On Call for Newark 's Teenagers

By Maryann Brinley

When Paulette D. Stanford, MD, was a child, her favorite toy was "The Visible Man," that transparent, biologically-correct, plastic introduction to the organ systems and parts of a human body. "I would spend hours and hours putting that thing together and taking it apart, trying to understand the GI tract, cardiac function, and everything," she recalls. "I always had a knack for science and in high school I took all the advanced courses in biology, chemistry and physics. I loved school, just loved it."

An only child who grew up in New York City, not only has this associate professor of pediatrics at New Jersey Medical School (NJMS) mastered those physical components of human anatomy and physiology, but along the way, she found her own special route into the bodies, minds and hearts of adolescents. As associate director of NJMS's Division of Adolescent and Young Adult Medicine (DAYAM), Stanford, who is a NJMS alum, has been developing life-saving community outreach programs and advocating for Newark's teenagers for more than 25 years. Co-author of Strength for Their Journey, 5 Essential Disciplines African-American Parents Must Teach Their Children and Teens (Random House), she knows these adolescents so well.

"Yes, some of these kids can seem a little threatening at first but if you get them in a room and just start talking one on one, you'll find that they are just like everyone else. They've been heartbroken. They've had a hard way to go in life. They may be angry with a mother or father who didn't pay any attention to them, who took drugs or whatever. You find out that there are a lot of nice kids out there who need some direction and somebody who cares about them."

Stanford is that somebody who cares. With approximately $1 million in grant support, she laughs about how appearances can frighten some adults away from adolescents. "My mother is 80 and I say to her, ''Mom, all teenagers aren't smoking, drinking, into crazy sex, taking drugs or causing violence.'" Impressions, especially those picked up from television or the media, can lie. Stanford and her co-director as well as co-author, Robert L. Johnson, MD, who is also interim dean of NJMS, smile about the type of teen who arrives in their offices, "the big guy wearing the baggy pants, huge shirt, sitting there, looking like he's part of a gang with the scarf around his head. You ask him, 'Are you sexually active?' and he answers quite truthfully, 'No.' Sometimes, what these kids have is just a look. Nothing more," she says.

Of course, many of the teenagers under her wing do have more than a look. They have serious problems. Perhaps Stanford's favorite program addressing these adolescent medical and social difficulties is the Spend Time On Prevention (STOP) program. "I love my STOP program. It was started back in 1996 to test teenagers in Newark for HIV/ AIDS." With a van donated by the Red Cross, Stanford's team started going out into the community to check high risk teens on their own turf, even if that meant arriving in a tough neighborhood in downtown Newark. "The kids weren't coming in to us so we obtained state funds to go to where they hang out and live."

At first STOP focused only on HIV/AIDS testing but Stanford soon realized that expanding the goals only made sense for a community which needed help for other sexually-transmitted infections (STIs) as well as social and physical diseases. When the donated van eventually broke down and a new one was under discussion, Stanford even had the standard recreational vehicle which usually comes with a back bedroom, "retro-fitted to include an examining table and a lamp so we could do pelvic exams right there, as well as pap tests, and clinical breast exams."

Now, under STOP, trained, certified, and bilingual counselors, a case manager, and medical technicians teach, counsel and test for HIV/AIDS, syphilis, gonorrhea, chlamydia, pregnancy, breast cancer and high blood pressure. Funded by the Division of AIDS Prevention and Control in the New Jersey Department of Health and Senior Services, a staff of nine is devoted to "prevention, education and care. We are right there in the community, discovering how many people have no health insurance, in fact, and how many are reluctant to come for treatment because of that. STOP is my baby and what I'm most proud of. Do you realize that we've had adolescents come onto the van who have as many as four to five sexually transmitted diseases?" All information about clients, test results and appointments are kept confidential and the STOP mobile unit also provides service at health fairs, on college campuses and during other community events.

As she speaks, Stanford is working on a grant to obtain funding for a full-time nurse practitioner to do more obstetrical/gynecological exams on the van. "Look at this paperwork," she says. "I have mountains of it and so many deadlines. But we can double the number of screenings if we have someone fully devoted to this."

Also on her desktop are pamphlets explaining other DAYAM endeavors. There are so many that it's easy to see why Stanford is a whirlwind of positive energy. She needs all of it to keep up with POWER (Peer Outreach Workers Educating Risk Takers), START (Screening Treatment and Risk Reduction for Teens), BHI (Brotherhood Health Initiative), YFP (Young Fathers Program), STAY (Support and Treatment for Adolescents and Young Adults), MSSP (Male Student Support Program), STAND (Services Targeting Adolescent/Young Adults Needing Direct Outreach), JUMP (Juveniles Understanding Methods of Protection), PCM (Prevention Case Management) The newest DAYAM initiative is VOICES (tk). "We just received funding to develop this one after seeing how successful it was for African American young people in other urban areas, including New York City ." What VOICES will do is bring kids in from a particular neighborhood for a session where they'll learn about contraceptives, including condoms, and how to negotiate their use. This program will also teach teens how to talk about condoms with a partner and deal with someone possibly prone to violence during such a discussion. She's also looking for funding for her FEMEX program, which offers all sorts of gynecological care and is oriented to young women. "That one makes me happy, too," she says.

Much of what Stanford does professionally makes her happy. In fact, it's hard to imagine that she didn't find her way into this medical specialty right out of college. The mother of a grown daughter -- who is now a lawyer -- Stanford had actually been working towards a Masters/PhD degree in microbiology at Rutgers University 's Cook College of Agriculture before wandering into medicine. After graduating from City College in New York City with a concentration in marine biology, she realized that jobs were going to be scarce and soon followed her love of science into microbiology. "Though I had obtained a Rutgers fellowship for this program, I decided after awhile that agriculture wasn't for me. I was a city girl and betwixt and between at that point in my life." When a friend applied to medical school, she followed suit and soon realized, "This is definitely what I was meant to do." Later, during her first rotation in internal medicine, caring for a 17-year-old patient convinced her that adolescent pediatrics was where she wanted to spend her time.

Back then, pediatricians did not care for patients older than 13 at Martland Hospital (the old UMDNJ-University Hospital ). She explains, "Here was this young girl who had contracted rheumatic fever and was very sick. She had damaged one of her heart valves, needed to be hospitalized for months and had been put on an adult floor. Multiple medical residents and attending physicians -- so many of them were male physicians -- would come to her bedside to examine her every day and make her open her gown. She was very sensitive to this care and would become upset." Stanford, who had been assigned as the medical student on the team, stepped in and knew how to calm her. "We would talk. She had just gotten into Rutgers and was going to miss entering as a freshman. She had also broken up with her boyfriend and felt as if the whole world was coming down on top of her."

The young clinician in Stanford liked the medical part of taking care of this teenage patient but also relished the emotional caretaking. "I liked the psycho-emotional dynamics," Stanford recalls. "That's when I decided to specialize in this area of pediatrics, to read everything I could and to learn all about adolescent psychology." At UH, teenage patients were soon being sent to the young Dr. Stanford. Though there were few formal training programs in existence then, after finishing her pediatric residency at UH, she spent a month caring for teenagers at New York City 's Montefiore Hospital . On her return to NJMS, she became the first fellow in adolescent medicine under Johnson.

"I would love to establish an adolescent health center here at UMDNJ," she says. Limitations on physical space keep Stanford from venturing into additional medical and social missions. In particular, she mentions the critical need to address nutrition and obesity concerns in the urban community. "We get calls for this expertise all the time," she explains. "There are so many overweight African-American teenagers." Meanwhile, her staff is spread out on campus and in different buildings. Yet, one thing is certain: she's definitely in the right place. "What I love most about working for UMDNJ is that I'm here physically in Newark , where there are great needs for improvement in healthcare. This University, and all of us who work here, really are Newark 's champions."