My early developmental experience included growing up on a farm in the Waikato. Although I enjoyed helping to care for the calves, lambs, piglets, chickens, puppies, and kittens, I never wanted to become a farmer. Animal handling practices at the time were not always baby-friendly, and some were cruel. It is reassuring that the practice has improved to some extent.
Instead of farming I was able to follow my older brother’s footsteps to New Zealand’s then only medical school at Otago. Despite the distance and the hazards of hitchhiking as the main form of travel, it was usual to return to the home farm during term holidays. Here I was able to be involved with the observations made by my paediatrician brother-in-law, Ross Howie, on the respiratory distress syndrome experienced by pre-term lambs in the makeshift “intensive care unit” in our woolshed. Along with Obstetrician Mont Liggins, also from Auckland, who discovered the maturing effect of maternally-given antenatal steroids on fetal lamb lungs, he went on to conduct the first randomised control trial of this intervention in humans. This practice which is now standard worldwide has saved many thousands of lives. While I was a medical student it was inspiring to be on the periphery of this ground-breaking research.
In 1967 professor James Watt was appointed to the first chair of paediatrics and child health established in New Zealand, located in Dunedin. He quickly became a role model for me because of his self-deprecating humour, teaching style, and exemplary communication skills. I remember as a house surgeon trying to use the same words that he had used in a difficult situation such as giving the bad news of an unpleasant diagnosis but not succeeding as well as he would have. At the time I explained the difference to myself as my lack of seniority and grey hair, but I know now there was more to it than that.
I had always enjoyed working with children, trying to share their vivid imaginations and the enjoyment they show for a good joke or surprise, or a newly understood concept. I soon learned that parents of sick children can become much more concerned and anxious on behalf of their child than they would about their own health issues. I enjoyed the challenges of trying to communicate effectively with them in this situation as well as with their child.
I chatted with Professor Watt about the possibility of postgraduate training in paediatrics and was successful in applying for a registrar position in his department. At that stage I was particularly interested in neonatal paediatrics and had excellent teachers and mentors, Donald Malcolm and Patricia Buckfield. Neonatal intensive care was a new speciality and new knowledge about ways of supporting preterm and ill neonates was often passed on in person, by visits to overseas hospitals or by attracting visitors to New Zealand. This was before the ‘information age’. When the new information eventually appeared in print a few years later we could reassure ourselves that we were properly up to date.
After passing the postgraduate Australasian College of Physicians’ exams in paediatrics I decided it was time to gain experience in a large centre. I spend a year at the Hospital for Sick Children in Toronto, and from there secured a neonatal fellowship at McMaster University in Ontario under the watchful eye of Professor Jack Sinclair, an inspiring and exacting boss. I had always said to myself and others, that if the opportunity arose I would return to Dunedin as a consultant to work in Professor Watt’s’ department. He visited McMaster University on his way to the UK and told me that there would soon be a vacancy, and invited me to consider the position. I said “yes please,” and after the usual formalities of that time, I was appointed. My only regret was the brief time he remained as head of department at Otago until ill health forced his retirement.
When you work with neonates for more than a few years and follow up their developmental progress, it becomes clear that for a minority of neonatal “graduates” there are long-term effects of the perinatal events they experienced. These include health, cognitive, educational, and behavioural difficulties, as well as the challenges and stresses for families who need to provide extra care. Core health services provided in these situations, although intensive initially, taper off all too soon and many families express their need to battle to get the help for their child’s special needs. So in later years after some further study leave and training in London (UK) I focused on issues to do with child development, child behaviour, and child protection, which can present singularly or in combination.
Studies of the effects of these conditions on family stress and functioning show that they generally have more impact that the kinds of illnesses which lead to admission to our generally well-supported paediatric acute wards and services. The conditions are long term and depend on the resources not only of families but of whole communities for several years. Until the Health Department was disestablished I became a community paediatrician in an attempt to give more attention to these issues. I was able to establish a distance teaching paper in community child health throughout New Zealand for a range of health professionals and am pleased that this still continues. I regret that as a country we have failed to develop cross-party support for the long term research and planning needed to address many of these issues effectively. The lack of attention to the underlying causes of domestic violence and child abuse is a clear and egregious example of this.
Most adults seem to respond in a protective way to babies and children and this is one of the appealing aspects of paediatrics practice. Professionals that work with children regard advocating for this dependant and non-voting part of our population as an intrinsic part of the job. Although disillusioned to some extent by lack of progress, I know that there are some inspiring people who are brave enough to enter the political battlefield to try and make improvements. Some countries have shown us that this is possible.
Most of the improvements in overall life expectancy over the last hundred years have been due to reduced infant and child mortality. Although there is still a long way to go I feel I have lived through a time of exciting changed in medicine and in the social structures that support children and their families.
From time to time in our small city of Dunedin there are people who stop and want to confirm that I really am the older version of the person they remember from years ago. They say things like “you looked after my child” or “you were my doctor.” This is almost always a happy encounter although I usually need to ask to be reminded about names and events. It is a privilege to be able to see children grow up and develop. I also enjoy hearing of the subsequent careers of the medical students and junior doctors who decided to train in paediatrics, even though caring for children often keeps you up at night. I do not know what I would have done if it had not been paediatrics. There was no ‘plan B.’ Knowing what I now know, I would be happy to follow the same path again.
Dr John Clarkson, who retired several years ago, was a senior lecturer in Child Health (Otago, Dunedin NZ,); paediatric consultant to the Southern District Health Board and its predecessors; and for the length of three parliamentary terms the clinical director of the Otago Child Health Service.