A peripatetic pediatrician's journey into pediatric rheumatology: part III

The largest pivotal force that moved pediatric rheumatology forward was the decision by the MCH to bring pediatric rheumatology to the head of the list as a major unmet medical need in the care of children in the USA.Even more important to pediatric rheumatology and to all of us caring for these children was the decision by the MCH to make pediatric rheumatology a model for implementing better care for all chronic illnesses of childhood. This included introduction of case management health teams. A national committee was formed to promote better understanding and availability of services for children with special needs in the educational system of our country. A valiant and slightly successful attempt was made to address insurance needs and deficits. For example, at this time, children with JRA were not only denied health insurance but even life insurance.We were struggling to become an identified area of medicine. It was an uphill effort. We were the stepchildren of adult rheumatology, and the pediatric world did not know of our existence. There were few identified programs in medical schools. We had no depth in basic research. Care for children with arthritis was difficult for parents to find.The BMCH was and still is a distinguished and modest federal agency that has as its main thrust the development of unmet medical needs of children. Few are aware that they developed the pediatric centers for hemophilia, pulmonary diseases, cardiology, and others.Sometime in 1980 Drs. Merle McPherson, Director of Special Needs Children BMCH, and Dr. Vince Hutchens, Director of BMCH (then Division of Maternal and Child Health), contacted me and related that they had selected pediatric rheumatology as the next unmet medical need of children. It was as if the burden of the world had been lifted. They proposed that our clinic in Houston be a pilot project. Fifty thousand dollars was the allotted amount to get started. Vince Hutchens later told me that two other pediatric rheumatol