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Holistic Care: Platitude… Pompous, Pious, or Prescient?

October 2, 2011
I spent the day at the European Gaza Hospital for my clinical practice of Paediatrics. During the fifty-minute bus ride from Jabalia to the hospital in the south of the Gaza Strip, colleagues were gossiping and the view from my window became dull and uninteresting once the bus got past the Old City and the famous market of Gaza. I reached for the Oxford Handbook of Clinical Specialties and started reading the chapter on Paediatrics. … There I sank in my seat and surrendered to the fine text of the introductory remarks at the beginning of the chapter…

Holistic Care: Platitude.. Pompous, Pious, or Prescient?

Manufacturing organs is the point of embryology…growth and development is the essence of childhood… and protection from a cynical world is the raison d’être of the family, that cardinal unit which prevents children cascading down the loveless spiral of truancy, illiteracy, street crime, violence, drug and solvent abuse, prostitution, and adolescent pregnancy. The abandoning of thousands and thousands of street children worldwide illustrates in a terrible way how paediatrics can never be done in a clinical vacuum and that solutions to paediatric problems entail social issues and politics as much as medicine. This cascade of urban poverty contrasts with the sane and ordered world of our paediatric clinics. But always remember there is another world or two out there. Beyond the window, the child is on tiptoes, peering out, and before he flits through it and is lost forever, weigh him, measure him, feed him, clothe him, immunize him – and above all educate him (him or her, of course). Look after the body, and the soul will look after itself provided the family is intact. You will see the immense pressure illness puts on families: don’t just observe. Help in any way you can: flexible clinics, home instead of hospital treatment, education going hand-in-hand with ward events, hospital-at-home, home-at-hospital facilities, and home-based nursing visits to help with complex cancer or HIV regimens.

We cannot hope to enable children to realize their full potential – for potential is only ever lost. The egg has more potential than the embryo (its sex, for example is yet to be determined). The child has more potential than the medical student who is forever closing off lines of enquiry to concentrate on one thing. So if potential can only be lost we must aim for potential to be lost in the least harmful way.
The essence of paediatrics is aligning embryology, growth-and-development, family interactions, and preventive and therapeutic measures to achieve a person who is capable of making choices. Happy or free? Creative or reasonable? Self-destructive and isolated, or participatory and social? We cannot hand down the answers – we just peddle our wares down this one-way street. Ask children what childhood is for, and they will tell you “Preparation. Learning. A time to become yourself…” This is why Paediatrics must be holistic – otherwise it will not contribute to these aims. It is against this background of enabling children to become themselves that paediatricians practice their art and their science.
We note with great interest that most patients between the ages of 15 and 20 who have acute leukaemia treated by paediatricians are cured – up to 63%, whereas <50% of this group survive if treated in adult units. This chapter aims to explain how this difference might arise – and to encourage the reader to extend the skills learned in paediatrics to all medical practice.


One Comment
  1. Rafi permalink

    So are you enjoying paediatrics? I am in my fifth year in Bangladesh. I enjoy this ward immensely. Perhaps the kids or their smile make me like it a lot. Anyways, what is the situation of child care in Gaza? I know there are around 800,000 kids. Allah bless they have grown up seeing lots of violence and oppression around them.

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