1042 Archives ofDisease in Childhood 1992; 67: 1042-1045 CHALLENGES Arch Dis Child: first published as 10.1136/adc.67.8.1042 on 1 August 1992. Downloaded from Paediatric care in Hungary Dezso Schuler This is the fifth paper in a Child health in Hungary has historically been an among young women. Counselling after artifi- series showing the problems facing the medical services important priority. Hungary was a pioneer in cially induced abortion is mandatory, but is for children in different inaugurating obligatory vaccination against seldom practiced. countries. smallpox in 1876. The fourth paediatric hospital Even educated and cultured Hungarians do was founded in Budapest in 1844, after Paris, St not readily accept current contraception infor- Petersburg, and Vienna. It is interesting too to mation; in most families the responsibility of note that the second paediatric hospital in birth control is left entirely to the woman. England was founded in 1856 by Whithead and Hence despite the availability of oral contracep- Schopf Merei. Schopf Merei was a Hungarian tives and condoms, 38-6% of pregnancies are refugee from a revolution against Austria. aborted. This is unethical, has an unfavourable The health care of children in our country is psychological effect on the mothers, and is loaded by many problems, the most prominent disadvantageous in relation to the outcome of being limited monetary support and the low the next pregnancy. Permission for induced sociocultural level, reflected by the fact that only abortion is not difficult to obtain. Criteria 15-8% of the population has a high school include two children already in the family, education and 6-4% are graduates from colleges genetic problems, social indications, and teenage or universities. Before the second world war or out of wedlock pregnancy. More stringent Hungary was half feudal, half democratic; after restrictions might decrease the number of such the war it became communist. The medical care abortions. budget in Hungary is £80 per person per year; One severe problem has been the high infant in contrast, it is £1100 per person per year in the mortality among people in the lower socio- United States. economic classes. Many gypsies live in extremely The most urgent problems facing Hungarians poor circumstances. Their appearance in are: (1) the high infant mortality; (2) the Hungary dates from the 14th century, and their limitations attending cardiac surgery, especially number has increased gradually. It is now paediatric cardiac surgery; (3) the lack of estimated that about 5% of the Hungarian modern diagnostic tools, particularly magnetic population consists of gypsies. However, in a http://adc.bmj.com/ resonance imaging and computed tomography; few counties it is between 7% and 10%, parti- (4) the unavailability of certain life saving cularly in some small villages, whose popula- transplantation procedures, for example, bone tions consist almost entirely of gypsies. Gypsy marrow and liver; (5) the lack of overnight women are reluctant to attend perinatal educa- facilities for parents in most hospitals; (6) tion classes. In 1970 the infant mortality among problems of child welfare and mental health; gypsies was 116 out of 1000 births, while the and (7) the need to overhaul the medical care national rate was 35 8 out of 1000 births. The on September 28, 2021 by guest. Protected copyright. system emphasising preventive and curative medical profession attempted with special care care, and to find the most suitable method of to rectify this unacceptable situation; in 13 financing and organising it to adapt to the new counties of the 19 from which data were democratic structure. available in 1990, the infant mortality among gypsies was 22 out of 1000, and the national rate was 14-8 per 1000. Infant mortality Many factors were responsible for this Infant mortality has decreased from 32 per 1000 welcome decrease in infant mortality among to 14-8 per 1000 in the past 15 years, but the gypsies: (1) special attention was given to them rate is still unacceptable. The main culprits are by health care visitors, and medical check ups the high rate of premature births (9-2%) and were done more frequently. (2) Resident the weight-specific mortality, which is also nurseries are free for poor patients. (3) Vitamins unacceptable, especially in very low birthweight are supplied free for pregnant women and infants. Smoking, other unfavourable kinds of infants. (4) Vaccinations are available in the behaviour, the number of previously induced home if necessary. (5) Education in hygiene and abortions, and lack of prenatal education and better health habits for adolescents and pregnant care have all been implicated as causes of women. (6) Special incentives for practitioners 2nd Department of Paediatrics, premature births. and health care visitors. (7) Better education Semmelweis Medical Although pregnant women receive benefits provided by the schools. University, for prenatal consultations, behaviour during Very low birthweight infants need special Budapest IX, pregnancy has Contra- care, in the form of intensive treat- Tiizolt6 u 7-9, H-1094, improved only slightly. especially Hungary ceptive education is not readily available in ment, parenteral nutrition, and respiratory Correspondence to: schools. The importance of a suitable time treatment. Between 1960 and 1970, 10 neonatal Professor Schuler. interval between pregnancies is almost unknown intensive care units (NICUs) were established Paediatric care in Hungary 1043 with governmental support. However, inade- Parents' stay in hospital quate funding has hampered the organisation There are few opportunities for parents to stay of good transport for newborns to these centres, with their children in hospitals. There are no Arch Dis Child: first published as 10.1136/adc.67.8.1042 on 1 August 1992. Downloaded from the hiring of sufficient personnel, and the Ronald McDonald Houses, as there are in installation and maintenance of equipment. several Western countries, and there are only a Nine more NICUs in regional hospitals have few institutions where parents can stay overnight been opened with local economic support. with their sick children. Furthermore, rent in Their financial problems are highlighted by the the cities is exorbitant. In our institution, which estimate of 320 million HF (£2-5 million) has 230 beds and houses a national oncology needed to bring these units to a medically centre as well, there are only three rooms with acceptable level. The scarcity of trained paedia- beds for children and their parents. tric nurses is a particular problem: one nurse has the responsibility in one shift for an average offour newborns. Child welfare and mental health Working mothers with children younger than 3 years of age can remain at home, they receive Cardiac surgery financial support at the place of employment, The incidence of congenital heart disease in and their jobs are kept open for them. However, Hungary is one in 200. About 50% of the this option is becoming more difficult because affected children would need surgical correction of the worsening economic situation of most during the first year of life. There are now two families. Despite this situation, the number of centres for cardiac surgical intervention: 90% of infants in day care centres has not increased. the surgery in Budapest, at the Semmelweis and 10% in The The state grants custody, either in institutions University, Szeged. Budapest or to foster parents, of children who are not or centre is too small and the equipment is cannot be cared for by their parents or who need inadequate. The turnover in nurses is high protection. Although the number of children at because of the patient load. During the summer risk is increasing, the number of children in the vacation period, the surgery must shut down custody of the state is diminishing; it is now because there is no second team. Although the 0 97%. Thus more parents or other relatives surgeons are well trained, the lack of facilities is care for the children, with some social and a limitation. The waiting time for open heart psychological assistance. In 1988 foster parents surgery is about one year. were granted custody of29-4% ofthese children. In the main, their care in such foster families is Modern diagnostic tools satisfactory. Of children cared for in institu- The new imaging techniques are essential in tions, fewer are attending secondary schools or paediatric diagnosis, but there are only two universities (1-26% compared with 3-02% of magnetic resonance imaging units in the entire children in foster families). The result is that country, which has a population of 10-6 million. beginning a career or finding a suitable occupa- In the diagnosis of brain tumours, for example, tion is difficult. Adoption, an appropriate solu- http://adc.bmj.com/ magnetic resonance imaging would be extremely tion for children in need, became slightly easier valuable. Ultrasound imaging is available and in 1990, but it is far from ideal: at the end of there are now 13 computed tomography facili- 1989 there were 1737 couples waiting for chil- ties; the waiting time for such an examination is dren to adopt. 10 to 15 days. More computed tomography and Mental health clinics and other centres are magnetic resonance imaging equipment is run by volunteers and school psychologists. urgently needed for adequate diagnostic work. There are consultation centres for the parents of on September 28, 2021 by guest. Protected copyright. Fortunately, children usually get priority in troubled schoolchildren, and in severe cases urgent cases. (12%) these children can be seen in psychiatric outpatient clinics. The great mental health problems are Transplantation developmental retardation, particularly in read- Before 1991 there were only two bone marrow ing, attention, and orientation; adaptation diffi- transplantation units in Hungary: one with two culties; emotional disturbances; and attempted beds and one with four, all for adults.