Beyond Public Health, Pit Bulls, and Pimps: Lessons in Trauma, Adverse Childhood Experiences, and Hope

OUTTisdaleClinicDocs21460By: Gerard Clancy, MD, professor, Department of Psychiatry, University of Oklahoma School of Community Medicine, and president, University of Oklahoma, Tulsa

In my recently published Academic Medicine commentary, “Understanding Deficiencies of Leadership in Advancing Health Equity: A Case of Pit Bulls, Public Health and Pimps,” I described my evolution in developing relationships with a community in need, as we built the new Wayman Tisdale Specialty Health Clinic in north Tulsa over more than a decade. I have now been caring for patients in an adult psychiatry clinic since we opened 20 months ago. The clinic is located in the heart of north Tulsa, where there is a 14-year difference in life expectancy compared to the more southern parts of our city. This area was previously devoid of specialty care and had very limited access to primary care. As we developed the plans for the clinic, the north Tulsa citizens clearly let us know that they wanted more than health care from the University of Oklahoma. They wanted new jobs and economic development. In this post, I describe how we continue to learn the important roles a university can play in urban revitalization at the broadest and most personal levels.

The business community and the City of Tulsa prioritized the location of our clinic for additional investments as a new “health corridor.” A new private primary care clinic and new retail businesses have opened across the street. A mobile grocery store uses our parking lot, providing access to fresh produce to our neighbors. A Community Development Corporation has been formed with plans for a grocery store, restaurants, and apartments. New streetscapes and street lighting will soon be in place. Our clinic serves patients from hundreds of miles away; they bring new revenue into north Tulsa as they visit us and the established and new businesses nearby.

Yet, the personal lesson for me has been how difficult of a life my patients have lived in a poor urban neighborhood. I am a seasoned psychiatrist with years of experience with the homeless mentally ill, homeless because of the biology of their severe mental illness. But in my clinic I see something different–significant mental illness and medical disease caused by an adverse environment. In our clinic, I care for a great number of women with personal and family histories of physical and sexual abuse and gun violence. Many have suffered from clinical depression, severe anxiety, and post-traumatic stress disorders for years. For a great majority, I am the first psychiatrist they have ever met. Alongside these trauma-induced brain disorders, there has been a great deal of self-medication for their psychiatric difficulties with methamphetamine for depression and opioids and benzodiazepines for anxiety and insomnia. As noted by Vince Felitti and Robert Anda in their work associating the degree of Adverse Childhood Experiences with higher rates of chronic medical diseases in adults, my patients often present with a common set of conditions–hypertension, diabetes mellitus, migraines, and back pain.

My work in our clinic is fulfilling at many levels. I am thrilled that our clinic has been a contributor to economic development in a community with great need. For me, the greater rewards have been at the personal level. Our patients show grit, are appreciative that we are trying to makes things better, enjoy working with our students and resident physicians, and are improving clinically. Even more powerful, initial reports from our county health department demonstrate improvements in cardiovascular, diabetes, and infant health across all of the north Tulsa zip codes. Maybe we had a small hand in that.

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