Daniel Rubin: Drexel program tackles invisible trauma of street violence

John Rich , an internist, is a director of the effort.
John Rich , an internist, is a director of the effort.
Posted: August 23, 2010

Every day, on average, a victim of violence is wheeled into the emergency room at Hahnemann University Hospital. He has been shot or stabbed, jumped or clubbed with a bat.

The odds are that he is young, black, and male and has wounds that run deeper than is apparent. A novel program tries to do something about that ugly fact.

When the patient is stitched up and stabilized, Dionne Delgado goes to work.

Her voice is easy, her questions pointed:

Do you have a safe place to go?

Do you know who did this to you?

Do you want to retaliate?

It's likely the patient lies to her.

Each patient is in "such an emotional crisis," as the Jamaican-born social worker puts it, that trust is hard to build. So she talks.

She explains about emotional trauma - how when sleep finally comes, nightmares are to be expected, how he may startle easily, and how his heightened anxiety may take a while to quiet.

Her hope is that a relationship begins to grow, one that lasts long after the patient is released. The aim is to treat all wounds, physical and psychic.

The program is called Healing Hurt People, created in late 2007 by Drexel's School of Medicine. Last year it expanded to St. Christopher's Hospital for Children, where such conversations about safety, pain, and reprisal are conducted with about 25 kids a month.

I sat with two of the program's directors one day last week - Ted Corbin, an emergency medicine physician who grew up in Yeadon, and John Rich, an internist and MacArthur Award recipient who grew up in Flushing, Queens.

"We treat them, we 'street' them - that's pretty much what we did in my residency" in Washington, Corbin said. "But there's also a sense of responsibility we have as health-care providers that we don't want them to come back."

The problem is, they often do come back. Rich spent hundreds of hours following 20 young African American men for a project that became Wrong Place, Wrong Time, published by Johns Hopkins Press last year.

In it, he writes about a conversation with a doctor friend at Boston City Hospital. The friend had saved a man who had been shot. Now the man had been shot again. This time he died.

"We need to do something," the friend said. "These guys just sit up here in the hospital for days recovering. They literally do nothing! They just lie there in the bed. Someone needs to talk to them."

His book's title came from a phrase Rich heard often during rounds that took him from the ER to patients' homes to their workplaces and sometimes their prisons: The person shot was just living his life, the victim of a random act.

The "wrong place," he writes, is a community abandoned, one "divested of the financial and human resources that are needed for the community residents to feel safe."

To make themselves safe, he says, young men do dangerous things. They have to project strength, show they are not "suckers." He likens their aggressiveness to a preemptive strike.

It's the way some kids make their mark. "These kids figure it's the only way people will pay attention to them," he says.

To date, the Drexel team has worked with 100 children, young men, and adults, ages 8 to 30. At the center of the program are 10 weekly group sessions in which victims of violence tell their stories and lean on one another for support.

Rich says once trust is built, it is surprising how many people want help - as much as 98 percent.

He measures the program's success in small and large ways.

"One way would be to ask: Do people get shot again? Do they go to jail?" Rich says. "That's pretty extreme. I would ask: Are their symptoms of trauma better? Has their sense of safety increased? Are they better connected to the resources they didn't have before? School, work, ID cards?

"It's really about helping these people make this moment of trauma not be the cliff they fall over."

Contact Daniel Rubin at 215-854-5917 or drubin@phillynews.com.

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