Beside each other!

The two Rambutan tress standing beside each other in our garden produce fruits which are different in colour and taste. 

When Anna and I planted the saplings five years ago, we had no idea of the difference between them. Their appearance was similar. They both grew together next to each other in similar soil and light conditions only to produce different fruits which have a distinct identity. In the market they are sold for the same price.

Their genetic programming was for bearing fruits different from each other.  The difference can only be understood by those who look at these two trees at the molecular level. The gross appearance of the trees is identical. 

This phenomena in nature struck me even more yesterday when one family was intrigued by the measurements I did of a child who had larger ears, palms, feet and inner canthal distance between eyes. Their question was as to why I was particular about these measurements. I  am normally hesitant to talk about the morphological differences in a child to the parents, till I feel fairly sure of  a recognisable morphological pattern in a child. 

Listening to the mother, I realised that she had health related difficulties for two years before marriage, which she did not give much importance to. When she became pregnant she was tested for her thyroid status along with all the other screening tests routinely done. She was found to be hypothyroid by the biochemical tests. By then she had already gone into the third moth of pregnancy. She conceived when she was significantly hypothyroid. This came up for discussion. I could not take the conversation further as to whether this deficiency had an effect on the morphological state of her child. It was his reduced head size which bothered me a lot. Children who are born with congenital hypothyroidism have normal or increased head size. I could not remember having read about the risk of reduced head size, if a child was conceived at a time when a mother was not on treatment for hypothyroidism. 

That dilemma hangs in the air. As the child has a behaviour phenotype of social aloofness, poor communication skills, altered learning skills and restlessness, this child was receiving therapy for two years from two different specialised centres. Having been in India to receive this developmental support for two years, the mother and child are to return to their country of residence shortly. 

What caused this child's different behaviour phenotype! This question is difficult to be answered. 

While I was in conversation with this mother, I heard the child singing outside. That was tuneful and captivating. I enquired from the mother whether he had any formal training to sing. He did not. That seemed to be his natural ability. That led me to enquire about his other natural abilities. He has an unusual visual perception of details of what he sees and attempt to draw them neatly. At five years, both these signalled higher level of proficiency. I turned the attention of the mother to these abilities and the prospect of developing them in to skills that her child can pursue.  

It was at this juncture this mother who is an academician raised this question: why are children born different!

That is when I remembered the two Rambutan trees in our garden, bearing differently coloured fruits. I an not sure if one can say one is better than the other. They are distinct and different. 

I have lived with this disturbing thought in my mind for the last forty years ever since I have been in full time practice of Developmental medicine. Why this classification of 'normally developing children' and 'developmentally challenged children'! The normality is presumed to be the right way and the only desirable way. It distresses me. The developmentally challenged children are also children. The common denominator is that all are children. Their abilities or inabilities differ. 

In the recent years, I have been struggling to avoid the terminology to describe children based on their abilities or inabilities. Instead see all children having different abilities. Every child, no matter what is his or her developmental trajectory or skills belongs to the human family of children. They live expressing themselves. The normality we define in the so called normally developing children is a skewed perception of normality as it is based only on skills. The integrated view of children is to be able to receive them as humans in formation. They would bear different fruits. 

In the last two years since COVID pandemic, this the truth came home even more. All children grew up without their usual social and school experiences. The stories I hear from families is that there was a better cohesion between children at home who had dissimilar abilities. A child with weakness of one side helped the family with lot of cooking. The other child took care of the kitchen garden. Both discovered their abilities and expressed them. It was then parents could move beyond perceiving their daughter with a limitation of movement and their son too bookish. 

The difference lies in our optic and orientation. 

Children are humans in evolution and formation. All of them are people of promising destiny.  

We would soon have a women president for the republic of India from a tribal background. Tribals lived with their tradition and practices and are on their way to get integrated to civil society through the benefits of education, health care,  and economic opportunities opened to them. They were thought to be less able; but they have been made able by a society who cared!

Helping who are differently able to get integrated to life and living is a calling!

M.C.Mathew (text and photo)