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English to Croatian: Prefeseability Study Krk
Source text - English EKOLOŠKI ZASNOVAN SUSTAV ZBRINJAVANJA KOMUNALNOG OTPADA OTOK KRK Zagreb, rujna 2006. Autor Studije: Suradnici na projektu: Prof.dr.sc. Stanko Uršić Prof.dr. Krsto Benčević Dr.sc. Slaven Dobrović Hrvoje Juretić, dipl.ing. Marko Srdoč, dipl.oec. Tomislav Lerotić, docent UMAS SADRŽAJ UVOD 4 KONCEPCIJA 5 DEFINICIJA PROBLEMA I CILJA 5 Polazišta za rješenje problema 5 SADAŠNJE STANJE - DEFINIRANJE PODLOGA 7 Domicilno stanovništvo 7 Korisnici vikendica i turisti 10 Količine otpada 12 Evidencije praćenjem volumnih količina 12 Evidencije praćenjem mase 13 Kategorije - segmenti otpada 16 Biološki otpad – biootpad 16 Papir i karton 16 Staklo 17 Polimerni materijali 17 Metali 17 Opasni otpad 18 Ostali otpad 18 Krupni otpad 19 Građevinski otpad 19 Sastav – kompozicija otpada 20 OPIS EKOLOŠKI ZASNOVANOG SUSTAVA ZA GOSPODARENJE KOMUNALNIM OTPADOM NA OTOKU KRKU 22 ORGANIZACIJA POSUDA za odvojeno prikupljanje ostataka tvari –PODSUSTAV I 22 1. odsjek podsustava I – kućne posude 22 2. odsjek podsustava I – sabirna mjesta SAM 22 3. odsjek podsustava I – posebna sabirna mjesta POSAM 22 Procjena potreba za posudama 22 Obrada segmenata otpada 23 Biorazgradivi otpad (BIOOTPAD) 23 Papir 31 Staklo 32 PET ambalaža 34 Ostala PLASTIKA 36 Al ambalaža 37 Ostali METALI 38 Opasni otpad 39 Organizacija odlagališta Treskavac 40 POTPORNI SUSTAVI - PROGRAMI 41 Sustav / program stalne komunikacije s općinstvom 41 Sustav / program za stalnu edukaciju 42 I FAZA – PRIPREMA ZA PRIHVAT PROJEKTA 42 II FAZA – TIJEK PROVEDBE PROJEKTA DO STUPNJA KOREKTNE UHODANOSTI 43 Program za poticanje suradnje građana radi poboljšanja provedbe projekta 43 UVOD Sadašnji način zbrinjavanja komunalnog otpada gotovo nigdje ne odgovara ekološkim načelima, kriterijima i standardima. U osnovi, to vrijedi i za otok Krk. Onečišćenje okoliša, voda, zemljišta i zraka, uništenje prostora i time uništavanje ne samo dijela naših vrijednosti i resursa već i uništenje dijela budućnosti naše djece, unuka i praunuka. Posebno i na dramatičan način to vrijedi u tako dragocjenom i osjetljivom (krš, more) prostoru kakav je jadranski otočni prostor, dakle i otok Krk. Problem dakle proizlazi iz pogrešne koncepcije i sustava gospodarenja otpadom koji nije ekološki zasnovan, jer onemogućuje takvo postupanje s ostatcima tvari kod kojeg neće doći do štetnih posljedica za okoliš i ljudsko zdravlje i do uništenja prostora, što sve jednom riječju nazivamo ekološki štetne posljedice. Pogrešna je koncepcija (zapravo nedostatak koncepcije): ostatke tvari- različite vrste otpada- stavljati zajedno i tako pomiješane prenijeti na odlagalište. Rješenje problema jest u odvojenom prikupljanju ostataka tvari, što onda normalno dovodi k preradi u nove uporabne oblike i izbjegavanje svih ekoloških problema. Cilj je ove studije predložiti takav sustav koji će omogućiti da se na otoku Krku s ostatcima tvari (komunalnim otpadom, smećem) postupa u najvećoj mogućoj mjeri tako da to bude u skladu s ekološkim principima, zahtjevima i vrijednostima. Temeljna pretpostavka za realizaciju takvog sustava jest pristup koji bitno uključuje 1.- odvojeno prikupljanje ostataka tvari (komunalnog otpada) i 2.- maksimalno mogući povrat odvojeno prikupljenog u ponovnu uporabu preradom u nove uporabne oblike. Za ilustraciju, papir i karton, u svim oblicima, čine najmanje jednu trećinu komunalnog otpada. Drugu trećinu čini kuhinjski biološki organski otpad. Papir se može reciklirati sedam puta, prije nego što će zadnji uporabni oblik (higijenski papir) završiti kao sirovina za humus. Za proizvodnju jedne tone recikliranog papira potrebno je dvostruko manje električne energije i tisuću tristo trideset puta manja količina vode. I niti jedno stablo. Za jednu tonu novog papira treba posjeći dva stabla. Kuhinjski biološki organski otpad bez poteškoća se može preraditi u biološko gnojivo, humus. Danas je već posve jasno da je to jedino gnojivo budućnosti, u razvijenim sredinama to je već s golemim uspjehom i ostvareno. Slično, gotovo svi dijelovi odvojeno prikupljenog komunalnog otpada, mogu se vratiti u uporabu. Dobro su poznati primjeri metala, stakla, PET ambalaže, drvenih otpadaka. Postupak koji sve to omogućuje je odvojeno prikupljanje. Na to se nadovezuje privremeno odlaganje i zatim prerada. Time je golemi dio problema riješen, budući da za deponij ostaje tek jedna dvadesetina do jedne desetine, ovisno o okolnostima, od ukupne količine otpada, i to uglavnom relativno inertnog i bezopasnog otpada, te posebno još dio opasnog otpada. Ipak, i taj opasni otpad može se sada kontrolirano čuvati i eventualno reciklirati ili uništiti. Druga temeljna pretpostavka ekološkog pristupa jest ekonomičnost i štedljivost što praktički znači koncepciju i organizaciju sustava koji će u najvećoj mjeri koristiti postojeće resurse (uz nužne preinake i nadogradnje) i maksimalno pažljivo uključivati nove. Ne smije se zanemariti ni činjenica da odvojeno prikupljanje i prerada u nove uporabne oblike znači i stanovito pokrivanje troškova sustava, jer dio vraćen u uporabu barem dijelom znači i povrat uloženih sredstava. To ujedno znači i minimum troškova koje moraju podnijeti građani financiranjem rješavanja tog temeljnog komunalnog problema. KONCEPCIJA DEFINICIJA PROBLEMA I CILJA Problem je sadašnji način zbrinjavanja komunalnog otpada na otoku Krku. Krajnji cilj je izmjena sadašnjeg načina zbrinjavanja tog otpada tako da se postigne “ekološko gospodarenje/zbrinjavanje”. Ekološko zbrinjavanje je ono zbrinjavanje kod kojeg na kraju svih procesa praktički više ne ostaje otpad kao kategorija, tj. proces u kojem se svi ostaci tvari vraćaju u uporabu. Do njega bi se došlo neprestanim povećavanjem opsega primjene potpuno ekološki zasnovanog postupanja po određenim fazama, od neke početne do konačnih faza. Polazišta za rješenje problema Ekološki pristup Ekološki pristup: to je pristup koji zahtijeva odvojeno skupljanje ostataka tvari (otpada) na mjestu nastanka, i takvu obradu skupljenih tvari koja omogućuje njihov povratak u uporabu. Neće biti moguće odmah provesti potpuno odvojeno skupljanje, ali opseg odvojenog skupljanja treba neprestano povećavati do mogućeg maksimuma. Slično može vrijediti i za obradu skupljenih ostataka tvari (otpada). Ekološki zasnovan sustav Ekološki zasnovan sustav – sustav koji u progresivno sve većoj mjeri slijedi ekološki princip. Ovdje će u početku imati sljedeće elemente: sustav posuda za odvojeno skupljanje – najmanje 3 posude (biološko-organski otpad, papir i ostalo) u kućanstvu – najmanje 7 posuda (3 + 4) u ulici / četvrti (bio-organski, papir, PET, plastika, staklo, kovine, ostalo) odgovarajuća vozila, vremenski i materijalno razrađen sustav odvoza odgovarajuća privremena i trajna odlagališta, uključujući prostor za preradu biootpada u kompost/humus, te eventualnu preradu drugih segmenata. odgovarajuća informacijsko-servisna službu – središnje računalo, pozivni broj za građevinski i glomazni otpad – služba za koordinaciju dalje obrade odvojeno skupljenih segmenata. Potporni sustavi sustav / program stalne komunikacije s općinstvom – uključuje sve institucije, organizacije, udruge, medije itd. sustav / program za stalnu edukaciju – uključuje sve dobne/profesionalne skupine sustav nadzora /sankcija – komunalni redari (možda srednjoškolci, dobri učenici – honorarno) SADAŠNJE STANJE - DEFINIRANJE PODLOGA Za potrebe izrade studije ekološki zasnovanog zbrinjavanja otpada na otoku Krku, nužno je poznavanje količina i karaktera otpada, broja stanovnika po naseljima i općinama, broja sezonskih i vikend posjetitelja, korisnika vikendica te broja gostiju korisnika hotela i kampova. Domicilno stanovništvo Kao mjerodavni podaci za broj domicilnog stanovništva preuzeti su podaci iz Izvještaja – Popis stanovništva 2001. godine, te se u sažetom obliku daju u nastavku. Ukupni broj popisanih osoba 1) Ukupni broj stanovnika naselja popisa 2) Stalni stanovnici naselja popisa 3) Broj kućanstava 4) Krk 5583 5415 5451 1952 Bajčići 129 129 128 42 Brusići 47 47 47 18 Brzac 148 138 138 58 Kornić 328 313 320 132 Krk 3411 3326 3341 1165 Lakmartin 22 21 21 13 Linardići 108 104 108 45 Milohnići 87 80 80 39 Muraj 11 11 11 5 Nenadići 128 124 126 41 Pinezići 147 134 135 66 Poljica 62 62 62 22 Skrbčići 152 145 144 49 Vrh 764 743 752 241 Žgaljići 39 38 38 16 Baška 1616 1500 1527 675 Baška 959 878 892 389 Batomalj 124 114 117 45 Draga Baščanska 287 265 273 135 Jurandvor 246 243 245 106 Dobrinj 2098 1932 1954 812 Čižići 98 87 91 49 Dobrinj 120 118 118 59 Dolovo Gabonjin 194 184 180 73 Gostinjac 81 74 79 35 Hlapa 63 62 62 21 Klanice 42 42 42 17 Klimno 125 120 120 43 Kras 189 185 185 87 Polje 336 282 284 104 Rasopasno 94 88 94 38 Rudine 6 6 6 3 Soline 50 48 48 22 Sužan 77 75 76 31 Sv. Ivan Dobrinjski 36 35 34 14 Sv. Vid Dobrinjski 79 79 78 28 Šilo 387 359 373 146 Tribulje 54 53 49 23 Žestilac 36 4 4 4 Županje 31 31 31 15 Malinska-Dubašnica 2794 2580 2600 1000 Barušići 25 21 21 10 Bogovići 162 136 152 53 Kremenići 65 53 52 20 Ljutići 19 14 14 7 Malinska 634 595 598 245 Maršići 16 10 10 3 Milčetići 252 240 235 91 Milovčići 79 73 73 19 Oštrobradić 92 90 89 36 Porat 146 135 135 41 Radići 527 478 478 183 Sabljići 13 13 13 5 Sršići Strilčići 10 10 10 3 Sveti Anton 110 109 110 42 Sveti Ivan 49 49 49 16 Sveti Vid-Miholjice 259 249 248 98 Turčić 17 17 17 6 Vantačići 187 161 169 83 Zidarići 68 68 68 20 Žgombići 64 59 59 19 Omišalj 3131 2977 2947 1036 Njivice 1283 1261 1176 425 Omišalj 1848 1716 1771 611 Punat 1879 1853 1860 732 Punat 1782 1758 1764 686 Stara Baška 97 95 96 46 Vrbnik 1260 1231 1233 1168 Garica 148 144 144 140 Kampelje 6 6 6 6 Risika 151 145 145 138 Vrbnik 955 936 938 884 UKUPNO 18361 17488 17572 7375 Tablica 1 Rezultati popisa stanovništva za otok Krk 2001. godine 1)Podatak o ukupnom broju popisanih osoba odnosi se na sve osobe popisane u Republici Hrvatskoj koje su državljani R. Hrvatske, strani državljani i osobe bez državljanstva koje imaju prebivalište u R. Hrvatskoj te osobe koje su u vrijeme Popisa imale boravište u R. Hrvatskoj. 2)U ukupan broj stanovnika uključeni su: a/ osobe koje u RH imaju prebivalište a prisutne su u kritičnom trenutku (31.03.2001.) b/ osobe koje u RH imaju prebivalište, a odsutne su iz RH manje od jedne godine, c/ osobe koje borave u RH godinu i duže d/ državljani RH -djelatnici diplomatskih službi i članovi njihovih obitelji, predstavnici međunarodnih org. i tzv. detaširani radnici e/ nomadi; skitnice; osobe u zabačenim krajevima; vojno, mornaričko i diplomatsko osoblje i članovi njihovih obitelji koji su izvan zemlje; pomorci trgovačke mornarice i ribari koji su na moru u vrijeme popisa; građani koji privremeno rade u drugoj zemlji; građani koji dnevno prelaze državnu granicu radi posla u drugoj zemlji; izbjeglice. 3)Stalni stanovnici su osobe koje imaju prijavljeno prebivalište - stalno mjesto stanovanja u tom naselju. Osobe bez stalne adrese, skitnice i sl. također se smatraju stalnim stanovnicima naselja popisa - naselja gdje su popisane. Nomadi se također smatraju stalnim stanovnicima naselja gdje su zatečeni. 4)Ovdje se misli na ukupan broj kućanstava (privatnih i institucionalnih). Korisnici vikendica i turisti Osim domicilnog stanovništva koji živi u ukupno 6207 domaćinstava (cca 18300 osoba), na otoku Krku postoji značajan broj kuća za odmor, odnosno vikendica. Na temelju pretpostavke od približno 11000 vikendica, može se broj gostiju – vikendaša u vrhu ljetne sezone procijeniti na 50000. Konačan broj ljudi (cca 120000 osoba) na kojem se temelji proračun količine proizvedenog otpada dobiva se pribrajanjem broja evidentiranih gostiju – prema evidenciji Turističke zajednice otoka Krka. U nastavku je dan pregled izvještaja Turističke zajednice otoka Krka o mjesečnom broju noćenja za razdoblje od 2002. do 2006. godine. Radi se o evidentiranim noćenjima u hotelima, kampovima, odmaralištima, i marinama. Slika 1 Evidencija o broj noćenja Sumarno se može dati sljedeći pretpostavljeni strukturirani prikaz ukupnog broja stanovnika (stalnih i privremenih) tijekom godine. Slika 2 Otok KRK – napučenost tijekom godine Može se računati da će stvarni broj turista biti veći, za udio posjetitelja u tranzitu, jednodnevne posjetitelje, neprijavljene goste i slično. Ako se ukupni broj ljudi pomnoži sa specifičnom količinom proizvodnje otpada po čovjeku, dobije se količina stvorenog otpada, što se može usporediti s evidentiranim količinama dovezenog otpada na odlagalište Treskavac. Na sljedećoj slici su prikazane evidentirane mjesečne količine dovezenog komunalnog otpada na odlagalište Treskavac i proračunane vrijednosti generiranog komunalnog otpada na temelju ukupnog broja ljudi. Slika 3 Usporedba mjesečnih trendova: evidentirane količine dovezenog otpada na Treskavac u m3 i proračunane količine otpada u odnosu na broj stanovnika i prosječne specifične produkcije otpada Proračunana količina nastalog komunalnog otpada na temelju specifične količine od 1,1 kg otpada po osobi dnevno. Iz gornje slike je vidljiva podudarnost između sezonskog rasta evidentiranih količina otpada i proračunane količine nastalog otpada, iz čega se može zaključiti da se pretpostavljena mjesečna razdioba može za potrebe dalje obrade smatrati zadovoljavajućom. Količine otpada Evidencije praćenjem volumnih količina Prema Izvještaju Ponikve d.o.o., može se primijetiti da od 1998. godine postoji stalni rast dovezene količine otpada na deponij Treskavac. Trend porasta je velik i iznosi 11, odnosno 13% za 1999. i 2000., 5% za 2001. te ponovo visokih 15% za 2002. godinu (relativni porast u odnosu na prethodnu godinu). Posebno veliki porast zabilježen je 2003. godine i u odnosu na 200.2 iznosi 36%. U odnosu na 1998. godinu, 2004. je dovezeno gotovo duplo više komunalnog otpada. Slika 4 Pregled godišnjih količina dovezenog otpada na deponij Treskavac Osim krutog otpada, na deponij se redovito dovozi od 2 do 5000 m3 godišnje fekalne vode iz septičkih jama. Slika 5 Pregled godišnjih količina dovezenih fekalija na deponij Treskavac Uslijed velike sezonske promjene broja gostiju, postoji izraziti ljetni porast količine dovezenog otpada. Ograđivanjem deponije te uređenjem ulazne porte 1997. godine uspostavljena je telemetrijska kontrola ulazaka vozila za dopremu otpada te pohranjivanja podataka o tim događajima. Stoga od 1998. godine postoji precizna evidencija o broju istovara pojedinih vozila, odnosno dovezenih kubika komunalnog otpada. Mjesečne količine dovezenog otpada prikazani su sljedećom slikom. Slika 6 Mjesečne količine* komunalnog otpada dovezene na odlagalište Treskavac za razdoblje 1998. – 2004. * Količine dobivene kao suma umnožaka broja posjeta pojedinog vozila s nominalnim kapacitetom vozila Mjesečna raspodjela dovezenog otpada važna je za definiranje kapaciteta sustava za obradu pojedinih segmenata, što se posebno odnosi na segment biorazgradivog otpada. Naime, pogon za obradu biorazgradivog otpada, odnosno proizvodnju komposta mora se dimenzionirati za maksimalne ljetne kapacitete. Evidencije praćenjem mase Ugradnjom vage, u rujnu 2005. omogućeno je maseno praćenje dovezenih količina otpada: Slika 7 Evidentirane količine dovezenog komunalnog otpada na odlagalište Treskavac tijekom razdoblja listopad 2005. – rujan 2006. Napomena – podatak za rujan 2006 procijenjen je na temelju podataka iz prijašnjih godina Gustoća otpada Slika 8 Evidentirane količine dovezenog otpada na Treskavac u m3 i proračunana gustoća otpada na temelju brojnosti ljudi i prosječne specifične produkcije otpada Proračunana količina generiranog komunalnog otpada na temelju specifične količine od 1,1 kg otpada po osobi dnevno. Proračunana količina generiranog otpada je 21.000 t, što bi u odnosu na 173.000 m3 dovezenog otpada značilo srednju specifičnu gustoću od svega 120 kg/m3. Podaci iz gornje slike ukazuju na specifičnu gustoću komunalnog otpada u kojoj su vjerojatno skrivene i netočnosti kod evidentiranja dovezene količine otpada u kubičnim metrima. Naime, ukupna količina dovezenog otpada računa se na temelju evidentiranih ulazaka računajući pritom na 100%-tnu popunjenost vozila. Kategorije - segmenti otpada Komunalni, odnosno kućni otpad se sastoji od sljedećih kategorija: biološki, ili biorazgradivi ostaci tvari papir i karton staklo polimerne mase – plastika metali razni predmeti iz kože, tekstila opasni – štetni otpad krupni otpad – povremenog karaktera Pored komunalnog otpada postoji tehnološki otpad koji nastaje u različitim proizvodnim djelatnostima, te građevinski otpad. Biološki otpad – biootpad Biootpad se sastoji od kuhinjskih ostataka tvari te različitog vrtnog otpada kao: ostaci od povrća i voća ostaci od čišćenja ribe i mesa kruh, ostaci hrane lišće, cvijeće, granje otkos trave, piljevina Među biootpad je dozvoljeno staviti i papirnatu ambalažu zaprljanu hranom, papirnate maramice te pepeo od loženja drveća. U ovu kategoriju se ne smiju stavljati tvari koje bi onečistile budući kompost kao što su: tiskani papir sredstva za čišćenje boje i lakovi, baterije i slično. Papir i karton U papirno kartonski otpad spadaju: novine i časopisi prospekti, katalozi, bilježnice knjige i slikovnice papirnate vrećice, kartonske fascikle i kutije valovita karton ostali papirni i kartonski predmeti bez plastičnih ili drugih materijala U ovu kategoriju ne stavlja se: višeslojna, kompozitna ambalaža (neke vrste mlijeka, jogurta i sokova) foto papir zauljeni papiri ostali nepapirni materijali Staklo Dvije glavne skupine staklenih predmeta u širokoj primjeni su: staklene posude – boce, demižoni, čaše prozorsko staklo Rašireni sustav prikupljanja je pripremljen za staklenu ambalažu – boce, dok je prozorske staklene ploče i staklene krhotine potrebno odnijeti na posebna sabirna mjesta (POSAM). Sa potrebe recikliranja, čep i etiketa onečišćuju bocu te ih je potrebno odvojeno odlagati. Polimerni materijali Gotovo 96% plastičnih predmeta na tržištu načinjeno je od ukupno 6 vrsta polimernih materijala: PET – poli(etilen-tereftalat) PE-LD – polietilen niske gustoće PE-HD – polietilen visoke gustoće PVC – poli(vinil-klorid) PP – polipropilen PS - polistiren Polimerni ili plastični materijali se prikupljaju kao dva osnovna segmenta: PET ambalaža ostala plastika Kako se odvojeno prikupljena PET ambalaža namjerava plasirati ili koristiti kao vrijedna sirovina za neku proizvodnju, u ovaj segment se prikupljaju samo lako perive posude i boce, dakle u prvom redu ambalaža od raznih pića. Ovdje spadaju: boce od pakiranja vode i mineralne vode boce od gaziranih pića (Inka, Schweeps, Fanta, Coca Cola, Pepsi, i dr.) boce od raznih sokova, i ostalih napitaka U drugu skupinu – ostala plastika skupljat će se prazna polimerna ambalaža od: svih prehrambenih artikala tekućih sapuna i šampona detergenata i sličnih sredstava za čišćenje i to bez obzira o kojoj vrsti polimerne mase se radi. Ako se radi o ambalaži opasnih tvari kao što su ljepila, smole za čišćenje, otapala, lijekovi, ambalažu je zajedno s preostalim sadržajem potrebno položiti u segment opasni otpad. Metali Metalni ostaci tvari se mogu podijeliti na željezne metale kao čelik, lim, lijev obojene metale kao aluminij, bakar, cink, olovo Posebnu kategoriju metalnog otpada čine aluminijska ambalaža za pakiranje piva i gaziranih pića. Stoga se organizira posebno prikupljanje ove vrste otpadnog materijala. Sav ostali metalni otpad prikuplja se ili na posebnim sabirnim mjestima (POSAM– ukupno 7 lokacija na otoku Krku) ili u organiziranim akcijama prikupljanja krupnog metalnog otpada. Opasni otpad U opasni otpad (kućni, komunalni) se ubrajaju sve tvari i ostaci tvari, odnosno ambalaža onečišćena tim tvarima koji izravno ugrožavaju zdravlje ljudi i životinja te smanjuju kakvoću okoliša (eng. Household Hazardous Waste - HHW). Ovdje spadaju: istrošeni akumulatori ambalaža od kemikalija, pesticida, boja, ulja, sredstava za čišćenje, otapala, ljepila,.. fluorescentne cijevi i živine svjetiljke svih vrsta baterije posude pod tlakom, sprejevi motorno ulje, ambalaža i filtri za motorno ulje (u principu pripada tehnološkom otpadu) ostaci lijekova, kozmetičkih preparata, stari živini termometri razni drugi predmeti koji zadrže opasne elemente i spojeve Opasni otpad se prikuplja u posebnim sabirnim mjestima (POSAM), te za pojedine vrste na specifičnim lokacijama kao baterije u trgovinama, staro ulje u mehaničarskim radionicama itd. Osim navedenih kategorija opasnog otpada postoje i materijali neprihvatljivi za odlaganje na posebna sabirna mjesta, kao što su: eksplozivi i razna streljiva komprimirani plinovi (osim aerosola) infektivni materijal biomedicinski materijal radioaktivni materijal ostali nepoznati materijal Za njihovo zbrinjavanje nadležne su posebne državne službe (MUP, HV, itd.) te se u ovoj studiji neće razmatrati. Ostali otpad U ostali otpad spadaju svi ostatci tvari koji ne pripadaju kategorijama čije se odvojeno prikupljanje organizira, tj. ono što nije: biootpad papir i karton staklo plastika metali opasni otpad U ovu kategoriju pripadaju sljedeće skupine predmeta (manjih i srednjih dimenzija): tkanine i koža (odjevni predmeti, obuća, torbe,..) pelene nespecificirana plastična ambalaža različiti sitni kompozitni predmeti (istrošeni upaljači, igračke,...) keramika i porculan,... itd. Jedino se za ovu skupinu otpada način zbrinjava suštinski ne mijenja. Odlaže se na deponiju, i postepeno kompaktira. No zbog inertnosti ovih materijala, problemi onečišćenja procijednih voda i stvaranja deponijskog plina izrazito su reducirani. Krupni otpad U ovu vrstu otpada ubraja se sljedeće: bijela tehnika – dotrajali hladnjaci, pećnice, bojleri i sl. namještaj automobili automobilske gume dotrajala elektronska oprema – računala, monitori, televizori, radio aparati i dr. Prikupljanje ovog otpada se odvija kroz sezonske pozivne akcije prikupljanja i odlaganjem na POSAM u svako doba godine. Mnogi od ovih predmeta sadrže tvari koje mogu bitno onečistiti okoliš, kao ulja, teški metali, freoni, te je važno pojedine segmente ovog skupine otpada valjano zbrinjavati. Građevinski otpad Građevinski otpad obuhvaća otpadne tvari koje nastaju prilikom građevinskih radova kao što je građenje, rušenje i sl. To su uglavnom inertne tvari kao: građevinska šuta – cigle, crijep, žbuka, .. iskopi raznih vrsta tla otpad od radova na prometnicama Građevinski otpad često može biti pomiješan s drugim materijalima – kablovima, komadima izolacije, onečišćenom ambalažom, i raznim drugim tvarima, što otežava valjano zbrinjavanje. Usitnjen građevinski otpad može se koristiti kao inertni materijal za nasipavanje ili kao sirovina za proizvodnju građevinskog materijala. Gospodarenje ovom skupinom otpada nije u nadležnosti Ponikve d.o.o., nego se zbrinjava u organizaciji pojedinih Jedinica lokalnih samouprava otoka Krka. Sastav – kompozicija otpada Od velike važnosti za daljnje razmatranje ovog problema je utvrđivanje sastava dovezenog komunalnog otpada. Kako na deponiji Treskavac nije mjerenjem utvrđivana kompozicija komunalnog otpada, načinit će se što bolja pretpostavka sastava dovoženog otpada. Računano je sa sezonski promjenjivim udjelom: 1/ biorazgradivog otpada, 2/ PET ambalaže, 3/ stakla i 4/ štetnih tvari. Pretpostavljene su sljedeće promjene masenih udjela: udio biorazgradivih komponenti mijenja se od minimalnih 33 % u veljači do maksimalnih 42 % u rujnu, udio PET ambalaže kreće od zimskih 0,5 % do ljetnih 5,5 %, te udio stakla od 4,8 % zimi do 7 % ljeti. Isto tako, pretpostavljeno je predsezonsko povećanje (na 1,5 %) i sezonsko smanjenje (na 0,6 %) udjela štetnih tvari. Prikaz pretpostavljenih sezonskih promjena masenog udjela za ove segmente dan je u sljedećoj slici. Slika 9 Pretpostavljene sezonske promjene masenih udjela biootpada, PET i Al ambalaže, stakla i štetnih tvari u komunalnom otpadu otoka Krka NAPOMENA: podrazumijeva se PET ambalaža za napitke Za ostale segmente komunalnog otpada – papir i karton, kovine, ostala plastika, te ostali otpad teško je predvidjeti eventualni sezonskih karakter te se računa s prosječnim godišnjim udjelima prema sljedećoj slici: Slika 10 Pretpostavljeni maseni udjeli pojedinih segmenata komunalnog otpada konstantnog karaktera ost. metali: svi metalni predmeti osim Al ambalaže za napitke ost. plastika: PET ambalaža za pakiranje nenapitaka, PS, PEHD, PELD, PVC, PP ostalo: tkanine, koža (obuća i odjeća), pelene, kompozitni predmeti,.. Sumarno, kompozicija komunalnog otpada po mjesecima se pretpostavlja kako slijedi. Slika 11 Prikaz pretpostavljenih masenih udjela segmenata komunalnog otpada Sumarno, uzimajući u obzir pretpostavljene mjesečne udjele pojedinih segmenata i mjesečne udjele u odvezenom otpadu, dobiva se raspodjela masenih udjela komunalnog otpada svedeno na cijelu godinu, prikaz na sljedećoj slici. Dobivena razdioba sadrži u sebi koeficijent neizvjesnosti najmanje 1 do 5 %. Slika 12 Prosječni godišnji maseni udjeli komunalnog otpada OPIS EKOLOŠKI ZASNOVANOG SUSTAVA ZA GOSPODARENJE KOMUNALNIM OTPADOM NA OTOKU KRKU Plan i program Izgradnje / organizacije ekološki zasnovanog sustava zbrinjavanja komunalnog otpada (u daljem tekstu ES) uključuje 3 podsustava od kojih se sastoji cjelina ES, koja treba biti bazirana i organizirana unutar "Ponikve d.o.o.", materijalno, prostorno i kadrovski. ORGANIZACIJA POSUDA za odvojeno prikupljanje ostataka tvari –PODSUSTAV I 1. odsjek podsustava I – kućne posude posude za odvojeno skupljanje ostataka tvari u domaćinstvu (kući, stanu itd.) posude za odvojeno skupljanje ostataka tvari u ugostiteljskim i turističkim objektima, školama itd. 2. odsjek podsustava I – sabirna mjesta SAM posude za odvojeno prikupljanje na javnim površinama, ulicama, trgovima, obali, zatim u ustanovama i tvrtkama - na "sabirnim mjestima" – organiziranim na razini ulice/četvrti 3. odsjek podsustava I – posebna sabirna mjesta POSAM Posude za opasni otpad na "posebnom sabirnom mjestu" Posebna sabirna mjesta služe za odlaganje opasnog otpada. Njihovom izgradnjom se osigurava ciljano privremeno zbrinjavanje prethodno odvojeno prikupljenog opasnog otpada. Posebna sabirna mjesta POSAM, raspoređena po općinama na otoku Krku obuhvaćaju: ograđena površina od približno 100 m2, s kolnim ulazom i rasvjetom; nadstrešnica, lagane konstrukcije, površine 20 m2; betonska podloga, površine 20 m2. Procjena potreba za posudama Na temelju podataka o sadašnjem broju posuda (tablica 5), brojnosti stanovništva te turističkoj posjećenosti predložen je sljedeći raspored posuda za odvojeno prikupljanje otpada. S obzirom da se otpad prikuplja odvojeno, potreban je manji prihvatni volumen te se sustav bazira na manjim posudama volumena, predvidivo 120 ili 240 L. Postojeće posude od 1100 i 5000 l se također koriste, na lokacijama većeg "opterećenja". Svako sabirno mjesto (u daljem tekstu SAM) sadrži posudu za prihvat biootpada, a većina isto tako i posudu za papir/karton te ostali otpad. Broj SAM-a praktički odgovara broju kontejnera za skupljanje Obrada segmenata otpada OSNOVE ZA PRORAČUN: Količine: godina 2002. (uz ekstrapolaciju zadnjeg tromjesečja) Kompozicija: prema mjesečnim predviđanjima – Slika 15 Biorazgradivi otpad (BIOOTPAD) Sustav za gospodarenje biološko-organskim ostacima tvari (biorazgradivi segment otpada, biootpad) od najveće je važnosti za cjelinu ekološki zasnovanog sustava budući da uklanja najveći dio problema koji nastaju prilikom neekološkog postupanja – mikrobiološki/higijenski/ambijentalni problem te onečišćenja okoliša, vode, zraka i zemlje. Dodatna korist takvog sustava jesu velike količine biognojiva – na otoku Krku godišnji je potencijal za proizvodnju biognojiva iz biootpada više tisuća tona godišnje – što može biti od izvanredne važnosti za razvoj poljoprivrede, posebno maslinarstva i vinogradarstva na otoku, a predstavlja i znatnu financijsku kompenzaciju u otočnom sustavu gospodarenja otpadom. Zbrinjavanje biootpada kao što je vidljivo iz cjeline sustava obuhvaća dva ključna segmenta: odvojeno prikupljanje u posude s dodanim slamnatim uloškom i obrada tako skupljenog otpada u procesu kompostiranja. Vrlo važna uloga slamnatog uloška u sustavu zbrinjavanja biootpada sastoji se od sljedećeg: 1.Slama služi kao spremnik zraka (kisika) što omogućuje aerobne uvjete u spremniku i produžuje trajanje aerobnih uvjeta, odnosno odgađa pojavu neugodnih mirisa (zbog anaerobnog vrenja). 2.Slama apsorbira kapljevitu fazu iz biootpada, koja je često odgovorna za brzu pojavu anaerobnih uvjeta, odnosno mirisa 3.Slama regulira odnos C:N (ugljik:dušik), što je važno za uravnoteženje procesa humifikacije Slamnati ulošci se koriste u kućanstvima, a mogu biti u formi kvadra dimenzije 20 x 30 x 2 cm, volumena 1,2 L. Proces kompostiranja drugi je ključni segment postupanja s biootpadom i povrata biorazgradivih ostataka tvari u novu uporabu. Korektno proveden taj postupak rezultira kompostom/humusom, tj. biognojivom. Važno je uočiti da se niti jedan od problema povezanih s neprerađenim biootpadom (mikrobiološki – higijenski, ambijentalni) ne pojavljuje kod komposta/biognojiva. S druge strane, biognojivo je izvanredno korisno za poljoprivrednu proizvodnju. Regularna provedba procesa prerade biootpada kompostiranjem mora voditi računa o kvantitativnim odnosima ugljika i dušika u sirovini, o sadržaju vlage i kisika te o temperaturnim promjenama u tijeku tog procesa. Važna je napokon i vremenska dinamika procesa. To je relativno lako upravljiv, ali ujedno i vrlo osjetljiv postupak, koji stoga zahtijeva znatnu pažnju i tehnološku disciplinu. Ulaganja u potrebne strojeve i opremu pogona relativno su skromna u odnosu na moguću dobit kod optimalnog korištenja. Prihvaćanje procesne varijante rada na otvorenom prostoru, što predlaže ova studija predstavlja prihvatljiv kompromis i svjesnu uštedu u odnosu na neke moguće varijante procesa u zatvorenom prostoru. Ujedno se ne očekuju nikakvi posebni problemi kao posljedica takvog tehnološkog izbora. Proces zbrinjavanja biorazgradivog segmenta otpada slijedi tijek postupka na sljedećoj slici. Slika 13 Proces zbrinjavanja biorazgradivog segmenta Elementi sustava za zbrinjavanje biootpada Posude sa slamnatim uloškom za sakupljanje ostataka u domaćinstvima Spremnici za sakupljanje Teretna vozila za sakupljanje Uređaj za pranje i dezinfekciju kamiona i kontejnera Kompostište sa sustavom za pripremu mase za proces kompostiranja i provedbu tog procesa Skladište, uređaji za prosijavanje i pakirnica gotovog proizvoda Broj radnika – 3 + sezonski 6 Sam proces pretvorbe biorazgradivog materijala u kompost je kako slijedi: Slika 14 Proces humifikacije biootpada Temeljem ulaznih podataka pretpostavljaju se sljedeće mjesečne količine selektivno prikupljenog biorazgradivog otpada. Slika 15 Mjesečne količine selektivno prikupljenog biorazgradivog otpada Kompostište – je središnje mjesto u kojemu se organski dio ostataka posebnim postupkom pretvara u organsko gnojivo upotrebljivo za gnojenje tla u različite namjene. Opis procesa Proces započinje postupkom istovara bioloških ostataka u pokretni uređaj sa sandukom za preuzimanje biootpada iz vozila. Na dnu prihvatnog uređaja je pokretna traka koja ostatke doprema do uređaja za usitnjavanje. Prije uređaja za usitnjavanje je magnet za izdvajanje metalnih predmeta. Prolaskom kroz sjekačicu, usitnjena masa se pokretnom trakom transportira i slaže u stazu, čineći hrpu visine do 2,5 m i širine oko 2 m. Tada započinje prva od tri faze, prema sljedećoj tablici. FAZA Trajanje dani Smanjenje volumena, % Temperatura mase, C Vlažnost mase, % I 15 20 40-60 60-70 II 30 20 25-35 55-60 III 45 15 20-25 50 IV skladište 60 15 15-20 50 Tablica 2 Tehnološki parametri višefaznog procesa kompostiranja Tijekom I faze se usitnjena i izmiješana masa biootpada ovlažuje sustavom za vlaženje do sadržaja vlage od cca 65%, koja se održava neprekidno. Započinje proces (fermentacije) kompostiranja u kojem se u biomasi podiže temperatura (na 45-60C) u roku 2-3 dana. Nakon približno deset dana (ovisno o vanjskim uvjetima i sastavu biomase) temperatura se počinje snižavati. Shodno uvjetima, masu je tijekom I faze potrebno mehanički prebacivati, čime se postiže ulazak kisika (zraka) u biološki materijal. Po isteku prve faze, kompostna masa se pomoću pokretne freze s transportnom trakom ponovno usitnjava i preslaže formirajući ponovo uzdužnu hrpu visine do 2,2 m. U II fazi se također održava vlažnost mase i nakon povišenja temperature – nastavlja se proces kompostiranja koji traje oko 30 dana. Nakon toga temperatura se spusti na vrijednost nešto višu od prosječne vanjske temperature u toplijem dijelu godine. Biomasa tijekom II faze gubi oko 25% obujma. Po isteku II faze, odnosno nakon ukupno 45 dana od početka obrade započinje III faza kompostiranja. III faza kompostiranja traje oko 45 dana. Tijekom te faze masa ostataka poprima svojstva komposta. Boja i struktura mase je tamno smeđa a masa je sipka. I u III fazi se održava vlažnost komposta 50-55%. To je vlažnost koja dozvoljava procese pripreme, pakiranje i razbacivanje po tlu, pa se kompost prodaje i rabi s vlažnošću oko 50%. Formirani kompost po isteku III faze se prebacuje u skladište, koje treba biti pokriveno, a u kojem slijedi proces humifikacije. U toj posljednjoj – IV fazi, može se računati sa smanjenjem volumena od cca 15 % tijekom 60 dana skladištenja, a rezultat je humificirani kompost nešto veće uporabne, pa i tržišne vrijednosti. Proces kompostiranja mase može se ubrzavati i mijenjati različitim aditivima, ali se za sve postupke moraju osigurati opisani temeljni uvjeti koji se mogu primjenjivati na otvorenom prostoru. Za ostale procese se grade zatvoreni prostori s posebnom opremom ovisno o zahtjevu investitora. Tijekom procesa potrebna je neprestana kontrola temperature i vlažnosti mase. Ti podaci su bitni za početak i nastavak procesa određene faze. Na čitavoj površini kompostnih jedinica je uređaj za prskanje vodom čime se osigurava potrebna vlažnost mase u kompostiranju. Površina kompostirnice je betonirana s blagim padom prema sabirnim kanalima koji odvode površinsku vodu do spremnika s taložnikom. Ukupna količina potencijalno prikupljenog biorazgradivog otpada procjenjuje se na 8100 t godišnje. Slika 16 Količine komposta u pojedinoj fazi prerade tijekom kalendarske godine Održavanje potrebne vlažnosti Za valjano odvijanje procesa kompostiranja potrebno je održavanje relativno visoke vlažnosti kompostne mase te je potrebno osigurati dostatne količine vode. Po fazama, nužne su sljedeće apsolutne vlažnosti kompostne mase: Faza kompostiranja Vlažnost, mas. % Faza I 65 % Faza II 60 % Faza III 50 % Tablica 3 Potrebna vlažnost kompostne mase Računa se da je prosječna vlažnost dovezenog svježeg biootpada oko 40 %, pa je u startu potrebno dodati vode do traženih 65 %. Nadalje, sve tri faze odvijaju se na otvorenom, pa je nužna nadoknada gubitaka uslijed isparavanja. Radi proračuna potrebnih količina vode uvode se sljedeće pretpostavke o srednjem tjednom gubitku vlage evaporacijom: FAZA Tjedni gubitak vlage evaporacijom zima ljeto Faza I 30% 45% Faza II 25% 40% Faza III 20% 35% Tablica 4 Procjena gubitaka vlage evaporacijom Konačni izračun gubitka vlage isparavanjem bit će moguć u prvom razdoblju uvođenja procesa, što će se produžiti vjerojatno najmanje kroz nekoliko sezona zbog klimatskih oscilacija. Ovdje je dana tek početna procjena. To ne predstavlja problem jer su korekcije moguće tijekom uhodavanja procesa i neće dovesti do nepredviđenih problema. S obzirom da se na odlagalištu Treskavac predviđa izgradnja sustava za prikupljanje kišnice s pokrivenih objekata i betonskih površina, očekuje se prikupljanje određenih količina vode. Izgradnjom vodospreme odgovarajućeg volumena moglo bi se djelomično ili potpuno pokriti potrebe za vodom prikupljanjem kišnice. Na temelju evidencija o padalinama na obližnjoj crpnoj stanici Ponikva, proračunane su srednje mjesečne padaline za razdoblje od 1996. do 2002. godine. Slika 17 Prosječne vrijednosti padalina- C.S. Ponikva Na osnovi sljedećih podataka je načinjena bilanca potreba i gubitaka vode na kompostištu Treskavac. ukupna površina za prikupljanje kišnice 8100 m2 volumen spremnika za prihvat kišnice 2000 m3 gubici isparavanjem Tablica 9 podaci o padalinama Slika 23 Može se uočiti da je maksimalna tjedna potreba za nadoknadom vode oko 1000 m3, što odgovara kapacitetu uređaja za ovlaživanje od 15 m3/h. Sustav za ovlaživanje se sastoji od: crpka samočišćeće sito tlačni filtar za pročišćavanje kišnice cijevni razvod s armaturom mlaznice za ovlaživanje Slika 18 Potrebe za vodom za nadoknadu isparavanja po fazama, potreba za dodatnom vodom, i količina vode u prihvatnom spremniku kišnice ukupna godišnja potreba za vodom – 18.200 m3 ukupno godišnje prikupljeno kišnice – 11.000 m3 Iz gornjeg prikaza je vidljivo je potreba za dodatnom vodom koju treba dovesti cjevovodom oko 9000 m3, uz retencijski spremnik za kišnicu od 2000 m3. Eventualnim povećanjem površina za prikupljanjem kišnice i adekvatnim povećanjem volumena prihvatnog spremnika bi se potreba za vodom mogla dodatno smanjiti. Fekalne vode Fekalne vode po dovozu na odlagalište Treskavac, izlijevaju se u plitki bazen, dubine cca 40 cm ispunjen biljnim otpadnim materijalom (grančice, lišće i sl. iz parkova i uređivanja javnih površina uz ceste). Zatim se proces kontrolira po potrebi enzimatskim dodacima da se izbjegne širenje neugodnog zadaha. Dalji proces se provodi analogno procesu kompostiranja i humifikacije biootpada. Konačni produkt je humus niže kvalitete, prikladan za parkove i javne površine i eventualno pošumljivanje krša. Višak ocjedne nečiste vode skuplja se u prihvatnom spremniku iz kojeg se crpkom vraća na masu u obradi. Elementi kompostišta Ograđeni prostor kompostišta - cca 5500 m2 Betonske površine - cca 4000 m2, nenatkriveno Pokriveni prostor za skladište, pakirnicu i priručni laboratorij, površine 500 m2 Prihvatni spremnik za prikupljanje ocjedne vode i kišnice s natkrivenih površina volumena 2000 m3, natkrivena ceradom (jednostavnije izvedbe) Prihvatni spremnik za prikupljanje ocjedne vode iz prostora za obradu fekalnih ostataka, opremljen sustavom za povrat tekuće faze u proces, volumena 100 m3, natkrivena ceradom (jednostavnije izvedbe) Pokretni uređaj sa sandukom za istresanje biootpada, s transportnom trakom za dopremu ostataka do sjekačice, uz nadzor i magnetsko uklanjanje metalnih dijelova. Uređaj za usitnjavanje baca usitnjenu masu na pokretnu traku s elevatorom koja masu istovara na staze I faze. Pokretna freza sa transportnom trakom za prebacivanje mase komposta Cijevni sustav za održavanje vlažnosti Sustav za pripremu i dobavu čiste vode za potrebe ovlaživanja kompostne mase Uređaji za usitnjavanje, prosijavanje, miješanje i punjenje komposta u vreće Prostorije za radnike Mjerni instrumenti za neprekidni nadzor temperature i vlažnosti kompostne mase Papir Proces postupanja papirnim otpadom: Slika 19 Proces postupanja papirnim otpadom Kvalitetu papira kao sekundarne sirovine smanjuju različita onečišćenja i neklasiranost, pa se odvajanjem nepapirnih segmenata i eventualnim klasiranjem postižu veće prodajne cijene. Odluku o stupnju obrade selektivno prikupljenog papira na odlagalištu treba donijeti na temelju analize tržišnih uvjeta i potrebnog obima angažiranja radne snage i opreme. Slika 20 Mjesečne količine PAPIRA Pretpostavljena godišnja ukupna količina papira je 6300 t. U mjesecu kolovozu se prosječno dnevno prikupi oko 120 m3 PAPIRA. Elementi sustava segmenta – PAPIR Sustav posuda za selektivno prikupljanje PAPIRA Presokontejneri za kartonsku ambalažu – sve pretovarne stanice i neki trgovački centri Ukupni prostor za prihvat, selekciju, baliranje i skladištenje, površine oko 1600 m2, od čega 500 m2 betoniranih i 500 m2 natkrivenih površina Uređaji za prešanje i baliranje papira Broj radnika – 2 + sezonski 3 Staklo Prikupljeno staklo potrebno je pripremiti (selekcionirati) da bi se moglo plasirati na tržištu sekundarnih sirovina – Opcija 1. Slika 21 Zbrinjavanje STAKLA - Opcija 1 Druga varijanta je obaviti samo lomljenje dopremljenog stakla, radi povećanja nasipne gustoće i takav materijal separatno odlagati ili koristiti kao inertni sloj – Opcija 2. Staklo je potpuno inertni materijal i kao takav nema utjecaja na okoliš. Slika 22 Zbrinjavanje STAKLA – Opcija 2 Pretpostavljena godišnja ukupna količina stakla je 1300 t. U mjesecu kolovozu se prosječno dnevno prikupi oko 9 t, odnosno 51 m3 STAKLA. Lomljenjem stakla se ostvaruje ušteda u odlagališnom prostoru jer se nasipni volumen smanjuje za više od 7 puta. Slika 23 Mjesečne količine STAKLA Elementi sustava segmenta – STAKLO Sustav posuda za selektivno prikupljanje Ukupni prostor za prihvat, selekciju, lom i skladištenje, površine oko 1000 m2, od čega 300 m2 betoniranih i 10 m2 natkrivenih površina Uređaj za lom stakla Broj radnika 1 + sezonski 1 PET ambalaža Proces postupanja s PET ambalažom: Slika 24 Zbrinjavanje PET ambalaže Pretpostavljene količine PET ambalaže, po mjesecima dane su sljedećom slikom. Slika 25 Mjesečne količine PET ambalaže Pretpostavljena ukupna godišnja količina PET ambalaže iznosi 640 t. PET ambalaža je izrazito voluminozan ostatak tvari, što potvrđuje podatak da masa PET boce od 1,5 L bez čepa i etikete varira od 36 g do 46 g, a boca volumena 2 L boca oko 54 g. Čep je potrebno odvojiti, jer u pravilu nije izrađen od PET materijala. Specifična gustoća nekomprimirane mase PET ambalaže je svega 12 kg po kubičnom metru, odnosno 0,012 t/m3. Prešanjem se može postići kompresija 1:12 pa će ukupni komprimirani volumen kroz cijelu godinu biti oko 4500 m3. U mjesecu kolovozu se prosječno dnevno prikupi oko 7200 kg PET ambalaže za što je potrebno više od 600 m3 prihvatnog prostora. Slika 26 Volumen selektivno prikupljenog PET- a, nestlačen i stlačen materijal Za postizanje više cijene ili veće uporabne vrijednosti prije prešanja je potrebno skinuti etikete i odvojiti čepove. Na međunarodnom tržištu sekundarnih sirovina mogu se postići relativno visoke cijene za selektirani i pročišćeni PET, a još veću potencijalnu vrijednost ovaj materijal predstavlja za eventualnu proizvođačku djelatnost. Poznata je primjena recikliranog PET materijala kao sirovine za proizvodnju PET posuda za napitke i tekstilnih vlakana za izradu odjevnih predmeta. Elementi sustava PET segmenta Sustav posuda za selektivno prikupljanje PET ambalaže Ukupni prostor za prihvat, obradu, prešanje i skladištenje, površine oko 1600 m2, od čega 600 m2 betoniranih i 10 m2 natkrivenih površina Radni prostor za skidanje etiketa i čepova Uređaj za prešanje i baliranje PET materijala Broj radnika – 1, sezonski +2 Ostala PLASTIKA Prikupljenu ostalu PLASTIKU potrebno je pripremiti (selekcionirati) da bi se moglo plasirati na tržištu sekundarnih sirovina – Opcija 1. Slika 27 Proces zbrinjavanja ostale PLASTIKE – Opcija I Druga opcija podrazumijeva samo prešanje dopremljenog materijala, te njegova separatno odlaganje. Ovakav materijal nema bitnog utjecaja na okoliš, a uvijek je na raspolaganju kao sekundarna sirovina u slučaju pojave takvog interesa. Slika 28 Proces zbrinjavanja ostale PLASTIKE – Opcija II Pretpostavljena godišnja ukupna količina ostale PLASTIKE je 1870 t. U mjesecu kolovozu se prosječno dnevno prikupi oko 10500 kg ostale PLASTIKE za što je potrebno oko 350 m3 prihvatnog prostora u nestlačenoj, odnosno 50 m3 u stlačenoj formi. Elementi sustava segmenta – ostala PLASTIKA Sustav posuda za selektivno prikupljanje Ukupni prostor za prihvat, prešanje i skladištenje, površine oko 1600 m2, od čega 300 m2 betoniranih i 10 m2 natkrivenih površina Uređaj za prešanje plastike Broj radnika 1 + sezonski 1 Al ambalaža Proces postupanja s Al ambalažom: Slika 29 Zbrinjavanje Al ambalaže Pretpostavljene količine Al ambalaže, tijekom godine dane su sljedećom slikom. Slika 30 Mjesečne količine Al ambalaže Pretpostavljena ukupna godišnja količina Al ambalaže iznosi 138 t. Slično kao PET, Al ambalaža je izrazito voluminozan ostatak tvari. Nasipni volumen nestlačenih Al kantica iznosi svega oko 20 kg/m3, dok se tlačenjem postiže gustoća od preko 500 kg/m3. Stoga se nakon prešanja, ukupna godišnja količina Al ambalaže može smjestiti u cca 250 m3 skladišnog prostora U mjesecu kolovozu se prosječno dnevno prikupi oko 1000 kg Al ambalaže za što je potrebno svega 2 m3 prostora. Sustav segmenta Al ambalaža nalazi se prostorno i kadrovski u okviru sustava ostali METALI. Ostali METALI Proces postupanja s ostalim METALIMA: Slika 31 Zbrinjavanje ostali METALA Pretpostavljene količine Al ambalaže, po mjesecima dane su sljedećom slikom. Slika 32 Mjesečne količine ostalih METALA Pretpostavljena godišnja ukupna količina ostalih METALA je 830 t. Elementi sustava segmenta – METALI (uključuje segment Al ambalaža ) Sustav posuda za selektivno prikupljanje Ukupni prostor za prihvat, selekciju, prešanje i skladištenje, površine oko 700 m2, od čega 200 m2 betoniranih i 15 m2 natkrivenih površina Uređaj za prešanje metalnih predmeta Broj radnika 1 + sezonski 1 Opasni otpad Prema potrebi sa posebnih sabirnih mjesta (ukupno 7 lokacija na otoku Krku) opasni otpad se dovodi na deponiju Treskavac, na posebno predviđeno mjesto za prihvat opasnog otpada. Ovo je poseban dio deponije, koji zbog svoje specifičnosti mora zadovoljiti određene zahtjeve: mora biti izgrađeno na stabilnim temeljima potrebno je osigurati adekvatan pristup specijalnim vozilima potrebno je aktivnu površinu reciklažnog dvorišta ograditi sigurnosnom ogradom, a ulazna i ostala vrata osigurati adekvatnim bravama i/ili lokotima potrebno je postaviti znakove upozorenja s odgovarajućim natpisom kao što je npr. "Pozor – nezaposlenima ulaz zabranjen" i to u dovoljnom broju, tako da je upozorenje vidljivo sa svih strana potrebno je izgraditi na prikladnom mjestu stanicu za smještaj protupožarne opreme potrebno je izgraditi tuševe za hitne slučajeve, prostor za ispiranje oči, skladišni prostor za zaštitu osoblja i telefonsku liniju potrebno je pri izgradnji poštivati građevinske, električarske i protupožarne standarde potrebno je spriječiti istjecanje tekućeg materijala pod reciklažnog dvorišta treba biti od armiranog betona izveden s nagibom od najmanje 1% radi drenaže i s predviđenim spremnikom za prihvat oborinskih voda Elementi sustava segmenta – OPASNI OTPAD POSEBNA SABIRNA MJESTA - POSAM, 7 lokacija GLAVNO sabirno mjesto za opasni otpad na deponiji Treskavac s odgovarajućim specijalnim spremnicima Vozilo, specijalizirano za ovaj segment, tipa kombi Broj radnika 1 + sezonski 1 Organizacija odlagališta Treskavac Prema Idejnom rješenju sanacije odlagališta Treskavac, HIS Višnjica, predviđeno je višefazno proširivanje odlagališnog prostora za prihvat komunalnog otpada. U prvoj fazi uređenja osigurava se površina od cca 9500 m2, koja bi prema Idejnom rješenju bila dostatna za petogodišnje razdoblje. Uvođenjem ekološki zasnovanog sustava zbrinjavanja otpada ostvarit će se značajno smanjenje dopreme neselektiranog otpada, čime se postiže višestruko produženje roka za iscrpljivanje kapaciteta površine uređene u I fazi. U nastavku prikazan je način korištenja prostora i njegova potrebna veličina u sklopu projekta predloženog u ovoj studiji. Sustav je potpuno orijentiran na odlagalište Treskavac, gdje bi se nalazili svi potrebni pogoni i segmenti odlagališta. POTPORNI SUSTAVI - PROGRAMI Sustav / program stalne komunikacije s općinstvom  Uključuje PONIKVU d.o.o. i sve institucije, organizacije, udruge, medije itd. Sustav obuhvaća jednu osobu u tvrtki PONIKVE d.o.o. koja je na specifično definiran način u stalnoj vezi s točno određenim osobama (na zahtjev PONIKVE d.o.o.) u svim relevantnim institucijama i tvrtkama i medijima na otoku kao ovlašteni čovjek za vezu, komunikaciju i nadzor provođenja zacrtanog programa (ovlast i zaduženje od strane Uprave PONIKVE d.o.o. ). Ta osoba ujedno ima pristup u središnje računalo sustava ekološkog zbrinjavanja komunalnog otpada u PONIKVI d.o.o. i opslužuje posebnu telefonsku liniju i elektronsku adresu (email) unutar PONIKVE d.o.o. koje su neprestano tijekom radnog dana (ako se ukaže potreba i više) na raspolaganju svim zainteresiranim građanima te predstavlja svojevrsni INFO-CENTAR u funkciji provođenja projekta. Info-centar se može organizirati u okviru postojećeg dispečerskog centra Ponikve d.o.o., s odgovarajućim osobljem i potrebnom opremom. Za ovu svrhu se organizira i posebna internet stranica sa svim relevantnim podacima, uputama i informacijama. Osnovni ciljevi kojima služi taj sustav su neprestani prijenos svih informacija relevantnih za funkcioniranje programa svim navedenim i ostalim sudionicima javne društvene razine kao i svim građanima, privremenim stanovnicima/posjetiteljima svih razina i konačno turistima. Program stalne komunikacije s općinstvom obuhvaća: 1.INFO-TELEFON i INFO email, dio su gore navedenog info-centra u PONIKVI d.o.o., na raspolaganju građanima radi davanja neposrednih i promptnih odgovarajućih informacija u svezi s projektom i funkcioniranjem provedbe projekta. 2.MJESEČNI LISTIĆ – LETAK koji će izdavati INFO-CENTAR PONIKVE d.o.o. LISTIĆ treba sadržavati sve relevantne AŽURIRANE informacije o odvijanju i izvršavanju PROJEKTA EKOLOŠKOG ZBRINJAVANJA KOMUNALNOG OTPADA NA OTOKU KRKU. Zatim treba sadržavati sve one informacije za koje će postojati saznanja da su tražene od zainteresiranih građana, ili one informacije koje je inače nužno uputiti građanima da bi se program predviđen projektom valjano izvršavao, a (te informacije) izlaze iz okvira koje omogućuje INFO-TELEFON. 3.INTERNET stranica Ponikve d.o.o. sa sadržajem kao pod prethodnom točkom. 4.TRAJNA KOMUNIKACIJA S OPĆINSTVOM putem anketa i drugih oblika javnog priopćivanja mišljenja. Analize anketa trebaju pomoći da građani izraze svoje mišljenje kao i da dožive projekt kao svoju i istodobno zajedničku stvar. Slično je moguće i preko organiziranja npr. dobrotvornih priredbi, koncerata mladih, još nedovoljno poznatih sastava i sl., u koja bi se zbivanja moglo uklopiti i druge komunikacijske sadržaje povezane s projektom radi bolje popularizacije i prihvaćanja. Sustav / program za stalnu edukaciju  uključuje sve dobne/profesionalne skupine i sve sudionike javnog i društvenog života, sve posjetitelje/privremene stanovnike i turiste Sustav se zasniva na gore opisanom INFO-CENTRU PONIKVA d.o.o. u suradnji s vanjskim suradnicima/stručnjacima i postojećim obrazovnim i drugim institucijama i medijima na otoku, posebno s Radio postajom Krk. INFO-CENTAR PONIKVA je pritom integrativni element sustava, to jest ujedinjuje i koordinira djelatnosti vezane uz stalnu edukaciju kojom se priprema i podupire projekt i njegova provedba. Program stalne edukacije ima za cilj prihvaćanje i provođenje PROJEKTA EKOLOŠKOG ZBRINJAVANJA KOMUNALNOG OTPADA NA OTOKU KRKU, što pretpostavlja promociju i potporu stvaranju klime razumijevanja za temeljne preferencije društvene odgovornosti, ekološke svijesti i odgovornosti te angažiranja za opće dobro i nesumnjivi interes svih građana otoka. OBUHVAĆA: I FAZA – PRIPREMA ZA PRIHVAT PROJEKTA 1.Najmanje pet prezentacijsko-edukativnih predavanja u gradovima/mjestima s preko 1000 stanovnika, od toga dva u školama a preostala tri u skladu s najboljim mogućim izborom u javnim institucijama gdje su mogući skupovi većeg broja građana. Početak najmanje 2 do 4 mjeseca prije započinjanja provođenja projekta u fizičkom smislu. 2.Najmanje dva prezentacijsko-edukativna predavanja u mjestima s preko 250 stanovnika, od toga jedno u školi (ako je ima). Vremenski raspored kao pod točkom 1. 3.Po potrebi jedno prezentacijsko-edukativno predavanje u mjestima s manje od 250 stanovnika. Vremenski raspored kao pod točkom 1. 4.Upućivanje specifičnog pisma svim sudionicima projekta: svakom domu/obitelji, svakoj instituciji i svakoj tvrtki na otoku neposredno pred početak provedbe projekta. Pismo treba poslužiti edukativnoj i psihološkoj pripremi građana za prihvaćanje projekta i biti će formulirano u apsolutnom skladu s tim ciljem, s posebnim naglaskom na karakteristike i funkciju sustava tri posude. Analogno će se postupiti prema povremenim stanovnicima (vlasnicima i korisnicima kuća za odmor, posjetiteljima i turistima) strogo uzimajući u obzir okolnosti u kojima se nalaze i činjenicu da u većini vjerojatno neće proći nikakvu prethodnu edukaciju i pripremu. Proces za njih počinje već na mostu KRK gdje će im se uručiti odgovarajuće materijale na stranim jezicima. Usklađeno s točkama 1., 2. i 3.. 5.Izrada i distribucija ostalih edukacijskih materijala: kompaktnih diskova – CD, crtanih materijala i sl. 6.Podjelu detaljnih pisanih uputa za opsluživanje SUSTAVA TRI POSUDE U DOMU. To trebaju biti sažete ali precizne upute koje će pomoći ukućanima da se snađu i uklope u provedbu projekta na razini kućanstva/stana. Podijelit će se svakom domu/obitelji, svakoj instituciji i svakoj tvrtki na otoku. Analogno će se postupiti prema posjetiteljima/turistima (v. također gore). 7.Ciljane edukacijsko-popularizacijske emisije na lokalnom radiju u svrhu informiranja o projektu, stavljanja projekta u svijesti slušatelja u aktualni vremenski tijek te stvaranja pozitivne klime za prihvaćanje provedbe projekta u svim slojevima općinstva. Učestalost i trajanje emisija: barem dvije emisije tjedno u trajanju od 20 minuta do pola sata (netto, bez glazbene pozadine), najmanje tri trominutne emisije s odgovarajućim edukacijsko-popularizacijskim sadržajem i scenarijem svakodnevno, u udarnim terminima. 8.Trajanje I (pripremne) faze: najmanje dva mjeseca u punom intenzitetu. II FAZA – TIJEK PROVEDBE PROJEKTA DO STUPNJA KOREKTNE UHODANOSTI Primjenjivati će se program I faze, smanjenom učestalošću i uz izmjene koje će zahtijevati stanje i napredovanje projekta. Tako će se program predavanja usmjeriti većinom prema školama, dok će na radiju biti dovoljno zauzeti približno jednu trećinu emisijskog vremena prve faze. Smanjivanje intenziteta aktivnosti karakterističnih za edukacijski program prve faze u drugoj fazi biti će postupno, do uspostavljanja stanja koje približno odgovara slici korektno uhodanog funkcioniranja programa provedbe projekta. Program za poticanje suradnje građana radi poboljšanja provedbe projekta Ovaj program polazi od pretpostavke da provedbu nije moguće poboljšavati u potrebnoj mjeri bez stalne suradnje građana. Obično se smatra da se to postiže mjerama stimulacije i nagrađivanja s jedne strane i mjerama kažnjavanja s druge strane. Mjere kažnjavanja ne mogu izricati i nametati tvrtke, kako u javnom tako niti u privatnom sektoru jer je to u suprotnosti s Ustavom RH i zakonima. Stoga će se pažnja posvetiti tijekom provedbe projekta mjerama legalnog i legitimnog nadzora načina i stupnja suradnje građana i nagrađivanja onih koji najbolje surađuju, te javnom objavljivanju podataka o onima koji budu kršili iz nekih razloga javno ustanovljenu suglasnost općinstva otoka Krka da iz ekoloških, ekonomskih, razvojnih, moralnih i drugih razloga OPĆEGA DOBRA I JAVNOGA INTERESA treba pristupiti provedbi PROJEKTA EKOLOŠKOG ZBRINJAVANJA KOMUNALNOG OTPADA NA OTOKU KRKU, u organizaciji PONIKVE d.o.o., Krk. 1.NADZOR. Potrebno je raspraviti u poduzeću Ponikve, d.o.o. uzimajući u obzir kompetencije Skupštine Ponikve, d.o.o. 2.NAGRAĐIVANJE. Nagraditi će se posebno savjesni pojedinci, kućanstva, tvrtke ili pojedinci u tvrtkama zaduženi za funkcioniranje sustava i suradnje s PONIKVOM d.o.o. Nagrade mogu biti novčane potpore za školovanje mladih, računala za škole i pojedince ili tvrtke i slično. 3.SANKCIJE. Potrebno je raspraviti i donijeti odluke o komunalnom redu u svakoj jedinici lokalne samouprave. Bilo bi poželjno da odluke budu usklađene po svim jedinicama lokalne samouprave na otoku Krku.	Translation - Croatian ECOLOGICALLY-BASED SYSTEM OF MUNICIPAL WASTE MANAGEMENT THE ISLAND OF KRK Zagreb, September 2006 The author of the Study: Associates: Prof.dr.sc. Stanko Uršić Prof.dr. Krsto Benčević Dr.sc. Slaven Dobrović Hrvoje Juretić, BSc.ing. Marko Srdoč, BSc.oec. Tomislav Lerotić, docent UMAS CONTENTS INTRODUCTION 4 CONCEPT 5 PROBLEM AND OBJECTIVE DEFINITION 5 Starting point for problem solving 6 CURRENT SITUATION – GROUNDWORK DEFINITION 7 Domicile population 7 Cottage users and tourists 10 Waste quantities 12 Records on volume quantities 12 Record-keeping by mass monitoring 13 Waste density 14 Categories – waste segments 16 Biological waste – biowaste 16 Paper and cardboard 16 Glass 17 Polymer materials 17 Metals 17 Hazardous waste 18 Other kinds of waste 18 Massive waste 19 Construction waste 19 Structure – waste composition 20 DESCRIPTION OF THE ECOLOGICALLY BASED MUNICIPAL WASTE MANAGEMENT SYSTEM ON THE ISLAND OF KRK 23 DECANTER ORGANIZATION for the separate collection of substance remains – SUBSYSTEM I 23 1. section of subsystem I – household decanters 23 2. section of subsystem I – collective areas "SAM" 23 3. section of subsystem I – special collective areas "POSAM" 23 Requirement for decanters 23 Processing of waste segments 24 Biodegradable waste (BIOWASTE) 24 Elements of the biowaste management system 25 Process description 27 I 27 Maintaining required humidity 28 Humidity, mas. % 28 Phase I 28 Weekly humidity losses caused by evaporation 28 Phase I 29 Faecal waters 30 Elements of the composting heap 31 Paper 32 Elements of the segment system – PAPER 32 Glass 33 Elements of segment system – GLASS 34 PET packaging 35 Elements of PET segment system 36 Other PLASTIC 37 Elements of segment system – other PLASTIC 37 Al packaging 38 Other METALS 39 Elements of segment system – METALS (Al packaging segment included) 39 Hazardous waste 40 Elements of segment system – HAZARDOUS WASTE 40 Organization of Treskavac landfill 41 SUPPORT SYSTEMS - PROGRAMMES 42 System / programme of continual communication with municipality 42 System / programme of continual education 43 I PHASE – PREPARATION FOR THE ACCEPTANCE OF THE PROJECT 43 PHASE II – PROGRESS OF THE PROJECT UNTIL IT DEVELOPS PROPERLY 44 Programme for encouraging the cooperation of citizens for the betterment of project implementation 44 INTRODUCTION Existing way of waste management almost nowhere complies with the ecological principles, criteria and standards. Essentially, this proves to be true for the island of Krk as well. The pollution of environment, water and air along with environment desctruction results not only in the destruction of our values and resources but in the destruction of our children's, granchildren's and great granchildren's future. In a special and dramatic way this happens to a precious and delicate environment (limestone area, sea) such as Adriatic insular environment, island Krk included. The problem emerges from the wrongful concept and the waste management system which is not ecologically based for it disables such waste management which would result in harmless consequences for the environment and human health, as well as the destruction of the environment; all the so called ecologically harmful cosequences. The wrongful concept (or better yet – the lack of it) is: the remains of the substances – various kinds of waste – mixing together and transportingt such mixture to the landfills. The solution to the problem lies in the separate collection of the substance remains, which then leads to processing it into new usable forms and avoidance of all ecological problems. The objective of this Study is to propose a system which would enable dealing with substance remains (waste, garbage) on the island of Krk to the fullest possible extent compliant with the ecollogical principles, demands and values. Fundamental precondition for the implementation of such system is the approach which essentially includes the following: 1- separate collection of substance remains (waste) and 2- maximally possible return of the separatelly collected remains for the re-use via processing it into the new usable forms. For example, paper and cardboard in all its forms make at least one third of the waste. Organic biological waste from people's kitchens makes onother third. Paper can be recycled seven times before its last usable form (toilet paper) ends up as raw material for humus. For the production of one tonne of recycled paper one needs twice less electrical power and one thousand three hundred and thirty times less water. And not a single tree. For the production of one tonne of new paper two trees must be cut down. Organic biological waste from people's kitchens can easily be processed into biological manure, humus. Nowadays humus is understood to be the only manure of the future and in well-developed environments this has already been successfully accomplished. Similarly, almost all parts of the collected waste can be reused. Well-known examples are metal, glass, plastic bottles and wood scraps. The procedure which enables it all is separate collection. This is followed by temporary disposal and processing. By this the vast part of the problem is solved, leaving only 1/20 to 1/10 , depending on the circumstances, of the total waste quantity for the landfill, and this is mostly inert and harmless waste and separately a part of the dangerous waste as well. However, this dangeros waste can also be stored in a controlled way and eventually recycled or destroyed. The second fundamental precondition of the ecological approach is economy and frugality which practically means concept and organization of the system which will to the fullest possible extent use the existing resources (with the neccessary alterations and upgrades)and extra carefully include the new ones. One must not ignore the fact that separate collection and processing into new usable forms means certain coverage of the system expenses because the part returned into usage is also the return of the invested means. This also menas the minimum of the expenses which should be covered by the citizens who must fund the solving of this fundamental communal problem. CONCEPT PROBLEM AND OBJECTIVE DEFINITION Problem is the existing way of communal waste management on the island of Krk. Ultimate objective is the change of the existing way of the management in order to achieve “ecological management”. Ecological management is the one whose processing results in the lack of waste as a category, that is the one where all the substance remains are being reused. To achieve it one must continuously increase the extent of the implemetation of the entirely ecologically based management through certain phases, from some initial to the final one. Starting point for problem solving Ecological approach Ecological approach: an approach which demands separate collection of the substance remains (waste) at the place of its creation and such processing of the collected substances which allows their reuse. Outright implementation of the separate collection will not be possible, however the extent of the separate collection must continuously be increased until reaching its feasible maximum. Similar can be valid for the processing of the collected substance remains (waste). Ecologically-based system Ecologically based system – a system which progressively at an increasing extent follows the ecological principle. Hereby contains the following elements: system of containers for the separate collection – minimum of three containers (biological-organic waste, paper, the rest) in each household – minimum of seven containers (3+4) in streets/neighbourhoods (bio-organic, paper, PET, plastic, glass, metals, the rest). suitable vehicles, timewise and materialwise elaborate system of collection. suitable temporary and permanent landfills, including the space for the processing of the bio-waste into compost/humus, as well as possible processing of other segments. suitable information service – central computer, call number for construction and massive waste – service for the coordination of further processing of the separately collected segments. Support systems system/programme of ongoing communication with the municipality – includes all the institutions, organisations, associations, media, etc. system/programme of ongoing education – includes all age/profession groups system of monitoring/sanctions – communal monitors (perhaps secondary school students, good students – part-time) CURRENT SITUATION – GROUNDWORK DEFINITION For the purposes of the creation of the Study of ecologically based system of waste management on the island of Krk it is necessary to familiarize oneself with the quantity and character of waste, the number of inhabitants in settlements and municipalities, the number of seasonal and weekend visitors, cottage owners as well as the number of hotel and campsite guests. Domicile population As authentic data regarding the number of domicile population, Report data were used – 2001 Population Census, given in its concise form hereafter. Total number of recorded inhabitants 1) Total number of inhabitants of the settlement in question2) Residents of the settlement in question 3) Number of households 4) Krk 5,583 5,415 5,451 1,952 Bajčići 129 129 128 42 Brusići 47 47 47 18 Brzac 148 138 138 58 Kornić 328 313 320 132 Krk 3,411 3,326 3,341 11,65 Lakmartin 22 21 21 13 Linardići 108 104 108 45 Milohnići 87 80 80 39 Muraj 11 11 11 5 Nenadići 128 124 126 41 Pinezići 147 134 135 66 Poljica 62 62 62 22 Skrbčići 152 145 144 49 Vrh 764 743 752 241 Žgaljići 39 38 38 16 Baška 1,616 1,500 1,527 675 Baška 959 878 892 389 Batomalj 124 114 117 45 Draga Baščanska 287 265 273 135 Jurandvor 246 243 245 106 Dobrinj 2,098 1,932 1,954 812 Čižići 98 87 91 49 Dobrinj 120 118 118 59 Dolovo Gabonjin 194 184 180 73 Gostinjac 81 74 79 35 Hlapa 63 62 62 21 Klanice 42 42 42 17 Klimno 125 120 120 43 Kras 189 185 185 87 Polje 336 282 284 104 Rasopasno 94 88 94 38 Rudine 6 6 6 3 Soline 50 48 48 22 Sužan 77 75 76 31 Sv. Ivan Dobrinjski 36 35 34 14 Sv. Vid Dobrinjski 79 79 78 28 Šilo 387 359 373 146 Tribulje 54 53 49 23 Žestilac 36 4 4 4 Županje 31 31 31 15 Malinska-Dubašnica 2,794 2,580 2,600 1,000 Barušići 25 21 21 10 Bogovići 162 136 152 53 Kremenići 65 53 52 20 Ljutići 19 14 14 7 Malinska 634 595 598 245 Maršići 16 10 10 3 Milčetići 252 240 235 91 Milovčići 79 73 73 19 Oštrobradić 92 90 89 36 Porat 146 135 135 41 Radići 527 478 478 183 Sabljići 13 13 13 5 Sršići Strilčići 10 10 10 3 Sveti Anton 110 109 110 42 Sveti Ivan 49 49 49 16 Sveti Vid-Miholjice 259 249 248 98 Turčić 17 17 17 6 Vantačići 187 161 169 83 Zidarići 68 68 68 20 Žgombići 64 59 59 19 Omišalj 3,131 2,977 2,947 1,036 Njivice 1,283 1,261 1,176 425 Omišalj 1,848 1,716 1,771 611 Punat 1,879 1,853 1,860 732 Punat 1,782 1,758 1,764 686 Stara Baška 97 95 96 46 Vrbnik 1,260 1,231 1,233 1,168 Garica 148 144 144 140 Kampelje 6 6 6 6 Risika 151 145 145 138 Vrbnik 955 936 938 884 UKUPNO 18,361 17,488 17,572 7,375 Table 1 The results of 2001 Population census for island Krk 1) Datum on the total number of persons included in the Census relate to all Census- included persons in the Republic of Croatia who are the citizens of Croatia, foreign citizens and persons without citizenship with legal domicile in the Republic of Croatia as well as all the persons who had habitual residence in the Republic of Croatia at the time of the Census. 2)Total number of inhabitants includes: a/ persons with legal domicile in the Republic of Croatia who were present at the crucial moment (31/03/2001), b/ persons with legal domicile in the Republic of Croatia who were absent from the country for less than a year, c/ persons who had been living in the Republic of Croatia for a year and longer, d/ citizens of the Republic of Croatia – diplomatic profession servants and memebers of their families, foreign organization's representatives and so called detaširani employees, e/ nomads; vagabonds; persons from remote areas; military, naval and diplomatic personnel and members of their families who are absent from the country; mariners of the merchant fleet and fishermen at sea at the time of the Census; citizens who temporarily work in another country; citizens who cross state's border on daily basis because they work in another country; refugees. 3)Residents are persons with reported legal domcile - permanent place of residence in that settlement. Persons without permanent address, vagabonds etc. are also considered permanent residents of the census-subjected settlement – settlement where they were recorded. Nomads are also considered permanent residents of the settelment where found. 4)This is related to the total number of households (private and institutional). Cottage users and tourists Besides domicile population which lives in altogether 6,207 households (cca 18,300 persons), there is a significant number of holiday houses or cottages on island Krk. Based on assumption of approximately 11,000 cottages, one can estimate the number of weekend guests at the climax of summer season to 50,000. The final number of people (cca 120,000 persons) on which the fundamental estimate of the quantity of the produced waste is based derives from adding the number of recorded guests – according to the data of Tourism Office for the Island of Krk. Hereafter we present a report overview of Tourism Office for the Island of Krk on the month overnight stays for the period between 2002 and 2006. This relates to recorded overnight stays in hotels, campsites, resorts and marinas. Picture 1 Records on the number of overnight stays When recapitulate, one can provide the following assumed structural presentation of the total number of residents (permanent and temporary) throughout the year. Picture 2 Island KRK – population throughout the year One can expect the real number of tourists to be bigger, thanks to the proportion of visitors in transit, one-day visitors, unrecorded guests etc. If we multiply the total number of people with the specific quantity of waste production per person, we get the quantity of the produced waste which can be compared with the recorded quantites of waste transported to Treskavac landfill. The following picture shows recorded month quantities of municipal waste transported to Treskavac landfill and estimated values of the generated municipal waste based on the total number of people. Picture 3 Month trends comparison: recorded quantities of waste transported to Treskavac landfill in m3 and estimated quantities of waste in comparison to the number of inhabitants as well as the average specific waste production Estimated quantity of the produced municipal waste based on the specific quantity of 1.1 kg of waste /person per day. The picture above clearly demostrates the compatibility between the seasonal growth of recorded waste quantities and estimated quantity of waste produced which leads to the conclusion that the estimated month division, for the purposes of further analysis, can be considered satisfactory. Waste quantities Records on volume quantities According to Ponikve Ltd. Report, one can notice a continuous growth of waste quantity transported to Treskavac landfill from 1998. An increase trend is big and amounts to 11, or better yet; 13% for year 1999 and 2000, 5% for year 2001 only to be followed by a very high 15% in 2002 (comparative increase related to the previous year). Particularly high increase was noticed in 2003 and in comparison to 2002 it amounts to 36%. In comparison to 1998, there was twice as much municipal waste transported in 2004. Picture 4 Overview of year waste quantities transported to Treskavac landfill Other than hard waste, between 2 and 5,000 m3 of fecal water is transported to the ladfill from septic tanks per year. Picture 5 Overview of year quantities of faeces transported to Treskavac landfill Due to major seasonal guest number variation, there is a noticable summer increase of the transported waste. By enclosing the landfill and regulating the entrance gate in 1997 telemetric control of incoming waste-transporting vehicles was established as well as data storing on these events. Therefore, ever since 1998 there is a precise record-keeping of the number of unloading per specific vehicle, that is; imported cubic metres of municipal waste. Month quantities of imported waste presented in the picture which follows. Picture 6 Month quantities of the municipal waste transported to Treskavac landfill for the period between 1998 and 2004. * Quantities were obtained as a sum of the products of the number of certain vehicle's visits and nominal vehicle capacity Month distribution of imported waste is important for defining the system's capacity regarding processing of certain segments. particularly biodegradable waste. In fact, Naime, plant for the processing of biodegradable waste, that is; compost production, must be sized to suit maximum summer capacities. Record-keeping by mass monitoring By installing the scales in September 2005 monitoring of imported waste quantities' mass was enabled: Picture 7 Recorded municipal waste quantities transported to Treskavac landfill in the period between October 2005 and September 2006. Note – information for September 2006 was estimated on the basis of information from previous years Waste density Picture 8 Recorded waste quantities transported to Treskavac landfill in m3 and estimated waste density on the basis of people's numerousness and average specific waste production Estimated quantity of the generated municipal waste on the basis of specific quantity amounting to 1.1 kg of waste/person per day. Estimated quantity of generated waste is 21,000 t, which compared to 173,000 m3 of transported waste amounts to a medium specific density of only 120 kg/m3. Information from the picture above points to a specific municipal waste density which probably hides some inaccuracies occured during the record-keeping of transported waste quantity in cubic metres. In fact, the total quantity of transported waste is calculated on the basis of recorded arrivals counting in the 100% vehicle occupancy. Categories – waste segments Municipal, that is domestic waste, is composed of the following categories: biological, that is biodegradable substance remains paper and cardboard glass polymer mass – plastic metals various leather and textile objects dangerous – hazardous waste massive waste - of temporary character Besides municipal waste there is also a technological waste emergent from various production activities, along with construction waste. Biological waste – biowaste Biowaste is composed from kitchen substance remains and various garden waste such as: vegetables and fruit remains fish and meet remains bread, food remains leaves, flowers, branches grass cutting, sawdust Among biowaste one is allowed to put paper packaging dirtied with food, paper tissues and ashes resulting from blazing wood logs. In order to prevent compost contamination one must not add the following substances to this category: printed paper abstergents colours and varnishes batteries etc. Paper and cardboard Paper-cardboard waste includes: newspapers and magazines brochures, catalogues, notebooks books and picture-books paper bags, cardboard folders and boxes wavy cardboard other paper and cardboard items without plastic or other materials This category does not include: multilayered, composed packaging (some kinds of milk, yoghurt and juices) photo paper oily paper other non-paper materials Glass Two major groups of widely-used glass items are: glass vessels – bottles, demijohns/ wicker-covered flagons, glasses window panes Prevailing collecting system is adapted to glass packaging – bottles, whereas window panes and glass debris must be taken to special collecting areas (POSAM). For the purposes of recycling, tap and lable contaminate the bottle and should therefore be disposed separately. Polymer materials Nearly 96% of plastic items present on the market are made of altogether 6 kinds of polymer materials: PET – poly(ethylene-thereftalate) PE-LD – low-density polyethylene PE-HD – high-density polyethylene PVC – poly(vinyl-chloride) PP – polypropylene PS - polystyrene Polymers or plastic materials are collected as two cardinal segments: PET packaging other plastic items Since separately collected PET packaging is intended for placing or using as valuable raw material for some oter production, this segment includes only easily-washable vessles and bottles, primarily various drinks packagings. It includes: spring and mineral water bottles fizzy beverages bottles (Inka, Schweeps, Fanta, Coca Cola, Pepsi, etc) bottles of various juices and other beverages Other segment - other plastic items will include empty polymer packaging from: all alimentary items liquid soap and shampos detergents and similar cleaning products regardless of the type of polymer mass used. In case of dangerous substance packagings such as adhesives, purging resins, solvents and medicines, packagings, along with its remaining content, should be disposed in the dangerous waste segment. Metals Metal substance remains can be divided into the following: iron metals such as steel, tin, cast non-ferrous metals such as aluminium, copper, zinc, lead Special category of metal waste is constituted by aluminium beer and fizzy beverages' packagings. For that reason separate collecting of this kind of waste material is organized. All other kinds of metal waste is either collected on special collecting areas (POSAM– altogether 7 locations on island Krk) or through organised actions of solid metal waste collecting. Hazardous waste This kind of waste (household, municipal) includes all substances and substance remains, that is packagings contaminated by substances which directly endanger human and animal health as well as impair the environment quality (eng. Household Hazardous Waste - HHW). This includes: burnt-out batteries packagings of chemicals, pesticides, dyes, oils, aperients, solvents, adhesives,... fluoroscent tubes and mercury lamps of all kinds batteries pressured vessles, sprays motor oil, motor oil and filter packagings (basically belongs to technological waste category) medicine remains, cosmetic remains, old mercury thermometers various other objects which contain dangerous elements and chemical compounds Hazardous waste is collected at special collecting areas (POSAM), and special kinds of waste can be collected on various special locations as for example batteries in shops, old oil at auto-mechanic shops etc. Besides the afore-mentioned hazardous waste categories, there are also some materials unacceptable for disposing at special collecting areas and those are the following ones: explosives and various ammunition compressed gases (except aerosol) contagious material biomedical material radioactive material other unknown materials Their management is the responsibility of special state authorities (MUP-Police Departments, HV- Croatian Army, etc) and will not be investigated in this Study. Other kinds of waste Other kinds of waste include substance remains which do not belong to categories whose collection is separately organized, that is; everything not belonging to one of the following: biowaste paper and cardboard glass plastic metals hazardous waste This category includes the following groups of items (of smaller and medium dimensions): fabric and leather (garments, footwear, bags,...) diapers non-specified plastic packaging various small composite items (disposable lighters, toys,...) ceramics and chinaware,....etc This is the only waste category for which the management way does not quintessentially change. It is being disposed at the landfill and gradually compacted. However, due to sluggishness of these materials, the problem of polluting distilling water and creating landfill gas is significantly reduced. Massive waste This category includes the following: consumer electronics – overaged refrigerators, stoves, water heaters, etc. furniture automobiles tyres overaged electrical appliances – computers, computer screens, tv sets, radio sets, etc. Collection of such waste is conducted through positive seasonal collecting actions and disposal to POSAM at any time of the year. Many of these items contain substances which can contaminate the environment, such as oils, heavy metals, freons, and it is therefore very important to manage different segments of this waste group separately. Construction waste Construction waste includes waste matters arising from construction work such as building, tearing down, etc. It primarily includes inert substances such as: building waste – bricks, roof tiles, plaster,... excavations of various ground types road work waste Construction waste can often be mixed with other materials – cables, insulation items, contaminated packagings, and various other substances which makes proper management rather difficult. Crushed-up construction waste can be used as inert material for leveling or as a raw material for the production of construction material. Management of this waste category is not the responsibility of Ponikve Ltd. but is being taken care of by certain local self-governments of island Krk. Structure – waste composition Matter of a great concern for the further examination of this problem is composition identification of the transported municipal waste. Since there were no measurements taken at Treskavac landfill with the purpose of identifying municipal waste composition, we shall make the best possible estimate of it. Seasonally changeable share was counted in: 1/ biodegradable waste, 2/ PET packaging, 3/ glass and 4/ hazardous substances. The following changes of mass portions were estimated: portion of biodegradable elements changes from the minimum of 33 % in February to maximum of 42 % in September, portion of PET packaging runs from 0.5 % in winter to 5.5 % in summer, and the portion of glass from 4.8 % in winter to 7 % in summer. Similarily, we assumed a pre-seasonal increase (to 1.5 %) and seasonal decrease (to 0.6 %) of the hazardous substance portion. Overview of the assumed seasonal changes of the mass portion for these segments is given in the following picture. Picture 9 Assumed seasonal changes of the mass portions of biowaste, PET and Al packaging, glass and hazardous substances in the municipal waste of island Krk. NOTE: by PET packaging beverage kind is assumed As far as other segments of municipal waste are concerned – paper, cardboard, metals, other kinds of plastic, as well as other kinds of waste - it is hard to estimate possible seasonal character so average annual portions are taken into consideration as shown in the following picture: Picture 10 Assumed mass portions of certain segments of the municipal waste with unchangeable character other metals: all metal items other than Al beverage packaging other plastic: PET packaging of non-beverages, PS, PEHD, PELD, PVC, PP other: fabric, leather (garments and footwear), diapers, composit items,.... To sum up, municipal waste composition is assumed through months as shown in the following picture. Picture 11 Overview of the assumed mass portions of municipal waste segments In the end, taking into account the assumed month portions of certain segments as well as month portions of transported waste, one gets the distribution of municipal waste mass portions reduced to the whole year, presented in the following picture. Obtained division contains incertitude coefficient of at least 1 to 5 %. Picture 12 Average annual mass portions of municipal waste DESCRIPTION OF THE ECOLOGICALLY BASED MUNICIPAL WASTE MANAGEMENT SYSTEM ON THE ISLAND OF KRK Plan and programme of the Creation/organization of the ecologically based municipal waste management system (hereinafter ES) includes 3 subsystems which make ES as a whole and which should be based and organized within "Ponikve Ltd", materially, spatially and personnelly. DECANTER ORGANIZATION for the separate collection of substance remains – SUBSYSTEM I 1. section of subsystem I – household decanters decanters for separate collection of substance remains in households (house, flat, etc) decanters for separate collection of substance remains in catering and tourist objects, schools, etc. 2. section of subsystem I – collective areas "SAM" decanters for separate collection on public areas, in the streets, squares, coastline, institutions and companies – at "collective areas" – organized at street/neighbourhood levels 3. section of subsystem I – special collective areas "POSAM" Hazardous waste decanters at "special collective areas" Special collective areas serve for the disposal of the hazardous waste. By its development targeted temporary management of the previously separately collected hazardous waste is ensured. Special collective areas POSAM, distributed in municipalities on island Krk include: restricted area of approximately 100 m2, with gateway and lighting; canopy of a light structure, 20 m2 in size; concrete undercoat, 20 m2 in size. Requirement for decanters Based on the data regarding the existing decanter number (table 5), population density and number of tourist visits the following decanter layout was suggested. Considering the fact that waste is collected separately it requires smaller carrying capacity so the system is based on decanters of a smaller volume, estimated at 120 or 240 L. The existing decanters of 1100 and 5000 l are aslo in use, on locations of bigger "load". Every collective area (hereinafter SAM) contains a decanter for the collection of biowaste, and most of them contain a decanter for paper/cardboard and other waste as well. The number of SAMs practically suits the number of collective containers. Processing of waste segments BUDGET BASIS: Quantities: year 2002 (with the extrapolation of the last quarter) Composition: according to monthly prognosis – Picture 15 Biodegradable waste (BIOWASTE) System for managing bio-organic substance remains (biodegradable waste segment, biowaste) is of utmost importance for the whole of the ecologically based system since it eliminates most of the problems emerging from non-ecological practice – microbiological/hygienic/ambiance problem along with the pollution of the environment, water, air and soil. Additional value of such system is big quantity of bio-manure – on island Krk annual potential for the production of bio-manure from biowaste is over several tonnes per year – this can be of exceptional importance for the dvelopment of agriculture, especially olive-growing and grape-growing on the island, and represents a substantial financial compensation in the insular waste management system. Biowaste management, as evident from the whole of the system, integrates two key segments: separate collection in decanters with added straw pad and processing of such waste through the process of composting. The important role of the straw pad in the biowaste management is: 1.Straw serves as air container (oxygen)which enables aerobic conditions in the container and prolonges their duration, that is postpones the appearance of the unpleasant smells (due to fermentation in a anaerobic environment). 2.Straw absorbs dripping phase from the biowaste which is often to be blamed for fast emergence of anaerobic conditions, that is unpleasant smells. 3.Straw regulates the C:N (carbon:nitrogen) ratio, which is important for the balancing of humification process. Straw pads are used in households and can be found in the square form of the following dimensions: 20 x 30 x 2 cm, 1.2 L (volume). Composting process is the second key segment when it comes to biowaste management and the return of biodegradable substance remains back in use. If conducted properly, this procedure results in compost/humus, that is biomanure. It is important to notice that neither of the problems related to non-processed biowaste (microbiological – hygienic, ambiance)does not occur with compost/biomanure. On the other hand, biomanure is exceptionally useful for the agricultural production. Regular implementation of the process of biowaste processing through composting must take into account quantitative carbon-nitrogen relation in the raw material, humidity and oxygen content, and temperature changes in the course of this process. Time dynamics of this process is yet another important issue to consider. This is a relatively easily-manageable however also very delicate procedure which demands considerable attention and technological discipline. Investments into required machinery and plant equiping are relatively modest in comparison to possible gain at optimal use. Accepting of outdoor process work alternative, as suggested in this Study, represents acceptable compromise and deliberate savings in comparison to some possible alternatives of indoor process. At the same time no extra problems are expected as a result of such technological choice. The process of biodegradable waste segment management follows the procedure presented in the picture below. Picture 13 The process of biodegradable segment management Elements of the biowaste management system Decanters with straw pads for the collection of remains from households Collective containers Pick-up lorries Device for washing and desinfection of lorries and containers Compost heap with the mass preparation system for the process of composting and the implementation of that process Storage area, peep devices and packing plant for the final product Number of workers - 3 + seasonal 6 The transformation process of biodegradable material into compost given as follows: Picture 14 The process of biowaste humification Based on the input data the following month quantities of selectively collected biodegradable waste are estimated. Picture 15 Month quantities of selectively collected biodegradable waste Compost heap – is a central area in which, through special procedures, the organic part of the remains is transformed into organic manure usable for fertilization of soil for various purposes. Process description The process begins with the procedure of unloading the biological remains into movable device with a crate for recepting biowaste from the vehicle. At the bottom of the receptive device there is an assembly line which is used for transporting the remains to the fragmentation device. Before the fragmentation device there is a magnet for separating metal objects. By passing through the cutting device, fragmented mass is transported via assembly line and folded into a trail making a heap up to do 2.5 m in height and 2 m in width. That is when the first of the three phases begins, according to the following table. PHASE Duration days Volume decrease, % Mass temperature, C Mass humidity, % I 15 20 40-60 60-70 II 30 20 25-35 55-60 III 45 15 20-25 50 IV storage 60 15 15-20 50 Table 2 Technological parameters of the multi-phase composting process During phase I fragmented and mixed biowaste mass is being moistened by the moistening system until it achieves moist content of cca 65%, which is then permanently maintained. Then the composting (fermentation) process begins in which biomass' temperatur is being raised ( to 45-60C) during the period of 2-3 days. After approximately ten days (depending on the outside conditions and biomass content)the temperature is lowered. Congruently with the conditions, mass needs to be mechanically tumbled during phase I to allow oxygen (air) to get in the biological material. Upon the expiry of the first phase the composte mass is again transported via assembly line and chopped with the rotary cultivator and then formed into sidewise heap up to 2.2 m in height. During phase II humidity of the mass is being maintained even after the temperature increase – the composting process continues and lasts for about 30 days. After that the temperature is lowered to slightly above the average for the warmer part of the year. Biomass loses approximately 25% volume during phase II. Upon the expiry of phase II, that is after altogether 45 days since the beginning of processing begins phase III of compostig. Composting phase III lasts for about 45 days. During that phase the remains mass turnes into compost. The colour is dark brown and as far as texture of the mass is concerned it is loose. In phase III humidity of the compost is also maintained at 50-55%. It is a humidity level which allows the processes of preparation, packing and soil dispersion so the compost is sold and used with the humidity level of 50%. Formed compost at the end of phase III is transposed to the storage area which needs to be covered, and then the humification process begins. In the last - phase IV, one can expect volume decrease of cca 15 % during the period of 60 days of storing, and the result is the humified compost of somewhat bigger quality and market value. The process of mass composting can be speeded up and altered by the use of various additives, however for all the procedures one must ensure the described fundamental conditions which can be applied outdoors. For other processes indoor facilities with special equippement are constructed on investors' demands. During the process constant control of mass temperature and humidity is required.These data are relevant for the beginning and the continuation of the processes at certain phases. On the entire compost unit area is a water aspersion device which maintains the required mass humidity during the composting process. The compost heap surface is covered with concrete with glacis towards collective canales which take away surface water to the sedimentation tank. The total amount of the potentially collected biodegradable waste is estimated to 8100 t per year. Picture 16 Compost quantities at certain processing phases within the year Maintaining required humidity For the valid takeoff of the composting process it is necessary to maintain relatively high humidity of the compost mass and to ensure sufficient water quantities. At phases, the following absolute compost mass humidity levels are needed: Composting phase Humidity, mas. % Phase I 65 % Phase II 60 % Phase III 50 % Table 3 Required humidity of the compost mass It is estimated that the average humidity level of the transported fresh biowaste is approximately 40 %, so it is necessary to add water at the very start until reaching the required 65 %. Furthermore, all three phases take place outdoors so additional compensation for the losses caused by evaporation is needed. For the purpose of calculating the required water quantities, the following assumptions on average humidity losses per week caused by evaporation are introduced: PHASE Weekly humidity losses caused by evaporation winter summer Phase I 30% 45% Phase II 25% 40% Phase III 20% 35% Table 4 Estimate of the humidity loss due to evaporation Total calculation of humidity loss due to evaporation will be possible in the initial period of process implementation which will probably be prolonged through at least several seasons due to climatic oscillations. Hereunder is given merely the initial estimate. This does not present any problems because the corrections are possible throughout the entire breaking-in process and will not lead to unpredicted problems. Taking into account that they are planning to construct a rain-water collecting system, from roofed facilities and concrete-covered surfaces, at Treskavac landfill, one may expect collecting of substantial amounts of water. By constructing water collectors of suitable volume one may, partly or entirely, cover water demands via rain-water collection. On the basis of rainfall records at the nearby pump station Ponikva average month rainfall for the period between 1996 and 2002 was calculated. Picture 17 Average rainfall values - P.S. Ponikva On the basis of the following data water need and loss account at Treskavac compost heap was created. total rain-water collecting surface 8,100 m2 volume of the rain-water collecting tank 2,000 m3 evaporation losses Table 9 rainfall data Picture 23 One can clearly see that the maximum water compensation need per week amounts to approximately 1000 m3, which is coherent with the capacity of the humidifying device of 15 m3/h. Humidifying system consists of: pump self-cleaning sieve pressure filter for rain-water purification tubular separation with reinforcement humidifying jets Picture 18 Water requirements for the compensation caused by evaporation through phases, additional water requirements, and the quantity of water at the collective rain-water tank total water requirement per year – 18,200 m3 total quantity of collected rain-water per year – 11,000 m3 From the above picture one can clearly see that the demand for additional water to be brought through pipe system amounts to 9,000 m3, with the retaining rain-water tank of 2,000 m3. In case of the increase of rain-collecting surfaces and adequate volume increase of the receptive tank, water demand could be additionally reduced. Faecal waters Faecal waters, upon transportation to Treskavac landfill, are poured into a shallow pool, cca 40 cm in depth, filled with plant waste material (branches, leaves, etc from parks and other public surfaces). The process is then controlled, if necessary, via the use of enzyme preparations in order to avoid spreading of unpleasant odours. Further process is carried out in comliance with the composting and biowaste humification process. The final product is humus of a lesser quality, suitable for parks and public surfaces and possibly afforestation of the limestone area. Surplus of the dirty water is collected in the tank from which it is being returned via pump to the processed mass. Elements of the composting heap Enclosed composting area - cca 5,500 m2 Concrete surfaces - cca 4,000 m2, not roofed Roofed storing area, packing plant and laboratory, surface of 500 m2 Tank for drained water and rain-water collection from the roofed surfaces of volume 2,000 m3, tarpaulined (simple construction) Receptive tank for the collection of drain water from the area for faecal remains processing, equipped with system for the return of liquid phase into process volume of which is 100 m3, tarpaulined (simple construction) Transportable device with a trunk for debarking biowaste, with transport line for delivering the remains to the cutter, supervised and with magnetic removal of metal parts. Fragmentation device dumps the fragmented mass on the assembly line with the elevator which then unloads it on phase I trails. Movable rotary cultivator with the transporting line for transposing compost mass. Pipe system for maintaining humidity levels Preparation and procurement of clean water system for the purposes of moisting the compost mass. Devices for the fragmentation, peeping, mixing and filling the bags with compost Room for the workers Measuring instruments for the constant surveillance of compost mass temperature and humidity Paper The process of paper waste management: Picture 19 The process of paper waste management The quality of paper as secondary raw material is lowered by various contaminations and lack of class so, by separating non-paper segments and possible classification, better selling prices may be achieved. The decision regarding the processing level of the selectively collected paper at the landfill should be made on the basis of market conditions analysis and the required scope of hiring workforce and equipment. Picture 20 Month quantities of PAPER Assumed total quantity of paper per year is 6,300 t. In August the average quantity of collected paper per day is about 120 m3. Elements of the segment system – PAPER Decanter system for the selective collection of PAPER Preso-containers for cardboard packagings – all trans-shipment stations and some shopping centres Total space for recepting, selection, packing into bales and storing, area of about 1,600 m2, of which 500 m2 concrete-covered and 500 m2 roofed surfaces Number of workers – 2 + seasonal 3 Glass Collected glass needs to be prepared (selected) in order to be sent to the market as secundary raw material – Option 1. Picture 21 GLASS disposal - Option 1 The alternative is only to conduct fragmenting of the transported glass, for the purposes of increasing the mound and such material dispoe separately or use as inert layer – Option 2. Glass is copletely inert material and as such has no effect on the environment. Picture 22 GLASS management – Option 2 Presupposed total annual glass amount is 1,300 t. In August 9 t are collected on daily basis, which amounts to 51 m3 of GLASS. By fragmenting the glass one saves space in the storing area because mound volume decreases by more than 7 times. Picture 23 Month quantities of GLASS Elements of segment system – GLASS Decanter system for the selective collection Total space meant for the reception, selection, fragmentation and storage, area of approximately 1,000 m2, of which 300 m2 covered in concrete and 10 m2 of roofed surfaces Glass fragmentation device Number of workers 1 + seasonal 1 PET packaging Conduct procedure regarding PET packaging: Picture 24 PET packaging management Presupposed quantities of PET packaging through months given in the picture below. Picture 25 Month quantities of PET packaging Presupposed total annual quantity of PET packaging amounts to 640 t. PET packagings are highly voluminose substance remains, as confirmed by the information that the weight of a 1.5 L PET bottle, without cap and lable, varies from 36 g to 46 g, and 2L bottle about 54g. Cap needs to be removed since it normally is not made of PET material. Specific density of non-compressed PET packaging mass amounts to only 12 kg per cubic metre, that is, 0,012 t/m3. By pressing it, one can achieve 1:12 compression so the compressed volume throughout the whole year is about 4,500 m3. In August 7,200 kg of PET packaging is collected per day which requires over 600 m3 receptive space. Picture 26 Volume of selectively collected PET, non-compressed and compressed material. For the purposes of achieving higher prices or better value it is necessary to remove all the caps and lables from the bottles before pressing them. On the international market of secondary raw materials relatively high prices can be achieved for the selected and purified PET, and it has even bigger potential value in terms of production service. Well-known implementation of recycled PET material as raw material is its use in the production of PET beverage containers and textile fibres for the production of garments. Elements of PET segment system Decanter system for the selective collection of PET packaging Total space for the reception, processing, pressing and storing, area of about 1,600 m2, of which 600 m2 concrete-covered and 10 m2 of roofed surfaces Work space for the removal of lables and caps Pressing and bale-making device Number of workers – 1, seasonal +2 Other PLASTIC Other collected PLASTIC needs to be prepared (selected) in order to be placed on the market of raw materials – Option 1. Picture 27 Management process of other PLASTIC – Option I Other option purports only pressing of the transported material and its separate disposal. Such material has no significant impact on the environment and it is always available as a secondary raw material in case of the emersion of any interest. Picture 28 Management process of other PLASTIC – Option II Presupposed total annual quantity of other PLASTIC is 1,870 t. In August 10,500 kg of other PLASTIC is collected on average per day which requires about 350 m3 of receptive space in non-compressed form and 50 m3 in compressed form. Elements of segment system – other PLASTIC Decanter system for selective collection Total space for recepting, pressing and storing, area of about 1,600 m2, of which 300 m2 concrete-covered and 10 m2 roofed surfaces Device for pressing plastic Number of workers 1 + seasonal 1 Al packaging Process of Al packaging management: Picture 29 Al packaging management Presupposed AL packaging quantities throughout the year presented in the following picture. Picture 30 Month AL packaging quantities Presupposed total annual Al packaging quantity is 138 t. Similarily to PET, AL packagings are also highly voluminose substance remains. Mound volume of the non-compressed Al cans amounts to merely 20 kg/m3, whereas by pressing density of over 500 kg/m3 can be achieved. Therefore upon pressing, total annual Al packaging quantity can be placed in cca 250 m3 of storage room. In August 1,000 kg of Al packaging is averagely collected which takes up only 2 m3 of space. Al packaging segment system is spatially and personnelly placed under other METALS system. Other METALS Other METALS management process: Picture 31 Other METALS management Presupposed Al packaging quantities through months are presented in the following picture. Picture 32 Month quantities of other METALS Presupposed total annual quantity of other METALS is 830 t. Elements of segment system – METALS (Al packaging segment included) Decanter system for selective collection Total space for the reception, selection, pressing and storing, area of about 700 m2, of which 200 m2 concrete-covered and 15 m2 roofed surfaces Device for pressing metal items Number of workers 1 + seasonal 1 Hazardous waste Where appropriate, hazardous waste is taken from the collective areas (altogether 7 locations on island Krk) and delivered to Treskavac landfill, to a special and for that purpose designated area. This is a special part of the landfill which, due to its specificity, must meet the following requirements: must be constructed on stable/solid foundations adequate acces for special vehicles must be ensured it is necessary to fence in the active area of the recycling surface and entrance gate whereas all other doors must be secured by adequate locks and/or padlocks it is necessary to put out warning signs with appropriate inscription such as "Warning – entrance forbidden to all unemployed persons" and to put out sufficient number of them to make the warnings visible from all sides it is necessary to construct a station for storing fire extinguishing equipment at a suitable place it is necessary to construct emergency showers, area for rinsing eyes, storage area for the protection of employees and a phone line it is necessary to abid construction, electrical and firefighting standards during the above mentioned constructions it is necessary to prevent leaking of the liquid material recycling yard's floor must be made of reinforced concrete sloped at least 1% for the purposes of drainage and with the tank for collecting rain-water Elements of segment system – HAZARDOUS WASTE SPECIAL COLLECTIVE LOCATIONS - POSAM, 7 locations MAIN collective location at Treskavac landfill equipped with special suitable tanks Vehicle, specialised for this segment, van,for instance Number of workers 1 + seasonal 1 Organization of Treskavac landfill According to Suggestions for the improvement of Treskavac landfill, HIS Višnjica, multi-phase spreading of disposal area is anticipated for the reception of municipal waste. At the first phase of organization area of cca 9,500 m2 is procured. This should be sufficient for the period of five years. By introducing the ecologically based waste management system, significant decrease of non-selected waste will be accomplished which will result in multiple deadline extension for the capacity exhaustion of the area stipulated in phase I. Hereafter the way of using space and its size within the project suggested in this study are presented. The system is entirely oriented on Treskavac landfill where all the required plants and landfill segments would be. SUPPORT SYSTEMS - PROGRAMMES System / programme of continual communication with municipality  Includes PONIKVE Ltd. and all institutions, organizations, associations, media, etc. System includes one person from PONIKVE Ltd. who is in a specially defined way constantly connected with very specific persons (on the demand of PONIKVE Ltd.) from all relevant institutions and companies, as well as media on the island. This person is duly authorised liaison person, responsible for communication and surveillance of the implementation of the chartered programme (authority and duty on the part of PONIKVE Ltd. Management). This person also has acces to the central computer of the municipal waste management system at PONIKVE Ltd. and services a special phone line and electronic address (email) within PONIKVE Ltd. which are available to all concerned citizens during the working hours (and afterhours on demand). This represents some kind of INFO-CENTRE within the project. Info-centre can be organized within the existing dispatch centre Ponikve Ltd. with suitable personnel and necessary equipment. A special web site containing all the relevant data, instructions and information has been organized. Fundamental aim of this system is a continuous flow of all the information important for the functioning of the programme on all the above mentioned levels and among other participants of the public sphere, citizens, temporary inhabitants/visitors of all levels and tourists. Programme of continual comunication with municipality includes the following: 1.INFO-LINE and INFO email are a part of the above mentioned info-centre at PONIKVE Ltd., and are at citizens' service in order to provide immediate and rapid information related to the project and how it works. 2.MONTH LEAFLET – LEAFLET issued by INFO-CENTRE PONIKVE Ltd. LEAFLET must contain all the relevant and UPDATED information on the the take-off and implementation of the PROJECT OF ECOLOGICAL MANAGEMENT OF MUNICIPAL WASTE ON ISLAND KRK. It must also contain all the information required by the concerned citizens or the information which should otherwise be sent out to citizens to make sure the programme forseen in the project is carried out properly, if such information is not covered by INFO-LINE. 3.INTERNET page of Ponikve Ltd. containing the above described content. 4.PERMANENT COMMUNICATION WITH MUNICIPALITY by use of polls and other forms of public opinion communication. Poll analysis should help the citizens to express their opinion as well as to start seeing the project as their own and mutual thing. Similar can be done through organizing exhibitions, youth concerts, concerts of less-known bands, etc. where other communication contents linked to the project could be added for the purpose of raising its popularity and public acceptance of it. System / programme of continual education  includes all age/profession groups and all the participants of the public and social sphere, all the visitors/temporary inhabitants and tourists System is based on the above described INFO-CENTRE PONIKVA Ltd. in cooperation with associates/experts and the existing educational and other institutions and media on the island, particualrily Radio station Krk. INFO-CENTRE PONIKVA is an integrating system element which means it unites and co-ordinates activities related to the continual education by which the project and its implementation are supported. Programme of continual education's goal is the acceptance and implementation of the ECOLOGICAL MANAGEMENT OF THE MUNICIPAL WASTE ON ISLAND KRK which presupposes promotion and support of the climate of understanding the basic preferences of social responsibility, ecological awareness and responsibility as well as the commitment for the common good and certain interest of all the island's residents. INCLUDES: I PHASE – PREPARATION FOR THE ACCEPTANCE OF THE PROJECT 1.Minimum of five presentation- educational lectures in towns/settlements with over 1,000 residents, two of which in schools and the remaining three in public institutions where assembleys of bigger number of people are possible. To begin at least 2 to 4 months before the beginning of the project implementation. 2.Minimum of two presentation- educational lectures in settlements with over 250 residents, one of which in school (if there is any). Time period as stated above. 3.On demand, one presentation-educational lecture in settlements with less than 250 residents. Time period as stated above. 4.Sending a specific letter to all the participants of the project: to every home/family, every institution and every company on the island immediately prior to the beginning of the project implementation. The letter should serve for the educational and psychological preparation of the citizens for the acceptance of the project and will be formulated in accordance with that goal, with a special emphasis on the characteristics and the function of three decanters system. Similar approach should be used on temporary residents (owners and users of holiday houses, visitors and tourists) taking into consideration their circumstances and the fact that most of them would not undergo any education and preparation. For them the process begins on KRK bridge where they will be given suitable information materials on all foreign languages. Coherent with point 1.,2. and 3. 5.The creation and distribution of other educational materials: compact discs – CDs, visual materials, etc. 6.Distribution of detailed written instructions on THREE DECANTER SYSTEM IN HOUSEHOLDS. These should be concise but precise instructions which will help people to get their way round the project and fit in on hte household/flat level. These will be distributed to every home/family, every institution and every company on the island. Similar approach will be used with visitors/tourists (see above). 7.Aimed educational – popularity-raising shows on local radio station with the purpose of spreading the information about the project, making the listeners aware of it at the given time line and creating the positive atmosphere for the acceptance of the project implementation at all levels of the municipality. Frequency and the duration of these radio shows: at least two shows per week lasting between 20 minutes and half an hour (netto, without musicical numbers), at least three three-minute shows a day of suitable educational- popularity-raising content during prime time. 8.Duration of phase I (preparation phase): at least two months intensively. PHASE II – PROGRESS OF THE PROJECT UNTIL IT DEVELOPS PROPERLY Programme of phase I will be implemented of reduced frequency and alterations demanded by the condition and project development. Therefore, the programme of lectures will be pointed towards schools whereas approximately one third of broadcast time from the first phase will be sufficient. Decreasing the intensity of the activities typical for the educational programme of the first phase will be more gradual in the second one until fairly established project implementation is achieved. Programme for encouraging the cooperation of citizens for the betterment of project implementation This programme emerges from the assumption that the implementation can not be adequately improved without the cooperation from the citizens. It is believed that this is normally achieved via stimulation and remuneration actions on one side and punishment measures on the other. Punishment measures can not be sentenced and imposed by the companies, neither of public, nor private sector, because it opposes the Constitution and Croatia's laws. Therefore all the atention will be focused on the measures of legal and legitimate control of the mode and level of citizen cooperation and awarding of those who cooperate best , and data on those who will break the publicly settled accord of the municipalities of island Krk that out of ecological, economical, developmental, moral and other reasons of COMMON GOOD AND PUBLIC INTEREST everyone must participate in the implementation of the PROJECT OF ECOLOGICAL MANAGEMENT OF MUNICIPAL WASTE ON ISLAND KRK, in organization of PONIKVE Ltd. Krk.will be publicly disclosed. 1.CONTROL.Needs to be discussed at Ponikve Ltd. taking into account the competence of the Agora of Ponikve Ltd. 2.REMUNERATION. Rewards are to be given to the particularly responsible individuals, households, companies or individuals within the companies in charge of the system operating and cooperation with PONIKVE Ltd. Rewards can be grants for the educaton of of young people, computers for schools and individuals or companies etc. 3.SANCTIONS. It is necessary to discuss and decide on the municipal order in each unit of the local self-government. Decisions should be harmonized in all the units of the local self-government on island Krk.
English to Croatian: Clinical Guidelines for the Management of Disorders of Sex Development in Childhood- Handbook for Parents
Source text - English Copyright © 2006 Intersex Society of North America Funded by The California Endowment and Arcus Foundation Consortium on the Management of Disorders of Sex Development HANDBOOK for PARENTS Consortium on the Management of Disorders of Sex Development Copyright © 2006 Intersex Society of North America Funded by The California Endowment and Arcus Foundation HANDBOOK for PARENTS Handbook for Parents Consortium on the Management of Disorders of Sex Development Published September 18, 2006 First Edition Copyright © 2006 Intersex Society of North America ISBN: 0-9773201-0-3 Published by Intersex Society of North America (a 501(c)3 tax-exempt corporation) 979 Golf Course Drive #282 Rohnert Park CA 94928 Website: www.isna.org Acknowledgments This handbook is the result of an extraordinary collaboration among parents of children with disorders of sex development (DSDs), adults with DSDs, clinicians who care for people with DSDs, and other patient advocates. Christine Feick and Sallie Foley wrote the original draft of this document, including much of the material contained in Chapters One through Three. Alice Dreger then invited review and contributions from others and edited the handbook, adding additional material with help from collaborators. We are truly grateful for the assistance and support that has been provided to us in this work, and we hope that readers will use the associated website (www.dsdguidelines.org) to give us feedback about it. We hope to refine and expand this document so that it becomes as supportive as such a book can be. We are grateful for the participation of David Cameron, Peter Trinkl, and Esther Morris Leidolf in this project. However, they would like to make it known that they do not support the term “Disorders of Sex Development.” We would like to thank Yvonne Day (www.ydaydesigns.com) for design assistance, Chris Dreger (chrisdreger.com) for illustration assistance, and Bob Stayton (www.sagehill.net) for technology assistance with DocBook. This document has been made possible by generous grants from The California Endowment (www.calendow.org) and the Arcus Foundation (www.arcusfoundation.org) provided to the Intersex Society of North America (www.isna.org). Web-browseable and downloadable versions (both with clickable links) of Clinical Guidelines for the Management of Disorders of Sex Development in Childhood and Handbook for Parents are available at no cost from www.dsdguidelines.org. Contributors Cassandra L. Aspinall, MSW, LICSW Craniofacial Center, Seattle Children’s Hospital; University of Washington School of Social Work, Seattle, WA Arlene B. Baratz, MD Medical Advisor, Androgen Insensitivity Syndrome Support Group, Pittsburgh, PA Max & Tamara Beck Atlanta, GA William Byne, MD Psychiatry, Mount Sinai Medical Center, New York, NY David Cameron Intersex Society of North America, San Francisco, CA Anita J. Catlin, DSNc, FNP, FAAN Nursing and Ethics, Sonoma State University, Sonoma, CA Cheryl Chase Founder and Executive Director, Intersex Society of North America, Rohnert Park, CA Kimberly Chu, LCSW, DCSW Department of Child & Adolescent Psychiatry, Mount Sinai Medical Center, New York, NY Howard Devore San Francisco, CA Alice Dreger, Ph.D. (Project Coordinator and Editor) Program in Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL Christine Feick, MSW Ann Arbor, MI Sallie Foley, LMSW Certified Sex Therapist, AASECT; Dept. Social Work/Sexual Health, University of Michigan Health Systems, Ann Arbor, MI Joel Frader, MD, MA General Academic Pediatrics, Children’s Memorial Hospital; Dept. Pediatrics and Program in Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL Jane Goto Board of Directors, Intersex Society of North America; Board of Directors, Androgen Insensitivity Syndrome Support Group, Seattle, WA Michael Grant Lansing, MI Janet Green Co-Founder, Bodies Like Ours; Board of Directors, CARES Foundation; Board of Overseers, Beth Israel Hospital; Board of Trustees, Continuum Healthcare, New York, NY Philip A. Gruppuso, MD Associate Dean of Medical Education, Brown University; Pediatric Endocrinology, Rhode Island Hospital, Providence, RI William G. Hanley, BPS Memphis, TN iii Debora Rode Hartman Board of Directors, Intersex Society of North America, Swedesboro, NJ Ginny Hayes, CMA Androgen Insensitivity Syndrome Support Group, Hampton, VA April Herndon, PhD Intersex Society of North America; Gustavus Adolphus College, St. Peter, MN Thea Hillman Oakland, CA Colleen Kiernan Intersex Society of North America, Chicago, IL Dixie Korlutis, RN Crouse Hospital, Syracuse, NY Esther Morris Leidolf Founder and President, MRKH Organization; The Fenway Institute, Fenway Community Health, Boston, MA Ana M. Lippert Peoria, IL Angela Moreno Lippert Chair of the Board, Intersex Society of North America; Androgen Insensitivity Syndrome Support Group, Coupeville, WA Iain Morland, MA, MPhil, PhD Cardiff, UK Lynnell Stephani Long Chicago, IL Bev Mill, RTR (retired) Androgen Insensitivity Syndrome Support Groups of Western Canada and Australia, Nelson, BC, Canada Charmian A. Quigley, MBBS Senior Clinical Research Physician, Lilly Research Laboratories, Indianapolis, IN William G. Reiner, MD Dept. Urology/Sect. Pediatric Urology, Dept. Psychiatry/Sect. Child & Adolescent Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City, OK Patricia Roberts Los Angeles, CA Aron C. Sousa, MD General Internal Medicine and Associate Dean for Academic Affairs, College of Human Medicine, Michigan State University, East Lansing, MI Herberta Smith, RN, PNP (retired) Kissimmee, FL Collin Stoll Portland, OR Cindy Stone Bloomington, IN Peter Trinkl Berkeley, CA Eric Vilain, MD, PhD Pediatrics/Urology/Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA Michael Walker Founder, Hypospadias & Epispadias Association, Point Reyes, CA and Auckland, New Zealand Roz Weiss Stamford, CT iv Nina Williams, PsyD Deptartment of Psychiatry, Robert Wood Johnson Medical School; Institute of Psychotherapy and Psychoanalysis of New Jersey, Highland Park, NJ Bruce Wilson, MD Pediatric Endocrinology, DeVos Children’s Hospital, Grand Rapids, MI v Contents Welcome to Parents ................................................................................................... 1 You Are Not Alone! ................................................................................................................... 3 What Are DSDs? ....................................................................................................................... 3 What Causes DSDs? ................................................................................................................. 4 Acceptance Takes Time .............................................................................................................. 5 Speaking About Shame, to Try to Get Beyond It ....................................................................... 6 Helping Yourself to Help Your Child ......................................................................................... 7 Secrecy=Shame, Honesty=Acceptance ....................................................................................... 9 Take-Home Messages of This Chapter .................................................................................... 11 Your Child’s Development, and How to Talk with Your Child ................................ 13 About the Language Used Here ............................................................................................... 13 Key Background Points ........................................................................................................... 15 Ages 12-36 Months ................................................................................................................. 16 Ages 3-5 Years (Pre-Schoolers) ................................................................................................. 19 Ages 6-11 Years ....................................................................................................................... 26 Puberty .................................................................................................................................. 31 Adolescence (11-18) ................................................................................................................ 32 Your Life Together ................................................................................................................... 36 Take-Home Messages of This Chapter .................................................................................... 37 How to Talk with Others ........................................................................................ 39 Introduction ............................................................................................................................ 39 What to Tell Your Friends and Family in General .................................................................... 40 If Your Newborn’s Gender Assignment is Delayed ................................................................... 41 What to Tell People Who May Think DSDs are Sinful ........................................................... 42 vii Tips on Interacting with Teachers and Daycare Providers ........................................................ 44 Talking with Your Child’s Medical Care Providers ................................................................... 46 Take-Home Messages of This Chapter .................................................................................... 51 Answers to Common Questions .............................................................................. 53 Helpful Handouts ................................................................................................... 67 About Disorders of Sex Development (DSDs) ......................................................................... 68 How Genital Development Happens ...................................................................................... 71 Things to Do and Things to Avoid .......................................................................................... 74 Preparing for a Medical Appointment ..................................................................................... 75 Record-Keeping and Journaling ............................................................................................... 77 Thoughts from Fellow Parents and from Adults with DSDs .................................... 79 Introduction to This Material .................................................................................................. 79 Letters from Fellow Parents ..................................................................................................... 80 Memories and Thoughts from Adults with DSDs ................................................................... 88 ................................................................................................................................................ 97 Other Resources (Where to Learn More) ................................................................ 99 Websites ................................................................................................................................. 99 Support Groups and Diagnosis-Specific Information ............................................................. 100 Finding a Child Psychologist ................................................................................................. 101 Books Devoted to DSD Issues ............................................................................................... 102 Videos and Television Broadcasts ........................................................................................... 103 Journal and Magazine Articles ............................................................................................... 103 General Parenting .................................................................................................................. 103 Sex Education for Your Child ................................................................................................ 103 Key to Photographs ............................................................................................... 105 Glossary (Explanation of Terms) ........................................................................... 113 viii Contents Index .................................................................................................................... 123 Contents ix Chapter 1 Welcome to Parents If you’ve just found out your child has some kind of disorder of sex development (called a DSD for short), you may be feeling confused and stressed. Like other parents in this situation, you may have these kinds of questions going through your mind: • Why me? Why my child? • Did I do something wrong? • What if I can’t love my child? • Are the doctors telling me everything? Is there more to come? • What am I going to tell my family and friends? • Is there a way I can make this all go away? Jane Goto 1 These kinds of questions are common to parents in this situation. We hope that this handbook will help you begin to answer these questions and that it will help you feel stronger, more certain, less confused, and less stressed. We hope it will assure you that, with your loving support, your child can grow up to be well, happy, loved, and loving. This handbook does not include a large amount of medical information about your child’s specific condition. That is because there are many conditions that count as disorders of sex development (DSDs), so it would be impossible for us to cover them all. Instead, this book is meant to give you some basic information about sex and gender development. It is also meant to give you emotional support and ideas about how to cope with your feelings and your day-to-day life. It gives ideas about how to help your child adapt and thrive, and it gives you advice about how to talk with your child (and others, too) as he or she grows up. The central purpose of this handbook is to help you as you travel on the journey of life with your child. This book is set up so that you can read it from beginning to end, but it also allows you to skip from chapter to chapter if you like. We do suggest you start by reading all of Chapter 1 Welcome to Parents [page 1] where we discuss the main issues of having a child with a DSD. Chapter 2 Your Child’s Development, and How to Talk with Your Child [page 13] walks you through the development of your child, including how to talk with your child, at various ages, about his or her DSD. Chapter 3 How to Talk with Others [page 39] gives you practical advice about how to talk with others about your child’s DSD, as you will sometimes need to. For example, it suggests how to talk with your child’s daycare provider or teacher. Chapter 4 Answers to Common Questions [page 53] gives answers to parents’ common questions about having a child with a DSD. Chapter 5 Helpful Handouts [page 67] provides helpful handouts that you can use as you do things like prepare for a doctor’s appointment, or as you think about keeping a journal of your own experiences. Chapter 6 Thoughts from Fellow Parents and from Adults with DSDs [page 79] includes letters from fellow parents about their real-life experiences. It also includes some memories from adults with DSDs, talking about key points of their experiences. Some of them take the opportunity there to tell what they wish, in retrospect, their parents had known. Chapter 7 Other Resources (Where to Learn More) [page 99] tells you about where you can learn more, including how to find a support group specific to your child’s DSD. The Glossary (Explanation of Terms) [page 113] provides a list of terms that you may not be familiar with, along with a definition for each. Before we get started, just one thing: While this handbook focuses on your child’s DSD, do try to keep it in perspective. Although your child’s DSD can sometimes feel like a skyscraper towering over you and your child, it is just one aspect of your child’s life—and just one aspect of your life with your child. Remember that your child, and your relationship with your child, is actually much richer and greater than can be captured in this book. 2 CHAPTER 1 WELCOME TO PARENTS YOU ARE NOT ALONE! First and foremost, you should understand that you are certainly not alone. DSDs occur around once in every 1500 births. This means that, every week, dozens of parents in the U.S., and hundreds worldwide, learn the news that their children have DSDs. Until recently, people did not talk about these conditions very much, so you may have never heard of your child’s condition before. But that is changing, and compared to just a few years ago, families like yours are getting much more information and support. Getting lots of accurate information, passing that information on to your child as he or she grows up, and reaching out to others will mean that you and your family do not feel alone in the dark. Lynnell Stephani Long WHAT ARE DSDs? In this book, we are generally going to use the term “sex” to talk about the physical parts of our bodies that have to do with being male or being female. The aspects of your sex include your “sex chromosomes” (which we will talk more about in a moment), and your sex/reproductive parts, like your ovaries or testicles, your vagina, clitoris, penis, scrotum, and so on. Sex hormones are another aspect of your sex; sex hormones are chemical messengers in your body that move through the blood. They help your body develop and function sexually. For example, before you were born, sex hormones contributed to the development of your genitalia, and during puberty, they helped your body change from a child’s to a man’s or woman’s. YOU ARE NOT ALONE! 3 From the time we are conceived until the time we die, our bodies pass through many steps of sex development. For example, during your puberty, you sexually matured, going from having a child’s body to having the body of a sexually mature man or a woman. Puberty, like menopause, is just one obvious stage of sex development. But there are a lot more stages that we do not usually see so clearly. Sex development starts right at conception, goes through the time in the womb, and continues through early childhood, adolescence, adulthood, and late adulthood. “Sex differentiation” is the term for when boys and girls, or men and women, take different paths of sex development. For example, in the womb, a few weeks after conception, an embryo will form “proto-gonads.” Several weeks later, those proto-gonads will usually take one of two paths to become either testes or ovaries. So that is one time when sex development happens—when, long before birth, the proto-gonads differentiate to become either ovaries or testes. Genitals (penis, clitoris, scrotum, labia, etc.) also differentiate at various stages of human life. Children with DSDs sometimes have genitals that look different than the average. Not all children with DSDs have genitals that look different than the average, and not all people who have genitals that look different than the average have DSDs. (“Averages” are just that—the middle of the spectrum.) There are pictures of genital development in Figure 5.1 “Genital Development Before Birth” [page 72]. Genital development is also talked about in more detail there. We could say that the first stage of sex differentiation happens right at conception. The egg and the sperm each contain chromosomes, little bits of matter that contain genes. Genes are like instructions for building the human body. Along with other chromosomes, usually the egg from the mother contributes one X chromosome, and usually the sperm from the father contributes either one X or one Y chromosome. So we could say the first stage of sex differentiation happens at conception. If an embryo ends up with an XX combination, usually the child that grows from that embryo will become a girl. If the embryo ends up with an XY combination, usually the child that grows from that embryo will become a boy. Because there are so many stages of sex development in human life, there are a lot of opportunities for a person to develop along a path that is not the average one for a boy or a girl. When a less-common path of sex development is taken, the condition is often called a “disorder of sex development” or DSD. So DSD is a name given to a lot of different variations of sex development. Often these conditions are called by a more specific name, like “virilizing congenital adrenal hyperplasia,” or “androgen insensitivity syndrome.” WHAT CAUSES DSDs? Your child’s doctors may be able to tell you about why your child’s DSD happened, so be sure to ask them. We can tell you this in general: Sometimes a DSD happens because the child has something other than either the XX or the XY chromosome pattern. So some children have XXY, and some children have different combinations in different cells of their body. (That’s called a mosaic karyotype.) 4 CHAPTER 1 WELCOME TO PARENTS Another way a DSD can happen is if a child is missing a common gene (part of the DNA), or has an uncommon combination of genes that make his or her body develop differently from most boys or girls. This can happen because of genes passed down through families, or because of a genetic change that happens by chance. Much more rarely, something happens to the mother during pregnancy that leads to a DSD; for example, on rare occasions a pregnant woman may be exposed to chemicals that can affect the sex development of her child. Sometimes we just don’t know why a DSD happened. You may find yourself in the situation where the cause of your child’s DSD is simply not known. That can be uncomfortable, but it does happen. Why do parents like you often long to know the cause? Sometimes it is because they want to make sure the diagnosis is right. And sometimes it is because they feel guilty and mistakenly believe they are somehow to blame. You may find that well-meaning medical professionals, family members, or friends accidentally make you feel guilty that your child has a DSD. These feelings can become overwhelming, depressing, or confusing. It can help to speak these feelings out loud, to tell people when you are feeling guilty, and to remind yourself and them that you are not to blame for your child’s DSD. Talking about these things gets these feelings out of your head and out into the open, and allows you to see and think more clearly. As your children grow, they will be learning from you about how they should feel about themselves. It will help them tremendously if you can find a way to show them (and yourself ) that you do not blame yourself for who they are, because they want you to accept and love them for who they are. ACCEPTANCE TAKES TIME Maybe you are not at all worried, concerned, frustrated, or angry that your child has a DSD. If that is the case, that’s great…but it’s pretty unusual. Just accepting that your child has a DSD may be difficult. In fact, it is common for parents at first to not believe what the doctor is saying. Acceptance is a process: it doesn’t happen in one magic moment. But to begin healing the sadness or anger that you may feel, you will find that you have to acknowledge the truth, including the truth of your child’s situation and the truth about your own feelings. Like many parents, your first fear may be that your child is sick. Your child’s doctors will try their best to help if your child is sick. But your second concern—perhaps a close second—may be that you want your child to grow up feeling normal. As to that, we can tell you from lots of experience that your acceptance of your child is what will make your child feel normal. Before you can do that, you may first have to learn to accept your own situation. That can take time, because chances are that you were not expecting to have a child with a DSD. A lot of parents of children with DSDs have said that they felt a sense of loss when they found out about the DSD, because they felt like they had lost the child that they were expecting (that is, the child ACCEPTANCE TAKES TIME 5 without a DSD). This is an emotion that has also been felt by parents who have had a child born with Down syndrome, cleft palate, and so on. Especially if the DSD is diagnosed when the baby is a newborn, you may feel yourself grieving the loss of the “wished-for” child. What’s involved in this grieving? You may have heard of people talk about the “five stages of grief.” Those are: denial of the truth; anger; “bargaining” with God or the universe for something less scary; depression; and acceptance of the situation. You may find yourself going through these stages, but the process of grieving is different for different people. Some other common feelings for parents in your situation are shock, disbelief, anxiousness, fear, curiosity, embarrassment, confusion, and helplessness. Some parents have physical reactions to the situation, so that they lose their appetites, are unable to sleep, have headaches or upset stomaches, or feel very tired. Some find it difficult to talk with their spouses, even though it is very important to talk often and deeply with one’s spouse during this time. We know it can be hard to talk about sex, especially when we are talking about the sex development of children, but a lot of parents tell us that it is very healing to talk about their experiences and the child’s DSD. Our culture often teaches us to feel ashamed about sex and not to talk about it. Shame comes from our fears and lack of understanding about things that are different. So you may feel ashamed or embarrassed about your child’s DSD. And you may get a domino effect from this: Some parents say that their greatest guilt comes from feeling these negative feelings—shame and embarrassment—about their children. Like some other parents, you may fear not being able to overcome these feelings. But it is very important to try to put into words what you are going through, so you do not go through it alone. SPEAKING ABOUT SHAME, TO TRY TO GET BEYOND IT Start by taking the time, now and frequently, to explore your own feelings of shame and embarrassment. Try to think about what you are feeling and why you are feeling it. You are not a bad parent just because you may feel ashamed and embarrassed about your child’s DSD. It is understandable that you might feel this way. But being ashamed and embarrassed forever will not work. We have heard from many adults with DSDs and their parents that staying ashamed and embarrassed will cause your child and you too much stress and pain. So what do you do? Do not expect these feelings to magically go away now or forever. Instead, start by reading this book so you understand what is going on, so you know why you are not to blame, and so you see you are not alone. And then try to communicate with people you trust (doctors, family members, friends, support groups) so that you can set up a good system of honest support for yourself and your child. Developing loving, honest, accepting relationships will help you and your child through the challenges that you may face in your lives. You will probably find, as many parents have, that as you move through the stages of acceptance, you sometimes find moments of real strength when you can help not only your child, but others in similar situations as well. And then, at other times, you will find that your strength has shrunk. It is okay to 6 CHAPTER 1 WELCOME TO PARENTS go through this cycle of strength and weakness. It is an understandable and acceptable part of being a parent of a child with a DSD. What so many parents of children with DSDs have told us is that, over time, they accepted their situation and learned to cope. Many say they found a special kind of love and joy from sharing this life with their children. As it was for them, for you these ways of coping will not develop in one day; they develop over time. And there is no simple resolution to the emotions that come with having a child, including having a child with a DSD. Just know that, as there are days where you feel frustrated, confused, sad, or angry, there will also be days of intense joy and wonderful peace. Max and Tamara Beck and family HELPING YOURSELF TO HELP YOUR CHILD We know that you want to protect your child. If you did not want that, you would not be reading this book! Having a child face something like a DSD will bring out the strong protective feelings in many parents. You want to know how to help. One of the things we have been saying in this chapter—and will keep saying throughout this book—is that, to help your child, you have to start by recognizing the ways that you yourself have been affected by having a child with a DSD. It may feel self-centered or even selfish to think about your own feelings and needs at this time. But thinking about yourself will help you to feel well enough to help your child. There is another really important reason to think about what you are feeling and experiencing. That reason is this: If you don’t think about your needs, you may, by mistake, make choices for your child HELPING YOURSELF TO HELP YOUR CHILD 7 not based on what he or she needs, but based on what you need. For example, in your desire to protect your child, you may think you have to make big, irreversible medical decisions because you must protect your child from any possibility of ever being teased for having a DSD. But if you slow down and think about it, you may realize your child has other needs that may speak against making such big decisions for him or her right now, before you know what he or she really would want. For example, you may slow down and realize that you really want the DSD to go away as much as possible; it stresses you out and makes you worry for your child. But it might be best for your child if you wait on some or all of the optional medical procedures being offered to you. Waiting can give him or her time to make those decisions; waiting can mean you and your child may get more information about how well the procedures being offered to you work; waiting can mean you give your child the message you accept your child as he or she came, and that you respect your child’s ability to make decisions about his or her own body. But again, to sort all of this out, you have to take care of yourself. A strong support system is key to helping your child. Parents of children with DSDs tell us it is very helpful to connect with other parents who have had similar experiences. (You may want to use Chapter 7 Other Resources (Where to Learn More) [page 99] to find support groups, and you can also ask your doctor for help finding support.) A good support system will help you know more and feel better. As your child grows, it will also help him or her know more and feel better. Chances are that, like you, your child will also sometimes experience feelings of grief because she or he has a DSD. Typically young children feel the pain of grief and then distract themselves with the normal activities of everyday life. Even though a child’s period of grief may be short, it can be very intense. Children often show their grief through the way they play. For example, a preschooler may scribble very hard and fast with a crayon when he or she is anxious about facing a visit to the doctor. Your six-year-old might begin to suck his or her thumb again. Children only deal with as much grief as they can handle at any time. They sometimes let us know it in indirect ways. And some of their grief may be put off until they feel safe enough to deal with it. You can help your child cope with grief by talking with him or her and creating a relationship in which he or she feels safe expressing feelings. It may be difficult for you to see your child feeling badly. But it is a mistake to run away from your child’s emotions or to try to make them disappear in an instant by distracting the child or simply telling him or her “everything is going to be fine.” It is crucial to allow your child to feel whatever it is he or she is feeling, and to allow your child to say or show what he or she is feeling. Your children need your time, care, support, honesty, openness, and acceptance. They need to work through their own feelings. As you go through your own emotions, your children will be watching and learning from you. Your children will adopt some of your strategies, and create some of their own. Their feelings will sometimes match yours, and sometimes they will not. The important thing is that you honor their experiences; recognize them and accept them with love. It is important for your children to understand that you are human, and so are they. They will not always feel or act the way they wish they would, any more 8 CHAPTER 1 WELCOME TO PARENTS than you will always feel or act the way you wish you would. But by accepting them as they are, by listening to them and staying with them, you will teach them understanding and love. Lynnell Stephani Long SECRECY=SHAME, HONESTY=ACCEPTANCE Would you like to know the secret of success according to people who grew up with the conditions we’re talking about? Well, here it is: the best thing you can do for your child is to be open and honest with him or her about his or her DSD. When you are honest, you let your children know that you are not ashamed of them. You also let them know that you can be trusted to be a source of truth in their lives. Sadly, a lot of people learned this lesson the hard way. Until recently, it was common for doctors and parents of children with DSDs to both hold back and misrepresent information, even after these children became adults. These parents and doctors did not do this because they wanted to hurt the children; on the contrary, they held back and misrepresented information because they wanted to protect them. But this backfired. The children who grew up in these situations often later felt betrayed by their parents and doctors, overwhelmed with feelings of shame, and frightened to seek medical care and family love, even when they needed it. In this way, the issue of truth-telling about DSDs can be compared to truth-telling about adoption. It used to be the case that most people kept adoption a secret and children would never be told that they were adopted. By the end of the 20th century, however, most people came to believe that it is actually SECRECY=SHAME, HONESTY=ACCEPTANCE 9 healthier for children to know their own roots and their own personal stories. Similarly, in the recent past, parents of a baby born with a DSD were sometimes told to keep it a secret. But, like information about adoption, we now know that children (and adults) with DSDs do better knowing their own personal stories and understanding their own uniqueness. If you find yourself wanting to keep your child’s condition secret from him or her, remember that secrecy often doesn’t work as it is meant to. Many people—including even young children—pick up on family secrets, especially when the secret that is being kept is about a member of the household. Secrets also have a way of eventually coming out, whether it’s through a family argument or an accidental slip. That’s not the best way to learn something like this. Even if the secret didn’t come out in this way, adults with DSDs who were not told about their condition say they sensed that there was something about them that they weren’t being told. Why all the trips to the doctor where their genitals were examined? Why did everyone act weird when they asked questions about their surgeries? These types of questions led adults with DSDs who were not told about their conditions to go to great lengths to find out the truth, and sometimes their imaginations filled in the blanks with “facts” that were more frightening than the actual truth. So one of the troubles with secrets is that they can’t easily be kept. Another problem with secrets is that they suggest there’s something bad or shameful that shouldn’t be spoken about. Hiding or lying makes shame get bigger and bigger. Adults with DSDs who were treated with secrecy and shame accidentally got the message that there was something monstrous about them. Again, many of these people felt deceived by both their parents and their doctors. As a result, it was extremely hard for some of them to have any type of trust toward their parents, medical people, or people in general. In addition to feeling confused, frustrated, and shameful, many adults with DSDs who weren’t told about their conditions felt a deep sense of isolation, often made worse by lack of trust. They felt all alone, as if they were the only people in the world who had this condition. This is another one of the “side effects” of secrecy and shame. Secrecy and shame shut down our understanding of difference and isolate those who are different. This is the cycle that needs to be broken. And the good news is that, nowadays, individuals with DSDs and their families don’t have to feel overcome with shame, confusion, loneliness, or secrecy. Support groups, patient advocacy groups, informal support networks, and condition-specific organizations give people with DSDs the chance to connect with one another and realize that they are not alone. The public education work done by support groups has let a lot more people know about DSDs and the people who have them. So here’s the bottom line: when you are open and honest with your children about their DSDs, it shows your children that you accept, love, and respect them, and that you are not ashamed of them or of being their parent. Again, your love and acceptance is what’s really going to do them the most good. 10 CHAPTER 1 WELCOME TO PARENTS Iain Morland, Ph.D. TAKE-HOME MESSAGES OF THIS CHAPTER • You are not alone. • It is common in this situation to feel a range of emotions. • You should be honest with yourself and others about how you are feeling. • You deserve—and should seek out—support from trusted friends, families, medical professionals, and support groups. • Over the years, your children may feel different about the situation than you do. • Your children need you to accept them as they are and to be open and honest with them as they grow. This book will help you think about how to do that. TAKE-HOME MESSAGES OF THIS CHAPTER 11 Chapter 2 Your Child’s Development, and How to Talk with Your Child All parents want the best for their children. You may expect your child to face special challenges due to his or her DSD, and naturally you want to help your child in every way possible. One way to help is to understand the stages of your child’s physical, emotional, and mental development. Another way to help is to talk with him or her regularly about his or her DSD and other concerns. This chapter reviews what you can expect in terms of your child’s development. It also talks about how you can help your child with loving, understanding, honest communication and emotional support. Here are some practical ideas about how to talk with your child and help him or her through challenging times. ABOUT THE LANGUAGE USED HERE Pronouns (he/she): You’ll notice that, in this chapter and in other places in this book, we sometimes use the pronoun “he” and sometimes use the pronoun “she” when talking about a child or a parent. When writing this book, we first tried always using the phrase “he or she,” to include everyone, but we found that that approach made the book harder to read. Please understand that just because we write “he” or “him” doesn’t mean we are talking only about boys and/or men, and just because we write “she” or “her” doesn’t mean we are talking only about girls and/or women. And, when we do use the phrase “he or she,” we do not mean to suggest that your child does not have a clear gender. We are just varying the pronouns we are using to try to make people feel included. Gender: In this book, we use the word “gender” when we are talking about someone’s identity as a boy or a girl, or a man or a woman. When we talk about a person’s “gender role,” we are talking about whether that person is seen socially as a girl or boy, woman or man. And when we talk about a person’s “gender identity,” we are talking about that person’s inner feeling of being a boy, girl, man, or woman. When we say a baby has been given a “gender assignment” of girl, that means she is being raised as a 13 girl (this has nothing to do with surgery). So when we talk about a person’s “gender identity development,” we’re talking about growth in her inner sense of self. Gender is different from sex, because “sex” is a word that refers to someone’s physical make-up. (More on that below.) It is important to know that a person’s “sex chromosomes,” sex hormones, and his or her sex parts (like testes or penis) do not always determine what gender identity a person will grow up to feel inside. Sometimes a person has a gender identity that is different than we would have guessed from her sex chromosomes or her genitals. Gender doesn’t come in two simple types. Most women and girls have at least a few traits, interests, and mannerisms that might generally be labeled “masculine,” and most men and boys have at least a few traits, interests, and mannerisms that might generally be labeled “feminine.” Some people feel in themselves a real blend of “masculine” and “feminine” elements. What’s expected of genders differs somewhat from culture to culture. Freema Hillman and her daughter Thea Sex: As we talked about in the last chapter, in this book we use the term “sex” to talk about the physical parts of our bodies that have to do with being male or being female. When we talk about a person’s sex, we are talking about whether that person is male or female from a biological (physical) point of view. The aspects of your sex include your “sex chromosomes” (the X and Y chromosomes) and your sex parts like your ovaries or testicles, vagina, clitoris, penis, scrotum, and so on. Sex hormones form 14 CHAPTER 2 YOUR CHILD’S DEVELOPMENT, AND HOW TO TALK WITH YOUR CHILD another aspect of your sex; sex hormones are chemical messengers in your body that move through the blood. They help your body develop and function sexually. So when we talk about “sex development,” we’re talking about changes in the body in terms of its physical nature. For example, we’re talking about changes in genital anatomy, or changes in sex hormones. Sexuality and sexual orientation: When we use the word “sexuality,” we are talking about a person’s experience as a sexual being. Sexual intercourse or other intimate relations with a romantic partner would be an example of a person’s sexuality. Sexual desires and feelings are also part of a person’s sexuality. “Sexual orientation” is a term usually used to talk about whether a person is straight (attracted to people of the “opposite” gender), gay (attracted to people of the same gender), or bisexual (attracted to men and women). Although most women are attracted to men, and most men are attracted to women, knowing a person’s sex or gender won’t tell you his or her sexual orientation. KEY BACKGROUND POINTS Whether they have DSDs or not, as they mature, all children go through a process of development in terms of their gender identities and sexuality. We will talk about this in depth below, because parents of children with DSDs have told us that honestly answering your child’s questions about gender and sexuality issues is a great way to help your child and to build a loving, trusting relationship with him or her. Many parents of children with DSDs have a whole set of worries that a lot of other parents do not have, and they have them right from the moment the DSD is noticed. They worry that the child has been assigned the “wrong” gender or that the child may turn out to be gay. Parents of children with DSDs tell us that they spend a lot of energy watching their children play and interact with others, trying to notice whether the child’s behavior is “girlish” or “boyish.” When they see their children acting like the “opposite” gender, or they see their children acting “gay,” they often wonder if the DSD (or a “wrong” gender assignment) is the cause of what they are seeing. Sometimes seeing their children behave “different” in this way will bring up strong emotions for parents, including sometimes a sense of guilt, fear, shame, or anger. So do DSDs cause some children to act and feel different than most people in terms of gender and sexual orientation? We are not sure. The truth is, even though scientists have attempted to find out why people end up with the gender identities and sexual orientations they do, the origins of gender identity and sexual orientation remain somewhat of a mystery for all of us. Do our gender identities and sexual orientations come mostly from our biology? Mostly from the way we are raised and our cultures? Or a combination of all that? The answer may be different for different people. And, although the causes of gender identity and sexual orientation may be important to scientists, this probably is not the most important issue to you. What is most important to you is your child’s happiness and well-being. In terms of your child’s gender identity and sexual orientation, it is very important to love and support your children over the years as they come to understand and express who they are. KEY BACKGROUND POINTS 15 What we do know for sure, from talking with parents of children with DSDs, is that these parents are a lot more likely to notice and take seriously the “gendered” behavior of their children. But when you are noticing these things, consider that maybe you’re just reacting more strongly to what lots of other kids also express, because you’ve been “put on alert” by knowing your child has a DSD. Parents who have been through this suggest that you try not to spend too much energy “keeping score” of the “gendered” behaviors of your child, because if you do, it is hard to accept your child for who she is. And you definitely should not conclude that, just because your child sometimes acts like the “opposite” gender or seems to be attracted to people of the same gender, you have his or her gender assignment wrong. Just because a boy is somewhat girlish does not mean he should have been raised as a girl. Just because a girl is attracted to other girls does not mean she should have been raised as a boy. If you talk with adults with DSDs, you will find that the majority of them do not think they were raised in the “wrong” gender. So it is statistically very unlikely your child will change the gender to which he or she was assigned. Adults with DSDs do remember feeling hurt when their parents rejected them or felt ashamed of them because they were different from the average in terms of their gender identities or sexual orientations. Again, what that teaches us is that parental love and honest acceptance are the main things children with DSDs want and need. The following sections walk you through different stages of children’s lives and help you think about how to be supportive of your child. AGES 12-36 MONTHS During the toddler years (when a child is 12-36 months old), big changes happen for children—and so also for their parents. Most children start walking before or during the toddler years. Other physical skills also develop during this period. For example, your child will start being able to control her movements more and more each month. She will learn to use her eyes and hands together, for example, to roll a ball towards you. Toddlers also usually make progress in toilet training, so that your child will probably start to grow out of diapers and start using the toilet. As your child enters the toddler years, he becomes more and more interested in exploring the world. He may seem to get into everything, or to ask “why?” over and over. He will start to figure out ways to deal with the stress of being away from you. He may use things like blankets, dolls, or stuffed animals to help him feel better when you are apart, whether that is at bedtime or during daycare. At the same time that your child is showing more independence, he will also continue to rely on you to help him cope with hard or painful situations. Early in the toddler years, most children see themselves as the center of the world and have little understanding of how to be social with others. Toddlers start to develop a sense of how to be social by interacting with their parents and playing with other children. Through these interactions, toddlers start to become aware of what people expect and how people behave. They start getting a sense of what is expected of them and of others. 16 CHAPTER 2 YOUR CHILD’S DEVELOPMENT, AND HOW TO TALK WITH YOUR CHILD As toddlers mature, their ability to think increases. Toddlers want to understand things going on around them. They start to observe and to copy the behavior of others at this stage. Toddlers also begin to recognize patterns in everyday life and will expect things to follow certain patterns. For example, a toddler will recognize that her family eats dinner after mom gets home from work and will learn to expect to eat every day at that time. Toddlers may be fiercely strong-minded in this stage and show a strong will. They will often want things to go their way, and will be upset if things do not. They are also able to make simple plans and goals. During the toddler years, most children start to understand words and how to use them. When children are between two and three years old, they begin to use language as a social tool to explain how they are feeling (for example, hungry, itchy, sad), to ask for what they want, and to find out more about the world. Sometimes toddlers feel frustrated when they can not get you to understand what they are trying to say. One way children may let you know their feelings and ideas is through their play. If you watch your children play, you can often learn how they are doing and what they are thinking about. For example, a child might use a doll to act out what he remembers most clearly from an important doctor’s visit. (One mother remembers her young son getting ready to play “doctor” with a friend by pulling out a ruler to measure their penises—something that happened every time he went to the doctor.) Or a child may pretend a swing at the park is an airplane and she is going to visit her grandmother. If a child acts something out over and over again, it may be a clue that she is confused or stressed, and she may benefit from having you play with her and talk with her. It is sometimes difficult to believe that children start to get a sense of right and wrong when they are just toddlers, but it happens as children see what is labeled “good” and what is labeled “bad.” This process of learning right and wrong is called “moral development.” Children at this age try to figure out how to get what they want (for example, by being “good”), and they also try to figure out how to please their parents. During the toddler years, children begin to develop a sense of who they are, and how that may be different from who other people are. When your child looked in a mirror when she was younger, she just saw a moving image. But during the toddler years, usually a child discovers that the image in the mirror is her, and not someone else. She begins to understand who her family members are, and how she is related to them; she learns who is her sister and who is not her sister. She begins to understand why she has the last name that she does, and she may start to understand that she is considered a girl, like her sister, and not like her brother. She also starts to understand that what she wants is not always what her parents want. All of this is called the development of “self identity.” In general, children have a sense of being boys or girls by about two years of age. Children begin to understand the difference between genders in many ways. Since children are told that they are either a girl or a boy by many people, they may attempt to fit the labels given to them. Children get cues AGES 12-36 MONTHS 17 about what counts as “appropriate” for their genders by watching the people around them, and by seeing how people treat them when they act like a girl or like a boy. They begin to notice that people are divided into two basic groups—boys/men and girls/women—by the way their voices sound, by the way they dress, by the way their hair is styled, and by the roles they play. If a toddler has seen people naked, he may also notice how most boys, men, girls, and women look, and he will begin to see how one’s gender identity usually matches one’s physical sex. During these years, most children become interested in playing actively with other children. The curiosity they have means that they are also curious about their own bodies and others’ bodies. Sometimes they’ll be curious about their own genitals and the genitals of children they spend time with. This is common in nearly all children. Some toddlers may see differences in genitals, while others may not notice the differences until preschool or after. Whether or not you see your child having this curiosity, it is a good idea to start letting your child know it is okay to talk about his body. Many parents of children with DSDs say that the earlier you start talking with your child about sensitive topics like genitals, the easier it will be to talk more about gender, sex, and sexuality as your child grows. You can start talking with your child about his or her genitals when you are changing a diaper or helping the child use the toilet. You can occasionally say simple things like “point your penis toward the toilet water so the pee-pee goes in the bowl,” or “after you poop, wipe your bottom away from your vagina like this.” In this way, you slowly start to give your child the language she will need to talk about her body. Do not try to push more information on your child than she is ready for. Take cues from her by listening to her questions and concerns, and answer those. Sometimes your own worries about her need to know or not know more will cause you to give too much or too little information. If you remember to go slow, take a deep breath, and listen closely to what your child is asking, you can be thoughtful in how you answer what she is really asking. You may need to teach a few new words as you answer questions. A toddler will not be able to understand all the details about his DSD, but you can start to tell him about how most girls have clitorises and vaginas, and most boys have penises and scrotums, and that some people are different. You can start to explain how your child looked when she or he was born. You may find that your three-year-old asks questions that catch you off guard, so it is helpful to think about and prepare for questions that your child might ask. Questions from toddlers are often about how their genitals function and why their genitals look the way they do. Here is an example of a question that a three-year-old might ask and a suggestion about how to answer. In this example, the child is using the word “pee pee” to talk about his penis. Child to parent Why doesn’t my pee-pee look like daddy’s? 18 CHAPTER 2 YOUR CHILD’S DEVELOPMENT, AND HOW TO TALK WITH YOUR CHILD Possible response Just like people’s faces look different, everyone’s parts look a little bit different, too. Pee-pee’s can come in many shapes and sizes. Yours turned out different from daddy’s, so it looks different from his. If your child has had genital surgery, now may be a good time to start explaining that part of the reason your child’s genitals may look or feel the way they do is because a doctor changed them when the child was younger. You can sometimes use a doll or a stuffed animal to explain a little bit about how surgery happens. Again, follow your child’s lead about what she or he wants to know, but don’t try to hold back this information when it could naturally come out. The earlier you start talking with your child about his or her body, the easier it will be to keep the conversation going as he or she grows. AGES 3-5 YEARS (PRE-SCHOOLERS) As your child reaches preschool age, his ability to understand more information naturally grows. If your child did not ask many questions when he was a toddler, he will most likely ask you many questions as he goes from age three to age six. Although preschool-aged children are able to take in more information than toddlers, they are still not yet able to fully understand all the details of their DSDs. They can, however, begin to understand the ways in which they are similar and different from their peers (“peers” means children the same age as them), and they can begin to understand simple explanations about their DSDs. Preschool children continue to mature physically. Most learn to do things like run, jump around, ride a tricycle, and hang from the monkey bars. They begin to do things they could not do when they were younger, like fastening buttons and tying their shoes. During the preschool years many children are better able to handle being away from their parents. Preschoolers have a better memory than toddlers, and a more mature sense of time that allows them to remember that you will eventually return to them after you go away. Your child, however, may sometimes seem to go backwards in terms of behavior, becoming clingy and having a hard time saying goodbye, especially when he or she is stressed. This behavior is common and usually temporary, and may have nothing to do with the DSD. Children with DSDs often have to go through things other children don’t, like extra medical exams or the challenges of learning that they were born with their genitals looking different from most other children. Because of this, their parents sometimes become over-protective and try to limit social opportunities for themselves or their child, so that the child will not be out of arm’s reach. In the short run, this may make the parent and child feel better. But in the long run, children and parents who do this wind up with fewer chances to practice being apart. This can accidentally make added stress for the parents and the child as the need arises to be apart. If you find yourself in this situation, you might start with thinking about whether you are mostly protecting your child or yourself when you are avoiding social settings that might put your child out AGES 3-5 YEARS (PRE-SCHOOLERS) 19 of your immediate reach. Remember that all children have to learn to be away from their parents sometimes. You might also think about how you can plan to have your child away from you once in a while in a “safe” zone—in other words, in a setting you feel comfortable with because you know and trust the other parents and children. Remember that you will not always be able to be in the same room as your child, so it helps to now start working on ways you can both feel okay when you are apart. If your child is having trouble being apart from you, know that many parents say it is helpful to do things like assure your child that you will return, and follow a clear pattern. Work out a routine for comings and goings, and, if possible, use the same care giver for your child when you are away from him. That way your child learns to feel okay when you are away, and you become used to being apart, too. As your children mature into the preschool years, their thinking abilities increase. Compared to toddlers, preschoolers begin to understand more, remember events better, and put things into categories. Preschoolers are able to start putting together the “big picture” by understanding the parts of the world and how they fit together. Preschool children sometimes do not know the difference between their fantasies and reality. They may, for example, think that a grandparent who has died will come back to life, because that is what they want to have happen. As preschool children mature, they begin to understand the difference between fantasy and reality. Preschool children begin to move toward an understanding of how and why things happen (“cause and effect”). They also start being able to see the world from somebody else’s point of view. Up until this point, children see themselves as the center of the world and believe that everyone feels the same way they do. Mostly through play activities, preschool children may gradually start to see things from another person’s point of view. Preschool children work on their language and work on communicating with others. They learn how to communicate their feelings with words. They will still often communicate through action (like by “acting out”) and their play. Preschool children often talk out loud to themselves. Preschool children are usually very interested in developing friendships with other children. At this stage, they are busy trying to figure out what it is that is important when trying to make friends. As they learn what these things are, they are figuring out how to change how they act, so that other children will want to be friends with them. This leads to being cooperative, sharing, understanding others’ feelings, and solving fights or disagreements. It also sometimes leads to copying other children’s behaviors and interests. Preschoolers obviously do not have perfect, rosy relationships with all of the other children they meet. Almost all preschoolers, at one time at another, will keep out another peer who wants to be involved. This happens in part because children of this age begin to think in categories. When preschool children realize that some of their peers are like them and some are different, they may see some children as 20 CHAPTER 2 YOUR CHILD’S DEVELOPMENT, AND HOW TO TALK WITH YOUR CHILD being in a different category and use this as a reason to keep them out of the game. This can be very painful for the child who is excluded. At this stage, children are very sensitive to how they are viewed by their peers. As your child’s friends and classmates grow better at using language, you may worry that they are going to use that language to hurt your child; you may worry your child will be teased because she has a DSD. The first thing to know about teasing is that teasing is a normal part of human life. Parents understandably want to protect their children from teasing, but it simply is not realistic to think you can save your child from ever being teased. Most children (if not all!) get teased and called names at some point. Sometimes your first reaction to hearing that your child was teased is to immediately say something to make your child try to feel better. But it is very important to listen to the fact that your child has been hurt and to let her know that you understand that she has been hurt. Trying to make the pain go away by telling your child “sticks and stones may break my bones, but names will never hurt me” denies the fact that she really has been hurt. Even though it is difficult to see your child in pain, it helps to sit with her and allow her to tell you about what she’s feeling. It is also important to let her decide when the conversation is done. Do not rush her to feel better, and do not make her dwell on it once she seems done talking about it (even if you do not feel done). So the way to respond to your child if she is teased is the same way that parents of any child should respond when their child’s feelings are hurt. Here is a possible response to a child who is feeling sad or angry because of teasing or name-calling: Child to parent Anna and Sara aren’t going to let me play with them anymore because they say that I don’t look like a girl and that I’m yucky and weird. Possible response I know it f	Translation - Croatian KONZORCIJ ZA LIJEČENJE POREMEĆAJA SPOLNOG RAZVOJA Copyright © 2006 Interspolno Društvo Sjeverne Amerike Potpomognuto od strane Kalifornijske zaklade i Fondacije Arcus PRIRUČNIK ZA RODITELJE Priručnik za roditelje KONZORCIJ ZA LIJEČENJE POREMEĆAJA SPOLNOG RAZVOJA Izdano 18. rujna, 2006 Prvo izdanje Copyright © 2006 Interspolno društvo Sjeverne Amerike ISBN: 0-9773201-0-3 Izdalo Interspolno Društvo Sjeverne Amerike (a 501(c)3 neoporeziva korporacija) 979 Golf Course Drive #282 Rohnert Park CA 94928 Internetska stranica: www.isna.org Zahvale Ovaj je priručnik nastao kao rezultat iznimne suradnje roditelja djece sa dijagnozom poremećaja spolnog razvoja (PSR), odraslih osoba sa PSR-om, kliničara koji se bave ljudima s PSR-om, i drugih zagovornika pacijenata. Christine Feick i Sallie Foley sastavile su prvotnu verziju ovoga dokumenta, uključujući većinu materijala od prvog do trećeg poglavlja. Alice Dreger zatim je pozvala i ostale na suradnju te je uredila ovaj priručnik, dodajući još neke materijale naših suradnika. Veoma smo zahvalni na suradnji i potpori koja nam je pružena prilikom pisanja ove knjige te se nadamo da će čitatelji koristiti navedenu internetsku stranicu (www.dsdguidelines.org) kako bismo od njih dobili povratne komentare. Želja nam je poboljšati i proširiti ovaj dokument kako bi doista nudio pomoć kakvu ova vrsta knjige može ponuditi. Željeli bismo zahvaliti Davidu Cameronu, Peteru Trinklu, i Esther Morris Leidolf na suradnji u ostvarivanju ovog projekta. Međutim, zamolili su nas da naglasimo kako oni ne podržavaju pojam “Poremećaji spolnog razvoja”. Također bismo željeli zahvaliti Yvonne Day (www.ydaydesigns.com) za pomoć u dizajniranju priručnika, Bobu Staytonu (www.sagehill.net) na tehnološkoj pomoći sa DocBook-om i Chrisu Dregeru (chrisdreger.com) na ilustracijama. Ovaj su dokument svojom velikodušnom financijskom podrškom omogućili Kalifornijska zaklada (www.calendow.org) i Fondacija Arcus (www.arcusfoundation.org) Besplatna elektronička verzija priručnika dostupna je na www.dsdguidelines.org. Suradnici Cassandra L. Aspinall, MSW, LICSW Kraniofacijalni Centar, Dječja bolnica u Seattleu; Washingtonsko Sveučilište, Studij socijalnog rada, Seattle, WA Arlene B. Baratz, MD Medicinska savjetnica, Grupa za potporu sindroma androgene neosjetljivosti, Pittsburgh, PA Max & Tamara Beck Atlanta, GA William Byne, MD Psihijatrija, Mount Sinai Medicinski Centar, New York, NY David Cameron Interspolno društvo Sjeverne Amerike, San Francisco, CA Anita J. Catlin, DSNc, FNP, FAAN Sestrinstvo i etika, Sonoma državno Sveučilište, Sonoma, CA Cheryl Chase Osnivačica i izvršna direktorica Interspolnog društva Sjeverne Amerike, Rohnert Park, CA Kimberly Chu, LCSW, DCSW Odjel za dječju i adolescentsku psihijatriju, Mount Sinai Medicinski Centar, New York, NY Howard Devore San Francisco, CA Alice Dreger, Ph.D. (koordinatorica i urednica projekta) Program sa područja Medicinskih društvenih znanosti i bioetike, Feinberg medicinski fakultet, Northwestern Sveučilište, Chicago, IL Christine Feick, MSW Ann Arbor, MI Sallie Foley, LMSW Certificirana seksualna terapeutkinja, AASECT; Odjel za socijalni rad/Seksualno zdravlje, Sveučilište u Michiganu Zdrastveni sustavi, Ann Arbor, MI Joel Frader, MD, MA Opća akademska pedijatrija, Dječja memorijalna bolnica; Odjel za pedijatriju i program sa područja medicinskih društvenih znanosti i bioetike, Feinberg medicinski fakultet, Northwestern Sveučilište, Chicago, IL Jane Goto Vijeće direktora, Interspolno društvo Sjeverne Amerike; Vijeće direktora, Grupa za potporu sindroma androgene neosjetljivosti, Seattle, WA Michael Grant Lansing, MI Janet Green Su-osnivačica, Tijela poput naših; Vijeće direktora, B, CARES Zaklada; Vijeće nadzornika, Beth Israel Bolnica; Odbor upravitelja, Continuum Healthcare, New York, NY Philip A. Gruppuso, MD Zamjenik dekana na medicinskom fakultetu, Sveučilište Brown; Dječja endokrinologija, Rhode Island bolnica, Providence, RI William G. Hanley, BPS Memphis, TN Debora Rode Hartman Vijeće direktora, Interspolno društvo Sjeverne Amerike, Swedesboro, NJ Ginny Hayes, CMA Grupa za potporu sindroma androgene neosjetljivosti, Hampton, VA April Herndon, PhD Interspolno društvo Sjeverne Amerike; Gustavus Adolphus College, St. Peter, MN Thea Hillman Oakland, CA Colleen Kiernan Interspolno društvo Sjeverne Amerike, Chicago, IL Dixie Korlutis, RN Crouse bolnica, Syracuse, NY Esther Morris Leidolf Osnivačica i predsjednica, MRKH Organizacija; Fenway Institut, Fenway javno zdravstvo, Boston, MA Ana M. Lippert Peoria, IL Angela Moreno Lippert Predsjedateljica odbora, Interspolno društvo Sjeverne AmerikeI; Grupa za potporu sindroma androgene neosjetljivosti, Coupeville, WA Iain Morland, MA, MPhil, PhD Cardiff, UK Lynnell Stephani Long Chicago, IL Bev Mill, RTR (retired) Grupe za potporu sindroma androgene neosjetljivosti Sjeverne Kanade i Australije, BC, Canada Charmian A. Quigley, MBBS Klinički istražitelj, Lilly istraživački laboratoriji, Indianapolis, IN William G. Reiner, MD Odjel za urologiju, zavod za dječju urologiju, Odjel za psihijatriju, zavod za dječju i adolescentsku psihijatriju, Sveučilište u Oklahomi, Health Sciences Centar, Oklahoma City, OK Patricia Roberts Los Angeles, CA Aron C. Sousa, MD Opća interna medicina i dekan, Academic Affairs, College of Human Medicine, Michigan State Sveučilište, East Lansing, MI Herberta Smith, RN, PNP (retired) Kissimmee, FL Collin Stoll Portland, OR Cindy Stone Bloomington, IN Peter Trinkl Berkeley, CA Eric Vilain, MD, PhD Pedijatrija/Urologija/ljudska genetika, David Geffen medicinski fakultet pri UCLA, Los Angeles, CA Michael Walker Osnivač, Udruženje za hipospadiju i epispadiju, Point Reyes, CA and Auckland, Novi Zeland Roz Weiss Stamford, CT Nina Williams, PsyD Odjel za psihijatriju, Robert Wood Johnson medicinski fakultet; Institut za psihoterapiju i psihoanalizu u New Jerseyu, Highland Park, NJ Bruce Wilson, MD Dječja endokrinologija, DeVos Children’s bolnica, Grand Rapids, MI Sadržaj Obraćanje roditeljima .............................................................................................. 1 Niste sami! .............................................................................................................. 3 Što je PSR? .............................................................................................................. 3 Što uzrokuje PSR? .............................................................................................................. 4 Za prihvaćanje treba vremena .............................................................................................................. 5 Razgovor o sramu u svrhu nadvladavanja istog.................................... 6 Pomoći sebi kako bi pomogli svojem djetetu ....................................... 7 Tajnovitost=sram, iskrenost=prihvaćanje ............................................ 9 Važne poruke ovog poglavlja ............................................................ 11 Razvoj vašeg djeteta i kako razgovarati s vašim djetetom .............................................................................................13 O jeziku koji koristimo ........................................................................ 13 Pozadina priče ................................................................................... 15 Dob od 12-36 mjeseci ............................................................................................................ 16 Dob od 3-5 godina (predškolci) ............................................................................................................ 19 Dob od 6-11 godina............................................................................. 26 Pubertet.............................................................................................. 31 Adolescencija (11-18) ............................................................................................................ 32 Vaš zajednički život ............................................................................................................ 36 Važne poruke ovog poglavlja ............................................................................................................ 37 Kako razgovarati s drugima ............................................................................................ 39 Uvod ................................................................................................... 39 Što reći prijateljima i obitelji................................................................ 40 U slučaju odgode određivanja djetetova roda..................................... 41 Što reći ljudima koji misle da je PSR griješan? ................................... 42 Savjeti za razgovor s djetetovim učiteljima i vrtićkim odgajateljima ............................................................................................................ 44 Kako razgovarati s djetetovim medicinskim skrbnicima ..................... 46 Važne poruke ovog poglavlja ............................................................ 51 Odgovori na najčešća pitanja ............................................................................................ 53 Korisne brošure ............................................................................................ 67 O Poremećajima spolnog razovja (PSR) ............................................................................................................ 68 Kako dolazi do genitalnog razvoja ............................................................................................................ 71 Što činiti a što izbjegavati ............................................................................................................ 74 Pripreme za posjet liječniku ............................................................................................................ 75 Vođenje evidencije i pisanje dnevnika ............................................................................................................ 77 Razmišljanja drugih roditelja i odraslih osoba sa PSR-om ............................................................................................ 79 Uvod .................................................................................................. 79 Pisma roditelja ............................................................................................................ 80 Sjećanja i razmišljanja odraslih osoba sa PSR-om ............................................................................................................ 88 Ostali izvori (Gdje saznati više) ............................................................................................ 99 Internetske stranice ............................................................................................................ 99 Grupe za potporu i informacije vezane uz specifične dijagnoze ............................................................. .............................................100 Odabir dječjeg psihologa .......................................................................................................... 101 Knjige posvećene PSR-u .......................................................................................................... 102 Video i televizijski materijali .......................................................................................................... 103 Članci iz stručnih časopisa .......................................................................................................... 103 Općenito o roditeljstvu ...........................................................................................................103 Seksualni odgoj vašeg djeteta .......................................................................................................... 103 Objašnjenja uz fotografije ................................................105 Pojmovnik (Objašnjenje pojmova) .................................... 113 Kazalo pojmova ............................................................... 123 1. Poglavlje Obraćanje roditeljima Ukoliko ste upravo saznali da vaše dijete ima neki oblik poremećaja spolnog razvoja (dalje u tekstu PSR), vjerojatno se osjećate zbunjeno i uzrujano. Poput ostalih roditelja suočenih sa takvom situacijom, vjerojatno si postavljate sljedeća pitanja: • Zašto ja? Zašto moje dijete? • Jesam li učinio/la nešto krivo? • Što ako neću moći voljeti svoje dijete? • Govore li mi liječnici sve? Hoću li se morati suočiti sa još neugodnih informacija? • Što ću reći obitelji i prijateljima? • Mogu li učiniti nešto da sve ovo nestane? Jane Goto 1 Ovakva pitanja česta su među roditljima suočenima sa opisanom situacijom. Nadamo se da će vam ovaj priručnik pomoći u pronalaženju odgovora na navedena pitanja te da će vam pomoći da se osjećate jače, samopouzdanije te umanjiti osjećaje zbunjenosti i uzrujanosti. Nadamo se da ćemo vas uspjeti uvjeriti kako vaše dijete uz ljubav i potporu može odrasti u zdravu, sretnu i voljenu osobu koja je sposobna uzvratiti danu joj ljubav. Ovaj priručnik ne sadrži veliku količinu medicinskih informacija o specifičnom stanju vašeg djeteta iz razloga što postoji veliki broj stanja koja se smatraju poremećajima spolnog razvoja (PSR), te bi bilo nemoguće sve ih uključiti. Umjesto toga, svrha ovog priručnika je pružiti vam osnovne informacije o spolu i spolnom razvoju, a ujedno i emocionalnu potporu te podijeliti sa vama neke ideje koje će vam pomoći u nošenju sa vašim osjećajima i svakodnevnim životom. U priručniku su sadržane ideje o tome kako da pomognete vašem djetetu da se prilagodi i napreduje, te ideje o tome kako da razgovarate sa vašim djetetom (i ostalima) tijekom njegovog ili njezinog odrastanja. Osnovna svrha ovog priručnika je pomoći vam na putu kroz život sa vašim djetetom. Ovaj je priručnik koncipiran na način koji vam omogućuje ne samo čitanje od početka do kraja već i preskakanje određenih poglavlja ukoliko to želite. Predlažemo vam da pročitate čitavo 1.poglavlje Dobrodošlica roditeljima [strana 1] u kojem se bavimo glavnim problemima s kojima se suočavaju roditelji djece sa PSR-om. 2. poglavlje Razvoj vašeg djeteta i kako razgovarati sa vašim djetetom [strana 13] vas vodi kroz razvoj vašeg djeteta, uključujući i savjete o tome kako razgovarati s djetetom o PSR-u tijekom njegovih/njezinih različitih razvojnih razdoblja. 3. poglavlje Kako razgovarati s drugima [strana 39] nudi vam praktične savjete o tome kako razgovarati sa drugima o PSR-u vašeg djeteta kada se za to javi potreba. Primjerice, savjetujemo vam kako da razgovarate sa odgajateljima i učiteljima vašeg djeteta. 4. poglavlje Odgovori na uobičajena pitanja [strana 53] nudi odgovore na uobičajena roditeljska pitanja o tome kako je to biti roditelj djeteta sa PSR-om. 5. poglavlje Korisne brošure [strana 67] nudi informacije o korisnim brošurama kojima se možete poslužiti dok se primjerice pripremate za sastanke sa liječnicima, ili dok razmatrate mogućnost vođenja dnevnika o vlastitim iskustvima. 6. poglavlje Razmišljanja roditelja djece i odraslih osoba sa PSR-om [strana 79] sadrži pisma roditelja u kojima opisuju svoja iskustva iz svakodnevnog života. Također sadrži neka ključna sjećanja odraslih osoba sa PSR-om. Neki od njih iskoristili su priliku da istaknu što bi željeli, retrospektivno gledajući, da su njihovi roditelji znali kad su njih odgajali. 7. poglavlje Ostali izvori (Gdje saznati više) [strana 99] upućuje vas na dodatne izvore korisnih informacija, uključujući i kako pronaći grupu za potporu specijaliziranu za specifičan oblik PSR-a vašeg djeteta. Pojmovnik (Objašnjenje pojmova) [strana 113] nudi listu pojmova s kojima možda niste upoznati, uključujući i definicije istih. Prije nego počnemo, željeli bismo istaknuti sljedeće: premda je ovaj priručnik usmjeren na PSR vašeg djeteta, veoma je važno stvari sagledati na pravi način. Iako vam se možda ponekad čini da je PSR vašeg djeteta poput ogromnog nebodera koji se nadvija nad vas i vaše dijete, ipak je to samo jedan aspekt njegovog života – i samo jedan aspekt vašeg života s vašim djetetom. Zapamtite da je vaše dijete, i vaš odnos s njim/njom, zapravo mnogo bogatiji i sadržajniji nego što je moguće prikazati u ovoj knjizi. NISTE SAMI! Za početak veoma je važno da shvatite First and foremost, morate razumjeti/ da svakako niste sami. PSR se javlja u omjeru jedan na svakih 1500 rođenih. To znači da se svaki tjedan desetak roditelja u SAD-u i stotine diljem svijeta suočavaju sa viješću da njihovo dijete ima PSR. Sve do nedavno nije se o tome puno pričalo tako da je moguće da nikad prije niste čuli za poremećaj koje vaše dijete ima. No, to se mijenja te u usporedbi sa razdobljem od prije samo nekoliko godina, obitelji poput vaše, dobivaju puno više informacija i potpore. Dobivanjem znatnih količina točnih informacija, prenošenjem istih vašem djetetu tijekom procesa njegovog/njezinog odrastanja, te povezivanjem sa ostalima sličnih iskustava, osigurati će da se vi i vaša obitelj ne osjećate sami i napušteni. Lynnell Stephani Long ŠTO je PSR? U ovoj ćemo knjizi općenito koristiti pojam “spol” u kontekstu fizičkih dijelova naših tijela koji imaju veze sa time da li je netko muškog ili ženskog spola. Aspekti vašeg spola uključuju vaše “spolne kromosome” (o kojima će biti više riječi uskoro), i vaše spolne/reproduktivne dijelove tijela, poput jajnika ili testisa, vagine, klitorisa, penisa, skrotuma, i tako dalje. Spolni hormoni također su jedan od aspekata vašeg spola; spolni hormoni su kemijski prijenosnici poruka u vašem tijelu koji putuju kroz krv. Oni pomažu tijelu da se razvije i funkcionira u seksualnom smislu. Na primjer, prije nego ste se rodili, spolni hormoni su doprinijeli razvoju vaših genitalija, a tijekom puberteta upravo su oni pomogli da se vaše tijelo transformira iz dječjeg u žensko ili muško. Od trenutka začeća pa sve do smrti, naša tijela prolaze kroz mnoge faze spolnog razvoja. Primjerice, tijekom puberteta dolazi do seksualnog sazrijevanja tijekom kojeg se tijelo mijenja iz dječjeg u tijelo spolno zrelog muškarca ili spolno zrele žene. Pubertet je, poput menopauze, samo jedna od očitih faza spolnog razvoja. No, postoji i čitav niz ne tako jasno uočljivih faza. Spolni razvoj počinje sa začećem, nastavlja se u maternici, nakon čega slijedi nastavak razvoja tijekom ranog djetinjstva, adolescencije, i kasne odrasle dobi. “Spolna diferencijacija” je pojam kojim se označavaju različiti putevi spolnog razvoja dječaka i djevojčica, odnosno muškaraca i žena. Primjerice, u maternici, nekoliko tjedana nakon začeća, embrij će razviti “proto-gonade”. Nekoliko tjedana kasnije te će se proto-gonade transformirati ili u tetise ili u jajnike. Dakle, to je jedna od faza tijekom koje se odvija spolni razvoj – kada se, dugo prije samog rođenja, proto-gonade transformiraju ili u jajnike ili u testise. Genitalije (penis, klitoris, mošnje, usmine, itd) se također diferenciraju u raznim fazama ljudskog života. Djeca sa PSR-om ponekad imaju genitalije koje se izgledom razlikuju od prosjeka. Nemaju sva djeca sa PSR-om genitalije različite od prosjeka, niti svi ljudi čije genitalije se razlikuju od prosjeka imaju PSR. (“Prosječno” je upravo to — središte spektra.) Poglavlje 5.1 pod nazivom “Genitalni razvoj prije rođenja” sadrži slike koje prikazuju genitalni razvoj [strana 72], a isti se u dotičnom poglavlju detaljnije obrađuje. Mogli bismo reći da se prva faza spolne diferencijacije odvija već pri samome začeću. Jajna stanica i spermij sadrže kromosome, malene količine materije koja sadrži gene. Geni su poput naredbi za izgradnju ljudskog tijela, u kombinaciji sa drugim kromosomima; obično jajna stanica majke daje jedan X kromosom, a spermij oca ili još jedan X kromosom, ili Y kromosom. Dakle, možemo reći da se spolna diferencijacija počinje odvijati već prilikom samog začeća. Ukoliko embrij u konačnici ima XX kombinaciju, dijete koje se iz njega razvije uglavnom bude djevojčica. Ukoliko embrij u konačnici ima XY kombinaciju, dijete koje se iz njega razvije obično bude dječak. Buduću da postoji toliko stadija spolnog razvoja tijekom ljudskog života, postoje mnoge prilike da se osoba razvije na način koji nije tipičan ni za dječake ni za djevojčice. Ukoliko dođe do manje uobičajenog puta spolnog razvoja, javlja se stanje koje nazivamo “poremećaj spolnog razvoja” ili PSR. Dakle, PSR je naziv koji obuhvaća mnogo različitih varijacija spolnog razvoja. Često za ta stanja postoje specifičniji nazivi, poput “virilizirajuća kongenitalna adrenalna hiperplazija” ili “ sindrom androgene neosjetljivosti”. ŠTO UZROKUJE PSR? Moguće je da će vam liječnici vašeg djeteta moći objasniti zašto je došlo do PSR-a, zato ne oklijevajte postaviti im to pitanje. Mi vam možemo dati opće objašnjenje zašto do njega dolazi: ponekad se PSR događa jer dijete ima neku drugu kombinaciju kromosoma od uobičajenog XX ili XY komosomskog uzorka. Tako neka djeca imaju XXY, a neka djeca imaju različite kombinacije u različitim stanicama svoga tijela. (To se naziva mozaični kariotip.) Drugi razlog zbog kojeg dolazi do PSR-a je nedostatak uobičajenog gena (dio DNK), ili posjedovanje neuobičajene kombinacije gena zbog koje se djetetovo tijelo razvija različito od tijela drugih dječaka i djevojčica. To može biti rezultat genetskog nasljeđa ili slučajne genetske greške. U mnogo rijeđim slučajevim, PSR je posljedica vanjskih utjecaja na majku; primjerice izloženosti kemikalijama tijekom trudnoće koje mogu poremetiti spolni razvoj djeteta. Ponekad jednostavo ne znamo zašto dolazi do PSR-a. Može se destiti da nikada zapravo ne saznate pravi uzrok pojave PSR-a u vašeg djeteta. To jest neugodno ali događa se. Zašto je roditeljima u vašoj situaciji toliko važno saznati pravi uzrok? Ponekad je to zbog toga što žele biti sigurni da je dijagnoza točna, a ponekad zbog toga što osjećaju krivnju te misle da su nekako sami pridonijeli pojavi PSR-a. Može se dogoditi da vam dobronamjerni medicinski stručnjaci, članovi obitelji ili prijatelji svojim reakcijama nenamjerno nameću osjećaj krivnje za PSR vašeg djeteta. Taj osjećaj može biti preveliki teret za vas i dovesti vas do depresivnog poremećaja i stanja zbunjenosti. U takvoj situaciji pomaže ukoliko progovorite o tim osjećajima te objasnite ljudima oko sebe kada se osjećate krivi, a ujedno i da sami sebi ponavljate kako vi ni na koji način niste krivi za PSR vašeg djeteta. Razgovor o tim stvarima pomaže vam da izbacite te osjećaje iz sebe te da stvari sagledate jasnije. Tijekom svog odrastanja, vaša će djeca od vas učiti kako da se postave prema samima sebi. Prilikom toga neizmjerno je važno da pokažete i njima ali samima sebi da nikako ne krivite sebe za njihovo stanje, jer ono što oni zapravo žele je da ih prihvatite i volite upravo onakve kakvi jesu. ZA PRIHVAĆANJE TREBA VREMENA Možda vi niste nimalo zabrinuti, frustrirani ili ljuti zbog činjenice da vaše dijete ima PSR. Ukoliko je tako, to je fantastično... ali i prilično neubičajeno. Samo prihvaćanje činjenice da vaše dijete ima PSR može biti veoma teško. Zapravo, veoma je uobičajeno da roditelji u početku odbijaju povjerovati u to što im liječnici saopće. Prihvaćanje je proces: ne događa se u jednom čarobnom trenutku. No, da bi proces zalječenja tuge i ljutnje koju možda osjećate mogao započeti, morati ćete prihvatiti istinu o situaciji u kojoj se vaše dijete nalazi kao i istinu o tome što vi sami osjećate. Kao što je to slučaj sa mnogim roditeljima, prvi strah sa kojim ćete se suočiti je strah od toga da je vaše dijete bolesno. Liječnici vašeg djeteta će učiniti sve što je u njihovoj moći da pomognu ukoliko je vaše dijete bolesno. No, vaša sljedeća briga, usko povezana sa prehodnom, je zabrinutost oko toga hoće li vaše dijete odrastati osjećajući se kao svako drugo, normalno dijete. Što se toga tiče, mi vam možemo potvrditi na temelju pozamašnog iskustva da je upravo vaše prihvaćanje vašeg djeteta ono što će učiniti da se dijete osjeća normalnim. Prije nego budete u mogućnosti to učiniti, morati ćete naučiti prihvatiti i nositi se sa svojom situacijom. To može potrajati jer vi zacijelo niste očekivali da će se vaše dijete roditi sa PSR-om. Mnogi su roditelji djece sa PSR-om izjavili da im se, nakon što su saznali da im dijete ima PSR, javio osjećaj gubitka jer su osjećali da su u tom trenutku izgubili dijete kakvom su se nadali (tj, dijete bez PSR-a). Slična se emocija javlja i kod roditelja djece sa Down sindromom te još nekih poremećaja. Posebice u slučajevima kada je PSR dijagnosticiran kod novorođenčadi, roditelji mogu iskusiti žalovanje zbog gubitka “priželjkivanog” djeteta. Što uključuje žalovanje? Možda ste čuli da ljudi spominju “pet stadija žalovanja”. To su: poricanje istine; ljutnja; “cjenkanje” s Bogom ili svemirom za nešto manje strašno; depresija; i prihvaćanje situacije. Možda prepoznate sebe u nekom od ovih stadija, no proces tugovanja nije jednak za sve ljude. Za roditelje u vašoj situaciji uobičajene su i sljedeće emocije: šok, nevjerica, tjeskoba, strah, znatiželja, sram, zbunjenost i osjećaj bespomoćnosti. Neki roditelji imaju fizičku reakciju na spomenutu situaciju te kod njih, primjerice, dolazi do gubitka apetita, nesanice, glavobolja ili nadraženosti želuca, te osjećaja iscrpljenosti. Nekima je teško razgovarati sa supružnikom, iako je veoma važno moći često i otvoreno razgovarati tijekom proživljavanja gore opisane krize. Znamo da je teško razgovarati o seksu, posebice u kontekstu spolnog razvoja djece, no mnogi roditelji priznali su da im je uvelike pomogao razgovor o vlastitim iskustvima i djetetovom PSR-u. Naša nas kultura uči da se sramimo spolnosti te da o njoj ne pričamo. Sram proizlazi iz naših strahova i nedostatka razumijevanja svega što je drugačije tako da nije neuobičajeno da osjećate sram zbog PSR-a vašeg djeteta. Također, to sa sobom povlači i stanoviti domino efekt: neki roditelji su izjavili da njihov najveći osjećaj krivnje proizlazi iz negativnih emocija koje osjećaju – srama i neugode – zbog vlastite djece. Poput nekih roditelja, i vi ćete se možda bojati da nećete biti u stanju prevladati te emocije. No, veoma je važno sve te strahove i strepnje verbalizirati kako kroz sve to ne biste prolazili sami. RAZGOVOR O SRAMU U SVRHU NADVLADAVANJA ISTOG Za početak, uzmite si vremena kako biste istražili vlastite osjećaje srama i neugode. Pokušajte razmisliti o tome što osjećate i zašto to osjećate. Vi niste loš roditelj zato što možda osjećate sram i neugodu zbog PSR-a vašeg djeteta. Razumljivo je ukoliko se tako osjećate. No, stvari neće funkcionirati ukoliko osjećaj srama i neugode nikada ne prevladate. Od mnogih smo odraslih ljudi sa PSR-om i njihovih roditelja čuli da nemogućnost prevladavanja tih osjećaja uzrokuje previše stresa i boli kako djeci, tako i roditeljima. Dakle, što vam je činiti? Nemojte očekivati da će ti osjećaji, na neki čaroban način, nestati odmah i zauvijek. Umjesto toga, počnite čitati ovu knjigu kako biste razumjeli što se zapravo događa, kako biste saznali da niste vi krivi te kako biste uvidjeli da niste sami u svemu tome. Zatim, pokušajte komunicirati sa ljudima kojima vjerujete (liječnicima, članovima obitelji, grupama za potporu) kako biste uspostavili dobar sustav potpore sebi i vašem djetetu. Razvijanje iskrenih veza, temeljenih na prihvaćanju i ljubavi, pomoći će vama i vašem djetetu da se nosite sa izazovima s kojima ćete se susretati kroz život. Vjerojatno ćete otkriti, poput mnogih drugih roditelja u vašoj situaciji, da dok prolazite kroz razne stadije prihvaćanja, ponekad nailazite na trenutke istinske snage kada shvatite da ste u stanju pomoći ne samo vlastitom djetetu, nego i drugima koji se nalaze u sličnim situacijama. A, onda opet, u nekim drugim situacijama, vaša sposobnost da se nosite sa problemima će se smanjiti na svoj minimum. Sasvim je u redu prolaziti kroz taj ciklus osnaživanja i slabljenja. To je razumljiv i prihvatljiv dio života kao roditelja djeteta sa PSR-om. Ono što su mnogi roditelji djece sa PSR-om priznali je da su, tijekom vremena, prihvatili svoju situaciju i naučili se s njome nositi. Mnogi su otkrili posebnu vrstu ljubavi i radosti u dijeljenju ovog života sa svojom djecom. No, kao što se to ni njima nije desilo preko noći, tako će i vama trebati određeno vrijeme da se prilagodite situaciji te da se naučite s njome nositi. Nema jednostavnog razrješenja emocionalne zavrzlame kada ste roditelj, pogotovo kada ste roditelj djeteta sa PSR-om. Zato je važno upamtiti da premda će biti dana kada ćete se osjećati frustrirano, tužno ili ljuto, isto tako će biti dana kada ćete osjećati intenzivnu radost i fantastičnu smirenost. Max i Tamara Beck sa obitelji POMOĆI SEBI KAKO BISTE POMOGLI SVOJEM DJETETU Znamo da želite zaštiti svoje dijete. Kada to ne biste željeli, ne biste ni čitali ovu knjigu! Imati dijete suočeno sa nečim poput PSR-a budi u mnogim roditeljima snažne zaštitničke osjećaje. Želite saznati kako da pomognete svome djetetu. Jedna od poruka ovog poglavlja – ujedno i poruka koju ćemo nastaviti isticati kroz ostatak knjige – jest da, kako biste pomogli svome djetetu, prvo morate prepoznati na koje načine je na vas, kao roditelja, utjecala činjenica da vaše dijete ima PSR. Možda vam se čini egocentričnim, ili čak sebičnim, razmišljati o vašim osjećajima i potrebama u ovome trenutku no, razmišljajući o sebi, pomoći će vam da se osjećate dovoljno dobro da budete u stanju pomoći vašem djetetu. Postoji još jedan dobar razlog za razmišljanje o tome kako se vi osjećate i što proživljavate, a to je: ukoliko ne vodite računa o vlastitim potrebama, mogli biste, greškom, donositi odluke vezane uz vaše dijete koje se ne baziraju na onome što on ili ona treba, već na tome što vama treba. Primjerice, u vašoj želji da zaštitite svoje dijete, možete pomisliti da morate donijeti velike, neopozive medicinske odluke kako biste zaštitili svoje dijete od potencijalnog zadirkivanja na račun njegovog/njezinog PSR-a. No, ukoliko malo usporite, i razmislite, shvatiti ćete da vaše dijete ima potrebe koje govore protiv takvih velikih odluka u datom trenutku, prije nego što zapravo znate što bi vaše dijete zaista željelo. Primjerice, ako usporite, shvatiti ćete da vi zapravo želite da PSR nestane, koliko god je to moguće; to u prvi plan gura vas i vašu zabrinutost za vaše dijete. No, ono što je vjerojatno najbolje za vaše dijete je da pričekate sa nekim ili svim mogućim medicinskim zahvatima koje vam se nude. Čekanje daje njemu ili njoj vremena da samo donese te odluke; čekanje može značiti da ćete vi i vaše dijete dobiti više informacija o tome koliko su zapravo učinkoviti ponuđeni medicinski zahvati; čekanje odašilje vašem djetetu poruku da ga prihvaćate upravo onakvim kakvo jest te da poštujete njegovo/njezino pravo da samo donosi odluke o svome tijelu. No, ponovno bismo željeli naglasiti da je važno da se pobrinete, prije svega, za sebe. Snažan sustav potpore ključan je za oporavak vašeg djeteta. Roditelji djece sa PSR-om ističu kako je veoma korisno povezati se sa roditeljima sličnih iskustava. (Obratite pažnju na poglavlje 7 Ostali izvori (Gdje saznati više) [strana 99] u kojem možete saznati kako doći do grupa za potporu, a također se možete obratiti i vašem liječniku za pomoć u potrazi za istima.) Dobar sustav potpore pomoći će vam da saznate više i osjećate se bolje, a kako vaše dijete bude odrastalo, pomoći će i njemu da sazna više i osjeća se bolje. Velika je vjerojatnost da će i ono, poput vas, s vremena na vrijeme osjetiti iznimnu tugu zbog svog PSR-a. Posebice je slučaj sa malom djecom da bol i tugu zbog PSR-a pokušavaju potisnuti tako da se okupiraju normalnim aktivnostima svakodnevnog života. Premda period tugovanja jednog djeteta ne mora potrajati dugo, on itekako može biti intenzivan. Djeca često iskazuju tugu kroz način na koji se igraju. Primjerice, predškolsko dijete može tjeskobu koju osjeća zbog posjete liječniku iskazivati agresivnim i brzim šaranjem bojicama po papiru. Vaš šestogodišnjak može ponovno početi sisati palac. Djeca se suočavaju sa onoliko tuge sa koliko se u datom trenutku mogu nositi. Ponekad nam to daju do znanja na indirektan način. A, dio tuge koju osjećaju će ponekad potisnuti sve dok se ne osjete dovoljno sigurni da se s njome ponovno suoče. Vi možete pomoći svome djetetu da se nosi sa tugom tako da s njime razgovarate te gradite odnos pun povjerenja u kojem se ono osjeća sigurno izražavajući svoje osjećaje. Teško je gledati vlastito dijete kako pati. No, pogrešno je bježati od djetetovih emocija ili se nadati nekom instant rješenju odvlačeći mu pažnju praznim obećanjima poput “sve će biti u redu”. Veoma je važno dopustiti djetetu da proživi to što osjeća te da isto iskaže riječima ili ponašanjem. Vaša djeca zahtijevaju vremena, brige, potpore, iskrenosti, otvorenosti i prihvaćanja. Ona moraju proraditi ono što osjećaju. Dok se vi bavite svojim osjećajima, vaša će vas djeca promatrati i učiti od vas. Vaša će djeca usvojiti neke od vaših strategija te kreirati neke vlastite. Njihovi će se osjećaji nekad poklopiti sa vašima, a nekad i neće. Ono što je važno je da poštujete njihovo iskustvo; da ih priznate i prihvatite s ljubavlju. Važno je da shvate da ste i vi i oni samo ljudi. Oni se neće uvijek ponašati i osjećati onako kako bi željeli, jednako kao što se ni vi nećete uvijek ponašati i osjećati kako biste vi željeli. No, prihvaćajući ih onakvima kakvi jesu, slušajući ih i podržavajući ih, podučiti će te ih razumijevanju i ljubavi. Lynnell Stephani Long TAJNOVITOST=SRAM, ISKRENOST=PRIHVAĆANJE Biste li željeli otkriti tajnu uspjeha po mišljenju ljudi koji su odrasli u okolnostima o kojima pričamo? Pa, evo je: najbolje što možete učiniti za vaše dijete jest da budete otvoreni i iskreni u vezi njegovog ili njezinog PSR-a. Kada ste iskreni, djetetu dajete do znanja da ga se ne sramite. Također im dajete do znanja da vam mogu vjerovati kao izvoru istine u svojim životima. Nažalost, mnogi su ljudi tu lekciju naučili na teži način. Sve do nedavno, bilo je uobičajeno da liječnici i roditelji djece sa PSR-om zatajuju i pogrešno tumače informacije, čak i nakon što su ta djeca postali odrasli ljudi. Ti liječnici i roditelji nisu to činili zato što su željeli povrijediti djecu; baš naprotiv, oni su tajili i pogrešno tumačili informacije jer su ih željeli zaštiti. No, to im se kasnije osvetilo. Ta su djeca odrastala s osjećajem iznevjerenosti od strane svojih roditelja i liječnika, preplavljeni osjećajem srama i u strahu od traženja medicinske skrbi i obiteljske ljubavi, čak i onda kada im je ona bila prijeko potrebna. Na neki način, zahtijevanje istine u takvim situacijama slično je zahtijevanju istine o posvojenju. Nekad je bilo uobičajeno da ljudi taje istinu o posvojenju te djeca nikada ne bi saznala da su posvojena. Međutim, do kraja 20. stoljeća, većina je ljudi shvatila da je zapravo zdravije za djecu ukoliko znaju vlastite korijene i osobnu povijest. Slično tome, u nedavnoj je prošlosti obično bilo savjetovano roditeljima djece rođene sa PSR-om da im taje istinu o tome. No, kao što je to bio slučaj sa istinom o posvajanju, sada znamo da djeca (i odrasli) sa PSR-om profitiraju ukoliko su upoznati sa svojom osobnom povijesti te ukoliko razumiju vlastitu jedinstvenost. Možda bi najradije zatajili svome djetetu istinu o njegovom ili njezinom stanju, no imajte na umu da tajnovitost nikada ne funkcionira na način na koji mi to priželjkujemo. Mnogi ljudi, uključujući čak i vrlo malu djecu, s vremenom otkriju obiteljsku tajnu, pogotovo ukoliko se ta tajna odnosi na člana kućanstva. U prirodi je tajni da prije ili kasnije izađu na vidjelo, bilo tijekom obiteljske svađe ili omaške nekog od članova. To nije najbolji način da se tako nešto sazna. Čak i ako tajna ne izađe na vidjelo na opisan način, odrasli ljudi sa PSR-om kojima nije bilo rečena istina o njihovom stanju, priznali su da su uvijek osjećali kako postoji nešto vezano uz njih što im se ne govori. Čemu svi ti posjeti liječnicima gdje su im pregledavane genitalije? Zašto su se svi ponašali čudno kada bi ih ispitivali o operacijama kojima su podvrgavani? Ovakva pitanja vodila su odrasle osobe sa PSR-om kojima nije bila rečena istina u temeljito istraživanje kako bi saznali istinu, a ponekad bi njihova mašta punila praznine “činjenicama” mnogo strašnijim od stvarne istine. Jedan od problema sa tajnama je taj što ih nije lako čuvati. Drugi problem sa tajnama je što one sugeriraju postojanje nečega lošeg i sramotnog o čemu se ne smije razgovarati. Sakrivanje ili laganje pospješuje bujanje osjećaja srama. Odraslim osobama sa PSR-om prema kojima se odnosilo sa tajnovitošću i sramom nenamjerno je odaslana poruka da u sebi nose nešto monstruozno. Još jednom ponavljamo da su se mnogi od tih ljudi osjećali prevarenima i od strane svojih roditelja i od strane svojih liječnika. Kao posljedica toga nekima od njih bilo je veoma teško uspostaviti bilo kakav oblik povjerenja u vlastite roditelje, medicinsko osoblje, ili ljude općenito. Osim što su osjećale zbunjenost, frustriranost i sram, mnoge odrasle osobe sa PSR-om kojima nije bila saopćena istina o njihovom stanju, iskusile su intenzivan osjećaj izoliranosti, često pogoršan nedostatkom povjerenja. Osjećale su se potpuno samima, kao da su jedine osobe na svijetu sa tim poremećajem. To je još jedna “nus-pojava” tajnovitosti i srama. Tajnovitost i sram onemogućuju naše razumijevanje razlika te izoliraju sve koji su na neki način drugačiji. To je začarani krug kojeg je potrebno razbiti. No, dobra je vijest ta da se danas pojedinci sa PSR-om i njihove obitelji ne moraju osjećati nadvladani sramom, zbunjenošću, osamljenošću ili tajnovitošću. Grupe za potporu, grupe koje zagovaraju prava pacijenata, neformalne mreže potpore i organizacije specijalizirane za rad sa specifičnim stanjima nude ljudima sa PSR-om mogućnost povezivanja sa sebi sličnima kako bi uvidjeli da nisu sami. Educiranje javnosti koje provode grupe za potporu omogućilo je da mnogo više ljudi zna za PSR i ljude koji žive sa njim. Dakle, da sumiramo: kada ste otvoreni i iskreni prema svojoj djeci o njihovom PSR-u, šaljete im poruku da su prihvaćena, voljena i poštovana te da ih se ne sramite kao roditelj. Ponavljamo, vaša ljubav i prihvaćanje je ono što će im najviše pomoći. Iain Morland, Ph.D. VAŽNE PORUKE OVOGA POGLAVLJA • Niste sami. • Normalno je u ovakim situacijama da doživljavate čitav spektar emocija. • Trebali biste biti iskreni prema sebi i drugima u vezi onoga što osjećate. • Zaslužujete – i trebali biste potražiti – potporu prijatelja kojima vjerujete, obitelji, medicinskih stručnjaka i grupa za potporu. • Tijekom godina moguća su razilaženja u osjećajima prema čitavoj situaciji između vas i vaše djece. • Vašoj djeci potrebno je da ih prihvatite onakvima kakva jesu te da budete iskreni iotvoreni prema njima tijekom njihova odrastanja. Ova će vam knjiga pomoći da razmislite o tome kako da to ostvarite. 2. Poglavlje Razvoj vašeg djeteta i kako razgovarati s vašim djetetom Svi roditelji žele ono što je najbolje za njihovu djecu. Vi, kao roditelj, očekujete da će se vaše dijete suočavati sa dodatnim životnim izazovima zbog svog PSR-a i naravno da mu/joj želite pomoći koliko god možete. Jedan od načina da pomognete svome djetetu je da razumijete stadije njegovog fizičkog, emotivnog i mentalnog razvoja. Drugi način je da s djetetom redovito razgovarate o njegovom ili njezinom PSR-u i svemu što ga/ju zanima ili brine. Ovo poglavlje daje pregled svega što možete očekivati glede razvoja vašeg djeteta. Također vam objašnjava kako mu/joj možete pomoći iskrenom komunikacijom temeljenoj na ljubavi i razumijevanju kao i emotivnom potporom. Nudimo vam pregršt praktičnih ideja o tome kako da razgovarate sa svojim djetetom i pomognete mu/ joj u teškim trenucima. O JEZIKU KOJI KORISTIMO Zamjenice (on/ona): primjetiti ćete da u ovome poglavlju, kao i na drugim mjestima u ovoj knjizi, ponekad koristimo zamjenicu “on”, a ponekad zamjenicu “ona” kada govorimo o djetetu ili o roditelju. Kada smo pisali ovu knjigu, prvo smo se trudili stalno koristiti frazu “on ili ona” kako bismo sve uključili no shvatili smo da to knjigu čini manje razumljivom. Molimo vas da shvatite da samo zato što pišemo “on” ili “njemu” ne znači da stalno govorimo o dječacima/ili muškarcima, a isto tako kada pišemo “ona” ili “njoj” ne mislimo isključivo na djevojčice/žene. Također, kada koristimo frazu “on ili ona” nikako ne želimo sugerirati da vaše dijete nema jasno određen spol. Mi koristimo različite zamjenice kako se nitko ne bi osjećao izostavljeno. Spol: u ovoj knjizi koristimo pojam “spol” kada govorimo o nečijem identitetu kao dječaku ili djevojčici, ili muškarcu ili ženi. Kada govorimo o nečijem “spolnom identitetu” to zapravo znači da li je ta osoba socijalno percipirana kao djevojčica ili dječak, odnosno žena ili muškarac. A, kada govorimo o “rodnom identitetu”, govorimo o unutarnjem osjećaju te osobe, tj da li se ta osoba osjeća kao dječak, djevojčica, muškarac ili žena. Kada kažemo da je bebi “dodijeljen ženski rod” to znači da je odgajana kao djevojčica (to nema nikakve veze sa operativnim zahvatom). Dakle, kada govorimo o “razvoju rodnog identiteta” neke osobe, govorimo o razvoju unutarnjeg osjećaja sebe. Rod nije isto što i spol jer “spol” je riječ koja označava nečije tjelesno određenje. (Više o tome dalje u tekstu). Važno je upamtiti da nečiji “spolni kromosomi”, spolni hormoni i njegovi ili njezini spolni organi (poput testisa ili penisa) ne određuju uvijek s kojim će se rodnim identitetom osoba poistovjetiti. Ponekad osoba razvije rodni identitet različit od onog kojeg bismo pretpostavili na temelju njezinih spolnih kromosoma ili genitalija. Ne postoje dva jednostavna tipa spola. Većina žena i djevojčica posjeduje barem nekoliko značajki, interesa i manirizama koje bismo općenito proglasili “muškima”, a također i većina muškaraca i dječaka posjeduje barem nekoliko značajki, interesa i manirizama općenito smatranim “ženskim”. Neki ljudi u sebi osjećaju istinsku mješavinu “muških” i “ženskih” elemenata. Ono što se očekuje od muškog i ženskog roda, razlikuje se od kulture do kulture. Freema Hillman i njena kći Thea Spol: Kao što smo spomenuli u prethodnom poglavlju, u ovoj knjizi koristimo pojam “spol” kako bismo govorili o fizičkim komponentama naših tijela koje nas čine muškarcima ili ženama. Kada govorimo o spolu neke osobe, mi zapravo govorimo da li je ta osoba muškarac ili žena gledano iz biološke (fizičke) perspektive. Aspekti vašeg spola uključuju vaše “spolne kromosome” (X i Y kromosome) i vaše spolne organe poput jajnika ili testisa, vagine, klitorisa, penisa, skrotuma, itd. Spolni hormoni čine drugi aspekt vašeg spola; spolni hormoni su kemijski prijenosnici poruka u vašem tijelu koji se kreću kroz krv. Oni pomažu da se vaše tijelo razvije i funkcionira u seksualnom smislu. Dakle, kada govorimo o “spolnom razvoju” mi zapravo govorimo o promjenama u tijelu u vidu njegove fizičke prirode. Na primjer, govorimo o promjenama genitalne anatomije, ili o promjenama spolnih hormona. Seksualnost i seksualna orijetacija: kada koristimo riječ “seksualnost” govorimo o iskustvu neke osobe kao seksualnog bića. Seksualni odnos ili intimni odnosi sa ljubavnim partnerom primjer su nečije seksualnosti. Seksualna želja i osjećaji također su dio nečije seksualnosti. “Seksualna orijentacija” je pojam koji obično koristimo kada govorimo da li je neka osoba heteroseksualna (privlače je osobe suprotnog spola), homoseksualna (privlače je osobe istoga spola) ili biseksualna (privlače je osobe oba spola). Premda većinu žena privlače muškarci, a većinu muškaraca privlače žene, spol ne određuje i seksualnu orijentaciju. POZADINA PRIČE Neovisno o tome imaju li PSR ili ne, sva djeca tijekom odrastanja prolaze razvojni proces u smislu svog rodnog identiteta i seksualnosti. Tu ćemo temu detaljno obraditi dalje u tekstu budući da su nam mnogi roditelji djece sa PSR-om priznali kako je iskreno odgovaranje na pitanja vašeg djeteta o rodu i seksualnosti odličan način da mu pomognete i s njime izgradite odnos pun ljubavi i povjerenja. Mnogi roditelji djece sa PSR-om imaju čitav spektar briga sa kojima se većina ostalih roditelja ne mora nositi, a sa kojima se suočavaju od trenutka kad je PSR primjećen. Brine ih je li njihovom djetetu pripisan “pogrešan” rod ili da li će dijete kad odraste biti homoseksualne orijentacije. Roditelji djece sa PSR-om priznali su nam da puno energije troše na nadgledanje svoje djece tijekom igre ili interakcije sa drugom djecom pri čemu pokušavaju otkriti je li ponašanje njihovog djeteta “djevojačko” ili “dječačko”. Kada primjete da se njihovo dijete ponaša kao “suprotan” spol, ili “homoseksualno”, često se pitaju da li je tome uzrok PSR (ili “pogrešno” pripisan rod). Ponekad takve situacije u njima bude jake emocije koje ponekad uključuju osjećaj krivnje, straha, srama ili ljutnje. Da li PSR doista kod neke djece uzrokuje da se ponašaju i osjećaju drugačije u usporedbi sa većinom ljudi u smislu roda i seksualne orijentacije? Nismo sigurni. Istina je da, premda su znanstvenici nastojali otkriti zašto ljudi završe sa rodnim identitetom i seksualnom orijenacijom sa kojom završe, porijeklo rodnog identiteta i seksualne orijentacije i dalje ostaje do neke mjere svima nama misterij. Prozlaze li naš rodni identitet i seksualna orijentacija uglavnom iz naše biologije? Ili uglavnom iz načina na koji smo odgajani i naše kulture? Ili možda kombinacije svega toga? Odgovor je možda različit za različite ljude. No, iako uzroci rodnog identiteta i seksualne orijentacije mogu biti važni znanstvenicima, to vjerojatno nije najvažnija stvar vama. Ono što je vama najvažnije jest sreća i dobrobit vašeg djeteta. U okvirima rodnog identiteta i seksualne orijentacije vašeg djeteta, veoma je važno da ga volite i podupirete tijekom godina kada ono počinje razumijevati i izražavati tko je. Ono što pouzdano znamo, iz razgovora sa roditeljima djece sa PSR-om, je da su ti roditelji skloniji ranije primjetiti te ozbiljnije shvatiti “rodno-tipično” ponašanje svoje djece. No, kada primjetite takve stvari, imajte na umu da možda reagirate burnije na nešto što inače i ostala djeca izražavaju, iz razloga što ste “alarmirani” saznanjem da vaše dijete ima PSR. Savjet roditelja koji su prošli kroz sve to je da pokušate što manje energije trošiti na “praćenje” “rodno-tipičnog” ponašanja svoga djeteta jer ukoliko to budete radili, teško ćete prihvatiti svoje dijete onakvo kakvo ono jest. I definitivno ne biste smjeli zaključiti je da je vašem djetetu pripisan pogrešan rod, samo zato što se ponekad ponaša kao da je “suprotnog roda” ili se čini da ga privlače ljudi istog roda. To što se dječak do neke mjere ponaša kao djevojčica ne znači da bi trebao biti odgajan kao djevojčica. Također, to što djevojčicu privlače druge djevojčice ne znači da bi je trebalo odgajati kao dječaka. U razgovoru sa odraslim osobama koje imaju PSR doznali biste da većina njih ne smatra da je odgajana u “pogrešnom” rodu. Dakle, veoma je mala statistička vjerojatnost da će vaše dijete željeti promijeniti rod koji mu je pripisan. Odrasle osobe sa PSR-om jasno se sjećaju koliko ih je povrijedilo kada su ih roditelji odbacili ili ih se sramili zato što su bili drugačiji od većine u smislu svojih rodnih identiteta i seksualne orijentacije. To nas ponovno uči da su roditeljska ljubav i iskreno prihvaćanje glavne stvari koje djeca sa PSR-om žele i trebaju. Odlomci koji slijede posvećeni su različitim stadijima dječjih života i trebali bi vam pomoći da razmislite na koji način možete biti potpora svome djetetu. DOB OD 12-36 MJESECI Između prve i treće godine djetetova života (12-36 mjeseci) velike se stvari događaju, kako djetetu, tako i roditeljima. Većina djece u tom periodu prohoda. Ostale fizičke vještine također se razviju u tom periodu. Primjerice, vaše će dijete iz mjeseca u mjesec sve bolje kontrolirati svoje pokrete. Naučiti će simultano koristiti ruke i oči kako bi, na primjer, otkotrljalo loptu u vašem smjeru. Djeca te dobi također napreduju u odvikavanju od pelena. Dijete te dobi postaje sve zainteresiranije za otkrivanje svijeta koji ga okružuje. To je period kada ga sve zanima i kada opetovano postavlja pitanja što počinju sa “zašto?” Početi će pronalaziti načine da se nosi sa stresom prouzročenim odvojenošću od vas. Korisiti će predmete poput dekica, lutki, ili plišanih igrački kako bi se osjećalo bolje kada nije sa vama, bilo u vrijeme spavanja ili tijekom dana. Istovremeno sa iskazivanjem sve veće količine neovisnosti, sve će se više oslanjati na vas i vašu pomoć u prevladavanju teških i bolnih situacija. Tijekom te dvije godine života većina djece vidi sebe kao centar svijeta i slabo razumiju kako da budu društveni kroz interakciju sa drugima. Predodžbu o tome počinju razvijati kroz interakciju sa roditeljima i igru sa drugom djecom. Kroz te interakcije, djeca počinju shvaćati što ljudi očekuju i kako se ponašaju. Počinju razumijevati što se od njih, ali i ostalih, očekuje. Kako sazrijevaju, njihova sposobnost promišljanja raste. Oni žele razumjeti kako svijet oko njih funkcionira. U toj dobi počinju promatrati i kopirati ponašanje ljudi oko sebe. Također počinju uočavati određene obrasce prema kojima se odvija svakodnevni život te očekuju da se stvari odvijaju po određenom redu. Primjerice, dijete će primjetiti da njegova obitelj svaki dan večera nakon što se majka vrati s posla te će naučiti očekivati da svaki dan jede u to vrijeme. Djeca mogu biti izrazito svojeglava u toj dobi. Često će željeti da stvari budu po njihovom te će biti uzrujana ukoliko nije tako. Također su u stanju praviti jednostavne planove i postavljati si jednostavne ciljeve. U tom periodu, većina djece počinje razumijevati riječi i kako ih koristiti. Djeca u dobi između dvije i tri godine počinju koristiti jezik kao društveni alat kako bi objasnili kako se osjećaju (npr; gladno, željno nečega, tužno), pitali za nešto što ih zanima, i kako bi saznali više o svijetu koji ih okružuje. Ponekad djeca te dobi budu frustrirana kada vam ne uspiju na razumljiv način priopćiti to što žele. Jedan od načina na koji vam vaše dijete može priopćiti svoje osjećaje i ideje je kroz igru. Ako promatrate svoje dijete tijekom igre, možete primjetiti kako je i o čemu razmišlja. Na primjer, dijete može upotrijebiti lutku da rekonstruira ono što je upamtilo o važnom posjetu liječniku. (Jedna se majka sjeća kako se njezin sin pripremio za igru “doktora” sa prijateljem tako da je izvadio ravnalo kako bi njemu i sebi izmjerio penis – nešto što se ponavljalo svaki put kakda bi on posjećivao liječnika). Ili se dijete može pretvarati da je ljuljačka u parku avion kojim ono ide u posjet baki. Ukoliko dijete stalno iznova, kroz igru, ponavlja neke stvari, to moze značiti da je pod stresom ili zbunjeno te mu vaš angažman kroz igru i razgovor itekako može pomoći. Ponekada se čini nevjerojatnim da djeca već u tako ranoj dobi počinju razvijati osjećaj za “dobro” i “loše”, no to je doista tako. Taj proces učenja o dobrom i lošem nazivamo “moralni razvoj”. Djeca te dobi pokušavaju dokučiti kako dobiti ono što žele (npr, tako da budu “dobri”), a također pokušavaju dokučiti i kako da udovolje roditeljima. Tijekom prve tri godine života, djeca počinju razvijati osjećaj o tome tko su zapravo i u kojoj mjeri se to razlikuje od toga tko su drugi ljudi. Ranije, kada bi se vaše dijete zagledalo u ogledalo, ono bi samo vidjelo pokretnu sliku. No, tijekom tih godina, dijete otkriva da je slika koju vidi u ogledalu zapravo ono, a ne netko drugi. Ono počinje shvaćati tko su članovi njegove obitelji i na koji način je ono s njima povezano; uči tko je njegova sestra, a tko nije njegova sestra. Počinje shvaćati zašto ima prezime koje ima i zašto ga drugi doživljavaju kao djevojčicu, kao i njegovu sestru, a ne kao njegovog brata. Također počinje shvaćati da ono što ono želi nije uvijek ono što žele i njegovi roditelji. Sve to nazivamo razvoj “vlastitog identiteta”. Općenito govoreći, djeca do svoje druge razumiju što to znači biti djevojčica, a što znači biti dječak. Počinju shvaćati rodne razlike. Budući da im je rečeno da su ili dječaci ili djevojčice, trude se uklopiti se u dane im okvire. Promatrajući ljude oko sebe i njihove reakcije na uživljavanje u ulogu djevojčice ili dječaka, djeca dobivaju informacije o tome što je “prikladno” za njihov rod. Primjećuju da se ljudi dijele u dvije osnovne skupine – dječake/muškarce i djevojčice/žene – s obzirom na to kako im zvuče glasovi, kako se oblače, kako uređuju kosu, i kakve uloge igraju. Ukoliko je dijete te dobi imalo priliku vidjeti nage ljude, vjerojatno je uočilo kako većina dječaka, muškaraca, djevojčica, žena izgleda te će početi shvaćati da se nečiji rodni identitet uglavnom podudara sa nečijim fizičkim spolom. U toj dobi, većina djece postaje zainteresirana za igru sa drugom djecom. Iz toga proizlazi i njihova zainteresiranost za tuđa i vlastita tijela. Ponekada će ih zanimati vlastite ali i genitalije djece s kojom provode vrijeme. To je normalno za većinu djece. Neka djeca te dobi će uočiti razlike u genitalijama, dok ostala djeca neće primjećivati te razlike do predškolskog doba ili čak kasnije. Neovisno o tome jeste li primjetili taj vid znatiželje kod svog djeteta, bilo bi dobro da mu počnete davati do znanja kako je u redu da govori o svome tijelu. Mnogi su roditelji djece sa PSR-om komentirali da što ranije počnete razgovarati sa svojim djetetom o osjetljivim temama poput genitalija, to će vam s njime biti lakše razgovarati o rodu, spolu i seksualnosti kako ono bude odrastalo. Sa djetetom možete početi razgovarati o njegovim genitalijama dok mu mijenjate pelene ili mu pomažete prilikom korištenja wc-a. Povremeno mu možete reći nešto banalno poput: “usmjeri penis prema vodi u wc-u kako bi pišalina išla u školjku”, ili “nakon što se pokakiš, obriši guzicu ovako od vagine prema natrag”. Na taj način polako počinjete učiti dijete riječniku koji će mu trebati kako bi razgovaralo o svome tijelu. No, nemojte forsirati više informacija nego što vaše dijete može podnijeti. Rukovodite se djetetovim pitanjima i brigama te odgovarajte na njih. Ponekad će vas vlastiti strahovi navesti da djetetu date previše ili premalo informacija. Važno je da si date vremena, duboko udahnete i pažljivo saslušate što vas dijete zapravo pita kako biste mu što obazrivije mogli odgovoriti. Možda ćete ga morati naučiti nekoliko novih riječi kako biste mu odgovorili na pitanja. Dijete te dobi neće biti u stanju razumjeti sve detalje svog PSR-a, no možete početi tako da mu objasnite kako većina djevojčica ima klitoris i vaginu, a većina dječaka penis i mošnje te da postoje i ljudi kod kojih je to nešto drugačije. Zatim mu možete objasniti kako je ono izgledalo kada se rodilo. Moguće je da vas neka pitanja vašeg trogodišnjaka uhvate nespremne, stoga je preporučljivo da unaprijed razmislite o mogućim pitanjima i pripremite odgovore. Njihova pitanja su obično o tome kako funkcioniraju genitalijei zašto izgledaju tako kako izgledaju. Dalje u tekstu navodimo primjer pitanja koje bi vam moglo postaviti trogodišnje dijete uz sugestiju kako da na njega odgovorite. U primjeru koji slijedi dijete koristi riječ “piša” kao sinonim za penis. Dijete roditelju – Zašto moja piša ne izgleda kao tatina? Mogući odgovor – Kao što ljudska lica izgledaju različito, tako i neki drugi dijelovi tijela isto mogu izgledati različito. Piše mogu biti različitih oblika i veličina. Tvoj je nešto drugačiji od tatinog pa zato i izgleda drugačije od tatinog. Ukoliko je vaše dijete imalo operaciju genitalija, to je možda dobar trenutak da mu pokušate objasniti kako je djelomičan razlog toga što mu genitalije izgledaju drugačije taj što ih je liječnik kirurški izmijenio kada je dijete bilo mlađe. Ponekada se možete poslužiti lutkom ili plišanom igračkom da mu malo pojasnite što se događa tijekom operacije. Ponovno naglašavamo; slijedite djetetove interese no nemojte pokušati zatajiti takve informacije te ih podijelite sa djetetom kada se za to ukaže dobra prilika. Što ranije počnete razgovarati sa djetetom o njegovom ili njezinom tijelu, to ćete lakše razgovarati s njime kako ono bude odrastalo. DOB OD 3-5 GODINA (PREDŠKOLCI) Kako se vaše dijete približava predškolskoj dobi, njegova sposobnost razumijevanja informacija raste. Ukoliko vam nije postavljalo puno pitanja tijekom prve tri godine života, vjerojatno će vam na putu od treće do šeste godine života postavljati sve više i više pitanja. Premda su predškolska djeca u stanju primiti više informacija nego trogodišnjaci, još uvijek nisu u stanju potpuno razumjeti sve detalje svog PSR-a. No, oni mogu početi shvaćati na koje sve načine su slični, a na koje se razlikuju od svojih vršnjaka, te počinju razumijevati jednostavna objašnjenja vezana uz njihov PSR. Predškolska djeca nastavljaju fizički sazrijevati. Većina njih savlada vještine poput trčanja, skakanja, vožnje tricikla, ili veranja po prečkama za igru na igralištu. Počinju raditi stvari koje nisu mogli dok su bili mlađi, poput zakapčanja dugmadi ili vezanja vezica na cipelama. U predškolskoj dobi djeca se lakše nose sa razdvojenošću od roditelja. Oni imaju bolje sjećanje od trogodišnjaka kao i zrelije poimanje vremena koje im omogućuje da upamte kako ćete se, nakon nekog vremena, vratiti po njih ako negdje odete. No, ponekad je moguće da dijete nazaduje po pitanju svog ponašanja, ispoljavajući ovisničku privrženost roditelju ili nemogućnost odvajanja od njih, posebice ukoliko je pod stresom. Takvo ponašanje je normalno i obično samo privremeno te ne mora biti povezano sa PSR-om. Djeca sa PSR-om obično moraju proći kroz neke stvari kroz koje ostala djeca ne moraju prolaziti, poput dodatnih liječničkih pregleda, ili izazova učenja da su rođeni sa genitalijama koje izgledaju drugačije od genitalija većine djece. Upravo zbog toga mnogi se roditelji postave previše zaštitnički te pokušavaju ograničiti vlastite i djetetove socijalne kontakte kako im dijete ne bi ni u kojem trenutku bilo “van dometa”. Kratkoročno gledano, to može biti korisno i za roditelja i za dijete, no dugoročno gledano, takva izolacija rezultira smanjenim brojem prilika za uvježbavanje razdvojenosti. To može rezultirati dodatnim stresnim situacijama za roditelje i djecu budući da se potreba za razdvajanjem javlja sve češće i češće. . Ukoliko se nađete u takvoj situaciji, mogli biste početi razmišljati koga zapravo štitite izbjegavanjem socijalnih kontakata; sebe ili svoje dijete. Zapamtite da se sva djeca moraju naviknuti na povremenu odvojenost od roditelja. Vjerojatno ćete razmišljati kako bi povremeno mogli organizirati odvojenost od djeteta tako da ga ostavite na čuvanju kod prijatelja ili drugih roditelja u koje imate povjerenja, u tzv. “sigurnoj zoni”. Nećete uvijek moći biti u istoj prostoriji sa vašim djetetom tako da je važno početi raditi na navikavanju na povremenu odvojenost. Ukoliko vaše dijete ima poteškoća u navikavanju na odvojenost od vas, znajte da mnogi roditelji smatraju kako je veoma korisno uvjeriti dijete kao će te se vratiti po njega i zatim biti dosljedni u tome. Razradite rutinu dolazaka i odlazaka i, ukoliko je to moguće, neka se za vaše dijete uvijek brine ista osoba. Na taj će način dijete naučiti osjećati se dobro u vašoj odsutnosti, a i vi ćete se naviknuti na povremenu odvojenost od djeteta. Kako vaša djeca sazrijevaju, raste i njihova sposobnost razmišljanja. U usporedbi sa trogodišnjacima, predškolska djeca više toga razumiju, bolje pamte događaje, te svrstavaju stvari u kategorije. Predškolska djeca sposobna su početi sastavljati “čitavu sliku stvari”jer razumiju dijelove i način na koji su oni međusobni povezani. Predškolska djeca ponekad ne znaju razliku između svojih fantazija i stvarnosti. Primjerice, ponekad vjeruju da će djed koji je umro ponovno oživjeti jer je to ono što bi oni željeli da se desi. Kako predškolska djeca sazrijevaju, počinju shvaćati i razliku između fantazija i stvarnosti. Počinju razumijevati kako i zašto dolazi do nekih stvari (“uzrok i posljedica). Također postaju sposobna sagledavati svijet sa tuđeg gledišta. Do tog trenutka djeca vide sebe kao centar svijeta i vjeruju da se svi ostali osjećaju onako kako se oni osjećaju. Većinom kroz igru, predškolska djeca mogu postepeno početi sagledavati svijet iz tuđeg gledišta. Djeca te dobi razvijaju svoj jezik i komunikaciju sa drugima. Uče kako objasniti svoje osjećaje riječima. I dalje će često komunicirati kroz akciju i igru. U toj dobi djeca često razgovaraju sami sa sobom na glas. Također, veoma su zainteresirani za sklapanje prijateljstava sa drugom djecom. U toj su fazi često preokupirani nastojanjem da otkriju što je, zapravo, ključno za sklapanje prijateljstava. Kako otkrivaju te stvari, počinju mijenjati svoje ponašanje kako bi druga djeca željela biti njihovi prijatelji. To rezultira njihovom željom za suradnjom sa drugima, dijeljenjem, razumijevanjem tuđih osjećaja i rješavanju svađa i nesporazuma. Također, to ponekad rezultira kopiranjem ponašanja i interesa druge djece. Predškolska djeca očito nemaju savršene, idilične odnose sa svom djecom koju sretnu. Gotovo svako predškolsko dijete će prije ili kasnije izolirati nekog vršnjaka koji bi želio biti uključen u igru. Do toga djelomočno dolazi i zato što djeca te dobi počinju razmišljati u kategorijama. Kada predškolsko dijete shvati da su neki njegovi vršnjaci poput njega, a neki drugačiji, mogu početi doživljavati neku djecu kao zasebnu kategoriju te iskoristiti tu činjenicu da ih ne uključe u igru. To može biti veoma bolno iskustvo za isključeno dijete. Djeca te dobi veoma su osjetljiva na to kako ih vršnjaci doživljavaju. Paralelno sa njihovim usavršavanjem verbalnih sposobnosti, rasti će i vaša zabrinutost da njihovo ovladavanje jezikom ne rezultira zadirkivanjem vašeg djeteta zbog PSR-a. Važno je istaknuti da je zadirkivanje normalan dio ljudskog života. Roditelji, što je i razumljivo, žele zaštiti svoju djecu od zadirivanja, no sasvim je nerealno očekivati da ćete u tome baš svaki puta uspjeti. Većina je djece (ako ne i sva) bila zadirkivana ili nazivana pogrdnim imenima u nekom trenutku svoga života. Ponekad je vaša prva reakcija na saznanje da vam je dijete netko zadirkivao želja da mu kažete nešto zbog čega će se bolje osjećati. No, veoma je važno priznati da je vaše dijete povrijeđeno i dati mu do znanja kako razumijete da je povrijeđeno. Pokušaj da se odagna bol tako što će se djetetu reći nešto poput “batine i kamenje mogu mi polomiti kosti ali vrijeđanje me nikada neće povrijediti” negira činjenicu da je ono doista povrijeđeno. Premda je teško gledati vlastito dijete kako pati, pomaže ako sjednete s njime i dopustite mu da vam ispriča kako se osjeća. Također je važno da djetetu prep

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