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In Wilmington, doctors try to undo effects of children living amid violence


(Delaware Online) – A small bulletin board inside Nemours’ Wilmington clinic serves as a reminder for Dr. Hal Byck of the work still to be done.

Funeral programs and childhood photos commemorate the patients he has lost over the years.

The names are often the same ones that dot crime stories and are sometimes later associated with city street gangs.

Byck reads the stories and hears the rumors.

But when Byck looks at those photographs, he doesn’t see criminals — he sees the young men and women that learned to walk and talk in his office.

As a longtime Wilmington physician serving the city’s youngest residents, gun violence has changed the way he thinks about his practice, which traditionally involves immunizing children and treating ear infections.

“If they’re going to be shot at 18 or 19, what could I have done?” Byck asked. “Because God knows that’s more important than any of the other things I’ve just mentioned, just (for a child) to survive.”

The balance is something Byck, who has worked in Wilmington for nearly 25 years, struggles with daily.

“I failed,” he said. “My purpose is not just to get them to 18 but to have them have a good foundation to get through life. So every time an 18- or 19-year-old is shot, not only does it hurt, but somewhere I didn’t do what I needed to do.”

The Jessup Street office, which serves mostly Wilmington residents, deals with wellness visits and the average childhood struggles. But Byck’s team also takes on chronic stress and trauma, the kind associated with seeing a person shot to death outside your home or hearing gunshots regularly ring out down your block.

Byck said about 25 to 30 percent of his childhood clients say they have seen someone get shot or die, a question he now asks as a part of childhood physicals. Some have seen this happen four or five times, he said. 

For many who call Wilmington home, that’s just normal. 

“I’ll ask them, ‘Does it bother you?’, and they say no, because they’ve learned to become accustomed to it,” Byck said. “This is part of what they see.”

That chronic stress has devastating effects on childhood development, long documented by extensive research, said Meghan Walls, a psychologist who works in the Jessup Street clinic. 

She compares it to a person’s reaction to stepping in front of a car that’s about to hit you, the “jumping back” reaction and the adrenaline rush that comes with it.

“That’s their stress response all the time, constantly. And so, it’s not surprising that when smaller things happen, these kids reactions may be bigger,” Walls said. “If our approach to kids for pediatrics and from schools and from the community was different, I think we would see a different outcome. So instead of just calling it trauma, when I talk to parents and communities, I talk about constant stress, what we call toxic stress.”

“The reality is it’s just a constant car that they’re jumping in front of and jumping out of the way of every day,” she added, “and so, by the time they’re getting into these bigger issues, it looks worse.”

When that’s the stress that clients feel regularly, visits to the doctor become about much more than making sure a child has its shots. Check-ins serve as opportunities to connect with counseling, get a family additional food or transportation services, and ensure that children aren’t just surviving but thriving. 

That can be hard. 

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