‘Don’t let our children die’

IT was 20 years last Friday since the signing of the United Nations Declaration on the Convention on the Rights of the Child.
This Declaration spells out the basic human rights that children everywhere should have: the right to survival and highest attainable standard of health; to develop to the fullest; to protection from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life.
If you were to board a plane at 7 o’clock tomorrow morning from any east coast capital city, by just after midday you could be in a country where death rates for children are 10-15 times higher than for Australian children.
In East Timor, for every 1,000 children born, 97 will die before their fifth birthday. In Papua New Guinea, 57 of every 1,000 children born will die before they turn one, and a further 18 by five years. In Australia, less than five children out of every thousand born die before their fifth birthday.
In these days of globalisation, freedom of travel and cooperation on so many things between countries, this can’t be allowed to continue.
Regionally, Australia cooperates closely on trade because it is important for our shared financial future. We work together on security to ensure regional stability.
So why don’t we put as much effort into cooperating on what is really our shared future ñ the survival, health and education of our children?
I am a paediatrician, and a father, so I’m biased. I have worked for the last 13 years with developing countries in the region, particularly in PNG.
In the first two years I worked in PNG, I saw over 350 children die. These children died from common diseases that you rarely see in Australia now ñ diseases such as pneumonia, meningitis, measles, malaria, tuberculosis, malnutrition, and infections in the newborn. These diseases are all preventable or treatable. The children died because their mothers received no care when giving birth, or the kids didn’t receive their vaccines. They died from malnutrition, from social dysfunction and poverty, or because their parents waited too long before bringing them to a hospital to be saved.
I recall vividly a small girl who was brought from a remote village to a health clinic one night. She had a very bad lung infection, and the hospital was out of oxygen. The little girl spent the night in this hospital, gasping for breath, her mother at the bedside, the health workers doing what little they could with the resources available. Then because the ambulance was broken down and there was no means of communicating, the mother brought the baby on a bus to the regional centre of Goroka, where the main hospital and the only source of oxygen was. The little girl arrived blue, floppy and gasping for breath. But it was too late: despite treatment she died in the first hour  I was with her.
I decided then that we should make more efforts to ensure that oxygen and basic treatment was available to all children with pneumonia and other serious illnesses.
In 2004, the Paediatric Society of PNG and the Department of Health started a program for providing oxygen in hospitals, which now runs in 17 hospitals in PNG. This has reduced death rates for pneumonia by 35%, saving hundreds of lives.
Because of great and varied efforts by many people, child mortality rates in PNG are falling, by as much as 20% over the last ten years. There are multiple reasons for this.
Many more young Papua New Guinean paediatricians have been trained, and are leading child health in the provinces. The National Department of Health has just endorsed a Child Health Policy and Plan. This outlines a comprehensive approach to measures that will further reduce child deaths and improve health and development. This policy and plan should be supported by all agencies, locally and internationally.
There is improved vaccine coverage and new vaccines against pneumonia and meningitis. Vitamin A is more widely available to address malnutrition, and there is increased use of bed nets to prevent malaria and other mosquito-borne infections.
Importantly, there is improved education for girls. Just by letting a girl complete primary school, the chance of her later having a baby who dies is less than half as much as if she has no schooling.
Most of these measures were not in PNG 13 years ago when the mortality rate among children up to five years was over 10%.
Now the death rate for children up to five years is 7.5%, still 10-15 times higher than in Australia, but this improvement represents the saving of more than 4,000 lives each year. There are some very good stories, and reasons for optimism.
But much more must be done. There is a great need for better care for pregnant mothers: there are more women dying in childbirth in PNG now than there were 10 years ago. Improved nutrition would have a dramatic impact on survival rates for both children and mothers, particularly from pneumonia and diarrhoea.  Pneumonia deaths will be further prevented by reducing environmental exposure to smoke and introducing a vaccine that has been available in Australia for several years.  Diarrhoea could be reduced by better use of oral rehydration solution and zinc.
The solutions are usually not very technical. Pacific governments are working hard to implement such changes ñ Australia must continue to support these efforts, financially and with expertise.
The solutions are all about people. By training nurses, doctors and teachers, building strong communities, and encouraging effective policies and responsive, compassionate governments, we can make a real difference for mothers and children in the Pacific.
I don’t think Australia completes our full obligations to the Convention of the Rights of the Child just by providing these services for the children who live within our national borders. As a prosperous, lucky country, we have a moral obligation to assist our neighbours in implementing the CRC and achieving the Millennium Development Goals. Civil societies in Australia and the Pacific have important roles to play, directly, and in demanding more from our governments.
There is an African saying that “the best time to plant a tree was 20 years ago, the second best time is now”; such as it is for the CRC, and for Australia’s role in improving child health in the region.

* Professor Trevor Duke is Director of the Centre for International Child Health at the University of Melbourne, and a paediatrician at the Royal Children’s Hospital. He is Adjunct Professor of Child Health at the University of Papua New Guinea, and formerly a paediatrician at Goroka General Hospital.