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Stanford Report, June 12, 2002

Packard program encourages resident advocacy


Teenage obesity and pregnancy along with unintentional injuries involving children are issues best adressed by going to the source. With that in mind, pediatric residents at Lucile Packard Children's Hospital are learning how to make a difference by taking off their white coats, leaving their clinics behind and venturing into the community.

Packard resident Joyce Javier (second from right) sits with Sarah Gonzalez, director of the Filipino Youth Coalition in San Jose during a meeting earlier this year. Through Packard's advocacy training program, Javier goes into the community to help encourage communication about sexual health.

A children's advocacy program was initiated two years ago by Lisa Chamberlain, MD, a fellow in general pediatrics at Packard Children's Hospital. The program, which encourage pediatricians not only to practice in the traditional clinical setting but also to engage with their communities in meaningful ways, has gained popularity among residents.

"More and more things that are threats to children's health are things like injury, violence, substance abuse and so on -- things that are really difficult to address in the clinical setting," said Chamberlain. "Some of them have roots in the community. It's a totally different way to think about practicing. It's a different way to think about having an impact."

Advocacy outside the clinical setting is becoming increasingly important. Advocacy training is a recent requirement for all pediatric training programs, and many programs across the country are working to develop curricula to meet this new standard. Stanford's particular curriculum has been adopted by UC-San Francisco and the University of Miami.

At Packard Children's Hospital, residents get to choose the topic they feel strongly about. "For me it was children's dental care, access to dentistry and the poor oral health that I see in about 50 percent of my kids," said resident Karli Cleary-Aboudara, MD.

Cleary-Aboudara is setting up a dental fair that takes place Thursday at an elementary school in Redwood City. Many of the students there are uninsured, and their health care is limited to a nurse practitioner, who sees them by appointment on school grounds.

"We will have dentists who do a screening program," Cleary-Aboudara said. "They don't do dental health care; they don't provide any dentistry; they're just screening the kids." A letter then informs the parents about their child's dental health and, if necessary, suggests dentists who accept Medicare. Her project also includes such basic things as demonstrating how to brush teeth.

"The school was really helpful, and they want this to work because it is something that could be done once a year and a lot of kids could benefit from it," Cleary-Aboudara said. "Our goal would be to bring a dental van to the school in the future."

Resident Joyce Javier, MD, focused on teen pregnancies in Asian communities. While working on her project, she was invited by a Filipino outreach group to address Filipino parents and encourage them to talk about sexual health issues with their kids. Javier, a Filipina herself, said that the parents wanted to talk with their children but didn't know how, because sexual health issues have traditionally been taboo. "But as a doctor, I could encourage the communication between those parents and their kids," Javier said. "I'm still learning that physicians do have a powerful voice."

The residents said they and their colleagues enjoy working in the program, adding that it affects how they see their own profession. "Residents do 19 rotations in the first year, and this program was ranked fourth in popularity. So it was very highly received," noted Chamberlain.

"Now I understand a lot more about the community," Cleary-Aboudara said. "When you're at Stanford you're in this bubble. But when you're out in the community, you're working on a whole different level. It made me understand that not every part of medicine is seeing the sickest kid all the time. It can be something as basic as looking at a child's teeth and prescribing fluoride drops."

Training program helps residents cope (10/17/01)