A Day in the Life at Primary Care

By C.J. Hirschfield

A 10-year-old boy in foster care comes out of his shell after completing a program at Fairyland that teaches him how to be an expert animal caretaker.

A 6-year-old boy, being raised by his grandmother after his brother was shot, enjoys coming with her to a place where he can be a kid again.

An elementary school student in East Oakland wins a Fairyland family pass in a library reading contest, and regularly takes the bus with her mom to delight in our laid-back reading room and literacy-rich activities.

The 2016 Junior Animal Caretaker group enjoys a visit from the Oakland Zoo's Zoomobile, one of several Fairyland community resources for underserved families.

An autistic child surprises his mom by boldly swallowing an edible flower during a horticultural therapy session in Fairyland’s gardens.

We’ve seen how our low-tech, high-touch park can have a markedly therapeutic effect on kids and their family members who have experienced trauma and other challenges.

Which is why we are so pleased that our newest board member, primary care pediatrician Javay Ross, understands the role Children’s Fairyland can play in helping families heal and thrive, and will help us move even further in that direction.

Dr. Javay Ross, Fairyland's newest board member.

We asked Javay, who works at an Oakland clinic for UCSF Benioff Children’s Hospital Oakland (BCHO), to make a presentation at our last board meeting about the state of pediatric health in Oakland. She decided the best way to do that would be to draw from her actual experience: a day in the life in primary care. She chose a few patients from the 12 she saw during a single day.

Here are a few of them, in her own words:

Patient #1: 11-year-old overweight autistic male here with dad and brother for check-up. Since last appointment, parents lost their public housing in Berkeley, moved to transitional housing shelter in Hayward, limited kitchen access.

History of autism-related dietary aversions/restrictions, so refusing to eat the meals prepared by the house staff.

Dad forced to purchase food with his limited income (mostly getting him fried chicken and corn dogs from Safeway, because that’s what he likes and will eat). Fasting labs ordered, dietary and lifestyle counseling, given limited kitchen access. Close follow-up, family likely to move soon.

Patient#4: 5-year-old female with severe asthma, here with parents and twin brother for check-in of asthma that has worsened in severity since family moved to new apartment where neighbors gather close to their front door to smoke cigarettes. 

Six ER visits in the past year for asthma attacks. Five rounds of oral/systemic steroids administered to help gain control of acute attacks. Asthma controller medication has been escalated. Followed by the Asthma Clinic. Letters written by MD to get the landlord to address the issue with no action taken on relocation. Referred to Alameda County Health Department and to Pulmonology at BCHO.

Patient #10: 8-year-old male with ADHD [Attention Deficit Hyperactivity Disorder], possible learning disability and other behavioral issues, here for ADHD med check. Medications don’t seem to be helping at all. Grandmother is legal guardian and having an extremely difficult time working full time (in Martinez) and dealing with all the issues he has at school. (in East Oakland). The school often calls her to come and pick him up or intervene re: his behavior. School threatening  suspensions and expulsions. This is a new school this year, moved from last school for similar concerns. 

Patient has a history of trauma, exposure to violence and abuse. Also being bullied at school. Not involved in any extracurricular activities because of grandmother’s work schedule. Plan to attend emergency IEP update meeting, ensure patient is plugged into therapy. Refer family to the Family Information and Navigation Desk for extra-curricular resources and family support.

*

Next week, Fairyland staff will be meeting with representatives of this Navigation Desk, a program at UCSF Benioff Children’s Hospital Oakland that was created to move beyond a focus on biomedical and risk-behavior explanations of health and toward an understanding of the root causes of health inequities, and to provide a preventive approach to population health.

By ourselves, Fairyland can’t fix social problems like food insecurity and housing instability. But as a community resource we can make an important impact. We provide a safe place and a low-stress experience for kids to just be kids. And we bring families together in a positive environment that encourages connection.

Next week we’ll find out how we can do more to help.

__

C.J. Hirschfield has served for 15 years as executive director of Children's Fairyland, where she is charged with the overall operation of the nation's first storybook theme park.