P&S Journal: Winter 1998, Vol.18, No.1

	Dr. Margaret Heagarty: Advocate for Harlem's Children By Kristen Watson Dr. Margaret Heagarty is not afraid to challenge people, herself included. A leading researcher of pediatric AIDS and the effects of cocaine abuse in unborn children, Dr. Heagarty, director of pediatrics at Harlem Hospital Center, has dramatically improved the lives of children in her community and beyond.
Whether a newborn infant afflicted with crack, a child injured in the playground, or an otherwise healthy child in the Harlem community, Maggie Heagarty has been an advocate for each and every child, says Dr. John Driscoll, chairman of pediatrics at P&S and director of Babies Children's Hospital Growing up in West Virginia, the daughter of a doctor who worked in the coal fields, Margaret Heagarty had no idea she would one day become a doctor herself and serve one of the sickest urban populations in the United States. After medical school at the University of Pennsylvania and a residency at St. Christopher's Hospital in Philadelphia, she accepted a fellowship in child health at Harvard, followed by a position as director of pediatric ambulatory care at New York Hospital-Cornell Medical Center. Dr. Heagarty became director of pediatrics at Harlem Hospital in 1978, inheriting a department with a neonatal mortality rate more than three times the national average, a demoralized faculty, decayed physical surroundings, missing supplies, a shortage of nurses, a glut of administrators, and no money.
Slowly, Dr. Heagarty began to change what she could, first by recruiting young and eager faculty who were attracted by her determination and vision then by reorganizing the delivery of child health care in the neighborhood. She introduced modern neonatology to the hospital and neonatal mortality soon dropped to a rate comparable with New York City as a whole.		Dr. Margaret Heagarty received one of three Ronald McDonald Children's Charities Awards of Excellence in 1993. Also honored that year were Fred Rogers of "Mister Rogers' Neighborhood" and Dr. Gerald Clark Yost, who spent 32 years with the Indian Health Service to improve the health care for native American children. The award honors dedicated individuals whose pioneering work has made an outstanding contribution to the lives of children. Dr. Heagarty donated her $100,000 award to the pediatrics unit at Harlem Hospital Center.
"In the early to mid-1980s we found these problems on our doorstep, and they had to be dealt with. The cocaine epidemic also resulted in an escalated amount of violence and trauma. Now the cocaine problem has moderated, but HIV continues to be a problem. Despite the hospital's location, high drama emergencies are not the only kind of cases she sees.This is a community hospital, says Dr. Heagarty. We see a full range--good and bad, hilarious and tragic. I used to compare it to 'Hill Street Blues,' but I guess that's outdated now. That show was about a ghetto precinct made up of devoted people. Harlem Hospital is a community hospital in every sense of the word. It is the largest employer in Harlem, and the majority of employees also live in the community and work at the hospital for an average of 20 years or more. Everyone seems to know one another in this warm and friendly environment.
Dr. Heagarty says the hospital is not looked upon as an equal by other hospitals because it is a community hospital even though, she stresses, "the faculty of Harlem Hospital Center are faculty of P&S. The research and services are not performed in a laboratory and will not win Nobel Prizes, but they are serious attempts to resolve serious problems. Any kind of medicine in an urban environment requires committed, caring people who care about the least fortunate of the population, says Dr. Barbara Barlow, professor of clinical surgery, chief of pediatric surgery, and a close friend of Dr. Heagarty's (the two doctors shared an office when Dr. Heagarty first came to Harlem). Harlem Hospital physicians are paid very little in comparison to physicians elsewhere, says Dr. Barlow.No one works here for the money: The motivation is totally different. Dr. Heagarty believes that growing up poor is the greatest danger to the children in her community (the median annual household income in Harlem is $8,000). "With poverty comes substandard housing, poor education, and a lack of access to health care. What's Mae West say? 'I've been rich and I've been poor--rich is better.
A Forte for Finding Resources Dr. Heagarty's forte is navigating the channels of negotiation and obtaining funding for community programs. In addition to keeping the pediatrics service in order, she has managed to assist in putting together and maintaining a school health program, a network of five neighborhood satellite health clinics, an injury prevention program, and a group home for HIV-infected children. Without the in-school and neighborhood clinics, the majority of children in the community would not receive medical attention because most do not have insurance. Thanks to Dr. Heagarty's help in obtaining grants, for example, Dr. Barlow received $1.2 million from the Robert Wood Johnson Foundation for her injury prevention program, designed to change the physical and social environment for children in the community by creating safe play areas, getting drugs off the playgrounds, and giving kids a place to go and creative things to do. The program maintains a bicycle shop in which kids build and repair their own bikes, an art program, a dance program with a troop that performs around the world, a Little League, 18 safe playgrounds (with three more being--or about to be--built), in-school seminars, and a pregnancy prevention effort. Incarnation Children's Center is a former convent converted into a group home for HIV-infected children. (See sidebar.) She is accepted as a member of the 'good old boy' network," says Dr. Barlow, explaining Dr. Heagarty's negotiating skills. "The male powers that be treat her as one of them. A Gifted Storyteller With 96 published articles to her credit (and counting), one might say Dr. Heagarty has a gift with words.She writes beautifully, Dr. Barlow says. She'll tell you it's her Irish genes; she claims to be related to James Joyce.She is also an effective and inspirational public speaker, which she proved as a guest speaker at the Central Park memorial for Princess Diana last September. Dr. Heagarty met Princess Diana when she visited Harlem Hospital's pediatric AIDS unit in 1989 and again in 1995. In her speech, Dr. Heagarty noted that the Princess of Wales was " . . . one of the first to draw attention to the problems and needs of those with the disease both in her own country and here, adding that she "picked up, cuddled, and embraced the children at a time when most were afraid to even be in their presence. Feet Planted Firmly in the Hospital Although Dr. Heagarty is well-known in her field and appears before Congressional committees regularly, her feet remain planted firmly in the hospital. She is a member of numerous state and national medical organizations and has received many awards and other prestigious recognition for her work, including a Second Century Award from Harlem Hospital Center (1990), a Martha May Eliot Award from the American Public Health Association (1994), honorary doctorates from Iona College (1989) and Yale (1995), the Ronald McDonald Children's Charities Award of Excellence ($100,000 for the Harlem Hospital pediatrics unit, 1993), and a Distinguished Alumna Award from West Virginia University School of Medicine (1997).		A Doctor and a Princess Make Wishes Come True Dr. Heagarty credits Princess Diana, shown below in 1989 during her first visit to Harlem Hospital's pediatric AIDS unit, with calling attention to children with AIDS. Dr. Heagarty paid tribute to Princess Diana at a memorial service in Central Park last fall. In the mid-1980s more than 60,000 children needed foster care, a social problem brought on by the rise of poverty, AIDS, crack, and the abuse and neglect of children. A large number of these children also had HIV and became "trapped on the wards" in the city's hospitals. Some of their parents were too sick with AIDS to care for their children or had died from the disease, some were homeless, and others were junkies. At the time, HIV was still a big mystery; potential foster families worried about catching the disease from the children and a stigma was attached to the disease that most people thought only homosexual men, drug addicts, and prostitutes could get. Many of these children were left in hospital pediatric wards for lengthy stays, while doctors and nurses acted as surrogate parents. Dr. Margaret Heagarty, director of pediatrics at Harlem Hospital Center, proposed small community-based homes for children with HIV. With the help of the Archdiocese of New York, Columbia University, philanthropist Jack Rudin, and others, ICC opened its doors in March 1989 in a former convent for the Incarnation Church in Washington Heights. The collective wish at ICC was that through education about HIV, potential foster parents would overcome their fears of the disease and the children would be taken into homes instead of spending years at the group home. Fortunately, something serendipitous happened one month before ICC opened: Princess Diana visited the Harlem Hospital pediatric AIDS unit and pictures of her cuddling a sick child were published throughout the world. The rate of recruitment of foster homes for children with HIV went from almost zero to a surplus of interested families. ICC placed 160 children--approximately two-thirds of the homeless HIV-infected children in New York City--in foster homes in its first two years. Now ICC functions more like a nursing home, housing only children who are too ill for foster home placement. The child care workers at ICC are mostly Dominican women from the Washington Heights neighborhood. "These women are all about love and nurturing children, says Dr. Stephen Nicholas, associate professor of clinical pediatrics and director of ICC. "They give the children quality care." But Dr. Nicholas stresses that ICC is not primarily a hospice: It's a place where children live until they are well enough to be placed in a home setting.
Somehow, with her foot in so many projects, Dr. Heagarty manages to step out of the picture once programs are put in place and allows others to take the reins. She is a true leader, not a manager. Dr. Heagarty updated the hospital's neonatal unit before Dr. David Bateman, assistant clinical professor and attending in pediatrics at Harlem Hospital, came on board and then passed the responsibility on to him.She rarely sets foot down here anymore, Dr. Bateman says. She allows me to run things in neonatal. Dr. Heagarty has an ability to mobilize the energies and talents of others--as much as she uses her own--to fulfill her vision.