Profile-Taking healthcare beyond medicine

Credit:www.sechc.org

It took me a few minutes to realise that the life-size sticker on the door of the Boston South End Community Health Center was Dr Robyn Riseberg herself. The photograph of the blonde and blue-eyed doctor showed her cradling an infant in her arms. I later learnt that the baby was her second daughter, and the picture was taken four years ago. Now in her late thirties, Dr Riseberg is more than a poster on a door. She has made it her life’s mission to work as a pediatrician with children and families of underserved populations, but her idea of holistic health care goes way beyond treating an illness alone.

A half hour after we were expected to meet at the clinic, Dr Riseberg limped her way into the hospital and proceeded to the practitioner’s office, her eyes scouring the crowd of mothers and babies in the pediatrics’ waiting room.  She wore high-heeled boots which gracefully set off her petite frame, but did little to disguise her limp. She had clearly still not recovered from running the Boston Marathon two days earlier. As board member for Casa Myrna- a non-profit dealing with issues of domestic violence, Dr Riseberg had run to raise funds for the organization.  “We raised over $23,000!” she filled me in as I followed her into the room where her first patient waited with his mother. It was not until two hours later that she paid attention to me again during a quick break in between patients.

“And how are things at home?” she asked the mother of her first patient, and the parents of all the other patients that followed. Based on the answer, Dr Riseberg would then proceed to tactfully investigate the domestic situation of the family checking for the availability of utilities like heat and electricity, and keeping her eyes and ears open to symptoms of domestic strife. When she felt confident, she would abandon her interrogation and carry on with the medical examination. This curiosity is typical of ‘physician champions’, a term used to represent doctors who pioneer the Medical –Legal partnership in their respective health care centers. Dr Robyn Riseberg is one such champion at the South-End Community Health Center, which caters to Latino and migrant communities in South Boston.

The Medical-Legal Partnership is a distinguished service initiated in the Boston Medical Centre in 1993. It creates a relationship between doctors and lawyers to help identify and mitigate social problems which have consequences on the health of poor families in urban areas. For instance, recurring asthma in a child can often be traced back to a moldy or rodent-infested apartment. The family of the child, either too poor to sue the landlord or too new to the country to know their rights, would not approach lawyers themselves to help with the issue. An insightful ‘physician champion’ often helps identify the problem and then puts the family in touch with lawyers who are part of the partnership. The process is entirely free for the family, as private law firms justify these expenses as part of their pro bono social commitments.

Introduced to it during her residency at Boston Combined Residency Program at Boston Medical Center and Children’s Hospital , Dr Riseberg was immediately attracted to the mission of the Medical-Legal Partnership. “It went along with my idea of medicine,” she said. Hired as Health Center Director, she perceives herself as a “relationship manager” who bridges the gap between doctors and lawyers. Since her introduction to the partnership in 2006, Dr Riseberg has helped expand the program to six other health-care centers in Boston.

The process was not easy and she constantly faced resistance by doctors and health care workers who felt that they did not have the time or skill to delve further into medical problems. Dr Robyn Riseberg believes that most of the illnesses brought to clinics are symptoms of a larger social issue. The real medical issue is sometimes hidden, and proper health care needs to dig deep into the family’s social and living conditions. With poverty, domestic violence and ignorance widespread in poor and migrant populations, legal assistance has been the answer to many a medical problem. In one instance she helped the grandmother, and only care-giver, of a mentally-retarded boy gain legal guardianship of the child before his 18th birthday. Her colleague, Dr Jack Maypole, described Dr Riseberg as a “tireless advocate”. “She will bear steel fangs if you come in the way of her and a patient,” he added.

Dr Riseberg holds training programs for doctors and lawyers to help them identify social issues, and approach them sensitively with patients. In the process she works as a mediator bringing legal perspectives to doctors and medical insight to lawyers. “Lawyers and doctors make strange bedfellows,” said JoHanna Flacks, Pro Bono Director of the Medical-Legal Partnership, “Dr Riseberg keeps us honest.”

Dr Robyn Riseberg was first exposed to less-privileged communities on a backpacking trip to Asia and South America, after completing her undergraduate degree in Sports Psychology. Travelling through India and China, she realized how far removed her own life was from these populations. On her return, she decided to study medicine and joined the Bryn Mawr Pre Med School and from there she graduated to the University of Massachusetts Medical School. Her studies and research through pre-med and med school always focused on challenging social issues. At Bryn Mawr, she singularly carried out a prison survey of incarcerated HIV positive male prisoners. Later, she conducted her final project on domestic violence at University of Massachusetts Medical School. Today, through her involvement with Casa Myrna, Dr Riseberg still campaigns against domestic violence in addition to her work as a medical practitioner.

With two young children and multiple passions, I was amazed at how Dr Robyn Riseberg manages to keep up. She admitted that she would have never been able to cope without the support and help of her husband and parents. At our second meeting over a quick cup of coffee, she repeatedly checked her watch to ensure she was not overstepping her next appointment. About ten minutes into our conversation, her phone vibrated impatiently inside her bag and I wondered which one of the many facets of her life was demanding her attention. As Dr Riseberg reached into her purse to find it, she laughed and said, “My life would have been a lot easier if I worked at GAP.”

Sources:

  • Robin Rich, Vice President, Casa Myrna
  • JoHanna Flacks, Pro Bono Director, Medical Legal Partnership, Boston
  • Jack Maypole, Pediatrician, South End Community Health Center

Profile- She’s not just a doctor

Dressed in scrubs, slightly tight around her second-trimester-pregnant belly, Julie Herlihy, walked briskly down the corridor of the pediatrics unit of the Boston Medical Centre to room number 10. Her first patients for the day, a Somalian family waited for her in the room with two of their ten children. The wife was dressed in a burkha while cradling the infant and the husband stared blankly at the wall in front of him. Their elder boy, not older than four, sat in a chair swinging his legs violently. The family broke out in a nervous smile when Julie entered unable to say anything because they can’t speak English. Julie returned their smile with a bigger one, a motherly tap on the little boy’s back and lots of welcoming words, which the family didn’t understand but responded to with an obvious sense of comfort and trust. Few minutes later, with help from a telephone translator, the children were thoroughly examined, their medical needs met, the family’s insurance sorted out, a breast pump was ordered and the family left with a look of satisfaction on their face.

This was one of many cases Julie tended to on that day. All her cases were met with the same smile and warmth on a bespectacled face adorned with a pair of simple silver hoops. She eased her way through every case without being limited by cultural, racial and language challenges presented by her patients. They all left smiling as though she had magically banished their illnesses away.

In her third year of residency, Julie Herlihy now 33 years old, has already spent several years in Africa teaching and volunteering with communities in Zimbabwe and Zambia. An east coast girl, Julie first left for Africa at the young age of 20 on a teacher exchange programme teaching Biology to high school students, only to discover a pleasant surprise. “The teachers there were way better than me”, she said with a laugh. Her journey then took her to the local public health clinic where she found herself learning and teaching women and children about primary care. All the while she lived with the village chief and his family, who wanted her to be under their wing due to their suspicions about foreigners. At the end of her six months, the chief, father to 14 and grandfather to over a 100, held a formal ceremony adopting Julie as his Manini, his last born.

Julie returned from Africa and spent the next decade designing curriculum for public health workers in refugee communities, joining Medical School at University of Massachusetts, obtaining a Masters from the Harvard School of Public Health and travelling back and forth to Zambia. Her love for the country and its people continued to grow as she involved herself in care for people with HIV. She worked with local communities and women to help empower their abilities to provide primary care in areas such as infant and child care, women’s health and nutrition. At a young age Julie had developed cross-cultural skills which taught her how to work and appreciate foreign customs while working with the community. This white American girl also learnt how to cook on a fire, live without water and electricity and bathe out of a well.

When asked how she first developed her passion for Africa, Julie confesses that there isn’t any one particular reason. Fascinated by the thought of going to the continent, she called up the Peace Corps at the age of nine begging them to enroll her. Today she is clearly satisfied with herself for living out her childhood dream.

The value she adds to the pediatric clinic is clearly notable. “If I could spend a day observing her, I would learn quite a bit myself,” said Dr Jose-Alberto Betances, Clinic Director of the Pediatric Primary Care Unit at BMC. Dr Megan Sandel, one of the preceptors at the clinic adds that Julie’s patients are very loyal to her. “We get a lot of patients from refugee and immigrant communities with different medical issues, especially trauma being a big issue. Julie  asks questions sensitively. She has both, skill sets of a scientific mind and a social perspective.” Dr Sandel further comments that “She (Julie) is laser-focussed on what she wants. That makes her very unusual.”

This is not the end of the road for Julie. Sitting in her office, one can tell that her mind is exploring the next place she wants to visit. “Ethiopia” she says, “they have different history from the rest of Africa.” One can tell that her mind is already travelling across the Atlantic.