Tuesday, August 19, 2014

40 years after the founding of our dialysis program, we honor Dr. Ira Greifer

I've now posted photos and text about three of the four inductees into the Hall of Fame for 2014. The last is Dr. Ira Greifer. Ira is in poor health and was unable to join us at the luncheon ceremony, but tomorrow (Wed., August 20) Jerry Huncosky and Rick Kaskel will visit Ira at home and present the plaque to him there, and will give him a copy of the "Summer Meeting" program, which includes a long profile of Ira and his involvement as a founder of our project to bring kids with chronic kidney disease to camp. Below is the full text of the profile as it appeared in the program.

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Ira Greifer

In 1974-75, Halbe Brown, Eva Gottscho, and Dr. Ira Greifer came together to co-found The Ruth Gottscho Kidney Center here at Frost Valley. It was the first of its kind—a program through which children with kidney disease could safely attend camp alongside healthy children. Eva brought her Foundation and fierce determination that no child would be forced to look out of a window and watch other kids going to camp without having the same opportunity. Halbe brought this magnificent space and his ability to take risks and his trusting attitude that if “you tell me we can, we will.” And Dr. Greifer brought the resources of a major New York City academic medical center along with his pioneering experience as a pediatric nephrologist.  It is rare to find such synergy and the three of them shared the same vision. [Above from left to right: Eva Gottscho, Halbe Brown, Ira Greifer and Bill Primack.]

Such a thing, in so remote a location, had never been tried, and indeed some thought it was an outlandish idea. Dr. Greifer was at the time the medical director of the Children’s Kidney Center at Albert Einstein Hospital of Medicine (now Montefiore), the largest such unit in the northeast U.S. and the only one in New York State. We must remember that it was only in 1973—just a year before the planning began to create our program—that Medicare began to pay for the costs of dialysis; it was also a time when it was thought too technically difficult to provide this type of therapy to children.

With crucial assistance from Dr. William Primack, one of Dr. Greifer’s first Fellows—his first “ambassador” to Frost Valley for the project—he worked with Frost Valley’s Chuck White on the careful design of the unit, and did what today we would be right to consider the miraculous political work of having the new dialysis unit at Frost Valley designated by the federal government and the State of New York an official satellite of Einstein Hospital in the Bronx.

In Dr. Ira Greifer this stupendous effort found a person with an already growing reputation as a true visionary for inclusive global health in pediatrics—someone who knew medically, institutionally, and ethically how to extend health care to children whose chronic condition had led many in hospitals, schools and, alas, even families, to give up on their ever having a chance to interact with healthy peers. Because of Dr. Greifer’s dauntless vision, children on hemodialysis—in those days just about as restrictive an ongoing medical treatment a child could have to endure—not only interacted with healthy peers at camp, but they swam in a cold mountain lake, played kickball with everyone else, screamed their village’s cheers after lunch, made real lasting friendships, found in their counselors supportive and understanding big brothers and sisters, and—most astonishingly—hiked to overnight campsites and slept out under the stars, far away from the camp’s medical staff and even further from understandably protective (and now remarkably gratified) parents and siblings. Dr. Greifer gave these children, through his vision, the gift of a childhood.

Ira Greifer had entered the field of pediatric nephrology as it was being defined at Albert Einstein College of Medicine by his mentor Dr. Henry Barnett. Very soon Dr. Greifer was himself leading the way in his advocacy on behalf of children’s medical and psycho-social needs (the latter was then a very new consideration), in his support of research and education in nephrology and pediatrics generally, and in his hard pushing for legislation to enable better delivery of health care to kids with chronic illness. He created an innovative family-centered care project, the famed “Mothering in Hospital Program”; worked with Senator Jacob Javits to establish the New York State Kidney Disease Institute; served as medical director of the National Kidney Foundation; made possible the funding of training fellowships that supported more than a thousand Fellows; and played a leadership role in the passage of federal legislation establishing access to dialysis treatment or the opportunity for transplantation as an equal right. Dr Greifer taught several generations of Fellows and his wisdom and sense of “the possible” lives on through them.

With all this going on, and while attaining the position of Director of Pediatrics at Einstein, he was actively involved in Frost Valley’s kidney camp program for a quarter century. He would simply not let the experiment fail, and that was no easy task. Dr. Rick Kaskel, a protégé of Dr. Greifer, was recruited—at the time Rick might have said exiled; he was forced to go!—to Frost Valley in 1978, and was truly astonished when he first saw the hard work being done to support the children while at camp. There were four beds in the unit, each next to a hemodialysis machine; with fifteen to twenty campers, all at first on hemodialysis, the doctors, nurses and technicians were dialyzing the campers six days per week, eight campers per day, each undergoing dialysis treatment every other day. During camp sessions of more than 16 children, there were double and occasionally even triple daily shifts. This intense medical service continued to make mainstreaming at camp possible for these socially and physically vulnerable children, and then in the 1980s, when new treatment modalities became available—transplantation, peritoneal dialysis (requiring sterile CAPD exchanges four times per day)—the capacity of Frost Valley’s kidney camp-within-a-camp to serve chronically ill kids doubled and tripled, and so the already revolutionary program was revolutionized still further. [Above: Rafik Ghobrial introduces the induction of Dr. Greifer, as Rick Kaskel waits to receive the plaque, which he will then give to Dr. Greifer in person.]

Frost Valley’s trustees have already honored Halbe & Eva with induction to the Hall of Fame. It is fitting that the circle is now closed with the induction of the third of these formidable people. The Board of Trustees of Frost Valley YMCA takes this time to recognize a world-renowned leader in pediatrics who has devoted so much insight and energy to the program here, but it is especially appropriate that his entrance into Frost Valley’s Hall of Fame coincides with the fortieth consecutive summer of our kidney program—of the project that was once deemed a truly impossible dream. That such an impossibility is now considered “just part of camp” is itself a testament to Dr. Ira Greifer’s true powers of tenacity and imagination.