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From International Paediatrics to Pastoral Geriatrics.

Wednesday, 22 February, 2017 -- Helen Wilson

Eltham 1946 -1952.  Those were powerful formative years for me, with good friends and inspiring role models.  For many of us. with missionary parents overseas, the Eltham Boarding House and Scout Troop formed our extended family.  The Scopes brothers, though orbiting way above most of us academically, were a good gang.  Others I remember for leadership, sportsmanship, enthusiasm and spiritual direction were Stephen Smith, Noel Shepherd, Arthur Wyatt, JAD Northfield and Stan Gregory.  Mr Occomore didn’t think I would get to University, so I was happy to surprise him.

I was fortunate to study medicine in Edinburgh.  In that era our teachers were both characters and world famous figures.  There I met and married Margot, who was also committed to Christian service abroad.  It’s been a good partnership, now pushing 60 years!  We worked in a rural Christian hospital in South India (1961-1973).  The hospital needed a paediatrician, but I had little experience of this specialty, so I had a lot of learning to be effective.  Two years in the middle of that time we were back in UK, and I worked frantically to get my specialist qualifications.   More important, I fell under the influence of the dynamic and innovative international paediatrician, David Morley, who had worked in West Africa, but was then Prof of Tropical Child Health at the Institute of Child Health in London.  He was a lifelong inspiration.

In 1973 I amazingly, no, providentially, went from a small rural hospital in India to the prestigious London School of Hygiene and Tropical Medicine and as part-time Hon. Consultant at Great Ormond Street Children’s Hospital.  It was a great privilege teaching some Post Graduates from around the world who became leading doctors.  I was also expected to work overseas for at least three months a year in developing countries.  This included WHO and UNICEF consultancies in a number of countries, especially in South Asia. 

In 1979 we returned to Edinburgh where my job was in the University and at the Royal Hospital for Sick Children.  My main responsibility was supervising the many international PGs who came to study paediatrics.  But at the same time I continued my international work, including two small research teams on HIV infection in children in Zaire and on catch-up growth in malnourished children in Bangladesh. 

My life was a challenging and rewarding international experience with the gift of many great contacts and good friends.  I had the opportunity to develop and promote several types of service that had roots in developing countries but relevance to developed countries.  (See below article.) 

After retiring in 1998 my clinical and pastoral interests turned to the many and varied needs of the elderly.  I metamorphosed from paediatrician to simple geriatrician.  I collected and wrote stories, biographical glimpses, poems, jokes, and practical advice with Christian devotions about health and wellbeing for Seniors.  I did few notable things at Eltham, but one was to win the gymnastics prize, the Achilles Cup, at age 14 in 1948.  Now as my frame shows serious wear and tear, I have to try and live by the encouragement and advice I have written for others! 

Simple Solutions but Sound Services.  Promoting Practical Paediatric Services, my first career.

Despite undistinguished achievements at school, I was fortunate to be able to achieve my ambition, indeed, my vocation, of international medical service. 
I believe that through God’s providence, I was in the right place at an appropriate time to help propagate and encourage some simple technologies that helped health care.  These methods had roots in what were called “developing countries” but have relevance to the services in all countries. 

Nutrition Rehabilitation  
This is the name of a practical management for significantly malnourished children.  It was first used by Dr Jose-Maria Bengoa in Brazil.  He was tired of admitting malnourished children to his wards, treating and discharging them, only to have them return with malnutrition a few months later.  Therefore he set up a Unit like a large village home and admitted the mothers with their malnourished children.  The mothers, under initial supervision, bought and cooked locally available foods, appropriate for the malnourished children, and fed them back to health.  The involvement and practical education of the mothers was the core.  Readmissions were rare, only if children contracted serious infections. 

Our task to modify this method for a drought-affected part of India was very challenging.  The whole cultural and agricultural setting was different.  Fortunately we called upon excellent Indian home science and nutritional expertise.  Our little Unit was a pioneer and became a demonstration. 

Sadly, in the first half of the20th Century many children’s hospitals in UK used to separate sick children from their parents on the principle that “professional nurses and doctors know best how to deal with ill children”.  Only in recent years are parents admitted with their children.  Now, of course, health services recognise that, especially for chronic diseases like diabetes and cystic fibrosis, it is essential to train the parents as they will be the primary providers of care.  In India we never admitted any child without his or her mother or grandmother! 

Home-based Health Records for children and Growth-monitoring, a method to promote health.
In rural Nigeria David Morley, working in a Christian hospital clinic was struggling to see over a hundred children a morning.  In a part of the country and at a time when malnutrition and mortality were high in children under 5 years of age he had to simplify and delegate.  From this grew the Under Fives Clinic.  One of its key tools was the Child’s Growth Chart. 

In a situation where under nutrition is a major health problem it is fair to declare that - “If a child is growing well, he or she is probably healthy”.  So David Morley delegated growth screening to specially trained nurses and had them weigh children at every visit, preferably monthly.  By getting them to plot the weights on a personal calendar weight card, the nurses could see at a glance if a child’s weight was going up in line with a “normal growth path” on the card.  If growth faltered, the child “fell off the growth path”, and needed review to see if feeding was inadequate or there was some underlying illness. 

Morley then went a step further and gave the parents the responsibility of keeping their child’s “Growth Card” in a plastic bag and bringing it with the child at every visit.  On the card he also recorded the immunisations and told the parents that this was the child’s “Passport to Health” for which they were responsible.  This was the birth of home-based, family-retained health records in developing countries, and it worked!  In India in the 1960ies and 70ies we had the opportunity of using some of David Morley’s principles including home-based health records and weight charts. 

Doctors and nurses have had a bad custom of keeping patient’s information in the hospital records system, as if it was their data and not that of the patients!  In the 21st Century in U.K. transparency about medical tests and results is much better, and patients are given more responsibility for looking after correspondence about their health and treatments. 

Early home rehydration for dehydration. 
Dehydration, the loss of water and essential electrolytes (salts) from the body, especially due to diarrhoea, is a major cause of death of children.  If glucose or other carbohydrates are added to saline, the small bowel is able to absorb many fold more volumes of this simple mixture than salt water alone.  This linked absorption mechanism has been verified in laboratory experiments and confirmed in field studies, especially in Bangladesh.  This is the sound scientific basis of the life-saving oral rehydration therapy (ORT). 

If a child with acute diarrhoea is given small repeated drinks of an appropriate sugar-salt solution it can prevent fatal dehydration.  Many studies have shown that this simple treatment, especially if applied from early in the disease, can be life-saving.  Unfortunately the message is almost too simple.  Alarmed parents come to the health service seeking a “strong injection”, and doctors and nurses have been trained to put up intravenous drips (and these do have a place).  Therefore many educational programmes were started to promote the benefits of ORT, and I was privileged to take the message across the world in many training programmes.  I was even Scientific Editor for a popular quarterly journal with the delightful title of “Diarrhoea Dialogue”.  Now ORT is the international initial treatment of choice for acute diarrhoea with dehydration.  This is another example of a simple technique, pioneered in poor communities, that is now accepted as universal best practice! 

I didn’t invent any of these methods, but my practical experience in India gave me the credibility and privilege to be an effective messenger. 

William A.M. Cutting.

Recent Books:-

Face the Future 1.  (ISBN 978-1-907509-97-1)
Seniors Can Inspire, Apply Wisdom and Model Values.

Face the Future 2.  (ISBN 978-1-910197-11-0)
Challenges, Joy and Faith for Seniors.

Face the Future 3.  (ISBN 978-1-910197-13-4)
Seniors, Make the Most of the Health You Have. 

Available from:- william.cutting@talktalk.net, (£8@ including p&p). 
Or from Publishers:- www.onwardsandupwards.org. and bookshops.

The Elthamians Office have a copy of William's 3rd book - Face the Future 3 which is available for any OEs who would like to write a review on the book. Plase contact the Elthamains Office via email or call 020 851 9840.

(Face the Future - Dementia: A Positive Response.
An additional Title inserted in the series. Due 2017. ) 

(Face the Future 4.  Hopefully Due 2018. 
Seniors: Celebrate in the Departure Lounge.)