Is health for all children an achievable goal?
At first the answer the question of whether health is an achievable goal for all children seems like an obvious yes. But after taking time to consider and take into account all aspects of children's lives including cultural, political and wealth differences, the question becomes a much more complicated matter. In some situations enabling all children to have good health can actually have a negative impact on their lives and those of their families.
Health can be a difficult concept to define and what constitutes healthy within one culture may not be the same as in others.
An example of this can be seen among the Hmong people of Laos, where epilepsy is seen as a gift rather than an illness that needs medical treatment. The Hmong people believe that illness is caused by the person’s soul being lost. They perform a soul retaining ritual on all babies as they believe that this ensures their souls stay with them and that they will have good health in life. It is believed that a person’s soul can be shocked or frightened out of the body later in life, by a soul stealing spirit known as a dab. This causes what the Hmong people refer to as 'qaug dab peg', which means 'the spirit catches you and you fall down'. Hmong epileptics often become shamans as it is believed that the seizures help them perceive things that others cannot and that they help them to enter trances and journey to the realm of the unseen. These shamen are known as tvix neebs and among the Hmong people they are held in great social status and are highly respected. What is seen as a serious illness in the western world is not viewed in this way to them at all and is in fact believed to be a great gift.
Diarrhoea kills by dehydration and is a very common cause of death in impoverished societies. Diarrhoea can be treated cheaply and easily using oral rehydration salts (ORS). These provide much needed water and restore the salts required by the body’s cells in order for them to retain water and stay hydrated. Treatment for diarrhoea using oral rehydration salts has been widely promoted worldwide but anthropological studies have shown that they are not always well received in non-western communities. Regardless of how effective a treatment or medication may be, it can only be successful if people are willing to actually use it.
This can be seen in a study carried out among the Huli people of highland Papa New Guinea.In 1984 Frankel and Lehman attempted to show mothers how ORS treatments could help their children recover from diarrhoea and decrease the number of children who died because of the condition.
At first Huli mothers responded well and child deaths from diarrhoea decreased. But mothers became dissatisfied with the treatments and the explanations that backed them up and later began to only seek western medical help if it was absolutely necessary. The mothers required that the diarrhoea be stopped, so being told to give lots of fluid went against what seems logical based on their understanding of diarrhoea. ORS treatments don't stop diarrhoea; they just keep the body hydrated during the period of illness. To the Huli people this does very little to solve the problem and so they were more likely to turn to know traditional treatments that better fit their understanding and cultural beliefs. Reluctant to embrace the concept of rehydration Huli mothers would attempt to dry out their children's stools by withholding fluid and offering dry, solid foods. Although the child may recover from the episode of diarrhoea they were at risk of becoming seriously dehydrated and then going on to suffer the complications of this and in many cases would die.
People living in non-western societies can be understandably resistant to western doctors and treatments. They may mistrust the techniques and ingredients used because they are unfamiliar to them or as can be seen with the Huli mothers, because they do not fit in with their own knowledge and beliefs. They may also feel that people from outside of their societies and culture have no right to come to them and claim that they have better ways of treating illness and their native beliefs are misguided and harmful. Both can be difficult to resolve and brings up the question of whether western doctors and other medical professionals have any right to travel to other societies and essentially push western views and practises upon their people claiming that they are right and better than their own. Even if it is true that a western developed treatment is more effective, all people have a right to live by their own beliefs. However, in practice to what point someone’s beliefs should be allowed to be ruling factors is something that is heavily debated and is a very complex and emotive issue in itself.
In the late 20th century South Africa was facing the worst HIV/AIDS epidemic in the world. Approximately 1 in 9 people living in South Africa at that time where HIV-positive. Over the country 4.7 million people, out of a population of 40 million, where living with HIV or AIDS.
It was not just adults who were affected; many children were born HIV-positive due to it being transmitted to them during pregnancy or at birth. Any babies who were born unaffected would be at high risk of becoming infected at a later time due to unsafe practices and unsanitary living conditions. Children were also greatly affected indirectly by the epidemic regardless of whether they were infected or not. Many children's parents would die due to the diseases meaning that the family may struggle even more than previously to live and cope with day to day life. Many children were also left as orphans with nowhere to go and no one to care for or about them.
Throughout South Africa there is a lot of stigma attached to being HIV-positive and people could be thrown out of their homes and shunned by the community if it was discovered they can succumb to the disease. This was of course doubly bad for a child who would be even less able to care for themselves and possibility not understand why it was happening to them. A few facilities exist to care for the many children orphaned by the epidemic but many more children were left with nowhere to go.
There was very little help available to people who became HIV-positive due to the lack of money, knowledge and also the absence of an infrastructure capable of dealing with so many sick people. Often all doctors and health workers had to give people where food supplements. Although these may help to increase the person’s general health they do nothing to help combat the HIV or go anyway towards breaking the cycle of infection by improving living conditions, knowledge and sanitation. Only very limited counselling and support was available to people.
Lots of myths and a general lack of knowledge of HIV and AIDS existed, for example one such myth was that HIV could be cured by having sex with a young virgin. Of course this is not true and led to further people becoming infected with the virus. Many people believe in the myths and stories and would turn to those and traditional healers before they would seek any form of westernised health care and advice, which made the epidemic even harder to fight. To help combat this a South African radio station called Bush Radio run a daily broadcast aimed at educating people and dispelling the myths surrounding HIV.
One of the most controversial matters of the HIV/AIDS epidemic was the South African government’s refusal to provide anti - retroviral drugs to pregnant women. These drugs can block transmission of HIV from mother to baby in up to 60% of cases, meaning that far fewer babies would be born HIV-positive and therefore in better health. Combined with education about the transmission of HIV giving these drugs could mean that children remain uninfected and the spread of the virus could be lessened over time.
Nkosi Johnson was born in 1989 to a poor black family. He contracted HIV from his mother during pregnancy and there were no drugs to help her or him after his birth. When he was 2 years old Nkosi's mum left him at a care centre for HIV-positive people due to her fear of the community’s reaction when it was discovered that he was HIV-positive. Nkosi was befriended and later fostered by one of the centres directors, Gail Johnson. This gave Nkosi access to a clean and healthy lifestyle and also some of the drugs required to treat his condition though when the time came schools were reluctant to take in a HIV-positive pupil. Due to this rejection Gail and Nkosi began campaigning to raise awareness of the stigma faced by HIV-positive children and Nkosi won the right to attend school. He went on to campaign for drug treatment for HIV/AIDS sufferers and publicly criticised the president at the Thirteenth International AIDS Conference in 2000 over his poor handling of the epidemic. Sadly not long after the conference Nkosi became ill and died in June 2001.
If children are living in extreme poverty well-meaning western intervention can sometimes be inappropriate and even run the risk of causing more harm than good. Nancy Scheper-hughes, a professor at the University of California worked as a visitadora in Brazil during the 1960’s. Afterwards she wrote a book about her experiences and detailed how women viewed and behaved towards the death of a child in a very different way than what is seen in the west.
During her time working in Brazil she found that women experience many pregnancies during their lives and that due to the extreme poverty they lived in they may have to make choices about which of the children will live and which will not because they simply cannot care for or afford to feed them all.
Preference was often given to older children who have already proved their 'willingness' to live. Another view that Nancy found was held was that a newborn baby is not yet formed as a person or within society and has not yet made any claim on people's emotions or had any impact on their lives, so therefore it is easier for them be the ones to die if a choice needed to be made.
Although this may seem very heartless and cruel, in keeping every alive the family would have lived in a gradually worsening state of extreme poverty. If a child then died later their deaths would cause sadness to family and friends and possibly make life harder if the family had come to rely on them for anything. By keeping only a few of her children alive the women give themselves and the surviving children the best chances possible in the terribly adverse conditions they faced every day. It is also important to consider that providing health care such as immunisations can be more dangerous for children living in impoverished conditions as their bodies are less able to cope due to their already poor health and malnourishment.
In impoverished conditions feeding babies formula milk instead of breastfeeding them can lead to malnourishment, illness and often death. In these poor conditions it is very difficult if not impossible for baby bottles to be property sterilised and the water used to wash the equipment and also make up the milk powder into feeds is very likely to be contaminated. Research has shown a clear link between child malnutrition and the feeding of infant formula milk in unsanitary conditions. Some governments, such as Papa New Guinea's have legislation that means baby bottles are only available on prescription. Others such as the Nicaraguan government limit the sale of powered baby milk and place warning labels on all products.
Formula milk is a very expensive alternative to breastfeeding, not only in buying all the required equipment but in also buying the continuous supply of the actual powered milk. Marketing of the formula can make it seem like a good and useful alternative to breastfeeding, particularly to mothers who have to work outside the home and even their own villages and towns, so spend a lot of time separated from their babies. The mothers that Nancy Scheper-Hughes interviewed had felt that baby formula would benefit them as they needed to work as much as possible to support their families and it would mean that they could leave babies with older siblings or other family and friends. Her research also found that although the mothers knew that their babies needed good food to survive and that watering down the milk powder was damaging, they did in fact not make up the formula according to the packet instructions because they had no money to buy enough tins of the milk and so felt they were left with no other choice. Even if the women could or wanted to return to breastfeeding they often could not or it would take a lot of time and effort to re - establish breastfeeding as it can be the case that it only takes a short space of time after stopping regular feeding before the mother’s milk stops being produced. The women would have to do this with no support or advice and possibly be met with resistance from their other children and family members because they were no longer able to work as they did before. Breastfeeding can also put additional strain on her body and the time she had to do other things needed by the family.
As well as being an ideal and safe food for babies, breastfeeding also has many additional health benefits for babies and for mothers as well. Regular breastfeeding can prevent menstruation occurring and therefore provide contraception to women who are struggling to care for the number of children they already have, help protect against certain types of cancer and also protect babies against various types of infection including gastrointestinal and ear infections. But sadly in these harsh and extremely impoverished conditions women are left with few options to do what is best and are forced to do whatever is necessary to survive each day, trapped in a cycle with no obvious escape.
It seems that health for all or at least many more children could be achieved but the situations causing their existing poor health are far more complicated than simply having a lack of available medical facilities and treatments. Differences in cultural and religious beliefs influence how people react to and treat diseases and illness. What is considered bad and unhealthy in one country or society may not be viewed the same way in another.
People with little experience of medical intervention and all its associated machinery, drugs and what may be seen as interference, not only in a societies beliefs but also with the body itself, may be reluctant to trust and unwilling to even try what is on offer. Many places experience a huge lack of education and also money to provide advice and help with health. Nkosi Johnson's story shows that by gaining access to a healthier lifestyle and money he was able to live a healthier, better and perhaps longer life than he would if he had stayed with his family and lived his life in poverty. Education about matters such as the transmission of HIV, contraception and also the myths surrounding HIV and AIDS could help lessen the epidemic in South Africa and also aid mothers like those Nancy Scheper-hughes worked with. By using contraception they could have fewer children by choice and be able to provide a higher standard of living for themselves and their children. Contraception can be a difficult matter as it may not be well received in some societies, again due to cultural and religious beliefs and prohibitions or the mistrust of something unknown and lack of the knowledge of how the body and medications such as contraception works. What is an everyday thing in western society may appear dangerous, scary or even the work of evil in another society.
For mothers forced to formula feed in unsanitary environments wet nursing and also expressed breast milk could be possible solutions to the dilemma of how to feed their babies in the safest and healthiest way. Governments need to seriously address issues concerning children's poor health and provide services and methods to deal with the situations. Education should also be provided to people so that improvements can be maintained and sustained in to the future. As people see that medical interventions do work, see that in some cases are more successful than their traditional ways and learn why they work and how diseases are caused and work within the body they may become more accepting and happy to use western medicine, even if it's only part of the time. It is important however, to not just discount something because it is traditional medicine or doesn't have quite as high success rate as something else. These remedies and methods have been used with success throughout time and it can be the case that these provide a reversal of the situation and that western medicine simply does not yet know why these remedies work because it does not concern itself with researching them. It is also vital to remember that people have a right to their own choices and beliefs and should not be forced to change or go against those. Hopefully by giving them choices and educating them they will be able to not only have more choices available but also have the ability make better informed decisions for themselves and their families.
© 2013 Claire