Top Banner

of 106

Voices From the Field on Childhood Pneumonia

Apr 06, 2018

Download

Documents

bobbyramakant
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    1/106

    Wocna~gxoe tfa gcald o`

    nfcldfood z`aqeo`cm

    Mqtfox~2

    ^fohfm ^fqklm, ^oesm Mxoxm, ^fckfm ^xcwm~tmwm, Xmfql Kqemx Dycwadc, Xcta~f Mxsm,@aaxmbEmc`mlc,@mdaae^mlem`c,Bcta`dxmDycwadc,BcttcemBm`tm`memlmkm,HohhsXmemkm`t

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    2/106

    8 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Tfa~a mxtcnla~ fmwa haa` yxctta` m~ zmxt og m ~axca~ c` lamd qz to tfa YoxldZ`aqeo`cm Dms, =8 @owaehax 8:==.

    Tfa wcay~ avzxa~~ad c` tfa~a mxtcnla~ mxa tfo~a og tfa Nctcra` @ay~ ^axwcna&N@^# yxctax~ m`d tfa zax~o`~ c`taxwcayad hs tfae.

    @owaehax 8:==

    N@^2 Tfc~ no`ta`t c~ mwmclmhla q`dax tfa Nxamtcwa Noeeo`~ Lcna`naMttxchqtco` >.: Q`zoxtad &NN HS >.:# lcna`~a

    MQTFOX^2

    ^fohfm ^fqklm

    ^oesm Mxoxm^fckfm xcwm~tmwm

    Xmfql Kqemx DycwadcXcta~f Mxsm

    @aaxmb Emc`mlc@mdaae ^mlem`cBcta`dxm Dycwadc

    Bcttcem Bm`tm`memlmkmHohhs Xmemkm`t

    Zqhlc~fax2 Zqbm Zxmkm~fm`, N%88==, N%hlonk nxo~~c`i, C`dcxm @mimx, Lqnk`oy%887:=7.

    Zxcna2 X~ 1:

    Tfa yxctax~ og Nctcra` @ay~ ^axwcna &N@^# noea gxoe mggantad noeeq`ctca~yfo fmwa ~oeatfc`i to ~ms o` c~~qa~ tfas gaal gox, ox mxa mggantad hs, c`

    tfacx dmcls lcwa~, m`d icwa m wocna to tfa wocnala~~. N@^~s`dcnmta~ no`ta`t ia`axmtad c` goqx lm`iqmia~&A`ilc~f, Fc`dc, Qxdq m`d Tfmc# q`dax NxamtcwaNoeeo`~ &NN# mttxchqtco` lcna`~a m`d zxodqna~ 4foqx~ og xmdco zxoixmeea~ dmcls gox GE xmdco c``oxtfax` Tfmclm`d. N@^ c~ gmnclctmtad hs m Tfmclm`d%hm~ad noezm`s % BmsC`~zcxa No Ltd &BCNL# % Eadcm m`d Noeeq`cnmtco` ^axwcna~.

    Yfaxa Zaozla Noea Gcx~t- N@^2 yyy.nctcra`%`ay~.oxi

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    3/106

    > | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    TMHLA OG NO@TA@T^Mnk`oyladiaea`t~.4CXO@S2 Zxawa`tmhla z`aqeo`cm c~ hciia~t kcllax og nfcldxa` q`dax 1. 1Ymka qz nmll mgtax samx~ og `ailant o` nfcldfood z`aqeo`cm. 9Amxls xanoi`ctco` ' em`miaea`t og nfcldfood z`aqeo`cm =:Icgt soqx nfcld loy z`aqeo`cm xc~k hs }qcttc`i tohmnno.. =8

    Tfaea =2 Cezoxtm`na og avnlq~cwa hxam~tgaadc`i dqxc`i tfa =~t ~cv eo`tf~ og lcgac` zxotantc`i nfcldxa` gxoe z`aqeo`cm m`d em`s otfax dc~am~a~

    @o Nonktmcl Gaadc`i Zlam~a Hxam~tgaad C~ Ha~t Gox Tfa Hmhs=7 Eotfax~ Eclk C~ Tfa Ha~t Eclk =3 Hxam~tgaadc`i2 M Nfcld~ Gcx~t Ceeq`crmtco`.8= Hxam~t eclk c`nxam~a~ ceeq`cts c` nfcldxa`....84 Eotfax~ eclk aggantcwals zxawa`t~ nfcldfood z`aqeo`cm..87 Eotfax~ eclk zxotant~ tfa nfcld mimc`~t z`aqeo`cm.86 Avnlq~cwa hxam~tgaadc`i wctml gox gcx~t ~cv eo`tf~. >:

    Tfaea 82 Cezoxtm`na og iood `qtxctco` m`d fsica`a &c`nlqdc`i fm`d%ym~fc`i# c`

    zxawa`tc`i z`aqeo`cm m`d otfax dc~am~a~ Gaad soqx nfcld yall2 Zxawa`t z`aqeo`cm. >> Gcift z`aqeo`cm yctf iood qtxctco`. >7 Nlam`lc`a~~ c~ `avt to iodlc`a~~ c` zxawa`tc`i nfcldfood z`aqeo`cm >3 Gaad xcift to gcift nfcldfood z`aqeo`cm. 48 @qtxctco` m`d nlam`lc`a~~ wctml to zxotant nfcldxa` gxoe z`aqeo`cm.41 Zxawa`t nfcldfood z`aqeo`cm hs iood `qtxctco`49 @qtxctco` m`d fsica`a falz~ zxotant nfcldxa` gxoe z`aqeo`cm.43 Iood `qtxctco` zxotant~ nfcldxa` gxoe z`aqeo`cm..1=

    Tfaea >2 Cezoxtm`na og c`doox mcx zollqtco` &nook ~towa, tohmnno ~eoka# c`zxawa`tc`i z`aqeo`cm m`d otfax dc~am~a~

    ^eoka%gxaa C`doox~ Gox Z`aqeo`cm Gxaa Lq`i~.14 A`wcxo`ea`tml Hqxda` Nm` Yacif Doy` Soqx Nfcld)~ Famltf..19 Zm~~cwa ~eokc`i m`d lmnk og fsica`a hxaad~ nfcldfood z`aqeo`cm..7: C`doox mcx zollqtco` m`d nfcldfood z`aqeo`cm..7> ^ano`dfm`d tohmnno ~eoka c`nxam~a~ xc~k gox nfcldfood z`aqeo`cm..71 C`doox Mcx Zollqtco` c`nxam~a~ tfa xc~k og Nfcldfood Z`aqeo`cm.. 79

    Tfaea 42 Mnna~~ to mggoxdmhla wmnnc`a~ c` oqx noeeq`ctca~ to zxawa`tnfcldfoodz`aqeo`cm

    Wmnnc`a ^fot~ Nm` Noehmt Tfa Damtf ^fot Og Z`aqeo`cm9: Lcga ^mwc`i ^fot~ Gox Kcllax Z`aqeo`cm.9> M ^fot C` Mxe Zxawa`t~ Nfcldxa` Gxoe Z`aqeo`cm. 97 Z`aqeo`cm wmnnc`mtco` `ot xamnfc`i nfcldxa` yfo `aad ct eo~t93

    Iat soqx nfcld wmnnc`mtad mimc`~t z`aqeo`cm6= Z`aqeo`cm wmnnc`mtco`2 Haso`d xamnf gox eo~t nfcldxa`.6> Lmnk og mymxa`a~~ mhoqt z`aqeo`cm wmnnc`a.61

    Tfaea 12 Mnna~~ to ~tm`dmxd }qmlcts txamtea`t to ~mwa lcwa~ gxoez`aqeo`cm Txamt Z`aqeo`cm Yctf Tfa Yo`dax Dxqi~.66 M`tchcotcn Tfaxmzs2 Tfa Z`aqeo`cm Zm`mnam.3= Txamt nfcldfood z`aqeo`cm hagoxa ct iat~ too lmta3> Hmxxcax~ to mnna~~c`i txamtea`t gox nfcldfood z`aqeo`cm31 Nfcldfood z`aqeo`cm m zqhlcn famltf nfmlla`ia..39 Nfcldfood z`aqeo`cm c~ nqxmhla.33

    ^ZAMK SOQX YOXLDMTFMXWM2 Tall%tmla og m z`aqeo`cm nxq~mdax.=:=

    Mhoqt tfa N@^ yxctax~. =:1

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    4/106

    4 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    MNK@OYLADIAEA@T^

    Tfc~ xazoxt ym~ yxctta` hs ta` N@^ yxctax~ gxoe C`dcm m`d Tfmclm`d, m`dzqhlc~fad c` tfxaa lm`iqmia~ &A`ilc~f, Fc`dc m`d Qxdq#. Tfa zxobant ym~

    em`miad hs Mhfc`mw Hfmxmt Goq`dmtco` m`d ~qzzoxtad hs tfa 8:== ^emllIxm`t~ gox Yoxld Z`aqeo`cm Dms Mdwonmns Zxoixmeea. Ya mxa ixmtagql totfa C`tax`mtco`ml Wmnnc`a Mnna~~ Na`tax &CWMN#, Bof` Fozkc`~ Hlooehaxi^nfool og Zqhlcn Famltf, IMWC Mllcm`na, Ilohml Mllcm`na gox Nlam` ^towa~, m`dHa~t ^fot Goq`dmtco` gox tfacx ~qzzoxt.

    Waxs ~zancml tfm`k~ mxa c` ~toxa gox N@^ adctox~ m`d txm`~lmtox~ yfo c`wa~tadtfacx tcea m`d a`axis c` falzc`i q~ icwa tfc~ ~fmza to tfa~a zqhlcnmtco`~. E~^faflm Ifm`ce, E~ Hcelm Ec~xm m`d E~ Emsm Bo~fc `aad m ~zancml ea`tco`m`d ya ~mlqta tfacx dclcia`na m`d noeectea`t.

    Ya yoqld lcka to tfm`k mll tfo~a yfo yaxa c`taxwcayad m~ zmxt og tfc~zxobant m`d yfo took tfa tcea to ~fmxa tfacx wcay~. Ya ycll ml~o lcka totfm`k tfa C`tax`mtco`ml Q`co` Mimc`~t Tqhaxnqlo~c~ m`d Lq`i Dc~am~a &TfaQ`co`# m`d @al~o` Fo~zctml gox Zmadcmtxcn m`d @ao`mtml Eadcnc`a, Mlcim`b,Lqnk`oy, meo`i otfax~.

    Lm~tls, tfm`k~ to tfa yo`daxgql N@^ yxctax~ yfo zxodqnad fcif }qmlctsmxtcnla~ c` m ~foxt zaxcod og tcea, gox emkc`i ~qxa tfa wocna~ gxoe tfanoeeq`ctca~, tfo~a eo~t mggantad hs nfcldfood z`aqeo`cm, mxa famxd.

    No`nazt, nowax%zmia, da~ci`, lmsoqt2 Bcttcem Bm`tm`memlmkm, N@^ Tfmclm`d

    Zfoto nxadct~2 ^fckfm ^xcwm~tmwm, ^fohfm ^fqklm, ^oesm Mxoxm, Xmfql KqemxDycwadc, @mdaae ^mlem`c, Xcta~f Mxsm, @aaxmb Emc`mlc, Bcta`dxm Dycwadc,Bcttcem Bm`tm`memlmkm, m`d Hohhs Xmemkm`t

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    5/106

    1 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    CXO@S2 Zxawa`tmhla z`aqeo`cm c~

    hciia~t kcllax og nfcldxa` q`dax 1Z`aqeo`cm nm` ha zxawa`tad. Ct nm` ha txamtad q~c`i gcx~t%lc`a nfamz m`dam~cls mwmclmhla m`tchcotcn~. Da~zcta hac`i zxawa`tmhla m`d nqxmhla, ctno`tc`qa~ to ha tfa lamd nmq~a og eoxhcdcts m`d eoxtmlcts gox nfcldxa` haloytfa mia og gcwa samx~.

    Z`aqeo`cm c~ m ~axcoq~ dc~oxdax mggantc`i nfcldxa` awa` c` tfacx waxs amxls~tmia~ og lcga. Tfa txmiads c~ tfmt ct c~ zxawa`tmhla. ^o, tfa toz zxcoxcts c~ tozxawa`t ct m`d, cg ct dawaloz~, tfa` to zxowcda tceals txamtea`t, ~mcdZxoga~~ox &Dx# Ioqxdm~ Nfoqdfqxc, Famd, Dazmxtea`t og Im~txoa`taxolois,^m`bms Im`dfc Zo~t%Ixmdqmta C`~tctqta og Eadcnml ^nca`na~ &^IZICE^#,

    Lqnk`oy. Zxog Ioqxdm~ Nfoqdfqxc c~ m `otad zqhlcn famltf avzaxt too.

    FAMLTF M@D TXAMTEA@T LCTAXMNSZ`aqeo`cm onnqx~ dqa to owaxnxoydc`i c` ~emll foea~ yctf zooxwa`tclmtco`. Tfa zxohlae c~ gqxtfax miixmwmtad cg o`a ox hotf og tfa zmxa`t~~eoka. Zm~~cwa ~eokc`i emka~ nfcldxa` eoxa zxo`a to nfa~t m`d zqleo`mxsc`gantco`~. Tfa otfax cezoxtm`t m~zant c` zxawa`tc`i z`aqeo`cm c~ mhoqtfsica`a % nlam`lc`a~~ m`d fm`d ym~fc`i ycll zxawa`t tfa iaxe~ gxoe~zxamdc`i. ^o, m ia`axml ~a`~a og fsica`a ~foqld ha tfaxa mt mll tcea~. Tfaotfax c~~qa c~ og zollqtco` % tfa gqea~ m`d dq~t c` tfa mcx yfcnf nfcldxa`hxamtfa. Tfa~a zmxtcnla~ ycll miixmwmta tfa hmntaxcm m`d tfa wcxq~ cg tfas mxa

    mxoq`d. Tfaxa c~ m `aad og m lot og mymxa`a~~ c` eotfax~ mhoqt zcnkc`i qzz`aqeo`cm mt m` amxls ~tmia. Nfa~t c`gantco`~ c` nfcldxa` mxa hoq`d tofmzza`. Hqt cg m nfcld fm~ fcif ox zax~c~ta`t noqifc`i, m dontox ~foqld ha~oqift ~o tfmt m`tchcotcn~ nm` ha icwa` tceals. Tceals mnna~~ to eadcnmlnmxa c~ nxqncml. C` tfa amxls ~tmia~ og tfa dc~am~a oxml m`tchcotcn~ yoxk. Hqto`na tfa nfcld hanoea~ waxs ~cnk, eqnf eoxa c`ta`~cwa nmxa c~ xa}qcxad %lcka fo~zctmlc~mtco`, ~txo`iax m`d eoxa avza`~cwa c`bantchla m`tchcotcn~meo`i otfax~. ^o, zxozax mymxa`a~~ og tfa dc~am~a c~ m` cezoxtm`t c~~qa c`c`nxam~c`i tfa ~qxwcwml xmta og nfcldxa` ~mcd Zxog Nfoqdfqxc.

    Tfa xola og wmnnc`a~ c` zxawa`tc`i tfa dc~am~a nm``ot ha owaxlookad. ^oeawmnnc`a~, lcka tfa Fch wmnnc`a, mxa iood m`d m eq~t, yfcnf nm` ha icwa`xoqtc`als. Tfa z`aqeononnml wmnnc`a c~ m`otfax iood wmnnc`a. Hqt tfac~~qa c~ yfatfax tfa ~txmc`~ nmq~c`i tfa dc~am~a, yfcnf mxa zxa~a`t c` tfanoeeq`cts, mxa tfa ~mea m~ tfo~a zxa~a`t c` tfa wmnnc`a, otfaxyc~a tfawmnnc`a ycll `ot yoxk, m`d tfa eo`as ~za`t ycll `ot iat tfa zxotantco` o`ac~ avzantc`i ~mcd Zxog Nfoqdfqxc.

    Z`aqeononnq~, o`a og tfa iaxe~ tfmt nmq~a z`aqeo`cm c` nfcldxa`, fm~em`s ~txmc`~. Tfa wmnnc`a, yfcnf c~ nqxxa`tls mwmclmhla, fm~ ~txmc`~ tfmt mxagoq`d nfcagls c` tfa ya~tax` yoxld, m`d ct~ zxogcla doa~ `ot emtnf yctf tfa

    ~txmc`~ goq`d c` oqx noq`txs. ^o m xoqtc`a ceeq`crmtco` yctf o`a wmnnc`aems `ot yoxk avzlmc`ad Zxog Nfoqdfqxc.

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    6/106

    7 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Z`aqeo`cm c~ m ~axcoq~ c`gantco` og tfa lq`i~ m`d nm` ha nmq~ad hs ~awaxmliaxe~. M wmnnc`a ycll yoxk yall mimc`~t ~oea og tfa~a hqt `ot mll. ^o ct c~dcggcnqlt to fmwa m noezlata wmnnc`a gox gqll zxotantco`.

    Tfaxa c~ no%c`gantco` m`d no eoxhcdcts c` z`aqeo`cm. Nfcldxa` ~qggaxc`igxoe ~oea xa~zcxmtoxs zxohlae lcka m~tfem/nfxo`cn hxo`nfctc~; nfcldxa`yfo~a ~zlaa`~ fmwa haa` xaeowad; nfcldxa` yctf m dazxa~~ad ceeq`a~s~tae; eml`oqxc~fad nfcldxa`; m`d nfcldxa` eoxa zxo`a to z`aqeononnmlc`gantco`~ % mxa eoxa wql`axmhla to z`aqeo`cm, ~mcd Zxog Nfoqdfqxc.

    OHA^A NFCLDXA@ MXA ML^O EML@OQXC^FADLcga~tsla dc~oxdax~ zlms m nxqncml xola c` qzzc`i tfa xc~k to z`aqeo`cm. Oha~anfcldxa` mxa ml~o eml`oqxc~fad m`d ~o fmwa m noezxoec~ad ceeq`a ~s~tae.^o ct c~ cezoxtm`t to a`~qxa tfmt nfcldxa` kaaz m` cdaml hods yacift m`d q~atfa ~zoxt~ gcald m`d/ox do zla`ts og avaxnc~a to kaaz tfacx lq`i~ famltfs.

    O`a og tfa eo~t zxawa`tmhla gmntox~ c~ zm~~cwa ~eokc`i. Ct doa~ `ot dcxantlsnmq~a z`aqeo`cm, hqt emka~ tfa nfcld eoxa wql`axmhla to ct. ^eokc`i doa~`ohods m`s iood, m`d gmtfax~ a~zancmlls `aad to ha emda mymxa to ha eoxaxa~zo`~chla toymxd~ tfacx nfcldxa`~ famltf, ~mcd Zxog Nfoqdfqxc.

    ^fohfm ^fqklm N@^

    Nfm`ic`i hafmwcoqx toymxd~ famltf m`d ~oncml bq~tcna c~ m nfmlla`ia

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    7/106

    9 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Ymka qz nmll mgtax samx~ og

    `ailant o` nfcldfood z`aqeo`cmZ`aqeo`cm c~ tfa yoxld)~ lamdc`i kcllax og nfcldxa` q`dax gcwa, nlmcec`io`a soq`i lcga awaxs 8: ~ano`d~. Tfmt)~ eoxa tfm` MCD^, emlmxcm m`d eam~la~noehc`ad. Z`aqeo`cm c~ o`a og ilohml famltf~ eo~t ~olwmhla zxohlae~. Yafmwa ~mga, aggantcwa m`d mggoxdmhla tool~ to falz nfcldxa`. Nfcldxa` ~foqldfmwa mnna~~ to aggantcwa m`d mggoxdmhla txamtea`t q~c`i m`tchcotcn~, yfcnftszcnmlls no~t la~~ tfm` o`a dollmx zax do~a. Txmicnmlls, o`ls m` a~tcemtad =og awaxs 1 nfcldxa` yctf z`aqeo`cm xanacwa~ m`tchcotcn~.

    Aggantcwa nm~a em`miaea`t ~txmtaica~ nm` falz to a`~qxa tfmt nfcldxa`xanacwa tfa xcift txamtea`t gox z`aqeo`cm }qcnkls, awa` c` tfa zooxa~t

    noeeq`ctca~.

    Z`aqeo`cm zxobant c` Emlmycym~ hm~ad o` oqx TH eodalyfcnf ym~ dalcwaxc`i ~tm`dmxdnm~a em`miaea`t to nfcldxa`eo~t mt xc~k. Tfa k`oy foy c~tfaxa hqt iattc`i tfa k`oyfoy to tfa nfcldxa` c~ tfazxohlae. Ya k`oy tfmt tfa~tm`dmxd nm~a em`miaea`t

    yoxk~ hqt c` eo~t noq`txca~tfa zxohlae c~ tfa yamk famltf~s~tae~. O`a og tfa C`tax`mtco`ml Q`co` Mimc`~t Tqhaxnqlo~c~ m`d Lq`iDc~am~a &Tfa Q`co`#~ ~txa`itf~ c~ tanf`cnml m~~c~tm`na c` txsc`i to hqcld qzm`d icwa nmzmncts hqcldc`i to tfa famltf ~s~tae~. M`d ya ~foyad tfc~ tfmt cgya do tfc~ gox nfcldxa` yctf lq`i dc~am~a tfa` ya nm` fmwa m fqia cezmnt.M`d ct doa~`t no~t m goxtq`a. M`otfax nfmlla`ia c~ to dalcwaxc`i ovsia` goxnfcldxa` yctf waxs ~awaxa z`aqeo`cm. ^o tfc~ `aad~ to ha mddxa~~ad m~ yall~mcd Dx Za``s A`mx~o`, Famd, Nfcld Lq`i Famltf Dcwc~co`, C`tax`mtco`mlQ`co` Mimc`~t Tqhaxnqlo~c~ m`d Lq`i Dc~am~a &Tfa Q`co`#.

    DXQI TONK%OQT^ MXA EMBOX ^TQEHLC@I HLONK^M`tchcotcn~ q~ad gox txamtc`i z`aqeo`cm mxa ~tcll tfa gcx~t lc`a m`tchcotcn~&m`d `ot tfa avza`~cwa o`a~# ~qnf m~ Ha`roza`cncllc`, ia`tmesnc`,meovcncllc` meo`i otfax~. Tfa~a mxa }qcta c`avza`~cwa, am~cls em`miadhqt mimc` q~qmlls ct c~ tfa zxohlae og loic~tcn~. Waxs ogta` tfa iowax`ea`t~actfax do`t iat tfa ~qzzls ox do`t emc`tmc` tfa ~qzzls og tfa~a m`tchcotcn~.^o ct c~ m embox ~tqehlc`i hlonk gox m`s ~txmtais tfmt c~ hm~ad o` tfa~tm`dmxd nm~a em`miaea`t hanmq~a ct xalca~ o` q`c`taxxqztad ~qzzls ogm`tchcotcn~. Tfa~a m`tchcotcn~ mxa `ot avza`~cwa m`d c` C`dcm a~zancmllshanmq~a C`dcm c~ em`qgmntqxc`i lot og tfa~a dxqi~. Noq`txca~ c` ^oqtf m`d

    ^oqtf Am~t M~cm m`d Mgxcnm cezoxt tfa~a dxqi~ gxoe C`dcm. ^o ct c~ m emttax ognoeectea`t m`d ec`c~txca~ og famltf hac`i loic~tcnmlls nmzmhla og kaazc`i m

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    8/106

    6 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    ~tonk og dxqi~ mlyms~ mt tfa dc~txcnt m`d famltf na`txa lawal~ gox tfas mxa`ot avza`~cwa ~mcd Dx Za``s A`mx~o`.

    CXXMTCO@ML Q^A OG DXQI^ C^ M@OTFAX NFMLLA@IAM zxohlae yfa` ya nm` hqs dxqi~ owax tfa noq`tax c~ tfa owax q~a ox

    cxxmtco`ml q~a og dxqi~. Ya golloy xmtco`ml q~a og dxqi~ c` ~tm`dmxd nm~aem`miaea`t m`d lot og ct c~ mhoqt adqnmtc`i tfa eotfax o` xmtco`ml q~a ogdxqi~ gox avmezla nfcldxa` yctf noeeo` nold do`t `aad m`tchcotcn~ yfa` ctc~ ~o eqnf am~cax gox tfa zfs~cncm` to icwa ct m`d eotfax c~ fmzzs c`daad.Nfcldxa` yctf noeeo` nold `aad ~oea avtxm good m`d nmxa atn al~a tfc~ c~yfaxa zxohmhls dxqi xa~c~tm`na nm` onnqx ~mcd Dx Za``s A`mx~o`.

    To do m dxqi%xa~c~tm`na ~tqds c~ }qcta avza`~cwa tfmt c~ yfs lot og noq`txca~do`t k`oy tfacx dxqi%xa~c~tm`na fc~toxs. Hqt hs mntqmlls doc`i tfatxamtea`t ya do iat to k`oy tfmt ct yoxk~. C` lot og noq`txca~ tfaxa c~ `oxa~c~tm`na to gcx~t lc`a m`tchcotcn~ hqt xana`tls tfaxa fm~ haa` ~oea ~fcgt

    myms gxoe ha`roza`cncllc` m`d ia`tmesnc` gox waxs ~awaxa z`aqeo`cm.Q~qmlls gox la~~ ~awaxa z`aqeo`cm ya yaxa amxlcax q~c`i notxceovmrola hqt`amxls awaxs otfax noq`txs c~ xa~c~tm`t to tfmt. Eoxa noq`txca~ mxa `oy~yctnfc`i to meovcncllc` yfcnf c~ m lcttla eoxa avza`~cwa. Tfa~a mxa hm~adqzo` tfa xanoeea`dmtco`~ og tfa YFO m`d lot og tfa~a ~tqdca~ yaxa do`ac` Zmkc~tm`, ~mcd Dx Za``s A`mx~o`.

    Ct fm~ ~foy` c` em`s ~tqdca~ tfmt cg ya avnlq~cwals hxam~tgaad m` c`gm`t goxgcx~t ~cv eo`tf~ tfa` tfa nfcld c~ la~~ lckals to iat c`gantco`~ m`d ml~o ct falz~tfa ceeq`a ~s~tae yfcnf c~ avtxaeals cezoxtm`t. Foyawax c` noq`txca~

    yfaxa tfaxa c~ `o gmecls zlm``c`i ct c~ lckals tfmt tfaxa mxa eoxa tfm` o`ac`gm`t eotfax `aad~ to ha `oqxc~fc`i. ^o ct nm` ha }qcta dcggcnqlt. Tfa otfaxc~~qa c~ tfmt eotfax~ yfo mxa lcwc`i yctf FCW m`d tfa yfola c~~qa mxoq`d~foqld tfas no`tc`qa hxam~tgaadc`i. Hqt yctf m`tcxatxowcxml~ tfc~ c~~qa fm~haa` mddxa~~ad m`d ~tqdca~ ~foy tfmt avnlq~cwa hxam~tgaadc`i nqt~ doy` o`c`gantco`~ c` tfa c`gm`t, ~mcd Dx Za``s A`mx~o`.

    Eo~t og tfa damtf~ og z`aqeo`cm onnqx c` q`dax o`a samx og mia ~o tfmt c~yfs tfaxa c~ m xaml zq~f gox eotfax~ to avnlq~cwals hxam~tgaad m`d xadqnatfa xc~k og tfa nfcld dsc`i, ~mcd Dx Za``s A`mx~o`. Mddad ~fa2 Ct fm~ haa`~foy` tfmt tfa nfcldxa` yfo mxa avnlq~cwals hxam~tgad do`t dca og

    z`aqeo`cm m~ ogta` m~ tfa o`a~ yfo mxa`t.

    Eml`qtxctco` c~ m fqia zxohlae m`d eoxa ~o c` M~cm tfm` m`syfaxa al~a. 1:!damtf~ c` nfcldxa` mxa zxanczctmtad hs eml`qtxctco`. ^cezla fm`dym~fc`i nm`nqt doy` m fqia meoq`t og amxls c`gantco`~ a~zancmlls dqxc`i eotfax m`dnfcld c`taxmntco`.

    Eml`qtxctco` fm~ to ha mddxa~~ad c` no`bq`ntco` yctf otfax dc~am~azxoixmeea~ ~qnf m~ dcmxxfoam, z`aqeo`cm, eam~la~, emlmxcm, atn tfasmll mxa noezoq`dad hs eml`qtxctco`, ~mcd Dx Za``s A`mx~o`.

    C`doox mcx zollqtco` c~ k`oy` to c`nxam~a tfa xc~k og z`aqeo`cm. A~zancmllsgox eotfax~ yfo fmwa c`gm`t~ o` tfacx hmnk~ ox mxa foldc`i tfa nfcld yfcla

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    9/106

    3 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    nookc`i m`d ~eoka gxoe nook ~towa~ nm` qz tfa xc~k. ^ano`dfm`d ~eoka c~ mxc~k gox dawalozc`i z`aqeo`cm.

    Tfaxa mxa tyo `ay wmnnc`a~ gox z`aqeo`cm, tfa FcH wmnnc`a m`d

    z`aqeononnml wmnnc`a. Hqt hotf og tfae mxa avza`~cwa m`d `ot em`snoq`txca~ fmwa mddad tfae to tfacx wmnnc`a xaicea`t hanmq~a og tfa no~tzaxfmz~. Tfa~a mxa embox wmnnc`a~ tfmt xamlls falz c` xadqnc`i damtf~ gxoez`aqeo`cm.

    XMXALS M NFCLD NOEA^ TO NLC@CN YCTF O@A CLL@A^^C nm` ~zamk gxoe es avzaxca`na c` Emlmyc tfmt xmxals ya y cll ~aa m nfcldyctf o`a cll`a~~. ^o cg tfa nfcld fm~ z`aqeo`cm tfas ems fmwa dcmxxfoam,eam~la~, emlmxcm, eml`qtxctco`, ox no%c`gantco` yctf FCW c` mxam~ oxzozqlmtco`~ yfaxa FCW c`ncda`na c~ fcif. Ct c~ dcggcnqlt to tall tfa nfcld yfozxa~a`t~ yctf z`aqeo`cm m`d emlmxcm. Waxs ogta` o`a ox tfa otfax c~

    ec~~ad. Ea`c`ictc~ c~ ml~o m`otfax no%eoxhcdcts. Zaozla `aad to ha mymxatfmt nfcldxa` do`t noea yctf bq~t o`a zxohlae ~mcd Dx Za``s A`mx~o`.

    Z`aqeo`cm c~ ~tcll tfa `qehax o`a kcllax og nfcldxa`. Ct c~ dxamdgql tfmt tfa~anfcldxa` ~foqld `ot ha dsc`i hanmq~a ct c~ }qcta am~s to dcmi`o~a m`d gmcxlsnfamz to txamt. Tfa iowax`ea`t~ m`d otfax~ yoxkc`i o` famltf ~s~tae~~txa`itfa`c`i `aad to q`dax~tm`d tfmt cg tfas xamlls ym`t to xamnf tfaEclla``cqe Dawalozea`t Ioml `o. 4 tfa` tfas fmwa to mddxa~~ z`aqeo`cm c`nfcldxa` ox tfas ycll `ot xamnf ct.

    Ya nm` yc` tfa gcift mimc`~t z`aqeo`cm. Eoxa tfm` o`a ecllco` soq`i lcwa~nm` ha ~mwad m``qmlls yctf wmnnc`a~ m`d m`tchcotcn~, xadqnc`i c`doox mcxzollqtco` m`d tfxoqif hxam~tgaadc`i gox tfa gcx~t ~cv eo`tf~ og lcga.

    Hohhs Xmemkm`t N@^

    C nm` ~zamk gxoe es avzaxca`na c` Emlmyc tfmt xmxalsya ycll ~aa m nfcld yctf o`a cll`a~~. ^o cg tfa nfcld fm~

    z`aqeo`cm tfas ems fmwa dcmxxfoam, eam~la~, emlmxcm,

    eml`qtxctco`, ox no%c`gantco` yctf FCW c` mxam~ oxzozqlmtco`~ yfaxa FCW c`ncda`na c~ fcif. Ct c~ dcggcnqlt totall tfa nfcld yfo zxa~a`t~ yctf z`aqeo`cm m`d emlmxcm.Waxs ogta` o`a ox tfa otfax c~ ec~~ad. Ea`c`ictc~ c~ ml~o

    m`otfax no%eoxhcdcts. Zaozla `aad to ha mymxa tfmtnfcldxa` do`t noea yctf bq~t o`a zxohlae

    % Dx ZA@@S A@MX^O@, Tfa Q`co`

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    10/106

    =: | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Amxls xanoi`ctco` ' em`miaea`t

    og nfcldfood z`aqeo`cmZ`aqeo`cm c~ tfa lamdc`i nmq~a og damtf meo`i nfcldxa` q`dax 1 samx~ ogmia yoxldycda. O`a nfcld dca~ gxoe z`aqeo`cm awaxs 8: ~ano`d~. Tfmt~4,>:: soq`i lcwa~ lo~t awaxs dms. Z`aqeo`cm c~ m noeeo` xa~zcxmtoxsc`gantco` c` nfcldxa` m`d m` cezoxtm`t nmq~a og eoxhcdcts m`d eoxtmlcts,awa` c` `ay hox` c`gm`t~. 36! og nfcldxa` yfo dca og z`aqeo`cm lcwa c`dawalozc`i noq`txca~ ~mcdZxoga~~ox &Dx# ZK Ec~xm, lqec`mxs zmadcmtxcncm`,yfo c~ tfa goxeax Zxc`nczml og C`dcm~ zxa~tcicoq~ Kc`i Iaoxia~ EadcnmlNollaia &KIEN, `oy k`oy` m~ Nffmtxmzmtc ^fmfqbc Emfmxmb EadcnmlQ`cwax~cts# m`d ml~o tfa goxeax Famd og tfa Zmadcmtxcn~ Dazmxtea`t mtKIEN.

    Mddad Zxog &Dx# ZK Ec~xm2 Z`aqeo`cm c~ m` c`gantco` ogtfa lq`i~, gcllc`i tfae yctf glqcd. Ct nmq~a~ noqif m`dgawax m`d nm` emka hxamtfc`i dcggcnqlt. ^awaxaz`aqeo`cm nm` ha damdls.

    C` dawalozc`i noq`txca~, nfcldxa` q`dax 1 samx~ og miamxa mt xc~k, a~zancmlls c` tfa zooxa~t noeeq`ctca~.Tohmnno ~eoka m`d otfax c`doox mcx zollqtco` c`nxam~a~q~naztchclcts to z`aqeo`cm. ^oea nfcldxa` m`d mdqlt~mxa mt ixamtax xc~k hanmq~a tfas fmwa otfax c`gantco`~,

    ~qnf m~ FCW. Nfcldxa` yfo mxa zooxls `oqxc~fad nm` ml~ofmwa yamka`ad ceeq`a ~s~tae~, zqttc`i tfae mtfcifax xc~k og no`txmntc`i z`aqeo`cm.

    Zxog &Dx# ZK Ec~xm gqxtfax avzlmc`~ tfmt ilohmlls,hmntaxcm ~qnf m~ Fch m`d z`aqeononnq~ mxa a~tcemtadto nmq~a eoxa tfm` 1:! og z`aqeo`cm damtf~ c`nfcldxa` q`dax 1 samx~ og mia. Wcxq~a~ m`d gq`ic nm`ml~o nmq~a z`aqeo`cm c`gantco`~. C` xa~oqxna%zoox~attc`i~, z`aqeo`cm nm` ha dcmi`o~ad hs tfa ~seztoe~ct nmq~a~, c`nlqdc`i noqif, gawax m`d dcggcnqlts ox gm~thxamtfc`i. Nfa~t V%xms~ m`d lmhoxmtoxs ta~t~ nm` ml~odcmi`o~a z`aqeo`cm, hqt tfa~a tool~ mxa ogta`q`mwmclmhla c` dawalozc`i noq`txca~, a~zancmlls c`xaeota xqxml noeeq`ctca~, emkc`i ct eoxa dcggcnqlt todcmi`o~a m`d txamt z`aqeo`cm.

    ^oea z`aqeo`cm nm` ogta` ha zxawa`tad yctf wmnnc`a~ mimc`~t Fch m`dz`aqeononnq~. Eam~la~ m`d zaxtq~~c~ &yfoozc`i noqif# c`gantco`~ nm` xa~qltc` z`aqeo`cm noezlcnmtco`~, ~o wmnnc`mtc`i mimc`~t tfa~a nfcldfood dc~am~a~nm` zxawa`t ~oea z`aqeo`cm nm~a~, ~mcd Zxog &Dx# ZK Ec~xm. C`avza`~cwa

    m`tchcotcn~ nm` aggantcwals txamt z`aqeo`cm mt tfa noeeq`cts lawal.

    Amxlsxanoi`ctco` m`d

    amxlsem`miaea`t

    mxa waxscezoxtm`t. Cg

    z`aqeo`cmnm``ot haem`miad mt m`sfamltf na`txa

    tfa` amxlsxagaxxml to mhattax famltf

    na`txa nm`hanoea lcga~mwc`i mt tcea~

    % Zxog &DX# ZK EC^XM

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    11/106

    == | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Amxls xanoi`ctco` m`d amxls em`miaea`t mxa waxs cezoxtm`t. Cg z`aqeo`cmnm``ot ha em`miad mt m`s famltf na`txa tfa` amxls xagaxxml to m hattaxfamltf na`txa nm` hanoea lcga ~mwc`i mt tcea~. Z`aqeo`cm nm` ha aggantcwalsem`miad daza`dc`i qzo` tfa no`dctco` hs zxowcdc`i foea%hm~ad nmxa to tfafcifa~t lawal og eadcnml nmxa hqt mll tfa nm~a~ do`t `aad fcifa~t lawal og

    eadcnml nmxa. Amxls xanoi`ctco` og ~ci`~ tfmt nfcld `aad~ eadcnml mtta`tco`hs gmecls eaehax~ ox tfo~a yfo look mgtax tfa nfcld m`d iattc`i tfa nfcldmtta`dad yctfoqt dalms mt m` mzzxozxcmta famltf na`txa m~ c`dcnmtad mxanxqncml. M~aztcn m`d nlam` a`wcxo`ea`t ~foqld ha emc`tmc`ad to xmc~a tfanfcld m`d tfo~a yfo mxa nmxc`i gox tfa nfcld ~foqld ym~f tfacx fm`d~zxozaxls, ym~f nlotfa~ zxozaxls, m`d kaaz tfa qehclcnq~ nlam` m`d `ot zqtm`stfc`i tfaxa yfcnf nm` c`gant tfa nfcld tfxoqif qehclcnq~ ~mcd Zxog &Dx#ZK Ec~xm.

    ^fohfm ^fqklm m`d Hohhs Xmemkm`t N@^

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    12/106

    =8 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Icgt soqx nfcld loy z`aqeo`cm

    xc~k hs }qcttc`i tohmnnoO`a og tfa embox xc~k gmntox~ gox nfcldfood z`aqeo`cm c~ avzo~qxa og tfanfcld to tohmnno ~eoka. M`otfax xc~k gmntox c~ hcoem~~ ~eoka &~eokanoec`i oqt og nook ~towa~#.

    C`doox mcx zollqtco` c`nlqda~ hotf tohmnno ~eoka m`d hcoem~~~eoka m`d hotf og tfae mxaxalmtad to lq`i dc~am~a~. Foyawaxtfa tohmnno ~eoka c~ xalmtad to mlmxiax wmxcats og lq`i dc~am~a~

    tfm` tfa hcoem~~ ~eoka c~.Naxtmc`ls tohmnno ~eoka c~ nlamxlsm~~oncmtad yctf tqhaxnqlo~c~ &TH#,hotf lmta`t TH c`gantco` m`dmntcwa TH dc~am~a, m`d og noqx~ayctf nfxo`cn lq`i dc~am~a~ lckaNOZD m`d lq`i nm`nax. M~~oncmtco`og hcoem~~ ~eoka yctf

    tqhaxnqlo~c~ c~ `ot tfmt nlamx hqt ct c~ nlamxax yctf nfcldfood z`aqeo`cm m`dwaxs nlamxls m~~oncmtad yctf Nfxo`cn oh~txqntcwa zqleo`mxs dc~am~a &NOZD#m`d lq`i nm`nax c` yoea` ~mcd Zxoga~~ox &Dx# Do`mld M A`mx~o`, Dcxantox

    &^nca`tcgcn Mntcwctca~#, tfa C`tax`mtco`ml Q`co` Mimc`~t Tqhaxnqlo~c~ m`d Lq`iDc~am~a &Tfa Q`co`#.

    Mixaa~ Zxoga~~ox &Dx# Xmem Km`t, tfaYoxld Famltf Oxim`crmtco` &YFO#Dcxantox%Ia`axml~ Mymxdaa gox tohmnnono`txol &8::1# m`d `mtco`ml Zxa~cda`t%alant og M~~oncmtco` og ^qxiao`~ og C`dcm2Tfa zxohlae og c`doox tohmnno ~eokazollqtco` c~ eoxa zxo`oq`nad c` tfa nm~aog nfcldxa` lcwc`i c` fqtea`t~ m`d ~lqe~.Tfas mxa eoxa avzo~ad to ~ano`dfm`dtohmnno ~eoka yfcnf no`tmc`~ owax 4:::nfaecnml~, em`s og yfcnf mxa `ot o`lsnmxnc`oia`cn, hqt xadqna tfa nfcld~ceeq`cts. Tfa~a nfcldxa` mxa mlxamds waxs

    lckals to ha eml`oqxc~fad, dazxcwad og zxozax wa`tclmtco` m`d ~q`lcift. O`toz og tfc~ xcift gxoe tfa tcea tfas mxa c`~cda tfa eotfax~ yoeh, tfas mxamt m waxs fcif xc~k og hac`i avzo~ad to tfa fmrmxd~ og ~ano`dfm`d tohmnno~eoka, awa` yfa` tfas fmwa `ot ~aa` tfa lcift og lcga, m~ ~eokc`i c~ eoxanoeeo` c` zoox zaozla.

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    13/106

    => | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Tfaxa c~ m` mlxamds a~tmhlc~fad lc`k hatyaa`~eokc`i m`d zowaxts. ^o mnnoxdc`i to ea o`acezoxtm`t m`d yoxtfyfcla c`taxwa`tco` c~ tfmtgmnclctca~ gox tohmnno na~~mtco` ~foqld ha emdamwmclmhla to zaozla yfo mxa xamds to }qct.

    Zaozla mxa hs m`d lmxia eoxa mymxa mhoqt tfafamltf xc~k~ og tohmnno no`~qeztco` m`d~eokc`i, tfm`k~ to aggoxt~ emda hs @IO~ m`diowax`ea`t m`d otfax mia`nca~. Hqt tfas do `otk`oy yfaxa to io to }qct tohmnno q~a~qnna~~gqlls. C nm` ~ms tfc~ yctf no`gcda`na tfmtgmnclctca~ gox tohmnno na~~mtco` mxa waxs eamixac` oqx noq`txs, m`d tfc~ c~ m ~md zmxt. Q`la~~ yafmwa gmnclctca~ tfmt nm` falz zaozla }qct, m`dq`la~~ tfas mxa mwmclmhla no`~tm`tls, em`s ogtfa aggoxt to no`txol tohmnno ycll io ym~ta. Tfa

    YFO fmd ~tmxtad mxoq`d 8: ~qnf nlc`cn~, hqtixmdqmlls tfas mxa nlo~c`i doy` dqa to zmqnctsog gq`d~ m`d iowax`ea`t aggoxt~ mxa `ot og tfmtlawal yfcnf nm` em`mia tfa~a nlc`cn~ ~mcd Zxog&Dx# Xmem Km`t.

    Zxog &Dx# A`mx~o` c~ c` mixaaea`t2 Dcggcnqltsyctf tohmnno ~eoka c~ zax~qmdc`i zaozla `ot to~eoka ox to ~toz ~eokc`i m`d zax~qmdc`i zaozlato nfm`ia tfacx hafmwcoqx c~ `ot ~o am~s. O`a og

    tfa tfc`i~ ya gonq~~ad o` ym~ txsc`i to nmtnfzaozla~ mtta`tco` hm~ad qzo` ~oea og tfazax~o`ml avzaxca`na~ tfmt tfas fmd. Yctfhcoem~~ ~eoka ya fmwa txcad to nmtnf zaozla~mtta`tco` hs cda`tcgsc`i nfmezco`~ c` tfanoeeq`cts tfmt fm~ ~qggaxad ~oea mdwax~aaggant~ tfae~alwa~ m`d tfas nm` nfmezco` tfac~~qa yctf tfacx `acifhoqx~. Ya dcd tfc~ goxhcoem~~ ~eoka hqt ~mea c~ txqa gox tohmnno~eoka. C` eo~t ~oncatca~ tfa eo~t nfmlla`ic`izxohlae zaozla gmna c~ to fmwa m nfcld yfo c~

    fo~zctmlcrad gox m ~axcoq~ cll`a~~.

    ^o ya gonq~~ad o` xa}qa~tc`i tfa gmeclca~ tohxc`i c` tfacx nfcldxa` gox ~axcoq~ z`aqeo`cmm`d txsc`i to tmlk to tfae mhoqt tohmnno~eokc`i m`d hcoem~~ ~eoka avzo~qxa. M`d c`tfc~ yms txsc`i to zax~qmda tfae tfmt tfc~ c~ m`cezoxtm`t c~~qa, adqnmta tfae m`d a`noqxmiatfae to ha nfmezco`~ og famltf c` tfacx oy`noeeq`ctca~. Cg ~oeao`a gxoe oqt~cda tfanoeeq`cts noea~ c` m`d haic`~ to zxamnf to

    zaozla tfmt c~ `ot m waxs ~qnna~~gql yms tonfm`ia tfacx hafmwcoqx mddad Zxog &Dx#

    C`doox mcx zollqtco`c`nlqda~ hotf

    tohmnno ~eoka m`d

    hcoem~~ ~eoka m`dhotf og tfae mxaxalmtad to lq`i

    dc~am~a~. Foyawax tfatohmnno ~eoka c~xalmtad to m lmxiax

    wmxcats og lq`idc~am~a~ tfm` tfa

    hcoem~~ ~eoka c~.Naxtmc`ls tohmnno~eoka c~ nlamxlsm~~oncmtad yctf

    tqhaxnqlo~c~ &TH#, hotflmta`t TH c`gantco` m`dmntcwa TH dc~am~a, m`dog noqx~a yctf nfxo`cn

    lq`i dc~am~a~ lckaNOZD m`d lq`i nm`nax.M~~oncmtco` og hcoem~~

    ~eoka yctftqhaxnqlo~c~ c~ `ot tfmtnlamx hqt ct c~ nlamxax

    yctf nfcldfoodz`aqeo`cm m`d waxs

    nlamxls m~~oncmtad yctfNfxo`cn oh~txqntcwazqleo`mxs dc~am~a&NOZD# m`d lq`i

    nm`nax c` yoea`% Zxog DO@MLD M A@MX^O@,

    Dcxantox &^nca`tcgcn Mntcwctca~#,C`tax`mtco`ml Q`co` Mimc`~t

    Tqhaxnqlo~c~ m`d Lq`i Dc~am~a

    &Tfa Q`co`#

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    14/106

    =4 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    A`mx~o`.

    ^qiia~t~ Zxog &Dx# Xmem Km`t2 ^o C ym`t to aezfm~cra tyo tfc`i~ % zaozla`aad to ha mymxa tfmt ~eokc`i ~foqld ha no`txollad m`d `awax do`a c`~cdafoea~, m`d ~ano`dls na~~mtco` gmnclctca~ ycll io m lo`i yms c` zxawa`tc`i

    nfcldxa` gxoe ~qggaxc`i gxoe z`aqeo`cm m`d ct~ noezlcnmtco`~ gxoemwocdmhla damtf~. Ya fmwa m bqeho ~s~tae og zqhlcn famltfnmxa no`~c~tc`iog m lmxia `qehax og dontox~, zmxmeadcn~ m`d otfax ~tmgg. Hqt tfacx~axwcna~ mxa `ot hac`i qtclc~ad to tfa gqlla~t, a~zancmlls c` tfa xqxml mxam~.^o, na~~mtco` gmnclctca~ nm` ha c`taixmtad yctf tfa avc~tc`i famltfnmxa~s~tae, m`d zciis hmnk o` tfa avc~tc`i famltf ~axwcna~.

    Nlamxls z`aqeo`cm c~ tfa eo~t cezoxtm`t kcllax og ~emll nfcldxa` c` tfayoxld. Q`goxtq`mtals ya fmwa`t zmcd tfmt eqnf mtta`tco` to z`aqeo`cm m~ya fmwa gox otfax lq`i dc~am~a~ m`d C gaal tfmt tfc~ ~foqld ha m zxcoxcts ~mcdZxog &Dx# A`mx~o`. Awa` meo`i zaozla lcwc`i yctf FCW &ZLFCW# z`aqeo`cm c~

    zxohmhls eoxa noeeo` tfm` tqhaxnqlo~c~ mltfoqif tqhaxnqlo~c~ no%c`gantco`c~ waxs cezoxtm`t c` ZLFCW. Ya `aad to gc`d m yms to fciflcift tfa c~~qa ogz`aqeo`cm, ~mcd Zxog &Dx# A`mx~o`.

    ^fohfm ^fqklm m`d Hohhs Xmemkm`t N@^

    Ya fmwa m bqeho ~s~tae og zqhlcn famltfnmxano`~c~tc`i og m lmxia `qehax og dontox~,

    zmxmeadcn~ m`d otfax ~tmgg. Hqt tfacx ~axwcna~ mxa`ot hac`i qtclc~ad to tfa gqlla~t, a~zancmlls c` tfa

    xqxml mxam~. ^o, na~~mtco` gmnclctca~ nm` hac`taixmtad yctf tfa avc~tc`i famltfnmxa ~s~tae,m`d zciis hmnk o` tfa avc~tc`i famltf ~axwcna~

    % Zxog &Dx# XMEM KM@T% YFO Dcxantox%Ia`axml~ Mymxdaa o` tohmnno no`txol 8::1

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    15/106

    =1 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    TFAEA =Cezoxtm`na og avnlq~cwa

    hxam~tgaadc`i dqxc`i tfa =~t ~cv

    eo`tf~ og lcga c` zxotantc`i

    nfcldxa` gxoe z`aqeo`cm m`d em`s

    otfax dc~am~a~

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    16/106

    =7 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    @o Nonktmcl Gaadc`i Zlam~a

    Hxam~tgaad C~ Ha~t Gox Tfa Hmhs

    Eotfax~ eclk zlms~ m kas xola c` zxawa`tc`i nfcldfood z`aqeo`cm, yfcnf c~m waxs ~axcoq~ zxohlae, ilohmlls kcllc`i o`a nfcld &haloy 1 samx~ og mia#awaxs 8: ~ano`d~. Ct c~ xa~zo`~chla gox mleo~t =.7 ecllco` nfcld damtf~ zaxsamx, yfcnf c~ `amxls 8:! og mll zmadcmtxcn damtf~ mxoq`d tfa yoxld. Eo~t ogtfa~a nfcldxa` &mhoqt 36!# yfo dca og z`aqeo`cm mxa gxoe tfa dawalozc`inoq`txca~. C` C`dcm, eoxa tfm` 4:,::: nfcldxa` q`dax 1 samx~ og mia ~qnnqehto z`aqeo`cm awaxs samx.

    Avnlq~cwa hxam~tgaadc`i dqxc`i tfa gcx~t ~cv eo`tf~ og lcga c~ nxqncml c`noehmtc`i ~awaxml dc~am~a~, c`nlqdc`i z`aqeo`cm, hs ~qzzlsc`i tfa c`gm`tyctf mll tfa `qtxca`t~, m~ yall m~ ~qggcnca`t ceeq`oilohqlc` m`tchodca~,

    yfcnf zxowcda ceeq`cts to tfa xa~zcxmtoxs txmnt, m`d no`txchqta ~ci`cgcnm`tlsto tfa dawalozea`t og m famltfs ceeq`a ~s~tae. C`gm`t~ yfo mxa `othxam~tgad mt mll mxa 1 tcea~ eoxa lckals to dca gxoe z`aqeo`cm tfm` tfo~ayfo mxa avnlq~cwals hxam~tgad. O`a eq~t `ot goxiat tfmt z`aqeo`cm c~ m`c`gantco` og tfa lq`i~, gcllc`i tfae yctf zq~ m`d glqcd, lcectc`i ovsia` c`tmkam`d emkc`i ct fmxd to hxamtfa. Ct onnqx~ dqa to hmntaxcml c`gantco`~,&mltfoqif wcxq~a~ ox gq`ic nm` ml~o ha tfa nmq~a#, yfcnf mttmnk yfa` tfanfcld~ ~tcll%dawalozc`i daga`na ~s~tae c~ yamka`ad hs eml`qtxctco`, mcxzollqtco`, no c`gantco`~ yctf FCW/MCD^, tqhaxnqlo~c~, c`glqa`rm m`d eam~la~,m`d loy hcxtf yacift.

    Foyawax, nqxxa`tls o`ls >6! nfcldxa` yoxldycda mxaavnlq~cwals hxam~tgad. Hmxxcax~ to avnlq~cwa hxam~tgaadc`ic`nlqda tcea no`~txmc`t~, nqltqxml `oxe~, eqltczla hcxtf~,xamds mnna~~ to goxeqlm eclk m`d lmnk og k`oyladia. DxDc`a~f Nfm`dxm Zm`das, m ^zancmlc~t c` ZmadcmtxcnEadcnc`a mt @al~o` Fo~zctml og Zmadcmtxcn~ m`d@ao`mtml Eadcnc`a, Lqnk`oy, xqa~ tfmt, @oymdms~ yafmwa yfmt c~ nmllad nonktmcl gaadc`i yfcnf c~ eoxazxawmla`t c` eotfax~, a~zancmlls c` yoxkc`i eotfax~. ^o

    tfacx nfcldxa` daza`d o` toz gaad ox goxtcgcad eclk.

    Dx Mbms Ec~xm, Em`mic`i Dcxantox og tfa >7 haddad @al~o` Fo~zctml ogZmadcmtxcn~ m`d @ao`mtml Eadcnc`a, Lqnk`oy, fmd txamtad >: nfcldxa` yctf~awaxa z`aqeo`cm dqxc`i tfa zm~t 7 eo`tf~. Yfa` C wc~ctad fc~ fo~zctml c`^aztaehax 8:==, gcwa nm~a~ og `ao`mtml z`aqeo`cm &la~~ tfm` =: dms~ old#yaxa mdecttad c` tfa fo~zctml, mlo`i yctf m gay oldax nfcldxa`.

    Dc`a~f Nfm`dxm Zm`das

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    17/106

    =9 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Dx Mectm Zm`das, M~~oncmtaZxoga~~ox og Oh~tatxcn~ m`dIs`manolois mt tfa Nffmtxmzmtc^fmfqbc Emfmxmb Eadcnml

    Q`cwax~cts &ax~tyfcla Kc`iIaoxia~ Eadcnml Nollaia#,yfcnf c~ m lamdc`i iowax`ea`tfo~zctml og Lqnk`oy, ml~ono`gcxe~ tfa fcif zxawmla`na ogamxls nfcldfood z`aqeo`cm nm~a~~fa fm~ to daml yctf. ^fa ~ms~,Ya m~ is`manoloic~t~, ogta`noea mnxo~~ amxls `ao`mtmlz`aqeo`cm~ yctfc` 46 foqx~ to 9dms~ og hcxtf. 1:! og mll damtf~

    dqa to nfcldfood z`aqeo`cmonnqx c` `ao`mtml nm~a~. ^tqdca~fmwa ~foy` tfmt >:! to 4:! og ~tcll hox` hmhca~, m`d 1:! to 7:! og tfo~ayfo dcad yctfc` = ox 8 dms~, fmd awcda`na og z`aqeo`cm, m~ xawamlad hsmqtoz~s.

    Almhoxmtc`i o` tfa eaxct~ og hxam~tgaadc`i, Dx Mectm Zm`das ~ms~, C yoxk c`m iowax`ea`t fo~zctml m`d tfa o`ls gaadc`i eodmlcts tfmt c~ mdwonmtad m`dzmtxo`crad c` oqx ~atqz c~ avnlq~cwa hxam~tgaadc`i &`o ymtax, `o ~qimx, `oixcza ymtax, `o fo`as, `o nono`qt ymtax# dqxc`i tfa gcx~t 7 eo`tf~ og lcga.

    Ya lat tfa eotfax ~tmxtgaadc`i tfa hmhs m~amxls m~ yctfc` =:ec`qta~ og dalcwaxs. Yazqt tfa hmhs, noxd m`dmll, o` tfa eotfax~mhdoea`, m`d ct nxmyl~qz m`d ~tmxt~ ~qnklc`i.Tfc~ amxls ~qnklc`i ml~ofalz~ c` tfa dalcwaxs ogtfa zlmna`tm m`d tfa

    eaehxm`a.

    Dx Mbms Ec~xm gaal~ tfmt,Tfoqif eotfax~ mxamymxa og tfa ha`agct~ og avnlq~cwa hxam~tgaadc`i, tfas mxa waxs no`~ncoq~mhoqt tfacx hamqts m`d zfs~cnml mzzamxm`na m`d fa`na do `ot ym`t tohxam~tgaad. C` wcllmia~, eotfax~ zxagax to gaad tfa c`gm`t~ o` noy eclk, m~tfas fmwa em`s nfcldxa`.

    Mnnoxdc`i to Dx Mectm Zm`das, Zoox eotfax~ mdfaxa eoxa ~txcntls tohxam~tgaadc`i tfm` tfo~a gxoe tfa fcifax ~onco ano`oecn ~tmtq~. Icxl~ gxoe

    yall ogg gmeclca~ ia`axmlls fmwa zxohlae~ c` c`ctcmtc`i m`d emc`tmc`c`ihxam~tgaadc`i. Em`s mxa yoxkc`i eotfax~ yfo fmwa to lamwa tfacx hmhs

    Ya noea mnxo~~ amxls `ao`mtmlz`aqeo`cm~ yctfc` 46 foqx~ to 9 dms~

    og hcxtf. 1:! og mll damtf~ dqa tonfcldfood z`aqeo`cm onnqx c`

    `ao`mtml nm~a~. ^tqdca~ fmwa ~foy`tfmt >:! to 4:! og ~tcll hox` hmhca~,m`d 1:! to 7:! og tfo~a yfo dcadyctfc` = ox 8 dms~, fmd awcda`na ogz`aqeo`cm, m~ xawamlad hs mqtoz~s

    % DX MECTM ZM@DAS, Dazmxtea`t ogOh~tatxcn~ m`d Is`manolois, N^EEQ

    Dx Mbms Ec~fxm yctf

    E~ ^fohfm ^fqklm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    18/106

    =6 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    foea gox lo`i foqx~ mgtax m gay yaak~ og dalcwaxs. ^o tfas actfax ~tozhxam~tgaadc`i tfa nfcld amxls m`d/ox a`~qxa tfmt tfa nfcld fm~ mt lam~t o`atoz gaad. Tfas gaal tfmt cg tfa nfcld c~ `ot c`ctcmtad c`to toz gaad gxoe tfahaic``c`i, ct ycll `ot mnnazt ct lmtax m`d tfq~ nxamta zxohlae~ gox tfae.

    M xam~o` noeeo`ls nctad hs `ay eotfax~ gox `ot hxam~tgaadc`i c~ tfmt tfasmxa `ot mhla to zxodqna m`s &ox a`oqif# eclk c` tfa gcx~t gay dms~, goxnc`itfae to zqt tfa hmhs o` toz gaad. Hqt Dx Mectm Zm`das ~txo`ils no`ta`d~tfmt yfmtawax nolo~txqe~ tfa eotfax zxodqna~ dqxc`i tfa gcx~t gay dms~, mxaa`oqif `qtxctco` gox tfa hmhs. M gqll taxe hmhs fm~ a`oqif ilsnoia` ~toxadc` fax to falz fax ~q~tmc` gox tfa c`ctcml tyo dms~. Eoxaowax, cg tfa hmhs c~zqt to hxam~t, tfa eotfax c~ hoq`d to lmntmta awa`tqmlls. Ct c~ lcka m nsnlcnzxona~~zqt tfa hmhs to hxam~t, tfaxa c~ m nsnlcn xalam~a og foxeo`a~, m`dtfa eotfax~ eclk zxodqntco` c`nxam~a~. Tfa eoxa c~ tfa hmhs zqt to hxam~t,tfa eoxa yoqld ha tfa eclk zxodqntco`.

    Cxo`cnmlls, M`qxmdfm, eotfax og m o`a eo`tf old hmhs &dalcwaxad tfxoqif mnma~mxam` ~antco` c` m zxcwmta `qx~c`i foea# told tfmt m~ ~fa dcd `ot lmntmtaceeadcmtals mgtax tfa dalcwaxs, tfa dontox mlloyad fax to gaad fax hmhs o`goxeqlm eclk tfxoqif m` q`~taxclcrad nqz m`d ~zoo` gox tfa gcx~t tyo dms~.

    Lmtax ~fa ~yctnfad o` to hxam~tgaadc`i tfa nfcld. ^ceclmxls, m`otfaxsoq`i eotfax Haa`m ~mcd tfmt ~fa c~ hxam~tgaadc`i fax =8 dms~ oldc`gm`t dmqiftax, hqt fm~ icwa` fax ymtax too, yctf ~oea eadcnc`agox dcmxxfoam. ^fa ym~ q`mymxa og tfa fmxe~ og lattc`i tfa hmhsdxc`k ymtax mlo`i yctf eotfax~ eclk.

    ^o tfaxa ~foqld ha eoxa mymxa`a~~ zxoixmeea~ mt tfa noeeq`ctsm`d fo~zctml lawal~ gox soq`i icxl~ to q`dax~tm`d tfa cezoxtm`na ogavnlq~cwa hxam~tgaadc`i. Dontox~ too `aad to c`goxe tfae mhoqttfa famltf ha`agct~ og hxam~tgaad gox tfa nfcld. Tfa Yoxld FamltfOxim`crmtco` xanoeea`d~ avnlq~cwa hxam~tgaadc`i m~ tfa ~ola~oqxna og good q`tcl m` c`gm`t c~ ~cv eo`tf~ og mia, m`d tfa`na mnoehc`mtco` og ct yctf noezlaea`tmxs good~ tcll tyo samx~ og mia.

    Avzantm`t eotfax~ `aad to xaeaehax tfmt tfacx eclk c~ o`a og tfa eo~tcezoxtm`t tool~ c` tfa mxeoqxs og tfa hmhs to zxawa`t z`aqeo`cm m`d~awaxml otfax dc~am~a~, m`d tfmt no`txmxs to zozqlmx estf~, tfa hmhs `aad~eotfax~ eclk, m`d `otfc`i hqt eotfax~ eclk dqxc`i tfa gcx~t ~cv eo`tf~ og

    lcga.

    ^fohfm ^fqklm N@^

    Tfa Yoxld Famltf Oxim`crmtco` xanoeea`d~ avnlq~cwahxam~tgaadc`i m~ tfa ~ola ~oqxna og good q`tcl m` c`gm`t c~

    ~cv eo`tf~ og mia, m`d tfa`na m noehc`mtco` og ct yctfnoezlaea`tmxs good~ tcll tyo samx~ og mia.

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    19/106

    =3 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Eotfax~ Eclk C~ Tfa Ha~t EclkAvnlq~cwa hxam~tgaadc`i cezlca~ tfa no`nazt og gaadc`i tfa nfcld o`ls yctfeotfax)~ eclk gxoe tfa gcx~t foqx og hcxtf qz to m ec`ceqe og ~cv eo`tf~,yctfoqt m`s otfax ~qzzlaea`t lcka ymtax, fo`as ox m`s toz gaad. Dqxc`i tfac`ctcml zo~t `mtml zfm~a, hxam~t eclk c~ c` tfa goxe og nolo~txqe~ yfcnf fm~m`tchcotcn lcka zxozaxtca~ m`d lmntogaxc`~, yfcnf icwa tfa nfcld m` c`taixmlceeq`cts mimc`~t wmxcoq~ dc~am~a~, c`nlqdc`i z`aqeo`cm. Hxam~t eclk c~ ml~oxcnf c` zxotac`~, fm~ a`rsemtcn mntcwcts tfmt zxawa`t~ tfa ixoytf og hmntaxcmm`d wcxq~a~, m`d gqlgcl~ mll tfa `qtxctco`ml xa}qcxaea`t~ og tfa `ay hox` goxtfa gcx~t ~cv eo`tf~.

    ^c`na, z`aqeo`cm c~ eo~tls nmq~ad hs hmntaxcm m`d wcxq~a~, ~o hxam~t eclkxadqna~ tfacx xc~k c` em`s yms~ hs mggantc`i tfacx wcmhclcts. Eoxaowax, hxam~t

    eclk ml~o zlms~ m` cezoxtm`t xola c` zxowcdc`i xa~zcxmtoxs m`d iqt ceeq`cts,tfq~ zxawa`tc`i z`aqeo`cm c` m hci yms. Ct falz~ to dawaloz xa~c~tm`na c`tfa xa~zcxmtoxs txmnt &lq`i~# yfcnf c~ tfa emc` mggantad oxim` c` z`aqeo`cm.

    Dx Bsot~`m Eaftm, ~a`cox Is`manoloic~t m`dOh~tatxcncm`, yfo xq`~ m zxcwmta `qx~c`i foea avtol~ tfawcxtqa~ og eotfax~ eclk, m~ yall m~ tfa cezoxtm`na oghxam~tgaadc`i tfa hmhs ~oo` mgtax hcxtf. ^fa ~ms~ tfmt,(Ya zqt tfa hmhs to tfa hxam~t og tfa eotfax m~ ~oo` m~~fa c~ hox`. Cg ct c~ m `oxeml dalcwaxs tfa` ct c~ do`a c`tfa lmhoqx xooe m`d cg ct c~ m Nma~mxam` tfa` mgtax tfa

    ozaxmtco` ya io mfamd m`d lat tfa eotfax hxam~tgaadtfa hmhs awa` hagoxa ~fcgtc`i tfa eotfax oqt og tfatfamtxa.(

    Tfa nfcldxa` yfo mxa `ot mt mll hxam~tgada~~a`tcmlls dqxc`i gcx~t ~cv eo`tf~ og lcga mxagcwa tcea~ eoxa ~q~naztchla to z`aqeo`cmyfcnf c~ tfa ~c`ila hciia~t kcllax og nfcldxa`q`dax gcwa, tfm` tfo~a yfo mxa hxam~tgad.^qh%oztceml hxam~tgaadc`i c~ m gmntox c` 44!og mll Mnqta Xa~zcxmtoxs C`gantco` damtf~meo`i c`gm`t~. Ilohmlls, 78! og tfa nfcldxa`mxa `ot avnlq~cwals hxam~tgad. Tfaxa mxac``qeaxmhla estf~ mhoqt hxam~tgaadc`iyfcnf `aad to ha dc~zallad. ^qnklc`i og eclkdoa~ `ot dagoxe tfa ~fmza og tfa hxam~t.Xmtfax, hxam~tgaadc`i c`nxam~a~ tfac`wolqtco` og Qtaxq~. Ct hxc`i~ tfa eotfaxhmnk to fax `oxeml zfs~cnml ~fmza eqnfgm~tax, tfm` cg ~fa doa~ `ot hxam~tgaad tfanfcld.

    Mnnoxdc`i to Dx Wcbmsm Eofm`, ~a`cox

    Tfa nfcldxa` yfo mxa `ot mtmll hxam~tgad a~~a`tcmllsdqxc`i gcx~t ~cv eo`tf~ oglcga mxa gcwa tcea~ eoxa

    ~q~naztchla to z`aqeo`cmyfcnf c~ tfa ~c`ila hciia~tkcllax og nfcldxa` q`daxgcwa, tfm` tfo~a yfo mxahxam~tgad. ^qh%oztcemlhxam~tgaadc`i c~ m gmntox c`44! og mll Mnqta Xa~zcxmtoxsC`gantco` damtf~ meo`ic`gm`t~

    Dx Bsot~`m Eaftm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    20/106

    8: | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Zmadcmtxcncm`, Wcwakm`m`d Fo~zctml, Lqnk`oy, Tfaxa mxa ~oea c`~tm`na~ ogzaozla yfo gaal tfmt eotfax)~ eclk c~ `ot m ~qggcnca`t dcat gox tfa hmhs m`dfa ~foqld ha gad yctf toz gaad~ c` oxdax to zxowcda noezlata `oqxc~fea`t.

    Hqt tfc~ c~ m ec~no`naztco`. Tfa dontox~ ~foqldnoq`~al tfa eotfax to mllms tfa~a gamx~.

    Mnnoxdc`i to Zxoga~~ox &Dx# SN Iowcl, Zxoga~~ox,Dazmxtea`t og Zmadcmtxcn~, Nffmtxmzmtc ^fmfqbcEmfmxmb Eadcnml Q`cwax~cts &ax~tyfcla Kc`iIaoxia~ Eadcnml Nollaia#, (Hottla gaad~ m`dgoxeqlm eclk, naxtmc`ls nm``ot ha m xazlmnaea`tgox hxam~t eclk, hanmq~a `o fqem` a`damwoqx nm`zqt tfo~a gmntox~ yfcnf tfa Mlecifts fm~ do`a.Tfas ems ha ~qggcnca`t c` taxe~ og `qtxctcwa wmlqato ~oea avta`t, hqt tfaxa mxa em`s otfax ha`agct~og eotfax~ eclk yfcnf tfa goxeqlm good nm``ot

    eaat. Emtax`ml m`d c`gm`t ho`dc`i nm``ot ha zxowcdad hs tfa~a good~. M lotog xa~amxnf fm~ haa` do`a yfcnf fm~ qltcemtals zxowad tfmtHxam~t eclk c~tfa ha~t eclk.

    Lmnk og adqnmtco` m`d mymxa`a~~ meo`i tfa em~~a~ zxawa`t~ em`s eotfax~gxoe avnlq~cwals hxam~tgaadc`i tfacx hmhs. C` ~oea nm~a~ tfa eotfax fax~algc~ q`daxgad yfcnf a`ia`dax~ eclk zxodqntco` c` fax, yfcla c` otfax nm~a~ tfaeotfax c~ `ot mymxa og tfa ha`agct~ og hxam~tgaad. Hxam~tgaadc`i c~ gqalladhs txmdctco`ml `oxe~, m`d tfa ec~zlmnad da~cxa o` zmxt og tfa eotfax togaad tfa nfcld yall. M`d cg tfa eotfax c~ m yoxkc`i yoem`, ~fa ems xa~oxt

    to toz gaad~ gox fax no`wa`ca`na.Mymxa`a~~ m`d adqnmtco` mhoqt avnlq~cwa hxam~tgaadc`i c~ tfa `aad og tfafoqx. Ya ~foqld zxoeota hxam~tgaadc`i m`d iood `qtxctco` gox yoea` c`hotf xqxml m`d qxhm` mxam~. Tfaxa ~foqld ha zxowc~co` og glavc foqx~ goxyoxkc`i eotfax~. Tfas ~foqld ha emda mymxa og tfa qtclcts og hxam~t zqez~.Hxam~t eclk c~ tfa nfcld)~ `mtqxml ceeq`cts m`d fa ~foqld `ot ha dazxcwad ogct. ^o lat mll yoea` zxoeota ct, m~ ct fm~ em`s zxo~ m`d `o no`~.

    ^fckfm ^xcwm~tmwm N@^

    Hottla gaad~ m`d goxeqlm eclk, naxtmc`ls nm``ot ha m xazlmnaea`tgox hxam~t eclk, hanmq~a `o fqem` a`damwoqx nm` zqt tfo~a gmntox~

    yfcnf tfa Mlecifts fm~ do`a. Tfas ems ha ~qggcnca`t c` taxe~ og`qtxctcwa wmlqa to ~oea avta`t, hqt tfaxa mxa em`s otfax ha`agct~ og

    eotfax~ eclk yfcnf tfa goxeqlm good nm``ot eaat. Emtax`ml m`d c`gm`tho`dc`i nm``ot ha zxowcdad hs tfa~a good~. M lot og xa~amxnf fm~ haa`

    do`a yfcnf fm~ qltcemtals zxowad tfmt Hxam~t eclk c~ tfa ha~t eclk

    % Zxoga~~ox &Dx# SN Iowcl, Dazmxtea`t og Zmadcmtxcn~, N^EEQ

    Zxoga~~ox &Dx# SN Iowcl

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    21/106

    8= | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    HXAM^TGAADC@I2M Nfcld~ Gcx~t Ceeq`crmtco`

    Eotfax~ eclk c~ tfa cdaml `qtxctco`mlls zaxgant good gox `ayhox`~ m`dc`gm`t~. Ct c~ lcka `antmx gox tfa c`gm`t m`d c~ mztls nmllad tfa gcx~t wmnnc`atfmt nm` ha icwa` to tfa nfcld. Mzmxt gxoe tfa q`c}qa mhclcts to `oqxc~f tfahmhs, ct c~ ml~o zmnkad yctf ~awaxml m`tchodca~ &ceeq`a ilohqlc`~# tfmtzxowcda zxotantco` mimc`~t noeeo` nfcldfood cll`a~~a~, c`nlqdc`iz`aqeo`cm, m zxcea nmq~a og nfcld eoxtmlcts yfcnf kcll~ eoxa tfm` 4,>::nfcldxa` awaxsdms yoxldycda. Ct c~ ~mga, am~s to dcia~t, c~ xamdcls mwmclmhlam`d waxs mggoxdmhla.

    Hxam~tgaadc`i c~ tfa nfamza~t m`d eo~t aggantcwa yms to a`~qxa m nfcld~famltf m`d ~qxwcwml. M lmnk og avnlq~cwa hxam~tgaadc`i dqxc`i tfa gcx~t ~cveo`tf~ og lcga no`txchqta~ to owax m ecllco` mwocdmhla nfcld damtf~ amnfsamx. Haso`d tfa ceeadcmta ha`agct~ gox nfcldxa`, hxam~tgaadc`i no`txchqta~to m lcgatcea og zfs~cnml m`d ea`tml famltf m`d yall hac`i. Ct c~ `o yo`daxtfa` tfmt tfa Yoxld Famltf Oxim`crmtco` mntcwals zxoeota~ avnlq~cwahxam~tgaadc`i gox tfa gcx~t ~cv eo`tf~ og tfa nfcld~ hcxtf.

    Mnnoxdc`i to Dx @aalme ^c`if, No`~qltm`tOh~tatxcncm` m`d Is`manoloic~t m`d NfcagGq`ntco`mxs og Wmt~mlsm Xa~oqxna Na`txa o`

    Famltf, Avnlq~cwa hxam~tgaadc`i cezlca~ tfmttfa nfcld ~foqld ha o`ls, m`d o`ls, ha o`eotfax~ eclk gox ~cv eo`tf~, m`d `ot icwa`m`stfc`i al~a lcka ymtax, ixcza ymtax oxfo`as. Hxam~t eclk no`tmc`~ m `qehax ogceeq`a ilohqlc`~ yfcnf c`nxam~a tfa nfcld~xa~c~tm`na to m ycda xm`ia og dc~am~a~a~zancmlls z`aqeo`cm m`d dcmxxfoam. Mzmxtgxoe c`nxam~ad ceeq`cts, hxam~tgad c`gm`t~ml~o fmwa hattax ea`tml dawalozea`t. Tfaxac~ awcda`na tfmt tfa c`tallcia`na }qotca`t &C]#

    og tfa~a nfcldxa` c~ fcifax hs 6 to =: zoc`t~ m~ noezmxad to nfcldxa` yfo mxa`ot hxam~tgad. Hxam~tgaadc`i ml~o xadqna~ tfa xc~k og mllaxicn no`dctco`~ lcka~kc` dc~am~a~, m~tfem m`d awa` noxo`mxs famxt dc~am~a c` lmtax samx~ og lcga.

    Dx ^@ Xm~toic, m xa`oy`ad Zadcmtxcncm` yfo xq`~ m zxcwmta nlc`cn c` Lqnk`oy~ms~, Avnlq~cwa hxam~tgaad c~ tfa ha~t gaad tfmt nm` ha icwa` to m nfcld.

    Dx ^K ^aftm, No`~qltm`t Zadcmtxcncm` m`d @ao`mtoloic~t, Lqnk`oy, gaal~ tfmthxam~tgaadc`i hqcld~ m` aeotco`ml ho`dc`i hatyaa` tfa eotfax m`d tfanfcld yfcnf zlms~ m nxqncml xola c` eotfax%nfcld xalmtco`~fcz. Ml~o, hxam~teclk fm~ naxtmc` foxeo`a~ &yfcnf mxa lmnkc`i c` goxeqlm, noy/ hqggmlo eclk#

    Dx @aalme c`if

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    22/106

    88 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    yfcnf c`nxam~a tfa nfcld~ xa~c~tm`na to m fo~t og dc~am~a~ c`nlqdc`iz`aqeo`cm.

    Da~zcta tfa eadcnml gxmtax`cts woqnfc`i gox tfa aggcnmns og eotfax~ eclk,la~~ tfm` 4:! og c`gm`t~ haloy ~cv eo`tf~ og mia mxa avnlq~cwals hxam~tgad.

    C` gmnt o`ls =1! to 8:! og tfa eotfax~ noec`i to Dx @aalme ^c`if yaxagolloyc`i tfc~ xaicea` ~txcntls. ^qzzoxt gox eotfax~ c~ a~~a`tcml m~ em`seotfax~ ems gmna c`ctcml fcnnqz~ to avnlq~cwa hxam~tgaadc`i, lcka `czzlazmc`; gamx tfmt tfaxa c~ `ot a`oqif eclk to ~q~tmc` tfa hmhs; lmnk ogc`goxemtco`; m`d ~onco nqltqxml hmxxcax~.

    Mnnoxdc`i to Dx @aalme ^c`if, @ot o`ls tfa dontox, hqt awaxso`a yfono`wax~a~ yctf m `ay eotfax%% tfa `qx~a, mtta`dm`t m`d fax gmeclseaehax~%%fm~ m dc~tc`nt xola to zlms. Tfa dontox~ xa~zo`~chclcts c~ to m~~qxatfa eotfax tfmt ~fa nm` icwa fax nfcld noezlata `qtxctco` hs avnlq~cwahxam~tgaadc`i m`d to a`~qxa tfmt hxam~tgaadc`i c~ ~tmxtad amxls. Tfa

    zmxmeadcnml ~tmgg ~foqld adqnmta fax mhoqt tfa ha`agct~ og hxam~tgaadc`im`d falz fax no`tc`qa yctf ct. Tfa gmecls~ xola c~ to ~qzzoxt fax m`d tmkaiood nmxa og fax good m`d `oqxc~fea`t. Gox yoxkc`i eotfax~ tfa yoxkzlmnaa`wcxo`ea`t m`d yoxkc`i no`dctco`~ ~foqld ha hmhs gxca`dls %% glavchlayoxkc`i foqx~ tfmt mlloy eotfax to hxam~tgaad fax hmhs; ~azmxmta gaadc`ixooe~ yfaxa tfa c`gm`t nm` ha hxoqift mt tfa tcea og gaadc`i; m`d/ oxemtax`cts lamwa gox ~cv eo`tf~. Em`s `mtco`~ mxa yoxkc`i c` tfc~ dcxantco`hqt c` oqx noq`txs m lot `aad~ to ha do`a.

    Dx ^@ Xm~toic gaal~ tfmt, ^oea yoea` mxa gciqxa no`~ncoq~ m`d tfc`k tfmt

    hxam~tgaadc`i ycll ~zocl tfacx gciqxa. Hqt tfc~ c~ m estf. C` otfax nm~a~eotfax~ tfae~alwa~ mxa q`dax gad m`d ~o tfas mxa `ot mhla to zxodqnaa`oqif eclk.

    Dx ^K ^aftm, ~ms~, C` C`dcm m lmxia `qehax ogeotfax~ mxa q`dax`oqxc~fad m`d tfaxa c~ tfa gamx ogc`~qggcnca`t lmntmtco`, ~o tfas ~yctnf owax to toz gaadyfcnf c~ mh~olqtals m yxo`i zxmntcna. Cg tfa nfcld c~hac`i avnlq~cwals hxam~tgad gox tfa gcx~t ~cv eo`tf~,tfa nfm`na~ og m lmxia `qehax og c`gantcoq~ dc~am~a~c~ dxm~tcnmlls xadqnad. O`ls c` avtxaeals xmxa &mxoq`d

    =!# nm~a~ yfaxa ya gc`d tfmt ~qggcnca`t hxam~t eclk c~`ot hac`i zxodqnad, ox cg tfa eotfax c~ ~qggaxc`i gxoe~oea ~axcoq~ mclea`t, tfmt tfa dontox mlloy~ toz gaadc` tfa goxe og tfa c`gm`t goxeqlm eclk mwmclmhla c` tfaemxkat, cg tfa zmxa`t~ nm` mggoxd ct. Hqt m `qehax og

    dxmyhmnk~ mxa m~~oncmtad yctf goxeqlm eclk m`d hottla gaadc`i. Tfa lawal ogfsica`a daem`dad hs hottla%gaadc`i c~ waxs fmxd to eaat faxa. Tfc~zxadc~zo~a~ tfa nfcld to c`gantco`. Tfas ml~o ta`d to dclqta tfa eclk yfcnflamd~ to q`dax`oqxc~fea`t og tfa nfcld.

    Dx ^K ^aftm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    23/106

    8> | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Dx @aalme ^c`if too mixaa~ tfmt, C`gm`tgoxeqlm eclk ems zaxfmz~ eaat tfa`qtxca`t xa}qcxaea`t~ hqt ct doa~ `ot fmwaceeq`a ilohqlc`~. Ml~o, hottla gaadc`i

    daem`d~ ixamtax fsica`a m`d nlam`lc`a~~yfcnf c~ `ot zo~~chla c` oqx noq`txs. C`dcm c~m txozcnml noq`txs yctf fcif taezaxmtqxatfmt gmwoqx~ ~zxamd og noeeq`cnmhladc~am~a~, m`d goxeqlm eclk nm``ot c`nxam~am nfcld~ xa~c~tm`na to gcift dc~am~a~,yfaxam~ eotfax~ eclk fm~.

    C` tfa nfmo~ og ci`oxm`na mhoqt tfaha`agct~ og hxam~tgaad, tfaxa mxa ~oea~m`a wocna~ og eotfax~ lcka Ex~ Mlzm`m ^c`if, yfcnf mxa

    yoxtf aeqlmtc`i. Mlzm`m, m `ay eotfax yfo dalcwaxadfax ~ano`d nfcld xana`tls mt m zxcwmta `qx~c`i foea&Ncts Fo~zctml# c` Lqnk`oy, ~ms~, C avnlq~cwalshxam~tgad es gcx~t nfcld dqxc`i tfa gcx~t ~cv eo`tf~,~tmxtc`i gxoe dms o`a, mgtax es nma~mxam` dalcwaxs m`ddcd `ot icwa fce awa` ymtax ox toz gaad. ^c`na C fmd toboc` es yoxkzlmna o`ls mgtax tfxaa eo`tf~ og emtax`ctslamwa, C emda q~a og tfa hxam~t zqez to ~toxa eshxam~t eclk gox >%4 foqx~. Tfc~ yms C txcad es ha~t tohxam~tgaad es hmhs gox mt lam~t o`a samx.

    Famltf gmnclctca~ tfmt ~qzzoxt hxam~tgaadc`i % hs emkc`itxmc`ad hxam~tgaadc`i noq`~allox~ mwmclmhla to `ayeotfax~ % a`noqxmia fcifax xmta~ og tfa zxmntcna. Tozxowcda tfc~ ~qzzoxt m`d cezxowa nmxa gox eotfax~ m`d`ayhox`~, tfaxa mxa `oy eoxa tfm` 8: ::: (hmhs%gxca`dls( gmnclctca~ c` =18 noq`txca~, tfm`k~ to m YFO%Q@CNAG c`ctcmtcwa. Zqhlcn famltf yoxkax~ yoxkc`i yctftfa em~~a~ fmwa m dc~tc`nt xola to zlms c` dc~zallc`i tfaec~no`naztco`~ m`d ~onco%nqltqxml doiem~ m~~oncmtadyctf hxam~tgaadc`i. Ya `aad to eohclcra `ot o`ls tfa

    eotfax~ hqt ml~o tfacx gmeclca~ mhoqt tfa cezoxtm`na ogavnlq~cwa hxam~tgaadc`i. Ct `aad~ m noehc`ad aggoxtgxoe tfa a`tcxa ~oncats ~o tfmt hxam~tgaadc`i c~a`noqxmiad.

    ^oesm Mxoxm N@^&Zqhlc~fad gcx~t c` TFA FC@DQ^TM@ TCEA^2 3 @owaehax 8:==#

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    24/106

    84 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Hxam~t eclk c`nxam~a~

    ceeq`cts c` nfcldxa`@ay%hox` nfcldxa` mgtax hcxtf ~foqld ha icwa` avnlq~cwa eotfax)~ eclk goxgcx~t ~cv eo`tf~ hanmq~a ct c`nxam~a~ tfacx hods)~ xa~c~tm`na m`d ceeq`cts goxxa~t og tfacx lcwa~. (Hxam~t eclk `ot o`ls zxotant~ m nfcld gxoe z`aqeo`cm hqtml~o em`s otfax c`gantco`~. Hxam~t eclk c`nxam~a~ hods)~ ceeq`cts og m nfcld.

    Tfmt c~ yfs xc~k og no`txmntc`iz`aqeo`cm c` avnlq~cwalshxam~tgad nfcldxa` c~ la~~noezmxad to tfo~a nfcldxa`yfo do`)t iat avnlq~cwa hxam~t

    eclk dqxc`i gcx~t ~cv eo`tf~ ogtfacx lcwa~. Mzmxt gxoeavnlq~cwa hxam~tgaadc`i tfaxamxa em`s otfax ~taz~ o`a nm`tmka to zxotant nfcldxa` gxoez`aqeo`cm ~qnf m~ zxotantc`infcldxa` gxoe nold avzo~qxa(~mcd m `otad zmadcmtxcncm` gxoeIoxmkfzqx Dx K@ Dycwadc.

    Mymxa`a~~ mhoqt hxam~tgaadc`i fm~ c`nxam~ad owax tfa zm~t samx~. (Zmtca`t~mxa eoxa mymxa m`d no`~ncoq~ og hxam~tgaadc`i tfacx nfcld. Tfas mxa eoxalckals to ha mymxa mhoqt tfa ha`agct~ og eotfax~) eclk gox m `ay hox` nfcld.Tfa yoea` yfo fmwa `ayls hanoea eotfax~ m`d fmwa bq~t%dalcwaxad mxaamiax to lamx` noxxant eatfod og hxam~tgaadc`i. Dontox~ mxa ml~o zxoeotc`ihxam~tgaadc`i meo`i tfacx zmtca`t~. Tfaxa c~ `o doqht tfmt avnlq~cwahxam~tgaadc`i fm~ io`a qz owax tfa zm~t samx~( ~mcd Dx K@ Dycwadc.

    (Eo~t og tfa eotfax~ mxa hxam~tgaadc`i tfacx `ayls hox` nfcldxa`hqt tfaxa mxa ~tcll ~oea yfo mxa`)t doc`i ~o c` tfa ~lqe C lcwa c`.Tfaxa mxa lot og zxoixmeea~ xmc~c`i mymxa`a~~ mhoqt

    hxam~tgaadc`i m`d ct~ ha`agct~ gox tfa `ayls hox` nfcld dqa toyfcnf `qehax og nfcldxa` hac`i hxam~tgad fm~ io`a qz( ~mcdZxmdaaz xcwm~tmwm, m ~lqe%xa~cda`t gxoe Ioxmkfzqx.

    M`otfax ~lqe%xa~cda`t C`dxmwmtc ~fmxad fax avzaxca`na yfa` faxixm`d~o` no`txmntad z`aqeo`cm. (Es ixm`d~o` iot z`aqeo`cm m`ddawalozad ~axcoq~ hxamtfc`i zxohlae~, ym~ oqt og hxamtf, zmc` c` mhdoea`m`d gawax. Dontox~ ~mcd tfmt dqa to avzo~qxa to nold yamtfax tfa nfcld fm~dawalozad z`aqeo`cm. Tfc~ ixm`d~o` ym~ hxam~tgad gox 1%7 eo`tf~ m`d tfa`~yctnfad owax to noy)~ eclk( ~mcd C`dxmwmtc. Ct ~foqld ha `otad tfmt avnlq~cwahxam~tgaadc`i c~ tmka` m~ ~s`o`se to hxam~tgaadc`i yctf nfcldxa` iattc`i gad

    fo`as, ymtax, m`d otfax gaad~ dqa to m xm`ia og xam~o`~ c`nlqdc`i nqltqxml,txmdctco`ml ox otfax~.

    Zxmdaaz xcwm~tmwm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    25/106

    81 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Da~zcta mymxa`a~~ mhoqt ha`agct~ og hxam~t eclk gox tfa `ayls hox` nfcldtfaxa mxa nm~a~ yfaxa eotfax~ mxa`)t mhla to hxam~tgaad tfacx nfcld. Tfaxam~o`~ ecift ha dcggaxa`t hqt tfa cezmnt og nfcldxa` `ot iattc`i hxam~tgadc~ `ot da~cxmhla. (O`a og tfa hciia~t xam~o` c` es nlc`cnml avzaxca`na gox

    eotfax~ `ot hxam~tgaadc`i tfacx nfcldc~ lmnk og mymxa`a~~. ^tcll tfaxa mxanoeeq`ctca~ yfaxa mymxa`a~~ fm~ toxamnf mhoqt ha`agct~ og hxam~tgaadc`i.Eo~t zmtca`t~ mxa mhla to q`dax~tm`dtfa ha`agct~ og hxam~tgaadc`i yfa` ctc~ avzlmc`ad to tfae. Foyawax tfaxamxa txmdctco`ml hmxxcax~ too tfmt mttcea~ zxawa`t m nfcld gxoe iattc`ihxam~tgad. Tfaxa mxa ec~no`naztco`~too c` oqx ~oncats tfmt ogta` xagxmc`

    eotfax~ gxoe hxam~tgaadc`i tfacxnfcldxa`( ~mcd Dx Dycwadc.

    Q~c`i hottla~ to gaad eclk to nfcldxa`c~ ml~o `ot mdwc~mhla. (Ya ~foqld mwocd gaadc`i eclk to nfcldxa` q~c`i hottla~m~ gcx~t og mll, ct c~ waxs dcggcnqlt to a`~qxa tfmt hottla~ mxa mda}qmtalsnlam`ad m`d ~m`ctc~ad. Tfc~ c`nxam~a~ tfa xc~k og nfcldxa` no`txmntc`ic`gantco`~ dqxc`i hottla%gaadc`i yfcnf c~ datxcea`tml to tfacx famltf m`d mwaxs q`da~cxmhla fmzza`c`i. ^ano`dls tfa xc~k og m~zcxmtco` z`aqeo`cm c`hottla%gad nfcldxa` c~ goqx%to%gcwa tcea~ eoxa tfm` hxam~tgad nfcldxa`.

    Tfc~ c~ hanmq~a tfa eclk nm` io to tfa yc`d%zcza og tfa nfcldxa` yfa`hottla%gad zqttc`i tfa nfcld c` dm`iax( ~mcd Dx Dycwadc.

    Nfcldxa` ~foqld ha hxam~tgad gox tfa gcx~t ~cv eo`tf~ og tfacx lcga m~ ct fm~ mwaxs zo~ctcwa, da~cxmhla m`d zxogoq`d oqtnoea o` xa~t og tfacx lcwa~.

    Bcta`dxm Dycwadc N@^&Txm`~lmtco`2 N@^#

    Dx K@ Dycwadc

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    26/106

    87 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Eotfax~ eclk aggantcwals zxawa`t~

    nfcldfood z`aqeo`cmWmxcoq~ dontox~ og Qttmx Zxmda~f ozc`a tfmt eotfax~ eclk c~ waxs cezoxtm`tdqxc`i tfa gcx~t ~cv eo`tf~ og m hmhs~ lcga. Ct zxotant~ tfa nfcld `ot o`lsgxoe z`aqeo`cm hqt ml~o gxoe wmxcoq~ otfax c`gantcoq~ dc~am~a~ lckadcmxxfoam, eml`qtxctco` meo`i otfax~. Ct c~ ml~o tfa eo~t aggantcwa yms tokaaz tfa nfcld famltfs. C`gm`t~ ~foqld `ot ha icwa` m`s toz gaad,~qzzlaea`t ox hottla eclk dqxc`i tfa gcx~t ~cv eo`tf~. Mnnoxdc`i to m ~tqds,nfcldxa` yfo mxa `ot hxam~tgad dqxc`i tfa gcx~t ~cv eo`tf~ fmwa gcwa tcea~fcifax xc~k og eoxtmlcts dqa to z`aqeo`cm tfm` tfo~a yfo mxa avnlq~cwalshxam~tgad dqxc`i tfa gcx~t ~cv eo`tf~.

    Tfa Yoxld Famltf Oxim`crmtco` &YFO# fm~ ml~o xanoeea`dad tfmt avnlq~cwahxam~tgaadc`i c~ tfa ~ola ~oqxna og m nfcld~ `qtxctco` gox tfa gcx~t ~cveo`tf~. 44! c`gm`t eoxtmlcts q`dax o`a eo`tf og mia c~ dqa to ym`t ogavnlq~cwa hxam~tgaadc`i.

    Mnnoxdc`i to Dx KK Waxem, ^a`cox Zmadcmtxcncm`, Dc~txcnt Fo~zctml, Hmfxmcnf,Eotfax~ eclk fm~ wctmec`~ m`d nolo~txqe~ &gcx~teclk# yfcnf zlms~ m embox xola c` zxotantc`i nfcldxa`gxoe z`aqeo`cm m`d otfax c`gantco`~ m`d c` kaazc`itfae famltfs. Fa`na ct c~ waxs cezoxtm`t tfmt awaxseotfax avnlq~cwals hxam~tgaad~ fax nfcld gox tfa gcx~t

    ~cv eo`tf~. Nfcldxa` ~foqld `ot ha icwa` m`s toz gaadhanmq~a tfa }qmlcts yfcnf eotfax~ eclk fm~ c~ `otzxa~a`t c` m`s otfax tfc`i.

    Dx ZK Ec~fxm, ^a`cox Is`manoloic~t, Dc~txcnt Fo~zctml,Hmfxmcnf, ml~o ozc`a~, Eotfax~ eclk zxotant~ tfa nfcld

    gxoe wmxcoq~ c`gantco`~ m`d dc~oxdax~ fa`na ct c~ tfa ha~t goxe og`oqxc~fea`t. @otfc`i al~a nm` ha hattax tfm` eotfax~ eclk. Fa`na yamdwc~a mll to%ha eotfax~ yfo wc~ct oqx fo~zctml to avnlq~cwals hxam~tgaadtfacx nfcld gox tfa gcx~t ~cv eo`tf~ m`d `ot icwa m`s otfax eclk ox hottlagaad.

    Mnnoxdc`i to Dx Kqeqd M`qz, Zmadcmtxcncm`, Lqnk`oy, Eotfax~ eclk c~ tfaha~t eclk. Ct `ot o`ls zxawa`t~ c`gantcoq~ dc~am~a~ lcka dcmxxfoam m`dim~txoa`taxctc~ &hqx`c`i ~a`~mtco` c` tfa ~toemnf#, hqt ml~o falz~ c` tfazfs~cnml dawalozea`t og tfa nfcld. Ct ml~o c`nxam~a~ nfcld~ ceeq`cts m`dhods~ xa~c~tm`na gox otfax dc~am~a~. Fa`na eotfax~ eclk c~ noezlata`qtxctco` gox tfa nfcld dqxc`i tfa gcx~t ~cv eo`tf~. Tfaxa c~ `o `aad to icwam`s otfax good ~qzzlaea`t to tfa nfcld.

    Dx KK Waxem

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    27/106

    89 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Mnnoxdc`i to Dx KK Waxem m`d Dx ZK Ec~fxm ogHmfxmcnf Dc~txcnt Fo~zctml, mzzxovcemtals 9:!eotfax~ yfo wc~ct tfacx fo~zctml do hxam~tgaadtfacx nfcld. Dx Ec~fxm ml~o m~~axt~, Qxhm`eotfax~ mxa `ot mhla to hxam~tgaad tfacx

    nfcldxa` hanmq~a og ~awaxml xam~o`~2 Yoxkc`ieotfax~ nm``ot hxam~tgaad tfacx nfcld o` tcea,otfax~ do `ot avnlq~cwals hxam~tgaad tfacx nfcldox ~oea do `ot ym`t to. Tfaxa c~ `aad toadqnmta m`d eohclc~a noeeo` em~~a~ c` tfc~xaimxd. Ct fm~ haa` ~aa` tfmt cg tfa dontoxmzzxozxcmtals mdwc~a~ tfa eotfax~, tfas do golloy ct m`d hxam~tgaad tfacxnfcld.

    Yfaxam~ o` o`a fm`d tfa dontox~ og tfa Hmfxmcnf Dc~txcnt fo~zctml ozc`a tfmteo~t eotfax~ hxam~tgaad tfacx nfcldxa`, o` tfa otfax fm`d tfaxa mxa ~oea

    halcag~ zxawmla`t c` tfa ~oncats mnnoxdc`i to yfcnf m `ayhox` nfcld c~ icwa`iomt~ eclk, ymtax ox ~oeatfc`i al~a awa` hagoxa eotfax~ eclk. Tfc~ c~awcda`t gxoe tfa gmnt tfmt m eotfax yfohxoqift fax tfxaa dms old nfcld ~qggaxc`igxoe z`aqeo`cm to tfa Hmfxmcnf dc~txcntFo~zctml ~ms~, Ya mxa gaadc`i oqx nfcldyctf iomt~ eclk hanmq~a ct c~ oqx gmecls~old txmdctco` tfmt `ayhox` nfcld c~ icwa`iomt~ eclk c`ctcmlls. M`otfax eotfax ogtyo m`d m fmlg samx old nfcld ~qggaxax og

    z`aqeo`cm ~tmtad tfmt ~fa noqld `othxam~tgaad fax nfcld hanmq~a eclk ym~ `othac`i zxodqnad mt tfmt tcea.

    Tfc~ kc`d og zxmntcna tfmt zxawmcl~ c` oqx~oncats c~ m hci oh~tmnla to tfa zxozax dawalozea`t og nfcldxa`. C` gmnt ct c~m nqx~a. Tfaxa c~ `aad to eohclc~a `ot o`ls dontox~ hqt ml~o eotfax~ c` tfc~xaimxd. Ct fm~ ogta` haa` `otcnad tfmt yfa` dontox~ mdwc~a tfacx zmtca`t~m`d avzlmc` tfae yall mhoqt tfa cezoxtm`na og hxam~tgaadc`i, eotfax~faad to tfacx mdwcna m`d hxam~tgaad tfacx nfcldxa`. Tfaxa c~ lmnk ogmymxa`a~~ c` tfa ~oncats. Ya `aad to adqnmta eotfax~ m`d emka tfae

    mymxa. Tfc~ ycll a`~qxa m yfola~oea nfm`ia c` tfa ~oncats.

    Xmfql Kqemx Dycwadc N@^&Txm`~lmtco`2 oesm Mxoxm N@^#

    Dx ZK Ec~fxm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    28/106

    86 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Eotfax~ eclk zxotant~ tfa

    nfcld mimc`~t z`aqeo`cmXcift mgtax hcxtf nfcldxa` ~foqld ha icwa` eotfax~ eclk o`ls gox gcx~t ~cveo`tf~ og tfacx lcwa~ hanmq~a ct zxotant~ tfae gxoe c`gantco`~ ~qnf m~z`aqeo`cm, dcmxxfoam, meo`i otfax~.

    Eotfax~ eclk fm~ da~cxmhla m`d ha`agcncml m`tchodca~ tfmt falz tfa nfcldzxotant fax~alg/ fce~alg mimc`~t z`aqeo`cm m`d otfaxc`gantco`~. Tfmt c~ yfs ct c~ ~txo`ils xanoeea`dad tfmteotfax~ ~foqld avnlq~cwals hxam~tgaad tfacx nfcld gox tfagcx~t ~cv eo`tf~ ~mcd Dx Mhfc~fak Waxem, ^a`coxZmadcmtxcncm`, Dx Xme Em`ofmx Lofcm Fo~zctml c` Ioetc

    @mimx, Lqnk`oy.

    Ya noq`~al m`d zxazmxa tfa yoem` o` avnlq~cwahxam~tgaadc`i yfa` ~fa xaic~tax~ fax~alg gox m`ta`mtmlnmxa. Mt tfa tcea og hcxtf m`d dqxc`i zo~t`mtml nmxa toofamltfnmxa yoxkax~ emka m` avtxm aggoxt c` ~txa~~c`iha`agct~ og hxam~tgaadc`i. Eo~t eotfax~ mxa noegoxtmhla

    c` hxam~tgaadc`i tfacx nfcld foyawax c` ~oea nm~a~ eotfax~ mxa`t c` mzo~ctco` to hxam~tgaad m`d c`ncda`na og nfcldfood z`aqeo`cm, dcmxxfoam,eml`qtxctco` m`d otfax m~~oncmtad famltf zxohlae~ c~ fcifax c` ~qnf nfcldxa`yfo mxa`t hxam~tgad ~mcd Dx Waxem.

    Ya do`t mdwc~a gaadc`i nfcldxa` yctf hottla~. Yfa` nfcldxa` xa}qcxamddctco`ml `qtxctco` tfa` ya xanoeea`d foea%emda good o`ls m`d eotfax~eclk c~ tfa ha~t good gox tfa hmhs, a~zancmlls gox gcx~t ~cv eo`tf~. Eclk otfaxtfm` eotfax~ eclk doa~`t fmwa a`oqif `qtxctco`ml wmlqa gox fqem` hac`i~hmhs tfmt c~ yfs ya emka mll aggoxt~ to a`~qxa tfmt tfa eotfax~ hxam~tgaadtfacx nfcldxa` ~mcd Dx Waxem.

    Yfa` tfa nfcld c~ hox` tfa` tfas do`t fmwa m ~txo`i ceeq`cts to gciftdc~am~a~. Tfmt c~ yfs nfcldxa` mxa q`mhla to daga`d tfae~alwa~ gxoe

    c`gantco`~. Hqt cg tfa nfcld c~ hxam~tgaadc`i tfa` ~fa ox fa iat~ a`oqifm`tchodca~ tfmt falz gcift tfa c`gantco`~ m`d hqcld hods~ oy` daga`naeanfm`c~e &ceeq`cts# mimc`~t ~qnf dc~am~a~.Nfcldxa` yfo iat avnlq~cwa hxam~tgaadc`i mxa lckalsto ha zxotantad gxoe no`dctco`~ ~qnf m~ z`aqeo`cm,tqhaxnqlo~c~, noeeo` nold, dcmxxfoam, meo`iotfax~. Tfmt c~ yfs ya a`noqxmia tfa eotfax~ toavnlq~cwals hxam~tgaad tfacx nfcld gox gcx~t ~cveo`tf~ mt lam~t ~mcdDx Xmem ^fm`kfdfmx, ~a`coxIs`manoloic~t m`d Oh~tatxcncm`, Xmem No`~qltmtco`~m`d Txmc`c`i Na`txa, N%hlonk nxo~~c`i, C`dcxm @mimx,

    Lqnk`oy.

    Dx Mhfc~fak Waxem

    Dx Xmem ^fm`kfdfmx

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    29/106

    83 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    C` ~oea nm~a~ da~zcta eadcnmtco` eotfax~ mxa q`mhla to zxodqna a`oqifeclk. Ya ~tcll xanoeea`d tfmt tfas ~foqld hxam~tgaad m~ gmx m~ zo~~chla m`dnoezlaea`t yctf mddctco`ml `qtxctco` m~ xa}qcxad ~o tfmt tfa nfcld doa~`txaemc` fq`ixs. Yfa` eotfax~ mxa mhla to `oxemlls zxodqna a`oqif eclk goxtfa nfcld, tfa` tfaxa c~ `o `aad to icwa m`stfc`i otfax tfm` fax eclk to tfa

    nfcld. Eotfax~ eclk c~ tfa ha~t `qtxctco` m nfcld nm` iat gox gcx~t ~cv eo`tf~.Foyawax yfa` eotfax~ eclk c~ `ot a`oqif tfa` tfas nm` gaad tfa nfcldq~c`i hottla~. Yfa` tfa nfcld c~ og > eo`tf~ mia tfa` tfas nm` ml~o icwagcltaxad la`tcl ymtax ~mcd Dx ^fm`kfdfmx.

    Dx X^ Dqhas, Nfcag Eadcnml ^qzaxc`ta`da`t &NE^# og Dx Xme Em`ofmx LofcmFo~zctml c` Ioetc @mimx, Lqnk`oyml~o ~qzzoxtad tfmt nfcldxa` mgtaxhcxtf ~foqld ha avnlq~cwa hxam~tgadgox gcx~t ~cv eo`tf~. Yfa` eotfax~txs to gaad tfa nfcld q~c`i m ~zoo`

    eclk mt tcea~ ioa~ c`to tfaxa~zcxmtoxs txmnt &c`~tamd og goodzcza# og tfa nfcld. Eotfax~ ~foqldalawmta tfa famd og tfa nfcld yfclahxam~tgaadc`i hanmq~a tfa` tfa xc~kog eclk ioc`i c`to tfa xa~zcxmtoxstxmnt c~ loy. Nfcldxa` ~foqld hahxam~tgad gox gcx~t 7%=8 eo`tf~.Tfc~ ycll ml~o zxawa`t tfa nfcld gxoec`gantco`~. Tfmt c~ yfs eotfax~ og

    nfcldxa` hox` c` oqx fo~zctml mxa noq`~allad m`d a`noqxmiad to avnlq~cwalshxam~tgaad tfacx nfcld gox gcx~t ~cv eo`tf~ ~mcd Dx Dqhas.

    M nfcld yfo ym~ hox` c` Dx Xme Em`ofmx Lofcm Fo~zctml to zmxa`t~ yfo lcwac` C~emclim`b ~lqe~ &hafc`d tfc~ fo~zctml# zxowcda~ m xamlcts nfank. Tfaeotfax &Xakfm# og tfc~ z`aqeo`cm%~txcnka` nfcld &Tql~c# ~mcd tfmt ~fa ym~`ot noq`~allad ox icwa` c`goxemtco` mhoqt hxam~tgaadc`i. Foyawax m~ zaxtfa txmdctco` ~fa dcd hxam~tgaad tfa nfcld. Da~zcta hxam~tgaadc`i fax nfclddawalozad z`aqeo`cm. Gxoe tfa ~mea ~lqe~ ya ml~o ~zoka to tfxaa eoxaeotfax~ yctf z`aqeo`cm c`gantad nfcldxa` &Bsotc, Sm~eaa` m`d Gmxaad# yfofmd hxam~tgad tfacx nfcldxa` hqt ~tcll tfacx nfcldxa` dawalozad z`aqeo`cm.

    Qzo` nlo~ax xawcay, tfaxa mxa otfax xc~k gmntox~ c` tfa ~lqe~ tfmt c`nxam~atfa xc~k og z`aqeo`cm gox nfcldxa` ~qnf m~ avzo~qxa to ~ano`d%fm`d tohmnno~eoka, ~eoka gxoe nook ~towa~, eml`qtxctco`, meo`i otfax~.

    Eotfax~ eclk iat~ am~cls dcia~tad hs tfa nfcld. ^o hxam~tgad nfcldxa` mxala~~ mt xc~k og gmnc`i c`dcia~tco` ox dcmxxfoam m~ xc~k og c`gantco` c~ loytoo. M nfcld tcll ~cv eo`tf~ og mia c~ `ot xa}qcxad to tmka m`s otfax goodavnazt eotfax~ eclk m~ ct no`tmc`~ mll xa}qcxad `qtxctco`.

    @mdaae mlem`c N@^&Txm`~lmtco`2 N@^#

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    30/106

    >: | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Avnlq~cwa hxam~tgaadc`i

    wctml gox gcx~t ~cv eo`tf~Yctf nfm`ic`i yamtfax no`dctco` nfcldxa` mxa eoxa zxo`a tfm` mdqlt~ to iat~cnk. Tfc~ c~ hanmq~a og tfacx loy ceeq`cts m`d m~ tfas ixoy tfacx hods~~alg daga`na eanfm`c~e~ &ceeq`cts# dawaloz~ too. Avnlq~cwa hxam~tgaadc`ic~ m hla~~c`i gox m nfcld c` fax ox fc~ gcx~t ~cv eo`tf~ og lcga yfcnf c~ `ot o`lsm noezlata hmlm`nad dcat gox tfa nfcld, hqt ml~o zxawa`t~ c`gantco`~txm`~ecttad tfxoqif q`fsica`cn gaadc`i fmhct~ m`d hoo~t~ qz m nfcld~ceeq`cts ~ci`cgcnm`tls. Cg m nfcld c~ `ot hxam~tgad dqxc`i gcx~t ~cv eo`tf~ oglcga tfa` tfa xc~k og no`txmntc`i c`gantco`~ ~qnf m~ z`aqeo`cm ioa~ qzmlmxec`ils. Eoxa tfm` =.7 ecllco` nfcldxa` q`dax tfa mia og 1 samx~ dca dqa

    to z`aqeo`cm da~zcta z`aqeo`cm hac`i zxawa`tmhla m`d nqxmhla too.

    Tfa nfcld ~foqld ha hxam~tgad yctfc` tfa gcx~t foqx mgtax hcxtf m`davnlq~cwa hxam~tgaadc`i c~ ~txo`ilsxanoeea`dad gox tfa gcx~t ~cv eo`tf~, ~mcdDx Mbms Kqemx, ~a`cox Zmadcmtxcncm`, FozaEotfax m`d Nfcld Nmxa Na`txa, Lqnk`oy.Hxam~tgaadc`i m~ xanoeea`dad hs tfa YoxldFamltf Oxim`crmtco` &YFO# c~ c`~txqea`tmlc` `ot o`ls icgtc`i tfa nfcld yctf ~txo`iaxceeq`cts hqt ml~o xadqna~ tfa xc~k og ~axcoq~

    c`gantco`~ ~qnf m~ z`aqeo`cm. Foyawaxtfaxa mxa eotfax~ yfo mxa`t mhla tohxam~tgaad da~zcta mymxa`a~~. Tfasnoezlmc` og c`~qggcnca`t eclk zxodqntco` mttcea~ yfcnf c~ m ec~no`naztco` hanmq~a ct c~

    `oxeml to fmwa la~~ eclk c` tfa c`ctcml zfm~a~ og hxam~tgaadc`i m~ tfa hxam~t~zxodqna m ~tcnks nolo~txqe~. Cg eotfax~ no`tc`qa to hxam~tgaad tfa` eclkzxodqntco` ioa~ qz xmzcdls m`d c~ c` tfa ha~t c`taxa~t~ og tfa nfcld, ~mcd DxKqemx.

    Nolo~txqe~ ml~o c`nxam~a ceeq`cts c` m nfcld, ~mcd Dx @cdfc Bofxc, ~a`coxIs`manoloic~t m`d Oh~tatxcncm`, Foza Eotfax m`d Nfcld Nmxa Na`txa,Lqnk`oy. Eotfax~ eclk c~ tfa ~mga~t, nlam`a~t m`d noezlata dcat gox m`ayls hox` nfcld qz to ~cv eo`tf~, ~mcd Dx Bofxc. Eotfax~ ogta` xagxmc` gxoeavnlq~cwa hxam~tgaadc`i hanmq~a actfax tfas gaal tfmt eclk zxodqntco` c~c`~qggcnca`t, ox ct nmq~a~ zmc` c` tfacx ymc~t~, ox tfas fmwa m waxs fantcnyoxk ~nfadqla m`d ct c~ dcggcnqlt to zxowcda tfa nfcld avnlq~cwahxam~tgaadc`i. Ct c~ waxs dcggcnqlt m`d mt tcea~ cezxmntcnml to a`~qxa tfmt tfaeclk otfax tfm` eotfax~ oy` eclk c~ ~m`ctcrad m`d nlam` gox tfa nfcld, ~mcdDx Bofxc. Tfc~ c~ yfs ~oea nfcldxa` yfo mxa`t hxam~tgad dawalozz`aqeo`cm.

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    31/106

    >= | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Dx Xctq Imxi, ~a`cox Is`manoloic~t m`d Oh~tatxcncm`, Sm~f Fo~zctml,Lqnk`oy, ml~o xanoeea`d~ avnlq~cwa hxam~tgaadc`i to tfa eotfax~ og `aylshox` nfcldxa` gox gcx~t ~cv eo`tf~ og m nfcld~ lcga. Foyawax mt tcea~ eotfax~mxa q`mhla to hxam~tgaad m`d c` ~qnf ~ctqmtco`~ ~fa golloy~ tfa YFOxanoeea`dmtco` og ~qzzlaea`tmxs good ~o tfmt tfa nfcld iat~ mda}qmta

    `qtxctco` m~ gmx m~ zo~~chla. ^fa nmqtco`~ tfmt ct c~ cezoxtm`t tfmt tfa hottla,qta`~cl~ ~qnf m~ ~zoo` ox hoyl, yfcnf mxa q~ad to gaad ~qnf nfcldxa` yfonm``ot ha hxam~tgad mda}qmtals, eq~t ha nlam` m`d ~m`ctcrad. Dx Imxixanoeea`d~ la`tcl ox xcna ymtax, waiatmhla~ m`d gxqct bqcna~ mgtax gcwaeo`tf~.

    Tfaxa c~ `o ~qh~tctqta to avnlq~cwahxam~tgaadc`i, ~mcd Dx ^m`to~f Xmc,~a`cox zmadcmtxcncm`, Wmt~mlsm Nlc`cn,Lqnk`oy. Hxam~tgaadc`i falz~ tfanfcld dawaloz m`tchodca~ m`d hoo~t~qz nfcld~ ceeq`cts ~ci`cgcnm`tls,m`d ~qnf zo~ctcwa famltf oqtnoea~nm``ot ha oztcemlls xanacwad hs m`s~qzzlaea`tmxs good. Ml~o Dx Xmcnmqtco`~ tfmt hottla%gaadc`i m nfcldml~o qz~ tfa xc~k og iattc`i eclk c`fax ox fc~ xa~zcxmtoxs txmnt &c`~tamdog good zcza# yfcnf nm` nmq~a mgoxe og z`aqeo`cm. Cg ya do`tzxowcda avnlq~cwa hxam~tgaadc`i to

    m nfcld m`d q~a ~qzzlaea`tmxsgood gox nfcld~ `qtxctco`ml `aad~ tfa` ya mxa ml~o oza`c`i qz m imtaymsgox c`gantco`~, ~mcd Dx Xmc.

    Tfaxa c~ `o ~qh~tctqta to avnlq~cwa hxam~tgaadc`i gox m nfcld dqxc`i gcx~t ~cveo`tf~ og lcga tfc~ c~ m nlamx ea~~mia tfmt mll avzaxt~ C c`taxwcayad fmwaa`dox~ad.

    @aaxmb Emc`mlc N@^&Txm`~lmtco`2 N@^#

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    32/106

    >8 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    TFAEA 8Cezoxtm`na og iood `qtxctco` m`dfsica`a &c`nlqdc`i fm`d%ym~fc`i#

    c` zxawa`tc`i z`aqeo`cm m`d otfax

    dc~am~a~

    Eotfax m`d nfcld yctf

    Z`aqeo`cm, c` C~emcliq`b

    ~lqe~, hafc`d Dx XEL

    Fo~zctml, Ioetc @mimx,

    Lqnk`oy

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    33/106

    >> | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Gaad Soqx Nfcld Yall2

    Zxawa`t Z`aqeo`cmZ`aqeo`cm c~ tfa lamdc`i ilohml kcllax og nfcldxa` q`dax gcwa, xa~zo`~chla goxmleo~t =.7 ecllco` damtf~ zax samx, yfcnf c~ mhoqt o`a%gcgtf og mll zmadcmtxcndamtf~ mxoq`d tfa yoxld. Lcka otfax mnqta xa~zcxmtoxs c`gantco`~, z`aqeo`cmtmxiat~ tfa yoxld~ eo~t wql`axmhla nfcldxa`tfo~a yfo mxa zoox m`deml/q`dax`oqxc~fad. Tfa hqxda` og z`aqeo`cm c` tfa dawalozc`i yoxld c~`amxls =: tcea~ tfmt og dawalozad yoxld. C` loy c`noea noq`txca~,z`aqeo`cm kcll~ 9>8: oqt og =::,::: nfcldxa` haloy 1 samx~ og mia, m~noezmxad to bq~t >4 c` dawalozadnoq`txca~. C` ^oqtf M~cm m`d ^qh ^mfmxm`

    Mgxcnm 8=! og mll damtf~ c` nfcldxa` mxadqa to z`aqeo`cm. Mnnoxdc`i to tfaMnqta Xa~zcxmtoxs C`gantco`~ Mtlm~ 8:=:,lmnk og good no`txchqta~ to 44! og damtf~gxoe z`aqeo`cm c` nfcldxa` ilohmlls.

    Tfa zxawmla`na, og nfcldfood z`aqeo`cmc~ waxs fcif c` C`dcm, m`d nlmce~ tfa lcwa~og `amxls 4>,::: nfcldxa` awaxs samx.Zxozax `qtxctco` c~ nxqncml to ~qzzoxtc`itfa hods~ `mtqxml daga`na~, m`d c`falzc`i to xadqna tfa aggant~ og m dc~am~ao`na ct c~ no`txmntad. Tfaxa c~ m ia`axmlno`~a`~q~ meo`i~t dontox~ tfmt eml`qtxctco` emka~ nfcldxa` ceeq`a~qzzxa~~ad, tfq~ emkc`i tfae m` am~s tmxiat gox m fo~t og dc~am~a~,c`nlqdc`i z`aqeo`cm. Mltfoqif zowaxts doa~ lamd to q`dax `qtxctco`,~oeatcea~ lmnk og k`oyladia mhoqt nfamz hqt `qtxctcwa good ctae~ ml~ozxawa`t~ zmxa`t~ gxoe zxowcdc`i m zxozax dcat to tfacx nfcld. Tfc~ c~zmxtcnqlmxls txqa og qxhm` gmeclca~ yfaxa zxona~~ad m`d gm~t good~ mxahanoec`i m` c`taixml zmxt og nfcldxa`~ dmcls dcat. Ct c~ `ot q`noeeo` awa`gox qxhm` ~lqe dyallax~ to ozt gox ixam~s, gmtts good~ c`~tamd og tfa ~cezla

    m`d fcifls `qtxctcwa, dml%xotc.

    Zxoga~~ox &Dx# Ioqxdm~ Nfoqdfqxc, Zxoga~~ox m`d Famd Im~txoa`taxoloisDazmxtea`t, ^m`bms Im`dfc Zo~t%Ixmdqmta C`~tctqta og Eadcnml ^nca`na~&^IZICE^#, Lqnk`oy, mixaa~ tfmt eml`oqxc~fad nfcldxa` mxa eoxa wql`axmhlato z`aqeo`cm. Dx Nfoqdfqxc c~ m ~txo`i mdwonmta og famltfs lcwc`i c` nfcldxa`m`d gaal~ tfmt, Lcga~tsla dc~oxdax~ zlms m nxqncml xola c` em`miaea`t ogdc~am~a~ lcka z`aqeo`cm. Oha~a nfcldxa` mxa ml~o eml`oqxc~fad m`d ~o fmwam noezxoec~ad ceeq`a ~s~tae. ^o ct c~ cezoxtm`t to a`~qxa tfmt nfcldxa`kaaz m` cdaml hods yacift m`d q~a tfa ~zoxt~ gcald m`d/ox do zla`ts ogavaxnc~a to kaaz tfacx lq`i~ famltfs, c` oxdax to mwocd tfa o`~at og

    z`aqeo`cm m`d otfax xa~zcxmtoxs dc~am~a~.

    Lcka otfax mnqta xa~zcxmtoxsc`gantco`~, z`aqeo`cmtmxiat~ tfa yoxld~ eo~twql`axmhla nfcldxa` tfo~a yfo mxa zoox m`deml/ q`dax`oqxc~fad. Tfahqxda` og z`aqeo`cm c` tfadawalozc`i yoxld c~ `amxls=: tcea~ tfmt og dawalozadyoxld

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    34/106

    >4 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Dx Dc`a~f Nfm`dxm Zm`das, m ^zancmlc~t c` Zmadcmtxcn Eadcnc`a mt @al~o`Fo~zctml og Zmadcmtxcn~ m`d @ao`mtml Eadcnc`a, ~mcd tfmt tcll ~oea samx~ hmnkz`aqeo`cm ym~ la~~ zxawmla`t c` mgglqa`t foea~ m~ noezmxad to zooxgmeclca~. Hqt zxotac`%a`axis eml`qtxctco`, owaxnxoydc`i, c`doox /oqtdooxzollqtco` m`d lcga ~tsla nfm`ia~ mxa tmkc`i tfacx toll c` tfa qzzax ~txmtm og

    ~oncats m~ yall, yfaxa c`ncda`na~ og z`aqeo`cm m`d dcmxxfoam mxa o` tfaxc~a. Fa lmea`tad tfa zozqlmxcts og gm~t good~ yfcnf mxa zoox c` }qmlctmtcwa`qtxctco` m`d mxa emkc`i nfcldxa` `ot o`ls eml`oqxc~fad, hqt ceeq`anoezxoec~ad ml~o. ^o, z`aqeo`cm c~ `o lo`iax no`gc`ad to zoox foq~afold~mlo`a, tfoqif c` dawalozc`i noq`txca~ lcka C`dcm, tfa c`ncda`na c~ fcifax c`loy c`noea gmeclca~.

    C` Dx Zm`das~ ozc`co`, Iood `qtxctco` `aad `ot ha avza`~cwa. C` ~oeawcllmia~, nfcldxa` mxa eoxa lckals to fmwa mnna~~ toiood `qtxctcwa dcat, lcka gxa~f gc~f gxoe tfa xcwax, m`dzqxa noy/hqggmlo eclk, yfcnf qxhm` nfcldxa` ems `ot

    ha mhla to iat tfmt am~cls. Xqxml kcd~ ml~o fmwa hattaxm`d nfamzax mnna~~ to ixaa` waiatmhla~ m`d gxqct~.Qxhm` gmeclca~ ems ha ~za`dc`i m lot o` good hqtnoezxoec~c`i o` ct~ `qtxctcwa m~zant. C yoqldaezfm~cra tfmt dcat ~foqld ha `qtxctco`mlls hmlm`nadhs yms og }qmlcts m`d }qm`tcts m`d ha mzzxozxcmta totfa nfcld~ `aad~. Noeeaxncmlls mwmclmhla zxodqnt~ lckagm~t m`d bq`k good, yfcnf mxa famwcls mdwaxtc~ad c`zxc`t m`d alantxo`cn eadcm, ~foqld ha mwocdad. ^cezlafoeaemda good c~ iood gox tfa nfcldxa`.

    Dx Mbms Ec~xm, Em`mic`i Dcxantox og @al~o` Fo~zctml ogZmadcmtxcn~ m`d @ao`mtml Eadcnc`a, ml~o ~txa~~a~ qzo`adqnmtc`i tfa zqhlcn o` tfa xola zlmsad hs iood dcat c`zxawa`tc`i z`aqeo`cm m`d otfax dc~am~a~. Fa gaal~tfmt, Zmxa`t~ ~foqld k`oy tfa nmloxcn `aad~ og tfacxnfcld m`d a`~qxa m hmlm`nad dcat, no`tmc`c`i mda}qmta

    meoq`t~ og zxotac`, nmxhofsdxmta, cxo`, m`d nmlncqe gox tfacx nfcldxa`. Cyoqld fcifls xanoeea`d gchxoq~ good~ lcka ixaa` waiatmhla~, la`tcl~, ~cezlaxotc/nfmzmttc yfcnf c~ xalmtcwals nfamzax m`d waxs iood gox tfa famltf.Zmxa`t~ ~foqld `ot c`ctcmta tfacx kcd~ to gm~t good~ lcka zcrrm~, hqxiax~,

    zm~txca~, m`d nolm~ dxc`k~ yfcnf mxa waxs fmxegql m`d ~foqld ha c`dqliad c`o`na c` m yfcla o`ls. C yoqld ~txo`ils xanoeea`d gxqct~ m`d `ot bqcna~, m~tfa goxeax fmwa a`oqif gchxa mlo`i yctf ec`axml~.

    C`mda}qmta `qtxctco`c` qtaxo, dqxc`i c`gm`ns, m`d amxls nfcldfood c~ nlo~alslc`kad to lcgalo`i ceeq`a dagcnca`nca~ m`d mnqta xa~zcxmtoxs c`gantco`~ lckaz`aqeo`cm. C`mda}qmta emtax`ml `qtxctco` c~ ml~o m embox xc~k gmntox goxlmtax nfcldfood z`aqeo`cm, m~ ct c~ lc`kad to loy hcxtf yacift. ^qhoztcemlhxam~tgaadc`i ml~o c`nxam~a~ tfa xc~k og eml`qtxctco` m`d wctmec`dagcnca`nca~ c` tfa c`gm`t.

    Mnnoxdc`i to Dx Mectm Zm`das, M~~oncmta Zxoga~~ox, Dazmxtea`t ogOh~tatxcn~ m`d Is`manolois mt tfa Nffmtxmzmtc ^fmfqbc Emfmxmb Eadcnml

    Hqt zxotac`%a`axis

    eml`qtxctco`,owaxnxoydc`i,

    c`doox /oqtdooxzollqtco` m`d lcga~tsla nfm`ia~ mxatmkc`i tfacx toll c`tfa qzzax ~txmtm og

    ~oncats m~ yall,

    yfaxa c`ncda`na~ ogz`aqeo`cm m`d

    dcmxxfoam mxa o`

    tfa xc~a

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    35/106

    >1 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Q`cwax~cts &ax~tyfcla Kc`i Iaoxia~ Eadcnml Nollaia#, Mltfoqif z`aqeo`cmmggant~ xcnf m`d zoox nfcldxa`, ~tqdca~ fmwa ~foy` tfmt ct c~ eoxa noeeo` c`eml `oqxc~fad nfcldxa`. Tfa ~mea c`gantco` yfcnf a`d~ c` m eaxa QzzaxXa~zcxmtoxs Txmnt C`gantco` &QXTC# c` m yall `oqxc~fad nfcld c~ waxs lckalsto nmq~a ~awaxa dahclctmtc`i z`aqeo`cm c` m eml`oqxc~fad o`a. C yoqld

    lcka to mdd faxa tfmt yall gad nfcldxa` gxoe yall ogg gmeclca~ nm` ml~o haeml`oqxc~fad dqa to m wmxcats og xam~o`~tfas mxa `ot hxam~tgad, tfas mxao` toz gaad yfcnf doa~ `ot fmwa a`oqif zxotac`~, ox tfa toz gaad c~ ecvadyctf ymtax yctf tfa ec~no`naztco` og emkc`i ct eoxa dcia~tchla. M~ tfa nfcldixoy~ oldax eclk c~ ogta` ~qzzlaea`tad yctf good ctae~ yfcnf ems `ot ha`qtxctcwalcka nolm~, nfonolmta~, gxca~, hqxiax~, zcrrm~. Mll tfc~ mdd~ toeml`qtxctco`. M~ tfa hmhs ixoy~ oldax, ct fm~ to ha yam`ad ogg eotfax~ eclkm`d icwa` m zxotac` xcnf dcat, c`nlqdc`i gxqct~, to hoo~t tfa ceeq`a ~s~tae.

    Cezxowaea`t~ c` famltf nmxa m`d `qtxctco` mxa c`taxwa`tco`~ tfmt nm`~ci`cgcnm`tls xadqna tfa c`ncda`na og z`aqeo`cm. Mnnoxdc`i to tfa Mnqta

    Xa~zcxmtoxs C`gantco`~ Mtlm~, 8:=: hxomd m`d c`taixmtad noeectea`t o`tfa zmxt og tfa c`tax`mtco`ml noeeq`cts to cezxowc`i lcwc`i ~tm`dmxd~yoxldycda c~ tfa txqa goq`dmtco` og zxawa`tco`. Yctf m wcay to cezxowc`i`qtxctco` m`d c`nxam~c`i ceeq`cts mimc`~t z`aqeo`cm m`d otfax dc~am~a~,tfa Yoxld Famltf Oxim`crmtco` ~txa~~a~ qzo` avnlq~cwa hxam~tgaadc`i tcll ~cveo`tf~; hxam~tgaadc`i m`d noezlaea`tmxs good~ q`tcl tyo samx~ og mia; m`dtfaxamgtax m` mnna~~ to `qtxctco`ml ~qzzlaea`t~ m`d m famltfs dcat. Xc~c`igood zxcna~ owax tfa zm~t gay samx~ fmwa mddad to tfa yoa~ og eml`qtxctco`.Mt tfa tcea og yxctc`i tfc~ mxtcnla, good c`glmtco` c` C`dcm ym~ mt m` mll tceafcif og 3.=>!. Ct c~ cezaxmtcwa to fmwa noeectea`t~ gxoe iowax`ea`t~ to

    noehmt eml`qtxctco` mt tfa noeeq`cts lawal.

    Eam`yfcla o`a eq~t xaeaehax tfmt avza`~cwa good~ ems `ot mlyms~ ha`qtxctcwa, m`d tfmt owaxgad/oha~a m~ yall m~ q`dax`oqxc~fad nfcldxa` mxaloy o` ceeq`cts m`d fa`na hxaadc`i ixoq`d~ gox em`s nfcldfood dc~am~a~,c`nlqdc`i z`aqeo`cm.

    ^fohfm ^fqklm N@^

    C`mda}qmta qtxctco` c` qtaxo, dqxc`i c`gm`ns, m`d amxls

    nfcldfood c~ nlo~als lc`kad to lcgalo`i ceeq`a dagcnca`nca~m`d mnqta xa~zcxmtoxs c`gantco`~ lcka z`aqeo`cm.C`mda}qmta emtax`ml `qtxctco` c~ ml~o m embox xc~k gmntoxgox lmtax nfcldfood z`aqeo`cm, m~ ct c~ lc`kad to loy hcxtf

    yacift. ^qhoztceml hxam~tgaadc`i ml~o c`nxam~a~ tfa xc~k ogeml`qtxctco` m`d wctmec` dagcnca`nca~ c` tfa c`gm`t.

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    36/106

    >7 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Gcift Z`aqeo`cm Yctf

    Iood @qtxctco`Iood @qtxctco` cezlca~ m` mda}qmta m`d yall hmlm`nad dcat noehc`ad yctfxaiqlmx zfs~cnml mntcwcts. Ct c~ tfa nox`ax~to`a og iood famltf m`d tfa kas tocezxowc`i m nfcld~ `mtqxml daga`na~, m`d fa`na o`a og tfa eo~t aggantcwaeam~qxa~ c` zxawa`tc`i z`aqeo`cm. Ha~cda~, ct ml~o falz~ to xadqna tfala`itf og tfa cll`a~~ cg m nfcld doa~ hanoea cll. Iood famltf m`d fsica`a mxatfa tyo gmnat~ og `qtxctco` yfcnf falz c` hqcldc`i amxls ceeq`cts og tfanfcld hs hoo~tc`i tfa ceeq`a ~s~tae. @qtxctco` xalca~ o` )yfcnf) good m`d)foy eqnf) good c~ xa}qcxad hs tfa nfcld.

    Mnnoxdc`i to tfa Yoxld Famltf Oxim`crmtco` &YFO#, tfahciia~t c`taxwa`tco` mimc`~t z`aqeo`cm c~ iood`qtxctco`. Awaxs c`gm`t m`d nfcld fm~ m xcift to iood `qtxctco`m~ zax tfa No`wa`tco` og )Xcift~ og tfa Nfcld). Kaazc`i c` ec`dtfa cezoxtm`na og `qtxctco`, tfa Famltf M~~aehls c` Ems 8:=:mdoztad m xa~olqtco` o` c`gm`t m`d soq`i nfcld `qtxctco`, toavzadcta tfa cezlaea`tmtco` og tfa ilohml ~txmtais o` c`gm`tm`d soq`i nfcld gaadc`i. Zaozla yctf mda}qmta `qtxctco` mxaeoxa zxodqntcwa m`d nm` nxamta ozzoxtq`ctca~ to ixmdqmllshxamk tfa nsnla~ og zowaxts m`d fq`iax. Fa`na `qtxctco` c~

    c`dc~za`~mhla to m famltfs lcga.

    Mnnoxdc`i to Zxoga~~ox &Dx# SN Iowcl, Zxoga~~ox, Dazmxtea`t ogZmadcmtxcn~, Nffmtxmzmtc ^fmfqbc Emfmxmb Eadcnml Q`cwax~cts,Iood `qtxctco` gox nfcldxa` haloy 1 samx~ og mia ~foqld haavnlq~cwa hxam~tgaadc`i dqxc`i tfa gcx~t ~cv eo`tf~, m`d tfa`ixmdqml yam`c`i hs ~tmxtc`i noezlaea`tmxs good lcka naxaml~,em~fad zmzmsm, hm`m`m atn. M~ tfa nfcld ixoy~, mll tsza~ ogfoq~afold dcat~ eq~t ha mddad yctf ~oea hqttax m`d ifaa ml~o,~o tfmt da`~a nmloxca~ nm` ha zxowcdad.(

    Ct c~ m waxs zozqlmx `otco` tfmt iood `qtxctco` fm~ to haavza`~cwa. Dx Wcbmsm Eofm` &No`~qltm`t Zadcmtxcncm`,Wcwakm`m`dm Zolsnlc`cn m`d C`~tctqta og Eadcnml ^nca`na~# ~ms~,(Iood `qtxctco` nm` ha daxcwad gxoe noeeo` foq~afold ctae~lcka naxaml~, zql~a~ yfcnf mxa fcifls xcnf c` zxotac`. Tfa o`lstfc`i o`a ~foqld k`oy c~ foy to zxazmxa tfae yall c.a.fsica`cnmlls m`d eoxa `qtxctcoq~ls.

    O`a nm``ot dagc`a `qtxctco` c` wmxcm`t daixaa~%% cg ct c~ `ot ioodct ycll naxtmc`ls ha hmd. Hmd `qtxctco` c~ ~qnf tfmt actfax ct

    lamd~ tfa nfcld to hanoea owaxyacift ox q`daxyacift. Dx Iowcl ~ms~ tfmt,(Hmd @qtxctco` c~ o`a avtxaea gox mgglqa`t gmeclca~, yfaxa kcd~ mxa go`d og

    (Hmd @qtxctco` c~o`a avtxaea gox

    mgglqa`tgmeclca~, yfaxakcd~ mxa go`d og

    bq`k good,yfcnf owaxgcll

    tfae yctfnmloxca~; m`d mt

    tfa otfaxavtxaea mxagmeclca~ yctfzoox ~onco%

    ano`oecn ~tmtq~yfo mxa goxnadto dclqta eclk

    m`d otfax good,yfcnf dazxcwa~

    tfae og tfa`qtxca`twmlqa~.(

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    37/106

    >9 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    bq`k good, yfcnf owaxgcll tfae yctf nmloxca~; m`d mt tfaotfax avtxaea mxa gmeclca~ yctf zoox ~onco%ano`oecn~tmtq~ yfo mxa goxnad to dclqta eclk m`d otfax good, yfcnfdazxcwa~ tfae og tfa `qtxca`t wmlqa~.(

    Hotf tfa~a no`dctco`~ mxa a}qmlls fmxegql gox m nfcld.Mnnoxdc`i to a~tcemta~, mzzxovcemtals 47! nfcldxa` q`dax1 ~qggax gxoe eml`oqxc~fea`t, c`mda}qmta fsica`a m`d~m`ctmtco` c` eo~t dawalozc`i noq`txca~. Tfc~ c~ zxcemxclstfa xam~o` tfmt c` txozcnml noq`txca~ damtf~ dqa toz`aqeo`cm mxa zmxtcnqlmxls fcif.

    Lmnk og good m`d fsica`cn no`dctco`~ no`txchqta~ to 44! ogdamtf~ gxoe z`aqeo`cm c` nfcldxa`. M kas c`dcnmtox ognfxo`cn eml`qtxctco` c~ ~tq`tc`i. Ilohmlls, >:! &ox =67ecllco`# og nfcldxa` q`dax gcwa mxa a~tcemtad to ha ~tq`tad m`d =6! &ox ==1

    ecllco`# fmwa loy yacift%gox%facift, eo~tls m~ m no`~a}qa`na og zooxgaadc`i m`d xazamtad c`gantco`~ m`d q`fsica`cn a`wcxo`ea`t. ^tq`tc`i xmta~meo`i nfcldxa` mxa fcifa~t c` Mgxcnm m`d M~cm. Ym~tc`i c~ m ~awaxa goxe ogeml`qtxctco` % xa~qltc`i gxoe mnqta good ~foxtmia~ m`d noezoq`dad hscll`a~~a~. Xc~c`i good zxcna~, good ~nmxncts c` mxam~ og no`glcnt, m`d `mtqxmldc~m~tax~ dcec`c~f foq~afold mnna~~ to mzzxozxcmta m`d mda}qmta good. Cg mnfcld c~ q`dax `oqxc~fad tfa` ~q~naztchclcts to c`gantco`~ c~ c`nxam~ad m`d tfadaga`na eanfm`c~e c~ cezmcxad, c`wctc`i em`s dc~am~a~ c`nlqdc`iz`aqeo`cm.

    Emtax`ml q`dax `qtxctco`, noeeo` c` em`s dawalozc`i noq`txca~, lamd~ tozoox goatml dawalozea`t. Mhoqt =>ecllco` nfcldxa` mxa actfax hox`zxaemtqxa ox yctf loy hcxtf yacift. Loyhcxtf yacift nfcldxa` fmwa mzzxovcemtalstfxaa tcea~ fcifax xc~k og eoxtmlcts m`d oghac`i eml`oqxc~fad c` gqtqxa. ^o tfa`oqxc~fea`t og eotfax~ ~foqld ml~o halookad c`to. Cg ya zms mtta`tco` to tfa`qtxctco` og yoea` xcift gxoe tfacxmdola~na`na tfc~ wcncoq~ nsnla og

    eml`qtxctco` nm` ha hxoka`. M yall`oqxc~fad eotfax c~ lckals to icwa hcxtf tom famltfs nfcld, tfq~ xadqnc`i tfanfm`na~ og z`aqeo`cm m`d otfax dc~am~a~c` c`gm`t~.

    Fsica`a falz~ `qtxctco` c` zxawa`tc`i z`aqeo`cm. Mnnoxdc`i to DxBsot~`mEaftm, zxmntcnc`i Is`manoloic~t m`d Oh~tatxcncm`, ^mfm`c m`d Ncts Fo~zctml,(^cezla fsica`a zxmntcna~, lcka fm`d ym~fc`i, c` tfa zo~t dalcwaxs zaxcod nm`xadqna tfa xc~k og c`gantco`~.(

    Tyo kas eam~qxa~ xanoeea`dad hs YFO m`d Q@CNAG to cezxowa nfcld~qxwcwml mxa fm`d%fsica`a m`d xa~zcxmtoxs atc}qatta. Txm`~ec~~co` og

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    38/106

    >6 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    noeeq`cts%mn}qcxad Mnqta Xa~zcxmtoxs C`gantco`~ onnqx~ eo~t noeeo`lstfxoqif c`fmlmtco` og xa~zcxmtoxs dxozlat~ zxodqnad hs tmlkc`i, noqifc`i,~zcttc`i m`d ~`aarc`i. Noqif~ m`d ~`aara~ ~foqld ha nowaxad yctf m tc~~qa,nlotf ox em~k. Fm`d%fsica`a zxawa`t~ tfa ~zxamd og noeeo` noeeq`cnmhladc~am~a~ dqxc`i noqifc`i ox ~`aarc`i. Zxozax ~m`ctmtco`, a~zancmlls c`

    dawalozc`i noq`txca~ yfaxa foq~a~ mxa owaxnxoydad m`d `ot yallwa`tclmtad, ml~o falz~ c` kcllc`i tfa dc~am~a iaxe~.

    Fa`na golloyc`i tfa~a ~cezla xaeadca~ og fsica`a ycll naxtmc`ls danxam~atfa xc~k og nfcldfood z`aqeo`cm.

    ^fckfm ^xcwm~tmwm N@^

    Eotfax m`d nfcld yctf z`aqeo`cm &o` tfayooda` had# c` m Ioxmkfzqx ~lqe

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    39/106

    >3 | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    Nlam`lc`a~~ C~ @avt To Iodlc`a~~ C`

    Zxawa`tc`i Nfcldfood Z`aqeo`cm

    Tfa ha~t yms to zxawa`t ~axcoq~ xa~zcxmtoxs c`gantco`~ ~qnf m~ z`aqeo`cmc~ to zxmntcna iood fsica`a. C`gantco` no`txol c~ fcifls daza`da`t o` tfazxc`nczla~ og zax~o`ml fsica`a, m`d hs kaazc`i oqx~alwa~ m`d oqx~qxxoq`dc`i~ nlam`, cll`a~~a~ lcka z`aqeo`cm nm` ha no`tmc`ad ox awa`zxawa`tad. Eo~t nm~a~ og z`aqeo`cm, yfatfax mn}qcxad c` tfa noeeq`cts oxc` tfa fo~zctml, mxa nmq~ad hs hmntaxcm, m`d ~oea hs wcxml ox gq`imlc`gantco`~. Tfa~a zmtfoia`~ txmwal m~ mcxhox`a zmxtcnla~, xamds to nmq~ac`gantco` o`na tfas mxa c`fmlad m`d mhla to mttmnk tfa lq`i~, gcllc`i tfa lq`i~mn~ yctf zq~ m`d glqcd, lcectc`i ovsia` c`tmka m`d emkc`i ct fmxd tohxamtfa. To zxawa`t tfa xanqxxa`na~ og mnqta z`aqeo`cm, emc`ta`m`na ognoeeq`cts fsica`a c~ m~ cezoxtm`t m~ zax~o`ml fsica`a.

    Nfcldxa` mxa eoxa wql`axmhla to tfc~ xa~zcxmtoxs c`gantco`,dqa to tfacx ~tcll dawalozc`i ceeq`a ~s~tae, m`d fa`na`aad ~zancml mtta`tco`. ^o ct c~ cezaxmtcwa to emc`tmc`zxozax fsica`a m`d nlam`lc`a~~ to zxawa`t tfa c`gantco`gxoe ~zxamdc`i. Ioc`i hmnk to tfa hm~cn~ og fm`d ym~fc`im`d emc`tmc`c`i ia`axml nlam`lc`a~~ nm` io m lo`i yms c`no`txollc`i z`aqeo`cm m`d ~awaxml otfax nfcldfoodemlmdca~.

    ^tqdca~ fmwa xawamlad tfmt fm`d ym~fc`i yctf ~omzzxawa`t~ tfa tyo nlc`cnml ~s`dxoea~ tfmt nmq~a tfa lmxia~t`qehax og nfcldfood damtf~ ilohmllsmnqta loyaxxa~zcxmtoxs c`gantco`~ lcka z`aqeo`cm m`d dcmxxfoam. C`gmnt, ~tqdca~ fmwa zxowad tfmt nfcldxa` soq`iax tfm` 1samx~ c` foq~afold~ tfmt xanacwad zlmc` ~omz m`d fm`dym~fc`i zxoeotco` ~foy m 1:! loyax c`ncda`na ogz`aqeo`cm. M ~cezla yms to falz zxawa`t Xa~zcxmtoxs^s`nstcml Wcxq~ &X^W# m~~oncmtad z`aqeo`cm c` nfcldxa` c~to ym~f oqx fm`d~ ogta`, a~zancmlls hagoxa toqnfc`i tfahmhs. Ct yoqld ha yoxtfyfcla to ea`tco` faxa tfmt

    mnnoxdc`i to tfa MXC Mtlm~, X^W c`gantco` c~ tfa eo~tnoeeo` ~oqxna og ~awaxa xa~zcxmtoxs cll`a~~ c` nfcldxa`yoxldycda kcllc`i m` a~tcemtad 77::: to =33,::: nfcldxa`m``qmlls, eo~t og yfo mxa c` tfa dawalozc`i yoxld.

    Mnnoxdc`i to Dx Dc`a~f Nfm`dxm Zm`das, m ^zancmlc~t c`Zmadcmtxcn Eadcnc`a mt @al~o` Fo~zctml og Zmadcmtxcn~ m`d@ao`mtml Eadcnc`a Lqnk`oy , Hm~cn fsica`a xqla~ ~foqldha golloyad. Fm`d ym~fc`i c~ waxs cezoxtm`t. Good ~foqldha nookad yctf nlam` fm`d~, kazt c` nlam` zot~, ~axwad c`nlam` zlmta~ m`d amta` c` m nlam` zlmna. Ct c~ cezoxtm`t tokaaz tfa a`wcxo`ea`t nlam` too. Q`fsica`cn no`dctco`~

    ^tqdca~ fmwaxawamlad tfmt fm`dym~fc`i yctf ~omzzxawa`t~ tfa tyonlc`cnml ~s`dxoea~

    tfmt nmq~a tfalmxia~t `qehax ognfcldfood damtf~ilohmlls mnqta

    loyax xa~zcxmtoxsc`gantco`~ lcka

    z`aqeo`cm m`ddcmxxfoam. C` gmnt,

    ~tqdca~ fmwazxowad tfmt

    nfcldxa` soq`iaxtfm` 1 samx~ c`foq~afold~ tfmtxanacwad zlmc`~omz m`d fm`d

    ym~fc`i zxoeotco`

    ~foy m 1:!loyax c`ncda`na

    og z`aqeo`cm

  • 8/3/2019 Voices From the Field on Childhood Pneumonia

    40/106

    4: | W o c n a ~ g x o e t f a g c a l d o ` n f c l d f o o d z ` a q e o ` c m

    nm` xa~qlt gxoe owax no`ia~tco`, q`zlm``ad qxhm`crmtco`, cezxozaxwa`tclmtco` c` foq~a~ m`d m dagantcwa dxmc`mia ~s~tae.

    Dx Mectm Zm`das, M~~oncmta Zxoga~~ox, Dazmxtea`t ogOh~tatxcn~ m`d Is`manolois, Nffmtxmzmtc ^fmfqbc Emfmxmb

    Eadcnml Q`cwax~cts &ax~tyfcla Kc`i Iaoxia~ Eadcnml Nollaia#,ml~o gaal~ tfmt ct doa~ `ot no~t eqnf to emc`tmc` zxozaxfsica`a. ^cezla xqla~ og fsica`a mxa zxozax nlam`lc`a~~,nlam` mcx, `o owaxnxoydc`i m`d zxotantc`i tfa nfcld gxoeotfax c`gantad zax~o`~.

    Dx Mbms Ec~xm, Em`mic`i Dcxantox, @al~o` Fo~zctml OgZmadcmtxcn~ m`d @ao`mtml Eadcnc`a, lc~t~ tfa ~cezla xqla~ ogfsica`a m~ nlam`lc`a~~ m`d fm`d ym~fc`i, m`d m nlam`, oza`a`wcxo`ea`t. Fa c`~c~t~ tfmt foea~ m`d fo~zctml~, hotf~foqld emc`tmc` fcif ~tm`dmxd~ og nlam`lc`a~~. Tfa doox~,

    yc`doy~, gloox~ ~foqld ha nlam`ad xaiqlmxls m`d zmxa`t~,gmecls eaehax~, nfcldxa`, fo~zctml ~tmgg ~foqld yamx nlam`

    nlotfa~. Mll tfc~ doa~ `ot no~t eqnfct o`ls xa}qcxa~ m zxozax ec`d~at m`dmttctqda. Lcwc`i c` zo~f foq~a~ hafc`d nlo~ad doox~ m`d yc`doy~, yctf `ozxozax wa`tclmtco` m`d gloy og nlam` mcx ml~o zo~a~ m dm`iax.

    Hmhca~ mxa mt zmxtcnqlmx xc~k og dawalozc`i c`gantco`~ dqa to tfacx dalcnmtam`mtoes m`d lawal~ og ceeq`cts. Hottla gaadc`i, yfcnf ~aae~ to ha mgm~fco` c` qxhm` m~ yall m~ xqxml C`dcm, ~axcoq~ls noezxoec~a~ tfa fsica`am`d famltf og tfa hmhs. Mdfaxa`na to tfa xaicea` og avnlq~cwa

    hxam~tgaadc`i dqxc`i tfa gcx~t 7 eo`tf~ c~ loy c` C`dcm too, m`d eotfax~ogta` noehc`a hxam~t eclk yctf hottla gaadc`i, c`nxam~c`i tfa xc~k ogc`gantco`, m`d tfa xc~k tfmt c`gm`t~ c`ia~t ymtax m`d otfax lc}qcd~ tfmt lmnka~~a`tcml qtxca`t~.

    C` Dx Mbms Ec~xm~ ozc`co`, Tfa~a dms~, hottla gaadc`i fm~ hanoea m gm~fco`c` qxhm` m