Q. Talk about your job as the Director of School Health. What is an average day like for you?
A. I have a very unusual role. I report both to the Department of Health and Mental Hygiene and the Department of Education. I head the Office of School Health, which is jointly funded by Health and Education. On the DOE side, I report to Deputy Chancellor Kathleen Grimm; at DOHMH, I report to Deputy Commissioner Andrew Goodman.
The Office of School Health is responsible for providing a variety of services to New York City schools. The most visible, I suspect, is nursing services. We have more than 1500 nursing positions in our schools. In addition, our office also provides nurses to about 250 non-public schools.
Our nurses do two things: First, they provide for the general health needs of our students. We call these public health needs and they include ensuring the physical exams, immunizations and other screenings students need. Second, we care for students with both physical and educational disabilities, who consequently need more services and attention.
Q. What is your background? How did you come to DOE? What made you become a doctor?
A. Part of the reason I became a doctor is because my father, who is 99, is a physician. I think that being a doctor is intellectually challenging and also offers a way of helping people. I went to medical school and trained as a specialist in internal medicine. I then I embarked on an academic career, first at the Albert Einstein College of Medicine, then at Harvard, and then at Mt. Sinai here in New York City. I’ve spent almost 30 years as a physician, administrator and teacher in those three medical school settings.
In 2002, I got a call from former Health Commissioner Tom Frieden, now the Director of Centers for Disease Control and Prevention, who said, “Do I have a job for you!” We talked awhile about the position. It sounded like a very interesting challenge, an interesting way to take on an entirely new set of issues, and a good way to finish my career in my hometown.
Q. Talk about growing up in New York City.
A. We lived in New York City until I was ten. I went to PS 101 in Queens through the fourth grade. We then moved out to the suburbs, where I finished high school. I’ve spent the vast majority of my adult life in New York City.
Q. While you were living in Queens, did you have an experience that inspired you to become a doctor?
A. I wish I could point to something specific. You know, often people ask if I was ever sick as a child. I did have one very mysterious illness when I was a teenager, and I think that certainly provoked my interest. I was sick and nobody was able to make a diagnosis. I was taken to the best and the brightest. Eventually I just got better. To this day, we don’t really know what caused that particular illness, and that’s not a rare thing.
Q. What are some of the challenges that you’ve encountered during your time with the Office of School Health?
A. I’ve been here since February 2003, and there have been many, many challenges. On the health side, we’ve created new programs to make sure our students get the care they need.
For example, we identify several thousand children every year who are at risk for an eye condition called amblyopia. With amblyopia the two eyes don’t work together, and what the child’s brain eventually does is suppress the image from one of the two eyes. The child can become blind in one eye. It’s a problem that needs to be identified and treated early in childhood. We’ve created a whole set of programs designed to first of all, detect children with amblyopia, and second, make sure they go to an eye doctor to get the treatment they need.
We’ve also created programs to improve care of our 40,000 students who have asthma, and our more than 1000 students with insulin-required diabetes.
We also need to make sure we are upgrading our skills and keeping up with technology of care. For example, when I arrived in 2003, you could count on your fingers the number of our schoolchildren who had implanted insulin pumps. We now have several hundred such students. We have had to teach all our nurses to work with those children and manage any complications associated with these pumps.
Q. This year, there’s a lot of talk about the H1N1 virus.
A. At the moment, we’re devoting most of our attention to H1N1. The presence of this illness sort of exploded in the spring. We had many schools in which dozens of children became ill, and we closed many schools.
We’ve done a lot of planning for the fall, with our efforts focused on the H1N1 vaccine. This week, we are beginning an immunization program for schoolchildren. We are prepared to immunize—either in school or at what we call weekend “pods,” which will also be largely in schools—several hundred thousand students against H1N1. This has taken, of course, a great deal of preparation and planning. The vaccine comes in different forms. There were all kinds of documentation issues and parent consent forms that we had to deal with, but we are ready to go.
Q. How are you communicating with parents?
A. We try to use many avenues for communication. The City has a public Web site that contains all of the information about H1N1. There’s also information on the DOE Web site. We’ve had extensive communication with all of our principals. We know that parents often rely on their principals for information. We have backpacked letters and other materials home to parents so that they have the information they need to decide whether to participate in the school immunization program.
Q. What should parents tell their children about preventing the seasonal flu or H1N1?
A. The most important thing is that the flu—seasonal and H1N1—is transmitted either by person to person contact or droplets in the air. We curtail the spread of the virus with frequent and thorough hand washing, especially after children have coughed or have been in contact with people on the playground or in the lunchroom.
Second, we want to have people cough and sneeze in a way that’s least likely to transmit the illness. That means either coughing into a disposable tissue that is then discarded, or coughing into your elbow. We’re all used to coughing into our hands, but it’s our hands that we use to touch other people. The health department has a big campaign that asks all of us to cough into our elbows. The germs on our elbows are much less likely to spread than those on our hands.
It’s also important is to make sure that the children who are ill are not sent to school. And, if children are ill and at home, they should not return to school until they are well—they should be fever free for 24 hours. We know this is not an easy issue, particularly for parents who work, but it’s absolutely essential that sick children stay away from school, where they can infect others.
Q. We’ve covered H1N1 pretty well. One more question for you: what advice would you give to a student who wants to become a doctor?
A. Well, I think the obvious advice is study hard and make sure you’re interested in the sciences. Students in New York are very lucky to be living in a city with six medical schools and many outstanding medical research centers. There are lots of opportunities available for high school students to work in medical settings, learn something about medicine, and see how they feel about being a doctor. If there are students who have that interest, they are welcome to contact the Office of School Health. We can advise them and help them evaluate their interests.