David Southall
David Southall is a retired British paediatrician who specialised in international maternal and child hospital healthcare and in child protection. He worked in Bosnia and Herzegovina in 1993-1995, for which he received an OBE in 1999. In 1995 he set up the charity Maternal and Childhealth Advocacy International, of which he remains a trustee as of 2023. His child protection work and research into Munchausen syndrome by proxy attracted controversy and led to conflict with the General Medical Council.
Early career
Prior to becoming a paediatrician, Southall spent four years in general adult medicine, one year in obstetrics and two years as a general practitioner.International humanitarian work
In 1993, during the Bosnian War, Southall was invited by the Overseas Development Administration of the British Government to visit Sarajevo to identify and evacuate children in need of urgent medical treatment which could not be provided locally because of armed conflict.After this mission he was asked by UNICEF to become a consultant and lead a programme from 1993-1995 to help children in Mostar and in camps for internally displaced families in other areas of Bosnia. Prompted by his experiences in Bosnia of what he described as "trauma inflicted on children and their families, not only by warring factions, but also by the indolence of the international community", Southall established Child Advocacy International on his return to the UK, to advocate for international child health issues. Since 2009, and in order to reflect the close involvement of CAI with the emergency care of pregnant women and adolescent girls, the charity was re-named Maternal and Childhealth Advocacy International.
Some of the main advocacy undertaken involved campaigns against the arms trade, healthcare in refugee camps and the development of the Maternal and Child Friendly Healthcare Initiatives. One particular success with advocacy involved the New Jalozai Afghan refugee camp where the Pakistan Government were encouraged by CAI to move the 70,000 refugees living in appalling circumstances into a more suitable camp. The United Nations High Commission for Refugees wrote a letter to Southall thanking CAI for this achievement.
From 1999 to 2004 Southall was Chairman of a working party developing the Child Friendly Healthcare Initiative. In addition to CAI, UNICEF UK, The Royal College of Paediatrics and Child Health and the Royal College of Nursing were parties to this work.
Since 2002, and following on to CAI's work in Afghanistan and Pakistan, and in collaboration with a British Medical Education charity a program called “Strengthening Emergency Healthcare” involving Emergency Maternal, Neonatal and Child Healthcare was established. The program was originally started in the Afghan refugee camps in Pakistan and has subsequently been developed in Pakistan with assistance from the local offices of the World Health Organization and UNICEF. In 2006, it was successfully introduced into The Gambia following a recommendation from WHO Geneva. In November 2012 a similar programme was started in Liberia with financial support from THET and UKAID.
Additional programs of CAI and subsequently of MCAI involved apprenticeship based training in hospital care of pregnant women, newborn infants and children in Kosovo, Sri Lanka, Afghanistan, Uganda, The Gambia and Liberia.
Respiratory research and child protection work
Between 1979 and 1983 a large prospective investigation funded by the British Heart Foundation and the Medical Research Council was led by Southall into the potential role of short episodes of absent breathing and heart rate and rhythm disorders in newborn infants. The study showed no evidence that these episodes in infants were related to subsequent SIDS leading to a major reversal of the role of apnoea monitors in SIDS prevention.For his research work into SIDS, Southall was given The Mary Gray and William W Cobey Award from the Sudden Infant Death Syndrome Institute in 1994, University of Maryland and in January 1995 the Annenberg Center Apnea of Infancy Award.
In 1993, Southall reported in the British Medical Journal a study investigating the performance of invasive procedures in the intensive care of infants and children. This study revealed inadequate pain control and sedation for a high proportion of painful procedures and led to a national review of this problem. As a consequence he was appointed chair of a working party of the British Paediatric Association to develop guidelines on the management of pain control in children in hospital in the UK.
Between 1986 and 1994, Southall led a programme of diagnostic and treatment-based clinical work at the Royal Brompton Hospital in London, and the North Staffordshire Royal Infirmary in Stoke-on-Trent involving patients with unexplained life-threatening events from a wide area of the UK. This work, involving the police and social services departments, helped protect children from life-threatening episodes of Fabricated or Induced Illness mostly involving suspected intentional suffocation of infants and young children by one of their parents, usually the mother. Techniques included the controversial covert video surveillance in hospital of infant and child patients by police or specially trained nursing staff to observe the interactions of their parents with the children.
Surveillance revealed abuse in 33 of 39 suspected cases, with documentation of intentional suffocation observed in 30 patients. Poisonings, a deliberate fracture, and other emotional and physical abuse were also identified under surveillance. Bleeding from the nose and/or mouth was reported in 11 of the 38 patients who had had episodes of near death and were undergoing CVS but in none of 46 controls. Four patients who had been subjected to recurrent suffocation before CVS suffered permanent neurologic deficits and/or required anticonvulsant therapy for epileptic seizures resulting from hypoxic cerebral injury.
The 39 patients undergoing CVS had 41 siblings, 12 of whom had previously died suddenly and unexpectedly. Eleven of the deaths had been classified as sudden infant death syndrome but after CVS, four parents admitted to suffocating eight of these siblings. Other signs of serious abuse were documented in the medical, social, and police records of an additional 15 of the siblings.
The project concluded in its report in the medical journal Pediatrics that “Induced illness is a severe form of abuse that may cause death or permanent neurologic impairment. It may be accompanied by other severe forms of abuse, may result in behavioural disorders, and may be accompanied by immeasurable suffering. Detection of this abuse requires careful history-taking; thorough examination of the health, social, and police records; and close and focused collaboration between hospital and community child health professionals, child psychiatrists, social workers, and police officers. Covert video surveillance may help investigate suspicions and ensure that children are protected from additional abuse. When parents have failed to acknowledge that they have deceived health professionals, partnership with them in seeking to protect their children may be neither safe nor effective”.
The project attracted controversy for its methods and raised ethical implications. Critics argued that the desire of the implementers of CVS to observe the carers harming the children exposed the children to further abuse, that the betrayal of doctor-patient trust necessarily involved in the surveillance could cause harm to the subjects, and that "a diagnosis should lead to treatment, not punishment". However, Southall and his team argued that the surveillance saved the lives of many of the children involved, and Southall himself said that "By doing covert video surveillance we are betraying the trust of parents... but if a parent has been abusing his or her child in this way then the trust between child and parent has already gone."
The concerns of a campaigning group of parents accused of abuse, a small proportion of parents involved in the ventilator study described below and their advocates, including a woman who was imprisoned subsequently for conspiracy to abduct a child, led to an investigation of Southall's child protection work, in particular covert video surveillance, by his employer the North Staffordshire Hospital. The campaigning group called themselves MAMA. The investigation by his employing hospital cleared Southall.
In the early 1990s, Southall led a randomised controlled study which pioneered continuous negative extrathoracic pressure therapy, a non-invasive treatment for breathing difficulties in infants and young children involving the application of negative pressure to the patients' chests. The technique was found to reduce the duration of chronic lung disease in premature newborn infants and to reduce the need for intensive care in infants with bronchiolitis, a common and dangerous chest infection. This study was criticised by the MAMA campaigning group described above, with some parents of the children involved suggesting that the treatment was linked to subsequent death or brain injury of their children. Based on these allegations, the research was also the subject of investigations by the North Staffordshire Hospital which again found no wrongdoing or harmful effects of the treatment. An independent follow-up study concluded in 2006 that there was "no evidence of disadvantage, in terms of long-term disability or psychological outcomes" from the use of the technique. The infants treated were all very premature babies in whom mortality and morbidity was expected, but there were no differences between study infants and control infants in this regard in the independent follow up study conducted. The long "saga" to discredit the researchers, perpetuated by constant media exposure, caused “widespread unpredictable damage”.
In November 2005, Southall retired from Keele University and his honorary status as professor there came to an end; they did not award him an emeritus professorship.