To My Fellow Pediatricians: You Are Advocates Too

To My Fellow Pediatricians: You Are Advocates Too

Source: K4 Photoshare

By Anita Shet, MD, PhD, International Vaccine Access Center (IVAC)

The work of a pediatrician brings a certain joy that few other professions can claim. It is a joy that stems from nursing ill children back to health, from watching these spontaneous little beings blossom into poised young adults. But there also is sadness as we witness children suffering from diseases and injuries, some of which claim these precious lives. The most painful moments are the ones we know could have been prevented.

Every pediatrician comes across children suffering from pneumonia and diarrhea, commonly occurring but highly treatable conditions. Fortunately, with the right treatment children bounce back to health in no time. However, in countries with a high burden of illnesses, there remains a stubbornly large contribution of pneumonia and diarrhea to deaths among children below 5 years of age. There are approximately 2,500 young children dying of pneumonia every day. Together, pneumonia and diarrhea  are responsible for one in four child deaths.

As witnesses to the unnecessary suffering of children, it is up to pediatricians to not only treat the children we see in clinic, but also to give voice to the needs of children everywhere. For example, one of the best ways to protect against diarrhea and pneumonia is through immunizations. Both the rotavirus vaccines (RVV) and pneumococcal conjugate vaccines (PCV) are safe and effective in saving young lives. However, not all children have access to them.

One of the best and most trusted voices in the public dialogue on child health is yours, a pediatrician. Talk to the public about the safety and benefit of vaccines. Talk to your local policy makers about economic and emotional gains when disease can be prevented with vaccines. Talk to your colleagues about the value of vaccines and appropriate antibiotic use.

One of the most effective steps—in any country, but more so in a high-burden one—is to simply talk to patients and their families. Talk to the grandparents, not just the parents of the child. In many cultures, the key to enabling behavior change, such as ensuring exclusive breastfeeding up to 6 months of age, is being able to convince the grandmother or mother-in-law. Encourage the father of the child to be present during the health care visit.

I remember a day several years ago when a beautiful 2-year-old girl named Reetu, unable to breathe, was rushed to my hospital in Bangalore city. She was admitted on earlier occasions with pneumonia, but always recovered within two or three days. Her family of four lived in a one-room cottage, with poor ventilation and heavy exposure to beedi smoking (unfiltered cigarettes) from the father. This visit was ominously different: Reetu was very ill when she was brought in, and was admitted straight away to the intensive care unit for treatment of severe pneumonia. I met her father for the first time, and I was able to spend time explaining the impact of passive smoking. A wrenching period followed and despite the best care, Reetu never recovered.

I am still haunted by several questions: Would things have worked out differently if I had taken the time to encourage the father to be present during the earlier occasions, and talked to him about reducing risk factors for childhood pneumonia, and seeking care earlier? Would Reetu have walked out of the hospital with a smile, if I had somehow convinced her parents to buy the expensive PCV vaccine that was available only at a private pharmacy? Would this little girl and hundreds of other young children like her still been alive had I added my voice to the growing call to action for bringing lifesaving vaccines to the national immunization schedule?

It is easy to pull out a pad and prescribe antibiotics, and often this is enough to help a child regain their health. An equally important action for pediatricians to perform is advocating for their patients. While you have a deep commitment to diagnosing and treating ill children, you also have the opportunity to change the environment to improve child health through prevention efforts. You can serve as a bridge between kids and their community, the medical establishment and policy makers. As a pediatrician, you have a powerful role in creating lasting and meaningful change for the children you love and serve.

Anita Shet, MD, FAAP, PhD, is a pediatrician, and associate scientist at the International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore. She is also a nominated member of the Society of Pediatric Research of America. She is adjunct professor of pediatrics and infectious diseases at St. Johns Medical College Hospital, Bangalore, India.