PUTTING CHILDREN IN CONTEXT THE SOCIAL ASPECTS OF PAEDIATRICS

28TH SEPTEMBER 2009 G. PLANGE RHULE

OUTLINE
PUTTING THE CHILD IN CONTEXT SOME LEGAL ISSUES THAT AFFECT CHILDREN CHILD ABUSE TRADITIONAL PRACTICES THAT AFFECT CHILDREN SOME PERCEPTIONS FROM THE KINTAMPO NEWHINTS STUDY

PUTTING THE CHILD IN CONTEXT

ASK
Always put the child in his/her context. Who is his mother? Who (where) is his father? Has he traveled? Did he name the child? (Beware of the child with a funny name) Who actually takes care? Who feeds?

ASK
Where do they live? What is their background? Income? Other siblings? Ages? Is the child in school? How is the disease affecting school attendance? BE INTERESTED!!

ASK
Why does THIS child from THIS place fall ill in THIS way at THIS time?

ISSUES FROM THE CHILDRENS ACT, ACT 560 1998

WELFARE PRINCIPLE (CHILDRENS ACT)

The BEST INTEREST of the child shall be paramount in any matter concerning a child.

(2) The best interest of the child shall be the primary consideration by any COURT, PERSON, INSTITUTION (this includes hospitals!) OR OTHER BODY IN ANY MATTER concerned with a child.

BEST INTEREST?

ABANDONMENT S.71 CRIMINAL CODE OF GHANA

Whoever unlawfully exposes or abandons any child, under seven years of age, in such a manner that any harm is likely to be caused to it, shall be guilty of a misdemeanour. (Is abandonment without harm a misdemeanour?)- the silver pot.

CHILD ABANDONMENT
Should abandonment always be criminalised? Should it be treated like infanticide?

CHILDRENS ACT ACT 5601998

"disabled child" means a child who suffers from ABNORMALITIES or loss of physiological functions, anatomic structure or psychological state and has lost in part or wholly the ability to engage in activities in a normal way and is as a result hampered in his normal functions in certain areas of social life;

CHILDRENS ACT
No person shall discriminate against a child on the grounds of gender, race, age, religion, DISABILITY, HEALTH STATUS, custom, ethnic origin, rural or urban background, birth or other status, socio-economic status or because the child is a refugee.

DISABLED CHILD - S. 10 OF CHILDRENS ACT

No person shall treat a disabled child in an undignified manner. (2) A disabled child has a right to special care, education and training(,) wherever possible(,) to develop his maximum potential and be self-reliant.

DISCRIMINATION
Does discrimination take place in the hospital? Onte kasa biara

CHILD ABUSE

CHILD ABUSE (Childrens act)

child abuse means contravention of the rights of the child which causes physical or mental harm to the child;

CHILD ABUSE
Health workers must be able to recognise Child abuse Obviously a broad definition, open to interpretation and often, where there is doubt, needs to be looked at in the socio-cultural context e.g. spanking

RIGHTS OF THE CHILD (CHILDRENS ACT)

Right from birth to a name, Right to acquire a nationality Right to know his natural parents and extended family Right to Grow up with Parents Right to life, dignity, respect, leisure, liberty, health, education and shelter from his parents.

RIGHTS OF THE CHILD CTD

Reasonable provision out of the estate of a parent whether or not born in wedlock. Right to access to education, immunisation, adequate diet, clothing, shelter, medical attention or any other thing required for his development. No person shall deny a child medical treatment by reason of religious or other beliefs.

WHEN SHOULD ABUSE BE SUSPECTED?

Unexplained injury Clear maternal/paternal mental illness, alcoholism, drug abuse Very disturbed social circumstances

MAIN TYPES PF CHILD ABUSE

PHYSICAL EMOTIONAL SEXUAL ABUSE NEGLECT WHO ADDS EXPLOITATIO N

Physical Abuse

CHILD ABUSE (?)

CHILD ABUSE - CHILDRENS ACT

Persons to Report Child Abuse and Protection Cases ANY PERSON with information on (a) child abuse; or (b) a child in need of care and protection shall report the matter to the Department..

BABY PETER

TRADITIONAL BELIEFS AND THEIR IMPACT ON CHILD HEALTH

TRADITIONAL TREATMENT
ASINAM- THYWILL TSATSU SABBLAH A disease that could be given to babies right in the womb or at birth by a person with a bad eye -A mother

The types of Asram

Bordedwo Nnawotwe anto Pmp Ntos Akanyaa Asensene Paano Sami, etc

Some beliefs from mothers

A woman should never expose her abdomen during pregnancy You must be cautious in purchasing some food items; kenkey, tomatoes It is safer to keep your baby indoors and away from strangers Anyone at loggerheads with you is a chief suspect if your baby has Asram

THE PRAYER OF ST. FRANCIS OF XAVIER MODIFIED

God give us the serenity to accept the cultural practices that should not be changed, courage to change the ones that should and wisdom to know the difference

CLEARLY HARMFUL PRACTICES

ATTEMPTING TO MAKE THE CORD FALL OFF EARLY SQUEEZING THE BREAST SOME ASRAM TREATMENT

HARMFUL TRADTIONAL PRACTICES

HARMFUL PRACTICES
KEEPING THE BABY IN A DARK ROOM ETC, ETC !!

PROBABLY (?) HARMLESS

MOULDING THE HEAD EXCERCISING THE BABY POURING WARM WATER ON THE FONTANELLE TYING DRIED CHAMELEON ON BABYS WRIST

DEFINITELY HARMLESS!!

HELPFUL PRACTICES
EXTRA SUPPORT, NO WORK FOR NEWLY DELIVERED MOTHERS GIVING THE NEW MOTHER EXTRA FOOD KEEPING THE BABY WARM OILING THE BABY USE OF BEADS LYING DOWN TO BREASTFEED (?)

SOME PERCEPTIONS FROM THE KINTAMPO COMMUNITY NEWBORN CARE STUDY (NEWHINTS) 2005

PERCEPTIONS SUPERVISED DELIVERY

I [fieldworker] asked that assuming the hospital was free which would she have preferred and she said she would still prefer home as she would not want people with bad eye to see her. Such people can put their foot hard on the floor and make delivery very painful [22 year old, recently delivered Bono]

PERCEPTIONS HAND WASHING

Imagine how ridiculous and what a scene youll create if you are going to bath and need someone badly to care for your baby and then you try to find out if they have washed their hands before entrusting the baby to their care. The person will just snub you [24 year old, pregnant Kangyaga]

PERCEPTIONS CORD CARE

Discomfort for the mother If the cord doesnt fall the mother cant eat because there would be some pain in the mothers stomach [TBA FGD] We have a custom for women after they have delivered before she can come out of the bedroom, this custom can only be done when the cord is off and since most women want to come out of the room quickly they will do anything to get the cord to come off early [85 year old, Gruma grandmother]

Child delays becoming a human being The cord has to be well kept so the child can become a human being [33 year old pregnant Frafra]

OTHER ISSUES
POSTED BABIES the anxiety factor Sexual abuse, rape, defilement Ethical issues surrounding HIV screening and counseling Social Welfare, WAJU Special Schools

CURRENT SOCIOPOLITIACAL ISSUES AFFECTING CHILDREN

FCUBE NHIS eg street children <18yrs? SCHOOL FEEDING PROGRAM. EDUCATIONAL REFORMS SCHOOLING OF CHILDREN IN CONFLICT AREAS CHINESE SCHOOL UNIFORMS DURATION OF SHS