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ACEs Champion: Dr. Tasneem Ismailji finds her niche in promoting ACEs as scientific evidence for health effects of violence and abuse

 

Pediatrician Tasneem Ismailji is a cofounder and former president of the Academy on Violence and Abuse (AVA). Her Pakistani heritage and love of children have informed not only her career choices but also her decades-long commitment to the prevention of the health effects of violence and abuse.

Born in the ancient city of Karachi, Pakistan, Ismailji was one of seven siblings — four girls and three boys — growing up in a loving Muslim family, where she spoke both Urdu and English.

In the eighth grade, while enrolled in all-girls school, she had to choose whether to focus on biology or mathematics. She told her father, “I’m very good at math and I would like to do engineering.”

He advised, “You are not going to survive because it’s all boys.”

So, she chose biology – and that changed her life.

In Pakistan, medicine has always been an accepted profession for women, because women preferred female ob-gyn doctors. Ismailji was admitted to a five-year medical degree program at an unusual kind of medical school in Lahore, Pakistan: It was for women only.

(In the U.S., there have only been two medical schools just for women. Both were established in the 19th century and neither exists today.)

Not all women in Pakistan choose to have professional careers. Ismailji explains her decision this way: “The predictable course of my life was that I would have an arranged marriage. Two of my sisters had arranged marriages, but this model did not appeal to me,” she says

“Starting at the age of 2, I made friends with little boys, flying kites, playing cricket,” she continues. “I was better than them in school, in sports, and I used to drive my mother crazy.”

Life begins with children

While in medical school, she was asked to choose her specialty. Top-ranking students were allowed to specialize in obstetrics and gynecology, while those in the bottom ranks could choose only pediatrics. Despite being top-ranked, Ismailji wanted to become a pediatrician.

“I have a love of children,” she says. “Life begins with children. I really wanted to take care of children and help heal them.” She quoted Nelson Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”

After her graduation and internship, she passed a rigorous exam so she could apply for a residency abroad. At 23, she got an internship at Rochester General Hospital in upstate New York. Later, while doing her pediatric residency at the University of Rochester, she met her husband, Bala Manian, an engineer who became a prolific inventor in digital optics, with applications ranging from medicine to the film industry.

After spending a few years near Boston, where they did not feel the kind of acceptance they had experienced in Rochester, they got into their van and drove through the country, evaluating potential cities along the way. “When we could drive no more, we ended up in the Bay Area.” she says.

While her husband was busy founding startups in Silicon Valley, Ismailji was busy raising two young children. Her son is now a Silicon Valley entrepreneur and her daughter is an economist and assistant professor at Washington State University in Pullman.

Ismailji worked part time at Kaiser Permanente in Sunnyvale for 10 years while she was taking care of the children. She stopped work for several years and then returned, but when Kaiser encouraged her to switch to a fulltime track with leadership potential, she left for good. Then, at age 44, she got a master’s in public health in an intensive nine-month program at UC Berkeley.

Supporting battered women

At this point, two events redirected her life.

First, her husband’s company had donated to the nonprofit Support Network for Battered Women. He passed along to his wife his invitation to a lunch there, and Ismailji began learning about domestic violence.

At the time, she was living in Saratoga, an affluent town in Silicon Valley, when she saw a police car drive up to the house next door. Her neighbor had been severely beaten by her husband, and Ismailji saw the police take the man away in handcuffs. The couple had two little boys, and Ismailji offered to take care of the children while their mother was being treated at a hospital.

When the mother returned, Ismailji told her to take her children and go to a motel, which she did.

Ismailji still seems shaken by what she had witnessed. “I knew I had no clue about domestic violence,” she says. “But I knew I had saved her life at that point.”

After being trained by the Support Network for Battered Women, Ismailji, always a powerful speaker, began going to local schools and hospitals to give talks about what she had learned.

She first heard about the ACE Study in 2004, when she heard Dr. Vincent J. Felitti speak at a Futures Without Violence conference.

The landmark CDC/Kaiser Permanente Adverse Childhood Experiences Study of more than 17,000 adults, linked 10 types of childhood trauma to the adult onset of chronic diseases, mental illness, violence and being a victim of violence.

The study found that ACEs are remarkably common — most people have at least one. People who have four or more different types of ACEs — about 12 percent of the general population, but more in communities with people of color who are poor as well as poor rural white communities — have a 1,200 percent higher risk of attempting suicide and a 700 percent higher risk of becoming an alcoholic, compared with people who have no ACEs. Many other types of ACEs — including racism, bullying, a father being abused, and community violence -- have been added to subsequent ACE surveys. (ACEs Science 101; Got Your ACE/Resilience Score?)

The epidemiology of childhood adversity is one of five parts of ACEs science. The other parts include how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, how toxic stress is passed on from generation to generation, and research on resilience, which includes how individuals, organizations, systems and communities can integrate ACEs science to solve our most intractable problems.

That presentation “was what I had been looking for: the scientific evidence for the health effects of violence and abuse. That’s my lens,” Ismaili says.

The science is clear: It’s a health issue

She wants health care professionals and others to understand that the health effects of ACEs and domestic violence are not only a social issue and something for social workers to handle: They are a health issue.

The Roadmap for Resilience,” a 2020 report issued by California Surgeon General Dr. Nadine Burke Harris, “has established the criteria for causation between ACEs and health effects,” Ismailji points out.

Her focus now has moved to those people who don’t suffer the health effects of ACEs.

“Each individual brings certain protective factors and strengths that moderate the effects of ACEs,” she says. “We have to see what it is about human beings and their ecosystems that allows individuals to flourish even when adversity happens to them.

As a physician, the more we understand this, the better we can help people.”

Founding the Academy on Violence and Abuse

In early 2004, Ismailji met with a group of 20 people from an American Medical Association council on violence and abuse. This meeting was a response to a seminal report, “Chronic Neglect,” that cited the lack of training about violence and abuse in the health care professions. The group of 20 decided to do something about it.

At a three-day meeting which included Dr. David Corwin, a pediatric forensic psychiatrist, Dr. Ismailji and this group decided to create the Academy on Violence and Abuse (AVA). AVA’s mission is to educate health care professionals and others about the health effects of violence and abuse. It is a nonprofit, member-based organization.

AVA produced a four-hour ACE DVD that has been widely distributed throughout the world. It has been well received by healthcare professionals, legislators, and many others.

The model for educating health care professionals

Ismailji’s influence is visible in AVA’s model for educating health care professionals and their local communities about violence and abuse.

First, from the beginning of AVA, she insisted on substituting the word “health” for “medical.”

“The term ‘medical’ makes nurses and other health care professionals feel excluded,” she explains. “Medicine has traditionally been a hierarchy, with doctors at the top and nurses below.”

In addition, she helped create the model for the “regional academy,” a town hall approach to spreading the word about the health effects of violence and abuse. Ismailji and her colleagues felt that AVA had to do more than just make educational presentations. AVA had to engage the community.

The first regional academy took place in Ashland, Ohio, in 2014 and included talks by national experts, local experts, a survivor panel and enthusiastic engagement by community leaders and members. Since then, AVA has conducted 15 regional academies on violence and abuse, customized for communities around the globe.

Of course, since the pandemic, they have had to pivot to a virtual academy, and consequently, “the community engagement has been a big struggle,” Ismailji says.

AVA received funding recently from the California ACEs Academy. CAA is a collaboration that includes the AVA, the American Professional Society on the Abuse of Children and its California counterpart, as well as the Center for Innovation and Resources.

Almost 3,000 visitors to the AVA site have viewed webinars by national experts as well as regional activities, such as the Santa Clara County Network of Care gathering. Many more webinars and interactive meetings are planned for 2021. Ismailji says we can expect a report evaluating the effect of the CAA model on health care professionals’ education and the communities they have touched.

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