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P&S Journal

P&S Journal: Fall 1994, Vol.14, No.3
Clinical Advances
The Medicine of Prevention

To understand the motivation of Dr. Barbara Barlow, Harlem Hospital pediatric surgery chief, a visitor need look no further than the words posted on her office wall: "A hundred years from now, it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove. But the world may be a different because I was important in the life of a child."
And modern pediatrics, to Dr. Barlow, means window guards, safe playgrounds, art classes, and sports programs. By developing programs that teach community kids about safety and nurture their talents and by fighting for and building safe places for kids to have fun, she and colleagues have reduced the number of children admitted to Harlem Hospital for major injuries by 42 percent since 1988.
That was when she started the Harlem Hospital Injury Prevention Program (HHIPP) with a four-year Robert Wood Johnson Foundation grant that provided $150,000 a year in support. In the early 80s, she noticed an alarming increase in children's trauma cases entered into a registry started in 1975, the year she arrived at Harlem. "We decided we had to do something about it." Dr. Barlow has monitored intervention effects by using the trauma registry, which documents injured children admitted to Harlem Hospital, and by tracking hospitalizations of 90,000 children who live in northern Manhattan.
Harlem Hospital is a Level I trauma center with a pediatric trauma service to care specifically for children-mostly African-American and Hispanic-who have injuries resulting from car accidents, window falls, sports, and stabbings and other assaults. Children with trauma usually stay hospitalized for seven days at $1,000 a day.
Dr. Barlow targeted window fall prevention in 1981. With help from Harlem school health clinics and Harlem Hospital's pediatrics department, parents received literature about obtaining window guards from landlords. In the late 70s, an average of 12 Harlem children fell from windows each year. Their chances of dying was one in four. Today, 95 percent of Harlem families have window guards and, at most, one child falls from a window each year. The "Children Can't Fly" program of the city's Department of Health reports that falls decreased from 200 to 20 a year citywide following introduction of prevention activities similar to Dr. Barlow's.
That was only the beginning. "Although we were educating children about window guards and safety, there were no safe places for them to play and few free activities," she says. Enter HHIPP. Dr. Barlow and co-workers documented the relationship between dangers in Harlem play areas and injuries to children there. Then HHIPP campaigned for renovation and enrichment of the play areas and created programs for community children to develop their talents. "We formed a coalition of community-based organizations, block associations, and government agencies also interested in improving community kids' lives."
Dr. Barlow proudly shows loose-leaf binders with pictures of almost 20 Harlem playgrounds before and after makeovers partially or completely supported by HHIPP. Dirty, dangerous, and drug-infested play areas now are covered in murals and brimming with flowers. The mural theme at P.S. 197 is Harlem children growing up and reaching out into the world through education. It has images of the Apollo Theater, the North Pole, Yankee Stadium, a rain forest, and Hawaiian volcanoes.
Dr. Barlow gives tours of Harlem Hospital's displays of art created by young artists from HHIPP's Harlem Horizon Art Studio, where children are nurtured to explore their own artistic vision, not one based on traditional aesthetics. Many of their works have sold for $600 to $3,000 in Manhattan galleries. Dancers in the HHIPP's Dance Clinic performed in France and Canada this year. In 1993, HHIPP added an urban youth bike corps. Besides learning about safe racing and bicycling, the kids learn how to repair bikes, a potential job skill. Other extramural programs supported by HHIPP include the Harlem little league, soccer, winter baseball, and a gardening program.
New HHIPP programs are aimed at preventing and coping with violence. Kids, Injuries, and Street Smarts (KISS) is a junior high school curriculum taught by city Emergency Medical Service paramedics and technicians. KISS interactive exercises address basic first aid, the dangers of guns, and the signs and symptoms of stress related to violence. Critical Incident Stress Management helps kids and adults handle stress symptoms following a violent incident. The Harlem Alternative to Violence trains adults and adolescents in conflict resolution techniques that could prevent violence.
Like the theme of the P.S. 197 mural, Dr. Barlow's program is now reaching out from Harlem. The Robert Wood Johnson Foundation awarded Dr. Barlow a $1.14 million three-year grant to replicate her injury prevention program in other U.S. cities. Programs in Atlanta and Pittsburgh are in organizational phases. Groups in Kansas City, Chicago, New Haven, Baltimore, and Oakland have expressed interest.
HHIPP also has been supported by George Steinbrenner, Columbia Community Service, the Texaco Foundation, the Rudin Foundation, and the New York State Department of Health.
More support is always needed. "We have four more playgrounds to build, and what we do is never enough."


copyright ©, Columbia-Presbyterian Medical Center

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