk that I wouldn't get in." Ben, mulling over his college experience in the months after graduation, puts it this way: "I'm thankful to Michele. I didn't think she was indispensable, though. Could I have done it myself? Maybe. Could I have gone somewhere else and been happy? Yes."Certainly, plenty of kids delight in the opportunities consultants like Hernandez make available to them. Many thrive under high expectations; others aren't undone by the sacrifices called for. Ben, for example, has no regrets about following Hernandez' advice, even if it meant giving up the camaraderie of the track team and summer camp. Andrew's experience led to a job with Habitat in Mexico for one year before he began Haverford. And during college vacations, he worked with microlending programs in Latin America.But, in general, the intense pressure to succeed is a big reason the incidence of anxiety, depression, and drug use is as high among children of the affluent as it is among children of the inner city, according to Columbia University psychologist Suniya S. Luthar. "Young people perceive that their whole lives are building to this moment of applications, rejections, acceptances. They see it as either you make it or you are doomed to a second-class existence," she says. Even those who do get into top schools may suffer the consequences of their success. Barry Schwartz, a psychology professor at Swarthmore College, says: "Those who excel enough to get into Harvard or Stanford are likely to be less inspired students once that goal has been achieved."Set aside for the moment the concerns of the affluent, though. There is another fear about expensive counselors such as Hernandez: that they help distort an educational system that can already leave the less privileged at a disadvantage. As Ben says, "It's so not a level playing field to start with, and then you go beyond. I just told friends it was my dad's idea to hire her."Hernandez, meanwhile, is finding new ways to extend her brand. She and Doe have created a virtual boot camp ($2,999). They have put together a 60-page book, Set Yourself Apart: The Ultimate Guide to Top High School Summer Programs ($189). They have a partnership with two SAT tutors who on Hernandez' Web site offer five hours of help over the phone ($1,600). And Hernandez and Doe are hoping to link up with a travel consultant, someone who could plan family trips to visit colleges. "That will be like Ralph Lauren's Purple Label," Hernandez says. "It won't be for everybody."
Menno
Mennonite Medical Association has been a great partner to Nepal in sending missionaries from USa to the remote mountains of Nepal as well as providing scholarship to several medical students and residents in their education as well as mission trip.
A fellowship of around 600 physicians, dentists, and medical or dental students and residents, who are members of congregations of Mennonite and Brethren in Christ Churches. Professional persons, not members of such congregations, or health care workers other than physicians and dentists, who are in harmony with the Purposes and Faith Statement of this organization may become Associate members.
Mobilization for Mission is a fund made up of voluntary contributions from association members and others. These funds are used to provide assistance in sharing specific medical and dental skills in visits to mission fields and in consultative services. They are also used for travel subsidies to help medical students experience a Student Elective Term in a trans-cultural setting. Such settings include hospitals in South America, Africa, and Asia, as well as North America.The Steven Roth Fund is a separate fund within Mobilization For Mission which was established in memory of Steven Roth, a medical student who died of cancer in December, 1990; to honor his dream of medical mission work. It is designed to stimulate and support the participation by MMA members in international missions.
The Dr. Mary Jean Yoder Memorial Endowment Fund is directed by a Committee within Mennonite Mission Network, and receives and disburses grants or self‑canceling loans for medical and paramedical training of national Christians in developing countries.
Established in 1990 by the Class of 1964 in celebration of the 25-year reunion of the class, this fund commemorates their classmate, Mary Jean Yoder, M.D., who exemplified the ideals of perseverance and service to others. Dr. Yoder was tragically killed in an automobile accident less than a week after graduation from Medical School ( the IU School of Medicine).
The Mary Jean Yoder AwardDr. Mary Jean Yoder was a Mennonite and a graduate of this school. In memory of her ideals, this award honors a graduating senior who exhibits high moral character, academic excellence, and, especially, dedication to service to others
Other Activities
Encourages Regional Chapters to organize and arrange for periodic meetings.
Maintains on‑ going contact between practicing physicians, dentists, and medical/dental students.
Presents the need for physicians and dentists in mission and church‑ related projects, both abroad and in North America.
Remains alert for projects that need the kind of assistance which MMA members can best give.
Arranges preceptorships for students with graduate members in a variety of settings.
Sponsors and finances the Student Elective Term (SET) program.
Brings Mennonite physicians and dentists together in an annual convention to share and formulate ideas pertinent to Christian faith and professional practice.
Encourages and facilitates medical service ventures on the part of all members.
Encourages and facilitates dialogue between members about issues at the intersection of their professional lives with their faith.
Helps to sponsor consultations on Anabaptist views of health and healing, medical ethics, and professional life.
A fellowship of around 600 physicians, dentists, and medical or dental students and residents, who are members of congregations of Mennonite and Brethren in Christ Churches. Professional persons, not members of such congregations, or health care workers other than physicians and dentists, who are in harmony with the Purposes and Faith Statement of this organization may become Associate members.
Mobilization for Mission is a fund made up of voluntary contributions from association members and others. These funds are used to provide assistance in sharing specific medical and dental skills in visits to mission fields and in consultative services. They are also used for travel subsidies to help medical students experience a Student Elective Term in a trans-cultural setting. Such settings include hospitals in South America, Africa, and Asia, as well as North America.The Steven Roth Fund is a separate fund within Mobilization For Mission which was established in memory of Steven Roth, a medical student who died of cancer in December, 1990; to honor his dream of medical mission work. It is designed to stimulate and support the participation by MMA members in international missions.
The Dr. Mary Jean Yoder Memorial Endowment Fund is directed by a Committee within Mennonite Mission Network, and receives and disburses grants or self‑canceling loans for medical and paramedical training of national Christians in developing countries.
Established in 1990 by the Class of 1964 in celebration of the 25-year reunion of the class, this fund commemorates their classmate, Mary Jean Yoder, M.D., who exemplified the ideals of perseverance and service to others. Dr. Yoder was tragically killed in an automobile accident less than a week after graduation from Medical School ( the IU School of Medicine).
The Mary Jean Yoder AwardDr. Mary Jean Yoder was a Mennonite and a graduate of this school. In memory of her ideals, this award honors a graduating senior who exhibits high moral character, academic excellence, and, especially, dedication to service to others
Other Activities
Encourages Regional Chapters to organize and arrange for periodic meetings.
Maintains on‑ going contact between practicing physicians, dentists, and medical/dental students.
Presents the need for physicians and dentists in mission and church‑ related projects, both abroad and in North America.
Remains alert for projects that need the kind of assistance which MMA members can best give.
Arranges preceptorships for students with graduate members in a variety of settings.
Sponsors and finances the Student Elective Term (SET) program.
Brings Mennonite physicians and dentists together in an annual convention to share and formulate ideas pertinent to Christian faith and professional practice.
Encourages and facilitates medical service ventures on the part of all members.
Encourages and facilitates dialogue between members about issues at the intersection of their professional lives with their faith.
Helps to sponsor consultations on Anabaptist views of health and healing, medical ethics, and professional life.
Sign of Love for Nepal- Iwa
In recognition of the highly distinguished contribution in missionary works as a doctor in Nepal for decades, Dr. Noboru Iwamura, former chairman of International Human Resources Institute Network has received many awards and honors.
In 1962, he came to Nepal as a doctor through Japan Overseas Christian Medical Cooperative Service. Since then, for 18 years he continued to render service to patients suffering from various diseases going from village to village. In the mountains of Nepal, the most common ailment he encountered was tuberculosis and leprosy. Concerned by the large number of patients suffering from these diseases in particular, he devised other ways to control these diseases by teaching the people how to improve public health and implementing immunization campaigns in the villages.
Besides, he also contributed in educating doctors, nurses and paramedical personnel for effective healthcare delivery in Nepal. These dedicated missionary activities that Dr. Iwamura carried out over the years have also contributed enormously in deepening the mutual understanding and friendly relations between Japan and Nepal.
Apart from this, his selfless service took him to far away places in Asia, Africa and Latin America. His work laid the foundation to bring together the leaders of Asian communities and he was conferred the 'Magsaysay Award' in 1993 for international understanding.
Dr. Iwamura Memorial Hospital and Research Center
Dr. Iwamura Memorial Hospital was established in December 2001 in Bhaktapur, in memory of Dr. Noboru Iwamura. To continue his unfulfilled duties towards the Nepali community, Ms. Purnima Gurung, colleagues from Nepal, India and Japan have founded this memorial hospital. Established under the financial assistance from the Rotary International District 2640 and 2680 Japan, the hospital provides 24 hours out patient services, emergency services, as well as general medical and surgical services especially on cardiology, nephrology, gastrology and neurology. This hospital needs you.
In 1962, he came to Nepal as a doctor through Japan Overseas Christian Medical Cooperative Service. Since then, for 18 years he continued to render service to patients suffering from various diseases going from village to village. In the mountains of Nepal, the most common ailment he encountered was tuberculosis and leprosy. Concerned by the large number of patients suffering from these diseases in particular, he devised other ways to control these diseases by teaching the people how to improve public health and implementing immunization campaigns in the villages.
Besides, he also contributed in educating doctors, nurses and paramedical personnel for effective healthcare delivery in Nepal. These dedicated missionary activities that Dr. Iwamura carried out over the years have also contributed enormously in deepening the mutual understanding and friendly relations between Japan and Nepal.
Apart from this, his selfless service took him to far away places in Asia, Africa and Latin America. His work laid the foundation to bring together the leaders of Asian communities and he was conferred the 'Magsaysay Award' in 1993 for international understanding.
Dr. Iwamura Memorial Hospital and Research Center
Dr. Iwamura Memorial Hospital was established in December 2001 in Bhaktapur, in memory of Dr. Noboru Iwamura. To continue his unfulfilled duties towards the Nepali community, Ms. Purnima Gurung, colleagues from Nepal, India and Japan have founded this memorial hospital. Established under the financial assistance from the Rotary International District 2640 and 2680 Japan, the hospital provides 24 hours out patient services, emergency services, as well as general medical and surgical services especially on cardiology, nephrology, gastrology and neurology. This hospital needs you.
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