Report 5 - Health Inequity Case Report DR ALEXIO TICHAONA DONGONDA

DEFINITION

Health inequity is a social injustice which is systematically designed to exclude the less

privileged from accessing better health care, it only rewards the elite group. It is an

unnecessary, avoidable, unfair and unjust difference between the delivery of health care

across individuals. These inequities can be eradicated through human action towards

equalisation of health services to all individuals.

THE CASE

AT is a 6 year old girl child, her parents work as peasant farmers .The father drinks alcohol,

violent; smokes marijuana and cigarettes. Both parents dropped school in order to start a

family. The father could not support her so the mother would make a living through piece

jobs.

The father got mentally ill due to substance abuse, but the family believed it was

bewitchment and he was taken to traditional healers in another town.

The mother and the child were left under the care of paternal grandmother. Later on, AT’s

mother was asked to leave and join her family because the mother-in-law had no resources

to cater for her and the child. AT’s mother took her baby to her brothers because both of her

parents were now late. She started to notice unusual behavior on her child when the child

would refuse feeds and cry inconsolably, therefore the mother thought this behavior had

traditional implications, then she returned the child back to the paternal grandmother and the

child started to do well. AT’s mother then migrated to Harare to look for a job as a baby

minder. Her father‘s whereabouts were still not known though unconfirmed reports

suggested that he had improved from his condition and had married another woman.

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AT was left unattended at home and accidentally caught fire whilst warming self and there

was no one nearby to rescue her, she ran to the grandmother who then put out the fire. She

was taken to a clinic with a scotch cart but the clinic had no resources and referred the child

to a hospital wrapped in a blanket .The child was seen by the doctor who diagnosed the

child with 52% deep partial thickness burns of the abdomen ,back and both lower limbs.

Child was put on daily dressing with silver sulphate diazin cream, intravenous antibiotics of

ceftriaxone 500mg intravenously 12 hourly and metronidazole 350mg intravenously 8 hourly,

and pethidine 20milligrams before dressings. The hospital pharmacy had no drugs, so the

caregivers had to source them from elsewhere, but they failed to buy the required

medication du financial problems and the child continued to deteriorate, until the child was

further referred t to a Provincial Hospital. At the Provincial Hospital the child faced the same

challenges of limited resources. The child was then further referred to a Central Hospital,

where i came across this case. The child was seen by general surgeons who continued with

the initial management as well as blood transfusion.

CHALLENGES

The management of the child was compromised due to the family poverty, disintegration and

misinformation which resulted in limited cooperation violating the Article 24 of Health and

Health services of the children’s rights. The child could have been referred to a central

hospital without delay but because of poverty and long chain of consultations the child was

put at a disadvantage which is the state’s obligation to work towards abolition of harmful

traditional practices. The financial problems also exposed the effects of health inequity after

the caregivers failed to source funds for medications. Healthy inequity was also manifested

when the child went through hospitals with limited resources despite her serious condition

which required immediate and extensive management. Negligence as well as lack of

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parental responsibility predisposed this child to harmful effects of inequity which is

condemned by article 18 of The United Nations Convention on The Rights of the Child.

RESOLUTIONS

When i recognised the serious challenges this child was facing i roped in the public relations

officer, the social worker and hospital management and the required treatment was offered. I

counselled the mother about the importance of diet and nutrition in a child with burns, though

I also I involved the dietician for reinforcement .I referred the mother and available relatives

to the family therapist. I wrote a letter to the district educational officer requesting for a grade

one place for this child in the coming year because the social services had pledged to pay

her fees. The condition of the child improved and she was discharged via physio and

occupational therapist.

CONCLUSION

Health inequity deprives the less privileged from acquiring affordable ,accessible and quality

health care as we have seen in the case of AT who was delayed from getting treatment due

to poor background, uneducated parents, poor geographical setting and poor infrastructure

which contributed to poor access to quality and affordable health care.

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REFERENCES

WHO Pocket book 2nd edition.

EDLIZ (2011) 11TH edition, Essential Drug List and Standard Treatment Guidelines for

Zimbabwe. WHO

The United Nations Convention on the Rights of Child

Nettina SM (2006), the Lippincott Manual of Nursing Practice, Philadelphia, New York

Sample Case Report- Health Inequity 2015 permission to publish_21.12.2015