Watching them grow
Watching them grow
What inspired you to pursue a career in pediatrics?
Madhu Bhogal : The pediatric rotation was my favorite in medical school because I enjoyed seeing the smiling faces on the children. In addition, the interaction with the entire family is extremely gratifying.
Suzanne Espalin Pardo: I had always wanted to be the “first” physician in my family. It was a choice that never wavered. The decision to become a pediatrician was cemented during my undergraduate years when my 13-year-old cousin, Karin, battled and later succumbed to cancer. It was the uncomfortable helplessness that I felt when I realized my passion for pediatrics. We are there at major stages of life from a baby’s first step, the kindergarten physical through to high school graduation. Wow! What a responsibility and honor. The bottom line is I love children.
Kaye Sykes: From the time I was in junior high I wanted to be a doctor and feel like I was doing something important. I didn’t decide to specialize in pediatrics until I was in my third year of medical school. Maybe it was hormones, maybe it was the impressive resiliency of children, or their instinct to try and overlook illness and go on. No matter what led me to go into pediatrics, I am sure that I never would have been as productive in any other field.
Valerie Cayabyab-Garcia: My goal in life is to make a difference. And I found it most rewarding in the form of teaching and helping at the same time. If you can positively influence a child early, then indirectly I may be helping society later as they become a healthy responsible adult.
What is the most fulfilling part of your job?
Madhu Bhogal: The most fulfilling aspect of my career has been to implement the Neonatal Intensive Care Unit at Bakersfield Memorial Hospital and watch it continually expand to provide the best possible care.
Suzanne Espalin Pardo: The most fulfilling part of being a pediatrician occurs daily. Fulfillment comes in healing. One day it could be that case you were told you’d never see in your career and you do. It could be that puzzling problem that you figure out. It occurs when dealing with other sub-specialists/surgeons and coordinating care in patients with complex problems. It is teaching a parent how to negotiate the difficult developmental stage of a 2-year-old or teenager. It occurs when I am out around town and a child points and says with pride, “That’s my doctor.”
Kaye Sykes: Being allowed to be a part of the wonder and watching children grow into healthy, responsible, productive, caring adults.
Valerie Cayabyab-Garcia: My heart still melts when a child smiles or gives me a hug because they feel better or I have helped alleviate their fear.
How has the community inspired or contributed to any differences your practice has to offer from others?
Madhu Bhogal: The needs of the community contribute to the way I practice medicine. For example, I see a lot of patients travel to Los Angeles or Fresno for health care that I know we can provide in Bakersfield. So I work to enhance the care provided in my community.
Suzanne Espalin Pardo: In August it will be nine years since my family and I moved here. My son Nick, 7, reminds his sisters he is the only one native to Bakersfield. I grew up in Orange County. I loved the close proximity to the beach and weather. But, I would not move back. No. Why? The best of Bakersfield is the people who live here. I know and love my neighbors. Our patient base is the best. When Dr. Ho was sick, I needed to work full time. It was our patients and families that helped to make that happen. Moms picked my children up from school, ferried them to piano, volleyball, tennis and swimming. If I forgot a lunch it was taken care of. The staff at St. Francis knew flu season meant I’d be late picking up my son … no problem. Teachers at Stockdale took my girls to practice. Our pediatric practice is a team relationship and the parent is integral to the team’s success.
Kaye Sykes: The differences between my practice and others in the community are based solely on the practice style that I prefer and have become accustomed to over the years.
Valerie Cayabyab-Garcia: We help children from many different walks of life and some of them do have rare disorders or learning disabilities. They have taught and inspired me to look closer at what resources are available to them in and around Bakersfield and Kern County.
In the community what improvements do you hope to see for your patients?
Madhu Bhogal : At Bakersfield Memorial Hospital we are working on starting a Pediatric Intensive Care Unit to help sick children remain in Bakersfield instead of being transferred.
Suzanne Espalin Pardo: When I moved here in August of 2000, I could not believe my anesthesiologist husband was moving my two children to a city without a children’s hospital. Children’s hospitals are completely geared to take care of the complex problems that we currently transport out of town. I would like to someday see a freestanding children’s hospital. Currently Memorial is working on a PICU. Sub-specialists in cardiology, GI, nephrology and endocrine come into town once or twice a month from Childrens Hospital Los Angeles. It’s a start.
Kaye Sykes: The opening of the Pediatric Intensive Care Unit at Bakersfield Memorial Hospital would attract more consistent local coverage by pediatric sub-specialists and improve the outcome of patients with acute illnesses that are at increased risk from the delay in specialty care since they require transfer to L.A. or Madera.
Valerie Cayabyab-Garcia: Bakersfield is rapidly growing from a sleepy suburb to the size of a metropolitan city with a rapid growing number of children and teens. Our children need easier access to specialty care. Currently many of our patients travel over 100 miles for access to pediatric gastroenterologists, pulmonologists and developmentalists, to name a few of the specialties. However, in the meantime, I am happy to say that some specialists come here once or twice a month and I applaud the rare few that have made serving the kids of Bakersfield their full-time occupation. This could be part of the stepping stone to a children’s hospital in the future.
In what ways can you see your pediatric practice grow in the future?
Madhu Bhogal : I am excited about the prospect of a pediatric medical center in Bakersfield. Here we will have specialty clinics such as a high risk follow up clinic for sick neonates, pediatric cardiology, sleep lab, and more.
Suzanne Espalin Pardo: We grow due to patients’ level of satisfaction. There are a lot of good physicians out there. One difference is availability. You can find me. Many patients know if I’ve left the office where I’m at, where my children go to school, or what activity is going on. So they know where to find me. I truly do not mind and most do not abuse the knowledge. In regards to the future, I would like to see myself closer to my children and their activities where it would be easier to be in two places at once.
Kaye Sykes: As technology goes so does the list of more advanced services that should lead to expediting diagnosis, providing more effective treatment and hopefully attaining the ability to anticipate and prevent illness and disability in our children.
Valerie Cayabyab-Garcia: We offer comprehensive care from infancy to adolescence, with an emphasis on preventative medicine. However childhood obesity is rapidly growing along with its associated co-morbidities. I hope to help make a difference by better educating my patients and their parents, thus in turn the whole family will be living longer healthier lives.
Being a pediatrician requires that you help both healthy and seriously ill children. What research do you hope is accomplished to address children’s health?
Madhu Bhogal : In my field of neonatology I deal with premature infants. Research to prevent prematurity and the complications associated with prematurity would be the research I would hope is accomplished.
Suzanne Espalin Pardo: In every age group, accidents rank in the top three causes of pediatric death. During infancy it is genetic/metabolic/developmental conditions and SIDS. It is important to support genetic research geared toward prevention and treatment of these conditions. Expanded newborn screening can help to identify illness early. And then of course there is childhood cancer, (I tell my children we cannot “hate,” we dislike — but I can honestly say I hate cancer.) Cancer research has and continues to be addressed. What would I like to see? A cure.
Kaye Sykes: I would like to see the way cleared for stem-cell research, which would make the most dramatic advance in the more serious conditions that affect children. The list of most likely illness to be addressed in the research include type 1 diabetes, severe combined immunodeficiency disease, and osteogenesis imperfecta, as well as the ability to improve outcomes after chemotherapy for an array of cancers and leukemia.
Valerie Cayabyab-Garcia: Medicine has been advancing rapidly as new technology has allowed. However in my opinion, the treatment of insulin dependent diabetes is not progressing fast enough. It is very difficult to control blood sugars of newly diagnosed patients and it is especially tenuous in the younger child. Uncontrolled diabetes will eventually affect their vision, kidneys, joints, growth, and ability to heal; in short just about every system of the body! My hope is that in the near future there will be a device, similar to the current insulin pump, but it will be self-sufficient in its ability to constantly check the blood sugar and deliver the appropriate amount of insulin without being dependent on the parents or child’s input. Of course a cure would be best!
What improvements do you see for the medical plan the United States currently has? In what ways would your patients benefit from those improvements?
Madhu Bhogal : Providing health care for every child is essential. I cannot comment on the best possible method of achieving this goal.
Suzanne Espalin Pardo: In plan I am assuming you mean the current administration. Hmm…the answer is not simple. On one hand medical costs have increased. The number of uninsured is increasing. Obama would require insurers to cover everyone regardless of their health status and charge community-rated premiums. One goal should be to encourage people to enter when they are young and healthy. This can be done by making insurance inexpensive for them and penalizing them if they wait to buy insurance when they are old and sick. Community ratings and guaranteed issue does the opposite. It raises the cost for the young healthy individuals and families and removes any penalty for waiting. So then the young will make the rational choice to go without. Affordable health insurance needs to be available whether it is private, regulated, or government subsidized. We all pay for it. We pay it in premiums, taxes, and higher costs of products. Some cap on insurance company profits and spreading the risk of high cost patients may need to happen.
The administration’s plan for electronic records is not going to solve the system. Already private sectors use electronic records. I don’t think a federally imposed system will be any more efficient or save substantial dollars.
In a plan we need to address some sort of tort reform. Malpractice insurance is continuing to erode salaries. Malpractice suits or any suit should not be viewed as a lottery. We need to educate families on preventative healthcare and to utilize services responsibly.
Kaye Sykes: This is a difficult subject in face of the dramatic changes I am expecting now that the Democrats are in power and in face of the state of the economy. California is not in any shape to expect anything but cutbacks in coverage for otherwise uninsured children. We could revisit this question when the economy gets back to normal and we have no idea at this time how long that will take.
Valerie Cayabyab-Garcia: In February 2009 President Obama signed into law the Children’s Health Insurance Program Reauthorization Act. CHIPRA is financed jointly by the Federal and State goverments but is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility programs and benefit packages. CHIPRA then provides a capped amount of funds to States on a matching basis. While this sounds promising, what does it mean for the State of California? On May 14 our Governor Schwarzenegger unveiled two May revision proposals to address California’s Budget Deficit and went to vote on May 19. Essentially the Governor is proposing a mix of cuts, borrowing and other measures to balance the budget. If the May 19 ballot fails, the budget problem will grow by $5.8billion on top of the $15.4 billion shortfall. Part of the deeper cuts to state programs and services could possibly include cutting off approximately 225,000 children from the Healthy Families Program and entirely eliminating funding for Substance Abuse Treatment and Crime Prevention and HIV Education and Prevention. The Semi-Official results are out for the California Statewide Special
Election and the final results will be out June 23. However, preliminarily five of the six propositions were not passed, including Proposition 1D Children’s Services Funding. Proposition 1D was voted NO by two-thirds of
Kern County and the state on a whole as well. Thus not supporting the measure that would shift about $1.7 billion away from early childhood development programs over the next five years to help balance the state’s budget. Of note 70% of that program’s revenue comes from a tax on cigarettes. So, at this moment it is hard to see what benefits will be given for my patients when the offered solution on the State level was really just a shift of health dollars away from the children in order to prevent health coverage from being cut. In turn if California decreases funding to the Healthy Family Program Plan, we will not receive matching funds from CHIPRA.