Beginning with weekly strategy meetings over coffee and bagels in 2004, Dr. Margaret Siber, a retired pediatrician, has been integral in shaping the success of Health Leads. At a time when Health Leads was first beginning to encounter and navigate the challenges of connecting patients with essential resources in a fragmented healthcare system, Dr. Siber would meet with our founder, Rebecca Onie, to provide insights and guidance from her deep experience serving medically and socially underserved children. From launching a student-run storefront health clinic in Montreal (recently celebrating its 50th year!) and several decades as a pediatrician to her volunteer work today reading with and to kindergarteners in a school on the south side of Chicago, Dr. Siber has always striven to ensure all children are given the opportunity to thrive. Her support was essential to shaping Health Leads into the organization it is today. We were incredibly fortunate to get to ask Dr. Siber a few questions about her journey with Health Leads and her extraordinary medical career. Here’s just a snapshot of the wisdom she shared.
Why do you continue to contribute to Health Leads?
If I were to try to design a program that exactly mirrored my concept of the promotion and provision of health and wellness, Health Leads would be the result. I support Health Leads because of its holistic approach to health.
What led you to first connect with Health Leads?
While I was a second-year medical student in Montreal, I joined six other classmates in launching a student health organization, (SHO), in Pointe St.Charles. The clinic was student-run with supplies donated by teaching hospitals and our teachers would regularly come down to the clinic to see patients. One of my roles was reaching out to all our professors and asking them to give some of their time to the clinic. I remember being so nervous AND so surprised by how quickly they said yes. I’m so proud of the fact that what started as a storefront clinic in a low-income neighborhood in Montreal, became the flagship medical clinic of the Quebec healthcare system, now known as Clinique Communautaire de Pointe St.Charles.
The children served by the clinic were small, undernourished, and in need of far more than addressing their illnesses. Their needs were both medical and social. For the first time in my education, I realized that medical and social needs could not be separated. It was a real “eureka” moment for me.
Many years later, back in Boston, I was introduced to Rebecca Onie by a good friend Judith Kurland. Rebecca would often bring coffee and bagels to my condo to discuss the many ramifications and challenges of running the clinic at Boston Medical Center (formerly Boston City Hospital). These conversations enlarged the vision I had had while establishing the Pointe St.Charles Clinic. I felt like my involvement with Project Health was destined to happen.
What were some of the challenges you and Rebecca wrestled with in the early days of Project Health? One of the many conversations I had with Rebecca that sticks in my mind was about the importance of data collection and metrics. We both understood that documenting and publishing outcomes would be crucial to shifting the healthcare sector towards addressing social needs and changing the conversation about health. Many outcomes could be recorded – the number of patients seen, diagnoses, use of the Help Desk while at a clinic visit, follow up by student volunteers – the challenge was computerizing all the relevant data to track over time. At the time they were just laying initial plans to digitize the data. It is amazing to me that what started as simple data collection has gone on to become the Reach platform and is now informing new data partnership efforts. Data collection and analysis are critically important in determining the most productive medical/social practices for improving health.
What inspired you to pursue a career in medicine?
Unlike most physicians, I cannot pinpoint the exact time or event that inspired me to go to medical school. I had no direct role models in my family or community. Looking back, however, there were many people who influenced my eventual decision. My high school biology teacher, David Smith, first sparked my interest in biology. He had a way of teaching students about the human body that was both fascinating and encouraged exploration. I went on to become the first person in my family to go to college – studying biology and chemistry at Bishop’s University in Quebec.
Shortly after college, I moved to Vancouver looking for adventure and ended up working as a nanny for the young family of Dr. Lehman, an orthopedic surgeon. Dr. Lehman was a quiet, kind man with a reassuring demeanor. He became an inspiration to me as a doctor and I was honored when he wrote a letter of recommendation to me to medical school.
A second physician whom I met in Vancouver, Dr. Kenneth Nickerson, had an enormous impact on my decision to become a physician myself. Dr. Nickerson was an extraordinarily respected physician who always took the time to get to know his patients as people, not just medical conditions. He was incredibly supportive of my decision to go to medical school – facilitating my taking of the MCATs and writing letters of reference for me.
To my great excitement, I was accepted into the McGill Medical School Class of 1970 – one of only ten women accepted to the program that year!
What are some of the inequities you still see in the healthcare system? What excites you about the future of healthcare?
It’s almost impossible to ignore the roles that race and racism play in the inequities of our healthcare system. Through my volunteer work, reading to kindergarteners of color in Chicago, I have become acutely aware of the violence that young black children may witness in their neighborhood. The families of these children may be deeply suspicious of white people and whiteness. Also, too often I see a person of color whose presence is unacknowledged by privileged white people. Through these personal experiences since I retired, my understanding and consciousness regarding systemic racism has evolved. I have become very concerned about accessibility, or lack thereof, to the health care system. I’ve learned how important it is to have conversations with persons of another color – and not letting the fear of saying something wrong keep you from speaking. I’ve learned that the best thing to do is apologize if I accidentally cause harm and to learn from those experiences. It is essential that all health care providers, POC or white, clearly acknowledge the worth and humanity of all persons. The feeling of invisibility due to race, income, or education is disempowering and impacts the ability of a patient to navigate the confusing health care system.
I also worry about women’s experience of healthcare. The US infant mortality rate is higher than that of any other similarly developed country. A low-income woman may not see a physician until she is pregnant and only at her first visit will she discover that she has undetected high blood pressure, kidney disease, or another serious medical condition that could be detrimental to not only her health but also the health of the fetus. And that is only if she has access to the healthcare system. There are so many obstacles to receiving care – from scheduling appointments, travel, finding a doctor, insurance questions. If you don’t have someone you know to show you how to make these connections it can be incredibly confusing.
I am very concerned about the lack of awareness and the shamefulness that still surrounds discussion of sexual abuse in healthcare. Statistics are very hard to come by but approximately 20% of girls and 8% of boys under the age of 18 experience some form of sexual abuse which results in long-lasting trauma and has an enormous detrimental effect on health and wellness. The #MeToo movement has highlighted the pervasiveness of sexual harassment, abuse, and rape. Health care professionals must address the possibility of sexual abuse on every health and wellness encounter, allowing children and teens permission and encouragement to feel comfortable in revealing sexual abuse. Such discussions are still considered taboo in too many healthcare discussions. We need to get to a place where sexual abuse is not only destigmatized but where it is documented in health records and where providers feel comfortable discussing these experiences.
However, I think we do have an opportunity at this moment to rethink how local organizations work together and allocate resources to improve health outcomes. I have every confidence that Health Leads can lead the way.
Through her relentless commitment to improving care to underserved children, Dr. Siber has truly redefined what it means to deliver quality healthcare and transformed thousands of lives. THANK YOU for helping to create a world in which every person, regardless of their zipcode, can live with health, well-being, and dignity.