Written by Jamie Hoffman-Rosenfeld, MD, Medical Director, Queens Child Advocacy Center
It was Friday morning, the final day of the five-day training program in St. Petersburg, Russia. I was ready early. The driver picked us up at the hotel at 7:30 for the drive from St. Petersburg’s historic heart to the city outskirts where Children’s Hospital #5 is located. I was excited! My colleague, Assistant District Attorney of Queens Lucinda Suarez, and I had been invited to St. Petersburg to train professionals about child abuse. This was a golden opportunity to share with professionals in Russia what I had learned during my 20 plus years working as a member of a sophisticated multidisciplinary child protection team. As an academic Child Abuse Pediatrician working as a Medical Director of the Queens Child Advocacy Center in New York, leading grand rounds – the regular educational gathering of hospital pediatricians –was familiar ground. ADA Suarez and I had already lectured to Russian prosecutors, social workers, policy makers and law enforcement professionals on the New York State child abuse response system. Now was my opportunity to shine on my turf: a children’s hospital.
Lecturing about responding to child abuse is very familiar ground; however, I could not have been more unprepared for the visual and systemic differences apparent in this hospital. In stark contrast to the beauty found in the palaces and cathedrals along St. Petersburg’s Neva embankment, Hospital #5 is colorless; there is no lobby with child-sized couches or play areas, as one would find in an American children’s hospital, and the paint on the walls was peeling. We saw few visiting family members, but, even more surprising, we saw no children. I was later informed that hospitals in Russia stick to the old Soviet theory of infection control, and patient movement outside their rooms is strictly limited. This would also explain the plastic booties that we were given to wear over our shoes. We walked up a dark staircase, littered with used paper cups and cigarette butts. I have to admit, my confidence was shaken. Would my American point of view be welcome? Would my similarities with my audience of pediatricians outweigh our differences?
Before grand rounds, I was given a tour of HealthRight’s Psychosocial Rehabilitation Unit. This model program is dedicated to providing psychological and psychosocial care to child victims of abuse and their supportive family members; the only mental health support available in the hospital. Program staff also work with local authorities and state centers of social services to ensure proper therapeutic follow-up and criminal investigation, when appropriate. Walking into that office was like landing on the other side of the rainbow. The staff had created a comfortable space for child interviews with toys and children’s drawings on the walls; we had gone from shades of gray to color. In that office suite, I felt at home. Of all the meetings that we had during the five-day program, this tiny refuge for child abuse victims demonstrated that a modern child protection movement that values multidisciplinary child abuse assessment has given birth in St. Petersburg.
One of my goals for this visit was to engage professionals, especially pediatricians, in making recognition, reporting and treatment of child abuse within their purviews. Over the ensuing hours, I spoke to pediatricians who seemed to want to avoid recognizing an injury as being from abuse: feet burns might have resulted from stepping in a hot puddle on the street, an infant’s arm fracture could have been caused by crib railings. I was transported back two decades to my early days in the emerging field of Child Abuse Pediatrics. I faced the same professional naiveté, but through the work of professionals dedicated to improving systems to address child maltreatment in the US, there has been a dramatic shift in the understanding of professional responsibility. Evidence of this is the creation of the American board certified field of Child Abuse Pediatrics. I applaud HealthRight for developing this fledgling program, which is currently the only one if its kind in the Russian Federation.
Child abuse (as well as intimate partner violence) is not monitored or legally differentiated from other violence in Russia. Pediatricians are not trained to evaluate patients for abuse, and other professionals working with children, such as teachers, are not legally mandated to report suspected abuse, as they are in the United States. About 20 years ago, I started my work in a program similar to HealthRight’s in the basement of a city hospital in New York. We had no budget but we had the will. I am witness to the fact that change comes slowly but it does come when dedicated professionals provide necessary support….one child at a time.
This program is supported by the World Childhood Foundation, the Boeing Company, and the U.S. Department of State.