For many residents of Wilmington, Delaware’s Jessup Street neighborhood, Nemours Children’s Health, Jessup Street is more than a primary care office; it’s a trusted source of support in both joyful and challenging times. That trust and loyalty stem from the dedicated people who work there — we meet two of them in this episode.
Guests:
Hal C. Byck, MD, primary care physician, Nemours Children’s Health, Jessup Street
Shamiya Gould, office manager, Nemours Children’s Health, Jessup Street
Host/Producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you’re here, let’s go.
MUSIC:
Let’s go well beyond medicine.
Carol Vassar, podcast host/producer:
In every neighborhood, there’s a place people know and trust to provide care, advice, and direction in times of need. It could be a church, a barbershop, a school, or a community center. For many residents of the Jessup Street neighborhood of Wilmington, Delaware, that place is a pediatric primary care center whose value to the community goes well beyond the healthcare services it provides.
For three generations of residents of this urban enclave, this Jessup Street clinic has been the place to turn in times of both joy and need, and they never disappoint. The reason that the Nemours Jessup Street Primary Care Center commands such trust and loyalty among local residents is the people who work there, and two of them joined me recently to share the Jessup Street story, a story that both underscores and exemplifies whole child health and whole community health.
Dr. Hal Byck is the Jessup Street lead primary care physician, and he’s been there for 32 years. He knows this neighborhood well. So does Shamiya Gould, the Jessup Street office manager who has family that grew up in this neighborhood. So what is it about Jessup Street that makes it unique? Shamiya Gould, take it away.
Shamiya Gould, Nemours Children’s Health:
I would say that it’s special. You have generations of mother, children, fathers, grandmothers all in one community. Like any other community, it has its highs and its lows, some tragic situations, and also, I would say they care for one another. There’s a lot of people in the neighborhood who know family after family, who can name who lives from one street to the next. They’ve all pretty much grown up together. I think that it’s a resilient community that sometimes could be misunderstood, but deserves a lot of tender love and care.
Carol Vassar, podcast host/producer:
Dr. Byck, I understand you’ve been part of the Jessup Street neighborhood for over 30 years. Give me more.
Dr. Hal Byck, Nemours Children’s Health:
Almost 30 years. Yeah.
Carol Vassar, podcast host/producer:
Almost 30 years.
Dr. Hal Byck, Nemours Children’s Health:
Yeah. 32. Almost 32.
Carol Vassar, podcast host/producer:
Oh my goodness. Tell me your impressions of Jessup Street. What makes it unique to you?
Dr. Hal Byck, Nemours Children’s Health:
It’s interesting from my individual. My plan was to start there and eventually go into a suburban private practice, but I fell in love with my patients. The authenticity, what they gave me, and the relationships that I built from the start, and everything that was formed there just drew me in. And honestly, at this point, I’m dealing with second generation, even third generation. I started with some patients who were 17 years old. I’m now on their grandchildren.
It’s kind of nice, and I’m not the only one. I mean, we have eight providers there. A few are new, but nobody has really left there. We’ve taken care of generations. And now, the newer physicians are coming in, and providers are coming in to take care of their generation. So it’s a place that once you go there, you feel a sense of purpose. You love your job, and it’s not a place you want to leave, at least from a provider standpoint.
Carol Vassar, podcast host/producer:
And from what I understand, it’s more than just coming in, getting a consultation or a well-child visit. There are some elements of a community center here. Give us some history of how the providers and staff and yourself have offered more than just medical care at Jessup Street.
Dr. Hal Byck, Nemours Children’s Health:
When we first started there, I think we wanted to be way more. We wanted to represent the community. We wanted people to come there and be able to get things that you weren’t able to get in other offices. We were really the first office to integrate psychology. So we knew that a lot of our patients weren’t able to go to other places, and the waiting lists were so long, and they also… There might have been problems with trust.
So they trust the office. They trust the staff. They trust their providers. And by extension, they trust the psychologists. So we really were able to build up a huge psychology offering at Jessup Street because of that. We were also the first to have a care closet, where we have a funded care closet for things like diapers, wipes, clothes, formulas. So anybody in need, we can help them at that point.
Carol Vassar, podcast host/producer:
And I want to dive into the care closet and some of the other services a little bit later, but you mentioned a word in here that I think is key to the success of Jessup Street, and that is trust, trust with the community. Shamiya, talk about the trust that’s engendered between the people who work at Jessup Street and the people who come to Jessup Street.
Shamiya Gould, Nemours Children’s Health:
We are very strategic at who we hire. So we don’t just do a typical interview and hire somebody to come in. We know that it takes a special type of person to work at a special place, in a community that deserves your full love, care, and support. You have to have a heart to serve. And so, when we interview, we bring our candidates in. We talk about the things that we offer. We ask specific questions to see how they will react, or facial expressions they may make to patients being late, or having to help a patient who needs diapers, or experiencing a patient who’s homeless or needs food.
We look for people with a heart to serve the community. So it starts with our staff. And then our patients who come in, we do not judge them. If they come in late, we don’t ask questions. They still see the provider. They still get the services that they need. If they come tell us they need food, it’s like no other conversation. We get them what they need. We get them the resources that they need without any type of judgment, and all of our staff are equipped, trained, and have the heart to serve.
Carol Vassar, podcast host/producer:
Dr. Byck, can you expand on that a little bit? You’ve been there, you said, 32 years, staff members building relationships with families to create that supportive environment. How do they do that, and how important is it to your success?
Dr. Hal Byck, Nemours Children’s Health:
I think it’s everything. Right? I think that, ultimately, anytime you deal with a lot of the patients that we’re dealing with, their lives are tough. They are so tough, and it’s exhausting. And some of us do get exhausted to hear story after story and know there are so many stories that we can’t really help them. But yet, what happens is the relationships we build is that of trust. So the fact that they know that we’re there. They know that we’re there for them.
I had a patient once that I took care of from birth. He called me, and this was 22 years later, and he was in the room where a baby was about to be delivered. And the baby, I hear the baby crying in the background. He said, “Hey, Dr. Byck, I just want to make sure. Are you going to be there? Because I want to bring my kid to you. I want to make sure my kid sees you, too.” I said, “Absolutely.”
So, I mean, that’s the kind of relationship. I think we all do that, and that’s why all the providers have stayed, because they build up those same relationships. I’m just telling you my own stories, but they all have stories of their own, some wonderful stories, some extremely tragic stories. There’s a patient who, I was there. When their child was shot, I was the first person they called. It’s not because we had the most special bond, because that’s who she thought of.
She thought of somebody within the community, somebody who knew her kid, who knew how good her kid truly was, and she needed to speak. They’re the kind of relationships that we built. And now, especially with Shamiya there, the staff has built the same thing. The turnover rate in the staff has gone so low. And honestly, in the 30 years I’ve been there, it’s never been this low, and that’s because Shamiya has built up a staff that truly has the heart, and she has made them into a family, and I give her all the credit in the world for that.
Carol Vassar, podcast host/producer:
Shamiya, how have you done that?
Shamiya Gould, Nemours Children’s Health:
We have challenges. When our metrics are low, instead of looking at it as a bad thing, we look at it as a way to get better and challenge each other to be at our best. We celebrate our small wins. We dance in the hallways. We love on a patient, and we just have a good time. It’s not always perfect, but we support each other, Dr. Byck and I. We do a lot with the staff. When things don’t feel so great, we make sure we have lunch. We find ways to celebrate even when things aren’t as great.
Carol Vassar, podcast host/producer:
What are some of the biggest challenges faced by the families that you see, Shamiya? I’m going to ask you the same question, Dr. Byck. But Shamiya, go ahead.
Shamiya Gould, Nemours Children’s Health:
Access to resources, or just the same care, because of their barriers. So when I say access to resources, housing. We have some families who are struggling to make ends meet, and there is a lack of resources right now in our state, and we’re seeing that. We’re seeing a lot of families who are struggling to buy food and provide for their children. They’re making decisions, “Do I buy diapers, or do I buy food?” So that’s why we have things to help with their struggles.
When they go to other places, they’re being looked at or judged, and they don’t feel comfortable, so they don’t go to those appointments. So that’s why we try to make sure we call ourselves like a one-stop shop. If we can draw the blood, we’re going to do it. If we can make that appointment for you, we’ll do it. We can set up that transportation so you can get a ride there. We’ll do it. So we try to decrease their barriers and provide the care at our office so that they know what it feels like to be loved.
Dr. Hal Byck, Nemours Children’s Health:
Yeah. I mean, to expand on Shamiya, because Shamiya said it well, I think a lot of patients, especially those who don’t have the means, that literally might be working two jobs while their kid goes to school and not have somebody to babysit a child who might have to go from the mother to maybe the father, to the grandmother and grandfather, and is overweight, because at each of the homes, they’re trying to support him.
And it’s a matter of so many of our patients, and so many of the patients are misunderstood, or they’re often categorized or put into a box, because it’s just easier for people within the system to do that. What we try our hardest to do, and that Shamiya alluded to, is really keep judgment out of it. And by doing that, I think they come in and they feel safe. There’s a safety. About 20 years ago, there used to be a question on a questionnaire, “Do you feel safe in your office?” And everyone thought, because of some of the crime around our area, that we would be low.
And out of all the offices at the time, we were always the highest. And at first, I didn’t understand, but I do understand, because it is a place where our patients, no matter where they live. They feel safe coming in. There’s a safety when they come in. They’re not being judged. They’re not being looked at any different, and I think that’s the beauty. And I think there is a feeling when they’re not able to take their asthma medicine, that someone’s… They feel a little bit condemned sometimes or feel like, “Well, you’re not taking good care of your child.” And I think that’s what we are really trying to get away from at Jessup Street.
Carol Vassar, podcast host/producer:
Do either of you have any family stories, patient stories, without going in too deeply, because we don’t want them identified publicly, that you can share of success based on the services provided by your wonderful staff at Jessup Street?
Dr. Hal Byck, Nemours Children’s Health:
I mean, I can think of a few. There’s been so many little stories. And sometimes when there are so many, it’s hard to think of anyone. But there was a family years ago who their house burned down, and two of the little children… In fact, Mom was holding the hand of one child, let go, and she couldn’t find him, and she lost two of her youngest children, and she lost everything. And the office at that point rallied together to get them all new clothes, all new pots, pans, and really helped them start again. So they looked at us as the people who can help them through this.
Carol Vassar, podcast host/producer:
Shamiya, you’re nodding your head. Any stories that you’d like to share?
Shamiya Gould, Nemours Children’s Health:
I think one that particularly sticks out to me is a great-grandmother who, unfortunately, had to step up and take custody of a brand-new infant baby. And instead of calling the social worker or the state, she walked into our office, because we’ve taken care of her grandchildren and her children. So she came into the office. She said, “I just got this brand-new baby. I don’t know what I’m doing. They gave me this can. I don’t know what this is. I don’t know how to make it. This baby is crying. I don’t even know where to start. What should I do?”
And every single staff member just like, “I’ll do this. I’ll do that,” and literally show her how to make the bottles. We had little pre-made bottles that we had from samples. We provided her with the pre-mades. And so, she had it down pat. She came in a couple times. It’s like, “I think I’m ready to make these bottles.” Showed her how to change the diaper, because the diaper was on backwards, and we made sure she had clothes, blanket. We ordered a stroller, and she just was so excited.
She was just so happy. She felt so supported. She would call and ask questions like, “This baby is screaming. Should I come in for her appointment? I don’t know. Tell Dr. Byck to call me.” She just was so happy, and she’s like, “This is the first place I thought of. I’m going to come there. I got this baby, just picked it up. I’m going to come to Jessup, because they’ll know what to do.” To me, that defines Jessup.
Carol Vassar, podcast host/producer:
Do you think that the work that you’re doing at Jessup Street impacts the health and wellness of the surrounding community, Dr. Byck?
Dr. Hal Byck, Nemours Children’s Health:
I think it does. There’s just so much more that needs to be done in order for you to truly see a large impact. So there is some impact, there is no doubt. And you know what? Sometimes there’s even just those moments that they know somebody that the system does work for them, and I think that’s one thing that we give to them. We often give them a sense that a system that’s often stacked against them. There are some elements that will work for you, and that’s what we hope to give.
So, do we make an impact? I think we do. For instance, in the summers, we have a church in Jersey, who collects the extra vegetables from the farms and delivers it, and we go and we pick it up from them, and we give it out to our patients. Is that making them healthy? No, but it’s a start. It tells them that we care, and we’re here to give that to you. So it’s little things like that. It’s having a breastfeeding counselor in the office so that anyone who is breastfeeding they go in. They talk to them.
Not only do we have a full-time breastfeeding counselor, but two of our medical assistants are trained to be breastfeeding counselors. So even when they’re getting vitals, they could be talking about breastfeeding, helping them out, encouraging them, because so many of these moms are young. And in the olden days, maybe about 10, 15 years ago, they wouldn’t be breastfeeding, or they’d stop after a week or two, and now so many are breastfeeding. So in that way, we have made a huge impact. So I think if you look at certain pockets, absolutely. I think in a whole, the system is just so overwhelming, and sometimes it’s hard to see.
Shamiya Gould, Nemours Children’s Health:
To piggyback off of what Dr. Byck said, I definitely agree we are making an impact, and I do think there’s room to grow and improve and continue. I do want to talk about our block party. So we’ve had a block party for a couple years. And just this last block party, I took a moment and looked around and seen that we had a lot of older members out from the community, a lot of younger members from the community, mid-aged.
And so, taking that in and just looking around and seeing all of the people who came to support and come to get resources, and enjoy the festivities, and learn about healthy and health wellness, and get their blood pressures checked. We had grandparents, checking their blood pressure and checking their vision. So when you look at that, yes, that is impactful. Yes, we did make an impact. But, of course, we definitely could do more. There’s room to grow. But ultimately, we try to impact as many as we can, and at least that’s the start.
Carol Vassar, podcast host/producer:
What more would you like to do, Shamiya? If you had all the resources in front of you, what else would you like to do?
Shamiya Gould, Nemours Children’s Health:
The whole city of Wilmington would have access to resources, right? Not only the whole city, but maybe the whole state. Doesn’t matter what your socioeconomic background is. Doesn’t matter if you have transportation or not. Doesn’t matter if you live in a shelter or if you live in a multimillion-dollar home. We would all have access to our resources. Everybody would be able to eat and not have to worry about food. People would have the clothing that they need. Kids would come in with jackets and hats and gloves when it’s cold, and socks. So just providing the simple things that we think is simple is a lot to someone who’s struggling to provide that for their children.
Dr. Hal Byck, Nemours Children’s Health:
I absolutely agree. I mean, obviously, that’s on a very large scale, but I agree. We have to get rid of some of the blocks, some of the barriers that go well beyond what we do, and that’s always going to be a struggle. Right? So we’ll keep pushing. We’ll keep fighting. There’ll always be a fight in us at Jessup Street, I promise you that.
Carol Vassar, podcast host/producer:
I want to circle back to some of the services that you provide. We talked about the care closet, which provides diapers, wipes. I don’t know if you have food in there, but it sounds like you might have food in there as well. Talk about some of the other unique services.
Dr. Hal Byck, Nemours Children’s Health:
We actually have a facility dog. So we worked hard to get a facility dog. He’s right now sleeping on the couch, because I’m not at work, but I take him home most of the time. One of the nurses takes him home, and he really is helpful. He goes in the room, helps kids who are maybe more anxious. We actually once had a child who was attacked by a dog in a parking lot and had huge scars, went to the emergency room, came in, and we helped him to acclimate the dog, who’s very, very gentle, and helped him be less scared.
So he really has been helpful. I can’t tell you how many patients come in and they say, “Where’s Talon?” And they go in and they pet him, or we bring him in the room, or he sits on the exam table with them while they’re getting the exam. So it’s little things like that that make the place somewhere that people want to go.
Carol Vassar, podcast host/producer:
Are there legal services there as well?
Dr. Hal Byck, Nemours Children’s Health:
So basically, we have medical-legal partnerships, and I would say the predominant ones are housing. But if there are housing issues, we can hook them up with legal, who can then help address some of those housing issues. It took us a while. We fought for, I would say, 15 years to get a social worker. And finally, we were able to get a social worker. And through that social worker, we’ve really been able to connect to the community. Unbelievable. We’ve been able to do our job while she’s been able to really help us connect in a way we weren’t able to do before we had her.
Carol Vassar, podcast host/producer:
I want to talk about and learn more about the learning opportunities that you provide for medical students and residents at Jessup Street. Dr. Byck, can you talk about that a little bit?
Dr. Hal Byck, Nemours Children’s Health:
Actually, I would say, when we started there in the early ’90s, we’ve had medical students, and that has grown throughout the years, and it’s been actually a very popular place for them to come, because we really integrate them. We have third-year medical students from Sidney Kimmel or Jefferson. We also have fourth year. We also started, about two years ago, a health equity elective where they actually… So they go into the community, but they also work within the office with psychology, with the office manager, with the social worker to see the different roles that each play in the health of the child.
So we have been having a lot of learners, and then we also have residents, and we’ve had residents there for the last 30 years, and we actually are now part of… It’s called HELA Track, Health Equity, Leadership, and Advocacy Track, and it’s a track. There’s about two or three residents a year, and they actually will be coming more frequently to help see patients down there and actually come up with quality improvement.
We have talks every week on some health equity topic, and they do quality improvement to help… We’re working now on obesity and whether we should be using things like Wegovy, and how do we get our patients access to it if they fit? So things like that. Teaching has been a very valuable part of what we do, because we hope that by them coming down, they can now pass on when they go to work. They could maybe have the same passion that you see with the staff and the providers who are down there now.
Carol Vassar, podcast host/producer:
I’m curious how you see Jessup Street fitting into Nemours’ broader mission of whole child health. Shamiya.
Shamiya Gould, Nemours Children’s Health:
I see Jessup fitting in and I would say helping define just what we talked about, all the things that we think about to make sure that we’re providing good care. And we know that when we provide good care, moms feel impacted and dads feel impacted or confident to parent. So we don’t say, “You need to do this to be a better parent.” But once they talk to the doctor, once a mom talked to the breastfeeding counselor, once a mom says, “I don’t have diapers,” then she just get them without being judged.
She has the tools and resources to go home and parent. Right? She feels confident in the advice that the doctor gives, knowing that she can come in and see the doctor right away, or knowing she can call and get the same-day appointment. She can talk to her provider about whatever they need to and don’t feel judged, and feel comfortable just relaying information that maybe she wouldn’t feel comfortable talking to someone else about, and getting those resources and those tools so that they can return and provide that to the child.
And once the child has what they need, it will help them succeed. So I think just eliminating just the small barriers that we don’t think about and giving them the tools and resources and loving on them just a little bit more, they feel more confident when they go home to parent.
Carol Vassar, podcast host/producer:
Dr. Byck, from a clinical perspective, same question. How does Jessup Street fit into that broader mission that Nemours has of whole child health and well beyond medicine?
Dr. Hal Byck, Nemours Children’s Health:
Yeah. I mean, I think you say clinical, but in a way, it’s all clinical. Right? And this might be nonclinical, but I think one of the things, our next step that I’d love to see us work on is feeling like there’s a more of a sense that even though we’re in the community, that we’re part of the community, not from the patient standpoint, but from the other community resources.
So maybe developing partnerships and relationships with more people who are there also to help, I suppose, to having these individual… We think of ourselves as a medical office with all these other services, but where do we fit into the broader picture of the community? And I think that’s something I’d like to see us in the future integrate better.
Carol Vassar, podcast host/producer:
But it sounds like you have some of those partnerships already in place, or else you wouldn’t have been able to do all that you’ve done so far.
Dr. Hal Byck, Nemours Children’s Health:
Correct. We have medical-legal, but I still think like local churches. I think there still could be a relationship, especially some of the places in the community where the patients go, where they have trust, et cetera. I’d like to see a little bit more of that in the future.
Carol Vassar, podcast host/producer:
Which actually leads to one of my last questions. This is a neighborhood. Neighborhoods change. They evolve over time. How do you anticipate Jessup Street and the practice that you have there changing over the next five or 10 years to meet the changing needs of the neighborhood? Dr. Byck.
Dr. Hal Byck, Nemours Children’s Health:
In all honesty, it’s putting everything we’ve said so far together, making it more organized, making it more structured. Right? I think there’s a lot that we do, but the question is, can you put it in a more structured way to help it move forward? Right? So it’s understanding everything you do, and what else do we have to do past that? It’s so hard to know, because medicine changes. Right?
So, if I look five, 10 years ago, everything was about a medical home. Value-based medicine didn’t… I don’t want to say it didn’t exist, but I never heard of it. And now, it’s all about value. So medicine will change, and I think one of the things that Jessup is very good at is adapting to the changes in medicine as we understand them. So, as we hear Larry Moss’s mission, it’s now, how do we help to carry that out? What do we do to continue to carry it out and to carry it out further? So it’s understanding what is out there, what way medicine is going, and how do we become a part of it or even a pioneer.
Carol Vassar, podcast host/producer:
Shamiya, same question. How do you see the practice changing in response to the neighborhood’s needs?
Shamiya Gould, Nemours Children’s Health:
I ditto everything Dr. Byck said. Just staying up with the times, right? There was a time that we didn’t have a text phone for patients to text patients and remind them of their appointments, and now we do, because people text more than calling. They’ll answer the text and say, “I’ll be there,” but they won’t answer the phone call. So, just trying to keep up with the times, offer more within the Nemours app. So I think we’ll just continue to adapt and adjust, and our staff will keep up with all the latest and the greatest, and keep educating Dr. Byck and I, and our patients will continue to tell us what the new lingo is, and we’ll keep adapting.
Carol Vassar, podcast host/producer:
Shamiya Gould is the office manager for the Jessup Street Nemours Primary Care Center in Wilmington, Delaware. We also heard from Dr. Hal Byck, the lead primary care physician for the Jessup Street clinic.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
The Jessup Street clinic is one example of how whole child health is already at work in communities across the nation. Maybe you know of more that we can highlight. Let us know by leaving a voicemail on our website, nemourswellbeyond.org. You can also send an email with your idea to [email protected]. We’ll be checking our email and voicemails regularly, and we hope to hear from you soon.
You can also visit nemourswellbeyond.org to find past episodes of our podcast, subscribe to it, and leave a review. And don’t forget, the podcast is available on your favorite podcast app and the Nemours YouTube channel. Our production team for this episode includes Cheryl Munn, Susan Masucci, and Lauren Teta. Join us next time as we learn what whole child health means to the man who’s leading the charge to bring it to full fruition, Nemours’ president and CEO, Dr. Larry Moss. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
MUSIC:
Let’s go well beyond medicine. well beyond medicine.
