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Treating root causes

Boston Medical Center volunteers try to solve social and environmental ills that damage health

Dr. Sean Palfrey talked with Wistha, Roges, and Roberta Noel at the Boston Medical Center. He was referring them to Health Leads, which runs family help desks that prescribe services instead of medicine. Dr. Sean Palfrey talked with Wistha, Roges, and Roberta Noel at the Boston Medical Center. He was referring them to Health Leads, which runs family help desks that prescribe services instead of medicine. (Bill Greene/Globe Staff)
By Akilah Johnson
Globe Staff / February 22, 2011

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After 2 p.m., the pediatric floor of Boston Medical Center comes alive with a flurry of activity.

Giggling toddlers dart in and out of exam rooms, dressed in little more than socks and miniature hospital gowns. Babies cry in protest at the prick of vaccination shots. Resident doctors recount the particulars of a patient’s condition to attending physicians.

But a small set of desks just off the elevator is as an oasis of calm. There, volunteering college students whisper into phones and quietly talk to patients in an effort to provide nonmedical “prescriptions’’ for such things as food, clothing, and child care.

“Health care is not simply treating colds and treating asthma,’’ said Dr. Sean Palfrey, lead pediatric clinician at BMC. “There are obviously things affecting their health that are not doctor issues.’’

The volunteers, from a nonprofit called Health Leads, are attempting to address the social and economic underpinnings of medical problems at a hospital where 75 percent of the patients use the state’s low-income health insurance program, MassHealth.

Students ensure houses are heated in the winter, help hungry families apply for food stamps, and prod landlords to clean up moldy apartments that can trigger asthma.

Health Leads, founded 16 years ago in Boston Medical’s fifth-floor pediatric department as Project HEALTH, is a national endeavor working in pediatric and prenatal clinics, emergency rooms, and community health centers in six cities. Its mission: to help low-income families tackle the environmental and social issues that contribute to their health problems.

More than 13,000 children visited BMC last year, and hospital officials said they expect the number to increase this year by about 20 percent. To respond to the growth, Health Leads officials in Boston said they plan to increase the number of volunteers, add more staff, and improve access to the patients’ electronic records.

Katie Miller, a sophomore at Harvard studying human evolutionary biology, has volunteered with Health Leads since last year and considers herself an advocate for patients.

“Just having someone who’s on your side is important,’’ she said.

The volunteers are often familiar faces when families return to the doctor, as was the case last week with a single mother of three from Mattapan. The woman works 10 hours a week as a certified nursing assistant but doesn’t make enough money to support her three children. On this visit, they referred her to a job agency. In November, the program helped her receive utility assistance and food stamps while double-checking her status on a subsidized housing waiting list.

“She’s been on since 2003,’’ Miller said.

Miller said she has always been interested in health care. Working the Health Leads desk and shadowing the doctors has turned her interest into a passion, she said.

“There is so much more than writing a prescription for a certain drug in medicine,’’ she said.

The doctors agree. Palfrey, examining a 2-year-old with a sore back, lets the toddler play with a plastic bear and horse while the doctor pokes and prods. Palfrey also inquires about things at home after asking about the boy’s physical condition. This boy’s family did not require nonmedical help — his mother has a job, and his grandmother helps with childcare. But many do need more than medicine.

“One out of four or five families might’’ get a help desk prescription, Palfrey said.

About 60 percent of patients referred to the help desk resolve their issue within 90 days of getting the referral, according to Health Leads.

But just as some patients don’t fill their medical prescriptions, some also don’t follow through on their help desk recommendations.

Roges Noel said he and his wife, Wistha Noel, didn’t need the prescription for “school’’ given to them by Palfrey for their 6-year-old. The family was at the hospital so Roberta could get a tuberculosis vaccine. She spent the past year in Haiti and was there with her mother at the time of last year’s devastating earthquake.

Noel said he hopes to soon enroll Roberta in first grade in Medford, where the family lives, and came to the doctor’s office in part to get the physical exam required for school enrollment. The Noels plan to return to the hospital in about three weeks, because Roberta has a hernia that needs monitoring. And when they do, the doctors will again ask about more than Roberta’s medical issues.

“We ask them every time,’’ Palfrey said. “How are things going? Do you have any needs?’’

Akilah Johnson can be reached at ajohnson@globe.com.