Immigrant Child Health(care)

As physicians we are trained to follow our assessments with a plan for our patients. However, sometimes issues such as immigration seem too daunting for the clinic room.

The AAP put together a toolkit on how to care and advocate for our patients who are immigrants or children of immigrants.

As said by my co-resident, Aaron Pankiewicz, “Regardless of how you feel about current immigration policy, as pediatricians, we know separating children from their parents can have a deleterious effect on health. There is not only the immediate period of stress, but also its effect over their life time as it most definitely represents an ACE (adverse childhood experience).”

Thank you Anna Ruderman for pointing out the toolkit!

~Lauren Klein

Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.

Speak Up

Doctors Need to Speak Up More published in the January 2019 issue of Pediatrics highlights two important topics

  1. we need to advocate for our patients inside and outside the clinic walls
  2. we must empower other physicians to be advocates

Thanks for the recommendation, Richard Chung, MD!

photo credit: shutterstock
Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.

Juvenile Justice.

“Caught: The Lives of Juvenile Justice” made it on The New Yorker’s List of Best Podcasts in 2018!!! The host, Kai Wright explores questions, including: “What happens once we decide a child is a criminal?” and “What does society owe those children, beyond punishment?”. Give it a listen, and hear directly from these kids.

This is not a topic routinely taught in medical school or residency, but it matters, especially for pediatricians. Adam Foss, a former assistant district attorney, was the keynote speaker at the 2018 AAP National Conference.  He urged, “Each one of you has the opportunity every single day to stick your arm in that pipeline and pull out one kid…Exercise your sword and your shield. Do something different at work. When you do, amazing things happen.”


Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.



Can collective advocacy for patients help physician burnout?

Debi Best, MD (Duke pediatrician) recommended the article, To Fight Burnout, Organize which is an opinion piece in the NEJM about burnout and collective advocacy.

The piece combines discussion about burnout and social determinants of health which are both current hot topics. The argument is that if we organize to help address upstream events of social determinants of health this will cause less downstream poor health effects on our patients, and therefore will also reduce the number of tasks physicians face (specifically those tasks that at times seem unachievable). I think this argument serves as interesting fodder for discussion about how to decrease barriers for health professionals to be able to spend their time caring for their patients.

Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.




Child and Family Separation at the Border

Home, by Warsan Shire (British-Somali poet) 
no one leaves home unless
home is the mouth of a shark.
you only run for the border when you see the whole city running as well.

your neighbours running faster
than you, the boy you went to school with who kissed you dizzy behind
the old tin factory is
holding a gun bigger than his body, you only leave home
when home won’t let you stay.

no one would leave home unless home chased you, fire under feet,
hot blood in your belly.
it’s not something you ever thought about doing, and so when you did –
you carried the anthem under your breath, waiting until the airport toilet
to tear up the passport and swallow,
each mouthful of paper making it clear that you would not be going back.

you have to understand,
no one puts their children in a boat
unless the water is safer than the land.

who would choose to spend days and nights in the stomach of a truck unless the miles travelled
meant something more than journey.
no one would choose to crawl under fences,
be beaten until your shadow leaves you,
raped, then drowned, forced to the bottom of
the boat because you are darker, be sold,
starved, shot at the border like a sick animal,
be pitied, lose your name, lose your family,
make a refugee camp a home for a year or two or ten, stripped and searched, find prison everywhere
and if you survive and you are greeted on the other side with go home blacks, refugees
dirty immigrants, asylum seekers
sucking our country dry of milk,
dark, with their hands out
smell strange, savage –
look what they’ve done to their own countries, what will they do to ours?

the dirty looks in the street
softer than a limb torn off,
the indignity of everyday life
insults easier to swallow than rubble, than your child’s body
in pieces – for now, forget about pride your survival is more important.

i want to go home, but home is the mouth of a shark home is the barrel of the gun
and no one would leave home

unless home chased you to the shore unless home tells you to
leave what you could not behind, even if it was human.

no one leaves home until home
is a damp voice in your ear saying leave, run now, i don’t know what i’ve become.


Poison Control Centers: Information + Human Connection

Last weekend, as I drove home from an ED shift, a Radiolab podcast about the evolution of poison control centers played.  In addition to exploring the creation and evolution of poison control centers, the show explores both the power of information and human connection.

Listen to this podcast here: Poison Control

See the source image

Call the national Poison Help Hotline at 1-800-222-1222 or text POISON to 797979 to save the number in your phone.

Evidence Based Advocacy:

A study by Wang et al. in the June issue of Pediatrics demonstrated that transitioning to unit-dose packaging of buprenorphine-naloxone products decreased accidental exposures by almost 80%.

Wang GS, Severtson SG, Bau GE, et al. Unit-Dose Packaging and Unintentional Buprenorphine-NaloxoneExposures. Pediatrics. 2018;141(6):e20174232

~ Lauren Klein

Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.


2017 Durham Community Health Assessment


Partnership for a Healthy Durham, along with the Durham County Department of Public Health and Duke Health, has just released this report that contains valid and reliable health information about the health of the Durham community in 2017.

It includes 14 chapters with 48 sections on various community health topics, with many community partners contributing to the report. Data in the survey came from three primary sources, including the County Community Health Assessment Survey, the Youth Risk Behavior Survey, and community focus groups and listening sessions that occurred over the prior year.

It can be found here.



The top health priorities identified by the Community Health Assessment Survey of Durham County Residents were:

  1. Affordable Housing
  2. Access to Healthcare and insurance
  3. Poverty
  4. Mental Health
  5. Obesity, diabetes and food access

~ Anna Ruderman


Evidence Based Advocacy – May 3, 2018

This month’s Evidence Based Advocacy session focused on immigrant children and the impact of toxic stress related to evolving immigration policy as well as separation from their parents at the border. This month’s EBA preceded an AAP Day of Action on May 4 opposing separation of children and parents. We started the discussion using the Kaiser Family Foundation’s issue brief, Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well Being, and Health. The main take aways from this article are: (1) immigrant families, including those with lawful status, are experiencing resounding levels of fear and uncertainty, (2) Most parents said they are continuing to access health care for their children and maintaining their children’s Medicaid and CHIP coverage, but there were some reports of changes in health care use and decreased participation in programs, and (3) Increased fears are having significant negative effects on the health and well-being of children that have lifelong consequences. Of note in 2016, nearly 20 million or one in four children had at least one immigrant parent, and nearly nine in ten (89% or 17.7 million) of these children were citizens. In NC, there are 404,000 citizen children with an immigrant parent and of those 219,000 have Medicaid or CHIP coverage.

Below are a few more articles pertinent to the discussion and some which discuss the impact of possible changes to the definition of public charge.


How much can our patients’ pasts actually predict their futures?

In medicine, we often use patterns and algorithms for diagnosis and management of disease. Today, this concept is now expanded with algorithms trying to predict everything about our behavior. Invisibilia recently released “The Pattern Problem“, a podcast episode about patterns and their predictive powers. This episode offers an interesting perspective about the role of both patterns and randomness. What do population level patterns tell us about an individual’s life?


Art work by Sara Wong for NPR

~ Lauren Klein

Blog posts represent the opinion of the author, not the Duke Pediatrics Residency Program, the Department of Pediatrics or Duke University.