A doctor's painful challenge: Dr. Tina Carroll-Scott talks about what children really need
Dr. Tina Carroll-Scott, a pediatrician and a graduate of the Boston University School of Medicine, is the medical director of the South Miami Children's Clinic, which is supported by Baptist Health System. She and her husband, also a medical doctor, live in Coral Gables and have three daughters.
By Dr. TINA CARROLL-SCOTT
I was always driven to succeed. Growing up in Upstate New York , I received some of that drive from my parents who expected me to surpass their own educational achievements. The rest came from an inner desire to work hard and take advantage of every educational opportunity available. Reading books became my passport to people and places. Being able to read early meant I could excel in school and in life.
Fast forward 40 years. Now I am the medical director of a non-profit pediatric clinic in South Miami . The clinic was started to improve access to health care and health education for children in the area. Many are uninsured or underinsured. The clinic provides a "medical home" for these patients and some continuity of care.
Since opening in 2007, there have been many rewarding experiences -- but many more obstacles than I anticipated.
It didn’t take me long to realize that I would have to deal with all sorts of other issues -- illiteracy, teenage pregnancies, poverty, sexually transmitted diseases, child abuse and neglect, domestic violence. I now am not only the pediatrician, but also the social worker, psychologist, teacher and lawyer.
Unfortunately, whatever I tell my patients about preventive medicine goes in one ear and out the other if they lack proper housing, electricity, or have problems at school. I must address these issues if I am going to make any difference in improving their health care.
Illiteracy is my greatest challenge. The children at the clinic are sometimes two or three or four grade levels behind in school. Some can barely read or write, yet continue to be pushed through the school system. It’s hard to do even a simple vision screening when 5 and 6 year olds don't know their numbers, shapes or symbols.
Apathy for higher education compounds the problem. For too many children their ultimate goal is a high school diploma or GED. The desire to study hard and do well so one can attend college is rare. Moreover, if parents or guardians have difficulty reading or communicating, their children won’t receive the at-home support they need to succeed.
I will give you an example of the challenges: Shortly after starting at the clinic, "Whitney" came in for a routine office visit. Actually there was nothing really "routine" about the visit. At 17, she was in 10th grade but skipping classes so she could meet much older men and engage in risky sexual behavior.
Whitney's mother had died from AIDS, and she and her siblings were being cared for by her maternal grandmother. On the death of the grandmother, the oldest sister (with four children of her own) took custody of all her siblings. She accepted this responsibility to avoid dispersing the family into foster care. Whitney's sister, however, was not equipped -- financially, emotionally, psychologically or intellectually -- to deal with this new responsibility.
Whitney told me she really wanted to change her life, but didn't know how. She had failed grades twice in school and was in danger of failing a third time. She had no real family support to help her navigate the system. I felt that if Whitney was not removed from her home environment, she surely would continue the cycle of poverty, illiteracy and teenage pregnancies so prevalent in the neighborhood.
After much research, I found a boarding school in Upstate New York that specialized in helping at-risk children, providing the home environment, structure and support system that these children so desperately needed. The school also provided individual tutoring to get students back to grade level. Most students who complete the program later pursue higher education.
The tuition was $15,000 a year. It turned into a cause that mobilized an entire community. Donations of money, clothes, books and school supplies came from neighbors, friends, church members, hospital colleagues and community leaders. Everyone saw this as an opportunity to save a child's life. The boarding school, inspired by the community outpouring of support, agreed to allow Whitney to go there with half the tuition paid. The other half would be paid through an on-campus work-study scholarship.
I boarded a plane with Whitney and her older sister to enroll her there. This was the first time Whitney had ever traveled on an airplane or left South Florida . What an experience!
At her new school, Whitney roomed with a young girl from Liberia , a country in Africa whose name she had never heard. How could a 17-year-old young woman make it this far in school without any real knowledge of our world? My anger quickly turned to a renewed hope that Whitney could break the cycle.
Whitney started out well. She seemed to adjust quickly to the strict regimen at the school and was excelling in her studies. Apart from one C, her mid-term report card had all As and Bs. She volunteered in the school's on-site child care and helped to package food in the bakery.
But as the months went on, the teachers saw it was becoming more difficult to keep Whitney motivated. She became homesick and was depressed about not seeing her older boyfriend.
Teachers tried to encourage her to remain in the summer program so she could advance more quickly and graduate earlier. But the fact that she was turning 18 that summer, and the absence of the boyfriend, became too much in the end. There was no real support from her family back in Miami . After much counseling from me and the school staff, the decision was made to let her come home for the week of her birthday. She agreed to return to school for the new semester.
I could definitely see a difference in her dress and demeanor. She looked like a college student. Although I was apprehensive about her coming home, I thought there was still a chance that she would return to the school. Surely the exposure at the school had fundamentally changed her in some way. Why would she want to come back to a life of not knowing where her next meal would come from, or where she would live?
But sadly she did. Everything that I saw wrong with her family and neighborhood was somehow comforting to her. The thought of aspiring to something so foreign scared her, making it easier just to fail.
Whitney came to my office to tell me that she would not be going back. She decided to get her GED in Miami , and find a job at McDonald’s. She had no long-term goals -- or any realistic way to achieve short-term ones. The older boyfriend also was waiting to lead her down a dangerous path.
I was so deeply disappointed. School is not a magic cure, but I surely thought seeing possibilities would change her life. I have come to believe that waiting to intervene until her teenage years was a major factor in her demise.
The research reminds us that becoming a proficient reader by third grade is a crucial factor in school success. In Florida , almost a third of our third grade students read below grade level.
I practice preventive medicine at my clinic. What we need is “preventive education” to deal with the crisis affecting our most vulnerable children. This includes quality social services to deal with the problems at home that inhibit children from excelling in school.
Do we abandon the older children like Whitney? Any intervention is time-consuming, expensive and the risk of failure is high. But it would be like denying care to a 50-year-old smoker with heart disease and lung cancer. We must provide care and try to heal what is ill. Young nor old should fall through the cracks. Whitney didn’t take advantage of this opportunity, but another child out there will. To fail to see the potential in any child is a travesty.
As a pediatrician, I counsel patients daily about healthy habits, necessary immunizations and preventing illness. But the most important advice I give to patients has to do with the value of education. With that comes the drive to do better and the ability to achieve goals.
Every year we see more cuts being made to public education -- and higher stakes for those children already falling through the cracks.
Our legislators must make funding for education a first priority in the state’s budget. We do not have the right to give up on children.