Going Where the Asthma Is
By Dr. Larry Chiaramonte
Would you go to Florida to help polar bears escape the effects of global warming? The only polar bears in Florida have already escaped. They’re sitting in zoos, although of course that is surely not the best thing for them either.
The weaknesses of the analogy aside, what does this have to do with treating asthma? It’s because I find it hard to attract young doctors to work with me in Hunts Point, which, with 12,000 diesel trucks unloading produce per day at the Terminal Market, is in the nation’s highest asthma zip code. Instead, they compete for openings in high-rent districts like Park Avenue or the suburbs. Look, asthma knows no class distinction, but it’s most prevalent among the poor and the working poor. I don’t blame any young doctor for wanting to make a good living and paying off those student loans, but they frequently have the wrong idea about practicing where the asthma is rampant.
Their objections boil down to these: 1) people are poor, and MDs will not be paid; 2) patients will not adhere to treatment, which will be professionally frustrating; 3) facilities and technique will be trailing-edge, and practice boring; 4) communities like Hunts Point are marginal.
Your Honor, I object! In the first place, the poor and the working poor have very good insurance in the form of Medicaid and Child Health Plus, at least as they are administered in New York–that is to say generously. I personally have a million objections to the way health care and government in general are administered, but this isn’t one of them. Second, people do respond to first-class asthma care, which is highly personal and high touch compared to general practice almost everywhere. Making a difference in the life of an individual or, as it turns out many individuals is highly edifying and affirmative of everything I have devoted my career to. (And make no mistake, affluent patients can be uncooperative and boring.) Three, because we have a societal stake in improving health outcomes, practices in these neighborhoods often have access to public and private grants to try cutting-edge ideas. And finally, as I have written in our book and on this website, Hunts Point is America’s asthma canary. That is what is happening to lungs in our poor urban communities will eventually happen elsewhere. There’s an asthma epidemic in rural America, too.
That is why I am working with my employers to start a freestanding asthma specialty clinic, which, if we are successful, will be known as the Anne Marie Chiaramonte Asthma Clinic, in honor of my late wife, who worked with me in Hunt’s Point for many years. To younger doctors, I can only say, join us—you will learn and make a huge difference in people’s lives.
(Photo by terminalmarkets.com)