SPRINGFIELD — When a patient at Baystate Medical Center has a gunshot wound, it’s likely that Dr. Kristina Kramer’s team treats them. And after they leave the operating table, a program she started can help them move forward.
She has seen — and felt — the increase in gun violence in her work in the hospital’s division of trauma, acute care surgery and surgical critical care.
“Taking care of victims of gun violence tends to be more stressful on the whole team,” said Kramer, associate trauma medical director. “People can be really, really sick. So you have to act quickly to intervene and to do what you can do to save their lives. They can get worse, much quicker.”
It’s a high when Kramer and her fellow health care workers can save someone: “That’s the reason that people go into this, is to be able to do that,” she said.
And then there are also times when Kramer has to tell people that their loved one has died, the most difficult part of her job. “You get better at it,” she said. “But it never gets easier. All you can really do is sit with people when they come apart.”
A death from gun violence is unexpected, she said. “People are normal, healthy, they were on their way to school or work, they had breakfast with their families. They were in too much of a rush to say goodbye that morning. It’s hard because families feel angry because their loved one has been taken from them.”
This year, there have been 27 homicides in Springfield, the highest annual number in the Springfield Police Department’s records going back 24 years. On Wednesday, a shooting at a Holyoke intersection left a pregnant woman riding on a bus in critical condition and her baby, which she delivered at the hospital, dead. The shooting came just 90 minutes after city officials held a press conference about gun violence and urged residents to call the police if they hear gunfire.
Kramer is the medical director for Better Tomorrow, a new violence intervention program at Baystate Health. It’s a partnership with Roca, a nonprofit focused on at-risk young adults, to try to reduce gun violence.
“There’s a lot of amazing things happening in the community, so part of my goal is to not reinvent the wheel,” Kramer said, “but to figure out what we can do from inside the hospital to contribute to prevention efforts.”
The program started operating in the fall of 2022 and is funded by a grant of nearly a million dollars from the U.S. Department of Justice. While it’s a first for Baystate, hospital-based violence intervention programs exist nationwide, like at John H. Stroger, Jr. Hospital of Cook County in Chicago, Illinois where Kramer previously worked.
“Hospital-based violence intervention programs are an essential component of a comprehensive response to gun violence,” Ruth Zakarin, executive director of the Massachusetts Coalition to Prevent Gun Violence, wrote in an email to The Republican. “Springfield has seen an alarming number of shootings this year, and a hospital response is absolutely necessary to change this narrative.”
At Baystate, when a patient injured by violence comes through the trauma bay, a Better Tomorrow staff person is paged. “We hit the ground running,” said Devonne Cumba, a social worker at Roca and hospital-based violence intervention program specialist.
Cumba goes to the hospital and, depending on the patient’s condition, talks to the patient. Her goal is to help support the victim and their family and connect them to services to help when they are discharged.
Not all patients are interested in talking, but most — she estimated 80% — want to engage with her.
If the person is outside the range of ages that Roca works with (17 to 24) the program refers them to other services like All-Inclusive Support Services, a program through the sheriff’s office, to help them after they are discharged. Those in the young adult age range can get enrolled in Roca, which has locations in Springfield and Holyoke and works with victims and perpetrators of violence.
Since starting work in the Better Tomorrow position last summer, Cumba has done therapy at the bedside of a patient who was shot, sat for hours with families whose loved ones are in surgery, and helped de-escalate family conflict in the hospital.
The hospital already has inpatient medical social workers, but they have busy jobs, Kramer said. “And there’s certainly not enough of them, either,” she added. Having an additional person like Cumba in these cases involving violence can be helpful.
“We’re talking about people who are scared, who are in pain,” Kramer said. “They need a little extra help to kind of get through that at the very least.”
In one case, Cumba worked with a young man who was shot in the spine and paralyzed from the waist down. Hospital staff reported that the patient was aggressive and difficult. Cumba was able to do therapy at his bedside and worked to understand why he was responding the way he was.
A week earlier, his family’s apartment had burned down. “They had lost everything,” Cumba said. She was able to support them with their housing issue and get them gas cards for travel when the patient was moved further away for care.
“That was the best experience — to be able to show up for the family,” Cumba said.
She helped the man get into a top-notch rehabilitation facility after his previous hospital behavior had threatened where he might be able to be authorized for care, she said. He is now actively involved in Roca, Cumba said.
The program tries to address trauma. “We can only impact violence if we address the trauma that young people have faced,” the Better Tomorrow brochure says in all caps. That can look like cognitive behavioral therapy, said Solomon Baymon, director of Roca in Western Massachusetts.
The goal is to have intentional conversations, Baymon said. “This is a victim. We get that person to take that pause and think things through,” he said. “We don’t want to get anyone in the mindset of retaliation.”
They also want to help them think logically and not reactively. “A lot of our young people in violence are thinking in that bottom brain,” Baymon said.
Is the new program working?
“Ultimately, if we’re going to say the goal is to decrease reinjury and retaliation, with that I need like 20 years of data to be able to show that we’ve made any difference,” Kramer said. “This is actually something we’ve struggled with: How do you say this is good? How you say we’ve done well?”
The team is working on data collection. So far, 183 patients have been referred to services through the program, according to Kramer.
Currently, the program is only working with the trauma unit at Baystate, which on average sees about 150 patients a year injured by violence, Kramer said.
Eventually, Kramer wants to expand the program to the emergency department, which sees hundreds of people each year with violence-related injuries. There, the program could reach people who have been in a fight or have less serious injuries from violence than the trauma patients she sees, but who could still benefit. “Maybe there’s a chance to do something for those people before they get shot six times in the chest,” Kramer said.
“If you’re waiting for people to be shot, it’s sort of late in the process,” she said.
At the same time, it’s a chance to intervene and prevent reinjury and retaliation. “It’s an opportunity,” she said, “so don’t miss it.”