On Saturday morning, hundreds of volunteers fanned out across Montreal in the annual fundraising drive for Dr. Julien, raising $508,000 in just a few hours.
Many Canadians may be scratching their heads at the notion: A fundraiser for a doctor? But in Quebec Gilles Julien is a household name, and his Christmas guignolée is a time-worn tradition that prompts people to give generously, even in tough times.
The work the pediatrician does with socially and economically disadvantaged children is the stuff of legend, though people are not necessarily familiar with the details.
Dr. Julien is the father of social pediatrics, an approach that holds that it takes more than vaccines and antibiotics to create healthy children, it requires engagement of the family and the community as a whole.
Practically, Dr. Julien runs two clinics in Montreal's poorest neighbourhoods, working class Hochelaga-Maisonneuve and immigrant heavy Côte-des-Neiges.
They are not medical clinics in the traditional sense. Sure, kids show up with run-of-the-mill health problems, but the woes are often physical manifestations of much larger problems.
The child with the recurrent earache may be sleeping on the floor in an unheated apartment; the one with a constant tummy ache goes to school hungry every day; the kid with the black eye from a fight at school may be acting up because he is a victim of sexual abuse.
Increasingly, the clientele suffers from severe mental health problems such as bipolar disorder and developmental disabilities such as autism. Children with "diseases of the brain" fare particularly poorly in the siloed health and welfare system. They need the holistic approach of social pediatrics.
For Dr. Julien, the idea of patching up the boo-boos and sending children back into untenable living conditions is a non-starter: In his little black bag, the UN Declaration of the Rights of the Child has as prominent a place as the stethoscope.
The work is predicated on the belief that socioeconomic conditions – the environment in which a child is living – have as much, if not more, impact on health as genetics.
That means the "treatment" for what ails a child can often be unconventional: A mattress instead of antibiotics, a tutor to help with homework instead of a prescription for Ritalin, or following up a routine vaccination with an appointment for the child's unemployed father with a counsellor who can help him draft a better résumé.
Appointments at the clinics rarely, if ever, involve only a physician. Rather, a social worker, police officer and teacher may gather round the table to resolve a health problem. And Dr. Julien believes the child and parents should be present, that the system should work with them to find solutions, not impose them.
"It takes a village to raise a child" has become a cliché, but it is a philosophy Dr. Julien adopted decades before Hillary Clinton used it for a book title.
The Montreal pediatrician has been practising medicine for almost 40 years but he learned early on that being a good doctor requires doing a lot more than traditional sickness care.
His epiphany came in 1981 when he volunteered for a stint in a clinic on the Comoros (an archipelago of volcanic islands situated off the southeast coast of Africa), where famine was commonplace but residents united to ensure children didn't starve.
Returning to Canada, Dr. Julien worked for several years in remote Inuit communities in northern Quebec. There, he saw an inordinate amount of deafness in children, a result of chronic ear infections that were, in turn, a byproduct of overcrowded housing and high smoking rates. Working with parents and community leaders, he was able to reduce the rate of hearing loss by half, and dramatically reduce the earaches that plagued children and interfered with their education.
The next stop was a CLSC (a community health clinic) in Hochelaga-Maisonneuve. During the day, Dr. Julien did his traditional doctoring but in his off-hours he travelled around the neighbourhood by bike, doing follow-up "social care." This caught the eye of a local school principal who started referring cases to him.
By 1997, Dr. Julien was able to scrounge up enough money – and a storefront donated by a local business – to open a social pediatrics centre. In 2003, he opened a second location. This early work on social pediatrics was bankrolled in large part by the Lucie and André Chagnon Foundation.
The Chagnon Foundation became so enamoured with the philosophy, however, that it started its own program, Avenir d'enfants, which will ensure that every future physician in Quebec gets training in social pediatrics.
But the shift in priorities resulted in a financial crisis for the Dr. Julien Foundation. The provincial government stepped in with an investment of $1-million a year but that expires in 2012.
What Dr. Julien is preaching is not handouts or special treatment for the poor. He is a social entrepreneur proposing that we actually practise health care differently, that we innovate.
The Montreal clinics show that we can have healthier children (even in the most challenging settings), and in the process we can get more bang for the buck for both public and private dollars.
The model has been perfected to the point where it can and should be replicated across Canada. A lot more kids suffer from the ill effects of poverty than of cancer or kidney disease. Pragmatically, helping them will pay dividends, social and economic.
But the sad reality is that while politicians, provincial ministries (health, education, child welfare), business people, charitable foundations and the media have been effusive in their praise of social pediatrics, there hasn't yet been buy-in in the form of a long-term commitment, financial and philosophical.
Dr. Julien and his supporters still have to stand on street corners every Christmas begging for coins because practising pediatrics and social welfare differently is a threat to our well-ingrained (and ineffective) practices.
It's time for a little derring-do, for some innovation in the name of child health.
André Picard