"Breukelen," as its Dutch settlers called it, was just a tiny agricultural village at the time of the American Revolution. Orchards, pastures, market gardens, and a scattering of farm houses dotted the landscape of woods and flat, marshy plains - not unlike the Holland homeland of those first white settlers.
Fast-forward to the dawn of the 21st century and Brooklyn bears no resemblance to those colonial days. Today it has the largest population of New York’s five boroughs, including Manhattan. Its 2.3 million residents represent a true melting pot of customs. First the Dutch, then the English, followed by the Irish, Germans, Poles, Slavs, Scandinavians, Italians, Southern Blacks, East Indians, Puerto Ricans, Asians, Central Americans, Caribbeans and others have all added to the culture that is uniquely Brooklyn’s.
Majestically standing over it all is the Brooklyn Bridge, which since its completion in 1883, has been an icon for the teeming borough. It is "the symbol of our constructive future, our unique identity, in which is also included our scientific hopes and achievements of the future," wrote Hart Crane in his epic poem "The Bridge" early in the 20th century.
The poet’s words describe with clarity the dedication of people who have a sense of vision and mission guiding their work and their lives. Many creative people began in Brooklyn, among them Arthur Miller, Barbra Streisand, Barbara Stanwyck, Woody Allen, Larry King, Isaac Asimov, Walt Whitman, and Richie Havens. In the health field, Margaret Sanger opened America’s first birth control clinic in 1916 in Brownsville, a neighborhood in Brooklyn that was then New York’s remotest and cheapest ghetto. Trying to be of service to immigrant women already struggling to care for the children they had, her clinic was closed down after nine days, and she was sentenced to 30 days in jail. Yet, Sanger continued her crusade, and her work lives on in family-planning clinics worldwide.
Such a sense of mission is a common characteristic among a group of modern-day physicians who practice in Brooklyn. Each day they push themselves and encourage those around them to make headway against the kinds of odds that many others walk away from.
One of a handful of Brooklyn clinics providing comprehensive HIV/AIDS care is the Treatment for Life Center. Sponsored by Brookdale University Hospital and Medical Center in the Brownsville neighborhood, TLC serves a population that is 84.8 percent African American and 13.3 percent Hispanic in a service area of approximately 624,000 people. These are some of the neighborhoods most afflicted with AIDS not only in Brooklyn, but in all of New York City.
While the US Centers for Disease Control reports a declining trend nationally in AIDS diagnoses, and that HIV diagnoses have remained stable, the New York City Department of Health has reported a disproportionate reversal in the percentage of blacks and Latinos contracting HIV and AIDS.
In 1985, of 2,690 living-with-AIDS cases in New York City, 45 percent were white, 32 percent were black, 21 percent were Hispanic and 0.6 percent were other minorities. In 1997, of 35,522 total cases, 24.6 percent were white, 41.4 percent were black, 32.8 percent were Hispanic, and 0.5 percent were other minorities.
TLC estimates about 6,777 adults with AIDS live in its service area. About 800 come to TLC for care, and 1,050 go to two other clinics in the area. That means at least 73 percent of the adults with AIDS are not getting care. The figure is low, according to Adele Flateau, TLC’s outreach coordinator, because the 6,777 is a conservative estimate.
"Part of our effort in the future has to be more outreach and education to reverse these trends," Flateau says.
As Flateau constantly seeks new funding sources to expand TLC’s programs, Medical Director Cheryl Croney works daily with the clinic’s consumers, as they are called, to give them hope.
"The word ’consumer’ has been part of the lingo for a while now," Flateau explains, "because of the idea that a consumer is an educated person, not a helpless victim, who is informed, has choices, and has rights. Here, the patients are very active in the electoral process and in other areas, so ’consumer’ is a much more appropriate name for them."
Following those principles, when Croney enters a relationship with a new consumer, they discuss and sign a contract that delineates when they will meet, what issues they will discuss and what issues are off-limits.
But it takes a long time to get to that contract-signing, Croney says. "This field takes a lot of patience. You have to have the ability to sit down and listen to people. Treatment is very complex, so you really have to understand this person."
"This is not a field where you write a prescription and send the patient on his way. You need to understand the total social and psychological background before you can prescribe them anything. It’s very possible there is domestic abuse or substance abuse involved, and some are homeless, all of which affect the patient’s compliance with taking their prescriptions. You have to understand all of that before you can enter a treatment relationship."
Croney has a staff of four other physicians, plus more than two dozen nurses, social workers, counselors, administrative staff, and other outreach people.
"It requires a very special staff to be able to do this work, and all of us have chosen to be in urban medicine," she says. Croney, 44 and single, chose the field because, as an African American woman who grew up in Brooklyn, "I knew the obstacles to getting good medical care in an urban setting," she says.
"There are a lot of issues in the African American community that contribute to their being afraid to approach the medical community, including the syphilis fiasco, which people still remember. I went into this hoping that when they see an African American doctor, they’ll say, ’Maybe I can believe what they’re saying,’ and I can be their introduction to the system."
Two other Brookdale physicians run programs that are an integral part of caring for the hospital’s predominantly African- American population.
As the chief of Brookdale’s Division of Pediatric Hematology/Oncology, Kusum Viswanathan, MD, established a comprehensive care program for infants and children with sickle cell disease and their families in 1995.
Ira M. Sacker, MD, the director of Brookdale’s Adolescent and Young Adult Medicine department and a well-known specialist in the treatment of eating disorders, has established a support group called H.E.E.D., Helping to End Eating Disorders. He has practices in Manhattan and Long Island where he lives, but he chooses to keep his work based in Brooklyn. That’s because he believes in the 77-year-old mission of Brookdale’s founders, who were primarily Jewish. Their intent was to give the best care possible for a community "notable for the rich cultural, ethnic, and socioeconomic diversity of its people."
"There’s an amazing staff here, and we all look to empower one another, which is rare in medicine," says Sacker, age 56.
No matter where he has practiced, Sacker says, eating disorders have been common throughout his almost 30 years in adolescent medicine. He has worked in Los Angeles, where he did his fellowship at Children’s Hospital, in New York, and in the US Army in the early 1970s. In Frankfurt, Germany, he set up a comprehensive adolescent care facility for GI families, and was commissioned by the White House Special Action Office to design similar programs for other major American military bases in Europe and the United States.
"As a child, I was a compulsive overeater, so I think that’s what makes me more sensitive to people with eating disorders," says Sacker.
When Sacker came to Brookdale in 1975 to develop Brooklyn’s first adolescent medicine program, his very first patient was anorexic. The number of reported cases of anorexia and bulimia is now eight million, up from three million in 1994. "Unfortunately, we live in a society where body image is the number one priority. Women all want to be runway model thin and boys want washboard abdomens," Sacker says.
This message has reached all socioeconomic classes, he says. "Of course, we see it in African Americans, and there’s also a problem in that community of obesity and compulsive overeating."
In religious communities as well, such as the orthodox Jewish community, "you’re dealing with issues in a group of children who have no other way to act out. Food is always there, 24-7, and it’s the one thing they can grab hold of and control," Sacker says.
Like Croney and her work with AIDS patients, Sacker sees his work as "dealing with the whole person." He recommends adolescent medicine to anyone looking for a field more focused than family practice, but who still wants variety. "The field of adolescent medicine is wide open here, and other places too, for eating disorders and other issues young people face as they move into adulthood. It’s a more holistic field that deals with the psychological and psycho-social issues of development."
Viswanathan’s comprehensive pediatric sickle cell disease program grew out of a gradual realization that families needed more than medical treatment for their children suffering from this genetic red blood cell disease. In the United States it mainly affects African Americans and Hispanics of Caribbean descent.
"Initially, I was just giving medical care, but I saw that they needed more comprehensive support, " Viswanathan says. "With a federal grant since 1995, we have been able to provide a nurse coordinator and a social worker for a parent support group and a teen support group to help them with this disease."
Universal screening for sickle cell disease in about 40 states and follow-up studies of patients’ care are showing that in addition to penicillin prophylaxis, adequate comprehensive care may reduce sickle-cell related illnesses and death.
"With a lot of these diseases like cancer and sickle cell disease, the prognosis keeps getting better. I find a lot of joy in being able to offer hope to the families," says Viswanathan.
She came to Brooklyn in 1980, the bride of an Indian psychiatrist who went to New Delhi to find a wife and bring her back to New York, where he was practicing. As she tells the story, they met and were married within two weeks, not a short courtship in traditional Indian marriage arrangements.
As the youngest of six children, her formative years in India were carefully guarded by her family. She entered medical training in Delhi quite naively, her parents never having broached serious discussions about life, death, and dying.
At age 23, when she began her residency in pediatrics at Long Island College Hospital in 1981, Viswanathan believed all
children were raised in the same way she had been. So, not surprisingly, her first emotion was "a feeling of shock" as children from single-parent homes, poverty-stricken children, children whose parents were obviously drug- or alcohol-dependent came to her for treatment.
But that initial feeling soon gave way to the emotion that sustains her to this day. "I discovered there is a joy in doing things for these people."
When her beeper sounds at 2 a.m. with a call from a young patient in the midst of a sickle-cell disease crisis, she calms him, instructs him to go to the emergency room, then calls the E.R. to advise the staff of the incoming patient’s needs. "This is almost a form of worship for me," she says. "It’s not that I don’t pray, but I sometimes feel I don’t have to go and pray because I am really doing what I am supposed to do with my life."
Yael Fuchs began to decide what she wanted to do with her life - and her career - five years ago as she was winding up her time as chief resident in obstetrics and gynecology at State University of New York in Brooklyn (abbreviated SUNYDownstate).
With family in New York City, she focused her search for her first job in the region with interviews in New Jersey, Westchester County, and in the city.
Her efforts netted several job offers, but she didn’t jump at any of them. Conversations with other young doctors kept revealing "horror stories," she says, "promises of partner when you’re hired, and then you’re fired right when it’s time to move into partner."
Then, she made a presentation of her research work as chief resident: the effects of magnesium sulfite in pre-eclamptic patients using intra-cranial dopplers. In the audience were staff members from New York Methodist Hospital who, impressed by her work, invited her to join the hospital as an attending physician. "It just sort of fell into my lap," she says, still a little surprised at how her career has unfolded in these five years in Brooklyn. "I said, ’OK, let’s start this way, and build from here.’"
For three years she was on staff at Methodist Hospital, in which time she launched two satellite clinics and built her own self-confidence. "When I saw I was able to do it, and that the practices were growing, I realized I could do this for me," Fuchs says.
"Nobody puts their shingle out anymore. Nobody thought I should do it, not my friends, not my family, nobody. It was a big step. I took a big chance." With her father, a retired accountant, keeping track of the finances, Fuchs has seen her own practice grow enough that she was able to hire an associate this summer. "I see about 200 patients a week and have about 20 deliveries a month."
She maintains a good relationship with the hospital. Not only does she admit her patients there, she sends her rent check there too. "I’m in a building right across the street from the hospital and I rent from them. It’s worked out very well."
A native of Queens, Fuchs now is at home in Midwood, a neighborhood in the southern portion of Brooklyn’s Flatbush, which the Dutch called Vlache Bos. The Dutch called Fuchs’ community Midwout.
The 36-year-old, single Fuchs bought a one-bedroom co-op apartment there because of Midwood’s strong Jewish traditions. "It’s your average, middle-class neighborhood and it’s the community I wanted. I’m Jewish, so it has the synagogues you can walk to and everything I needed as far as my religion is concerned. It’s a nice neighborhood, it’s safe, and it’s very convenient - a five-minute drive to work when there’s no traffic, or half an hour of bumper to bumper traffic. But that’s New York," she says.
New York Methodist is called the Mother Hospital of Methodism. Founded in 1881, it was the first of 78 United Methodist Church-affiliated hospitals in the United States. It is located in Park Slope, often called the "Gold Coast" of Brooklyn because of its Victorian-era mansions and brownstones. The neighborhood is within walking distance to the Brooklyn Museum, the Botanic Garden, and the main Brooklyn Library. It flanks the western side of the 526-acre Prospect Park, de signed in 1866 by Frederick Law Olmsted and Calvert Vaux, who liked it better than their Central Park creation because no streets divided it and no skyscrapers interrupted the illusion of a rural setting.
Like much of New York, depending on which street you take, Park Slope can have extremely different looks. "It’s more of a middle-class, yuppie community, but it’s also very multi-cultural, very ethnic, depending on which block you’re in," Fuchs says.
Most of Fuchs’ patients are middle-class, although 15 percent of them are on Medicaid. "That’s one of the nice things about having my own practice is I can make the decision to care for someone for free if I want to," she says.
"Absolutely, I have to work very hard," Fuchs says of her practice. "With the HMOs paying less and less for what we do, you have to work twice as hard for half the money. But I really have to say I was lucky the way this has all worked out."
Even in her independent ob/gyn practice, Fuchs faces challenges not every practice would face. She has several patients with AIDS who come to her for their gynecological care. Because she worked with AIDS patients while she was training at Downstate and neighboring Kings County Hospital, she developed a comfort level seeing them. "Some doctors won’t operate on them, but I have no problem taking them into the O.R.," Fuchs says. She does HIV testing in her office (it’s required of all pregnant women in the state of New York).
It’s all part of practicing in this diverse community. These Brooklyn doctors rely on faith in their mission and a drive to help their patients in order to span the challenges they face each day.
Pam Prescott regularly writes community profiles for UO. She is a free-lance writer based in Roscoe, Illinois