The Constellation of Care: A Conversation with Dr. Paige Perriello
Paige Perriello understands health as a network of interlocking systems rather than a series of isolated symptoms. Since 2008, she has brought this framework to bear on her work as a pediatrician in Charlottesville, advocating for environmental justice, fair housing, and most recently serving on the Greater Charlottesville Trauma Informed Community Network; which seeks to expand the often narrow lens through which we view trauma and its impacts. When we spoke over zoom, we discussed the overlapping viruses of Covid-19, institutional racism, and climate change, and the ways in which Covid has placed, in Perriello’s words, “a spotlight on pre-existing inequalities that cannot be ignored now.”
In 2017, Perriello worked alongside her brother Tom (who was then running for governor), to research and raise awareness about the potentially harmful effects of the proposed Atlantic Coast Pipeline, particularly the pipeline’s compressor station which was slated to be built in Buckingham county, in a predominantly African American community. In this work, Perriello found herself inside an old and insidious American story: where it is often low-income communities of color that are most obviously and gravely impacted by climate change. Later that year, after witnessing many of her black and brown patients on the streets during the racial violence of August 11th and 12th, Perriello remembers returning to her office that Monday and asking herself if she was doing everything she could “to help these same families understand that this was a space that they could feel safe in.”
This simple inquiry evolved into an office-wide effort, led by Perriello, to acknowledge and screen for racial trauma. This effort also focused on white providers educating themselves about the long history of racism in the field of medicine itself, a history which Perriello tells me: “We are not taught in medical school.”
In all the trauma resources that Perriello consulted, there was one question that continued to come up as a potential entry point towards a more holistic conversation with patients: “Is there anything really scary or frightening that has happened to you or your family since the last time you saw us?”
Many of Perriello’s colleagues wondered what they would ultimately do with that information once it was collected. While Perriello shared their uncertainty, she also sensed the relatively higher cost of not making an effort to acknowledge the larger context of patients’ lives.
When I ask Perriello about the role of climate specifically in regards to healthcare, she tells me: “As the planet warms, and the impact of this is felt disproportionately by those in lower socioeconomic groups, we must redouble our efforts to address how these social determinants of health are adding toxic stress to families already under duress. This includes things like extreme weather events, that cause physical and emotional trauma to families, as well as thinking about the monthly electric bill and whether or not a family can afford to pay that. For a child with asthma or other underlying health concerns, lack of air conditioning in the summer or ability to turn on a nebulizer to receive life saving medications-- this adds another layer of trauma to this child and her family.”
Especially through the incredible hardship of Covid, giving patients the opportunity to share more about their lives has lead to stories of eviction and homelessness, food and job insecurity, divorce, addiction, incarceration, and the overarching trauma of families being told to shelter in place and educate their child online while facing the unimaginable stress of losing their home.
Sometimes, Perriello’s conversations with her patients lead to discussions of the physiology of stress and its effect on the body and behavior. Other times, to simply hold space for the pain is a starting point. Towards the end of our interview, when I ask Perriello how she manages to maintain such an expanded, complex view of healthcare, she reflects: “We were scared when we started asking patients to share more with us about the events of their lives, and we didn’t write it down, but week in and week out and slowly we would understand that sometimes just asking the question is part of the solution.” Guided by this simple practice of asking questions and holding space for answers, Perriello and her colleagues are striving towards a place where neither health or illness are understood as isolated events, but rather elements of an ever-changing, interconnected web.