Sarah Rose Smiley
A generation or two ago, the pediatrician was the guy (yes, they were mostly guys) who gave your kids shots and prescribed big bottles of antibiotics for every sniffle. Madison's Dipesh Navsaria is a different breed of pediatrician. He's a siruclast -- a term he coined himself from the Latin for "silo breaker." For him it means breaking down barriers between isolated fields, or "silos," rather than just thinking unconventionally, as "outside the box" suggests.
Possessor of master's degrees in library science and public health to go along with his M.D. credentials, Navsaria doesn't believe in the kind of old-school doctoring done primarily with stethoscopes and syringes.
He thinks doctors should partner with parents to help promote the healthy development of their kids' brains. And he thinks doctors should partner with elected officials and other leaders to promote social policies that support healthy children, families, and communities.
"We tend to divide everything into specialties and disciplines, and of course there's value in that depth of knowledge," Navsaria notes. "But the people within those disciplines have their own languages, and they're often not very good at talking to their counterparts in other fields."
As a result, according to Navsaria, there's a shortage of the kind of broad-based thinking that makes connections between different schools of thought and leads to new and better approaches to problems.
A literature maven since childhood, Navsaria is inspired as much by Milton as by Hippocrates in his work. It was that silo-busting mentality that led him to get involved in both literacy and advocacy. Navsaria's main jobs are assistant professor of pediatrics at the UW School of Medicine and Public Health and primary care pediatrician at Access Community Health Center.
But he wears several other hats. He is the founder and director of the Pediatric Early Literacy Project at UW and the founding medical director of Reach Out and Read Wisconsin. Reach Out and Read is a national evidence-based early literacy program implemented in pediatric clinics and hospitals. With Navsaria's help, Reach Out and Read is now in place at several UW Health clinics, and the American Family Children's Hospital is home to one of the only 24-hour in-hospital children's libraries in the country.
Early on in his medical career, Navsaria became aware of the importance of parents reading with their children. While training to become a physician assistant at George Washington University in Washington, D.C., he saw pediatricians handing out books to kids, and was struck by what a great idea that was. He recognized that reading with children gives them the kind of face-to-face interaction many kids don't get at any other time. This interaction is one of the chief ways a child learns how to connect with other humans; in fact, it actually influences the development of the parts of the brain that govern social behavior.
Books also make for excellent diagnostic tools, according to Navsaria. "When I hand a child a book, I can instantly observe gross motor skills, fine motor skills, language skills, memory.... I can get more information that way than I can get with a stethoscope."
Born in London to Indian immigrant parents and raised in New York, Navsaria took a circuitous path to pediatrics. He was initially enrolled in a seven-year combined undergraduate and med school program at Boston University. But the school changed the rules in midstream; once a student was accepted, it was supposed to be noncompetitive, but that turned out not to be the case. So he was dropped from the medical program and ended up graduating from BU with undergraduate degrees in biology and English. From there, he moved on to George Washington for physician assistant training before winding up in Illinois, where his wife had landed a tenure-track gig in academia.
After working as a PA in Danville, Ill., for a few years, Navsaria enrolled in medical school at the University of Illinois in Champaign-Urbana. Champaign happened to be a mecca for his other passion, children's literature, as home to UI's Center for Children's Books. During his second year of med school, he started taking library sciences classes, eventually earning a master's degree in that field.
During his time in Illinois, Navsaria helped found a free clinic, and it was there that his thinking about advocacy and addressing health problems on a systemic rather than individual level began to gel.
"When I was working at the clinic, we would get these kids with asthma triggered by, for example, cockroaches," Navsaria explains. "We can fix the problem after the fact one child at a time by pumping them full of prednisone. Or we could do something more effective through prevention that would help more kids, like getting landlords to deal with the cockroaches through building codes or other policy changes."
Navsaria came to Madison for a pediatric residency in 2006 and was hired by UW right afterward. He was immediately asked to head up the department's advocacy training program, which all pediatric residents are required to participate in.
Residents are sent out to organizations that specialize in advocacy to see how they go about changing systems. "They're writing op-eds, they're meeting with lawmakers," says Navsaria.
He has also been actively involved in the Wisconsin chapter of the American Academy of Pediatrics (AAP), which has embarked on a major campaign to address the health effects of child poverty.
"Growing up in poverty has a negative impact on just about every indicator of a child's health," Navsaria says.
AAP has developed a strategic agenda that touches on four main areas: expanding access to affordable health care services; expanding access to basic needs such as food, housing and transportation; promoting positive early development and school readiness; and supporting parents.
The AAP initiative suggests that poverty is the underlying public health problem afflicting a great number of children and that pediatricians should naturally be interested in alleviating it. But pursuing these strategic goals will require doctors to get their hands dirty messing around in politics, which does not come naturally for a lot of them.
"Physicians need to understand that their role goes beyond what they do in the clinic," Navsaria maintains. "If we care about healthy families and healthy communities, we have to be willing to work outside of our traditional doctor-patient relationships."
In other words, you need the courage to smash a few sacred silos.