The voice over the phone sounded gravely and time-worn. “If you can’t find Chryssa at the hospital before six this afternoon, ask for her again at this number before nine, or later in the evening at home. If you still can’t catch her, call her house again before eight in the morning.”
These were detailed instructions from Chryssa Tzoumaka-Bakoula’s father. The first round of calls ended in failure, so I called back the next day. The voice sounded the same; the instructions were the same, spoken surely and firmly. There was no question that he meant to make our meeting possible, though no doubt she was very busy and that I would make her busier. But in the father’s eyes, his daughter was available any time that there was work. A family of doctors is like that, bound by duty and solicitude.
The next round of calls proved successful, and a visit to Bakoula’s office left no doubt as to the resemblance between father and daughter: patient, firm, detailed, dedicated, hardworking.
Talking on the phone with her clients or her friends while we chatted, her intimacy made it difficult to draw a line between the duty and the solicitude.
“Do call the pediatrician I just mentioned. Tell him you’re calling on my behalf. He’s the best we have around for your little daughter’s problem. But before you go, make sure you pass by. I want to examine her again.” These words were repeated frequently and, although well after her office hours, she showed no sign of irritation or weariness.
On May 6 Bakoula, pediatrician at the Aghia Sophia Children’s Hospital in Athens, is receiving the 1993 World Health Organization award in Geneva for her contribution to the advancement of children’s well-being and health in Greece. She is the first Greek to receive the bi-annual International Child Health Foundation Prize.
Bakoula’s encounter with WHO goes back to the late 1970s when she first entered the field of social pediatrics. The numerous WHO posters hanging on the walls of her office have messages which suggest they have been carefully gathered. They carry powerful logos: ‘Children Ask the World of Us’ or ‘Disarmament for a Safer World.’ A picture painted by a child reads: I am suffering from AIDS. Hug me. Υου are not in danger.’
Her career in social pediatrics began in England. She spent a year in Bristol working for the local Community Child Health Services, an affiliated centre to the Royal Hospital for Sick Children. There, she became familiar with many aspects of the practice ranging from screening tests for children to providing guidance to families. Later she took her master’s degree in Mother and Child Health at the Institute of Child Health, London University.
“My experience there gave me impetus to start applying new methodologies and a new approach to pediatrics in Greece,” Bakoula said. “At the time social pediatrics was at a rather primitive stage here.” A sick child was treated strictly by medical means. “But research, carried on abroad, had already shown that a child’s sickness was only partly due to physical causes. Family, psychological and social reasons also played an important role,” Bakoula said.
Today, Bakoula directs the social pediatrics curriculum at the Pediatrics Department of Athens University. The primary definition of social pediatrics can be expressed in Bakoula’s words: “A child is but a little hostage in a society tailored to suit adults.” It has certainly been her concern since she first set out to make its practice the norm for child care in Greece. It may also be the reason she has always let her son, Vassilis, now a 22-year biology student, call her by her first name. “He once wrote in a primary school paper: Chryssa is what we call mother,” she remembered with laughter.
During the early 1980s, she started “working with and collecting information about mothers and their children.” Her efforts resulted in the first nation-wide perinatal study ever undertaken in Greece. “This was a Herculean task. Nobody expected it would ever end,” she said. WHO officials were also reserved. At the time only Britain, Cuba and a few other countries had conducted such a study nationwide.
The study comprised a collection of a wide range of information about every birth that took place in Greece during April 1983. This meant that all medical staff delivering children during that month had to be ‘persuaded’ to volunteer and cooperate in the project.
“We had to inform, and keep in contact with, even the smallest village on the islands or with the most remote community on the mainland,” Bakoula said. Around 11,000 births were reported, representing eight percent of the annual total.
Distinguished doctors called the results of this research ‘revolutionary’ when it disclosed the shortcomings of medical treatment and services offered in Greece. “The study revealed that the main cause for stillborn children originated in doctors’ habits and treatment rather than in biological or social reasons as was mistakenly assumed at the time,” said Bakoula.
When the research took place, there were no files on the death of a stillborn child. “The birth was registered, the death was not. It was all a blank as far as how many children were born dead or died within their first week.”
The survey revealed that 24 out of every 1000 children died within a week of birth. “Given that a pregnant woman in Greece has been, by tradition, looked after by her family, this finding led to the conclusion that maternal services fell short of quality.”
This revelation almost impaired her relations with most of the medical community in Greece. “I struggled hard to keep a balance, to avoid bad feelings. I tried to make my colleagues understand that labour was a natural event and its medical aspects should not prevail over others.” she said.
After publishing her perinatal research, she travelled extensively to medical conferences as consultant to WHO to publicize the conclusions of her study. At the same time her close collaborators kicked off a campaign to make these findings known to the Greek medical community. “At the time some of my friends used to tell me, ‘You’ve got an army working for you,’ but it was only by chance I worked with the right people at the right time,” she said.
Later, Bakoula became WHO’s Officer for Maternal and Child Health for Europe and back home her theory increasingly gained momentum, but at first the shift from ‘aggressive’ medical techniques of child-care to social-minded methods was gradual and improvised.
Efforts to set it within formal channels began in the mid-1980s. Along with Professor Nikolaos Matsaniotis of Athens University and author of We and Our Child (1981), Bakoula set up the Developmental Centre for Children. It offers services to children with special needs and support for their parents. The centre also ran specific studies about children, ranging from ‘The Child as a Passive Smoker’ to ‘The Child’s Behavior’.
Today, social pediatrics is the norm rather than the exception at Aghia Sophia, the most noted children’s hospital in Greece. In addition, the Department of Pediatrics, directed by Dr Matsaniotis, has become the WHO’s reference and cooperation bureau in Greece.
Dr Matsaniotis, who has cooperated with Bakoula over the past 20 years, partly attributes her success to her “charismatic communication skills”. Her students at Athens University, where she is an associate professor of pediatrics, say she “has a talent for breaking down her thoughts, no matter how complicated or analytical, into simple and understandable concepts.”
Some colleagues say Bakoula “successfully combines scientific competence with the ability to project herself.” Others say she works co-operatively, but never accepts ‘no’ for an answer or apologies as an excuse for failure. Social pediatrics has become widely recognized here since a flurry of sociological studies, published in Greece during the past decade, have played a significant role in alerting medical doctors to the importance of social factors in the individual’s well being.
“Awareness of current social problems has led to the recognition that children are more often than not sick because their parents live separately or because their fathers remain jobless for over a year. To assess how social and economic factors affect a child, we retraced from our studies all the children born in April 1983,” Bakoula noted. This task, undertaken in 1991, resulted in yet another pilot study, which gives details of a child’s life from its birth until age seven.
Bakoula stresses the crucial role a family plays in the upbringing of a child. “Here in Greece a child stifles under a surfeit of material goods. There is more encouragement to play with plastic toys than to run around with friends. In other European countries children are let loose. They play on the streets, they interact with each other more often,” she said.
Family affairs are sensitive topics for Bakoula. She admits to needing more time to spend with her son and husband, Giorgos, a cardiac surgeon with an equally demanding schedule. Yet she vigorously notes, “Unless my family were tolerant, I wouldn’t have been allowed to concentrate on my work.”
