Yet another blot: Sri Lankan govt., hospital facilities for adolescents

By Dr B.J.C.Perera 
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

Adolescents and young people are in the news for a variety of reasons; some good, some bad, and some even ugly. However, there is no question about their importance to the nation as our Motherland’s future belongs to them. They are indeed the jewels of Sri Lanka.

Yet for all that, when one looks around at the present time, one sees the grim spectacle of adolescents suffering a great deal through disruption of their education, undeniable problems with transportation, poverty, food insecurity and to cap it all, unsatisfactory provision of facilities in our much-bandied and government-run free health service.

The Convention on the Rights of the Child defines a “child” as a person below the age of 18 unless the relevant laws of a country recognize an earlier age of majority. Sri Lanka is a signatory to this convention. However, currently, all Paediatric Wards of the National Health Service of Sri Lanka, in all hospitals, including the specialized children’s hospitals, admit patients below the age of 14 years. Those over this age are admitted to the adult wards. We need to analyse and mull over this situation in some detail.

There is an abundance of research publications regarding different perspectives of older children and adolescents being admitted to Children’s Wards and Adult Wards. In a nutshell, these youngsters are quite uncomfortable and unhappy in either place. They do not wish to be treated like children and they are quite bothered by what goes on in the Adult Wards. They would dearly love to have Adolescent and Young People’s Wards in which specific facilities are provided for their needs and steps are taken to provide age-appropriate facilities and care for their age group.

The prestigious British Medical Journal Paediatrics Open, in the Special Supplement of Volume 6 published on the 15th of December 2022, has printed not one, or, not two or not even two, or even three; but a total of 70, YES…, seventy, research articles from several countries, related to a myriad of different aspects of providing healthcare for adolescents. These include physical, mental and socio-economic problems faced by adolescents and young people. The central theme of most of those publications is the axiom that the requirements of adolescents differ very significantly from those of children and adults. When one looks carefully at the content of these erudite works, it is evident that these differences are of the utmost importance and are of paramount implications in the ultimate quest towards providing optimal healthcare to adolescents.

At least now, the political and administrative powers in our Motherland should be pushed or even cajoled and even coerced to take useful steps to even to start thinking of providing wards, clinics and necessary healthcare services to adolescents, at least in the island’s major hospitals for a start. These services would need specifically designated wards for adolescent boys and adolescent girls separately, adolescent healthcare clinics and most importantly, specifically trained and qualified grades of all healthcare personnel to cater to the needs of these youngsters. These adolescents need privacy, empathy, and kindness, and they need to develop confidence in and continue to trust those designated to care for their health needs. To foster such an assurance, special training for these workers is absolutely mandatory. As paediatricians who provide healthcare for little children, we are all too familiar with the little ones growing up to be adolescents who still insist on us continuing to provide healthcare for them because they have faith in us. This is particularly true of those who need long-term care.

At the present time, the required facilities for adolescents in our National Health Service are woefully and totally inadequate and for that matter, virtually non-existent. In such a scenario, it will need at the outset, a paradigm shift and a complete revamping of the mindset of the legislators, to get it into their feeble brains that the provision of such facilities is absolutely essential and is one of the ways forward towards the future advancement of our country. If we do not look after the health needs of young people, we will not get anywhere. An endeavour of such an attempt and one of such vast magnitude to look after adolescents would need to start with providing infrastructure facilities to cater to the special needs of adolescents. New wards and clinics will need to be built or commissioned and healthcare staff will need to be specially trained to look after the very distinct needs of youngsters. The infrastructure should be purpose-designed to ensure privacy for these young people.More than anything, these patients have to be provided unmitigated privacy.

It is particularly important to have trained staff to look after adolescents. People working in children’s wards are specially trained for the job at hand to attend to the needs of children. However, those handling adolescents and young people need very special extra training. That includes Specialist Physicians/Paediatricians, Psychologists, Sisters and Nursing Officers and all grades of minor staff.

Of course, at the present time, in a country that is reeling from the unrelenting impact of an economic downturn, rampant corruption, and extremely poor governance, such an initiative as the healthcare of youngsters may come way down in the list of priorities of the people at the top of the legislature. Yet for all that, the emergent and nascent problems for the populace of our beautiful land that is envisaged for the immediate future, which includes wayward education, food insecurity, international indebtedness, poverty, unemployment, as well as a whole host of a conglomeration of catastrophes including repression of the youth, are more than likely to cause severe hardships for the youngsters of our beloved island. We, as adults, and this applies even more to the legislators, are duty-bound to look after our nation’s adolescents and young people. It is said that none are as blind as those who refuse to see and none are as deaf as those who refuse to hear. It is all there to see and also there to hear from the mouths of the horses as well. The best evidence for this notion is the number of young people clamouring to go abroad, seeking greener pastures.

Finally, I would like to echo the immortal words of that great statesman, Nelson Mandela, even at the risk of repeating them again for all to see and hear. He said, “There can be no keener revelation of a society’s soul than the way in which it treats its children. Let us reach out to the children”. I am sure he meant to include adolescents and young people as well. Nelson Mandela would be turning in his grave, over and over, again and again, if we refuse to do so.

It is now over to you, the powers-that-be.