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KEYNOTE ADDRESS

 

BY
C, EVERETT KOOP, MD

DEPUTY ASSISTANT SECRETARY FOR HEALTH
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

NINTH ANNUAL APPALACHIAN CHILD DIVELOPMENT AND
HEALTH SYMPOSIUM

MARIETTA, OHIO

May 20, 1981
(GREETINGS TO HOSTS, GUESTS, ETC.)

IT IS AN HONOR TO COME HERE AS THE REPRESENTATIVE OF
SECRETARY SCHWEIKER AND THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES, CHILDREN HAVE BEEN MY LIFE’S CONCERN, 1 KNOW
THEY ARE YOURS, ALSO. 1 FEEL VERY MUCH “AT HOME” HERE,
BECAUSE I KNOW YOU WORRY ABOUT THE KINDS OF THINGS I WORRY
ABOUT, ,..HOW CHILDREN COME .INTO THIS WORLD,.,.HOW THEY ARE
CARED FOR AND LOVED....AND HOW MUCH THEY MATTER TO US AS A
SCCIETY AND AS INDIVIDUALS,

THERE’S A LITTLE MOTTO HANGING ON THE WALL OF A FRIEND'S
OFFICE. IT WAS WRITTEN BY JOH! RUSKIN ABOUT A HUNDRED YEARS
AGO AND I THINK IT SAYS IT ALL:

"GIVE A LITTLE LOVE TO A CHILD, AND YOU GET A GREAT DEAL
BACK,”

Se

 

[T WISH PHYSICIANS AND EDUCATORS AND GOVERNMENT PEOPLE
COULD WRITE THINGS LIKE THAT -- AND REALLY BELIEVE IT. OUR
WORK, YOURS AND MINE, WOULD BE SO MUCH EASIER AND WE COULD
APPROACH IT WITH SO MUCH MORE JOY,

STILL, I ADMIT THAT 1 COME HERE FEELING QUITE COMFORTABLE,
T KNOW WHO YOU ARE. 1’VE SEEN YOUR PROGRAM. 1 KNOW SOME OF.
-2-

YOUR GUEST SPEAKERS PERSONALLY AND OTHERS BY REPUTATION. SO IT
IS AN HONOR TO BE HERE AND, TO BE TRUTHFUL, IT’S ALSO A PLEASURE.

THIS MAY BE A STRANGE PREAMBLE FOR SOMEONE WHOSE OFFICIAL
MESSAGE BEARS THE MARK OF AUSTERITY. BUT I WANT YOU TO KNCt
THAT, WITH YOU, I ALSO FACE THE DIFFICULT CONTRADICTIONS IN QUR
SOCIETY:

* WE ARE BASCIALLY A HUMAN, COMPASSIONATE PEOPLE, YET WE
DO HAVE A DARK STREAK OF VIOLENCE -- OFTEN DIRECTED AT CHILDREN.

* WE ARE A JOYFUL PEOPLE -- I THINK YOU COULD EVEN SAY
WE HAVE A NATIONAL CHARACTERISTIC OF GOOD HUMOR -- BUT WE ARE
WRESTLING IN PUBLIC WITH SOME OF THE MOST SERIOUS ISSUES FACING
THE HUMAN RACE TODAY

* AND WE ARE A WEALTHY PEOPLE -- THIS IS A RICH NATION
-- YET WE ARE IN THE THROES OF TRYING TO REPAIR A BATTERED
ECONOMY THAT IS FAST MAKING PAUPERS OF US ALL.

THERESS HO WAY AROUND IT, ALL OF US COME HERE IN OUR
VARIOUS OFFICIAL AND PROFESSIONAL CAPACITIES BEARING A MIXED
MESSAGE OF OPTIMISM AND DOUBT, OF VICTORY AND CONTINUED STRUGGLE,
OF WONDER -- AND SKEPTICISM,
-3-

—T'M NOT AN ECONOMIST OR A CERTIFIED PUBLIC ACCOUNTANT, So |
I WON'T TALK A LOT ABOUT THE FEDERAL BUDGET. BESIDES, WHAT ELSE
IS THERE TO SAY THAT THE DAILY PRESS HASN’T.ALREADY SAID? THIS
IS A VERY DIFFICULT TIME, AN AUSTERE TIME, IN WHICH THIS COUNTRY,
UNDER THE LEADERSHIP OF PRESIDENT REAGAN, IS GOING TO TRY TO
BRING INFLATION UNDER CONTROL.

INFLATION 1S NOT JUST AN ECONOMIC ISSUE. IT’S A HEALTH
ISSUE, THE COSTS ARE RISING FOR SUCH VITAL HUMAN SERVICES AS
QUALITY HEALTH AND MEDICAL CARE, CONTINUITY OF SOCIAL SERVICE, AND
NEW AND EFFECTIVE THERAPIES FOR PHYSICAL AND MENTAL HEALTH, WE
ARE A GENEROUS SOCIETY -- BUT WE CAM! NO LONGER GIVE MUCH AWAY,

AND THERE IS THE RISK THAT MANY HEALTH AND SOCIAL SERVICES MAY
ONLY BE AVAILABLE TO A SMALLER AND SMALLER NUMBER OF PEOPLE FROM
AMONG THOSE WHO TRULY NEED THEM,

THAT ISSUE IS OUR ISSUE. AND WHILE WE ARE IN FOR A PERIOD
OF BELT-TIGHTENING, I DO NOT BELIEVE IT WILL BE A PERMANENT
CONDITION, [ BELIEVE THAT THIS ADMINISTRATION IS DETERMINED TO
BRING INFLATION UNDER CONTROL, TURN IT AROUND, AND EVENTUALLY
RETURN TO THIS COUNTRY [TS ABILITY TO MAKE ITS HUMAN SERVICES
INVESTMENTS ACCORDING TO THE NEEDS OF OUR PEOPLE, RATHER THAN
“ACCORDING TO THE APPETITE OF INFLATION,
-4-

I STILL PREFER TO LOOK UPON THIS FIGHT AGAINST INFLATION
AS A VITAL -- BUT TRANSIENT -- AFFAIR, ULTIMATELY, WE’RE GOING
TO WIN AND THEN, MY FRIENDS, WE HAD BETTER KNOW WHAT WE'RE ABOUT.
THERE IS A GREAT TENDENCY TO DEAL WITH TODAY'S PROBLEMS, TODAY'S
CRISIS, AD TODAY'S OPPORTUNITIES....EXCLUSIVELY, WE'VE GOT TO
BE SENSITIVE TO THAT TENDENCY, RECOGNIZE IT, PUT IT ASIDE, AND
EXERCISE A LARGER PERSONAL AND PROFESSIONAL VISION.

YOUR PROGRAM FOR THESE TWO DAYS INDICATES THAT YOU ARE
PREPARED TO DO THAT, AND FOR THE NEXT FEW MINUTES I’D LIKE TO
PURSUE WITH YOU SOME OF THE BASIC, LONG-TERM CONSIDERATIONS
NEEDING OUR BEST JUDGMENT TODAY, TOMORROW, AND FOR SOME YEARS
TO COME.

I WANT TO FOCUS YOUR ATTENTION, IF I MAY, ON THE CONCERWS
SURROUNDING {IEO-NATAL CARE. AND I ESPECIALLY WANT 10 CATCH
THE ATTENTION OF THOSE OF YOU WHO DEAL PRIMARILY WITH THE CARE
REQUIRED IN EARLY CHILDHOOD OR IN ADOLESCENCE. YOUR TASKS ARE
OFTEN REPARATIVE IN ONE WAY OR ANOTHER -- YOU TRY TO CORRECT
OR COMPENSATE FOR SOME LACK OF CARE OR UNDERSTANDING SEVERAL
YEARS EARLIER, DURING THE PREGNANCY OF THE MOTHER OR THE BIRTH
EVENT ITSELF.

YOU'RE AWARE. 1 AM SURE, OF THE GRADUAL BUT STEADY
DECLINE IN OUR INFANT MORTALITY RATE. IT WAS 13.8 IN 1973, |
IT DROPPED TO 13.0 If] 1979. OUR HEWEST PROVISIOMAL DATA FOR ~
-5-

1980 INDICATES THAT OUR RATE WAS 12,5 DEATHS PER 1,000 LIVE
BIRTHS, |

THAT, HOWEVER, 1S THE NATIONAL INFANT MORTALITY RATE, IT
INCLUDES CHILDREN BORN IN CHILDREN’S HOSPITAL OF PHILADELPHIA
AND IN TINY BEDROOMS IN MAGOFFIN COUNTY, IN THE BIRMINGHAM
MEDICAL CENTER AND: IN AN AMBULANCE RACING THROUGH MOUNT GILEAD.
IT INCLUDES THE BABIES BORN INTO MIDDLE-CLASS SECURITY AND
THOSE BORN INTO POVERTY AND INSECURITY,

 

OUR NATIONAL EXPERIENCE SO FAR HAS BEEN THAT CHILDREN
OF THE POOR AND OF MINORITY COMMUNITIES DIE AT BIRTH AT ALMOST TWICE
THE RATE FOR THE WATION AS A WHOLE. IT IS TRUE THAT OUR NATIONAL
INFANT MORTALITY RATE HAS BEEN DECLINING STEADILY -- AND THE RATES
FOR MINORITIES AND THE POOR ARE GOING DOWN, ALSO -- BUT WE CAN’T
ALLOW OURSELVES TO BE SATISFIED WITH THAT,

AS YOU KNOW, THE U.S. PUBLIC HEALTH SERVICE PUBLISHED
LAST YEAR A SLIM VOLUME TITLED “PROM@TING HEALTH AND PREVENTING
DISEASE: OBJECTIVES FOR THE NATION.” IF YOU HAVEN'T GOT A
COPY, I HOPE YOU WRITE US AND GET ONE, BECAUSE IT REPRESENTS
THE BEST THINKING AMONG SEVERAL THOUSAND EXPERTS OUTSIDE
GOVERNMENT ON WHAT OUR MAJOR PUBLIC HEALTH ISSUES ARE AND WHAT
WE OUGHT TO DO ABOUT THEM,
-6-

THE CHAPTER ON PREGNANCY AND INFANT HEALTH INDICATES
WHAT OUR OBJECTIVES SHOULD BE FOR THIS DECADE. FOR EXAMPLE, ....

* WE WANT TO REDUCE THE INFANT MORTALITY RATE 10
9 DEATHS PER 1,000 LIVE BIRTHS AS A NATIONAL AVERAGE

* IN ADDITION, WE WANT TO MAKE SURE THAT NO RACIAL OR
ETHHIC GROUP OR NO GROUP OF PEOPLE ISOLATED BY GEOGRAPHY OR
ECONOMIC STATUS SUFFERS AN INFANT MORTALITY RATE HIGHER THAR
12 PER 1,000 LIVE BIRTHS. |

a _.* WE NEED TO ADDRESS. THE FACT THAT THE GREATEST SINGLE
PROBLEM ASSOCIATED WITH INFANT MORTALITY IS LOW BIRTH WEIGHT,
NEARLY TWO OF EVERY THREE NEWBORN WHO DIE WEIGH LESS THAN 2,500
GRAMS. THAT'S LESS THAN 5% PCUNDS, [EARLY EVERY CAUSE OF LOW
BIRTH WEIGHT CAN BE PREVENTED. AND IF WE COULD SUCCESSFULLY
PREVENT IT, WE COULD DRAMATICALLY REDUCE THE INFANT MORTALITY

AND MORBIDITY RATES,
- 6A -

* AND WE NEED TO ACHIEVE A HIGHER RATE OF TECHNOLOGY
TRANSFER FOR HANDLING DISTRESSED BIRTHS, BIRTH DEFECTS, AND
DISEASES OF THE NEWBORN; THAT IS, WE NEED TO GET THE RESULTS OF
OUR EXTRAORDINARY AMERICAN RESEARCH ENTERPRISE INTO THE CAPABLE
HANDS OF THE PHYSICIANS, NURSES, AND OTHER HEALTH PERSONNEL -
WHO ARE INVOLVED IN MATERNAL AND INFANT CARE.

LET ME ADD A FOOTNOTE HERE OF PERSONAL EXPERIENCE, My
MAJOR EFFORTS AS A SURGEON HAVE BEEN WITH THE EONATE. SOME OF
YOU MAY KNOW THAT I BUILT THE FIRST NEONATAL INTENSIVE CARE UfIT
IN THIS COUNTRY, I KHOW -- AS I AM SURE YOU DO, ALSO -- THAT
THE APPLICATION OF NEW KNOWLEDGE Off BEHALF OF CHILDREN PAYS
TREMENDOUS PERSOMAL AMID SOCIAL DIVIDENDS. THE YOUNGSTERS, IF
SALVAGED, GROW UP TO BE LOVED AND LOVING, IHNOVATIVE AND CREATIVE,

THESE KINDS OF ISSUES -- AND MANY MORE OF THEM -- ARE
SPELLED OUT THE REPORT TITLED “OBJECTIVES FOR THE NATION,” IT
IS THE CONSENSUS OF THOSE HHO DEDICATE THEIR LIVES TO MATERIAL
AND CHILD HEALTH. IT’S A TALL ORDER -- BUT WE CAM] HARDLY IGIORE
IT, AND A CHALLENGE OF THAT MAGNITUDE WOMN’T JUST GO AWAY,

CAN WE RESPOND TO THIS AGENDA -- OR MUST WE RELEGATE IT TO
LAST YEAR’S FILES? 1 THINK WE CA RESPOND, EVEN THOUGH THE ECONOMIC
AND SOCIAL CLIMATE IS VERY CHILLY. BUT WE MAY HAVE TO RE-THINK
-/-

SOME OF OUR ASSUMPTIONS. THAT’S ALWAYS THE HARD PART, BUT
LET’S WORK THROUGH SOME OF THEM TOGETHER.

ONE ASSUMPTION HAS BEEN THAT THE PRESENCE OF THE FEDERAL
GOVERNMENT IS ESSENTIAL FOR THE DELIVERY OF HEALTH SERVICE,
AT ONE TIME -- AND IN MANY, NOT NECESSARILY ALL, PLACES -- THAT
WAS PROBABLY TRUE. BUT IT IS NOT TRUE ANY MORE, THE FACT IS °
THAT LOCAL AND STATE HEALTH AGENCIES, VOLUNTARY AGENCIES,
PROFESSIONAL ASSOCIATIONS, MAJOR CORPORATIONS, LABOR UNIONS,
SCHOOLS, AND OTHER COMMUNITY GROUPS HAVE TAKEN OVER THE TASK OF
DELIVERING HEALTH CARE IN OUR COMMUNITIES AND NEIGHBORHOODS,

THEY MAY DO IT WITH FEDERAL MONEY. THEY MAY DO IT UNDER
FEDERAL GUIDELINES OF ONE SORT OR ANOTHER. THEY MAY DRAW UPON
MUCH FEDERAL RESEARCH AND OTHER EXPERTISE, BUT THE ACTUAL
DELIVERY OF CARE IS BEST HANDLED -- AND ACTUALLY HANDLED -- BY
STATE AD LOCAL GROUPS,

HOW SEEMS TO BE A VERY PROPITIOUS TIME TO RECOGNIZE THAT
AS TRUE AND TO BUILD UPON IT, THE BLOCK GRANT APPROACH OF THIS
ADMINISTRATION DOES JUST THAT. AND I HAVE TO SAY THAT THE |
PROGRAM OF THIS SYMPOSIUM AND ITS ATTENDANCE LIST GIVES AMPLE
PROOF THAT THE STRENGTH AWD VITALITY IN THE FIELD OF CHILD
DEVELOPMENT AND HEALTH RESIDE IN HUNDREDS, EVEN THOUSANDS, OF
STATE AND LOCAL AGENCIES AND INSTITUTIONS, THE FEDERAL ROLE
MAY WELL HAVE ACHIEVED WHAT IT WAS SUPPOSED TO ACHIEVE: THE
THE RE-DIRECTION OF LOCAL PRIORITIES, THE RE-ASSESSMENT OF LOCAL
NEEDS, THE RECONGITION OF LOCAL RESPONSIBILITIES -- THESE MAY |
HAVE ALREADY TAKEN PLACE BUT OUR OWN THINKING JUST HASH’T CAUGHT
UP WITH THEM YET,

I SUGGEST WE STEP BACK AND SEE WHAT IS REALLY HAPPENING IN
OUR COMMUNITIES WHERE PARENTS AND CHILDREN NEED HELP, I THINK
WE’LL FIND THAT THE FEDERAL ROLE HAS EITHER DISAPPEARED OR IS
LARGELY SUPERFLUOUS. WE HAVE SEEN SOCIAL JUSTICE OCCUR WHERE IT
MIGHT NOT HAVE EXISTED BEFORE. WE HAVE DEMONSTRATED COMPASSION
AHD THE WILL TO HEAL, WHERE WE MAY HAVE BEEN REMISS BEFORE. ONCE

HAVING MADE THAT PROGRESS, THIS SOCIETY WILL NOT TURN BACK, WE

HAVE TO BELIEVE THAT, IF WE WAIT TO BELIEVE I THIS COUNTRY, TOO.

THE FEDERAL GOVERNMENT IS NOW IN THE PROCESS OF OFFICIALLY
EXTRICATING ITSELF FROM THE DELIVERY OF HEALTH SERVICES. THERE
ARE SOME SPECIAL CIRCUMSTANCES -- OUR SYSTER FOR CARING FOR

VETERANS AND OUR COMMITMENT TO THE HEALTH CARE OF NATIVE AMERICANS

AND ALASKAN NATIVES -- BUT OTHERWISE-WE ARE FULLY RECOGNIZING THE
FACT THAT THE DELIVERY OF HEALTH AND SOCIAL SERVICES IS BETTER
HANDLED BY STATE AND LOCAL AUTHORITIES.
~g9-

“THIS HEW REALITY PRESENTS AN EXTRAORDINARY OPPORTUNITY FOR
STATE, COUNTY, AND MUNICIPAL HEALTH AGEHCIES TO FORM NEW AND
EFFECTIVE PARTNERSHIPS WITH THE PRIVATE SECTOR, PARTICULARLY THE
MANY VOLUNTARY HEALTH AGENCIES. JUST THINK OF THE POTENTIAL
FOR IMPROVED HEALTH STATUS FOR PEOPLE OF ALL AGES, IF THE RESOURCES
— OF BOTH THE PUBLIC AND PRIVATE SECTORS COULD BE COORDINATED.

ANOTHER ASSUMPTION IS THAT THE AMERICAN FAMILY CAN’T HANDLE
ITS PROBLEMS OF PHYSICAL AND MENTAL HEALTH BECAUSE IT IS UNDER
SUCH HEAVY PRESSURE FROM LARGER ECONOMIC AND SOCIAL FORCES. WELL,

I AGREE THAT THE AMERICAN FAMILY IS UNDER TERRIFIC PRESSURE --
BUT I CANNOT ACCEPT THE CONCLUSION THAT, THEREFORE, IT CANNOT

TAKE CARE OF ITS OWN AFFAIRS, THAT OTHERS HAVE TO STEP Il AND Do IT
FOR FAMILIES UNDER STRESS,

A VARIETY OF INSTITUTIONS HAVE SPRUNG UP TO INTERVENE AND
BECOME, I! EFFECT, A “MEMBER OF THE FAMILY.” WE ASK PARENTS 10
DELEGATE THEIR RESPONSIBILITIES TO OUTSIDE AGENCIES, IN ORDER
TO HELP TROUBLED CHILDREN. WE ASK GHILDREN TO DELIVER THEIR
PARENTS TO OUTSIDE AGENCIES AND INSTITUTIONS TO PROVIDE LOVE
AND CARE, PARTICULARLY IN THE TWILIGHT TIMES BEFORE DEATH,
-10-

I'M NOT AT ALL SURE THAT SUCH INTERVENTION IS COMPASSIQFIATE
OR HELPFUL OR USEFUL -- TO THE INDIVIDUALS AND FAMILIES INVOLVED
OR TO SOCIETY GENERALLY. BUT I DO HAVE THE STRONG FEELING THAT
WE MUST ORIENT OURSELVES MORE TOWARD STRENGTHENING THE FAMILY
SO THAT IT REMAINS UNIFIED, STAYS TOGETHER EMOTIONALLY IF NOT
GEOGRAPHICALLY, AND DRAWS UPON ITS OWN RESOURCES -- WHICH ARE »’
DEEP, AS DEEP AND AS MYSTERIOUS AS THE HUMAN BEING ITSELF IS --
AND USES THOSE RESOURCES TO COPE WITH THE STRESSES OF MODERYI ’
LIVING,

WHEN WE -DISCUSS SOCIAL PROGRAMS THESE DAYS, WE TALK OF
THE “SAFETY NET” PROVIDED BY CERTAIN PROGRAMS -- SOCIAL

SECURITY, WORKMAN’S COMPENSATION, AND SO ON, ON ONE LEVEL, |
WOULD AGREE. SUCH A “SAFETY NET” SHOULD CONTINUE TO EXIST, BUT

BEYOND LAW AND SOCIAL PROGRAMS, BEYOND BUDGETS AMID REGULATIONS
STANDS THE CONCEPT OF THE FAMILY AS THE ULTIMATE AND BEST “SAFETY
NET” IN AY SOCIETY,

SAYING THAT TO THIS GROUP IS LIKING TAKING COALS TO NEWCASTLE.
YOU KNOW MORE ABOUT FAMILY STRENGTHS THAN I, BUT I WANT TO
SUGGEST THAT WE NEED TO TAKE THE FAMILY MUCH MORE SERIOUSLY THAN
WE HAVE ALREADY, AND WE NEED TO CHALLENGE THE ASSUMPTION THAT
-ll-

OTHER INSTITUTIONS CAN DO A FAMILY’S JOB BETTER. IT’S TOO EASY
TO SAY THAT -- AND THE CONSEQUENCES ARE TOO OVERWHELMING TO
CONTEMPLATE.

LATER ThIS YEAR THERE WILL BE A WHITE HOUSE CONFERENCE ON
AGING, NEXT YEAR, THE WORLD HEALTH ORGANIZATION WILL ALSO HOLD,
A CONFERENCE ON AGING IN VIENNA. I HOPE DELEGATES TO BOTH
THOSE MEETINGS WILL FOCUS ON WAYS TO NURTURE THE STRENGTHS TO BE
FOUND IN FAMILY LIFE, RATHER THAN FIND WAYS TO TRANSFER THAT
STRENGTH AND THAT SEWSE OF RESPONSIBILITY TO OUTSIDE FORCES AND
INSTITUTIONS,

LET ME CLOSE BY SETTING OUT ANOTHER FAMILIAR ASSUMPTION
THAT WE FEEL COMFORTABLE WITH, BUT NEEDS TO BE RE-ASSESSED,
WE TEND TO BELIEVE THAT WE OUGIT TO TAKE SOME ACTION TO CORRECT
SOME HEALTH OR BEHAVIORAL DEFICIT IN AN INDIVIDUAL, A FAMILY,
OR A COMMUNITY, AND I TEND TO AGREE. IT’S DIFFICULT TO SPEND
OHE’S LIFE AS A PEDIATRIC SURGEON AND PREFER INACTION TO ACTION,

MY PERSONAL AND PROFESSIONAL LIFE HAS BEEN VERY ACTIVE AND,
HENCE, VERY SATISFYING,
-2-
THE ONLY PROBLEM IS THAT WE ALL KNOW THAT EPISODIC CARE
IS USUALLY SECOND-BEST CARE, WHAT WE ALL USUALLY STRIVE FOR
IS SOME KIND OF CONTINUITY OF CARE FOR THE PEOPLE WE CARE ABOUT ,
HOWEVER, WE HAVE ENTERED SOME HIGHLY COMPLEX AND SOPHISTICATED
AREAS OF CHILD CARE WHICH SEEM TO BE OUTSIDE THE CONCEPT OF
CONTINUITY OF CARE.

 

FOR EXAMPLE, THERE ARE INSTANCES WHEN, AT DELIVERY, THE
BABY WILL SUFFER A SUDDEN INTERRUPTION OF ITS OXYGE!] SUPPLY --
ACUTE HYPOXIA -- AND WILL REQUIRE, AMONG OTHER THINGS, THE
__INMEDIATE APPLICATION OF A RESUSCITATOR AND THEN TRANSFER TO
A RESPIRATOR. WE SAVE THE BABY’S LIFE. THE PARENTS ARE
HAPPY, ALL THE DELIVERY ROOM PEOPLE ARE RELIEVED.

BUT WE MAY HAVE PRESENTED THAT HOSPITAL AIID THAT FAMILY
WITH A CHRONIC RESPIRATOR-DEPENDENT CHILD, SOME NEWBORN REMAITI
FOR WEEKS, EVEN MONTHS, CONNECTED TO A RESPIRATOR FOR THEIR VITAL
OXYGEN SUPPLY. NE ARE NOW BEGINNING TO GRAPPLE WITH THE
ISSUES THAT FOLLOW THIS HEROIC EPISODE. WE ARE NOW TAKING A LOOK
AT THE PROBLEM OF SOME CONTINUITY OF CARE FOR THE INFANT AND
THE PARENTS, SO THAT THEY CAN ALL COPE ATID SURVIVE THE PERIOD
-- HOWEVER LONG IT MAY HAVE TO BE -- DURING WHICH THE CHILD IS
RESPIRATOR-DEPENDENT, =
- 13 -

“THE COMMON PRACTICE WAS TO KEEP SUCH BABIES IN THE HOSPITAL
UNTIL THEY COULD MANAGE THEIR AIR SUPPLY ON THEIR OWN, BUT WE
SOON DISCOVERED WE HAD WHOLE WARDS FULL OF CHILDREN BREATHING
WITH THE HELP OF RESPIRATORS. THE COST WAS ASTRONOMICAL BECAUSE
THESE CHILDREN WERE BEING GIVEN IN-PATIENT INTENSIVE CARE,

WE HAVE SINCE LEARNED THAT IT IS MORE EMOTIONALLY BENEFICIAL
TO THE CHILD AND THE PARENTS -- AND A GOOD DEAL CHEAPER -- TO
SEHD THE CHILD HOME WITH A RESPIRATOR -- AFTER WE HAVE INFORMED
THE FAMILY OF ALL THE FACTS AND HAVE HELPED THEM TO COPE WITH THIS
UNUSUAL EVEN IN THEIR OWN HOMES, BUT IT DOES WORK,

IT BELIEVE WE HAVE TO MAKE GREATER USE OF THE NEW KNOWLEDGE
AND THE NEW TECHNOLOGIES OF CARE THAT WE’VE DISCOVERED -- BUT
WE HAVE TO DO THAT WITH THE UNDERSTANDING THAT SOME LONG-TERM
PROBLEMS FOR THE INDIVIDUAL PATIENT AND HIS OR HER FAMILY MAY
BE AMONG THE OUTCOMES. AND, THEREFORE, IT SEEMS TO ME TO BE
ESSENTIAL THAT PROFESSIONALS IN MEDICINE, IN HEALTH CARE
SERVICE DELIVERY, IN SOCIAL SERVICE,-AND IN THE BEHAVIORAL
SCIENCES POOL THEIR KNOWLEDGE EVERY TIME WE TAKE A STEP FORWARD,
- 14 -

“IT IS NO LONGER HELPFUL OR “HEROIC” TO MAKE EXTRAORDINARY
LIFE-SAVING EFFORTS, AND THEN LEAVE THE PATIENT AND THE FAMILY
TO PUZZLE OUT THE FUTURE ON THEIR OWN, AND THIS IS ESPECIALLY
TRUE IN CHILD HEALTH, WHERE THE INFANT OR YOUNG CHILD IS TOTALLY
DEPENDENT ON ADULT KNOWLEDGE AND WISDOM, WE MUST COMMIT OURSELVES
TO EXHIBIT BOTH, OTHERWISE, I HAVE A STRONG FEELING THAT THE ’
PUBLIC, WHOM WE SERVE, WILL QUESTION AND REJECT -- AT THE WRONG
TIMES AND FOR THE WRONG REASONS -- OUR SUGGESTIONS FOR ACTION
AND THE REQUEST FOR THEIR CONSENT,

THE PUBLIC NEEDS TO BE ASSURED THAT WE KNOW WHAT WE’RE DOING
AND ARE SENSITIVE TO WHAT THE CONSEQUENCES MAY BE. AND WE CAN
HELP THEM ADJUST, If! ORDER TO GIVE THAT ASSURANCE, WE OURSELVES,
AS PROFESSIONALS IN HEALTH CARE AND SOCIAL SERVICES, QUGHT TO
WORK OUT THOSE ISSUES AMONG OURSELVES, TEST THEM Il PUBLIC
DIALOGUE WITH OUR PATIENTS, THE CONSUMERS OF OUR SERVICES, AND
THEN -- AWD ONLY THEN -- PROCEED.

THESE ARE SOME OF THE THINGS THAT CONCERN ME AS A PEDIATRICIAN,
AS A SURGEON, AND AS A MEMBER OF YOUR GOVERNMENT. AND I WOULD
-15-

HOPE THEY STIMULATE YOU TO GRAPPLE WITH THESE QUESTIONS, TOO,
THE ANSWERS WILL BE FORTHCOMINIG, I’M SURE, ALTHOUGH SOME OF THEM
MAY NOT APPEAR WITH A'Y CLARITY FOR SOME TIME, BUT WE HAVE THE
TIME AND SPENDING TIME ON LEARNING NEW THINGS IS AMONG QUR MOST
PROFESSIONAL RESPONSIBILITIES,

t

| AM REMINDED OF THE DEFINETION OF EDUCATION THAT THE POET
ROBERT FROST ONCE WROTE. “EDUCATION,” SAID FROST, “IS.,.HAIGING
AROUND UNTIL YOU'VE CAUGHT ON,”

I THIIK THOSE OF US WHO ARE DEDICATED TO THE IMPROVED
HEALTH AND WELFARE OF CHILDREN CAN ALWAYS DO A LITTLE MORE “HANGING -
AROUND.” | INTEND TO -- AND | HOPE YOU’LL JOIN ME,

THANK YOU AND BEST WISHES FOR A VERY SUCCESSFUL SYMPOSIUM.

He H # OH