By Adam Freeman, OMS-III
Touro University, College of Osteopathic Medicine
According to the law in India, if a child commits any crime, they can be forced to spend a maximum of three months in a juvenile detention center or other form of incarceration before they may be released. While participating in a public health clinical distinction, I was able to visit one of these places. During the visit, the manager of the site explained to us that up until an amendment passed a few years ago, this framework was in place until a child’s 18th birthday. Once the child completes his full sentence at a rehabilitation facility (like the one I visited), they can request to stay longer, but they are also allowed to leave. Criminals are known to take advantage of this loophole. Criminals will get children addicted to drugs and then refuse to provide said drugs unless the child performs a crime for them. Some children become addicted to drugs by age seven. Thankfully, centers such as the one I visited, are working hard to treat this issue.
I felt a strong connection to the facility I visited. It had a lot of similarities, as well as some stark differences, to a facility where I worked in New Hampshire called Wediko. Wediko deals with children who have emotional and behavioral issues. While the children at Wediko might abuse drugs, the predominant issues we were tasked with addressing were psychiatric and social. In contrast, the center in India handles children addicted to drugs. The majority of these children are sent to the center due to criminal activity. Many of them likely have psychiatric or relationship issues, but the primary focus of the center is addiction rehabilitation.
At the facility in India, only a select number of staff is aware of the crimes that each child has committed. They treat the patients as children instead of criminals. The same was true at Wediko, where we were unaware whether a child was diagnosed with social anxiety or bipolar disorder. The label would bias the treatment of the child, so it was removed. The head of the rehab center also explained that it was not enough to simply cure the physical addiction to the drug. It was equally important to work on the skills and positive life influences that would prevent the child from feeling the desire to abuse drugs. Similarly, at Wediko, we allowed the different students to choose activities or hobbies to practice. For the older children, we also gave them an opportunity to earn a minimal salary working for the facility. Creating these positive interactions and work experiences shows the kids that they can succeed in traditional society, which is a major worry for many of them.
This type of thinking coincides with one of the osteopathic principles. In osteopathic medicine, we treat the person as a whole instead of focusing solely on treating the disease. This has been illustrated to me in my work with pediatrics patients. So far, my pediatric clinic experience has been in foreign countries with a slight language and cultural barrier. Many of the clinic patients lived in rural communities and had initially attempted to shrug off any illness. It was only when an issue became truly debilitating that they would come to the hospital. When interacting with worried parents about their sick child and while struggling to translate a technical diagnosis, it would be ineffective to tell these parents that it would have been much easier to treat their child if they had sought medical treatment sooner. That mindset, while applicable in the US, is based on a cultural bias that would not resonate in these rural clinics. It was too focused on the disease and the extensive treatment protocol. However, explaining to the parents, in simpler terms, how we had found the source of the symptoms and had identified the signs to take note of in the future, was more warmly received. This approach tacitly acknowledged the parent’s cultural views regarding illness. Moreover, it viewed the diagnosis in context, as just one aspect of the rural life of the patient, instead of providing the patient with an all-encompassing label as a certain diagnosis to treat.
One unique difference between Wediko and the facility in India is that while there is a small staff at the rehab center, the boys have their own system of self-governance. They elect a group of their peers to be in charge, so to speak, and each night this group handles any complaints or altercations. The leaders are able to decide the proper punishment if an issue arises. This provides a level of autonomy for the boys and teaches them valuable lessons about living in society. This caters to the hands-off approach of the center. For their first ten days at the center, new children are kept away from the rest of the group as they detox from various drugs. For the rest of the time, they are incorporated into the community as they develop skills and techniques that would make them productive members of society upon release. All of this stems from the recognition that although addiction itself is a problem, aside from that, these are just boys who made some bad choices. The goal is not to treat the addiction, but treat the boys and help provide them with the tools to overcome the addiction on their own. Once someone is given a diagnosis, it creates a domino effect of accepted treatment regimens based on the progression of the disease. However, while this type of treatment protocol is necessary in medicine, at times it can be too singularly focused. Most treatment plans are designed based on their effectiveness at eradicating disease or prolonging quantity of life, without placing much focus on the patient as a whole. The impact of this factor is usually left up to the compassion of the physician. I have learned from my experiences, both in the US and abroad, that once someone is given a label, whether good or bad, it is incredibly difficult to overcome. Our goal as physicians is to get our patients to an optimal level of health so they can return to living their lives as fully as possible. To achieve this goal, we must look beyond the diagnosis.
Editor's Note: Each issue of the PULSE will feature a commentary from one of our students. We encourage submissions from all of our Colleges and Schools of Osteopathic Medicine. Please contact us at ACOPPULSE@gmail.com.
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