Administering “A Miracle”

Georgia Armstrong remembers standing in a long line wrapped outside an elementary school one Sunday morning as a child. She was waiting to receive the new polio vaccine. It came delivered on a sugar cube.

“[Back then] kids were getting polio like crazy, I mean people were keeping their kids home from school, didn’t let them go swimming,” she says from her office at People’s Community Clinic. “And then the vaccine came out and everything changed.”

Armstrong, R.N., oversees the clinic’s Immunization Program, which controls the clinic’s inventory of Advisory Committee of Immunization Practices (ACIP) vaccines and monitors when PCC patients are due for a dose. In 2013, 17,157 immunizations administered last year, the majority to children under age 5.

“We have a strong program,” Armstrong says. “We have all the vaccines that are recommended for everybody. “We just want to make it our standard of care for best practices to prevent what’s preventable.”

Armstrong, immunizations staff, and volunteers, have streamlined the tracking system that alerts PCC providers when patients are due to receive vaccinations. Although the City of Austin does not have a compliance system in place, PCC strives to exceed national compliance rates for youth and adult patients. Adult patients requires a bit more finesse than younger patients because they do not follow a vaccination schedule dictated by age.

“It’s also disease and health indications of when they would need a certain vaccine or not,” Armstrong says. “That just takes some time, but we’ll get it figured out.”

The walls of the adult exam are decorated with posters of individuals blistered with shingles, an infection caused by the chickenpox virus that commonly affects patients over age 60 and those with suppressed immune systems. Armstrong launched a PR campaign to get more adults eligible for the shingles vaccine to get it and avoid what could potentially be years of pain. Beside her desk hums one of six refrigerators containing vaccinations. Fastened to the front is a clip from the Austin-American Statesman about last year’s flu season. She makes sure to stay on top of flu vaccinations for PCC staff too.

“I like the whole prevention idea,” Armstrong says after fastening a Band-Aid on her interviewer. “Sometimes you realize that you spend a lot of time [working] with health education and then [patients] leave the clinic, light up their cigarette and drive through Popeye’s and buy some fried chicken. But when you administer a vaccine you know you’ve done it – you’ve put protection in ‘em right there. You go … next! And that appealed to me.”

Georgia Armstrong, RN, PCC’s Immunization Supervisor
Georgia Armstrong, RN, PCC’s Immunization Supervisor

 

Armstrong recalls elementary school classmates who came down with polio. As a nursing student in the 1970s she became friends with a woman was one of the longest polio victims to live with the assistance of an iron lung. She encountered a child that had to be tube fed because of brain damage he sustained from a haemophilus influenza type B (HIB) infection.

“It was just awful. He was like a vegetable,” Armstrong says shaking her head. “Vaccines can prevent that type of thing. It’s incredible what we have. People say, ‘Don’t stick my baby so many times!’ I say ‘Hallelujah there’s that many sticks. More sticks means more protection … Vaccines are just miracle drugs, they really are.”

Her tenure at PCC began in 1993 as an employee of the state’s Shots for Tots program, which she ran out of the clinic once a week. Armstrong was hired on at PCC a year later to run its walk-in clinic. At the time, the clinic did not have a vigorous pediatric department.

“If there were five Well Child Checks in a week’s time it was kind of amazing,” she says. “Things have changed a lot.”

The clinic now has a robust pediatric department and four times as many employees. Over the years Armstrong has noted changes in the mindset of community members—namely, those who are electing not to vaccinate their children from diseases that have largely disappeared from the United States. This decision reduces the community’s herd immunity, leaving individuals who haven’t been vaccinated due to age, allergy, or illness vulnerable. That’s why Armstrong is vigilant about vaccination.

“Some kids can’t get vaccinated,” she says. “Some kids may have a very suppressed immune system so even if they are vaccinated, it doesn’t produce the antibodies needed to protect them from the disease. It’s not just about you, it’s about everybody you’re around.”

Last year an outbreak of the measles occurred in the Fort Worth and this summer in Austin, a Hepatitis A scare arose. Pertussis, also known as whooping cough, is making a comeback in Texas as well as in California. Some parents still question whether or not the MMR vaccine causes autism after a 1998 paper by Andrew Wakefield linked the two. It has been proven to be false many times since, but doubt lingers. Armstrong sees her role as an educator who can point people with questions to reputable sources and help them make more informed decisions about vaccinations. She wants them to be afraid of the things they should be afraid of: preventable diseases.

“We have to figure out how to make them unafraid,” she says. “I think some parents also aren’t familiar with the diseases. They haven’t seen them in their lifetime and so they’re more afraid of the vaccine than they are the disease. They don’t really understand the risk-benefit ratio, whereas, someone older like myself … I personally have four friends that have polio because the vaccine wasn’t available. They don’t remember that that’s exactly how it was when I was little with polio … People should be in line to get these vaccines.”

-KM

The Case for Oral Hygiene

This toothbrush has orbited the moon.

Astronaut Michael Collins brought it aboard Apollo 11 in 1969 in his Personal Preference Kit, a small bag of personal items each astronaut was allowed to carry on the lunar mission. Perhaps even more impressive is the impact this plastic device has made right here on Earth. While chewing sticks appeared thousands of years ago as a form of oral hygiene, the modern bristled toothbrush we recognize today wasn’t manufactured in the United States until the late 1930’s when DuPont de Nemours debuted a model with nylon bristles. (Previous versions were made with boar hairs found on a hog’s neck.)

Even with advances in toothbrush technology, brushing didn’t became popular in the United States until after World War II when returning soldiers brought the good habit back with them.  Routine tooth brushing has helped reduce the prevalence of periodontal disease, also known as gum disease, in adults since the early 1970’s. However, despite the incorporation of tooth brushing into our everyday lives, periodontal disease is common in American adults aged 30 and older.

A recent study by the Centers for Disease Control and Prevention found that nearly half (47.2 percent) of this population have some form of periodontal disease. The prevalence of periodontal disease increases with age—over 70 percent of adults aged 65 and older have it. And disparities do exist. Men are more likely than women to have gum disease, as well as current smokers, and those with lower socioeconomic and education levels.

Perhaps you are thinking if periodontal disease is so common what’s the big deal about it? Well, it’s a bacterial infection of the mouth tissue caused when a sticky plaque builds up around the teeth. In its early stage gingivitis, your gums may bleed and become swollen and red. Ever floss and notice some blood on the string? That’s an early indicator. Once the infection becomes more serious, a stage called periodontitis, your gums can actually pull away from teeth, creating pockets where bacteria can gather. Eventually, your teeth may loosen or even fall out. But that isn’t the only reason to brush and floss every day.

Around the time Collins donated his toothbrush to the National Air and Space Museum in 1984, medical studies revealed periodontal disease is associated with cardiovascular disease. It appears Collins had his priorities in order when he piloted the trip to the moon. Some studies have shown a 19 percent increase in the risk of future cardiovascular disease. While a clear link remains to be identified between heart disease and periodontal disease, scientists believe the connection may involve the role inflammation plays in both diseases.

In August, the American Journal of Preventative Medicine published a study showing that patients suffering from periodontal disease, as well as chronic conditions such as diabetes, that received frequent follow up dental treatments, accrued lower medical costs and required fewer hospitalizations afterward. In other words, it paid to take care of their gums.

The researchers write that treatment of periodontal disease involves cleaning above and below the gum line. While routine dental visits are important, a healthy habit of brushing and flossing, and microbial mouth rinse are helpful, too. The bottom line is invest in a good toothbrush. Use it often and correctly. It may not take you to the moon, but it will let you keep your smile for life. Unlike George Washington, who spent much of his adult life afflicted with inflamed gums and wearing ill-fitting dentures.

-KM

Photo credit: Eric Long, National Air and Space Museum, Smithsonian Institution

Sources:

Vettore, M. V. (2004). Periodontal disease and cardiovascular disease. Evidence-based dentistry, 5(3), 69-69.

Dave, S., & Van Dyke, T. E. (2008). The link between periodontal disease and cardiovascular disease is probably inflammation. Oral diseases, 14(2), 95-101.

Jeffcoat, M. K., Jeffcoat, R. L., Gladowski, P. A., Bramson, J. B., & Blum, J. J. (2014). Impact of Periodontal Therapy on General Health: Evidence from Insurance Data for Five Systemic Conditions. American journal of preventive medicine, 47(2), 166-174.

A Place to Call Home

Everyone seems to know the creation story: People’s Community Clinic began in the basement of the Congregational Church of Austin in 1970. It was a humble operation. A few evenings each week, a volunteer staff of physicians and health providers delivered free healthcare to patients who otherwise couldn’t afford it. Patients wrapped around the side of the church waiting to be seen, and volunteer doctors and staff stood on the sidewalk shaking coffee cans for donations to keep the clinic afloat. This is not that story. This is the story of Reverend John Chesley Towery—the man who gave PCC its first home.

His story begins in Corydon, Kentucky five decades earlier. Towery was born March 25, 1926—the older of two sons who would one day become ministers. After graduating valedictorian of his high school class in 1943, Towery attended the University of North Carolina and joined its V12 Naval Reserve Officers Training Corp, an accelerated program designed to produce naval officers for the war effort. He was commissioned at graduation in 1946, and afterward served as an ensign on the USS Nantahala, a tanker that replenished fuel for ships in the Pacific theater.

One might think of the Nantahala as a service ship that played a support role as it delivered the fuel and cargo others needed to do their jobs. Crew members worked tirelessly as they traveled throughout Japan, the Philippines, the Malay Peninsula, and along the coast of China refueling ships. Although the war had ended during Towery’s service, the devastation from it had not. Viewing the damage likely influenced his career path, wrote longtime friend Mel Oakes.

Upon returning stateside he used the GI Bill to attend Yale Divinity School where he received his Masters of Divinity. He was ordained in 1950 and accepted a position as minister of the Mount Holly Christian Chapel in Amelia, Ohio where he met and married Eleanor Ruth Morgan that same year.

Together they served in churches in Ohio, Idaho, and Wyoming before a position opened at the Congregational Church of Austin in 1959. It would be Towerys final move and where their three children Joseph Chesley ‘Ches’, Sally, and Mary were raised. It was also where Reverend Towery pressed for his congregation and community to build a culture of inclusion—regardless of the color of one’s skin, their sexual orientation, politics, or poverty. For Oakes and his wife Pat, that message of inclusion is what drew them into the Congregational Church in 1964. The Oakes moved to Austin from Tallahassee where they had stopped attending church in Florida due to segregation policies. A visit to the Congregational Church of Austin proved different.

Reverend Towery worked to upend segregation policies in Austin. He demonstrated against segregated movie theaters in Austin. He drove to Huston-Tillotson University each week to invite students and faculty to attend church services—actions that would later prompt the university to award him with an honorary doctorate for his involvement in the civil rights movement.

“John had a special affinity for those people who were closed out of society because they were poor, or troubled, or discriminated against because of prejudice,” Oakes said during a recent memorial service for the reverend. “John opened the church’s doors to troubled youth and invited them inside to be cared for in a ministry called The Raft. And through his personal involvement in the civil rights movement, his personal commitment to desegregate Austin, John helped open up the doors that were closed to people because of the color of their skin … John’s unflagging support of gender equality and gay rights enabled the church to be a haven for many that felt un-welcomed in many other churches at that time.”

As a child, Mary Towery, now Mary Masters, didn’t realize the impact her parents had on their church and their community. Part of it is because Reverend Towery was her father, and partly because he and her mother lived what they preached. Her dad had the ability to challenge the status quo without being confrontational; he had a soft touch that was effective when dealing with hard issues. And they operated as a team. Just as her father helped push through programs in the church like the Raft, it was because he had his wife’s support and energy to do it, Masters said.

Her parents approached the world with open arms and hearts. They impressed upon their children the importance of fairness, openness, and equality, she said. “It wasn’t just something they preached form the pulpit on Sunday. They lived it.”

The Towerys applied the same open door policy to their home as well as the church. Occasionally the family took in people who needed one. Part of this is likely the influence of her mother, a foster child herself, Masters said. Sometimes for the Towery children this meant sharing rooms as well as a home.

“I don’t remember it being hard because it was always filled with love,” Masters said.

After starting the Raft program, which provided shelter to homeless teens who needed it, Reverend Towery offered did the same for those who needed healthcare. He saw that people in the community were in need and offered the basement of the church to the People’s Free Clinic who were working to address it.

“He was the type of minister who felt that the church should not just be used on Sunday,” Masters said. “My father fought very hard for [the clinic] and wanted it to be a success. He never dreamed that it would outgrow the church, or outgrow the clinic where you are now.”

Growing up, Masters often helped clean rooms in the church for potluck events and would open the refrigerator to find it stocked with medications and syringes as well as leftovers. Sunday school rooms were flanked by examining tables stashed behind curtains.

“It was all so fascinating to me,” she said. “It was the real world and as Christian it made you realize that this is what it’s supposed to be about.”

Alicia M. Jarry, one of PCC’s earliest volunteer providers, recalls how Reverend Towery’s invitation to house the clinic in its basement allowed thousands of people, including pregnant women and homeless individuals, access to care.

“I remember so clearly his involvement in expanding our services and allowing us to use the upstairs sitting area to have counselors give health information and advice to those who could not receive it elsewhere,” she said. “He was part of the health care team that included many doctors and nurses who worked as volunteers or for low wages to serve this population. He understood the mission of this alternative style of health care to teach patients about their health problems and advocate for them in the complicated health care system.”

And his impact on PCC continues today. One impressionable 8-year-old never forgot the lessons she learned in the Towery household. Robin Rosell, PCC’s director of social services, was childhood best friends with Mary (Towery) Masters. Reverend Towery used to drive the girls to middle school events and later to high school football games. He was a master gardener and had a plot in one of the city’s community gardens. He routinely sent friends and neighbors home with fresh produce.

“He planted literal seeds and so many other seeds that are continuing today,” Rosell said.

Towery was the type of person who didn’t assume a locked gate meant no entry, he just looked for another way over. And when he spoke, Rosell listened.

“I heard him tell the stories of the very beginning [of People’s Community Clinic],” she says from her office on the clinic’s second floor overlooking I-35. “He always talked about People’s. He was very proud of what had started there … He was a bit of a Renaissance man. I think growing up watching somebody who put his beliefs into action and did so much good in the community, it was inspiring. I thought that is the type of person I’d like to be.”

She remembers the lines of people waiting to be seen at the clinic, when Lucinda Williams still played on the drag. In PCC’s early days there was no air conditioning, there weren’t even exam tables available. Over time, the clinic acquired an air conditioning unit and eventually grew so large it had to move out of the church basement. Rosell grew up too.

She studied special education teaching and later social work as a graduate student at UT Austin. If she had a hard day she headed for the Towerys. And she never went to the front door. She knew the couple would be sitting in the back of the house and head straight for it.

Nearly 19 years ago Rosell saw a job posting in the newspaper seeking a social worker at a “fast-paced community clinic.” There was no name listed for the clinic. She applied anyway. When Rosell was called for an interview she learned it was at PCC. After being offered the job she picked up the phone.

“The Towerys were the first people I called,” Rosell said smiling. “It kind of felt like I had grown up.”

Reverend Towery led the Congregational Church for 30 years. He died November 28, 2014. Eleanor passed away March 3, 2014. They were married 63 years. A celebration of Reverend Towery’s life will be held January 18 at 11 a.m. at the Congregational Church of Austin located at 408 West 23rd Street.

-KM

 

A Light Touch

Before clinic hours begin, Dr. Richard Peavey can be found reviewing the day’s cases in the workspace he shares with other PCC physicians and nurses on duty. He’s wearing his traditional uniform: button down dress shirt, bolo necktie, and stethoscope draped around his shoulders. Ten patients are on his schedule.

“It’s going to be a busy day,” he says, picking up a metal clipboard before heading into the hallway.

Peavey understands busy. He began practicing medicine in 1977 and came to People’s in 1999 after spending two decades working in urgent care, general practice, and occupational and rehabilitation medicine. He saw it as “a chance to see the other side of care,” he says.

Peavey earned his medical degree at the University of Texas Southwestern Medical School, and since 2003, he has served as PCC’s director of adult medicine. Most of the patients he sees battle at least one chronic health condition such as diabetes or heart disease. For them, there is no easy fix, no Band-Aid solution, but rather, continual management of their illness.

However, even patients with the best intentions can wind up in the emergency room when familial or work demands trump obligations to monitor their own health. At PCC, a network of support exists to help patients stay on top of their disease. One of those institutional supports is Dr. Peavey. He makes sure he spends time building trust with his patients so that together they can prevent symptoms from spinning out of control.

“All humans deserve the same dignity,” Peavey says, “and part of that is being able to take care of their health.”

Peavey practices medicine with a light touch. When a diabetic patient confesses he’s lapsed in testing his blood sugar as often as she should, Peavey refrains from lecturing. He doesn’t try to guilt the man into action. Instead, he touches the man’s feet to test his circulation. He asks about the man’s family. Peavey listens to what’s really going on in his life. He explains how diabetes affects the blood vessels in the body, often constricting the vessels of the eyes and feet. Then Dr. Peavey focuses on the path forward. A nurse will start calling the patient daily for his numbers to get him back on track.

Fear is a lousy motivator for long-term behavior change, Peavey later explains in his office. There are myriad reasons people don’t follow through with treatments. Never assume anything about a patient’s motivations or the obstacles that they may face.

“I try to encourage people with the prospect of living longer,” he says. “The most important thing with patient care is empathy. That’s not sympathy—it’s just walk a mile in someone else’s shoes. And don’t judge.”

In between patient consultations, Peavey and a volunteer hematologist discuss a mysterious case she hasn’t yet solved. A nurse pops in with a question. A PCC employee shadowing him for the day asks a few more.

“There’s an art and science to practicing medicine,” Peavey explains. “As a young doctor I focused more on the science. Now, perhaps more on the art.”

The art he displays during every patient encounter that day. He isn’t sure how one visit will go. The patient recently won a battle with cancer, but the last few months haven’t been easy. She has chronic pain. Peavey gently knocks on an exam room door before entering. The elderly patient perched on the table gives him an update.

“I’m trying to stay upbeat,” she tells him, her voice wavering. “There’s just a lot of stuff piling up on me.”

Dr. Peavey places his hands on her shoulders. She takes a deep breath and visibly relaxes. She smiles into her tissue.

“I respect what you’re going through,” he says. “It’s good to see you smile.”

-KM

A Universe Within

Space. It was supposed to be the final frontier of discovery. On October 4, 1957 the Soviet Union launched its satellite Sputnik, kicking the race for supremacy of the skies between the United States and USSR into full throttle. Advances in space technology enabled humankind to walk on the moon, send dogs into orbit, and successfully land rovers on Mars. One could say we’ve come a long way.

But it turns out space wasn’t the final frontier. Over the past few decades, scientists have increasingly turned inwards for exploration. In the 1980s and 90s, mapping the human genome to unlock the mysteries of our DNA became the next big target. The Human Genome Project was an international effort spearheaded by the National Institutes of Health and U.S. Department of Energy to sequence the human genome as well as species such as fruit flies, influenza, and mice. It concluded in 2003 with the successful mapping of the human genome—a feat geneticists compared to the moon landing.

The journey inside continues. In 2008, the Human Microbiome Project was initiated to understand how the trillions of microorganisms such as eukaryotes, bacteria, and viruses found in and on our bodies affect our health. The human body contains about ten times as many microbial cells as human cells. Think about that for a second. By a cellular count, we are comprised more of microbes than ourselves. And the microbiomes in our gut are as individual to us as our fingerprints. Some of these strains we inherit at birth, others we gather over the years through diet. So does this mean health is more of a reflection of our genes or of our microbes?

The Microbiome Project aims to find out how these tiny microbial communities living (and thriving) in our nasal passages, urogenital, and gastrointestinal tracts work to keep us healthy, and how we might manage them to treat disease. For example, some microbes have been found to produce vitamins like folate in babies. However, separating and culturing individual microbes for study in experimental settings is largely impossible because many can’t be isolated for analysis. This is believed to be because they require specific environments for growth we haven’t been able to replicate in a lab setting.

The workaround this problem is metagenomics. Microbiologists use DNA sequences of microbial communities to analyze these populations in their natural habitat and compare them to strains they can isolate for a clearer picture of the roles they might play in our health. Understanding how these communities operate to protect against inflammation and infection could lead to advances in how physicians treat patients with debilitating conditions such as Crohn’s Disease.

Microbial samples were collected from 242 healthy adult men and women between the ages of 18 and 40 for the project. So far more than 1,300 reference strains that have been isolated from the human body have been sequenced to date. While the Microbiome Project is no longer recruiting participants, the American Gut Project, a similar mapping endeavor conducted by a consortium of university researchers around the world still is. So next time you’re looking up at the stars with wonder, consider the universe within you that remains unknown.

-KM

The Importance of Vaccines

Vaccines (also known as ‘immunizations’) are one of the most proactive steps you can take to protect your health. People’s Community Clinic promotes the recommended vaccine schedule for most patients. Why? Because vaccines work.

Let’s take a look into the science behind vaccines to see how they’re so effective in stemming the spread of contagious disease.
 

What are vaccines?

So what exactly is a vaccine? A vaccine is a very small dose of an agent that is similar to a virus, often a much weaker or inactive form of the virus itself. The dose stimulates our immune system to produce the antibodies needed to fight off the disease. This allows the body to develop immunity and fight off the disease efficiently next time it’s encountered.

Vaccines are an excellent example of preventative medicine: the practice of reducing risk and costs associated with treating an illness by working proactively to prevent the illness from developing in the first place.

An infographic using pictures to show that the body produces antibodies to fight a weakened form of the disease, which is injected during vaccination, so that it can better destroy the real germ later on.

 

The Bigger Picture

Since their discovery in the late 1700’s vaccines have worked to slow the spread of many debilitating and deadly diseases.

In the 1950’s the U.S.A. saw a rate of over 55,000 cases of polio a year. Thanks to the success of the polio vaccine, in 2017 there were only 113 cases reported. In 1980 the World Health Organization declared smallpox completely eradicated worldwide. Smallpox once took the lives of hundreds of thousands each year, yet successful global deployment of vaccines took that number down to zero. Vaccines save lives every day.
 

Herd Immunity

The concept of “herd immunity” helps explain the remarkable effectiveness of vaccines. We may feel that vaccines are something we do for ourselves to protect our own bodies from contagious disease. But the fact is, when we receive a vaccine we are helping protect our friends, families, and community as well.

Each person who receives a vaccine reduces their own risk of contracting a disease, subsequently reducing their risk of spreading the disease to others which in turn reduces everyone else’s risk of getting sick. So we all see the benefit of each vaccine, even those who chose to remain unvaccinated.
 

So, Why Should I Vaccinate?

You may be asking yourself: “If everyone else’s vaccines protect me from illness, and the rate of disease has already been dramatically reduced, do I still need to get a vaccine?” The answer is “yes!”

This excerpt from the CDC may help illustrate why:

“In 1974, Japan had a successful pertussis (whooping cough) vaccination program, with nearly 80% of Japanese children vaccinated. That year the country saw only 393 reported cases of pertussis, and there were no deaths from pertussis.

But then rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe. By 1976 the rate of infants vaccinated against pertussis in Japan dropped to 10%. In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths. In 1981 the government began vaccinating with acellular pertussis vaccine, and the number of pertussis cases dropped again.”

Each person who forgoes a recommended vaccine raises their own chance of contracting the disease and everyone else’s risk along with it. Even if we reduce the spread of a disease to only a few cases each year there is always a chance another epidemic could occur if we don’t take preventative measures.

Protect yourself and your community; follow the recommended vaccine schedule suggested by your doctor.

Open letter: Isolating children at border is harmful

Pictured: Louis Appel, MD, MPH performs a routine well child check up with a young girl and her mother.

June 11 letter to the editor, “Texas border a flashpoint in humanitarian crisis.”

To the Editor:

As a pediatrician at People’s Community Clinic, I am greatly alarmed by the long term adverse health consequences of forcibly separating children from parents at the border as described by the letter writer.

Research shows that traumatic events in childhood—even in infancy—are associated with poor health outcomes later in life. Chronic, unmitigated stress activation in the body—known as toxic stress— increases risks for everything from depression to heart disease. Parental support and nurturing–precisely what the family separation policy deprives children of–  are the critical protective factors.

Families arriving at our border have already experienced profound trauma, from violence in their home countries to the hardships of their journey. Inhumane detention practices here inflict further harm. Separating children from their parents in the name of deterrence is an unconscionable injury to children at a time when they need their parents the most. It must stop!

Sincerely,

Louis Appel, MD, MPH
Chief Medical Officer, People’s Community Clinic

 

Louis Appel, MD, MPH serves as Chief Medical Officer and Director of Pediatrics at People’s Community Clinic in Austin, Texas. Dr. Appel provides primary pediatric care at the Clinic in addition to overseeing the clinical programs. At the clinic he has championed projects on lactation support, group pediatric well child checks, postpartum depression screening, childhood obesity prevention focused on the prenatal and immediate postpartum periods, and promotion of parent-infant bonding. To learn more about Dr. Appel and other clinicians at People’s Community Clinic, click here.