The Children’s Hospital at Montefiore is perhaps the most engaging and advanced hospital for children in the world. But the breakthrough technology, top-notch medical staff, and innovative atmosphere mean nothing if Montefiore can’t reach the patients who need it most.
“One of the delicious ironies in this process is that we have one of the most advanced children’s hospitals in the world here in the Bronx, which is one of the most medically underserved and disenfranchised communities in the nation,” says Dr. Irwin Redlener, cofounder and president of the hospital. “But we still only touch a minority of the children in this city, much less the country or the world. That’s why it’s so important to take on the role of doctor-advocate — to do your thing for your practice and your hospital, but to always have one eye on the bigger picture and what you can do to change the circumstances that get kids to the hospital in the first place.”
Over the years, Redlener has become a kind of pied piper, summoning creative advocates and inspiring humane health care for children around the world. Alan Shapiro and Debby Snider are poster children for this special breed of medical professional — passionately connected to the well-being of patients and willing to push the envelope when it comes to the role of health care. Both have worked with the Children’s Health Fund, helping patients and pioneering programs for the past 15 years. Today, they run the South Bronx Health Center for Children and Families.
The center began in a van parked on a street corner in one of the most devastated neighborhoods in the Bronx, Hunts Point, which became a symbol of urban decay in the 1981 film Fort Apache, the Bronx. Today, the center is a gleaming facility that provides comprehensive care to more than 6,000 patients during 23,000 visits a year. The brightly decorated, spotless building — which more closely resembles a private day school than an urban drop-in center — provides a full array of health services for children and their families.
Echoing Redlener’s emphasis on equal access, Snider points out the subspecialty referral desk, which is equipped with staffers dedicated to hooking patients into the health-care system by filling out Medicaid applications and arranging transportation to referral appointments. Shapiro, who created a special mobile medical program for New York City’s street youth, exemplifies Redlener’s creative whole-child approach to health care.
“People who work here are medical missionaries,” says Shapiro. “We’re not in competition as most doctors are. We really work together. And that can mean filling out college applications, calling a school when a kid is not reading as she should, creating a partnership with the Police Athletic League to provide cheap gym memberships, or lobbying the Board of Ed for better schools. Whatever it takes to help kids thrive, you do it.”
Isabel Pino, a 10-year Children’s Health Fund veteran stationed in Huntington, West Virginia, offers a similar level of patient service to the extremely isolated communities of Appalachia. She travels weekly in her bright-blue mobile medical unit along steep, winding roads to remote hamlets with no running water, phone service, or essential services. She provides everything from regular checkups to chemotherapy. And she says that every time a child walks in the door, “I’m not just looking at a possible ear infection, I’m trying to examine the child’s life. How is his nutrition? How is he doing in school? It’s hard to understand what this kind of isolation is. These families rely on us as a lifeline.”
The patients Dr. Jeffrey Avner sees every day suffer from a different kind of disconnect. Avner, director of pediatric emergency services at the Children’s Hospital at Montefiore, led the design of the hospital’s emergency-care ward. From the separate ambulance bay, to the child-sized beds, to the Game Boys hooked up to IV poles, to the unparalleled pediatric emergency staff, this ER was obviously created with children in mind. The Montefiore ER is the busiest in the city with 42,000 patients in 2001, up 20% from 2000. Although the numbers are overwhelming, Avner doesn’t subscribe to the “treat and street” doctrine of care.
“We’re emergency doctors, but we’re also pediatricians,” he says. “There’s that excitement of diagnosing emergency cases, stabilizing a patient, and treating an emergency, but we get just as much satisfaction when we can help a family that has had a hugely frustrating time with hospitals and doctors by hooking them into this system of stable, quality care.”
Indeed, those change agents all share one common power source — a robust medical network that includes 16 national programs of the Children’s Health Fund and various programs and facilities linked to the Montefiore system in the Bronx. Without those connections to a larger, mission-driven system, Redlener says, medical professionals who choose duty in the toughest communities with the most intractable problems risk becoming “dysfunctional idealists.”
Just as important as providing care in these communities, he says, “is turning our hospitals, clinics, and programs into dynamic cauldrons of ideas. We have to be a combination of aggressive and creative. Aggressive because children don’t have time to wait for slow, evolutionary change. Creative because we simply haven’t fixed it. There is really no explanation why we still have so many children living in poverty, with terrible housing conditions, poor sanitation, and inadequate access to health care, good education, and public transportation.
“There are millions of children who are disconnected from mainstream America. If we want to deal with this problem, we can’t just be doctors — we need to work as thinkers and advocates to constantly come up with new approaches to accelerate the process of curing these chronic ills.”