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In summer 2015, two young children were admitted to the OU Schusterman Pediatric Clinic in Tulsa with respiratory complications. This was their fourth visit to an emergency room in the span of one month, despite being healthy before the sudden onset of their symptoms. Sensing that something at home might be putting them at risk, the doctor at the clinic referred the family to the lead attorney of the Medical-Legal Partnership for Children, April Merrill.

Upon investigation, Merrill learned the children and their parents had moved into a contaminated home that just four months before had contained standing black wa­ter—raw sewage. The smell in the home was so strong the children’s mother had resorted to putting Vick’s VapoRub™ under their noses so they could sleep. Trapped in their lease, the father of the children com­mitted suicide after three months living in those conditions, leaving their mother alone with nowhere to turn. Not only were both children diagnosed with asthma, a chronic disease, but they were also faced with the devastating challenge of coping with the death of their father while in a living situation that was threatening their own health.

Unfortunately, this kind of story isn’t un­common in the everyday work of Alizay Paracha, PACS student and intern with the Medical-Legal Partnership for Children (MLPC). As advocates for underprivileged families, the MLPC brings legal represen­tation into the healthcare setting, helping patients navigate complex government and community systems that may hold solutions to social determinants of health. Paracha became involved with the group as an in­tern while pursuing her Master of Preven­tion Science degree.

Thankfully, Merrill and the MLPC were able to use their legal ex­pertise to terminate the lease for the family and have the property condemned. Unfortunately, the MLPC has many other stories just like this one.

The Birth of the Medical-Legal Partnership for Children

The MLPC was founded in 1993 by nationally-renowned pediatrician Dr. Barry Zuckerman of the Boston Medical Center. He found that his skills as a doctor were insufficient to keep his low-income pediatric patients healthy. His innovation—bringing poverty lawyers into the medical setting to address social issues that make children sick—launched this national move­ment. Now, more than 80 partnerships are in place around the nation and the MLPC in Tulsa is the first in Oklahoma. Essentially, through the MLPC lawyer embedded in the clinic, the healthcare team can help patients navigate complex government and commu­nity systems that may be able to help.

“These social determinants of health can be pivotal points at which the community can intervene or implement prevention so that health conditions, especially in children, don’t worsen,” said Paracha. “Examples of cases that an MLPC lawyer come across include income supports for food-insecure families, utility shut-off protection during winter months, mold removal from the homes of asthmatic patients and protective orders and child custody for domestic vio­lence and child abuse victims. Any of these social issues can be potential risk factors for poor health in children.”

“Every professor I have had in this program has given me valuable knowledge that I will carry with me as I pursue a career in med­icine, and the biggest benefit I have gained is that I can directly apply my prevention science knowledge into real-world prac­tice,” she said. “At the MLPC, we directly address the social determinants of health of underprivileged pediatric patients and their families. Identifying and eliminating risk factors that negatively impact physical and mental health of these patients are among our primary strategies in helping people.”

After the case above, Merrill and Paracha initiated their research project, the Hous­ing and Health Inequality Coalition, where they will use geographic information sys­tem mapping to visualize and confirm poor housing and poor health in Tulsa County. They also plan to lead a community re­sponse to outreach, advocate and imple­ment prevention measures so the commu­nity’s health doesn’t continue to worsen.

“The black water experience made us realize that the sub­standard housing issue in Tulsa needed to be identified and ad­dressed at the community lev­el,” said Paracha. “It is directly impacting the health of the res­idents in these poor housing ar­eas, especially the children who can potentially be at risk to poor physical and mental health outcomes.”

Improving the Community

This kind of social activism is exactly why Paracha decided to pursue a career in the field of prevention science. Her concern about healthcare and desire to make a pos­itive change in her community went hand-in-hand with the curriculum in the Master of Prevention Science (MPS), a program that empowers individuals with the knowledge they need to prevent addiction, substance abuse and detrimental behaviors in society, among others.

“Every professor I have had in this program has given me valuable knowledge that I will carry with me as I pursue a career in med­icine, and the biggest benefit I have gained is that I can directly apply my prevention science knowledge into real-world prac­tice,” she said. “At the MLPC, we directly address the social determinants of health of underprivileged pediatric patients and their families. Identifying and eliminating risk factors that negatively impact physical and mental health of these patients are among our primary strategies in helping people.

“My MPS degree is going to benefit me greatly in the future because I will have valuable knowledge in prevention that I can implement into the delivery of ef­fective healthcare. It will complement the knowledge I will gain in medical school and allow me to not only think about the curative aspect of treating a patient, but also the preventive aspect as well. After completing this program and eventual­ly medical school, I plan to be the kind of physician who addresses all health factors when treating patients and works with pro­fessionals from other disciplines to help achieve that goal.”

Beyond the Comfort Zone

Paracha committed herself to the Master of Prevention Science program and succeeded in completing two years of coursework in the span of just one year. She has since been accepted into the OU School of Community Medicine in Tulsa. The road has been long for Paracha, but she says that it has been worth it.

“It sounds cliché, but taking a gap year, earning a Master of Prevention Science and applying for medical school were all things out of my comfort zone and, quite frankly, very scary for me to even think about,” she explained. “But I learned that this was my time to grow as a person by learning from my successes and failures, and I wanted to throw myself into doing something I never imagined. This past year, I started and have almost completed my master’s degree, I ap­plied and was accepted into medical school and I used any free time I had during my year off to travel and spend time with my family and friends.

“This year proved to be the most rewarding year of my life so far and, looking back, it seems foolish to me that I was even a little bit hesitant about it all in the first place. I am now confident I will enter medical school this fall with my prevention science degree in hand and a unique perspective on medi­cine and delivering quality patient care.”