The Art of Caring: The Mayerson Center’s Dr. Pratima Shanbhag
From the moment you sit down with Dr. Pratima Shanbhag, she’s an old friend and an immediate joy to be around. Dr. Shanbhag’s compassion and empathy is effusive and she channels it toward her passion: advocating for children of abuse and neglect as a pediatrician. And maybe unbeknownst to her, through her example, she’s advocating for everyone she meets to view the world through a lens of compassion.
Interview by Chelsea Weaver. Photography by Nicole Mayes.
Trigger warning: This article/interview contains references to child abuse and neglect, human trafficking, sexual assault, and addiction.
Introduce yourself; who is Pratima?
Professionally, I am a child abuse pediatrician at Cincinnati Children’s. I just finished all of my training and now I’m finally a full-time physician. It’s the beginning of the next chapter.
Personally, my family is very important to me. I spend a lot of time with them. They are probably the biggest part of how I got to where I am today.
What has your professional journey looked like?
Right now, I’m at the Mayerson Center. After completing medical school here in Cincinnati, I went to residency in Florida; it was three years of general pediatric residency. Then I came back to Cincinnati for a fellowship at the Mayerson Center, which is a child advocacy center. I’m staying on as faculty now.
I always knew I wanted to be a doctor; I always wanted to be a pediatrician. I love working with children and being around kids. So, I went to college knowing that was my goal. Then I spent some time in college as a sexual misconduct advisor, working with my peers who were either experiencing sexual trauma or involved in sexual trauma in any capacity. We could be a confidential resource for them: “How do I make a report to the police?” or “How do I get counseling services?” or just being someone to listen to what happened to them and then not say anything – giving them space to just feel like someone could hear their story, whether or not they wanted to report it. And I really found some connection with that work.
When I went to med school – still knowing I wanted to do pediatrics – I thought there probably wasn't a field that would be a good marriage between those two. But then I spent a summer working with women who had been through some kind of experience in their life that led them to addiction. They’re living in this home; they’re getting treatment and rehabilitation services, and most of them have a dual diagnosis of a mental health disorder. But the unique thing about the center was that they all had children and their children lived there, too. So, I thought I would go into that: helping with parental coaching and building that relationship with children. I ended up spending more time with the women, and really learning from them; I was humbled by the fact they would share that they experienced some kind of childhood trauma, whether that was physical abuse, sexual abuse, human trafficking, substance abuse, domestic violence. It was really eye-opening. Especially knowing it was going on in the city where I was born and raised. I had never been so close to someone who had been through that experience.
A social worker told me I’d be really good working with woman who had survived sexual assault. And I remember telling her, “Well, they just don’t have that in pediatrics.” Cut to my fourth year at medical school: I did a rotation at the Mayerson Center, and that was it. It was a field that was multidisciplinary where everyone’s working together, everyone’s collaborating. The patient population is children, but they’re also suspected victims of abuse and neglect and it just all kind of clicked. Now it’s seven years later and I’m back there doing that exact job. So, it definitely was a passion I didn’t think I could pursue. But all these experiences led me to realize that this is what I want to do and I found the place I could do it.
Can you talk a little bit about the Mayerson Center and what it does?
The Mayerson Center is the child advocacy center for (technically) Hamilton County, but we serve all the surrounding counties in Indiana, Kentucky, and Ohio. It’s about 20 years old now. A child advocacy center is considered a resource for children and families that have been through trauma. A major part of what we do is help evaluate children who are suspected victims of abuse or neglect; that’s largely what I do there. Part of my evaluation is the medical piece. So, I do physical exams and make recommendations about what testing or treatment needs to be done. We do that in our clinic and sometimes we’re called in to the hospital to evaluate patients admitted there.
You don’t know what someone else has been through or what they’re going through. So, maybe the best way to proceed in the world is as kind as we can be to one another.
And we have other services: We have social workers and forensic interviewers who speak to children and talk to them about their traumas and try to get that history from them. We have therapists who treat not only the patients, but the families. And we have staff members who participate in research and bring more trauma-informed care to the center, as well as to the hospital. A big part of being a child advocacy team is collaborating with the hospital and outside partners. There’s law enforcement (whether that’s Cincinnati Police Department or Hamilton County Sheriff’s Office), the prosecutor’s offices, child protective services. There’s a whole bunch of partners that make the multidisciplinary team.
How do you go from that back to your daily life?
I think I can preface it by saying that the work I do is a very small piece of the big picture. So, in that way, a lot of the secondary trauma I would experience from being involved in these patients’ lives is kind of dissipated and it’s spread amongst my team members. I’m not carrying the burden of feeling that trauma alone. But we also work really hard on self-care and making sure that when I go home, I’m taking care of myself. I’m taking time to honor and reflect on the emotions that I’ve felt throughout the day. And things that make me feel better are, of course, spending time with my family, but also working really hard at my job. And when I leave for the day, I can rest knowing I’ve done the best I could do for that patient and then wake up the next day and do it all over again. And it’s rewarding work. It’s really challenging work, but it’s also unique and I enjoy it. I get up in the morning excited to go to work.
It sounds like mental health is a big piece of this story.
So much of what we do is traumatizing: We’re caring for victims of trauma and families of trauma, and it's undeniable that trauma affects mental health. It’s there. Part of it – and the biggest piece probably – is recognizing that trauma and trying to be more trauma-informed ourselves. So, referring to the examination table as an examination table and not a bed. That makes a difference to a child who’s been a victim of sexual assault. Little things like that – we can always improve and be more trauma-informed in our actions and our words.
Are there other ways our readership could work toward being more trauma-informed?
There are trainings; Darkness to Light is a fantastic training that trains members of the community to recognize sexual abuse or the signs of sexual abuse. I think recognizing it is one piece, but also recognizing that how someone presents themselves to the world is not the whole story.
I think of this speech called “This Is Water” by David Foster Wallace. I heard about this speech when I was in high school and I’ve thought about it ever since, especially when I’m struggling. There’s a part about how you never know what anyone else is going through. Like, why is someone honking behind me? You have no idea what they’ve been through. Things like that really help me put things, terrible things, in context. Or things that are frustrating me, because I don’t know what someone else’s trauma is and maybe that’s the biggest part of it. You don’t know what someone else has been through or what they’re going through. So, maybe the best way to proceed in the world is as kind as we can be to one another.
What kind of research are you doing right now?
I joined a human trafficking workforce within the hospital. They’ve developed a screening tool to be used in the emergency department when children come in and there’s potentially some red flags, or someone has a concern that they might be trafficked. Our forensic nurses use that screening tool frequently, so now the goal is to roll it out in more areas of the hospital.
The research I’m hoping to do with this group – and it’s still in the very beginning stages – is determining what this screening tool shows us and how it helps children and adolescents, and then putting that all together into some kind of meaningful knowledge for other practitioners around Cincinnati and the country. There is a lot that we need to know. There’s a lot of children we can help.
I, personally, have a very limited knowledge of trafficking. Could you talk a little bit about what trafficking actually is?
Trafficking doesn’t have to be that traditional thing you see on TV where a child is kidnapped across state lines. That definitely happens, but it can also be a form of force or coercion, whether it’s insidious or not. It could be labor, household labor, or various industries – beauty industries, for example – or it can be sexual trafficking. There’s so much that can happen when a child is involved in trafficking. It’s very complex and it’s almost hidden.
Someone’s trauma doesn’t define who they are. It doesn’t mean the rest of their life is doomed. The other side of trauma is resilience.
Part of the goal of rolling out the screening tool is to give clinicians and practitioners a way to effectively identify these victims. Then, when they screen for them and they screen positive, what are the next steps? Connecting them with appropriate resources to get help and doing that in a safe way. The last thing we would want to do is identify a victim of human trafficking and make them unsafe in any way. So, we have to be really careful with how we screen these victims and get them to a place where they can be safe and healthy.
What do you think is important for people to know about what you do?
So, I’m a pediatrician by training. I got extra training to help evaluate these children [potentially experiencing] sexual abuse, physical abuse, medical neglect, and medical child abuse, also known as Munchausen syndrome by proxy. My job is to help evaluate what happened. So, sometimes I diagnose abuse and neglect, and sometimes I don’t; I don’t diagnose every patient I see with abuse or neglect. Sometimes it’s a medical mimic, or it’s an accident.
I think when people think about child abuse pediatrics, or child abuse in general, they feel like it’s really sad. And it is sad – bad things happen. I would love to be put out of business. It would be great if this problem didn’t exist. But that’s not all of the story. Someone’s trauma doesn’t define who they are. It doesn’t mean the rest of their life is doomed. The other side of trauma is resilience. We all have some level of resilience that is inherent in us. We also can learn to be resilient. I want people to know that trauma itself is not the end of the story.
The other thing I want people to know is that abuse or neglect doesn’t have a preference. It can affect any socioeconomic status, race, color, creed, religion, neighborhood. It’s everywhere and keeping your eyes open and your biases at the door is sometimes hard to do, but that’s my goal. I feel that I have a duty to my patient, and I think every physician feels that. My patients happen to be suspected victims. It’s a field that hasn’t been around forever – it’s newer – and it was created in response to this diagnosis of abuse. It’s complex and it’s hard to make sometimes, but it's needed.
What should someone do if they suspect abuse or neglect?
If someone suspects that a child is a victim of abuse or neglect, they can make a report to their local child protective services agency. So, the way that works is you make a report to the county where the child lives. In Hamilton County, that’s 241-KIDS; if you look online, you can find the numbers for other counties. You give your information, you give your reason for concern, and the county investigates. So, they decide whether or not to open a case and investigate.
How has COVID-19 affected what you do?
The numbers dropped. And that’s probably because mandated reporters, people who would usually make a report about abuse and neglect, were not seeing children. Now they’re starting to rise again as children are going back to school, going back to daycare. But we know based on past recessions that the number of cases of abuse and neglect rise when there’s stress. Right now, our world is going through a lot of stress – stress about jobs, health, the election. There’s so much going on. So we are seeing a surge.
Who is a womxn you find really inspirational and influential?
My mom. She’s an immigrant. She and my father came to this country and they both gave our family their all. I think about what it must have been like for her to leave her home country – everything she knew, the language, her friends, her family, the food, even the weather – to come to another country and start over. And when I ask her if she was nervous to come to America, she says no. America is where you go. It’s where your dreams can come true. So, that’s the way we were raised. Hearing this is the place where if you work really hard, then you can achieve what you want.
And certainly, that’s not true for everyone. There are challenges, but she was so inspirational. She worked really hard raising our family. She’s a very good mother and a very good person. She’s resilient. I think that’s the thing I admire the most about her. No matter what has happened in her life, I don’t know if you would ever notice that it has affected her because she’s always had this ability to bounce back so well and give us light in our lives. She’s definitely been one of the biggest, if not my biggest, supporter in life.
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