One question changed everything for trauma surgeon Dr. LJ Punch: “Where you at?”
In 2016, Punch was a panelist at a community forum on gun violence, hosted by Better Family Life. It was just six months after Punch arrived in St. Louis, and Punch’s new employer Washington University School of Medicine had a gun-violence initiative. Punch had just been recruited from Baltimore to work in the surgery department at Barnes-Jewish Hospital.
“After the panel — which I felt did not go particularly well from my standpoint, because my white coat and long answers were not inspiring to anybody — James Clark came up to me,” Punch said. “I shared with him that he knew my boss. And he said, ‘Yeah, I know your boss. Where you at?’”
The disconnect between the two worlds — the community and hospital — was jarring, Punch remembers.
“That’s when I decided to match and marry a public-health campaign with this boots-on-the-ground program that Mr. Clark was starting, the gun violence de-escalation program,” Punch said.
STOP THE BLEED is a national campaign that was launched after the tragic shooting at Sandy Hooks Elementary in December 2012. Through free courses, anyone can learn how to stop life-threatening bleeding in emergency situations.
“While it’s wonderful and important, mass shootings represent only 2 percent of all gun violence,” Punch said. “How can we take this well-thought-out approach and apply it to communities where gun violence is not an ‘if,’ it’s a ‘when’?”
It took about two years of discussions with Clark and his team of outreach workers before they had their first class. It was led by Punch, along with medical student Jane Hayes and Dr. Erin Andrade. While attendees liked learning about how to use a tourniquet to prevent bleeding and other medical skills, the more powerful moment came when the class received certification cards to put in their wallets, Punch said.
“People were holding up their cards, walking around saying, ‘I’m certified,’” Punch said. “That experience really brought home for us a couple really key principles. One, radical generosity. We have to undo this sensation of distance and scarcity — and instead infuse people with the idea that you are enough and can act as a helper on the scene wherever you are.”
The second principle was being accessible to people, which often goes against the numerous boundaries commonly experienced in health care, Punch said.
In the first year, Punch’s team certified 3,000 people in these life-saving skills at schools, churches and other community events. Since the program started, they’ve instructed 8,000 people and provided just as many medical kits along the way — including to many teenagers. That effort led to the opening of The T, at 5874 Delmar Blvd. The logo — a capital T with a slash going through it — was meant to look like a tourniquet.
“But it ended up looking more like ‘No more trauma,’” Punch said. “Since we’ve been at The T, our platform has gone way past STOP THE BLEED.” It now includes youth nights, classes on opioid overdose, and programs to aid recovery, emotionally and physically, from bullet injuries.
‘Stop the virus’
“So, the T is wonderful,” Punch said. “We’ve got programming, volunteers, students — and then the pandemic hit. And everything we had based our space on was proximity.”
Interestingly, Punch’s team had established an international trade and supply chain for the trauma first-aid kits. In January, they learned that the pandemic was really serious, so they decided to shift gears.
“This is coming,” Punch remembers thinking. “It’s going to be very similar to violence because it will take advantage of those who don’t have what they need. And maybe we’re in a position, the same way we were to stop the bleed, to now stop the virus.”
They shifted their purchasing to Personal Protection Equipment (PPE), including masks and gloves, and began making Stop the Virus kits. They crossed paths with PrepareSTL — a regional governmental outreach campaign that gives out PPE and educational resources on COVID-19. So, they joined forces and turned The T into a sterile room to make the kits.
“Many weeks later, I don’t know how many thousands we’ve reached in partnership with PrepareSTL,” Punch said.
COVID-19 reinforced a powerful concept for the team.
“If you are surrounded by bullets, if you are surrounded by a virus, if everyone around you doesn’t have what they need in terms of their nutrition, if pain and trauma are the lived and breathed norm, it can seem as the only choice you have is to succumb to it,” Punch said. “We say, ‘No, no, no.’ With the right training, with the right equipment — whether a tourniquet or a mask or a Narcan or a bandage — you have the power to change the outcome.”
‘Trauma surgeon in recovery’
“I’m a trauma surgeon in recovery,” Punch said. “I have been there when many, many beautiful black men have taken their last breaths, all due to the impact of violence. I have gotten to a point where I can no longer accept that fate for my people, having seen the power people have when you simply take the time to be present, teach and give. I am so compelled by both that strength and so disturbed by the horrors I’ve seen, I can no longer sit inside the walls of the hospital and be satisfied.”
On July 1, Punch will be moving the work outside the walls of the hospital and will be working full time in what Punch calls “community health.” Punch will work through the T and a newly established nonprofit, Power4STL, to focus on four areas: bullets, COVID, homelessness and opioids.
“They are all areas where I find both tremendous resilience and profound suffering,” Punch said. “I’m going so far as to take my office on wheels.”
Punch bought a used ambulance to move within the community. But the end game is The BRIC — Bullet Related Injury Clinic, which Punch hopes to open by the end of the summer. The clinic will serve the needs of people who have experienced a bullet injury and are being discharged from the hospital. More than 2,000 people experience bullet injuries in this region every year, Punch said, and half of them are discharged from the emergency room without being admitted.
“Frequently, their wounds are superficial enough that they don’t require surgery, but they are still deep enough that they completely disrupt a person’s wellbeing,” Punch said.
When they are discharged, they are often forced into the very difficult task of caring for their wounds themselves. The pain is immense, and often fragments of the bullets are left in the body.
“The thing is it doesn’t just limit itself to the bullet track,” Punch said. “It impacts the family and it hurts one of our most essential components of wellbeing — the need to belong or connect to others. Because when someone shoots a piece of metal into your body intended for your death, and you then walk around with that hole, scar or even that metal still in you, it’s very, very difficult to believe the world is a place in which you are safe.”
For all this profound work and impact in the gun violence and COVID-19 pandemics, Punch is receiving the 2020 Stellar Performer in Health Care at the virtual Salute to Excellence in Health Care Awards event on July 9. The St. Louis American Foundation’s annual Salute programs help foster more than $1 million in local minority scholarships each year.
“Making the decision to move beyond the walls of the hospital and into the community was one of the richest, most amazing decisions I made — that I didn’t necessarily realize I made,” Punch said. “That’s how all this got started — was me simply trying to answer the call, ‘Where you at?’”
The 20th Annual Salute to Excellence in Health Care Awards will be celebrated online as a free virtual event at 7 p.m. on Thursday, July 9. For additional details and to register, visit givebutter.com/salutehc.