Child poverty: The need is great and opportunity awaits

I have a picture in an album of five beautiful Malaysian children. Their mother, a rubber tree tapper, had died from a snake bite leaving her unemployed husband to provide for the children in a society that at that time (1969) was without social services or state support. On their abdomens are the outlines that I had drawn of their massively enlarged livers and spleens. I also recorded their ages (four, five, six, seven and nine years), weights (16 lbs, 25 lbs, 27 lbs, 32 lbs and 28 lbs, respectively) and hemoglobin levels (7.5 g/L, 6.3 g/L, 5.0 g/L, 3.1 g/L and 3.6 g/L, respectively). All the children had chronic malaria, severe malnutrition and multiple intestinal parasites. I have never forgotten them or the reality of that family’s poverty and its impact on their health. In 1968, two years after I graduated from medical school, after one year as a solo general practitioner in a small community and three months after marrying my physiotherapist wife, we set off for west Malaysia on a two-year contract with CARE Canada (Ottawa, Ontario). The experiences of those two years influenced the direction of our lives from that point on. We initially worked in a rural district hospital, where I was strongly affected by the desperate needs of children suffering from malnutrition, parasites, malaria and anemia. Later, we moved to a small hospital in the jungle that served the needs of Aboriginal people throughout the Malay peninsula. In this setting, one of my duties was to visit remote Aboriginal communities by helicopter, boat or foot. The people within these isolated communities were independent and most of their needs were provided by the jungle landscape in which they lived. Houses were built from bamboo, and food was foraged from the surrounding fauna and wildlife. If supplies became depleted, they moved to a new setting carrying with them all their belongings. The small village which was left behind was quickly reclaimed by the jungle, leaving a minimal footprint. My exposure to treating children there, the healthiest of whom was often sicker than the sickest child I was to see in my paediatric training, prompted me to enroll in a paediatric residency program. I wanted to better understand why some children I had treated had gotten better and some with the same treatment had died. I had planned to study for one year and return to general practice. However, once in the residency, my love of paediatrics swayed the next decision, to complete my fellowship. I was, I think, fortunate. Today, medical schools require students to make a choice for early specialization. In my case, the practical experience of working with sick children set the course. As a result of my Malaysian experience, I chose to practice in a smaller, less-serviced community that was looking for a paediatrician. Later, I had an opportunity to serve on the Paediatric Death Review Committee of the Office of the Chief Coroner of Ontario. This Committee reviews all deaths of children in the care of child protection in Ontario. The reviews are passed on to the child protection agencies and government ministries involved, for them to address issues that relate to the protection of children. Poverty and its impact are over-represented factors in these reviews. I am now approaching retirement. My wife and I thought it would be appropriate to end our careers as we began them, in a setting where children have restricted resources. With this in mind, I have taken the opportunity to work as a consulting paediatrician in the Baffin region of Nunavut. Public health issues are significant, with lack of housing, poor nutrition, poverty, spousal abuse, dental caries, iron deficiency anemia and a high suicide rate being just a few. The exposure to child poverty in the early years of my medical career profoundly affected the direction of my career. For that career and for that direction, I am most grateful. If I were a new graduate today, I would jump at the opportunity to work in less-serviced areas. The need is great, the learning rich, and the opportunity to make a difference for children and their families is there… and awaits you.