Sally Becker, founder of British based charity Road to Peace, has been helping children in areas of conflict since 1993, bringing the injured across front lines to safety, creating mobile emergency paediatric units and arranging evacuations for children in need of specialist treatment.
Whilst humanitarian organisations like Road to Peace can make a huge difference, lives are often lost due to a lack of specialist insight and instruction in the most critical moments. In areas where the healthcare infrastructure has been damaged, access to paediatric expertise is limited, which can lead to suboptimal treatment. Children with acute or chronic illnesses are often equally at risk as those with traumatic injuries and the high mortality rate of these patients suggests that untreated medical conditions can often be more lethal than the weapons of war.
With the advent of communication, remote medical technologies are becoming more commonplace and in 2017, Sally enlisted the help of a team of paediatric specialists to help diagnose and treat children remotely. The concept was tested during a mission to Northern Iraq where many children benefited from the online consultations.
Following the success of the mission, Sally founded Save A Child and is building a global network of paediatricians and paediatric specialists ready to assist remotely.
Armed conflict affects one in ten children globally and over the past few decades many urban areas have become direct targets, producing large numbers of casualties that outstrip the ability of healthcare infrastructures to provide adequate care by medical professionals with expertise in paediatric emergency medicine.
Children with acute and chronic medical conditions are often equally at risk as those with traumatic injuries and the high mortality rate of these patients suggests that untreated medical conditions can often be more lethal than the weapons of war.
Medical care for children requires a specific skill set and the old adage still holds true that 'children are not small adults'. Humanitarian agencies provide tremendous support but field medics often lack the specific training required to support infants and children during critical events and lives are lost due to a lack of paediatric expertise.
Up to 80% of children presenting to hospitals in conflict areas are suffering from penetrating trauma to the head due to shelling, shrapnel injuries and gunshot wounds. Medical care focuses on preventing further damage from swelling of the brain or bleeding and monitoring of the brain activity, which only a team with knowledge of specialised paediatric care can provide.
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Children have a unique anatomy and physiology which, if not acknowledged by the medical team, can lead to life threatening pitfalls in their treatment. For example a child's ribcage is still flexible (made of cartilage instead of adult bone), which allows any sudden impacting forces to be transmitted to the chest organs (heart, lungs, major vessels). Following a blast injury and even in the absence of any rib fractures, the child could have sustained severe damage to their heart and lungs, requiring acute and life saving procedures such as placements of tubes directly through the ribcage to drain any blood or air.
When a child has suffered a burn injury or loss of blood, it is crucial to give intravenous fluids, however too much or too little can be fatal. Estimating the amount of fluid that is needed has to be done immediately, based on the child's weight, without using scales and by a doctor trained in these calculations. Placing intravenous access (drips, lines) to give fluids and medications is much more difficult in children then in adults due to their smaller size and differences in anatomy so guidance to find appropriate sites is needed. Shock can be difficult to recognise in children due to their ability to compensate for fluid loss. This can create a false illusion of stability, which if not recognised and treated appropriately, will be followed by a precipitous deterioration and death.
In areas where the health infrastructure has been damaged, more fatalities occur due to disease and other factors than to battle. Children require treatment for all kinds of acute or chronic illnesses but without an effective healthcare system and dedicated paediatric care, common paediatric conditions (for example asthma) can't be treated and children die from preventable diseases like respiratory tract infections, diarrhoea, malaria and vaccine preventable diseases. A paediatrician can also advise on children suffering from dehydration or severe acute malnutrition and can suggest alternative treatments when supplies are not available/sufficient.
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