Say Yes, Spring 2003: Family Man -- Dr Mehmet Rifat Köse

As the General Director of the Mother and Child Health and Family Planning Directorate for the past six years, Dr Mehmet Rifat Köse has worked in partnership with UNICEF Turkey on many of our programmes and projects. This month, we visited Dr Köse at his office in the Ministry of Health (MOH). A family man and a keen gardener, he shared his views on many issues concerning the health and development of women and children in Turkey, his own children and their love of animals and the finer points of cultivating roses -- with occasional interjections from a boisterous canary which fluttered freely around the room.

Dr Köse never planned to work in management. When he began working professionally at his first practise in the Zonguldak-Çaycuma-Hisarönü Health Centre, he did a great deal of work on environmental health and drinking water. The experience he gained at the time was to influence his subsequent career dealing with public health issues.

His vocation didn’t proceed as straightforwardly as he would have wished. With a touch of regret he explains: Shortly after qualifying, I was promoted to Assistant Health Director at my first hospital in İstanbul. So within a month, I was in management and that’s where I’ve been ever since.

Being doctors, he says, (Dr Köse specialises in Public Health while his wife, Afet, is a dermatologist) my wife and I are very aware of our responsibility as parents to ensure the health and development of our children. We have a boy and a girl and my wife breastfed them for the first six months after birth. Compared to other children of their age, they are taller and generally well-developed. They’re doing very well at school and I’m sure that much of this is a benefit of breastfeeding.

He is naturally voluble on the subject of breastfeeding:

Over a million infant deaths are prevented world wide by breastfeeding. Formula-fed children are more susceptible to infections which may be fatal or may lead to more serious illness in later adolescence.

Turkish women consider breastfeeding to be one of the virtues of motherhood. Something like 95% start off well by breastfeeding their babies, although the percentage drops critically after the second month and it’s as low as 1-2% by the sixth.

With the best of intentions, they tend not to be properly informed of the facts and are too heavily reliant on the advice of their elders within the family who aren’t well informed.

Dr Köse says that the issue of exclusive breastfeeding cannot be addressed by educating the mothers alone:

It’s a complex of many factors. Apart from ensuring that the mother is psychologically prepared to breastfeed, she should also know when to begin feeding her baby supplementary foods. Support from health advisors is necessary to counteract outside pressures, from the family for instance, which might affect the mother’s resolution. For example, it’s an old wives’ tale that a crying baby should be soothed with sugared water which is absolutely wrong. The baby’s appetite is affected and it won’t be able to take the breast when it should. In this respect, the quality of education for health personnel is vital so that they can advise the mother and her family effectively, ensuring that their advice is not only heeded but followed.

The recent introduction of a statutory two-hour feeding break for working mothers was a very positive step.

The mother’s diet affects the nutritional content of her milk so it’s important to make sure that her diet is appropriately balanced. Also, a recurrent problem is that a woman’s iron supply is depleted by the birth process and anæmia is very common amongst Turkish mothers. So new mother’s need to have their iron supply carefully monitored.

Our conversation leans to more general issues of Mother and Child Health and Dr Köse expands on the subject of education:

The legal status of Turkish women has improved to the point where they have all the rights and advantages of their Western counterparts. But the use of those rights is limited very much for want of education, so we need to look at raising the standard of girls’ education. We strongly support the issue because it has a direct and positive effect on mother and child health in general.

Mother and child health issues present a cycle of cause and effect in that health problems during infancy are the source of many problems in later life, he says, when we ask about prioritising health issues, Taking the long view of society as a whole, we tend to prioritise those diseases and conditions which are fatal, debilitating or harmful to the productivity of the work force.

Rates of spina bifida, hypothyroidism, folic acid deficiency and even Down Syndrome aren’t as high as those for other illnesses in Turkey. On the other hand, you can’t categorise diseases in order of importance although priorities in dealing with certain diseases may change: an iron-deficiency or hypothyroid problem which would not be immediately apparent in early childhood can cause learning difficulties in later life, for example. The quality of the parents’ life as well as that of the child is affected. So we need to set our priorities according to the availability of resources and develop programmes to deal with these conditions.

Nationwide health issues don’t arise overnight, they result from an accumulation of factors and can only be addressed successfully by long-term programmes where all the sectors work together.

The number of health institutions has grown and they tend to be better provided with funding, personnel and facilities but that only goes so far towards a solution -- we need stronger psychological and social approaches to dealing with health problems.

We have to motivate the public to join in with marches and events which would be so much more effective in raising public awareness of health issues. Communal events of this kind can be cathartic for health workers, allowing them to approach the issues on the emotional level. It’s an important point because I’m sure that, at heart, many health workers feel the pain of all those infant and maternal mortalities.

Highlighting some of the difficulties he has met with personally, he talks about a recent training session in İstanbul:

We organised a seminar on breastfeeding and I was a little put out on the first day to see that doctors weren’t happy about having to be there.

A short time after, I received a letter from a doctor at the Gaziosmanpaşa hospital there. He confirmed my first impression about his colleagues unwillingness to attend, saying that in the beginning he thought a week was far too much time to steal from a medic’s already overcrowded schedule for such a simple topic. However, he admitted that at the end of the week he felt the seminar was justified since he and his colleagues plainly did not know enough about breastfeeding techniques.

I still have the letter, he adds with a smile.

Read A Mother’s Story in this Spring 2003 issue of Say Yes. There is more about the Baby-friendly Hospitals Initiative (BFHI) in the February 2002 issue of Say Yes.

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