New hope for the children

PEETER KOPVILLEM February 3 1986

New hope for the children

PEETER KOPVILLEM February 3 1986

Their pleading faces haunt the dark side of the Western world’s conscience. For visitors to the developing world’s poor countries, they are the ragged waifs begging for a few pesos, cruzeiros or rupees. For most, the images of children in want, or dying of preventable diseases, are disturbingly documented on television in the faces of famished African infants, orphans of Asian wars or abandoned urchins in the streets of Latin America. The wealthy world has been moved as never before—last year Canadians privately donated $65 million toward African famine relief alone. Now, child health authorities are convinced that a new global crusade using simple but potent remedies will save millions from needless pain and early death.

Daunting: The challenge of the children’s plight is staggering. Of the world’s 1.6 billion children under age 15, fully 21 per cent—343 million—live largely impoverished lives in developing countries. Most of them suffer from malnutrition. Child mortality statistics in the poor world are grim. While in Canada the mortality rate for infants in their first year is only nine per thousand, in the perennially parched African republic of Mali the rate is 180 of every 1,000. Worse, the United Nations Children’s Fund (UNICEF) reports that 15 million children under the age of 5 die every year, many of them from preventable diseases. For those who survive, the prospects are still daunting. Widespread malnutrition stunts growth, intelligence and productivity. Lack of vitamin A—the result of dietary deficiencies—results in blindness in about 250,000 children a year.

Still, there is now a new sense of optimism among Western aid workers. Said David Morley, executive director of Toronto-based Pueblito Canada Inc., a charitable organization that works with children in Costa Rica and the Dominican Republic: “There is a child survival revolution.” Indeed, UNICEF’s most recent report, The State of the World’s Children 1986, says that revolution-based on simple, cheap and effective methods—has the potential to save 7.5 million Third World children a year. Universal immunization can virtually eradicate measles, whooping cough, tetanus, diphtheria and polio, which between them kill about 3.5 million children annually.

At the same time, oral rehydration therapy (ORT)—the administration of a salt, sugar and water solution to children, usually by their parents—can effectively counter the effects of diarrhea-induced dehydration, which kills as many as four million children each year. Central to the program is education: helping Third World parents watch for signs of illness or malnutrition which can often be cheaply remedied.

Agonizing: In fact, UNICEF estimates that increasing immunization is already preventing up to a million child deaths a year. More than 40 countries—containing two-thirds of the developing world’s children—have announced that they will implement universal immunization by 1990. In some countries the results have been spectacular: since instituting its National Vaccination Days in 1980, Brazil, for one, has significantly reduced the incidence of polio. Before 1980 the disease paralysed 2,000 children a year. That number has dropped to less than 40. Protection against measles for Brazilian children under 1 now stands at 80 per cent compared with 58 per cent in 1978. And immunization against diphtheria, whooping cough and tetanus is up to 67 per cent from 39 per cent.

Those results—also evident in other countries—can save children from the ravages of diseases that have been all but eliminated in the Western world. Whooping cough, for one, which did not take a single Canadian child’s life in 1983—the last year for which statistics are available—still kills 600,000 Third World children a year. Their deaths, as described in the UNICEF report, are agonizing: “Weakened by vomiting and coughing, struggling to breathe through lungs blocked by mucus and food, the child begins another fit, uncontrollable coughing pumping the air unremittingly from the lungs, finally forcing the chest to collapse, slumping the child forward until the fit ends. Only this time, the child does not breathe in.”

Campaign: No less dramatic than the spread of immunization is the rapidly increasing use of ORT, a simple and effective treatment for diarrheal dehydration. The method is already saving more than 500,000 Third World children a year. It replaces fluids in a child’s body lost through diarrhea, which is usually caused by water-borne bacteria. More than 170 million packets of premixed ORT solution are available worldwide. If packets are unavailable, parents can be taught to prepare their own. Egypt, where 80,000 children die every year from dehydration, began a campaign in 1983 to promote ORT throughout the country. More than 4,000 health clinics have since started ORT centres to administer the substance and instruct parents in its use. In trials done in the city of Alexandria in 1983, the child death rate was reduced by 30 per cent. Egyptian authorities say that when the nationwide campaign ends in 1987 they expect the country’s child mortality rate of 100 deaths per thousand births to be reduced by 25 per cent.

Just as important in the battle to save the developing world’s children is the need to train local health volunteers to offer advice on simple ways to improve nutrition and health. One method is the addition of high-energy fat, oil and mashed vegetables to a weaned infant’s food to counter the danger of malnutrition. As well, breast-feeding has increasingly replaced the use of artificial milk formula.

Volunteers: The use of volunteer health care workers has expanded rapidly in some developing countries. In Indonesia almost one million local volunteers—called kaders—now work in more than 40,000 of the country’s 67,000 villages. In Thailand about 500,000 trained village volunteers have brought primary health care to 95 per cent of the country’s 56,000 villages. Indeed, UNICEF’s 1986 report poses a challenge to the rest of the world to build on those impressive results. Concluded the report: “Present knowledge holds out the opportunity to provide, for the first time, a basic minimum protection for the lives and growth of all the world’s children and to do so at a very low cost and in a very short time.”

Fragile: The message is one of hope—but the overall picture is still colored with despair. For one thing, even if UNICEF’s optimistic projections are realized, at least 7.5 million children under the age of 5 will continue to die every year. The survivors will inherit a world filled with major problems. Because of accidents of geography, Third World countries are prone to disasters that serve only to further destabilize a child’s already fragile existence. Drought and famine now hold large parts of the African continent in a cruel stranglehold, and experts say that the situation will worsen as the Sahara desert continues its inexorable advance southward. The devastation wrought by the Mexican earthquake last September is not an exception—most of the earth’s natural violence occurs in the Third World.

Warfare, in which children are often innocent victims, is also a Third World fixture. Of the more than 120 nations that make up the developing world, 43 are now or have recently been involved in war or civil strife. In Lebanon, where children have grown up with bloodshed since that country’s civil war began in 1975, psychologists have observed that many have developed symptoms of depression and an inability to concentrate. In El Salvador, where government troops and rebel guerrillas have battled for more than five years, as many as 200,000 children have been orphaned—many of them suffering psychological damage after witnessing the torture or murder of family members. Said Toronto Western Hospital staff psychiatrist Dr. Federico Allodi, a member of the Canadian Centre for the Investigation and Prevention of Torture: “If an alternative family bond is not established, these children have a great possibility of becoming delinquent or disturbed.”

Still, the most pressing problem facing the developing world is grinding poverty. From the shantytown favelas of Brazil to the malaria-infested villages of equatorial Africa, an estimated 25 per cent of the developing world’s children are perpetually deprived of adequate food and other necessities. In many rural areas of Africa farming families carve out a marginal existence on land fast turning into desert. In Bangladesh and other Asian countries the practice of dividing property among many heirs has resulted in the cultivation of small plots of land that simply cannot sustain them. Many compete for the small number of farm labor jobs available from larger landowners. Others join the flood of migrants to city slums, from Bombay to Mexico City.

Jobless: But urbanization does not lead to the creation of new jobs, and there is little improvement in living conditions. In the Kenyan capital of Nairobi, whose population of one million is growing at about seven per cent a year, makeshift one-room structures patched together out of cardboard and plastic sheets provide about a third of urban housing. Without such essential services as water, basic sanitation and refuse collection, the slums are home to most jobless rural immigrants. Their diets are inadequate, and malnutrition is passed from mother to child during pregnancy. In turn, the malnourished children—beset by physical illness and rooted in poverty—also produce malnourished children.

Brazil, for one, regularly rejects about half of the young men who report for military service each year. The reason: they are physically below standard, a result of malnutrition that began in the mother’s womb. In the impoverished northeastern Brazilian state of Sergipe, children are on average five inches shorter than those from wealthier Sào Paulo. Said Frederico Augusto de Lima e Silva, a doctor at the Alberto Sabin children’s hospital in Fortaleza, in northeastern Brazil: “We are creating a race of idiots with almost no intellectual capacity because protein intake during pregnancy is vital. We call these children abestado—reduced to beasts—because they will never learn to write and will be condemned to delinquency or prostitution in the cities.”

In fact, some do become prostitutes—often following the example of mothers who can find no other means of earning an income. Said Anne-Brit Nippierd, an officer of the Child Welfare Society of Kenya in Nairobi: “Prostitutes put their children on the streets while they are working at night. A lot of girls start plying their mothers’ trade at the age of 10. They are expected to bring home some money, no questions asked.” Others turn to petty crime. But all are part of the growing army of street urchins who plague most Third World cities. In Latin America and the Caribbean alone, an estimated 40 million children spend most of their time on the streets.

Many of them are orphans, runaways or abandoned children. Others eke out a marginal but honest living to supplement the meagre incomes of their families. The number of working children in the developing world is uncertain, but in India government officials estimate that as many as 44 million children work—carrying water, shining shoes or selling pens—to survive. And working conditions are often inhumane. In a recent and widely publicized case in India, a local barber enticed 27 boys between the ages of 5 and 10 away from their village in a primitive part of northern India. Among the promises: a free film show and 10 rupees—about $1. Instead, they were driven to a town in Uttar Pradesh and put to work making carpets—for no pay. If they complained during their 20-hour workdays, a foreman would beat them.

Cured: Indeed, poverty-stricken parents often seek such employment for their children. In Kenya rural parents send their offspring to urban areas where they work as nannies for as little as $80 a month. In India parents use their children’s labor as collateral for private loans. Said Tara Ali Baig, former president of the Indian Council for Child Welfare: “In almost every case there is a nexus between the parents and the employer. A child is an integral part of the family’s economics and has always been a worker in a rural family. That pattern doesn’t change if they come to live in a city slum.”

Spokesmen for some Western relief agencies say that unless the social abuse of children is cured survival through medical remedies and improved nutrition means little. OXFAM Canada, an international development organization, concentrates on community self-help projects in Latin America, Africa and the Caribbean. Said OXFAM’s Mary Corkery: “You cannot live on rehydration salts.” Another such agency is CARE Canada, which funds agriculture education programs in Kenya and Nicaragua designed to help children learn garden farming and small-livestock production. Said CARE’S Patricia Shapiro: “The basic idea is to make it possible for kids to make a living where they are and stem the flow of people into the city slums.”

Those programs, however, cannot address the developing world’s continuing problem: too many people straining limited resources. And as developing countries struggle under the burden of their more than $1-trillion debt to the developed world’s banks and governments, demographers say that the globe’s population will double by the middle of the next century. Still, they add that advanced health care and a decline in infant mortality will stimulate a decline in birth rates as parents, more sure of keeping the children they have, settle for smaller families. The UNICEF report points out that China, Sri Lanka, Costa Rica, South Korea and Singapore have all accomplished this.

Those countries, however, have long-standing family planning programs. In other countries cultural obstacles must be overcome before the birth rate declines. Egyptians have resisted planned parenthood campaigns, although the country’s infant mortality rate has been reduced from 185 per thousand births in 1960 to 100 in 1983. One reason: large families are a source of pride.

Pregnant: Relief workers say that ultimately a fundamental restructuring of the world’s economy is necessary: the developed world must be prepared to pay fair and stable prices for Third World products to ensure an adequate flow of capital—even if it involves some degree of sacrifice. As well, more relief is needed, and priorities will have to change, experts say. The United States, the world’s single largest source of foreign aid, will hand out $12.7 billion for each of the next two fiscal years. Much of the money, though, is earmarked on the basis of political alliance: Israel will receive $3 billion a year, Egypt $2.1 billion. Declared Peter Taçon, UNICEF’s senior adviser on child development, who works with street children around the world: “There are kids out there behind the numbers. We’re part of the problem.”

Still, governments are chipping away at problems that compromise the future of the world’s young. Last November Brazilian President José Sarney announced a program to eradicate the country’s worst poverty within four years. Among the planned measures: food subsidies for the poor and extra food and medicine for needy pregnant mothers and for children up to age 4. Whether the campaign will adequately address the monumental problems remains in doubt. Vultures still circle over the sun-parched streets of Fortaleza, where small children pick through mountains of trash, pausing now and then to retrieve an edible morsel. For them, and for millions of the Third World’s children, relief—if and when it arrives—may come too late.