"Adolescents are not cute and cuddly," says Dr. Alwyn Cohall, a pediatrician with a specialty in adolescent medicine. "They don't have lobbyists and advocates. They only have each other, and a few dedicated providers in this city."
"This city" is New York, and Alwyn Cohall, M.D., who grew up here, is one of those providers. Born in 1955 in Jamaica, West Indies, he was raised in Harlem. As a way of "giving back," he has been instrumental in bringing health care to the youth of that neighborhood and other underserved communities.
Dr. Cohall currently serves as an Associate Professor of Clinical Public Health and Clinical Pediatrics at Columbia Presbyterian Hospital's Mailman School of Public Health, and at Columbia's College of Physicians and Surgeons, and he is an Associate Attending in Pediatrics at New York Presbyterian Hospital. He has also served as a consulting physician at such community-based organizations as The Door, a downtown Manhattan center for youth at risk; VERITAS, a young mothers' program; and satellite clinics he has pioneered in city high schools.
In 1991, he cofounded and since then has directed, Harlem-based Project STAY (Services to Assist Youth), which provides comprehensive medical and psycho-social services to youth living with HIV. Clients run the gamut -- from street youth who have engaged in survival sex, to high school students from relatively intact families who may have had only one or two sexual partners. Dr. Cohall reports that the majority of these young people are responding well to triple therapy, and are working and/or are in school.
Still, he is frank about the predicament of youth in his neighborhood: "Many a day I've left my clinic stunned once again by the atrocities inflicted upon this segment of our population. Young people growing up in fractured homes, who have been victimized and abused, who are depressed, who lack basic academic skills, who see little hope of their lives improving, and thus may become fatalistic. They may believe that they won't live to see the age of majority, so it makes little difference whether it's a bullet or AIDS taking them out."
Dr. Cohall is nonetheless humbled by his patients' "enthusiasm, resilience and strength." One imagines that his patients have been heartened by the clarity with which he sees their world, a world he grew up in, as well as by the dedication he demonstrates.
How long have you been practicing?
Can you describe how your practice has changed since you first started?
More hope for the future with the advent of HAART (highly active antiretroviral therapy).
What's the best thing about your job?
The best thing about my job is being able to stabilize patients, get them back on course with their lives and help them realize that they are in control, not the virus.
What's the worst thing about your job?
Lack of resources to provide more services for infected youth and reach more youth who are currently unaware of their status.
What have been your greatest successes and failures?
Greatest successes: Establishing a program from the ground up. Helping young people successfully navigate their adolescence while living with HIV and being able to transition them to adult providers knowing that they are stable and looking forward to the future.
Greatest failure: The inability to find an angel -- someone with deep pockets who cares passionately about youth and is willing to help support our program. Adolescents are not cute and cuddly, they don't have lobbyists and advocates. They only have each other, and a few dedicated providers in this city. We need more support to be able to help more kids.
Do you think prevention efforts are sufficient?
No, youth need comprehensive and consistent sex education from kindergarten to grade 12, such as what is currently being done in Sweden and the Netherlands. Also, they need ready access to contraceptives and condoms. Further, they need access to mental health support and substance abuse counseling. We need to make a more substantial and tangible investment in youth, instead of trying to balance the budget on the backs of the most vulnerable segment of the population. In any budget crisis, youth development programs, after-school programs, libraries, recreational programs, etc., are always among the first to be cut and the last to be restored. This is penny-wise and pound-foolish. Studies have shown that communities with enhanced resources for youth (social capital) have youth who are significantly less likely to engage in risk-taking behaviors.
What's the key to a great healthcare provider/patient relationship?
Honest, consistency, compassion and humor.
If you weren't a clinician what would you be?
A writer. I enjoy the creative aspect of the work. Love the sound, flavor and cadence of how words dance with each other on the page.
Who would you dedicate this award to if you could?
My wife, for all her support. And my patients, for being so courageous.
I'm married to a social worker who has also been intimately involved in providing services for high-risk and HIV-positive youth. We are raising three small children. By a previous marriage, I have two older sons who are grown.
Where did you grow up?
I was raised in Harlem. I welcome the opportunity to come back to this community and provide needed services.
When did you decide on medical school?
As a child, I knew that medicine was something I wanted to do. In college, I was an anthropology major, but took the requisite pre-med courses.
What made you decide to go into HIV care?
I am a primary care physician. As part of our school-based clinic program, we uncovered several cases of youth living with HIV. They felt uncomfortable receiving care in either pediatric or adult programs and entreated us to develop a clinic just for them. With support from the Mailman School of Public Health at Columbia University and the New York State Department of Health, we were able to do just that.
What do you do in your spare time?
Enjoy my family, play tennis, write fiction. Any time I can, I get to the white sands and crystal clear waters of the Caribbean.
What's the biggest adventure you ever had?
Surviving my childhood and adolescence in Harlem, when so many other young people, unfortunately, did not.
What kind of music do you like to listen to?
I enjoy jazz, but my kids keep me current with rap and hip-hop.