|Home | About | Journals | Submit | Contact Us | Français|
Most doctors who have worked in Africa will agree with the late Imre Loefler that the preferential treatment of children is misplaced (JRSM 2007; 100: 110-111). In fact, I wrote a piece in 1983 entitled ‘Should Charity always begin with Children?’, which pleaded for more help for women with vesico-vaginal fistulae. But incontinent women are not as photogenic as wide-eyed children and, as fundraisers well know, rational argument rarely wins over emotion.
I found the avoidable deaths of young adults much harder to take than the high child mortality for two reasons. My first reason is that the best security for a child in Africa, where the welfare state is rudimentary, is to have two healthy parents. My second reason will be considered more controversial, but I came to realise that some of the children who returned to my clinic time after time were not meant to live. In a survey of 1200 consecutive admissions to the children's ward, done primarily to assess the effect of measles vaccine, the mortality was 21.5%, and of those 77.7% died with 24 hours of admission. In an area where abortion was unthinkable and Children's Homes a rarity, unwanted babies just faded away. Even in this rich country a judgement has to be made about the allocation of resources, and that is even more important in Africa.
Competing interests None declared.