Nursing and medical minds must put aside time to discuss what is needed locally and how to produce it.
The experience of others will be helpful here.11,12 For some, this will involve reorganization rather than expense. Others will have to think how to provide accommodation for resident parents, the best option from the child's viewpoint being a foldaway bed or mat close by the cot. (At home, they may share a bed but hospitals have concrete floors as well as drips and
~ther
eq~i?~ent to consider.) Toilet, laundry and eating faCIlIties, however basic, need to be provided.
Personnel trained in health education may also be nurses or even sweepers. There must be someone to act as social worker to help families work out their priorities in financial and supportive terms for the child in hospital. Depending on the size of the hospital, one person may have to supervise others or fulfil all these roles. This person must be identified as having this responsibility if plans are to develop into more than
dreams and if parents are to be better informed as a result of the hospital experience.
The word 'parents' rather than 'mothers' is used deliberately here. For years we have spoken of maternal and child health as though one-parent families were the norm! Fathers have become a neglected species, yet unless the father is committed to the child's health, he will not ensure that the family income is fairly divided.
Involving him in the child's care may to him be a compliment to his importance and to the mother a relief that her burden is shared (Fig. 1.7.8). In some cultures this may be hard to get across, but to encourage awareness of how the child thinks and develops provides an intellectual interest for the father which comple-ments the mother's tender, loving care. In an extended family, other relatives may take a share in the child's care, but parents and grandmothers remain the prime targets for health education.
Fig.1.7.8 Father is important too.
References 127
Including parents will save lives
One of the first things to strike me on arrival in East Africa was the sad, withdrawn expression in the eyes of many children with kwashiorkor. It became clear that many of these children had suffered a sudden, and to them inexplicable, interruption in a very close relation-ship, usually with the mother13. Some of these children died.
In contrast to these sad expressions, the radiant faces of two mothers will always stay in my memory. The first mother addressed a packed lecture theatre in her own language. It needed no interpreter to tell us of her joy in the transformation of her malnourished child to the happy little person sitting on her back and peeping over her shoulder as she spoke to us. Her message was very simple. Someone had taught her about the correct food for the child and she herself had given it. Physical nutrition and emotional nurture had gone on together, the child's life had been saved and she was taking back to the village not only the 'before and after' photo-graphs but missionary zeal to teach others also.
The second woman was equally radiant. Her toddler had come in with diphtheria and required a tracheo-stomy. During this serious illness he contracted measles with pneumonia. His mother stayed at his side through-out the weeks of his illness, watching his drip, coping with nasogastric feeding, collecting his medication and guarding his tracheostomy. What sleep she had was on a small bench at his cotside and her only food was the ward's very simple diet. The combination of over-crowding with shortage of nurses almost certainly meant that he would have died without her devotion.
Any other children she had could be spared this experience as she was taught about immunization during her stay, so perhaps other lives would be saved.
The pride and pleasure on her face as she hitched him on to her back to take him home, was to us the most vivid testimonial that children in hospital do need to be accompanied by someone who loves them and that this can be life-saving.
References
1. Robertson J. A Two Year-Old Goes to Hospital. Tavistock Child Development Research Unit, London, 1953 (film).
2. Bowlby J. Child Care and the Growth oj Love. Har-mondsworth, Pelican Books, 1953 (reprinted 1980).
3. Sebikari SRK. The role of mothers in hospital. Journal oj Tropical Pediatrics and Environmental Child Health. 1972; 18:
96-8.
4. Sainsbury CPQ, Gray OP, Cleary
J
et al. Care by parents128 Parents and children in hospital
of their children in hospital. Archives oj Disease in Childhood.
1986; 61: 612-5.
5. Klaus MH, KennellJH. Maternal lrifant Bonding, 2nd edn.
St Louis, CV Mosby Company, 1982.
6. Lynch M. Ill-health and child abuse. Lancet. 1975; 2:
317-9.
7. Aarons A, Hawes H, GaytonJ. Child to Child, Macmillan London, 1979.
8. Mateega PH. The work of the maternal and child health demonstrators. Journal oj Tropical Pediatrics and Environ-mental Child Health. 1972; 18: 99-103.
9. Teaching Aids at Low Cost (TALC), PO Box 49, St.
Albans, Herts ALl 4AX, UK.
10. Stenbak E. Care of Children in Hospital. Copenhagen, WHO,1986.
11. Waterston AJR. Child health in district and rural hospitals. Central Ajrican Journal oj Medicine. 1982; 28:
298-303.
12. GoodallJ (ed.). The hospital care of East African children (Report of a UNICEF assisted seminar). Journal of
Tropical Pediatrics and Environmental Child Health. 1972; 18:
46-125.
13. Goodall J. A social score for kwashiorkor: explaining the look in the child's eyes. Developmental Medicine and Child Neurology. 1979; 21: 374-84.
Further reading
Beadle M. A ChildJs Mind. London, Methuen, 1972 and 1977.
Bowlby J. Loss, Sadness and Depression. London, Hogarth Press, 1980.
Lewis C. Becoming a Father. Milton Keynes, Open University Press, 1986.
Rutter M. Maternal Deprivation Re-assessed. Harmondsworth, Penguin, 1972.
Topics dealt with in this chapter are also illustrated by the author in tape/slide sets available from Graves Medical A-V Library, 220 New London Road, Chelmsford, Essex CM2 9BT, England.