Child health dilemma

Five-year-old Hassan Bukenya, from a poor neighborhood outside Uganda’s capital city of Kampala, faced certain death without surgery at Children’s National Medical Center in Washington to repair the hole in his heart.

A few days after a 24-hour journey from Uganda, Hassan — whose family survives on a few hundred dollars a year — was in one of the world’s finest operating rooms last month for a procedure that typically costs up to $35,000.

Hassan’s operation was a success. The dilemma facing doctors and public health officials is that millions of other children in poor nations are dying. And not for want of an expensive operation, but for lack of pennies to buy rehydration salts, vaccinations, antibiotics or daily vitamins.

Amid huge need, resources are limited. Someone decides where money will be spent and thereby chooses who lives and who dies.

“The hardest part is deciding who can come,” says Dr. Craig Sable, a heart surgeon who went to Uganda and picked Hassan from among 90 children who required extensive medical treatment. “It’s not a decision I enjoy making.”

The World Health Organization (WHO) says nearly 11 million children under age 5 die each year from easily preventable and cheaply cured diseases — including pneumonia, diarrhea, malaria and complications during the first year of life.

It costs just 2 cents for a six-month supply of vitamin A supplement, 15 cents for a five-day course of antibiotics to treat pneumonia and $15 to immunize a child against the six main childhood diseases, according to the U.S. Coalition for Child Survival.

A bed net, treated to kill and repel malarial mosquitoes, costs less than $10.

“The bottom line is that we do have to have priorities,” says Dr. William H. Foege, former director of the Centers for Disease Control and Prevention (CDC) in Atlanta and currently senior adviser to the Bill and Melinda Gates Foundation for Global Health. “I don’t see any way around the fact that we have to do basic treatments first.”

In January, President Bush promised to increase spending on HIV/AIDS, mainly in Africa and the Caribbean, to $15 billion over the next five years.

Public health specialists fear the plan, while urgently needed for HIV/AIDS, might wind up siphoning money away from other public health crises.

“I’d put my money on the [funds] for child survival before the [funds] for AIDS,” Dr. Foege says, referring to U.S. spending on global health.

By all accounts, the United States already outspends other rich countries on global health in terms of total aid delivered, although not necessarily on a per-capita basis.

The United States spent $1.7 billion on global health, education and population programs in 2001, according to rough calculations based on figures from the Organization for Economic Cooperation and Development. France was the second-biggest spender, with $1.1 billion in aid, followed by Germany at $1 billion and Japan at nearly $800 million.

In the same year, the United States was the biggest contributor to UNICEF with about $110 million, followed by Norway, the Netherlands, Sweden, Japan, Britain and Denmark, which each contributed between $35 million and $20 million.

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