I can say that I apparently knew I was going to be a doctor as early as kindergarten. My mother tells the story of how I was asked what I was going to be when I grow up as part of a classroom discussion, and I answered "a doctor." A boy in the class said, "You can't be a doctor, you have to be as nurse!" My mother's response when I informed her of this exchange was "No, you are going to be a doctor!" I'm sure parental influence was part of what led me in the direction of science and medicine, and my desire to be challenged. My goal was having the freedom to balance family and career. My ability to listen, connect, and resolve conflict led my to the specialty of psychiatry.

Dr. Jill Afrin, the first specially trained psychiatrist for the deaf in South Carolina, gives psychiatric consultations in American sign language via video conferencing. This innovative approach allows her to treat patients throughout the state over the internet, maximizing her consultation time by cutting down on travel and helping her balance family life with her career.

Jill Nina Newman was born in Suffern, New York, in 1962. Her mother, Jeanette Newman was a social worker, public relations counselor, and a journalist, and her father Edward Newman was a crime reporter who died when his daughter was just 4 years old. A few years later, Morris Rosenfeld, a medical supplier who provided equipment for dialysis clinics, joined the family as Jill Newman's stepfather.

Jill Newman received her undergraduate degree in biochemistry from the State University of New York in 1984, and enrolled in Vanderbilt University School of Medicine in Nashville, Tennessee that same year. After graduating in 1988, she completed an internship and residency in psychiatry at the Medical University of South Carolina in Charleston, followed by a fellowship in community and emergency psychiatry which she completed in 1992. She began learning sign language as a college student and carried on during her medical training.

In 1989, the South Carolina Department of Mental Health launched the Deaf Services Program to provide psychiatric care for deaf and hard-of-hearing clients throughout the state. Although case managers and other clinical staff were fluent in sign language, non-signing psychiatrists had to rely upon an interpreter in clinical consultations. Instead of traditional one-on-one sessions where the patient builds a confidential relationship with their psychiatrist, all discussions were conducted with the help of the interpreter. Staff at the department decided that ideally, these consultations should be provided by a signing psychiatrist, and moreover, one specially trained in mental health care for the deaf community and familiar with deaf culture. In 1992 they employed Dr. Jill Afrin, the only psychiatrist fluent in sign language in the whole of South Carolina.

Dr. Afrin spent Monday to Friday driving to appointments all over South Carolina, and was only able to see about ten patients a week. She kept up with the demanding schedule for three years, but in 1995, when she and her husband Lawrence B. Afrin, M.D., decided to start a family, the time away from home and the traveling became untenable. Anxious to retain their only psychiatrist specially trained to care for the deaf, the Deaf Services Program offered to set up an online home office for Dr. Afrin where she could hold sessions over the internet with patients from across the state. The telepsychiatry program was launched with the installation of a video-conferencing system in Dr. Afrin's home and three more in mental health centers around South Carolina. By 1997, systems had been installed at six hospitals, another fourteen health centers, and South Carolina School for the Deaf and Blind.

Telemedicine (the use of telecommunications technology to deliver health care) has developed along with the technologies that connect people across distances, such as the telephone and the world wide web. The technology can be used to bring medical care to patients in rural or isolated communities, and is especially useful in bringing new approaches and the best in medical expertise to more and more people around the world. Once the technology is in place, it can also help cut health care costs while improving services. Dr. Afrin's patients, for example, can now schedule appointments on a more flexible basis and in emergency circumstances, and Dr. Afrin can run sessions from home, saving the health department about $14, 000 a year in travel costs. Because of all the time she saves, Dr. Afrin can hold ten appointments a day and spend more time with her children, Jessica and Michael.

The technology of videoconferencing is also particularly suitable for Dr. Afrin's patients, who communicate visually. However, very subtle movements, such as small facial movements or tremors, are hard to see, and for this reason, a health care worker always sits in with a patient in a telepsychiatric conference online with Dr. Afrin. Although this again brings a third person into the encounter, unlike an interpreter, the health care worker can observe without needing to intervene. Furthermore, Dr. Afrin and the majority of her patients have grown accustomed to the technology and are comfortable using it. The only drawback, says Dr. Afrin, "I missed... being able to see them in their environment and the physical ability to hand them a tissue." For that reason, since 1999 she has returned to the post of traveling staff psychiatrist, but this time for only a selection of South Carolina health care centers, as well as providing telemedicine-based appointments across the state.

The telepsychiatry program has become a model for health departments around the country, and in 1998 it was chosen to represent South Carolina at the State Leadership Technology Expo and in 1999, the Southern Innovators Fair. Dr. Afrin's work for the Deaf Services Program has also been featured in Telehealth in 1998 and Health Data Management in 2000. Dr. Afrin has also given presentations on the topic around the country. She was vice chair of the Mental Health Section of the American Deafness and Rehabilitation Association from 1993 to 1995, and is a sign language instructor at Chesterbrook Academy in South Carolina.

What was my biggest obstacle?

Although I may be unaware of many obstacles that I faced, I would say my greatest obstacle was myself. I have always been my hardest critic. In addition, I have always needed a variety of outlets in my life (theatre, music, writing) as well as balance between my "work" and my personal space/time. These two things are often in direct conflict with the rigors of medical training and the development of a successful career.

How do I make a difference?

This is perhaps the hardest question to address because it requires that I look at myself and my life/career with the initial assumption that I make a difference. As I will explain further later, it is very difficult for me to separate what I do and have done from what the South Carolina Department of Mental Health Deaf Services Program does. Who I have become as a physician has been integral with what this program has done and my participation in it.

Who was my mentor?

The answer to this has two parts. First, my mentor during psychiatric training was Dr Joseph Zealburg who at the time was director of Emergency Psychiatric Services. I was always impressed with his ability to stay not only calm but reassuring when faced with any crisis or floods of crisis. His ability to see the potential and strengths in any patient, no matter how ill and assist them in using those to accept help and heal was a skill/talent/gift I aimed to achieve. Second, my mentor during my work as a psychiatrist for Deaf Services truly was a multidisciplinary team of professionals who had immense knowledge and experience with deaf people and communities and the patience to teach me, work with me as partners in caring for our mentally ill clients.

How has my career evolved over time?

My plans for my medical career shifted a few times but seemed to always return to psychiatry and a life with balance. I remember thinking I would have an office in my home so I could see patients and be available for my children almost simultaneously. When my psychiatric training began, I realized having an office in my home was not appropriate or viable. When I began working with deaf services, I traveled more than I would have ever expected. Following the birth of my first child, the department of mental health set up the video conferencing/telemedicine system so that I could continue to provide my services to distant patients and I subsequently obtained "the office in my home" where I could be available for both family and career. My involvement with deaf services and specializing in working with deaf patients was entirely unplanned and unexpected. I took a sign language class in college for fun and took a series of classes at a teacher's college near Vanderbilt Medical School as a substitute for medicine/science related electives that were offered as part of the curriculum. This allowed me to maintain some of my "balance" and provided me with a tool that later made me a perfect fit for the program for deaf services begun in South Carolina (with first outpatient site in Charleston). While in my residency at the Medical Universty of South Carolina in Charleston I continued to take classes to further improve my signing skills and by virtue of mere interest and awareness of communication needs, I became the "staff psychiatrist" for the program. I would say that I continue to view myself a member of the program with one small role in the bigger picture of meeting the needs of these clients as individuals and as a community.