It is no secret to anyone who is breathing that our economy has taken a few terrifying turns these past four months or so and has slowly but surely begun to affect everyone. When parents get laid off, they lose their health insurance, not to mention any leeway they had in their budget to seek medical care for themselves and their children. In the case of Kartini Clinic parents, in the past, one parent could afford to seek family medical leave of absence to engage in family based treatment here while the other kept earning an income…as long as the other was earning an income.
Medication, especially the kind we prescribe in the world of eating disorders and psychiatry, is very expensive. Very. Without health insurance we have begun to see families not be able to fill their prescriptions, or to have to delay doing so.
I am certain there are new families out there who would prefer to seek specialist treatment for their child with anorexia nervosa, but who simply cannot afford it when one or both parents have been laid off, and are scared and guilty that they can no longer “afford the best treatment” for their child.
What can we do? Not much it turns out. But I have found some consolation in an Israeli article published in 1994 in Acta Paedopsychiatrica 56: 291-293, written by Yardena Danziger, Anca Ram and Marc Mimouni entitled: Outcome of Israeli adolescents with anorexia nervosa whose ambulatory treatment was abruptly interrupted during the Gulf War.
Apparently this Israeli pediatric team uses a form of family based treatment similar to that used at the Kartini Clinic, formulated on the belief that re-feeding is essential to recovery and that parents are essential to re-feeding. When the Gulf War broke out on January 16th 1991, Beilinson Medical Center where the Children’s Hospital was located became a military hospital overnight and the treatment of children with anorexia nervosa was abruptly discontinued. At the time there were two children in the hospital being acutely re-fed (although it appears that their “inpatient” would encompass both our “inpatient” as well as our “day treatment” as it involved at least 2 months of care). Eleven children were still in the phase of close outpatient follow-up (several times a week). These children, regardless of their medical state, were sent home with their parents.
What happened once hostilities ceased and why?
The war lasted for 6 weeks; examination by the treatment team of the children immediately after the war found that all had been able to maintain their weight. Of course, this says nothing about their psychological recovery, something we all know takes longer and is more difficult than “mere” weight restoration, but still it was encouraging. Imagine how frightened parents were to have their child’s medical care abruptly halted. What accounted for this welcome stability?
The authors analyze their results at the end of the article. They point out that “due to the civil defense order to close schools and their request that people stay home close to a sealed room, families gathered together and shared mutual tensions and feelings.” Not to mention meals, I might add! They went on: “This setting mimics the ?therapeutic milieu’ of the day care unit, where our main goal is to create closer bonds between parents and children and mutual feelings of responsibility. Therefore parents were able to continue our treatment programme at home during the war.”
Despite our bad economy we have not all been told to stay home, nor are the schools closed. But some parents have been laid off, perhaps with more to come. This gives parents and unlooked-for opportunity to solidify parental supervision of re-feeding in a child with anorexia nervosa. Rather than feel despair that they cannot afford the same level of medical care as before, they might take heart from the Israeli experience and know that they can “put a thumb in the dyke” of further weight loss while they wait for the situation to improve and their access to medical care to be restored.
Additionally, it is becoming an economic necessity these days to eat at home. When an adult does not have to go to work (or can’t), cooking meals at home becomes much easier. It is cheaper and more healthful and for parents whose child has an eating disorder, much less stressful to supervise. At least there may be a silver lining to these dark economic clouds.
