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J R Soc Med. 2007 September; 100(9): 396.
PMCID: PMC1963403

Resources could be spent better than on saving children

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.


1. Loefler I. Of saving children. J R Soc Med 2007;100: 110-1 [PMC free article] [PubMed]
2. Savage A. Should charity always begin with children? World Medicine 30 April 1983

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press