Specialty Community Paediatrics is a new and expanding arm of the paediatric service provided within the public health system of Trinidad and Tobago. A good community paediatrician recognises that there are several forces such as social, spiritual and cultural beliefs that impact favourably and unfavourably on the child’s health and functioning. He/she uses all of the community’s resources in collaboration with other professionals and agencies to achieve optimal care.
Under the United Kingdom health system, Specialty Community Paediatrics covers six (6) core areas of care: developmental paediatrics, medicals for education, child protection, looked after children or children in foster care, health promotion and general paediatrics. In Trinidad and Tobago, mandatory medicals for looked after children are not yet the norm; this is an area that needs greater attention as we improve services.
From January 2011, Specialty Community Paediatrics was launched in the South West Regional Health Authority (SWRHA). Five (5) clinics were set up to cover the five (5) main clusters allowing the service to be brought closer to the patient. Prior to this, patients with developmental concerns had their consultations at the Eric Williams Medical Sciences Complex (EWMSC) and lengthy waiting times and the distance needed to commute proved a hindrance to some patients.
In the first three (3) years of the service, from January 2011 and December 2013, there were 106 clinics per year with 569 patients seen per year. Of these, 56% had a developmental concern, 22% had a general paediatric concern and 22 % held both concerns; 69% of the children were between the ages 3 of 12 years (school aged children). Of the patients having development concerns, autism spectrum accounted for 21%, Attention Deficit Hyperactivity Disorder (ADHD) 8%, cerebral palsy 2.6% and learning difficulty 4.2%.
Due to the range of development issues seen in the clinic, there is an urgent need to implement support services and therapies. Services which would benefit our patients include Speech Therapy (58%), Occupational Therapy (29%), Student Support Services (54%), Medical Social Worker (39%), Dietician (22%) and Child Psychologist (10%). Despite their importance, these support services are not always easily accessible to all patients. This may be due to the service being limited or, as in the cases of speech and occupational therapy, the service is altogether unavailable.
What are these families to do then? How can we help children receive the best care?
This brings us to the important role of the community paediatrician, or any doctor, nurse, social worker, parent and other professionals as advocates for children. Advocacy involves speaking up for someone else – particularly vulnerable groups. Extra attention is given to paediatrics as children are usually not able to advocate for themselves and quite often their needs are eclipsed by those of adults.
Children have a right to have their best interests considered whenever decisions pertinent to their well-being are being made. But who determines the child’s ‘best interest’? Is it the politician, hospital administration or even the doctor? The United Nations Convention on the Rights of the Child is the most widely accepted international treaty, to which Trinidad and Tobago is a signatory.
Advocacy-related activity can be direct, where interests of individual children or groups of children are sought, or it can entail influencing public policy so as to impact the entire population. The community paediatric team directly advocates for our patients. For example, when children with learning difficulties are in need of extra support in school, letters are written to the school and student support services outlining the child’s difficulties and requesting further assessment and supports to be implemented. Another example includes the recognition of a child with a behavioural problem due to a learning difficulty or Autism spectrum disorder to elicit the engagement of all the relevant agencies to fully support the child’s needs.
Data collected from our clinics is used to provide tangible evidence of the demand for specific services and this is used to lobby for and influence service policies at a hospital and ministerial level. Without our research and advocacy efforts, patients may be unable to access vital care.
To strengthen our advocacy initiatives, coalitions are often forged with other organisations in the child care field. For example, the Specialty Community Paediatrics department has an established relationship with the Child Guidance clinic at the Pleasantville Health Centre. Regular conferences are held to discuss cases and together we share our expertise to devise a way forward with some of our difficult cases.
Apart from having the interests of our patients at heart, we are involved in health policy development at a national level. We contributed to the ongoing discussion on the childhood obesity action plan which will help curb this alarming trend when implemented. Also, community paediatrics played a vital role in facilitating the upcoming World Health Organization (WHO) growth charts within the SWRHA.
Overall, there are many basic services needed for patients of our community paediatric clinics that are not available. To keep up with the demands, continuous advocacy efforts are needed to establish new services essential to the patient population. The onus is on us as child care professionals to advocate in order to improve the lives of our patients and afford them the best quality of life.
About the Author
Dr. Ravi Ragoo has served as a House Officer at the Paediatric Department of the San Fernando General Hospital under the South West Regional Health Authority of Trinidad and Tobago for more than four years. Dr. Ragoo graduated from The University of the West Indies, St Augustine campus in 2009 with a M.B.B.S. and is currently pursuing postgraduate studies in the field of Paediatrics. He is presently a member of the Specialty Community Paediatric Team, led by Dr P. Bahadursingh who established the service in 2011.
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