Departments
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Week of 20 February 1998 |
Vol. I, No. 21 |
Feature
Article
BMC doctors make a house call
by Eric McHenry
One of the children Joshua Sharfstein, M.D., treats is doubly afflicted -- cancer and asthma -- and lives in an unsubsidized Dorchester apartment infested with rats and cockroaches.
"There's a real risk of infection," says Sharfstein, a pediatric resident at Boston Medical Center (BMC) and Children's Hospital, "particularly while he's undergoing chemotherapy, and those conditions could also trigger his asthma. He's a kid with a very good prognosis. It's just scary to think that one of his biggest risks is at home. It's very frustrating for a doctor, because it's just outside of my reach."
Sharfstein speaks with his mouth full, having asked to be
interviewed during lunch. It's not that he lacks a sense of
decorum; he just lacks time. In a "normal" week, Sharfstein
works between 80 and 100 hours, which makes the
comprehensive report he and some colleagues have just issued
concerning the effects of substandard housing on children's
health in the United States all the more remarkable.
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Dr. Seth Kaplan, a BMC and
Children's Hospital pediatrician who contributed to
a report on the ways substandard housing affects
children's health, talks with Kingsley Mason of
Dorchester. Photo by
Kalman Zabarsky
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"Basically, you don't see too many of these projects done by medical residents," he says, "because of the time commitment residency requires. I don't think it would have been possible if BU hadn't helped us out the way it did."
The University and BMC contributed financial and advisory support to the production of the report, which Sharfstein and coauthor Megan Sandel, M.D., presented at a February 9 press conference in Roxbury. Entitled Not Safe at Home: How America's Housing Crisis Threatens the Health of Its Children, it is a collection of carefully marshaled statistical and anecdotal data that Sharfstein, Sandel, and six other pediatric residents, collectively known as the Doc4Kids Project, surveyed and culled from books, articles, and other reports.
"The scientific part of Not Safe at Home is essentially a literature review," says Sharfstein. "We tried to find every single article available that concerns the relationship between housing and children's health. Based on those materials, we made estimates of the national impact of poor housing."
The researchers also set up and publicized an e-mail account, which served as a receptacle for stories from pediatricians around the country. Sharfstein and Sandel edited and assembled these more personal pieces of evidence, creating a substantial appendix to the report. Since their objective was to produce a document both accessible and compelling for legislators, housing advocates, and the general public, the pediatricians' accounts were particularly useful, Sharfstein says.
A sampling of the stories is unsettling:
Boston, Asthma: Lawton is an 11-year-old boy who has been admitted to the hospital five times over the last nine months for asthma. His roof at home leaks water into the living area, and he is allergic to mold, dust mites, and cockroaches . . .
Philadelphia, Lead: Toddler hospitalized for treatment of lead poisoning whose landlord will not cooperate with lead abatement.
Seeing maladies attributable to poor home conditions on a day-to-day basis prompted Sharfstein and his fellow pediatricians to undertake the project.
"We got together and said, 'It's just amazing how many of our patients have terrible housing situations that are making them sick. What can we do about it?' " he recalls.
"These are not problems that we have medicines for or can remove with surgery," adds Seth Kaplan, M.D., another pediatric resident who contributed to the report. Kaplan is particularly concerned with the health threat that lead poses to poor children, who are disproportionately affected by it. Many lower-income families, he says, can only afford housing in older units with lead-based paint, to which the young are particularly susceptible because their brains are still developing. According to a study cited in Not Safe at Home, 5.9 percent of all U.S. children aged 1 to 2 have lead levels in their blood greater than 10; children lose an estimated 2.5 IQ points for every increase of 10 in that level.
"Especially in the Northeast," Kaplan says, "and in other parts of the country that have very old housing stock, lead-based paint is everywhere. And over the past 10 years we've gotten a much better understanding of the long-term effects of lead exposure. Even when kids don't exhibit symptoms such as vomiting and abdominal pain, they can nevertheless be undergoing very subtle changes related to intellectual development that can have a lifelong impact on them."
In addition to lead poisoning, the report examines asthma and respiratory disease, injuries, homelessness, and malnutrition as they relate to inadequate housing. It notes, for example, that approximately 18,000 inner-city children will be hospitalized this year for "asthma . . . attributable to cockroach infestation." Nearly 1,500 children will be burned by exposed radiators during that same time period.
"In order to take complete care of our patients," says Kaplan of the conditions revealed in the report, "we have to get beyond just putting Band-Aids on. And a lot of what we do in the hospital involves putting Band-Aids on. All of us are very interested in preventing these conditions from happening to begin with."
Massachusetts Senator John Kerry spoke at the February 9 press conference, praising the report and its authors. David Kass, Senator Kerry's legislative assistant, says documents such as Not Safe at Home are valuable tools for lawmakers working to rectify the problem of substandard housing. Many of the issues raised in the report, Kass says, would be directly addressed by legislative measures Senator Kerry supports: sufficient housing subsidies, assessment of asthma risk factors by housing inspectors, accurate and inexpensive lead testing, and fuel assistance.
"It's an important report, and the Senator applauds the Doc4Kids Project," says Kass. "We hope this will help people understand that living in substandard housing has terrible long-term effects on children."
The University has assisted the Doc4Kids Project in setting up a Web site, where the report can be read in its entirety. The address is www.bmc.org/program/doc4kids/.