Family | Chief physician Marke Hietanen-Peltola remembers a child with a career who was found to have cancer during a routine examination – School health care should not be compromised, he says

If we condition school health care, we pile up the problems of children and young people and pay a big bill for that later.

This is what the chief physician of the Department of Health and Welfare (THL) says Marke Hietanen-Peltola.

As an expert at THL, Hietanen-Peltola is responsible for the national guidance and development of school health care and student care services.

In addition to his expert work, he has worked as a school doctor in Tammela and Forssa for twenty years.

Really it is a coincidence that Hietanen-Peltola became a school doctor. He defended his doctorate in neuroanatomy at the University of Tampere, where he studied the function of neurotransmitters in the rat nervous system.

“I have such a funny career in my medical career that I have progressed from the cellular level first to organs and people and finally to community issues and larger entities,” says Hietanen-Peltola.

He describes his training as a family doctor at the University of Tampere’s Continuing Education Center as revolutionary for his work as a school doctor.

“It fascinated the whole basic idea that things can be addressed before they become ill and that the whole, like the family, is taken into account.”

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There were municipalities where some of the children did not have any medical examinations during the entire primary school.

MORE there may be memories where the school doctor’s office mainly measured height and weighed weight and nothing else. This may have been the case in some municipalities just over ten years ago.

“During the recession, school health care was cut down. As a result, the municipalities had very varied practices left, ”says Hietanen-Peltola.

In some municipalities, such as Tammela, health examinations were carried out in much the same way as today, but there were also municipalities where some children did not have any medical examinations during the entire primary school.

“The situation had to be made more cohesive, as it put children in a terribly unequal position,” says Hietanen-Peltola.

Year 2009 the regulation made the medical examination by a doctor statutory and is currently carried out in the first, fifth and eighth years.

Despite this, there are still big differences between municipalities in how inspections are carried out. It shows, for example, how much time is available at the doctor’s office.

Made by THL in 2019 according to the report the time the pupil and family received from the school nurse and doctor at the health check-up ranged from 20 minutes to more than two hours.

“It means a big difference in how the doctor manages to address the child’s situation.”

In school health care operating doctors some have recently pointed out that statutory age checks in school health care take time out of those in need.

According to Hietanen-Peltola, however, the solution is not to reduce inspections, as they help to identify problems.

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“Investing in school health care could prevent the problems from getting worse.”

The situation has worsened, especially during the Korona period, when in some municipalities nurses and doctors were transferred from school health care to corona care.

However, Hietanen-Peltola believes that inspections should not be postponed due to the corona epidemic.

In the long run, it could have far-reaching consequences and could become more costly as the problems of children and young people accumulate, he warned recently. To the opinion department of Helsingin Sanomat in its opinion paper.

“Investing in school health care could prevent the problem from getting worse and the need for more expensive services,” he wrote.

Although the shortage of school doctors has been talked about constantly, and the situation has improved considerably over the last ten years.

In 2009, the school doctor was responsible for an average of more than 7,000 students, compared to just over 3,000. The goal is to have 2,100 students per medical year.

Hietanen-Peltola would like school doctors to be able to focus on full-time work.

He is frustrated by the talk of “unnecessary health checks on healthy children”. According to him, some of the doctors are also to blame.

In that case, the speaker said he did not understand the whole idea of ​​school health care. The work of a school doctor differs from that of a hospital because it is preventive work.

“The primary purpose of a health check is to support a student’s growth and well-being, not to spot illnesses,” he recalls.

Preventive the benefits of the work will only be seen in the future. It is therefore difficult to assess or measure the significance of an individual health examination.

However, it is known that up to 70-80% of extensive health checks lead to some measure.

“The child is referred on, a prescription is written or some other action is taken,” Hietanen-Peltola describes.

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She remembers a child who was diagnosed with cancer during follow-up examinations of the health check.

For the sake of example, he kept a diary of one of his reception days for this interview. During that time, he met a total of nine students: fifth-graders with their parents and eighth-graders between the two.

In addition to the inspections, the day accommodated two follow-up meetings. During the day, she contacted the adolescent psychiatry outpatient clinic, the curator, arranged follow-ups for the nurse, and made one referral to the pediatrician.

And we also see diseases in health checks. He remembers, for example, a child who was found to have cancer during further investigation of the findings of the health check.

UranSa During Hietanen-Peltola, Hietanen-Peltola has had a foothold in how the lives of both children and families have changed – for better or for worse.

Let’s start with the good. The good thing is, at least, that parents are more interested in their lives than before.

According to him, modern parents are also capable of resolving situations. Sometimes a “little wake-up call” is enough to get things right.

Hietanen-Peltola remembers, for example, a child of primary school age whose attention had been paid to depression at school. The findings from the school for the parent were a surprise.

“The matter was discussed during the health check, and together we considered the means and agreed to return to the matter again,” says Hietanen-Peltola.

At the next reception, the child’s situation had changed for the better.

“The parent had made changes to the family’s daily life, which allowed him to have more time with the child. That was enough to trigger the situation.”

Always not all situations are solved as easily. It has sometimes happened that the bruises of a child who has come to the reception are revealed as signs of domestic violence and a child protection declaration has had to be made.

The advantage of a small municipality is that children and families become familiar over the years and schools have a good culture of care.

She especially praises the working couple as a nurse Kaija Rämö. Hietanen-Peltolaak has worked in Tammela for a long time and knows some of the parents of the families from their own childhood.

“Trust is built early,” says Hietanen-Peltola.

For decades lifestyles of children and young people have improved.

Until twenty years ago, eighth-graders could smoke an entire class of students.

“Now few people of the same age smoke. The same applies to alcohol consumption, ”says Hietanen-Peltola.

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“It’s no longer a taboo for young people to talk about their anxiety or mental diagnoses.”

Instead, it has been replaced by an increased overweight of children. When surveying the family’s situation, Hietanen-Peltola has noticed that fewer and fewer families are eating together on weekdays or breakfast may be skipped.

“There’s then a conversation with the family about the importance of regular eating,” he says.

Renew Another problem is the increase in various mental symptoms. According to the latest school health survey, nearly a third of girls in 8th and 9th grade reported experienced moderate or severe anxiety during the previous two weeks.

On the other hand, they may also be better detected.

“It is no longer a taboo for young people to talk about their anxiety or mental diagnoses. We have also learned to ask about these things better than before, ”says Hietanen-Peltola.

Nevertheless, it is also clear that the Korona period in particular has clearly increased the mental strain of children and young people.

Hietanen-Peltosta is particularly concerned about child and adolescent psychiatry queues, which have recently been written about in the news. It also affects parents ’coping.

If Hietanen-Peltola should summarize her advice to parents on the three most important aspects of children’s well-being, what would they be?

The question is difficult because well-being is affected by so many factors. After thinking for a while, he ends up listing the following three things:

1. Does the child have a close person, be it a guy or an adult to share their concerns with?

2. How is the school doing in terms of both learning and friendships? Are absenteeism starting at school?

3. Does the child get enough sleep? Is he fresh enough when he wakes up?

“If these things are found, it will go a long way,” says Hietanen-Peltola.

HS Our Family is a magazine focused on families and parenting, edited by Helsingin Sanomat. The story has appeared in issue 2/2022.