Dr. Margaret Heagarty was familiar enough with poverty and disease when she went to work in Harlem in 1978. She had grown up in the hardscrabble coal fields of West Virginia, where her father was a physician to miners and their families. She had also been separated from her parents, like many children in Harlem, and placed in an orphanage.

But for all the similarities, the contrasts were striking: She was the first white doctor and the first woman appointed director of pediatrics at Harlem Hospital Center.

Dr. Heagarty, who died on Dec. 23 at her home in the Bronx at 88, won Harlem over. Her death was confirmed by William Burgan, her brother-in-law.

In her 22 years at Harlem Hospital, a public institution run by New York City’s Health and Hospitals Corporation and affiliated with Columbia University’s College of Physicians and Surgeons, Dr. Heagarty made a name for herself as an eloquent and effective champion for children’s health. She fought for causes like reducing teenage pregnancies and playground injuries.

Thanks in part to her efforts and other community programs, the infant mortality rate in Central Harlem dropped dramatically during her tenure. From 1990 to 2008, the number of babies born there who died before their first birthday plunged from about 28 a year to fewer than seven.

She also enlisted Diana, Princess of Wales; Barbara Bush, the first lady; and Dr. C. Everett Koop, the surgeon general, to rally public support nationally for combating two of the newest scourges her department faced: cocaine-exposed babies abandoned by drug-addicted parents, and H.I.V.-infected infants and young people.

“She was a mountain of an Irishwoman, a mother superior in disguise,” said Dr. Stephen W. Nicholas, who succeeded Dr. Heagarty as the director of pediatrics at Harlem Hospital and is now president of the Children’s Global Health Fund. “In her no-nonsense way, she captured the imagination of many, including a princess, a first lady and a surgeon general, to address the plight of children in Harlem during the ravages of AIDS and crack during the 1980s.” 

Hundreds of miles divided West Virginia from Harlem. But Dr. Heagarty discovered that the common cause of helping the next generation survive trumped any disparities in distance, race or gender.

Margaret Caroline Heagarty was born on Sept. 8, 1934, in Charleston, W.Va., the oldest of three children of Dr. John Patrick Heagarty, who practiced in Ward, a tiny company-owned coal town, and Margaret Caroline (Walsh) Heagarty, a nurse. The household was racked by alcohol abuse and addiction, Mr. Burgan said, and she and her sister were placed in an orphanage when they were teenagers.

After earning a bachelor’s degree from Seton Hill College in Greensburg, Pa. (formerly a Roman Catholic women’s college and now Seton Hill University), she became one of two women attending West Virginia University’s two-year School of Medicine and then earned her medical degree from the University of Pennsylvania in 1961.

She completed a pediatric residency at Temple University with St. Christopher’s Hospital for Children in Philadelphia in 1964. She then accepted a fellowship in child health at Harvard University and served as director of pediatric ambulatory care services of what is now NewYork-Presbyterian Hospital before joining Harlem Hospital.

Dr. Heagarty inherited a department with an infant mortality rate more than three times the national average, a demoralized faculty, decrepit facilities and new challenges posed by the epidemics of crack cocaine and AIDS.

“It’s one thing to preach from the ivory tower what’s good for the poor,” said Dr. Janet Stewart Claman, associate professor emerita of pediatrics at the University of Colorado School of Medicine, who met Dr. Heagarty when they were both residents. “It’s another to go into one of the poorest hospitals in America in one of the most afflicted neighborhoods and try to accomplish something.”

“Maggie was a doer,” Dr. Claman said by email. “She believed it was better to err by commission than omission. She was often underestimated; she could play the role of a country girl from West Virginia to the hilt, and she physically reminded one of a maiden aunt. But Maggie had a mind like a steel trap, and she always knew her facts.”

Not long after Dr. Heagarty arrived, as many as 15 percent of the babies born at Harlem Hospital were testing positive for cocaine, ingested by their mothers, and as many as 4 percent of the pregnant women were infected with H.I.V. Babies languished for months because foster parents feared contagion, stigma and behavioral issues related to addiction. In her early years at the hospital, Dr. Nicholas said, admissions for gunshots and stabbings quadrupled.

“There are times when my wards look more like a battlefield than a pediatric unit,” Dr. Heagarty once wrote.

But if caring for Harlem’s children was a battle, she was an unrelenting fighter.

She helped reduce the hospital’s infant mortality rate to the New York City norm. To care for children with AIDS, she, along with Msgr. Tom Leonard, Sister Una McCormack and the real estate developer and philanthropist Jack Rudin, founded Incarnation Children’s Center. She also established a network of five neighborhood satellite health clinics in Harlem and a group home for H.I.V.-infected children.

In 1989, she escorted Princess Diana on a tour of the hospital’s pediatric AIDS unit, an event depicted in the Netflix series “The Crown.” The princess was quoted as asking, “When you have a problem with the drugs, how on earth do you deal with AIDS as well?”

Her response, Dr. Nicholas recalled, was: “It is bad enough to have a fatal disease, but with poverty and drugs, you have a very bad problem indeed. It is easy to say that these mothers are irresponsible, but still, I have seen them grieving over their dying children. These mothers love their children the same as you love your little princes.”

In 1993, Dr. Heagarty, who was also a professor of pediatrics at Columbia University, received a Ronald McDonald House Charities award of $100,000. She donated it to the Harlem Hospital pediatrics unit.

Dr. Heagarty never married. In addition to Mr. Burgan, her survivors include several nieces and nephews.

Dr. Heagarty’s strategy could be unorthodox, her manner blunt. Dr. Nicholas recalled that when Dr. Heagarty was president of the hospital’s medical board from 1992 to 1995, she strongly disagreed with a new department director, who was Black.

The director turned to a Columbia dean, Dr. Nicholas recalled, and asked, “Is Dr. Heagarty racist?”

“Oh, no,” the dean replied. “Dr. Heagarty’s not racist. She treats everyone that way.”

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