Magazine article The New Yorker

The Poverty Clinic

Magazine article The New Yorker

The Poverty Clinic

Article excerpt

Monisha Sullivan first visited the Bayview Child Health Center a few days before Christmas, in 2008. Sixteen years old, she was an African-American teen-age mother who had grown up in the poorest and most violent neighborhood in San Francisco, Bayview-Hunters Point, a bleak collage of warehouses and one-story public-housing projects in the city's southeastern corner. Sullivan arrived at the clinic with ailments that the staff routinely observed in patients: strep throat, asthma, scabies, and a weight problem. The clinic's medical director, Nadine Burke, examined Sullivan and prescribed the usual remedies--penicillin for her strep throat, ProAir for her asthma, and permethrin for her scabies--and at most clinics that would have been the end of the visit. But Burke, who founded the center in 2007, was having a crisis of confidence regarding her practice, and Sullivan was the kind of patient who made her feel particularly uneasy. Burke was diligently ticking off each box on the inner-city pediatrician's checklist, but Sullivan's problems appeared to transcend mere physical symptoms. She was depressed and listless, staring at the floor of the examination room and responding to Burke's questions in sullen monosyllables. She hated school, didn't like her foster mother, and seemed not to care one way or the other about her two-month-old daughter, Sarai.

Burke is charismatic and friendly, and her palpable concern for her patients disarms even the toughest cases. It helps that she is dark-skinned, like most of her patients, and young--just thirty-five. But her childhood was very different from theirs. The daughter of Jamaican professionals who moved from Kingston to Silicon Valley when Burke was four, she attended public school in Palo Alto, where the kids were mostly white and well-off, and where girls cried in the cafeteria if they didn't get the right car for their sixteenth birthday. Like many children of immigrants, Burke has learned to move fluidly between cultures. She now lives in a house in an upscale part of Potrero Hill, a San Francisco neighborhood, with a closet full of designer clothes, and she has a fiance who is a wealthy solar-energy entrepreneur. But she seems just as comfortable among the mostly poor families she sees in her examination room: laughing, gossiping, hugging, and scolding, in Spanish as well as in English, in a full-throated alto that echoes down the hall.

At the clinic, Burke gently interrogated Sullivan until she opened up about her childhood: her mother was a cocaine addict who had abandoned her in the hospital only a few days after she was born, prematurely, weighing just three and a half pounds. As a child, Sullivan lived with her father and her older brother in a section of Hunters Point that is notorious for its gang violence; her father, too, began taking drugs, and at the age of ten she and her brother were removed from their home, separated, and placed in foster care. Since then, she had been in nine placements, staying with a family or in a group home until, inevitably, fights erupted over food or homework or TV and Sullivan ran away--or her caregivers gave up. She longed to be with her father, despite his shortcomings, but there was always some reason that he couldn't take her back. For a long time, she had the same dream at night: taking the No. 44 bus back to Hunters Point, walking into her father's house, and returning to her old bedroom, everything just as it used to be. Then she'd wake up and realize that none of it was true.

When I met Sullivan, last September, she had recently turned eighteen, and three days earlier she had been emancipated from foster care. She was now living alone, in a subsidized apartment off Fillmore Street. In California, emancipated foster children are given a summary of their case file, which meant that Sullivan had just been handed an official history of her rootless adolescence. "It brought up a lot of emotions," she told me. "I read it, and I kind of wanted to cry. …

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