Start where they are, not where you are

Total commitment to underserved children

Imagine you are an immigrant, moving to America in the hope of a better life for your family. It’s a difficult transition. Everything seems different: the food, the clothes, the way people greet one another. Even the water tastes strange.

Now imagine your child becomes sick. You don’t speak the language well so you don’t understand what this means. You try talking to your doctor in Spanish, but get only an apologetic look in return.

Enter Monica Federico​, MD, associate professor of pediatrics, who would look like a godsend right about now. (Dr. Federico pictured at right)

Dr. Federico not only speaks Spanish, she is also dedicated to helping underserved populations get access to care. She started her career torn between studying social work or medicine, and in many ways she’s managed to combine the two.

A Remarkable Contribution

“Dr. Federico has a total commitment to underserved children, particularly the Latino population,” said ​Frank J. Accurso​, MD, professor of Pediatrics at Children’s Hospital Colorado.

“Her patients and families know that they can rely on her for empathetic care at all times. She has built an entire system of care to aid families who have not had access to care, by partnering with the community and sponsoring agencies to coordinate care for each child – a truly remarkable contribution to the health of underserved children.”

Dr. Federico works primarily with children who have asthma or cystic fibrosis. In 2005 when she joined the Pulmonary Medicine department at Children’s, the biggest child-health problem was asthma.

“At the time I was the only Spanish-speaking provider, so I took on this population. A nurse, Julie Micalizzi, and I started an outpatient program to meet the need. It started with one half-day a week clinic, 500 visits per year. Now we have 4–5 different providers, with clinics most days. We now have over 3000 visits each year.”

“We worked with primary care providers; inpatient and outpatient respiratory therapists, nurses, and staff at Children’s Colorado; and Emergency department providers and staff, to create a high-risk asthma program. This program allows us to reach out to children who have recently been hospitalized or in the ER.”

Working in the Community

The other hat Dr. Federico wears is that of medical director of clinical alignment. “This means working to improve care and patient experience by working within the community,” she said. “We’re circling the wagons around the patient to ensure they receive the best possible care.”

This has involved collaborating with several organizations and community-based providers, including Colorado Pediatric Partners – a group of 20–25 private practice clinics – to align the care provided at Children’s Colorado with the work occurring in the community.

Despite her achievements, Dr. Federico remains humble. “I am really not the person who should get the praise for this work,” she said. “I’m just the coordinator. The team is doing all the hard work – they are amazing.”

Dr. Federico’s team includes the respiratory therapist Mary Walsh, nurses such as Beth Carroll and Julie Troglia, Kate Johnston, MPH, and providers such as Bridget Raleigh, FPNP, and Kate Michalek, PA.

“Their work is incredible,” said Dr. Federico. “They work hard to maintain the level of care we deliver.”

Caring for the Whole Patient

The affinity Dr. Federico feels for the population she serves runs deep. “I am lucky. I have not had to negotiate a health-care system and culture that I do not understand, or handle the chaos that comes with limited resources or an unsafe environment,” she said. “Families cannot prioritize health if they cannot pay the rent or feel unsafe.”

Even with patients whose first language is not Spanish, Dr. Federico manages to make a connection. “There’s a mom who speaks French, and while I only speak a few words, I try. And I think it’s because I try that they tend to open up.”

One patient’s mother confided that she thought her child was being bullied at school, while another wanted to discuss her child’s eating issues. “Some parents bring everything to me,” said Dr. Federico. “And it’s only because I speak their language.”

With so many language and cultural barriers to health care, Dr. Federico’s patience and understanding go a long way toward ensuring excellent quality of care.

“I end up taking care of the whole patient,” she said, “and I guess that sums up my approach: you have to take care of the whole family and the whole patient. You have to start where they are, not where you are. Otherwise, you can’t achieve much.” ​​