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ICHG Winter Meeting Workshop Audience Poll Medical Foundation Paediatric student doctor trainee SAS doctor Other Tell us what Consultant Retired healthcare we have professionals forgotten...Where are you based?What is inequality? Please type your thoughts in the comments boxHave you seen the impact of any inequality at work? If so, please tell us in the comments box • UK, defined as living in a household with ann the income less than 60% of the median household RCPCH income • Infants in the 10% most deprived areas are twice as likely to die in infancy as those in the Facts: 10% least deprived • For each increase in decile of deprivation, the relative risk of mortality increases by 10% Poverty in • Over a fifth of the 3,200 child deaths in England between April 2019 – March 2020 might have been avoided if children living in the the UK most deprived areas had the same mortality risk as those living in the least deprived • Between 2011 and 2020, the child death rate Wales compared with the least deprived areas RCPCH Facts: Impact on Health Children living in poverty are Healthy foodsare nearly three significantly morelikely to suffer Children living in the poorest20% times moreexpensive than less They are significantly morelikely of householdsin the UK are four means families may be more likely to require hospital admissionand times morelikely to developa to eat foodthat is cheap but were 72%more likely than other mental disorderas those fromthe nutritionally poor,leading to children to be diagnosedwith a wealthiest 20% obesityand malnutrition in long-term illness. children Children in low-income families have lessaccessto the medical Living in a cold home has a care they need.The average cost negative impacton physicalhealth of attending a clinic appointmentis by, respiratoryillnessesing £35-50due to travel, parking, food,childcare costsand potential lossin earningshttps://www.rcpch.ac.uk/key- topics/child-health- inequalities-povertyClinical CasesCase 1 – Emergency Resuscitation in Sierra Leone • 2-year-old girl in resus • Brought with fever and reduced consciousnessCase 1 continued A: snoring and unresponsiveCase 1 continued A: snoring and unresponsive B: severe increased work of breathing, RR 50, SpO2 unavailableCase 1 continued A: snoring and unresponsive B: severe increased work of breathing, RR 50, SpO2 unavailable C: HR 160, CRT 5 seconds centrally, cool peripherally, no pitting oedema, no wasting, no palmar pallorCase 1 continued A: snoring and unresponsive B: severe increased work of breathing, RR 50, SpO2 unavailable C: HR 160, CRT 5 seconds centrally, cool peripherally, no pitting oedema, no wasting, no palmar pallor D: unresponsive, pupils sluggish, BM unavailableCase 1 continued A: snoring and unresponsive B: severe increasedwork of breathing, RR 50, SpO2 unavailable C: HR 160, CRT5 seconds centrally, cool peripherally, no pittingoedema, no wasting, no palmar pallor D: unresponsive, pupils sluggish, BM unavailable E: convulsing, temperature39.3, no rashes • Emergencies common in low resource settings – late presentation and barriers to healthcare • Resource limitations in healthcaree.g. equipment unavailable, lack of staff Case 1 • cases e.g. ETAT+ (Emergency Triage, Assessment and Treatment plus) Discussion • Febrile child – always think malaria • Consider malnutritionand anaemia • Emergency Triage, Assessment and Treatment plus (ETAT+) - online learning | RCPCHCase 2 – Traditional Medicinein South Africa • • • •Case 2 continued A: Alert but drowsyCase 2 continued A: Alert but drowsy B: Mildly increased work of breathing with normal oxygen saturationsCase 2 continued A: Alert but drowsy B: Mildly increased work of breathing with normal oxygen saturations C: HR 120, CRT 7 seconds, poor skin turgor/‘skin tenting’, no oedemaCase 2 continued A: Alert but drowsy B: Mildly increased work of breathing with normal oxygen saturations C: HR 120, CRT 7 seconds, poor skin turgor/‘skin tenting’, no oedema D: Drowsy with normal BMCase 2 continued A: Alert but drowsy B: Mildly increasedwork of breathing with normal oxygen saturations turgor/‘skintenting’, no oedemakin D: Drowsy with normal BM E: No temperature, signs of malnutrition Malnutrition Multistep approach Look up local/WHO guidelines Sagoma = Traditional healers or ‘Witch doctors’ ⚫ Important cultural role in communities ⚫ Often give ‘muthi’ (medicines made from plant/animal/minerals with spiritual significance) ⚫ Can have harmful side effects! ⚫ E.g. soap enemas in diarrhoea and vomiting⚫ Estimated to be 200 000 traditional healers in South Africa compared to 25 000 doctors ⚫ Easier accessibility for rural population as based locally ⚫ Many barriers prevent patients accessing hospitals e.g. high cost and transport issues ⚫ Potential role in identifying early signs of illness with training → Can signpost sick patients to clinics/hospitalsCase 3 – Unaccompanied asylum seeker in the UK 16 year old boy from Vietnam Looked After Child Clinic in UKCase 3 continued Points to consider before meeting the child? – please comment in chatCase 3 continued • Points covered in the health assessment include: • General health – concerns, wishes, eating, sleeping, interests, friendships, aspirations • Current living circumstances – how long and how it’s going • Journey to UK – reasons for leaving, route taken, experiences en route, entry point • Medical health – vision, hearing, PMH, DH, FH, allergies, imms, birth, health teams • Social history – abuse, neglect, domestic violence, lifestyle • Emotional health – mood, behaviour, bullying, bereavement • Safety – smoking/e-cigarettes, alcohol, drugs, domestic violence, sexual exploitation, FGM, radicalisation, forced marriage, self-harm • Health promotion – washing, dental hygiene, diet, weight, exercise, relationships, puberty, sex, substance misuse • Functional assessment – education, self-care and independence skills • Examination – general, growth, oral, ENT, eyes, resp, cardio, abdo, neuro, MSKCase 3 continued • Statutory paperwork completed with youngperson with virtual professional translator • occasional headaches, eating ok, thinks lost weight on journey • Current placement – semi-independent accommodation past 2-3 weeks, weekly social to other Vietnamese people sports days, speaksCase 3 continued • Journey to UK – • Forced to leave Vietnam 3 years ago as family had taken a loan via a “loan shark” and were unable to pay it back • Trafficked to China by car and forced to work for around 2 years pressing plastic/collecting metal/bins including long hours and physical abuse • Taken on plane from China then cars/lorry but unsure where/how transited - generally in a group & crowded conditions, forced to smoke cigarettes that may have “contained something”, never injected • In UK, forced to grow cannabis & beaten with wires • Escaped out of window & police alerted by publicCase 3 continued • Medical history – eyes tested two weeks ago and given prescription, never had hearing tested, normally well, duecatch-up immunisations • Social history – mother died when young, father died in an accident shortly before he left Vietnam, denies domestic abuse/drugs/alcoholin past • Emotional health – low mood, nightmares, no suicidal ideation, referred to Barnardoself-harm, noCase 3 continued • Safety - no smoking/vaping/drugs/alcohol,cash from council for food, unsurehow to count change • Health promotion – showers & brushes teeth daily, prepares 3 healthy meals daily, exercise, not sexually active, learning Englishand taking cooking classes • Functionalassessment – washes/dresses/cooks, difficultycountingmoney, aware of how to access health services & help from support/socialworkers th th • Exam – weight 9 centile, height 25 centile, systems NADCase 3 discussion • All children new in care have statutory Initial Health Assessment (shouldbe completed within 28 days) • Summary provided to social care with health recommendations for care plan (health need, SMART action required, deadline and person responsible) • Ongoinghealth reviews every 6-12 months • Refugee and asylum seeking childrenand young people - guidancefor paediatricians | RCPCHCareers in Global Health Webinar Tuesday 19th July 18:00-20:00 BST Webinar Series Education and Training Series: Crafting a Career in Global Child Health: for Trainees We will be covering: • Pathways and possibilities to gain experience as a trainee and beyond • Practical aspects including revalidation and finances • Impacts on personal and professional life, including bidirectional learning Speakers: • Prof. Elizabeth Mason – Prior WHO Director Maternal, Newborn, Child & Adolescent Health • Prof. MD Ravi – Professor of Paediatrics & Director of Research in Mysore, India • Dr. Joe Langton – PEM Consultant in Liverpool, PG Lead for Paediatrics in Blantyre, Malawi • Dr. Rathi Guhadasan – Director of Medical Education in Laos & Cambodia Teaching Hospitals • Dr Michael Malley – PEM Consultant in Bristol, MSF in Middle East & North Africa Webinar available on ICHG website and YouTube Education and Training Webinars Please suggest topics for our 2024 Series Preferred Time? LUNCHTIME EVENING WDAYTIMEAny Questions?