From sick kids to SicKids

Faculty of Forensic and Legal Medicine (FFLM) – 29 October 2016, London

 

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Ladies and Gentlemen; Chairman; thanks for inviting me to talk to you today.

 

I’m going to take you on a journey. A journey that begins in Salford and returns to Salford. A journey that has started international collaborations and new projects within the UK. A journey that involves adults, children and young people from around the globe.

 

And a journey that I hope will encourage you to Travel to Learn and Return to Inspire. That journey will help you to understand how, with a few ideas, with a great deal of enthusiasm and with commitment to succeed we can all help to turn sick kids in to SicKids.

 

By engaging with other communities be they in our own countries or around the globe and by fully involving children and young people in decisions that are made about them to become decisions that are made with them, we will better protect children and young people in the future. But we can’t do that sat behind our desks – we have to engage with children and young people in an environment that they consider to be suitable to talk to us.

 

Child abuse and neglect has always occurred. In Roman times children were considered as chattels – items of property that their Father’s could sell, use and, looking back into history, abuse. We know that 50% of one year olds are hit weekly by a parent here in the UK. We know that each week at least one child dies from cruelty and we know that sexual abuse is rife amongst communities.

 

Right now, right here children and young people around the world are being abused and neglected by the very communities who ought to be caring for them, ought to be helping them to develop and ought to be providing a stable environment in which they can grow up to lead the lives that they wish to.

 

But the stark reality of the situation is that tens of thousands of children and young people throughout the UK are suffering from abuse and neglect. So, what are we going to do about it? The Winston Churchill Memorial Trust is an amazing organisation I’ve had the privilege of being associated with since the latter part of 2013. A charity set up on the death of Sir Winston Churchill in 1965, they now fund around 150 British Citizens each year to travel abroad, gain new skills and knowledge and to return to recommend how our society can change for the better here in the UK.

 

Or, put more simply, you can’t stay in your corner of the forest waiting for others to come to you. You have to go to them sometimes.

 

On a journey that took me 35043 miles, to nine different cities in six different countries I have had the most amazing professional experiences that have, I believe, changed my career forever. In my report, Living on a Railway Line, that was launched at MediaCityUK, I’ve made key recommendations to turn the tide of child abuse and neglect in the UK and overseas. Recommendations that I’m really delighted have been grasped by a number of organisations and we are starting to see implementation.

 

It was a community, living beside a railway line, that I met whilst I was travelling in Cambodia, that inspired the name of my report because some communities are physically living on a railway line and some communities and individuals back here in the UK are metaphorically living on that railway line never sure where the next insult to their emotional or physical integrity is going to come from.

 

The communities I’ve visited, the people I’ve met and the experiences I have had have very clearly taught me that we have to do something different here in the UK if we are ever going to make a difference to the lives of children and young people.

 

But understanding the key reasons in society WHY children are abused and neglected is the key to preventing it.

 

It is beholden upon us all in society to recognise the vulnerabilities that exist within our communities and to do something about them.

 

But, looking critically at the those themes we have just watched, am I really suggesting that they are transferrable to here in the UK? Am I really suggesting that children here might be being sold?

 

Well, maybe not for $300 as you have just seen. But you only have to look at some of the learning from, for example, the cases in Rochdale to realise that these themes are not a million miles, not a thousand miles, not even a few miles away from the parallels we have seen in cases here. I have no doubt that children and young people ARE being used as a form of currency here in the UK and that is something that our society has to put a stop to.

 

The learning from work overseas has been immense ever since I launched our partnership between Salford University, my NHS Trust and M’Lop Tapang a social development organisation in Cambodia.

 

That partnership, to improve the health and social care of children and young people living on and around the streets and beaches of Southern Cambodia, continues to go from strength to strength.

 

When I first announced the partnership we have been developing a colleague of mine said, “well, that’s a one way partnership I suppose” seemingly indicating that knowledge transfer would be unidirectional – from the UK to Cambodia.

 

He couldn’t have been more wrong.

 

M’Lop Tapang envisions an environment where all children and young people are allowed to grow up in their families feeling safe, healthy and happy; a society where all children and respected and treated equally; a community where all children and given choices about their future.

 

M’Lop Tapang provides a complete range of services for children, young people and families where statutory services are absent and there is no possibility of their introduction.

 

I think that there are seven key steps to better protecting children and young people in the future. At the core of many of these ideas is your role as a community leader – not just a clinician – and I’ll come back to that later.

 

As I’m talking to you I’d like you to be thinking about what it is that you can do, either in your own communities or as professionals, to implement these seven steps to reducing abuse that we’ve come to realise from our work abroad and here in the UK.

 

Taking things in no particular order.

 

Education is one of the most important things that we as a community can do to try and change the way that our society views children and young people.

 

We know that missing from education is a risk factor for child sexual exploitation, but we need to take a step back and consider in much more general terms, the impact that increased educational levels can have on decreasing adverse opinions communities may have about children and young people so that they are seen more properly as the valuable members of our community that they are.

 

Because education really is the most powerful weapon you can use to change the world.

 

Increasing employment in our societies is something that leads to better economic and social development of those societies and, consequently, over time less poverty and less need for children to be involved in abusive situations through no fault of their own.

 

And increasing employment is something the sustainable team at M’Lop Tapang in Cambodia are fully aware of. With 200 staff, of whom 197 are from Cambodia, they have introduced a new programme in the region

 

In the case of Cambodia it is providing employment for parents so that they children can go to school, which helps to not only increase educational levels but also reset the social norm from not being in education or employment to the future where education and employment will go hand in hand, meaning that children and young people are less likely to be in situations where they can be harmed and are more likely to have developed resilience to protect themselves from risks in the future.

 

Poverty isn’t something that just affects children abroad, it is at the root of dealing with the chronic neglect that exists in our societies; neglect that has to be resolved for those same societies to become safe places for children to grow up in the future.

 

Poverty has to be tackled to give communities the economic foundation to build a better chance of a successful future and to give the children and young people in it every chance of happiness, every chance of good health and every chance of protection from harm.

 

We’ve got to remember that to some people this beach – Otress Beach in Southern Cambodia – is a place where there are calm waters, golden sand and idyllic sunsets. To others, it is their home.

 

I genuinely believe that if we were to decrease chronic neglect in society, and to fully recognise protecting children as a public health priority rather than child protection being a social problem, we would make a real difference.

 

Organisations working in the community on child abuse prevention programmes should incorporate material related to Adverse Childhood Experiences (ACEs) and provide community education, to adults as well as children and young people, about recognising these ACEs and minimising them in our societies.

 

For it really is easier to build strong children than to repair broken adults.

 

Whether or not you recognise it, you all – as clinicians working on behalf of some of the most vulnerable members of society – have a key role to play as a community leader.

 

Whether this is undertaking community outreach work or rural clinics for people who often cannot access healthcare resources in a clinic, hospital or health centre. And if you’d have seen me collapse through that platform as it gave way underneath me a few moments later you’d have seen that even with a language barrier a sense of humour still unites communities even from different parts of the globe. Here those clinics are in the jungle but the concept can apply wherever you practice.

 

The point being that sometimes you have to take your skills to where the community are prepared to engage with them.

 

It is not just your role in medicine that is important. You, as professionals – often respected by the community – have a key role to play to change, in the future, how those communities view children and young people living within them.

 

Although child labour has fallen by around one third, there are still 168 million children and young people around the world forced to work. I’ve seen at first hand through my work in Cambodia the effects that children having to work has on them and their communities.

 

Throughout the world neonatal and childhood mortality is still too high. But the learning from resource-poorer communities, who don’t have the facilities that we have access to here in the UK, can really teach us skills of rapid service improvement. The can-do attitude of the multi-professional staff at M’Lop Tapang is inspiring in its own right and if we could only transfer a little part of that back to here in the UK our health and social care system would be dramatically more efficient and sustainable.

 

The significant negative consequences of violence against children, using Cambodia as but one example, is a humanitarian disaster; but aside from the health and social consequences of such attacks on the physical and emotional integrity of some of the most vulnerable members of our society, the economic costs are staggering.

 

Fully recognising that those consequences will be having deleterious effects all throughout the world is a starting point to try and change the minds of those with political and financial responsibility who may be reluctant to invest new money now to better protect children and young people in the future, instead of face the economic costs for generations to come of failing to act today.

 

Building a better society for the future is easier, and more successful, if the building blocks are intact than it is if we are trying to rebuild a community after it has fallen.

 

Respecting children and young people for the valuable citizens that they are is one of the fundamentals tenants a society must abide by if we are to make any headway into reducing the abuse and neglect that they suffer from, wherever they live in the world.

 

Providing children and young people with the social scaffolding and social resilience to grow up stronger, and more able to launch a defence against the physical and emotional attacks that come their way, gives an opportunity for the whole community to network together to better protect the children within it and recognising the community-specific risk factors that exist within the individual society, which place children and young people at risk of harm of all kinds, is crucial to be able to address the issues.

 

That requires us to take a much more local approach to the specific vulnerabilities that exist within our communities and to tackle them at a grass roots level. The brilliant work by the NHS youth forum tackle those very issues and make sure that the voices of children and young people are properly heard in the NHS.

 

As my talk draws to a close I want to reflect on how some children and young people have really grasped the challenge of making a difference to our society themselves, where I work in the UK.

 

I want to introduce you a group of children and young people from Greater Manchester who are tackling the problem of child sexual exploitation themselves.

 

That’s Woolf and the other presenters standing next to me in the photo – and you’ll hear more from them just now.

 

Children and Young People, being supported by adults, and demonstrating the crucial role that peer to peer education has in building a brighter future for them all.

 

No matter what anybody tells you, it is words and ideas, such as the words and ideas of those children and young people, that can and will change the world.

 

What about making our communities safer?

 

Fully engaging with children and young people – so that they can co-design services aimed at them is key to helping them to protect themselves in the community in the present and the future.

 

There is so much we can learn from countries around the world who have introduced new schemes to protect children and young people – including the ChildSafe movement. A scheme launched in South East Asia that really gets back to basics to enable the community to better protect the children and young people who live within it.

 

With key components of peer to peer education, community education about child abuse prevention and recognition and accreditation of ChildSafe businesses; I believe a Child Safe UK pilot could be a new way of thinking about communities that might just reset the frame from some communities that tolerate the abuse and neglect of children to communities who actively respect the rights of children and young people and better protect them.

 

If we could replicate that in the UK ultimately we could create so many more communities where children and young people are actively protected from forms of abuse by the community itself.

 

Through proper engagement, real engagement not tokenism, we can work collaboratively with children and young people to involve them in decisions that are relevant to them and, in time, as children and young people develop more resilience to the factors acting against them in society, over time, the communities in which they live and the society in which these communities are placed will, ultimately, become a safer place for those children to grow up in.

 

Every child should have every chance of good health, every chance of happiness and every chance of protection from harm. Recognising the role you can play is vital to make our society a healthier, safer and happier place for children and young people to grow up in the future.

 

But what has all of my experienced taught me personally?

 

I said at the start that the award of my Churchill Fellowship, and the experiences that I have had since then, have changed my professional life for the better in a way that I could never have imagined. And having returned bursting with ideas of things we can do to make our society a healthier, safer and happier place for children to grow up in

 

I have now founded a brand new registered charity in the North West of England. A charity that has four great trustees who are as committed as I am to making our communities, both here and in Cambodia a better place for children and young people to live and prosper.

 

A charity that will support us delivering outreach healthcare in Cambodia, a charity that will help us to improve the development of children with disabilities by providing sensory room facilities, a charity that will allow children and young people themselves to remind the rest of the community that they still need protection and different forms of support even when others within that community fail to recognise them as still children, and a charity that will help to draw attention to, and combat, the adverse health consequences of homelessness.

 

With values that are crucial to ensure we act with equity and diversity, having just launched and become registered in October 2015, I very much hope that 2017 will be a good year for all of us and that we will be looking forward to exciting fundraising times ahead. With a goal to relieve sickness and preserve health the knowledge I’ve learned from abroad and applying it here in the UK can and will make a huge difference to children and young people living side by side in our communities with us. Being involved in this kind of work is vital to make our society a healthier, safer and happier place for children and young people to grow up in the future.

 

Because, what IS the use of living if it be not to strive for noble causes and to make this muddle world a better place for those who will live in it after we are gone?

 

The majority of children and young people in our communities are not abused. But what the focus of our efforts should be is to facilitate children and young people leading the lives that they wish to supported by communities and families. Recognising the early intervention that can improve health care experiences for children… Whether that is by providing outreach support to rural communities in Cambodia, by providing clinical and educational support, such as through our monthly skype clinics that we have now set up with the team in Sihanoukville, or by transferring and applying that learning from abroad to here in the UK, it is very clear to me that we can make a huge difference to the lives of children and young people in two geographically distant areas, but socially connected communities, and I know, from a very personal view, that my involvement with the team in Cambodia has developed me in a way I could never have imagined.

 

None of this would have been possible without the support of The Winston Churchill Memorial Trust and the Association of Paediatric Emergency.

 

It is global health work and bidirectional learning that will continue to improve the health and social care of children and young people in our communities and the global society in which they are placed.

 

Work that will, over time, help us to really turn the tide of child abuse and neglect in the UK and overseas, so that, in the future, starting in some small way, the day may dawn when fair play, love for one’s fellow human beings, respect for justice and freedom and intolerance of injustice will enable future generations, to emerge from the lives that they lead and would wish to change… and those young people who are the present and the future of our global society will be able to grow up, leading the lives that they wish to lead, better protected and in better health.

 

Thank you very much.

Sunrise over one of the most amazing archaeological structures on the planet.

Today began at 03:45am to see the sun rise over one of the most amazing architectural structures on the planet. Angkor Wat.

It is sad that this country had the capabilities to build something so incredible in the 12th century yet the country was practically destroyed in the 20th.

It’s been a fantastic two weeks:
Clinics in the health centre…


Mobile clinics with displaced communities…



Teaching health, education & social care staff children’s rights, first aid and recognition of abuse…


as well as a visit to the Royal Palace…

learning about the Khmer Rouge…


and land mines…


and a visit to the Angkor Archaeological Park.

Photos to follow but updates from the fortnight are here:
 https://drandrewrowland.wordpress.com
https://mobile.twitter.com/drandrewrowland
https://mobile.twitter.com/SicKidsUK
https://mobile.twitter.com/dencarter1
Good night! 🇰🇭

A harrowing but fascinating & enlightening visit to a UNESCO memory of the world site: The Khmer Rouge S-21 interrogation centre

Before reading this you need to know that it may be upsetting. That isn’t deliberate. It isn’t gratuitous. It isn’t intended. But I think it is impossible to not be moved by learning about what happened in the Khmer Rouge S21 interrogation centre & prison.

The site is a former high school which was used as the Security Prison 21 (S-21) by the Khmer Rouge from 1975 to 1979. 

We’re talking about something occurring during my lifetime. S-21 was one of at least 150 execution centres in Cambodia during those four terrible years at at least 12000 but possibly up to 20000 prisoners were killed in S21 alone.

The Khmer Rouge adapted high school to become a prison by converting classrooms to torture chambers & tiny prison cells.

Prisoners were provided with a munitions box in which to defaecate and a plastic bottle in which to urinate. Any spillage is on the floor resulted in beatings or electrocution.

Prisoners were showered by hose pipes – sometimes once every three months – and spent their time shackled to iron bars and each other in the larger chambers.

The people who were brought here – children, women and men – were repeatedly tortured and coerced into providing false confessions to “crimes” they never committed, after which they were murdered.

Medical experiments were carried out in the prison by Khmer Rouge doctors who had received four months of training – including blood draining until death and removal of organs without anaesthetic.

Physical torture, mental torture, neglect, disease, dehumanisation and outright degrading treatment occurred, it would seem, every day.

Only 7 people are known to have survived S21 and when the prison was discovered during the liberation in 1979, the final 12 prisoners who had been murdered there – and left behind – were given a proper funeral in the grounds of the compound.

This is a place of great sadness but it is preserved very carefully, very factually and very respectfully.

I believe it is important, when working in a different country from home to try and learn more about the history of the communities and the society in which they are now placed. It is only by trying to learn about this that I think it is possible to even try to understand about why people living in communities today do, or have to do, the things we see.

I’ve had the privilege over the last week to be able to speak privately to an academic lawyer working in the Khmer Rouge Tribunal:

http://www.eccc.gov.kh/en

That tribunal – properly constituted in accordance with law – is still hearing cases now of people from the Khmer Rouge who are accused of genocide and other crimes against people. What is absolutely right is that they have the right to full legal representation and to defend themselves. Their cases are handled in accordance with accepted legislation with international and Cambodian legal experts involved.

To do otherwise would be no better than the lack of human rights in S21 interrogation centre itself.

This centre is now a very calm and peaceful place.

As we finished the visit there was an old man sitting on a chair, asleep in the shade.

He was one of the seven survivors of S21. 

He deserves to sleep there, or wherever he wants to, for as long as he wants to.

Hello, my name is Andrew… in Khmer

It has been great to meet the Youth Volunteers at the Board Meeting today.

Andrew

Young people who have been teaching me Khmer as well as talking about their experiences here at the centre – what works well and what they would like to see changed.

We had a lot of laughs as I mis-pronounced my name MANY times but I can now count to THREE (four and five are a bit of a struggle at the moment), say “Hello, my name is Andrew”, say I am a Doctor, say “Thank you”… and also tell a joke (thankfully it is only two words in Khmer!).

The value of co-designing services with children and young people cannot be underestimated. I’ve seen here in Cambodia that the Youth Volunteers often have things said to them that the children and young people may be shy about telling the teachers and this can be incredibly beneficial to ensure that some of the more difficult issues facing children and young people are found out about and tackled.

Back in the UK there are many great examples of children and young people taking a leading role in policy development. Have a look at these for a few examples:

NHS England Youth Forum

http://www.byc.org.uk

Becoming a Member

 

4509 children and young people supported Jan-Apr 2016

Over the last four months, 4509 children and young people and 2219 families have been provided with support from M’Lop Tapang.

image

  • 2231 children and young people from 1497 families have been supported by the Outreach Team
  • 882 children and young people are in the Back to School programme
  • Each month 309 children have been provided services by the mobile library
  • There have been 222 hotline calls
  • There are now 1017 ChildSafe members

 

From a medical point of view:

  • 8893 treatments for children and 436 treatments for adults have been provided in the Medical Clinic
  • 379 treatments have been provided through outreach visits

 

image-1

 

We are currently in the process of writing up, for scientific publication, the results of research undertaken with vulnerable street-living, street-working and street-associated children and young people. Watch this space as the results will, I believe, really advance the worldwide understanding of the issues faced by vulnerable children and young people. The partnership with Salford University and The Pennine Acute Hospitals NHS Trust is crucial in helping us to move this important piece of work forwards before moving on to further academic evaluation of outcomes of the above work.

One of the new partnerships being formed here is a three year project focused on re-integration and job employment activities for children and young people incarcerated in the local prison.

There are about 286 children and young people in the prison and optimisation of their health both prior to and after release will be crucial to maximise the success of this project.

286 children and young people in prison with a problem with their water supply.

286 children and young people, in one town, who will require a huge amount of support to re-integrate them into society.

The child protection issues here are prevalent in every part of the town and it is through the recognition of the interaction between health, education, social care, vocational opportunities and justice that the best opportunities will be available to optimise the future for these children and young people.

Remembering the seven steps to better protection of the health and wellbeing of children and young people is crucial to continue to improve the lives of the people who are the present, and the future, of our global society:

1.Improve education

2.Increase employment

3.Tackle poverty

4.Decrease neglect

5.Recognise YOUR role as a community leader

6.Empower children and young people

7.Develop ChildSafe communities with children and young people at their hearts

 

Snake bites!

It’s been a day of teaching today.

The day started with a 0600am wake up and we were in the M’Lop Tapang centre before 0800am. This morning we delivered four hours of training on first aid and recognition of the seriously ill or injured patient.

We expected ten people in the group but 30 arrived which made for a lively interactive session!

We don’t teach CPR here – it isn’t right to potentially resuscitate a child to the point where an intensive care admission might be required when there is no such unit here – but that doesn’t stop us from teaching important skills to recognise and respond to serious illness or injury.

After a working lunch at the Holy Cow, I spent the afternoon talking to the outreach, education and social-work teams about the recognition of child abuse cases and the seven steps to greater protection of children and young people that I’ve learned from my work visiting different professional groups around the world.


After teaching I went straight into a videoconference discussing global health and immigration.

The team here are really pleased to have received a grant from the BMA information fund providing much-needed educational resources. I’ll try and get a photo of the books tomorrow to demonstrate why we need to build a new library here in the near future!


The first half of my meeting didn’t end until after the centre here had closed but one of the staff kindly dropped me off in the 4×4 so I’d be in time for the second half of the meeting before doing some more work on which patients might need a referral up to Siem Reap – a twelve hour bus journey away.

It’s been proper bi-directional learning today. I’ve learned loads about treating medical emergencies in resource-poor settings and have been able to pass on knowledge and skills to hopefully further develop the skills of the super multidisciplinary team here.

That bi-directional learning brings me back to snakes. I’m none too fond of our slithering neighbours. I say neighbours as they are, apparently, all over the community here.

Ravy – the amazing Nurse Practitioner here – has been teaching us about snake bites today. Something I didn’t know much about but I’m glad I learned.

Apparently the snake sometimes come to visit clinic! I only hope I’m at an outreach clinic if they do! 🐍

::gulp::

Good night!

Lead poisoning

I’ve seen some incredibly anaemic children in clinic today. One child was in urgent need of a blood transfusion. The local referral hospital has run out of blood. When that happens they need to ring around anyone they know might have the same blood group to see if they can donate.

There are lots of children here who have anaemia from many different sources:

  • Dietary – lots of children exist on little more than white rice
  • Haemoglobinopathies
  • Poisoning

For sure, there are more causes as well but the number of children here with lead poisoning far exceeds the number I’ve ever seen in the UK. Not difficulty really given the number is, as far as I recall, zero.


After clinic today we came down to a coastal village – a village where there are no toilets and limited electricity – where there are a large number of children with lead poisoning.

It’s a fishing village and the nets that are made in the village are weighted down with lead.


We’ve been learning about the challenges faced by the local community here. SicKids’ trustee Den Carter has been capturing our work this week – he’s an expert at sensitive image and video capture and over the coming months we’ll be able to talk about the amazing success stories we’ve seen this week. Success stories that I hope will encourage people back in the UK to get involved in the work of SicKids. Watch this space!
I’ll leave you with the following thought…


That photo was taken from the fishing community village. The village with no toilets. The village where there are large numbers of children with lead poisoning. The village where the mobile school goes each week to deliver education to the children, and the mobile medical team provides outreach clinics.

In the back of the photo you can see a golden beach. That beach is a private beach belonging to a Five Star hotel. People from all around the world come to visit. I wonder, when the guests are lying on their sunloungers, if they realise the stark juxtaposition of their privileged lifestyle as compared to the poverty a mere metre or two away.

I hope they venture out of their comfort bubble and make sure that some of their dollars go to the community who really need them.

Tomorrow, its first aid training in the morning and I’m giving some human rights lectures in the afternoon before preparing for the arrival of the other Board Members on Friday.

Good night! 🌜