Last month, I had the honor of shadowing two pediatricians, Dr. Ashok Ghooi and Dr. Dinesh Giliyar, in Brentwood, a hamlet in the Town of Islip, Suffolk County, Long Island. Both Dr. Ghooi and Dr. Giliyar migrated to the U.S. from India for their medical residency and eventually ended up opening two offices: one in Brentwood and one in Harlem, New York City. Brentwood’s population is predominantly lower-income and Hispanic, and Black, and many of the clinic’s patients came with obesity-related health issues such as fatty liver and urinary tract issues. During my time at the clinic, watching doctors’ interface with patients and formulate treatment plans, I gained not only a better understanding of the field of medicine but also a more well-rounded view of the many other aspects of a doctor’s job. So much goes into doctor-patient relationships, and it is important that doctors maintain an awareness of different cultures to recognize how patients with different backgrounds approach healthcare. In this blog, I would like to discuss my surprise with the variety of health issues such young kids came in with and my understanding of the reasons these health issues are so prevalent in this population.
My visits to my own family doctor growing up weren’t very often, usually with common colds and sore throats or for a regular annual check-up, which we all get. However, patients at the Brentwood office came in with a surprisingly wide variety of illnesses. For example, I sat in on a young girl named Isabella’s general check-up, and while reviewing her bloodwork, Dr. Giliyar noted that her AST and ALT were high, signaling that she had fatty liver. He explained that Isabella’s obesity was likely the reason for her fatty liver, as the excessive junk food, or food that is high in calories and sugar but low in nutritional content and value, consumption would have caused fat cells to develop and build up in and on her liver. I wondered out loud, “Is that normal in kids, and isn’t this going to cause serious health issues for her later on in her life?” Dr. Giliyar said that if she doesn’t watch her diet and start exercising, playing sports, and overall being active, she could have serious health issues such as cirrhosis leading to liver failure. Regarding the part of my question about whether it is normal or not to have this kind of disease at such a young age, he said that it isn’t really normal or common to have it, but it is possible in a lower-income population.
Because Brentwood is a town with a predominantly lower-income population, the diet of the people is not as healthy compared to the diet of someone who perhaps lives in a more financially well-off town. According to Dr. Ghooi, in Brentwood and other lower-income communities, people don’t spend the money to buy healthy food to eat, as healthy food that is high in vitamins and minerals, protein, and antioxidants costs more than junk food. For example, this study illustrates that lower-income households generally buy and consume more unhealthy foods compared to higher-income households. In the study, annotated food purchase receipts were collected from the main household shopper of each of the 90 households in a community. The households ranged from having a lower income to a higher income. The results of the study are as follows.
Results:
● Higher-income households spend more money on average per person on a monthly basis compared to lower-income households, including both eating at home and going out ($163 vs. $100)
● Higher-income households spend more money on average on fruits and vegetables compared to lower-income households ($21.50 vs. $10.20)
● The proportion of sugary and sweetened drinks and beverages was significantly higher in lower-income households compared to higher-income households (45% to 26%)
As we can clearly see from the results of this study, higher-income households buy and consume significantly more healthy food and drinks than lower-income households. This is because people of higher incomes not only have the financial strength and ability to spend more money on things like good quality food, but the educational background of the parents and awareness also matter. On the other hand, lower-income families/households and populations are pressured to save whatever money they can and budget. Therefore, it makes sense that the relatively larger intake of junk food, which is cheaper, within the lower-income population, causes issues such as high sugar levels and calorie count, resulting in conditions such as fatty liver, which I observed in patients like Isabella.
Throughout my shadowing experience, not only did I see a high amount of cases related to fatty liver, I also saw cases related to urinary tract issues and alarmingly high sugar levels and high alkaline phosphate levels in children; anemic kids all primarily caused by diet. On the other side, an hour's drive away, when I visited my pediatrician here in New Hyde Park, I asked her about the kind of patients she sees and if any of them have diseases of such severity as fatty liver. She said she does see some concerning conditions, but it’s usually quite rare. She generally just sees patients with common illnesses we all get, like the flu and the common cold.
I’d like to end with something that both Dr. Giliyar and Dr. Ghooi said that stuck out to me: while Brentwood is a lower-income area, the children’s parents often came from even poorer backgrounds, where basic necessities like food and water weren’t always reliably and readily available, let alone quality education opportunities. So, from a parent in this neighborhood’s perspective, their child’s health is actually quite good compared to their own health when they were young. Also, due to the fewer education opportunities, these people grow up to be in lower-income populations, and therefore, as the quality and nutritional value of the food they buy is lower, they end up having an overall more unhealthy health.
Although it’s easy to think down upon them and point fingers, the place many of these families are today is worth celebrating, knowing the hard work and effort it took them to get there.
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