April 21, 2010

Healing in the City

2010 1512 page20 cap pediatric residency program designed to meet the health-care needs of inner-city kids in San Bernardino, California, is proving to be a blessing for the families it serves as well as the pediatricians it educates.
According to Marti Baum, assistant professor of pediatrics at the Loma Linda University School of Medicine, the residency started a pediatric continuity clinic at the Social Action Community Health System (SACHS-Norton Clinic, for short) in 2006. SACHS-Norton is housed in a 42,300-square foot site on the campus of the former Norton Air Force Base.
Nine residents—graduate physicians taking additional clinical training under the supervision of licensed pediatricians—are currently in the program. Although they’re at the clinic only half a day each week, they gain invaluable experience during the three-year duration of the program. 
“One tenth of their time in the residency is dedicated to continuity care, either at the pediatrics teaching office in Loma Linda, or here at SACHS-Norton,” Baum notes. “They follow their own patients and develop a minipractice. The experience helps them acquire important clinical skills under the direction of Dr. Catherine Tan, Dr. Pejman Katiraei, and myself.  
2010 1512 page20“Residents follow a family from the time a baby is born,” she says. “They start with three patients the first year, pick up one additional patient in year two, and another in year three. By the time they finish, they have a five-patient caseload per half-day clinic.
“The really important thing,” Baum continues, “is that pediatricians learn to survive in the community by being good, solid doctors who consistently make good clinical decisions in the best interests of their patients—even if their patients have very little resources. There is also the need to learn to connect with patients’ family members and other county agencies, and to develop good case-management skills for coping with difficult situations that their patients find themselves in. That’s what we hope to emulate and model at SACHS.”
Baum is happy to report that residents are committed to coming to the SACHS-Norton Clinic, even though it requires them to drive across the San Bernardino Valley. “They love coming here,” she says. “We have no trouble attracting residents who want to take their continuity clinic here.”
One of the primary draws of inner-city clinics is that they offer residents wide exposure to conditions not often encountered in a suburban context.
“This is the poverty clinic,” she notes. “We have kids here who have lived in tents, been homeless, came across the border. Many of their families have food insecurity issues. We connect them with our own SACHS pantry and with our on-campus partner, Helping Hands.”
Another attraction is that the clinic provides a high level of convenience.
2010 1512 page20“We have behavioral health, dentistry, a pharmacy, adult primary care and preventive care, and pediatrics all under the same roof,” she explains. “We also have the Women, Children, and Infants (WIC) program to provide food for low-income families. If we have domestic violence issues, Behavioral Health can arrange an immediate intervention. If patients come in with horrible dental caries, we march them right down the hall to Dentistry.
“We frequently treat kids who have no shoes or haven’t had a physical exam for years. We help them get basic medical insurance. One 14-year-old kid actually came in with leukemia,” Baum recalls. “He had been wandering around the valley for almost two months, going from hospital to hospital without getting a diagnosis, since he had no insurance. Because of our gateway insurance program, we were able to help him.”
Baum is proud that the clinic received a Good to Grow grant from First 5 California, the agency that makes sure children get good care during their first five years of life. “It allows us to screen them for behavioral issues, developmental issues, safety factors in the home, and family stressors, as well as conducting a nutritional survey,” she notes. “We also refer [parents] to our Behavioral Health center for assistance with jobs, housing, drug and alcohol rehab, a parenting program—in short, whatever resources are available in the county.
“During their third year, residents do a month of pediatric advocacy and community services learning projects,” Baum reports. “Residents work in a homeless clinic, work with pregnant teens, track nutrition and obesity issues in junior high, and lecture on safety and injury reduction in second and third grades. They also work in juvenile hall clinics.” 
What does Baum hope the residents take from their time at SACHS-Norton?
“A sense of passion for working with the most at-risk populations in pediatrics,” she replies. “I tell every one of the residents who work here that I’m going to call them in five years and ask what community charity program they volunteer for. It’s essential to personal happiness. I am hoping they will tell me they have chosen the difficult projects that require a lifetime of commitment to raising the health and education of children; not the easy jobs.”
“I love my job!” she exclaims. “Every morning when I wake up, I’m excited to go back to work. I think the best part of being a Christian is being allowed to serve God; it is the best of the best.”
James Ponder is publications editor of Loma Linda’s Office of University Relations. This article was published April 22, 2010.