http://www.thestar.com/News/article/177904

Paging Dr. Hope

In one of Canada's poorest districts, maverick pediatrician leads a 
revolution
Feb 03, 2007 04:30 AM
Sean Gordon
Quebec Bureau Chief

MONTREAL–The brightly lit waiting room, with its frayed, garish couches, 
stuffed toys and a shopworn Fisher-Price farm, is a maelstrom of activity.

Doors open and close, and Sylvie, a vivacious receptionist, is joshing 
with a steady stream of adults and children in between making phone 
calls to confirm medical appointments with Dr. Gilles Julien, a gentle, 
grandfatherly pediatrician who is quietly leading a medical 
revolution.But this is not your typical medical practice.

To give just one example, Sylvie is having a hard time getting hold of 
people; in this neighbourhood, paying the phone bill tends to be far 
down the list of priorities.

"Oh well," she smiles, "the phone may be disconnected, but I'm sure 
they'll show up; they always do."

It's nearing closing time on clinic day at Aide aux Enfants en 
Difficulté (AED), a multi-disciplinary centre housed in a dowdy building 
on a bleak corner in the east-end Montreal neighbourhood of 
Hochelaga-Maisonneuve.

The surroundings may be humble, but this is a success story in a place 
where there are all too few triumphs, an oasis of hope in a converted 
red brick walk-up.

Next door is a greasy spoon, and the building across the street is a 
former crack house. The centre stands out, not least because of the 
garish rainbow painted on the outside, but mostly because of the solace 
it has offered to families through an innovative approach to addressing 
child poverty: social pediatrics.

The model is beginning to catch the attention of public health officials 
in other cities: Vancouver is setting up a similar centre and others are 
planned in Quebec City and Gatineau.

Though Julien has spoken at conferences in Toronto in recent years, 
there are no plans in Ontario to adapt the concept he developed with 
public health nurse Claudette Everitt and with whom he co-founded AED in 
the mid-1990s.

The pair worked out of a car at first, then cadged a disused classroom 
in a local school, before a benefactor offered a free 10-year lease on 
the current digs.

Julien is 60 but looks a decade younger. He is constantly hugging kids, 
tapping them on the shoulder, teasing them. There are no ties or white 
lab coats in this office; Julien is partial to sweaters and cords, he 
wears his grey hair long, and his smooth, tanned face sports white, 
two-day stubble.

Possessed of a card sharp's instinct for reading human behaviour, Julien 
is preternaturally calm and has a freakish ability to remember names, 
faces and individual circumstances, as well as family and friendship 
links from the neighbourhood.

The examination room looks more like a dining room. There's a large wood 
table with eight chairs, and a folding partition discreetly hides his 
medical gear.

Julien describes his work as social pediatrics, meaning he spends as 
much time providing advice, listening to problems and negotiating with 
parents as he does dispensing medical advice.

It's a novel approach, one he developed over a peripatetic career that 
started in Quebec City, took him to Ungava Bay, the Outaouais and 
eventually to Africa, where he worked on a United Nations project aimed 
at easing urban child poverty.

"When I came back to Montreal about 15 years ago ... I wanted to develop 
a practice that was closer to my tastes, to my dreams," Julien said.

Peeling a banana – there are bowls of fruit on seemingly every flat 
surface in the AED's 10 rooms – Julien talked about how he grew 
disillusioned while working as a public health official and in Quebec's 
public medical clinics.

"So I left. I started to do more home visits, and then got involved with 
community organizations," he says, adding he left a provincially run 
community health clinic "because it was getting on my nerves. 
Establishments are controlling."

"We had a very local practice, in the streets. I was doing house calls 
on my bike. ... Little by little it built up more and more. People came 
and said `I'll help out,' then our building owner said `I'll lend you a 
space.'"

What started out as a way to address the immediate and urgent health 
concerns of children in one of Canada's poorest neighbourhoods – a 
two-person war against poverty – has evolved into what Julien and his 
collaborators hope will be a new way of doing things.

"My practice is based on cultivating. The first step is to captivate, to 
tame a child. It doesn't look like much when I'm wandering around (the 
clinic) but that's where you create the comfort zone. True proximity 
brings out all sorts of information, confidences and creates a 
partnership with the children," he said.

After years of struggling to keep AED open – billionaire philanthropist 
André Chagnon has assured the centre's budget since 2002 – Julien is 
reaching another milestone. For the first time since he and Everitt 
opened the doors of AED, one of two centres the pair operates in 
Montreal, the provincial government is getting involved financially.

"It's not easy for them. I'm largely out of their system, not 
completely, but still. And I've attacked them a lot," said Julien, a 
strident critic of the Quebec children's aid and foster-care system 
where "we're punishing kids for being abused."

And if the province is finally providing a three-year, $750,000 grant 
for a program aimed at preventing child negligence, it's because "to my 
great surprise, there's been a big buy-in from the population. I guess 
it recalls some pretty fundamental values that we've kind of gotten away 
from."

Julien has also succeeded in convincing the Université de Montreal and 
McGill University to make it a mandatory requirement for first-year 
pediatric residents to rotate through his centres (the second, aimed 
largely at immigrant children, operates in the heavily ethnic Montreal 
neighbourhood of Côte-des-Neiges.)

Julien, a father of four with apparently boundless energy, teaches 
pediatrics at both universities and spends two days a week at AED and 
two days at the Côte-des-Neiges centre.

The Hochelaga centre now has 12 employees, including social workers, 
psychologists, teachers, art therapists and early childhood education 
specialists.

The ground floor is where the staff have their offices, but the waiting 
room is the focal point. There's a small TV playing a Harry Potter 
movie, and along the wall is a row of cramped desks.

Sylvie, the receptionist, guards a low filing cabinet that holds the 
stash of toys that attracts the attention of every child who comes 
through the door.

"If you hang around here long enough, you'll see that sad kids come in, 
smiling kids go out," said Brian Legrand, a mechanic who was waiting for 
his daughter, one of 1,300 or so children with files at AED.

On the day Julien met with the Star, he had to deal with a pair of 
unexpected emergencies: two of his former patients attempted suicide.

"Working around here can sometimes get heavy," Julien said.

One of the near-suicides is a young woman with aggressiveness issues; 
Julien persuaded her to enrol in a boxing program run in the neighbourhood.

Julien has also had to deal with a 12-year-old who is taking heavy doses 
of five antidepressant medications

"I asked him if any of his other doctors just sat down to talk to him. 
He said `no.' Can you imagine?" Julien said, adding the youth would 
probably have to be hospitalized to wean him off the drugs.

Julien has been a strident critic of the way the government cares for 
children, and takes a resolutely personal approach: in the 12-year-old's 
case, he took him into a quiet room to talk.

"It turns out he loves to play drums, his dad plays drums, too, and so 
does his grandfather," Julien said. "But they live in an apartment now, 
so he can't play. I asked the dad to call his grandfather so the three 
of them could go and play together. We even have a drum kit around here 
somewhere."

There are cluttered playrooms in a pair of converted flats upstairs and 
there is also a full-service kitchen. As Julien toured the building with 
a reporter, there was a raucous dinner going on, the children shouting 
"Hey, Julien" to catch his attention.

There's a piano, toys are scattered around the brightly painted room 
where the younger children play ("stimulus is often a problem for 
underdeveloped kids," Julien murmurs absently). A bookcase groans under 
the weight of the board games jammed in its shelves, and there are sacks 
of mismatched skates – Julien routinely attracts unsolicited donations.

Volunteers help the clinical staff with activities, which go on seven 
days a week, from early morning until about 8 p.m. The centre is a safe 
house for kids to hang out in, do homework, have a bite to eat, talk 
about their problems.

"We don't have constraints on our resources, on our availability. 
Pediatricians aren't easily accessible. And yet, here I am. People just 
call me Julien. They wait at the door, I grab them around the neck, 
whatever. And in that, there's empowerment.

"People watch you and wonder why you're here when you could be sitting 
in an office, or on a beach, and they ask questions. And I say that I 
don't understand how you find yourself in such miserable straights with 
all the potential you have. It's that simple."

Julien describes the development of his practice, which he loves and 
plans to continue until he drops, as a decade-long process of trial and 
error.

"Children need accompaniment, they need a neutral space where they can 
breathe ... everything is based on proximity, on the way we work with 
the family and the social institutions. We want to be a catalyst for a 
movement that revolves around children."

Julien's concept is based in creating a flexible structure that can 
answer the community's needs. In the early days, he put a heavy emphasis 
on nutrition. Now his focus is on the isolation some children feel 
because the streets aren't safe to play in.

"My dream would be to reopen the alleys, we would clean them up, get the 
parents involved; we could have someone go from alley to alley to 
organize games, hand out balls and hockey sticks," he said.

The plan is still in the works, but the centre hopes to involve the 
Montreal Canadiens. If the past is any indication, they will find it 
hard to resist Julien's magnetic personality.

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