Reflections and Thanks: On Receiving WCAAP’s Inaugural Lifetime Achievement Award

Edgar Marcuse, MD, MPH, FPIDS, FAAP

I am so pleased to see our Chapter choose to celebrate advocacy by establishing this annual award. Child advocacy been a core component of pediatrics predating the founding of the AAP in 1930 when 35 pediatricians resigned from the AMA after it sought to repeal legislation that had just created public health clinics for children.

As clinicians  we witness daily effects of our national policies on children’s and their families’ well-being. We have a responsibility to bear witness and then to act! It is not sufficient to decry injustice: we must act! As Abe Bergman often said:  “Indignation without action is froth!

Our advocacy has accomplished a lot: Head Start, Medicaid, car seats, poisoning and burn prevention, newborn screening , helmets, consumer child product safety to highlight a few.  But our nation still allows levels of  gun violence, child poverty, hunger, educational and childcare inequity that few similarly affluent nations tolerate.

We speak of children as our future, but in the US we focus on our own family’s children, and overlook the sad state of many, many children in our communities. Why?

I think the root of our failure lies in our national credo which celebrates individual freedom and initiative: life, liberty, and the pursuit of happiness. Contrast this with Canada’s credo: peace, order, and good government: a call for collaboration and collective action.

The broad societal consensus based on shared values required to sustain public health has eroded. We must find a way to rebuild it and elect leaders who can inspire us to collaborate to achieve lofty goals.

I had the good fortune to enter medicine at a propitious moment. The 1960s were the days of the new frontier, full of possibility, of opportunity. The torch had indeed been passed to a new generation and with it a call for action: recall the Peace Corp, National Health Service Corp, Civil Rights movement.

By serendipity I ended up working in what seems in retrospect an almost idyllic time and circumstance. Children’s was then governed by an all-woman Board dedicated to making state-of-the-art care available to all children in the region, irrespective of their own family’s circumstances. The hospital was largely run by nurses, depended on community physicians’ clinical engagement, and enjoyed incredible community support. Quality clinical care with dignity, education, research and, I believe, child advocacy were Children’s four missions. I was given great freedom as a hospital-based clinical faculty member so long as what I did contributed to the hospital, its educational programs, or the well-being of children in the community.

I went into medicine inspired by the fabled by Microbe Hunters — Pasteur, Lister, Semmelweis — and by the achievements and opportunities in public health then recently evidenced by polio, measles, and rubella vaccines, and the impending eradication of smallpox.

I had the good fortune to be mentored by Russ Alexander at the UW School of Public Health, Abe Bergman, and Jack Docter at Children’s. Excellence in clinical care and teaching was defined by George Ray, Lynn Staheli, Jane Schaller, David Shurtleff, Alexander Bill, Ron Chard, Bob Hickman, and Mike Rothenberg. I was privileged to have such colleagues who exemplified excellence and to work with residents and fellows who were smart, idealistic, and critical, and thereby kept my boat afloat.

To effect change in community required collaboration and the available route for a newcomer was through the WA Chapter AAP. Suffice it to say via the chapter I came in contact with pediatricians throughout the State and then in time the national AAP which gave me opportunity to participate play a role in achieving change.

These activities were outside my assigned clinical and administrative responsibilities, were unremunerative and time consuming, but so rewarding! I now recognize such advocacy and the relationships that evolved from it served as a lifeline to my core values and protected me from burnout: working to change the ground rules, promote and sustain the values I cared about though mentoring sustained me.

Ron Lemire who gave me and so many other much good advice, also gave me some advice I was incapable of following. When I complained to him about what seemed to me at the time as the irrelevance of UW promotion guidelines he said “When you join the Navy you learn the rule book, you don’t try to change it.”  

With time, perseverance, exceptional mentees and collaborators: you can effect meaningful change and promote the values that you care about.

Today the WA Chapter AAP has become far more effective advocate for our State’s children than I ever conceived was possible thanks a succession of outstanding, hard working legislative chairs, wonderfully dedicated, competent, and creative Chapter administration and staff, and committed clinicians across the state. Our voice for children and families is heard in Olympia! The Chapter’s recent work to improve and support the practice of community based primary care pediatrics through initiatives relating to child development, mental health and immunization testifies eloquently to our dedication to our mission.

Cognizant that this is an election year when many candidates will give lip service to child and family issues and too many young voters may opt out: I want to call your attention to a quote from Herbert Hoover: “Words without actions are the assassins of idealism.

I deeply appreciate this recognition.  At  this stage of my life as I reflect on my choices, wise and unwise, successes and failures, opportunities seized and missed, such validation by you my colleagues is particularly welcome. A heartfelt thank you!

2 comments

  1. Christina Pease says:

    Thank you Ed for your forever wise words. You, Abe and Ron kept me reflecting during my chief year and beyond. True mentors passing along the torch of the art and heart of what medicine set out to be. Am finding my path and purpose. I feel more hope and joy now that I have partners in the community and community members in the medical home. Building bridges between educational and health systems so that we can all navigate them more fluidly. Thank you for paving the way. Be well!!

  2. Robert Hauck, MD says:

    CONGRATULATIONS (!!) to my admired colleague of yesteryear.
    Your advocacy for the children of Washington has been remarkable.
    Bob Hauck, MD, FAAP

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