THE WAY I SEE IT

We have to stand up for the children

This doctor was initially reluctant to get involved. She's glad she changed her mind.

By Deanna M. St. Germain, DO
Family Practitioner/Anna, IL

Several years ago, a staffer gave me a plaque that read, "A hundred years from now it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove. But the world may be different because I was important in the life of a child."

No one could have given me a more precious gift.

To explain why, I have to step back to 1985, when I began my career in an underserved southern Illinois town of about 5,000. I did obstetrical work and, because the town had no pediatricians, I also treated a lot of kids. A friend of mine, a caseworker for the Illinois Department of Children and Family Services, told me how frustrated she was because physicians in our area wouldn't review cases of suspected sexual abuse of children. Some refused to believe that the problem even existed in their community. Others said they weren't comfortable doing the exams. As a result, kids had to be driven three hours away to be evaluated.

My friend asked if I'd do the examinations. I was flattered but hesitant. Surely, someone more qualified would step up to the plate. Well, no one did. My friend explained that I'd be trained by physicians at a tertiary care center on how to evaluate prepubertal children for signs of abuse.

For sure, the subject resonated with me. A college roommate of mine had been sexually abused as a child. She struggled emotionally for years after the abuse ended. One bleak Sunday morning, about a year after we'd lived together, I learned that she had been found dead in her dorm room from a drug overdose.

The memory of that incident, combined with my love of children, led me to accept my friend's offer. I read everything I could find on child sexual abuse; trained with physicians, therapists, and caseworkers; and attended national conferences. My community health center was very supportive. I had use of a colposcope one day a week and a dedicated nurse who learned to do interviews and assist me with the exams.

Before long, it became clear to me why so many of my colleagues didn't want to get involved. I had to spend a lot of time fielding phone calls and, occasionally, testifying in court. The children often have no insurance or Medicaid coverage, so doctors receive little or no reimbursement for these services. Moreover, in court, physicians and other medical providers are subject to some rough treatment by opposing attorneys (and even by a few judges), who question their education, judgment, and integrity.

By the time I learned these hard realities, though, it was too late. I was hooked on what I was doing. Thankfully, I don't go to court nearly as often as I'm subpoenaed. It still feels awkward to testify, but like anything, the more you do it the more you get comfortable with it. The idea that my time and testimony might benefit a child is enough to motivate me.

Unless there's DNA evidence to support my suspicions, I don't identify perpetrators; only the child can do that. But I won't hesitate, where appropriate, to present my findings and clinical opinions as objectively as possible. In that way, I serve the children best.

Together, we sometimes prevail. But, in general, there's no more powerless, disfranchised population than abused children.

Nationwide, an estimated 875,000 kids were maltreated in 2000 alone and approximately 1,200 died from their injuries, often at the hand of a parent, or other relative or caregiver. Many more reports of abuse go unsubstantiated for lack of convincing evidence, or remain uncounted due to poor record-keeping. I remember reading in a magazine several years ago that we know more about how many cars are built in this country than we do about how many children are abused. In my opinion, that's unconscionable.

Over the years, my work has presented me with many wonderful opportunities. I've been chairperson for our regional child death review team since its inception in 1995. I've also participated in the (Illinois) Governor's Task Force on Child Abuse and Neglect. Being there for these children has made both my personal and professional life more fulfilling and rewarding.

I have the best of both worlds now: Each week, I work three days seeing patients in an outpatient setting, and one or two days on the issues of child abuse. I've also secured a government grant to help educate medical providers on abuse and neglect, and deploy them as consultants in underserved areas.

You don't need to get involved to the extent that I have, but I urge you to do something. For every child we reach out to now, we increase the likelihood that he or she will become a responsible adult, who in turn may help another child. My staff and I make a difference in the lives of the children who come to our little rural hospital. You can make a difference in the lives of the children in the community you serve. As physicians, we need to do our part.

 

Deanna St. Germain. We have to stand up for the children. Medical Economics 2002;14:50.