As the medical director of HELP/PSI, an organization that provides residential care, adult day care and other services to people with HIV and substance abuse problems, Dr. Barbara Zeller faces some of the most complicated issues in AIDS care head-on. But she’s not likely to be discouraged, as she’s wrestled with the unique challenges of treating AIDS and substance abuse since the beginning of the epidemic. Zeller has tackled the epidemic from various angles—as a doctor, researcher and administrator—and the New York State Department of Health AIDS Institute recently recognized her work by presenting her with the Dr. Linda Laubenstein HIV Clinical Excellence Award. But Zeller is, above all, a caregiver. “Fundamentally, I love caring for people, and that’s where my heart is,” she says.
How did it feel to receive the Laubenstein Award?
I was both surprised and very excited. It's wonderful to be recognized by colleagues. The day-by-day challenges of this field tend to make me feel that I can never do enough or know enough. But this was a moment that helped me reflect on some accomplishments. The awards ceremony was very lovely. We were surrounded by the AIDS quilt up at the convention center in Albany.
Why were you first drawn to HELP/PSI?
In the ’80s, I worked with an acupuncturist in the [gay] community who was very bravely seeing people with AIDS before there was any treatment. She would call me for medical advice. Through her, in 1991 I found out about PSI, which was new at that point.
I’d always had an intimate relationship with community health in New York, and I worked with Lincoln Hospital’s Detox Program in the ’70s to develop their first community acupuncture program. It was very innovative—they began using acupuncture to treat drug addiction, and then expanded to provide it to the community’s health in general. I was always connected to the issue of substance abuse, and then the AIDS epidemic hit.
So you knew right away you wanted to devote yourself to AIDS care?
I started at PSI in 1990 with trepidation. I’m an internist and I’d certainly worked in the community and was experiencing the AIDS epidemic—but this was full-time work with AIDS and with people who were very sick and had a lot of issues. The state helped us create a fairly remarkable model for long-term care, and HELP/PSI opened a 66-bed nursing home. Suddenly we were able to deliver care where people had a roof over their heads. They had medical and nursing services 24/7, social workers on-site and recreation therapy. It felt like I was in a small town. You could take care of people and see them at lunch. In the early days, many people died here, but now they live here for a year or two before returning to the community—in better health and clean and sober. And the way I feel about the nursing home hasn’t changed. For an AIDS physician, it’s a very intimate, gratifying way to give care.
What were the greatest challenges of being an AIDS physician in the early days of the epidemic?
It was a new and frightening disease with little expertise to rely on. But that was also what drew me to AIDS. All of us in the field had to develop a very real sense of humility. You couldn’t be arrogant and be an AIDS physician—you still can’t, but you certainly couldn’t in those days. And you had to have an incredibly collaborative relationship with your patients, because they were experiencing things that we didn’t know much about. You had to learn to listen, listen, listen and to be able to say to people, ‘I might not know the answer today but I’ll stick with you and we’ll figure it out tomorrow.’
Was there anything else you could offer these patients when you couldn’t offer a clear solution?
I understood, early on, that developing an integrative medical approach was very important for care. At HELP/PSI, we provide acupuncture, massage, Reiki, herbs and nutrition. We feel very strongly that in the middle of this rather alienating world of pills, pills and more pills, complementary medicine—whether it’s touch or some other treatment—is very healing.
How have these challenges changed as the epidemic has changed?
There are still unknowns. Because the field is rapidly developing, unless we get the updates every month—or year, as it may be—we’re behind. It’s important to acknowledge the dynamism of the field and yet still give people a sense of security in their care. We might not be able to know the answers all the time, and therefore we have to work together.
How is your work particularly difficult?
In addition to [dealing with] the complexities of HIV, the people we treat have enormous social issues that are not easily solved. I think that the instability of lives—and that could be drug relapse, or non-adherence to psych meds with a relapse of a psychiatric condition—makes it too easy for people to cycle out of care. Those are the times you say, Oh, no! We’ve all pieced together this thing that will work if it can be done, but there are so many complicating factors for our residents. Their lives fall apart very quickly and very easily.
Are there ever days when you don’t think you can continue?
No. I’ve been lucky to work in a healthy organization. There has always been a deeply felt response to the epidemic, and in general, the people in the field are wonderful to work with.
In the public health movement, there’s an amazing connection between scientists, physicians and other service providers—where else do you have that in medicine, or in life? So you have a sense that this collaborative, international public health movement is still reaping change.
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People in neighborhoods all over New
York City recognize C. Virginia Fields. For nearly 20 years she played
several major roles in city government—including a seven-year term as
Manhattan Borough President and a run for mayor. Now, as the new
president and CEO of the National Black Leadership Commission on AIDS
(NBLCA), she brings her political energy to a different campaign:
Battling HIV/AIDS in the African-American community.
Woman of the Month is supported by exclusive advertising from Gilead.
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