Dr. Rochelle Dicker is a Trauma Surgeon in San Francisco. She is the Director of the Wraparound Project, a hospital-based violence prevention program that has been replicated in other trauma centers. She has created a cutting-edge model for disrupting the perpetual cycle of violence in vulnerable communities.
What inspired you to devote your life to helping others?
Growing up, my family would watch the national news and then we would discuss what we just watched around the dinner table. Through these conversations, I was compelled to help the world in some way.
On the weekends, I went with my dad to his job. He was the owner of a clothing manufacturing business. At 10 years old, I was taken by how hard new immigrants were working in my dad’s factory. They came in on the weekends because they wanted the over-time. They were doing everything possible to make life better for the next generation. I witnessed a lot of their struggles. They were incredibly kind whenever I visited. I thought at some point I would serve communities that were vulnerable.
Why did you want to become a surgeon?
In high school I was told that I was lucky to be passing basic math. In college I was told to give up my dream of going to medical school because I was too old to switch majors. I had started out as a literature major. Nobody was going to stand in my way and tell me “I can’t.”
I went to the University of Vermont for medical school. I did my surgical rotation in my third year and thought there was no way it would be a good fit. But after the first three weeks, I was hooked. It gave me the feeling that I could make people better right away. It provided instant gratification. The ability to change people’s lives was extraordinary.
I then had to reconcile surgery with public health and my desire to serve communities. I always thought that surgery was about the individual and about expensive medicine – not about serving the masses. I struggled with this tension but when I became an intern I realized that surgery could be about vulnerable populations if you focus on injury. Those who are injured are mostly from vulnerable populations.
What has been your experience as a woman working in surgery?
When I was a resident, I definitely felt discrimination. In order to be treated equally you had to be better than the guys. Leaders in surgery were reluctant to have women in the field. It was hard to find mentors.
Becoming a surgeon is a really long road and that deters many women who want families. We’re slowly shifting the tide – both in terms of the acceptance of women and also by understanding that it’s okay to have a life outside of medicine. Now that women are part of the leadership, there’s no turning back!
Why did you found the Wraparound Project?
When I was an intern I met a man who doubted he would live to 25 years old because he thought he’d be shot and killed. He came back twice in the same month with gunshot wounds and survived both surgeries.
I did a violence prevention fellowship and learned that there are risk factors and preventative measures in violent injury. Just like there are risk factors to heart attacks such as diabetes, poor diet, and lack of exercise that make you susceptible, the same is true for violence. The risk factors are socioeconomics, poor education, poor opportunities for jobs, unsafe neighborhoods, drugs, dysfunctional family units, etc. But there are conditions that are reversible, which can reduce the risk of violence.
I started the Wraparound Project and hired a case manager who had a deep understanding of urban violence. He, himself, came from a vulnerable community. Because of his background he was able to go to patients’ bedsides and create an incredible bond.
What resources does Wraparound provide to injured patients?
We provide a risk assessment and needs assessment based on the individual’s profile. We offer a long-term case management plan where people are shepherded through risk reduction resources. We try to create protective factors and opportunities like helping them go back to school and find jobs. Some individuals need to first address a mental health disorder before they apply to school.
What has been the progress of Wraparound to date?
Today Wraparound has served over 600 people and the re-injury rate has been cut in half. We have four case managers. Right now we are interested in creating an internship program because a lot of clients who have been served by Wraparound want to become case managers.
What is challenging about working with vulnerable communities?
There are extraordinary challenges. The case managers often represent the first people in our clients’ lives that believe in them. The clients have a hard time trusting. They’ve never had structure or discipline and they’re stuck in a desperate situation, often without any resources. We’re trying to help them create a safer life for themselves.
They think in terms of the day-to-day and we’re trying to shift their perspective to think in the long-term. They didn’t grow up believing that if they work hard, over time they can achieve their goal.
What are your short-term and long-term goals for Wraparound?
My short-term goals are to create the internship program and hire a clinical psychologist on staff. Mental healthcare is essential for our clients.
My long-term goal is to expand the program to serve the older population in San Francisco. People in their 40s and 50s who get injured have a different set of needs from the younger population. I want to provide case management services for them. They’re typically homeless and have severe mental health issues such as schizophrenia. If we had a program specifically for them, we could make real headway.
In November I’m going to the Panamerican Trauma Conference in Brazil and I have an opportunity to do a workshop for hospitals in Central and South America. I will teach them how to set up a hospital-based violence intervention program. I’ve spoken in the U.K. and I’m also helping a few programs across the U.S. So the expansion of this model is a long-term goal.
We want to incorporate these programs into the fabric of trauma centers nationally. We’re working with the Law Center to Prevent Gun Violence, which is an organization comprised of lawyers who are interested in the cause. We’re figuring out a way for case managers to be paid as healthcare providers. There’s a coalition of 30 programs like ours called The National Network for Hospital-based Violence Prevention Programs. We work on this as a big group so we can come up with a sustainable solution instead of having to fundraise every year.
What are you most proud of?
I’m proud that medical students and residents today see that surgery has a gentle side. Programs like Wraparound acknowledge that surgery is not all about genotypes and phenotypes. A lot of risks that go into someone needing a surgical procedure are based on the fact that there are social determinants of health. And those are as important as genetics.
What life experience has had the greatest impact on you?
My parents never pushed anything down my throat, but daily there was an underlying feeling that you’re supposed to serve your community. It’s spiritual, it’s religious, it’s familial.
What do you want your legacy to be?
I want my legacy to be about establishing an even playing field and acknowledging that a community, state, or country can’t be healthy unless our most vulnerable people are cared for.