The essential work of social paediatrics

By Dr. Sarah Gander

I have been told I am an essential worker.

Essential is defined as: “extremely important, indispensable, and absolutely necessary”. Physicians have been working under the constraints of social distancing and effective lockdown of the community for a couple weeks now, and we’ve have been told we are essential workers — to carry on, to figure it out. We have the option to try community outpatient virtual visits, phone appointments, face to face with proper screening and PPE. And then there is the inpatient work.

Today I held a full clinic with a mix of the above with some success – but many patients didn’t answer their phone, forgot to log on despite reminders, and at the end of the day I finally had a face-to-face home visit. Why? Because that family does not have a phone; we communicate through Facebook messenger when she can find free WiFi. Her chief complaint today: the cupboards were empty and the thought of her two children (one with special needs) going hungry had her worried about whether she would use drugs despite being successful on methadone for several years. This mom does not have a credit card to order groceries online and has been shamed more than once bringing her two children to the store. The children’s community services (and school, of course) are all on hold. So I went to her house. I sat 6 feet away from her ground floor window, and we talked. I wore a mask. I took her a few bags of groceries. I laughed with the kids for a while and sent her some activities to do with them and for them to do on their own in an effort to give her some breathing room.

Beyond physicians and other health care workers, I would suggest that community is essential. We do not work alone. There are basic human rights — access to nutritious food and adequate medical care — that are not being met. We all had some patience for this when we thought it might last for a couple weeks, but now we recognize that we are in it for the long haul.

This is where community shines and, for my paediatric world, it is where community social paediatrics shines. Paediatricians are not just thinking of the here and now — we are also very concerned and focused on what is to come, and on how isolation will affect mental health, family dynamics, and chronic conditions.

Yes, we need to be careful and we need to keep our families safe. But we are only as important as the difference we make and, for many of our patients and families in precarious living circumstances, delivering groceries or connecting in order to offer some hope is absolutely essential.

Dr. Sarah Gander is a general paediatrician in Saint John, New Brunswick and President of the Canadian Paediatric Society’s Social Paediatrics Section.

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