 |
Seeing the Whole Child
by Isabel M. Estradas-Portales
IMCI promotes a holistic view of the child, as a means of better ensuring good health in the first 5 years of life. (Photo ©Armando Waak/PAHO) |
For doctors and other health professionals, saving the lives of young patients means learning new ways of looking at children, parents...and themselves.
It was a follow-up visit, not just for the 7-month-old baby who had been diagnosed previously with pneumonia, but also for the doctor examining her. The young pediatrician had recently received training under an innovative international public health strategy known as Integrated Management of Childhood Illness (IMCI).
Dr. María Lucía Mesa, director of the Ciudadela Medical Center in Bogotá, Colombia, was making her rounds to observe the clinic's newly trained staff when she joined the exam in process. "The baby had arrived with her mother, and she was in a very good general state: smiling, good color--she really looked happy," says Mesa. "The doctor carried out a thorough IMCI check-up and found that the baby's respiratory rate was elevated. She then checked to see if the baby's breathing was labored, and it was, though slightly. She referred the baby immediately to the clinic. Once the child was gone, the shaken pediatrician told us, `It was only because you were here that I took her respiratory rate, and that led to the complete exam. IMCI saved this baby from being sent home. Who knows what could have happened....'"
Throughout Latin America and the Caribbean, medical students and experienced pediatricians alike are learning the virtues of IMCI as a protocol for pediatric exams, one that dramatically reduces the chances of missing something that may be wrong with a child. Launched in 1996 by the World Health Organization (WHO) and UNICEF, IMCI is today being implemented throughout the developing world to promote healthy growth and development in children under 5 and to reduce mortality and morbidity from the principal causes of childhood illness. In Latin America and the Caribbean, the strategy has been expanding its influence for the last six years.
Mesa and other supporters in the Region have no doubt that IMCI improves children's health and saves lives, because they have seen it happen. Yet not all their anecdotal evidence is so sanguine. Mesa also recalls a 2-year-old boy who visited her clinic, was examined under IMCI, and was diagnosed with pneumonia. "He was given ambulatory treatment and clear instructions about when to return. When he didn't get better and started to have labored breathing, his parents took him to a second-level facility, which had not received IMCI training. They sent him home. He died after three days in intensive care in that same institution."
According to UNICEF, more than 10 million children under 5 die each year from illnesses that can be readily prevented or treated, including dehydration, acute respiratory infections, measles, and malaria. In half these cases, the condition is complicated by malnutrition. In the majority, the child's illness cannot be attributed to a single cause. Thus, the creators of IMCI conceived a broad, intersectoral approach to childhood health.
The strategy is challenging but straightforward. It takes advantage of a child's visit to a health center to assess his or her general health status and identify any problems that may be present. Health workers first identify seriously ill children who require hospitalization and refer them to more specialized care. For less serious cases, health workers must focus on treating the whole child, assessing not only the problem that prompted the consultation but also any signs of other common childhood illnesses or conditions.
Continuing with a comprehensive assessment, the health worker evaluates the child's nutritional status, vaccination record, growth pattern, and the quality of care received at home. Finally, he or she ensures treatment of any and all detected health problems and--equally important--provides information to parents, other family members, and caregivers about proper prevention strategies and child care at home.
Seemingly simple and even commonsensical, the strategy nevertheless entails what is often an important redirection of emphasis. It calls on mothers or other primary caregivers to participate more actively in consultations and to be better observers of their children's health. It assigns doctors and community health workers new roles as social communicators and educators, who must teach parents how to promote and monitor key aspects of their children's physical development. Most important, it calls upon physicians to invest the extra time and effort necessary to make a thorough, holistic assessment of each small patient's health.
 Continue
|
|
| 
