A piece of Cure Kids' history

A poignant Woman's Weekly article from 1971, found in the family archives of Cure Kids' co-founder Dr. Ron Caughey

Disclaimer: Transcribed directly from the 1971 article featured in the New Zealand Woman’s Weekly. Some copy has been removed due to sensitivity. 

NO ROOM IN NZ FOR COMPLACENCY ABOUT CHILD HEALTH

By Staff Writer Sue Cornwell

Woman’s Weekly, 1 November, 2017

Concern in the medical world that all is not as it should be in the realm of child health has prompted Rotary to launch an appeal to establish a Research Chair in Child Health at Auckland University Medical School.

New Zealand children generally appear healthy and well cared for – and to all intents and purposes, they are. But are they healthy and cared for enough? Or is there an immediate need for ensuring that there is no doubt?

There is concern in the medical world that all is not as it should be in the realms of child health, and this concern has prompted Rotary clubs in Rotary District 292 (taking in a number of Pacific Islands as well as the broad Auckland-South Auckland-Northland area) to launch a major project to correct the situation.

A National Children’s Health Research Foundation has been formed to establish a research chair in Child Health (Paediatrics) at the Auckland University School of Medicine, and to provide the finance for research and other related activities associated with child health. A public appeal for funds opens on November 6.

Once the research programme is underway, it’s hoped, eventually, the findings will lead to the establishment of a national children’s hospital.

At present, while there are excellent facilities for sick children at public hospitals, New Zealand is the only country among the developed nations without a specially planned and equipped children’s hospital.

The need for such a research programme is great, according to Dr Ronald H. Caughey, a Senior children’s physician at Auckland Hospital, Saint Helen’s Hospital and the Wilson Home for Crippled Children, and Medical Adviser to the Auckland branch of the Crippled Children Society.

“There is no sense of alarm or panic about the need for paediatric study in this country, for on the whole the health of our children is good by most standards,” Dr Caughey says. “However, the standard does not, in general, reach the standard of excellence which is their due.”

Not many years ago, he points out, New Zealand could report one of the lowest infant mortality rates (number of deaths under one year of age per 1000 live births) in the world. Now it has regressed to sixth place.

“Moreover, in the period from one month of age to one year, World Health Organization statistics place New Zealand 14th on the world mortality scale. This puts the country among the highest mortality figures for the age group among the developed countries.”

Dr Caughey says the trend is similar in the one to four age groups and is evident in older groups too, although to a lesser degree.

At this stage, he feels the need is for prevention rather than cure, instancing the estimated 60,000 children who are admitted to New Zealand public hospitals each year as one reason why.

“Hospitals are constantly battling to firstly keep seriously ill children off the mortality tables, and secondly to investigate and treat numerous ailments and disorders, a large number of which are still mysteries.”

Children’s physicians are becoming increasingly aware of the large number of children permanently crippled with muscular, brain, bone, heart, lung, bowel, kidney, intellectual, emotional and other problems, the doctor says.

Likewise, recognition of congenital abnormalities or inherited diseases such as metabolic disorders grows daily, Dr Caughey says these “unknowns” are now a primary cause of death in newborn babies and of prolonged ill health, and need much careful study.

The number of fields requiring research in the child health spectrum are almost never-ending … the dangers involved in the very process of being born … premature births which cause a relatively high mortality rate … infections and respiratory complaints in very early life … specialist child surgery … meningitis … gastro-enteritis … pneumonia … malignancies … and the whole gamut of social and emotional problems.

In the respiratory field for example, infections and diseases of the lungs are common among children, and not infrequently lead to death.

Pneumonia is one of the worst offenders in this area, Dr Caughey says, and there is a big research area in considering the figures for Polynesian children.  “It appears that these children have an unfortunate pre-disposition for contracting pneumonia – and also gastro-enteritis – and naturally this is something which badly needs looking into.”

Malignancies are now a relatively common cause of death in children, such diseases as brain tumours, leukaemia, cancers of the bowel, kidney, liver and nervous tissue other than the brain.

Another interesting factor in the need for paediatric research in this country is the number of adult diseases which are traceable to childhood. Dr Caughey says evidence is now appearing which indicates that coronary heart disease tendencies may be in a baby at birth.

“A recent survey showed that some two per cent of newborn babies have a high fat content in their blood. Naturally, the reasons for this need to be defined and appropriate research performed into treatments, diets and so on.”

Social problems too are an area for extensive research. Dr Caughey gives as an example the battered baby group, which if taken comparatively on American statistics suggests that 500-600 infants suffer from adult aggressiveness in this country every year. He adds that there are also increasing numbers of children suffering from varying degrees of emotional problems, many of them carrying the scars throughout life.

Nutritional deficiencies and emotional deprivation may also have a significant effect in reducing the intelligence of growing children.

“The last 25 years in the field of medicine have been marked by the discovery and development of antibiotics which have solved many problems.” Dr Caughey says. “During the next 25 years I feel a much closer look will have to be taken at the dynamics of family living and associated emotional problems.”

He adds that mental health is far from being the only aspect of social medicine which requires assessment. Taking this field further, we run into things like rickets and tuberculosis, which can relate to poor social standards.

“There is just no room for complacency about child health in New Zealand any longer. We have a definite need for research specifically directed to the needs of children, and for the subsequent development of a hospital designed for children.

Dr Caughey says these measures will not only benefit New Zealand children but also those in less fortunate countries. He feels New Zealand is in a perfect position to offer unique information to the rest of the world, being situated as it is in the Pacific area.

The Rotary project setting up the Children’s Health Research Foundation takes in many Pacific Island areas as well as New Zealand, and Dr Caughey says there is a tremendous chance for this country to fulfil a world and social obligation in improving and researching child health in the Pacific.

On the subject of the island areas, Rotarians report that the response from people there has already been great. Big and small Rotary clubs from various island districts have wholeheartedly given their support, with the indication that they sincerely want to play their part in helping establish the foundation.

Surveying all these facts, it seems obvious that there is indeed a need for the Rotary inspired research foundation project.

It is also interesting to note that 25 years ago, NZ Rotary raised £100,000 ($200,000) to set up a postgraduate chair in obstetrics and gynaecology in Auckland. Subsequently, the support was such that the Government granted money to build the National Women’s Hospital. From this, New Zealand can take pride in its high standard of obstetric care, having one of the lowest “Perinatal” (from the 28th week of pregnancy to one week after birth) mortality rates in the world, and the lowest in the British Commonwealth.

Such an achievement reflects the high standard of clinical care, teaching and research emanating from National Women’s Hospital.

Now, Rotary has again stepped into an apparent breach, and if the pattern follows that of their effort on behalf of New Zealand women, it should not be too long before the standard of care for the country’s children is hauled to the top.

Dr Caughey says the quality of the life of the adult depends on the standards of care of the mother, and on the quality of the care of the individual from birth to adulthood.

As Disraeli put it, many years ago, “the health of the people is the foundation upon which all their happiness and all their powers as a state depend.”

 

THE CASE FOR MORE RESEARCH

Obviously, there are many case histories which bear out the effects intensive research would have on child illnesses. From Auckland Hospital files come the following two cases, naturally given fictitious names here, but containing true facts.

Seven-year-old John, a normal, happy child who had suffered only minor illnesses in his short life, was admitted to the Princess Mary block at Auckland Hospital with what appeared to be a chest infection.

With influenza rife at school it wasn’t surprising when John began to feel chilly and developed a slight cough. However, the cough worsened, and on the morning of his admission to hospital, he seemed breathless. His mother called the family doctor who in turn referred her to the hospital.

John was examined and X-rayed and found to have pneumonia of moderate severity, but without features to distinguish it from that seen in many other children each day in a busy hospital ward, and nothing to say it wouldn’t get better quickly with regular modern treatment.

The child was given injections of antibiotics and oxygen to breathe from a face mask. Despite these measures, his condition rapidly worsened and blood tests showed that although he was breathing oxygen at a concentration four times higher than that in air, the concentration in his blood was only half the normal amount.

Another X-ray showed that both legs were affected and that little normal lung remained for the transfer of oxygen from the air to the blood. A tube was put in John’s windpipe to allow him to breathe only pure oxygen, but still his condition worsened and he died in the evening of the same day he was admitted.

When tiny fragments of the child’s lungs were examined under a microscope it was seen that the cause of his pneumonia was influenza – an infection with a virus that causes mild illness in thousands each winter, but in John’s case was overwhelming.

The reason why some children die from an infection that merely inconveniences others will be better understood only through research. Likewise, through it will come methods of detecting such susceptible children, more effective vaccines to ensure immunity from such diseases, antiviral substances to kill the virus in the body and possibly even a machine to supply oxygen direct to the blood in a similar fashion to the heart-lung machine.

John’s case history is an example of how perfectly healthy children can be affected by an illness that is fatal within a matter of hours despite the best intensive medical treatment, and an example of an avenue which desperately needs researching.

Two-year-old Sharon’s case history is an example of an inherited disease. She does not speak at all, and has only recently learnt to walk. She is a contented, cheeky child and her general health is excellent, but she will almost certainly be [intellectually disabled].

She has Phenyl ketonuria (P.K.U), a condition inherited when both parents carry the gene for it, and caused by the absence in the liver of an enzyme necessary to convert a common dietary constituent (known as phenyl alanine) into other chemicals required by the body. As a result, the unconverted substance builds up in the blood and interferes with the growth of the developing child’s brain.

If detected very early in life the effects can be minimalized by feeding a special baby formula … in this substance. When solid foods are required for the baby’s diet, special foods, carefully balanced with ordinary foods are used.

Sharon’s disease was detected by the programme which ensures that all babies born in New Zealand have blood samples taken in the first few days of life. These samples are sent to a laboratory in Dunedin for testing to determine whether selected chemical substances known to be high in inherited diseases are present.

The little girl was immediately put on the special diet formula before she left National Women’s Hospital where she was born, but as she was the child of a broken home, the administration of this special formula was somewhat erratic, and possibly contributed to her progress not being quite as good as expected.

Now, although she will still be slightly [intellectually disabled], she will not be severely so as she would have been had it not been for early detection of her disease. With early detection and careful treatment, P.K.U. is controllable.

Sharon’s story is related as an example of an inherited condition resulting in an upset of the chemical regulation of the body which is amenable to treatment. Medical research has provided considerable understanding of the mechanisms of this disease in the past few years, but much remains to be done.

There are many similar inherited conditions, every parent runs the risk that their child could inherit one of these conditions, as each person carries the genes for about eight serious inherited disorders. It is only because there are so many disorders that thanks to the rules of chance, they are individually infrequent.

Many inherited diseases have been identified in recent years, and the methods of inheritance are known. After an affected child has been born it is possible to advise the parents on the chances of recurrence in future pregnancies. The parents then have the choice of avoiding further pregnancies or accepting the risks as stated.

This situation is naturally far from satisfactory, but improved methods of dealing with this problem will become available provided the appropriate research is done.

Professor Liley, of National Women’s Hospital, has already clearly demonstrated that the unborn child can be treated for some diseases, as shown by the development of his technique of giving blood transfusions to unborn babies.

The whole field of inherited diseases resulting in disordered body chemistries is one which is advancing rapidly, and which involves everybody. It is essential for everybody that the work continues.