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Child poverty - a medical student’s perspective

Guest Blogger Frances Oliver is a fifth year medical student at The University of Auckland and a General Executive of the Paediatric Interest Group.   She recently shared some experiences from her paediatrics attachment at a CPAG and Auckland University Medical Students Association event.  Patient details have been changed for confidentiality. 

I met a Pākehā family of four whose toddler suffers from a chronic lung disease.  This family live in their Auntie’s garage.  The garage has not been converted into a sleep-out.  There are mattresses on the floor next to a washing machine, freezer, and lawn mower.  For a child with a lung disease to be sleeping in cold, damp, debris filled air significantly increases their risk of chest infections and permanent lung damage. 1  They struggle to pay for power required for their son’s nebuliser necessary for his treatment.  I was shocked to meet a family living in such poor conditions.  They suffer from material hardship, the kind of poverty I used to associate with overseas, not right here in our own backyard.  But sadly, 18% of New Zealand children live in families like this. 2 In absolute numbers, that is the population of Hamilton going without essentials.

Not surprisingly, the boy keeps getting deterioration of his disease.  Last year, he was hospitalised four times.  The hospital now plans for him to come in every three months, for up to two weeks at a time, for intravenous antibiotics, knowing when he goes home, his lungs get worse.  Even if as a doctor you are doing your best while the boy is in hospital, the improvement you can make is limited by the home environment.  Poverty is a multidimensional issue, and it effects can’t be fixed just by a single solution, or the right antibiotic.

If you wanted to make a difference for the child, he would need an affordable, warm, dry home – a challenge to find in Auckland’s current housing situation.  The family have been waiting for a Housing New Zealand house for six months! How can someone with so much need for a warm home environment not be higher on the priority list?  But the sad reality is that there are 3188 families with the same level of need as this one. 3 Even if decisions are made on economics, it makes more sense to improve the living situation, rather than pay for lengthy hospital admissions every three months for the rest of this child’s life.   

Another frustration I felt for this family was that they couldn’t attend outpatient appointments.  Why? Simply because the appointments were scheduled for the day before pay day, meaning the family had no money left for petrol.  This family showed me what ‘difficulty accessing care’ looks like.  The barriers we learn about: living in a rural community, the language barrier, not having a car, don’t apply to this family, yet they still have difficulty accessing health care.

This is an everyday example of the poverty cycle.  This child needs chest physiotherapy and medication at every meal and because of this, no day-care will accept him.  As a result, mum is the fulltime caregiver and unable to take up paid work. Even if mum was to get a job, the family could remain in poverty.  Unfortunately, working is not a guaranteed way out of poverty, as half of children in hardship have parents who work. 2 This financial issue also affects the education of the older sibling. When her brother is in hospital she stays with extended family members and is often unable to get to school. 

During my attachment, I saw great hospital medicine.  The right diagnosis was made.  The right antibiotics were given.  But for families living in poverty, this is not always enough to improve children’s health.  Even the best hospital care will be ineffective if the political, social, and economic factors that affect health are not addressed. 

References

  1. Thompson H, Thomas S, Sellstrom E, Pettigrew M (2013) ‘Housing improvements for health and associated socio-economic outcomes.’ Cochrane Database of Systematic Reviews,(2)
  2. Ministry of Social Development (2105) Household Incomes in New Zealand: trends in indicators of inequality and hardship 1982 to 2014, Wellington: Ministry of Social Development
  3. Johnson A. (2013) Give me shelter – An assessment of New Zealand’s Housing Assistance Policies, Auckland: Salvation Army Social Policy and Parliamentary Unit