JPGN, A Potential Instrument Of Freedom From Fear, Devoted To The Children Of The World

Abstract

The birth of a child after 9 months of expectancy and alternating hope and despair is a triumph, a source of an inexpressible joy. Yet, very soon after, the evidence must be faced: life is fragile and uncertain. Tension increases when symptoms of disease appear: jaundice, vomiting or diarrhea. Most of the time, fortunately, hope can be quickly restored. Now, let us imagine the same situation in a different context. The country of the child’s birth is in a state of misery because of an economic embargo, a repressive dictatorship or war. The birth of a child may not bring joy but may be an event that increases the uncertainty of life for the family. Ensuring a supply of water and food completely occupies the family and there is little strength and few resources left to cope with disease in a newborn child. There is no reason to look with confidence to the future. Fear suffocates life. This evocation grips us, at least momentarily, as we read about it. Although we are concerned about the exigencies of life for families in the developing world, we must acknowledge our helplessness, and the evocation of the moment passes. All of us have an opinion on the political, economic and historical causes of conflicts that cause human misery, but they are for the most part beyond our ability to solve. Sometimes, even war may seem to be fair. In that case, we call it a ‘‘right to interfere.’’ Isn’t it fair to expel by force a dictator oppressing his people? Isn’t it fair to limit the power of a rogue state by isolating it through embargo? But.what about the children trapped in these situations? Everyone agrees that they are innocent victims, but who will commit to taking their side? Who will defend their rights, so regularly affirmed by governments of states and even by the United Nations? Why care about the anxiety of Third World parents if they are not voters in the elections of our more privileged countries? Not only as pediatricians but also as citizens and parents we must assume some responsibility. As I am presently ending my term as ESPGHAN Editor of the Journal after 5 years of collaboration, I think it is important to examine how our Journal can contribute to liberate children from the fear caused by disease. It is obvious that the Journal actively contributes to improving the diagnosis, treatment and prognosis of digestive diseases. Among the topics most frequently considered in these pages are, in descending order, diarrhea and dehydration, inflammatory bowel disease, celiac disease, abdominal pain and Helicobacter pylori infection. Among liver diseases, hepatitis and cholestasis are well covered. The same is true for the organic and metabolic aspects of nutrition, from studies on human milk and its substitutes to the functions of the digestive organs including the pancreas, and the metabolism of macronutrients and micronutrients. A long forgotten partner, the colonic microflora, has been rediscovered with the use of new genetic molecular tools. Digestive diseases and nutritional functions are well covered from pregnancy to adulthood. The Journal provides original articles, reviews and ‘‘news and views’’ in a field that is involved in the treatment of the most prevalent childhood diseases worldwide. Through publication of the best and most relevant contributions, our community does participate in the relief of disease in children. However, I see two main limitations to our worldwide impact. First, we are not experts in disease prevention. I can cite an example from my own field of expertise: infectious diarrhea. In the late 1960s, as a resident at the Hopital des Enfants in Tunis, I quickly recognized the close link between malnutrition, diarrhea and mortality risk. Later, in Montreal and Paris, I acquired the basics of pediatrics and gastroenterology. In addition, I studied the biophysics of membranes and started my research on the mechanism by which intestinal water absorption and secretion follow the movements of electrolytes, especially sodium and chloride. The World Health Organization, a United Nations agency, then called me to initiate a global program on diarrheal disease control. Oral rehydration therapy has been a great achievement in that area, but it does not prevent Journal of Pediatric Gastroenterology and Nutrition 40:26–27 O January 2005 Lippincott Williams & Wilkins, Philadelphia