Reverend Clementa Pinckney was 24 when I met him. He had just been elected to the General Assembly in South Carolina from the county adjacent to mine. He was imposing – tall with dark ebony skin, intelligent and in command of the room. This guy, I thought, was going to be the first African-American governor of South Carolina. He had a likability and charisma about him that made him stand out.

As one of my colleagues said, he was one of the good ones. I met then–State Representative Pinckney because I had been lobbying for child health issues, in particular for a gun safety bill. It seems ironic that, almost 20 years later, State Senator Pinckney himself would die from gun violence.

This was the mid 1990’s, and although we never got our gun bill passed, the resulting furor, both here in South Carolina and elsewhere, led to a significant drop in childhood gun mortality that persists to this day. But we still have a long way to go. Somewhere between 30 and 40 young people under the age of 21 die in just South Carolina every year. When are we going to take the steps we know will help reduce even further the ongoing tragedy of too many children dying from bullets?

Two days after the massacre in Charleston, I ran into a colleague. He looked distressed. He told me he had been the alleged murderer’s pediatrician some years ago. Without my prompting he began to think out loud as to whether he could have done something then that would have made a difference. But do we have the systems and procedures in place to identify and help troubled kids? We in pediatrics see them. And we do a lot for them. But so many slip through our fingers. What else can we do as a profession to help identify troubled youth and get them services before it is too late?

Racism is an ugly fact in most societies. I truly believe we have made progress in South Carolina confronting intolerance, but we still have a long way to go. There are significant disparities in health outcomes that are racially linked. I know that I, like most of you, have my own prejudices. The first step is recognizing them. Pediatricians in South Carolina almost universally come in contact with those who are victims of racism, and we need to carefully consider how we overcome our own preconceived notions to provide care to everyone.

I have lost a friend in Clementa Pinckney, but his death causes me to wonder about our own individual and collective responsibility, and what our response should be.

Dr. Rushton is clinical professor of pediatrics at the University of South Carolina, Columbia, and medical director of the Quality Through Technology and Innovation in Pediatrics (QTIP) network. He has practiced pediatrics in Beaufort, S.C., for 32 years.

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