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- BUILDS

“…While I nodded nearly napping

Suddenly there came a tapping

As if someone gently rapping

Rapping at my chamber door.

“Tis some visitor,” I muttered

Rapping at my chamber door.”

 

Though slightly faded, this verse, scribbled on a grey wall, peeks out from behind an over-laden coat hanger in a room in the Boston University Math and Computer Science Building. I scan quickly across the crowded room to notice a bookshelf, wall murals, a few white boards, computers –in part and in whole, and jumbles of wires, switches and cables. Scattered haphazardly, are about a dozen college students. A few of them turn towards me and smile.

BUILDS, an acronym for Boston University Information Lab and Design Space, is a hacker space for students from the university to work on individual and group engineering, software and electrical projects. Housed in what was once a leaky furniture storeroom, the lab was inaugurated in February 2010 for the sole purpose of providing students an avenue to work on creative projects outside of the classroom.  It is open around the clock to BUILDS members who enter it using a magnetic swipe card, an action that triggers off a personalized greeting on a computer screen hanging on the door. This unique access route is a student project too. The enigmatic door-monitor is one of many salvaged electronics in the room.  “We have a tendency to scavenge around,” said Danny, a Computer Science undergraduate freshman marked by a thick mop of magenta-dyed hair.

Managed by a group of university students, BUILDS provides a tangible work arena for interested students of any discipline. Members range from math and computer science majors, to artists and even a few high schoolers from the Boston University Academy. The process to become a member is a simple registration on the BUILDS website which immediately adds newcomers to a mailing list. Kyle Broglek,  an undergraduate Computer Science major and President of BUILDS said that most students from other courses do not have access to engineering laboratories, and even those who do, cannot work in them after hours. Personal spaces, like bedrooms and basements, do not always provide needed tools and a safe environment for invention. BUILDS addresses both those concerns and offers mentoring and assistance through interdisciplinary communal learning.

BUILDS was founded by David House, an engineering major who graduated in 2010. A ‘Scarlet Key’ and ‘Phi Beta Kappa Centenial’ awardee, House worked hard to improve student life on campus. “He’s not here now but BUILDS still keeps going. He showed undergraduate students that one person can change the world as he changed the environment at BU,” says Leonid Reyzin, Academic Advisor for BUILDS. Professor Reyzin describes BUILDS as an important self-directed, non-graded component of school where students are motivated to develop their skills because they choose to do so, and not because they need to earn a grade.

Along a longer wall inside BUILDS, lies yet another rack. It’s stocked with electric saws, drills and a host of other power tools. A rugged three-step wooden stairway, with electric wires crisscrossing its veneer, sits close to these tools. The stairway is part of a larger project to build musical stairs at the George Sherman Student Union, similar to the instrumental staircase at the Boston Science Museum. Valerie Young, a purple-haired Physics Undergrad says that the stairs will be programmed to produce different musical notes, which will be triggered off by footfall on each step. ‘Rusty’, a junior majoring in Mechanical Engineering , is BUILDS’own in-house carpenter. When questioned about the need to be part of BUILDS he explains that the college curriculum is not designed for hands-on modelling but leans more toward mathematics. According to him, students are not given the opportunity to do any design work until their senior-level projects. “I’d rather learn than just get a degree. BUILDS is a good place to say screw you. I’ll do what I want!” he says. Professor Reyzin helps put Rusty’s opinion in context, “Here students learn things outside of their immediate interests which universities are not equipped to do because of fixed course and semester structures.”

In a far corner of the workshop a huge pile of circuit boards hides yet another BUILDS member, whose colleagues describe as a “hardware genius”. Wishing to stay anonymous, he talks about his passion while tinkering away with wires and mother boards to. “It’s my recycling hobby. None of this is garbage,” he says, pointing to what appears to be a mountain of e-waste. Admitting to having built several dozen computers in the past, he expresses gratitude to BUILDS for providing him the tools and resources to do so.

Techno music directed through camouflaged speakers engulfs the room. In tracing its source I chance upon yet another ingenious project. A group of BUILDS members worked out a programme that sends mp3 files to a computer in much the same way as print commands are sent to a printer. This allows remote, wireless control over the music, and also gave every young member a chance to listen to his or her preferred song.

Out of the many murals painted on the walls of the room, my eyes linger on one that looks like the circuit room of a mid twentieth century telephone exchange. It cleverly incorporates the actual electrical outlets on the wall within it, which gives the art work a provocative three-dimensional feel. Spanning an entire wall, the mural borders on the fantastical with its painting of a large space balloon framed within a window. The air here was electric, literally and otherwise.

As I leave the room, I glance once again at the Edgar Allen Poe-verse scribbled on the wall, and was glad to have visited BUILDs.

 

 

 

 

Sources:

Kyle Broglek- President

Valerie Young- Treasurer

Other BUILDS members: Rusty, Zalika Corbett, Shidash Mcgrath, Darian Springer, Liam Wang, Kit, Danny, Math graduate major who did not want to be named, Mikhail Andreev

Leonid Reyzin- Academic Advisor BUILDS and Associate Professor, Computer Science, BU

 

 


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.


Who needs a cat anymore?

 

Exotic Animal Care at Angell Memorial Hospital

“Ryu hasn’t been eating for three weeks,” sobbed a twenty-something year-old young lady as Dr Jennifer Graham examined the animal. First she shone a flashlight in his eyes, then examined the legs, then the tail and finally his anus. “His tail is so thin, it’s normally as broad as his head,” added the pet’s owner. Dr Graham nodded in quiet agreement and then asked her technician Deborah to switch off the lights in the room. She then picked up the creature in the palm of her hand, lay him on his back and shone the powerful LED flashlight under him. His translucent skin was no match for the powerful light and one could see silhouettes of a heart, liver and intestines. “No. he hasn’t swallowed anything which is obstructing his digestive system, “was the diagnosis of that ‘ultrasonic’ examination.  The lights came on and the tired Leopard Gecko was placed on the examination table as the perplexed doctor drummed her fingers, lost in thought. Perhaps stressed by the physical examination, Ryu, which means dragon in Japanese, excreted a viscous green drop of stool which, when placed under a microscope, revealed a protozoan infection. Dr Graham prescribed a chicken-flavoured multivitamin solution and medicine for the infection while Deborah reassured Ryu’s owner. After they had left, the vet and her assistant quickly returned to the inside office to record the proceedings of the first examination of that morning.

This was the start of a busy weekday at the Avian and Exotic Animal Care Centre at the MSPCA Angell Memorial Hospital in Boston. The hospital website  claims that it hosts two of the 130 avian specialists in the world and is renowned for its range of treatment and therapies. These two specialists along with four devoted technicians form the backbone for running this centre which caters to hundreds of birds, rabbits, ferrets, rodents, hedgehogs, reptiles and amphibians every month. The centre is equipped with general and isolation wards, thermal-controlled reptile and avian incubators and offers surgery, endoscopy, radiology, bloodwork testing, ultrasonography and advanced diagnostics among its range of services along with a day care shelter. The centre’s uniqueness is amplified by the passion and care which the six-member team showers upon their scaly-skinned and feather-covered patients.

The inside office is a fairly large sized room which doubles up as the general ward. Two bunnies recovering from surgery and a bright blue budgerigar who was brought in for regurgitation issues, watch Dr Graham and Deborah, from their respective cages, as they move around the office typing in diagnostics and readying themselves for the next patient. The office cum general ward is startlingly sterile with an air tinged with the smell of fresh lettuce and cilantro leaves. Its white walls are lined with photographs of previous patients, and clip boards with lists and instructions. Dr Graham recalls her experience with Ryu and said that the clinic gets a lot of geckos and bearded dragons. “We used to see iguanas before but not too many anymore cause they’re very big and need humid conditions. Boston is very dry for them.”

The second patient for the morning cancelled his appointment which gave the doctor a window to quickly take a walk into the recovery ward to check on Topo. The scrawny brown ferret stared at the doctor through dilated pupils as she gingerly lifted him from his cage to look at the stitches on his shaved pink belly. “Topo has been diagnosed with a sarcoma tumour on his side and has just come out from surgery.” She went on to explain the nature and dangers of this type of tumour which is characterized by finger-like projections which delve deep into muscle tissue often leaving surgeries unsuccessful as doctors are unable to remove all traces of it at one go. Dr Graham cooed a few consoling words at the semi- conscious ferret and then placed him back into his cage bundling him into a blanket as she did so. “We’ll try laser as the next option to cure his cancer and pray that that works for Topo.”

Meanwhile Deborah was back in the examining room trying to wriggle Toast out his plastic strawberry-shaped house while his owner nervously stood by chewing on her finger nails.

Pet hamsters live to an average age of two to three years and are highly prone to tumours. Uterine cancer is especially common in this breed of rodents. This one-and-a-half year old hamster came with symptoms of a swollen vagina and severe urinary tract infection which immediately put the doctor and her technician on alert. Using a stethoscope, Dr Graham felt around the hamster’s belly for tumours. He didn’t have any but the doctor suggested that they conduct an ultrasound to rule out cancer. She then prescribed a berry-flavoured antibiotic to his owner and worked out a date for the ultrasound. After the owner left she explained that surgeries among hamsters can be very complicated as they often chew on their incision lines causing room for infections to set in. She also added that surgery in such an ‘old’ hamster may not be the best option. The surgeries are expensive and could range anywhere between $150-600 including costs for anesthesia, histopathology and post operative care and when chances of survival are so low, these surgeries often appear to hasten the decline of the hamster’s health.

Deborah said that the clinic saw an increasing number of smaller birds, hamsters and rabbits these days. “Apartments in Boston are small so people find it easier to look after tiny animals.”

Next, walked in Hobbes. Though his name was inspired by the stuffed tiger-shaped toy in the famous comic strip by Bill Watterson, this Angora Rabbit was far removed from his better known cheeky comic avatar. The vast overpowering bulky grey fur coat enveloping the tiny rabbit within could have left a stranger guessing about the location of the bunny’s face had it not been for his antennae-like conspicuous ears. The one-year old rabbit was brought in by his devoted owners who insisted on being referred to as his parents. Their winter coats, originally black, were covered in grey fur shed by their ‘son’.  His symptoms included an overall drop in energy, an ocular discharge and very flaky fur. The family conglomerated around the examination table as Dr Graham explained her diagnosis. “It’s just the Walking dandruff mite. It’s very common among rabbits,” she said while injecting a vial full of medicine into the nape of the rabbit’s neck. Stunned by the prick, Hobbes jumped off the table and scurried across the floor to hide itself behind the trash can. His large body, which was as big as an average sized Maltese dog, stuck on either side of the can. Hobbes’ mother ran across the room and scooped him up into her loving arms.

As time inched closer to Dr Graham winding up her shift for the day, she flipped over her charts to check for the last patient for the day. Princess Jefferson, a large white male cockatoo, rode into the examination room on his owner’s shoulder. The middle-aged lady anxiously explained that Princess had been obsessively picking out his feathers from his chest for the past week. A bald patch on his otherwise immaculate white body confirmed what she said. His crown rose at the sound of his name and fell again a few seconds later. Dr Graham patiently asked the owner questions about the bird’s diet, sleep cycles, cage, water and toys and asked if any of them had been changed or altered in the past few days. She also checked if the owner had turned on the heat in her apartment and asked her if she had installed any devices to control humidity in the apartment to which the lady frantically answered in the affirmative. After a thorough 20 min- long interrogation about the bird and his owner’s lifestyle, of which no altercation emerged, the doctor suggested that the bird be subjected to a bloodwork sample to check his hormone levels.

Dr Graham explained, “Cockatoos don’t do very well in cages. They show a lot of behavior problems of which feather-picking is the most common one. They are very social birds and in the wild would normally be in flocks.” She added that packaged bird food is very low on nutrition. They come with a high fat content which leads to heart disorders and complicates their hormonal make-up leading to stress. These and unpredictable changes in the bird’s environment like a change in the owner’s work hours or a new toy, could lead to obsessive compulsive disorders which are self-destructive in nature. Feather picking and self-mutilation are commonly seen and even when the environmental trigger for the problem is recognized and addressed, the behaviour often does not resolve itself. The clinic has seen cases where these birds have mutilated themselves to an extent that they would chew through their keel bone into their chest muscles.

While the nature of this disorder has been understood, its uniqueness offers very few solutions to the problem. Like humans, each bird is different and the same therapy cannot be applied to all of them. While some are given collars or sweaters to limit access to their chests, some are put on behavior-modifying drugs like Prozac. However, the success rate varies and doctors are unable to put a finger on any one promising solution to the behavior. Deborah, the technician on call for the day, mentioned that her cockatoo was put on acupuncture therapy. “It worked wonders for her. She was so relaxed after every session,” said Deborah.

As Dr Graham prepared to leave, she peeked into every cage in the office to ensure that the pets were in stable conditions. She left adding yet another day to the 11 years of experience she carried with her. As one of five double board-certified avian and zoological medicine specialists in the world, she exemplified a passion for a category of animals which most people would not associate as conventional pets. Walking out of the clinic, she waved out to Dr Connie Orcutt, the second of the two exotic animal specialists in the hospital.

According to the hospital website, Dr Orcutt has over 20 years of experience working with small mammals, reptiles and other exotic pets to her credit. She is also one of the only 11 board-certified doctors in Exotic Companion Mammal Practice. Her areas of specialistion include diagnostics and medical and surgical treatment.

Putting on her doctor’s coat, Dr Orcutt cheerfully greeted her technician Jenny and took into account the patients for the day. Her personal involvement and attachment to the animals in her care was demonstrated through the elated responses at improving cases and disappointing sighs at lesser-promising ones. She says that her job is a passion for her, even though the money is not as attractive as human medicine. “Human doctors may care for their patients, but we are in love with ours,” she said as she slipped on her gloves and walked out to greet her first exotic patient for the day.

Sources:

  • Dr Jennifer Graham, MSPCA Angell Memorial Hospital
  • Dr Connie Orcutt, MSPCA Angell Memorial Horp