Indian Pediatrics 1999; 36:237-242
Inaugural Function of V Internation Congress of Topical Pediatrics, February 9, 1999, Jaipur
Honourable chief guest, guest of honour, distinguished dignitaries on the dias, present and past presidents of lAP, executive members of ICTP and lAP, members of APSSEAR, IPA, ISTP, WHO, UNICEF, Ministry of Health and Family Welfare, guest speakers, delegates from India and abroad, respected teachers, organizers of the Vth ICTP and XXXVI National Conference 0 lAP, fellow delegates, media persons, friends, ladies and gentlemen.
At the outset, I would like to express my deep sense of gratitude of all the fellow members of lAP and International Society. of Tropical Pediatrics (ISTP) for reposing their confidence and electing me to the coveted post of President of Vth ICTP. I consider it a great honour and with infinite humility, I stand before you to deliver the presidential address.
We all are aware of the rich heritage of the presidents of lAP and ISTP with their outstanding contribution for the pediatric field. However, I do assure you of my humble contribution to the best of my capacity towards child welfare with your active help and co-operation. It will also be our endeavour to establish and maintain the high standards of pediatric fraternity in every country.
Though children constitute more than 40% of our population, unfortunately they are not able to air their views or concerns as they are not allowed to the houses where national and state policies are formulated. They accept the decisions gratefully and gracefully and therefore the young ones are many a times taken for granted.
Children are our greatest assets who will shape the future of our country and strengthen the nation. We, the pediatricians are the custodians of their future and therefore we all must strive hard to ensure the optimal growth and development of children, so that they can effectively contribute towards progress of the nation.
The year 1998 has seen tumultous changes both at the global level as well as in our country. The changes which were political, social and economical have affected the child health of today as well as of future. Our country has gone through its worst ever crisis of balance of payment, rupee devaluation, all time high population of more than 900 million and its consequences. However, rays of hope .are seen due to the market oriented economic reforms, national literacy mission and reservation of 30% seats for women.
Thus major revamping efforts are necessary to protect the lives and ensure the healthy development of children. Global unified efforts are required to end the poverty on this planet. The efforts in this direction therefore will be the greatest long term investment, which the human race could make in its future to achieve universal economic prosperity, political stability, environmental integrity and safety.
The theme of the Congress is "Happiness to childhood in 21st century-A universal commitment". Therefore, a parallel focus on completing the unfinished agenda of the 20th century will be highly appropriate and will result in specific recommendations from the Congress that can be implemented throughout 1999 to fulfill our promises to children and making this potential into a reality before the end of 20th century.
I take this opportunity to share with you my perceptions and perspectives regarding the policies' and directions which we all have to pursue to improve the status of the child population.
It is estimated that approximately 500 million people, most of them poor, suffer from tropical diseases. This exposes them to many kinds of sufferings which include deformities, blindness, brain death and premature deaths.
Tropical diseases are a serious impediment to individual and national development. They impair intellectual and physical growth, make fertile land unusable and burden economies with huge costs for treatment and control.
Substantial progress has been made in four of eight tropical target diseases, namely, lymphatic filariasis, onchocerciasis, Changes disease and leprosy. However, new tools are urgently needed to control schistosomiasis, 'leishmaniasis, and malaria. Malaria in particular remains a considerable challenge.
Child Health Concern
The proportion of children who reach their fifth birthday is one of the most fundamental indicators of country's concern for its citizens. Child survival statistics are a poignant indicator of the priority given to the services that help a child to flourish.
Adequate supplies o( nutritious food, the availability of high quality health care, easy access to safe water, sanitation facilities, the family's overall economic condition and the health and status of women in the community, all together cO!1tribute towards the child survival index.
Birth Registration: The First Right
A birth certificate is a ticket to citizenship, without which an individual does not officially exist and therefore lacks legal access to the privileges and protections of a nation. Civil registration is also the bask tool by which an efficient government counts its citizens and plans the schools, health centers and other services they need. Yet many nations lack effective systems for recording births. Every year, about 40 million babies - one third of all births - go unregistered around the world.
Status to Newborn
Gessel in 1950 described the newborn "The poor babe, like seaman, wrecked thrown from the waves, lies naked on the ground". More than 49 years later still the newborn of 1998 has failed to achieve the separate identity inspite of 28.2% of babies being bornas low birth weight who deserves a greater attention.
There is a close relationship with the survival rate of the child and the body mass index of the mother. And it is found that 53% of women with grade III chronic energy deficiency have delivered low birth weight babies. This quality of new born and child care in society largely depend on women's health, status and education.
It will be appropriate here to state the comment of Dr. Hiroshi Nakajimo, former Director General, World Health Organization that most of the world's major health problems and premature deaths are preventable through changes in human behavior and at low cost. We have the requisite know how and technology but they have to be transformed into effective action at the community level.
Immunization: Going the Extra Mile
Immunization is the greatest public health success story in the history. Between 1980 and 1990, massive efforts have raised coverage rates worldwide from 5% to 80%. But just as a new generation of vaccines is about to come in the market (capable of saving million more children's lives each year, though at greater cost), the momentum to sustain immunization is faltering.
We cannot ignore the fact that one third of world's malnourished children live in India and malnutrition among children is maximum between 12-23 months. Therefore it is important to educate the community including both mother and father on better child caring practices.
On present trends, more than 100 million of children still die from illness and malnutrition.
WHO and UNICEF believe that halving the rate of child malnutrition and eliminating severe malnutrition by the end of century is feasible target as almost half of today's malnourished children live in the eight nations of South Asia. .
AIDS in Children
AIDS is now a major threat to the health and survival of children and women in many countries and its impact is expected to grow by 2000 AD.
As Dr. Reginald Boulos, Haitaian Pediatrician said "Unless something is done soon, AIDS threatens to wipe out all the progress we have made in child survival in the last 10 years".
Dr. Wilson Carswell, Technical Advisor on AIDS points out that "we hear very little about AIDS prevalence in children because children are visible socially as well as economically and the earliest effects of HIV are unspectacular. The suffering baby appears to be simply going through typical childhood maladies" .
As you all know, we are sitting on the sleeping volcano of AIDS. Therefore the mass education at a community 'level for safer sex and prevention of AIDS is necessary. Sex education which is neglected in our country since long, will have to be successfully implemented at least at the high school level. lAP is ready to offer its share byway of resources and personnel for successfully carrying out this programme with the help of the government and other NGOs.
Education for All
There should be efforts of the international community to ensure that all its children enjoy their human right to a high quality education. These- efforts are resulting in an 'education revolution' .
As the world's commitment to the principle of "Education for All" is put to into practice at the local level, certain elements have emerged as necessary for its success. Schooling should provide the foundation for learning for life; it needs to be accessible, of high quality and flexible; it must be gender sensitive and emphasize girls' education; the state needs to be a key partner; and it should begin with care for the young child.
Adolescence Claiming the Future
Adolescence has long been viewed as a distinct stage of life in the industrialized world. Now it is also emerging as a key interval between childhood and adulthood in the developing countries. Young people aged 10 to 19 account for one sixth of the population on earth, making them a force for profound change. But they need the support of their families, communities and nations if they are to capitalize on their potential.
As stated by "Carol Bellamy, Executive Director, UNICEF", the Progress of Nations (1998) points out that society has largely overlooked the vulnerabilities of adolescence in developing countries and that young people need the support of their elders if they have to fulfill their promises and avoid the inevitable perils that lie ahead.
Violence Against Women and Girls
Violence against women and girls is the most pervasive violation of human rights in the world today. Its forms are both subtle and blatant and its impact on the development is profound. But it is so deeply embedded in cultures around the world that it is almost invisible and yet this brutality is not inevitable.
Discrimination against women can end only when there is a sea change in attitudes, when women's inferior status at all levels of society (economic, social and political) is recognized as a travesty and not the norm.
Unfinished Child Health Agenda of 20th Century
Oral rehydration therapy and oral antibiotics are two of man kinds most powerful instruments for the protection of children next to breastfeeding, immunization and nutrition. The training of all health workers in the use of these two technologies is therefore one of the most important public health priority for the year 2000 and beyond.
I would like to mention here specially about ORS "potentially the greatest medical advance of the 20th century" which has saved millions of children. But unfortunately it has still remained one of the important unfinished agenda of this century which calls for our renewed and sustained commitments.
The question which one faces today is whether ORT wilt be made as available and as well known as coke and pepsi or we will be watching thousands of children dying of dehydration in the next millennium?
In addition it is the greatest condemnation of our times that more than quarter a million children should still be dying every year of easily preventable illnesses and malnutrition. Measles, whooping cough and tetanus all of which can be prevented by inexpensive course of vaccines, kill, almost 8000 children every day. Pneumonia can be treated by low cost antibiotics and it kills more than 6000 children per day.
The Progress of Nations
The Progress of Nations (1998) tells news which is good, bad, and a mixture of both. For example, mortality rates among children under 5 have declined impressively over the past 15 years but HIV/AIDS is undermining that success in about 30 countries.
A code is in place to protect breastfeeding from unethical infant formula marketing practices but enforcement of the code is spotty. Safe water supplies have expanded dramatically in recent years but access to sanitation is falling.
The 1998 era has witnessed the issues that have been less visible on the development agenda, such as violence against girls and how justice system handles young offenders.
The Progress of Nations is a clarion call for children. It asks every nation on earth to examine its progress towards the achievable goals set at the World Summit for Children in ] 990 and to undertake an honest appraisal of where it has succeeded and where it is falling behind. This year's. report highlights successes attained and challenges remaining in efforts to register each child at birth, to immunize every child on earth and to help adolescents, particularly girls, as they set out on the path towards adulthood. Commentaries by leading thinkers stress the need for an approach to development based on child rights, calling on governments to fulfill the promises they made in ratifying the Convention on the Rights of the Child.
Health for All by 2000 AD
The universal goal of health for all by 2000 AD seems to be quietly slipping away from our control. It is a sad reality that we are far from the enunciated health indices and targets to be achieved by the end of the century. There are many reasons for the failure of our commitment of global health care of our children. More than 3 million children per annum are dying quietly in India al0ne due to low birth weight, malnutrition and respiratory infections. Inspite of this, there seems to be lack of initiative on the part of the government toopen up the institutions for maternal, newborn and child health care. Therefore the slogan of health for all by 2000 AD will be an empty promise unless it is undertaken with political will to provide food for all, education for all, safe drinking water for all, homes for all and above all dignity for all.
Child Health by Next Millennium
Much of what we will see in the next millennium will depend on how we care for our children today. Tomorrows may be influenced by science and technology but more than anything it has already taken shape in the bodies and minds of our children.
In particular, policy commitments to universal health care and universal education, the two greatest goals of social development are of fundamental importance to today's children and tomorrow's world.
It is clear that high level political intervention is now necessary to overcome the obstacles, to mobilize the resources in addition to the national commitment to achieve these obvious goals.
When a hundred of a country's citizens are killed in a plane crash or a rail accident, the event can be sure to demand the attention of press, public and' politicians. But unfortunately inspite of the fact that five million children a year are being killed because of the non availability of the two known and inexpensive solutions, it does not seem to be worthy of the attention of the nations and the interventions by their leaders.
It is only the commitment of the nation's leaders, the awareness of the nation's people and the mobilization of a nation's organised resources which can put today's solutions into effect on the scale required. Thus the world now looks for renewal of our commitment and for a new impetus to convert what can now be done into what will be done.
Fulfillment of these goals will ensure that all children especially the least advantaged, have a real chance to survive, grow up healthy and well nourished, go to school and achieve their full potential.
Offering Children a Bright Future
UNICEF views that principle of FIRST CALL should influence the nature of progress in all nations in the] 998 and beyond. In a sense, it implies that the growing minds and bodies of children should have first call on society's capacities and that children should be able to depend upon the committment in good times and in bad. No matter what the nation and no matter what the cause, time has come to protect children as far as' humanly possible from the mistakes, excesses and vicissitudes of the adult world.
Thus, we are looking forward for the day when nations will be judged not by their military or economic strength, nor by the splendour of their capital cities 'and public buildings but by the well being of their children, opportunities to earn a fair reward for their labour, by their ability to participate in the decisions that affect their lives, by the respect that is shown for their civil and political liberties and by the protection that is afforded to the growing minds and bodies of their children.
More broadly, todays children look forward to our renewed commitment of providing them adequate nutrition, clean water, safe sanitation, primary health care and basic education (including for all girls) in the decade ahead.
I would like to mention here with pride and simultaneously compliment the organizers of the V ICTP and XXXVI National Conference of lAP for carrying out this mega academic event successfully without any financial assistance from the infant food industries and thereby again establishing a global precedence after the 8th Asian, Congress of Pediatrics which has recently been highlighted and complimented in the British Medical Journal. This is as per our commitment for the promotion of breastfeeding and for the welfare of the mother, newborn and child. Thus with this we are approaching a new era of "baby freindliness with baby friendly doctor".
Dear fellow delegates, with your valuable support, guidance and encouragement, I look forward to 1999 and beyond as an year of activity, progress and achievement towards better child health.
I owe my thanks to Dr. R.D. Potdar, Advisor CTP, Dr. N.R. Bhandari, Member IPA, Dr. Jacob John, President lAP; Dr. M.R. Lokeshwar, Immediate Past President lAP, Dr A. Parthasarathy, Past President lAP, Dr. Swati Bhave, President Elect, lAP, Dr. R.N. Srivastava, Chairman, Scientific Committee, Dr. Y.K. Amdekar, Past President lAP, Dr. G.S. Hathi, Honorary General Secretary lAP and the Executive members of lAP for their valuable guidance and encouragement.
With special words of appreciation for Dr. Ashok Gupta, Secretary General, Dr. R.S. Bhasin, Treasurer, Executive Members and to the Organizing Committee Chairpersons of Vth, ICTP and XXXVlth National Conference of lAP for the magnificent, Conference arrangements, I conclude Jai lAP, Jai Hind.