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The Remarkably Direct Path from Poverty 101 to Pediatrician Advocate

Ms. Vander Schaaf is a 2005 graduate of Washington and Lee University, there she received a Bachelor of Sciences in Neuroscience. After graduating from the University of North Carolina at Chapel Hill School of Medicine and completing her residency, Vander Schaaf went on to become a NRSA Primary Care Research Fellow at UNC Chapel Hill.

"Poorer kids are sicker. I wanted to learn more about why, and how to stop it."

“Poorer kids are sicker. I wanted to learn more about why, and how to stop it” says Vander Schaaf (W&L 2005).

Only in retrospect, the path from the Shepherd Poverty Program to my current life as a pediatrician and health services researcher is direct and nearly linear.  As a nineteen year-old undergraduate, I had no idea where signing up for Poverty 101 would lead me.

As a sophomore at W&L, I received a mass solicitation email for Shepherd Internship applications at just about the time that I was realizing I wanted to be a pediatrician.  I had never heard of Shepherd and, despite some high school volunteer work, really did not know I cared about helping the impoverished.  I just knew I needed some more exposure to the health care setting, and an internship in a community health center outside Boston seemed like a good way to get it.  I applied, was lucky enough to be accepted.  In many ways, my life was changed.

My internship at Codman Square Community Health Center was my first introduction to models of care for the underserved.  During the day, I worked in its pediatrics department, observing patient interactions and talking with staff about their experiences serving the poor.  At night, I lived with a family in the same Dorchester neighborhood, gaining an appreciation of how community health centers both treat and employ their neighbors.

The Shepherd Program’s coursework was instrumental in developing and strengthening my interest in how poverty affects health.  In Poverty 101, a core reading described the work of Barry Zuckerman.  He was (and still is) a pediatrician in Boston that employed lawyers on his clinic staff to help address children’s social determinants of health.  I read that if a patient’s asthma was poorly controlled because of a mold or cockroach infestation, the clinic’s lawyers would contact his family’s landlord to enforce remediation.  I thought, “That is the kind of pediatrician I want to be.”  I wanted to treat kids both within and beyond the clinic’s walls.  My capstone poverty paper cemented my interest in the role environment and societal circumstance plays in children’s health.   As I researched and wrote about how impoverished children have more frequent and more severe asthma than their wealthier peers, I realized that diseases such as asthma are not just organic.  Poorer kids are sicker.  I wanted to learn more about why, and how to stop it.

From the moment I enrolled in medical school at the University of North Carolina, my experience was colored by my interest in serving the underserved.  My now best friend and I bonded during orientation over our time spent in community health centers.  I volunteered in free clinics, conducted cardiovascular screenings in Mexico, and led an HIV testing outreach program.  Later, a member of the admissions committee would tell me I got into medical school because I am a “humanist.”  I know that the Shepherd Poverty program made me that way.

During medical school, I took a year-long leave to earn my Master’s in Public Health, seeking to build upon what I learned in the Shepherd Program, to strengthen my knowledge of population health and social determinants of health.  I chose my MPH advisor because she reminded me a lot of my poverty studies professor and advisor.  She was incredibly knowledgeable about how policy affects the population.  And like my undergraduate poverty studies professor, she pushed me to work harder and learn more than I would have thought to do myself.  Under her guidance, I studied the development of North Carolina’s Medicaid program.  This experience taught me of policy’s role in the care of vulnerable children.

In pediatrics residency, I received a grant to help identify and enroll eligible impoverished children and families in government-sponsored insurance programs.  This strengthened my knowledge of children’s health policy and emboldened me to think of ways to I could improve the health of children at the individual and population health level.

As residency and my clinical training ended, I sought to strengthen my skills in population health improvement.   I began an NRSA Primary Care Research Fellowship, in which I divide time between working as a primary care pediatrician and developing health services research skills.  In that role, I study barriers to care for vulnerable populations, while working in a nonprofit that improves population health at the county level.   I will continue this sort of work once I finish the fellowship this summer: working both as a primary care pediatrician and as a researcher and advocate in children’s population health.  I will be doing what I first learned about in Poverty 101: treating children’s health within and beyond the clinic walls.

In so many ways my interests and career path today are shaped by what I learned and experienced as a student in the poverty studies program.  The coursework and internship were my first introductions to the concept that children’s health results not just from intrinsic biology, but also from their environment, societal circumstance, and affecting policy.  This shocking realization at the time became the reason I now balance my time between treating individual children within the clinic walls while working to study and eliminate the barriers to good health for children at a population level.  I am a pediatrician and budding child health advocate today because of the Shepherd Poverty Program.


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