Combat Medic Describes Urban Violence as the 'War at Home'

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John Pryor, leads the University of Pennsylvania's trauma program, and is a former combat medic in Iraq. Pryor draws parallels between his experience working in West Philadelphia hospital emergency rooms to his work in Iraq war zones. To Pryor, urban violence is the "war at home."

MICHEL MARTIN, host:

I'm Michel Martin. This is TELL ME MORE from NPR News.

Just ahead, a former slave founds a newspaper a century ago to tell the stories of his people. His descendants run it to this day. The Afro American newspaper turns 115 years old today. That's next.

But first, we want to continue our conversation about violence in the inner city with Dr. John Pryor. He's experienced many combat zones - those in Iraq, where he was an Army surgeon, and those on the streets in Philadelphia. He joins us from his office at the hospital of the University of Pennsylvania in Philadelphia.

Dr. Pryor, welcome, and thanks so much for speaking with us.

Dr. JOHN PRYOR (Director, Division of Traumatology and Surgical Critical Care, University of Pennsylvania): Hello, Michel. It's my pleasure.

MARTIN: Dr. Pryor, you wrote an article for The Washington Post in which you said - well, let me just read what you said, that...

(Reading) "In Iraq, ironically, I found myself drawing on my experience as a civilian trauma surgeon each time MASCALs or mass casualty situations would overrun the combat hospital. As nine or 10 patients from a firefight rolled in, I sometimes caught myself saying just like another Friday night in West Philadelphia.

Did - it sounds like you're surprised yourself that it was so similar.

Dr. PRYOR: It is. Yeah. It's a terrible testament that, you know, sometimes I can't tell whether I'm in Iraq or if I'm in West Philadelphia. I sometimes have to look at the ceiling and see if it's a tent above me or solid ceiling. And, you know, and unfortunately, what we learned how to take care of people in Iraq, we've really learned on the streets of America taking care of civilian casualties over the last 20 to 30 years.

MARTIN: Now, I know that your job is to fix what's broken. But I would like to ask you why you think this is happening. I mean, this isn't the only city -Philadelphia's not the only place that's grappling with this. I mean, there've been some terrible stories out of Oakland and, of course, the Newark situation that we've just been talking about here. Why do you think this is happening? Do you have any idea?

Dr. PRYOR: You know, it's - the first thing is that's been going on for a long time. I mean, the epidemic of interpersonal violence has gone through the '90s and now into the 2000 to 2007. It gets worse and it gets better. Right now, we're on a kind of a trend of getting worse again. And it's always there in the background. There's always thousands and thousands of kids being killed every year. But of course, you know, we get to - we get used to that fact. And we have, you know, a lot of other things that we need to worry about, international events, and sometimes it gets off our radar screen. But now, the violence seems to be getting worse again. And that's why I think it's back again.

MARTIN: But why do you think - and again, I understand this is not your area of expertise. Your area of expertise is to try to keep these kids alive, to save their lives. But, you know, I've been, you know, following the discussion in Philadelphia. People are just outraged and disgusted as one would hope they would be. But people you're saying, well, you know, it's the parents. Well, you know, there are dysfunctional parents in lots of situation. People say it's guns. Well, you know, there have always been guns in the United States. What is it that leads to these - I don't know. It's almost like a virus, like some virus that breaks out.

Dr. PRYOR: Yeah. And, of course, the problem is it's an extremely complex problem. I mean, we just heard from Mr. Harvey, who, you know, emotionally told us how he did everything he could to keep his son out of trouble. And he did. And his son wasn't in trouble. He was an innocent victim of the violence that's going on in the cities. And obviously, when you look at this problem, it's very multi-factorial. It has a lot to do with economics. It has to do with social situations. It has to do with, basically, a culture of how people interact with each other. And when you put all that together, there's no quick, easy fix. And I think that's the thing that frustrates people. People want an easy answer, like let's do this and this and this then it'll go away. And obviously, it's not. And it has a lot to do with the whole structure of the city, the whole way we interact with each other. And I think that's the difficulty right now.

MARTIN: Well, I also read your piece as a cry for attention. I think part of what I thought you were saying is that this matters, and that we can't just act as if, you know, if it doesn't happen to me, it's not happening. And I'm just wondering why you think it is that - you know, we have vanquished other diseases in this country. We've, you know, we pretty much wiped out tuberculosis, although it does sort of surface again from time to time. We wiped out polio. Do you think it is possible to wipe out urban violence if we address it as a disease that had to be fought?

Dr. PRYOR: That's very insightful, Michel. I mean, what we're trying to do at the University of Pennsylvania with the Firearm Injury Center here at Penn and others are to look at this interpersonal violence as a disease. And when you do that, there are ways you can use public health kind of techniques to address the problem.

Let me give you an example. You know, back in the '50s and '60s, you know, automobiles were deathtraps. There were horrendously, you know, bad instruments, and people were getting killed. And the government and along with researchers were able to, you know, address that as a health problem, not as a economic problem, not as a political problem, but as a health problem. And over the last 20 or 30 years, we've been able to do amazing things to try to stem the death from motor vehicle crashes. We need to do the same thing with interpersonal violence. We need to adapt these techniques in learning research to interpersonal violence.

MARTIN: But what would that mean?

Dr. PRYOR: Well, it means, like, a good example in here in Pennsylvania, you know, Pennsylvania obviously recognized the problem and established back in 2005 what's called a PIRIS Program, which is the Pennsylvania Injury Reporting and Intervention System. And what this is is basically taking every gun-shooting that happens in the city and try to put it into a database, try to understand what happened with that shooting - not only the physical, you know, shooting, but what happened with the victim and with the shooter, and then try to have some type of intervention to make sure that that type of interaction doesn't happen again. And using data and using, you know, scientific methods could really look at the problem as a scientific and public health problem, not as a political problem or a socioeconomic problem.

MARTIN: To see what the triggers are. And finally, doctor, I don't mean to intrude but - and I know you're a professional and, you know, your job requires a lot of emotional discipline. But I wonder if this ever gets to you.

Dr. PRYOR: Absolutely. And let me tell you, Michel, that what - listening to Mr. Harvey is what drives myself and my nine partners who work every single day to try to get these kids through their injuries. That is exactly why we do it, because, you know, 50 or 60 times a year, I have to walk into the emergency room and tell somebody that their son is dead. And that is the motivation for us to work harder.

MARTIN: You ever think about getting out or doing something else?

Dr. PRYOR: No, you know, we say you're born a trauma surgeon, there's not much else you can do. And, you know, I think someday, you know, it might all get to you. But right now, we're trying to do the best we can to get these kids saved.

MARTIN: What can the rest of us do?

Dr. PRYOR: I think one is, you know, realizing that there's a problem and pushing our political leaders to make this a national agenda item. You know, we're in the midst of a campaign, and I have not heard interpersonal violence come up on the radar screen of our national leaders very often in the early debates. And that's something we can probably push, because this is clearly a national problem. It affects every city in the country.

MARTIN: Dr. John Pryor is the director of the trauma center at the University of Pennsylvania Hospital. He joined us from his office.

Dr. Pryor, thank you so much for speaking with us.

Dr. PRYOR: Thank you for having me, Michel.

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