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A MON T HLY NE WS M AG A ZINE OF SPOKANE COUNTY MEDICAL SOCIETY – MAY 2012
Lending a Hand in Foreign Lands By Terri Oskin, MD SCMS President
V O L U N T E E R I N G A B R OA D
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T a b l e o f C o n te n ts
2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect Bradley Pope, MD Immediate Past President David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD
Lending a Hand in Foreign Lands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Volunteering Overseas: One Surgeon’s Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Medical Missions in Guatemala and Ecuador . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Learning Haiti: A Medical Student’s Effort to Transform Aid . . . . . . . . . . . . . . . . . . . . . 5 From Spokane to Kopanga, Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Spokane Physicians Sponsor Children in East Africa . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Clinical Elective in The Gambia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Rwanda 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Orthopedic Missions in Myanmar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Beyond the Mountains, There are Mountains. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Orthopaedic Medical Missions in Haiti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Volunteering with Healing Hearts Northwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Spokane’s Medical Education Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Project Access and the Ongoing Search for Sustainable Funding . . . . . . . . . . . . . . . . . . 20 Having a Rational Conversation about Health Care Reform Symposium Summary . . . . . . . . . 21 Graduate Medical Education Summit Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. The annual subscription rate is $21.74 (this includes the 8.7% tax rate). Advertising Correspondence Quisenberry Marketing & Design Attn: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.
In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Physician Leadership Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Membership Recognition for May 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 New Physicians/Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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"The heart of a volunteer is not measured in size, but by the depth of the commitment to make a difference in the lives of others." D eAnn Hollis
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Lending a Hand in Foreign Lands
our interview Kari states, “I didn’t realize how much time the community spends just surviving. There is very little time to spend on development. I was shocked at how primitive things were and the lack of resources available. The outpouring of hospitality was incredible. I plan on continuing my work with P4P, but do not plan on going back. I will continue my involvement from a distance. My philosophy is helping by sustaining.”
By Terri Oskin, MD SCMS President “The servant leader is servant first. It begins with the natural feeling that one wants to serve first. Then conscious choice brings one to aspire to lead.” – Robert K Greenleaf, The Servant as Leader Why is it that so many Spokane-area colleagues spend time away from their busy practices and lives to serve abroad? You’ll see that the motivation and experiences are as varied and unique as the people themselves. Over the past month I had the opportunity to interview several of our colleagues. I’ve excerpted highlights from my interviews about how they became involved in volunteering abroad; here’s what they have learned. Joel Sears, MD, a dermatologist, has travelled to Equator and Guatemala with Hearts in Motion, a group of oral and maxillofacial surgeons. His involvement started with casual conversations with his nurse-anesthetist. He has since completed several trips. Joel says, “I’ve had the opportunity to practice medicine with people who really do need our help and to have an impact on their later quality of life. These experiences have reawakened my original altruistic reason for going into medicine. Serving abroad allows physicians to set aside Western medicine’s complication, regulations and paperwork and simply practice medicine.”
Beth Peterson, MD, is a plastic surgeon who has volunteered abroad for 20 years. Dr. Peterson knew this was her mission in life; she just had to complete medical school first. Dr. Peterson says, “I have been very inspired. People are the same all over the world. Parents love their children, which is seen on their faces and in their actions. I have been impressed with how extremely smart the doctors from other countries are and impressed with how they can do more with so much less. The magical part is the joy of working together over the face of a child despite political differences. The rewards are greater than the giving and no price can be put on that.” An anonymous person once said: “A hundred years from now it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove, but the world may be different because I was important in the life of a child.” Hearing these people’s stories has been inspirational. And let’s not forget all our colleagues who also give their time here at home. What is your mission?
Harold Goldberg, MD, a cardiologist, is involved with Healing Hearts Northwest, making regular trips to Rwanda. The first time Dr. Goldberg was asked to volunteer abroad he said, “No, I don’t want to go.” In fact, he declined requests on four separate occasions. He took his first trip as part of the Health Development Initiative along with Dr. Pam Silverstein and Dr. Adie Goldberg. In 2009, Healing Hearts Northwest was created as a non-profit organization to help develop an open heart surgery program in Rwanda. Here’s Dr. Goldberg’s advice to other volunteers: “Remember, although we are there with good intentions, it is not your house. The country hosting you may have its own Administration of Health and its own politics. You are there as a guest. Working with physicians and nurses from different countries takes a coordinated effort and team approach. We really get to know each other. In contrast, back home we work beside others, but yet at the end of the day do not know very much about each other.” Kari Holman, PA, notes that her relationship with Partners for Progress (P4P) started when she received a call from Stacey Mainer, ARNP, who was looking for a pediatric-trained health professional to help with the malnutrition problem in Kopanga, Kenya. She made her first trip with P4P this past October. In May SCMS The Message 1
Volunteering Overseas: One Surgeon’s Perspective By Elizabeth Peterson, M.D. Why do physicians leave modern comforts, relative safety and advanced technology to work in the developing world? Most of us give as reasons the desire to travel, to have an adventure, to see challenging cases or to fulfill religious and humanitarian motives. Ultimately, whatever our individual motivation, after serving as a volunteer in a developing country, most physicians say that it was the most joyful and meaningful experience that they have ever had in medicine. Western physicians began traveling to foreign countries to work in the eighteenth century, when religious missionaries and evangelists were often accompanied by doctors, who were invited initially to provide care for the missionaries themselves. As the needs of the indigenous population became apparent, those physicians began to treat the local people. By the twentieth century, many groups were organized specifically to provide medical care to indigent people around the world. Some established themselves permanently in the overseas communities that they served; others traveled periodically on medical missions.
We found ourselves in diverse, even exotic places, from the modern industrial city of Hangzhou, China to the jungles of Panama to the islands of the Philippines. We treated diverse populations, as well. Among our patients were nomadic Masai people, Vietnamese villagers, and Palestinians from Gaza. But all those missions had one theme in common: the necessity of providing medical care in the face of fundamental deficiencies in resources. Twenty years ago on-site supplies were inadequate or non-existent, electricity erratic, cargo lost or held hostage for bribes and yet veteran volunteers showed me what perseverance could accomplish. No electricity for the next hour - bring out the flashlights. Need an unanticipated instrument for some bone work - go to the local roadside stand and buy a chisel and mallet which could then be sterilized. Precious supplies starting to disappear - keep them locked up. Safety concerns - occasionally, at the insistence of local hosts, armed bodyguards.
These groups have proliferated in recent decades, serving a range of focused purposes including caring for the sick and injured after natural disasters; treating refugee camp populations and addressing specific medical and surgical problems in all corners of the globe. As I contemplated a career in medicine, I assumed that treating people affected by conditions such as malaria or diseases associated with malnutrition, would be an essential part of my practice of medicine and I was certain that it would include helping people in developing countries. I took advantage of opportunities to study overseas and work in developing countries while still in medical school and residency. On my first trip to Tanzania I realized how little I knew about tropical disease and subsequently I enrolled in the London School of Tropical Medicine and Public Hygiene. The following year I obtained a fellowship to work in rural Indonesia. I became increasingly aware of the fact that surgical skills would be important in serving the populations of the developing world and soon thereafter I entered a surgical residency. After training in General Surgery and Plastic Surgery I spent a year working with a volunteer group. We traveled extensively throughout the developing world, providing reconstructive surgery, mostly cleft lip and palate reconstruction. Over the course of that year, our group screened over 1400 patients, and operated on 750. Through that experience I developed a much keener appreciation of modern Western surgical and anesthetic techniques, while also learning about the inherent difficulties in performing surgery in austere environments.
Beth Peterson, MD operating. But for me, the lasting impact of these medical missions was the development of relationships that transcend nationality, culture or even language. I have met warm, wonderful and devoted people in each location who have welcomed me and offered their friendship. Patients are impressed that I have come all the way from America to offer medical and surgical expertise. And yet the specter of poverty is everywhere. It is gut-wrenching to have to refuse a patient either due to the complexity of the case or in accordance with the team’s priorities.
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Continued from page 2 Sometimes there are simply too many cases to accommodate, despite having six surgeons operating twelve to sixteen hours per day. Families often hang on and plead their cases, only to be told feebly “next year”. On overseas missions, the team is determined to meet the standard of care that we maintain in our home country. An important underlying ethical principle that we take pride in upholding is that even in impoverished areas and where there is no medical care of any type; those patients deserve the same level of care as patients at home. “But isn’t something better than nothing?” one is tempted to ask, but the answer must always be a well-reasoned “No”. If the overseas mission team lacks the resources or the expertise to provide care at the level which would be required at home, then it should reconsider its plans, and forego the mission until it is able to provide the best and safest care. This is especially important because groups need to earn the respect and trust of the local medical community, who often have expertise and knowledge, but simply lack the resources to care for their community’s needs. In addition, local governments are sometimes fearful that these surgical “expeditions” could be perceived as second- rate. So it is simply smart politically, as well as ethically correct, to adhere to high standards, and to emphasize safe surgery. Some consistent themes strike me as I look back on these experiences: People everywhere have similar reactions to deformities, and parents everywhere want the best for their children. They are grateful beyond measure when life-changing surgery is provided.
Physicians and other team-members are deeply touched by such gratitude. That is why so many of us are determined to continue this work into the twenty-first century. However, our goals have evolved well beyond the original desire to provide surgery for some of the thousands of children afflicted with deformities in the developing world. Today our goals must include the development of expertise and self-sufficiency in the host countries themselves. I have been amazed to see how successful such efforts can be. Over the past three years we have helped to establish a Cleft Center in Guwahati, India. It is now up and running, staffed largely by local professionals who take pride in the care they provide, and are equally touched by the gratitude of the people they serve. The other, perhaps unexpected, consequence of volunteer work overseas is the development of the culture of compassion and volunteerism in these countries. This, I believe, is the most significant accomplishment of the volunteer group that I work with, even more transformational than the cleft lip and palate repair work that has benefitted more than two hundred thousand children over the years. It may seem that volunteers on overseas missions are giving a wonderful gift to the indigenous people in need. Yet it is actually the reverse: the wonderful surgical gift is reciprocated many times over by the recipients through their overwhelming gratitude. One of my colleagues, a surgeon from Ecuador, puts it this way: “I am addicted to volunteer missions”, he says. Why? “Because this work gives me joy!” What could be better?
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Medical Missions in Guatemala and Ecuador By Joel Sears, MD When I was first asked to consider volunteering abroad in a medical mission, right away I wondered how could I, as a dermatologic surgeon, possibly be helpful in a medical missions team? My question was instantly answered the first morning of my Guatemala trip when, as our bus rounded the corner, I saw a couple hundred attentive stares from patients lined up at the pre-screening/triage clinic hoping and praying that we would be able to help them with whatever malady they had. Many brought their children with devastating cleft lips and palates whom the maxillofacial and plastic surgeons would treat but dozens of patients, some who had walked as far away as Honduras, arrived with cutaneous tumors, congenital deformities, skin cancers and restrictive burn scars which were all amenable to treatment well within my armamentarium of cutaneous surgical procedures. In fact, sadly, we had to turn away many simply because we lacked enough time to meet every need. I participated in medical trips to Zacapa, Guatemala and to Cañar, Ecuador, which were arranged by Hearts in Motion (H.I.M.), an organization based in Indiana. Several Spokane-area physicians, dentists, anesthetists and an array of medical/dental assistants and technicians have been very involved with H.I.M. mission trips over the last two decades. If you ever contemplate volunteering abroad, I would highly recommend participating through a recognized organization, like H.I.M., because of their experience in handling important logistics such as making arrangements with the local hospitals and doctors, providing safe transportation, food and lodging and also to ensure cooperative relationships with local government authorities. As a dermatologic surgeon my duties basically boiled down to any surgical procedure that could safely be accomplished under local anesthesia or IV sedation. I treated anything from common skin growths, tumors or skin cancers to conditions less commonly seen in the U.S. such as supernumerary digits or other congenital facial deformities. Such deformities are severely stigmatizing in the local culture and so relatively simple procedures allow an affected child to be free of repeated shame or ridicule. Since households still commonly use open flames to cook food, many children suffer burns in their own homes. Many of those burns result in scar contractions of fingers or elbows rendering their hands essentially useless. After many Z-plasty or skin graft scar revisions, those patients were once again able to use their crippled limb.
The hospital facilities were adequate but it felt like stepping back in time to the 1950s or 60s with “institutional green” walls, old foot-pumped OR tables, stained tile floors and ancient cavernous autoclaves. The nursing staff was very proud of their hospital and fairly strict about surgical facility rules. I was scolded on a couple of occasions when I forgot to don a gown upon leaving the operating room…never mind the gecko lizards crawling on the OR walls during surgery! One of the most personally gratifying aspects of volunteering abroad is that I was able to involve my entire family. My wife, who is an RN, and my teen-aged children, played active roles both in cultural and medical activities. One of the first activities the volunteer team did was to visit the local landfill, “the dump,” where many poverty-stricken families live. We gave away toys and treats to dozens of happy children, some of which literally slept in old rusty barrels at night. As you can imagine, seeing this level of poverty has left a lasting impression on my family and me. Other activities for my son and daughter included helping construct a new medical clinic building and teaching school children about dental care, giving away toothbrushes, applying fluoride treatments and even getting to pull a tooth. But the highlight was when we were short personnel; so my wife, son and daughter were all able to work with me in the OR during a procedure. My wife and son surgically assisted while my daughter circulated…it gives a whole new meaning to the phrase “Family Practice”
Joel Sears, MD and his "family practice" Although volunteering would have been nice enough on its own, I would be remiss not to admit we were able to take advantage of the proximity to some of the most interesting locales in the world. After completing the medical mission in Zacapa, we spent a weekend enjoying the beautiful city of Antigua. While in Ecuador, we made time to visit ancient Inca ruins followed by a trip to the Galapagos Islands.
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Continued from page 4 Serving in short-term medical missions is not for everyone, but if you want a gratifying experience providing healthcare to people who really need and appreciate any help you can give them while observing and learning different cultures, enjoying the camaraderie of the medical team, and perhaps including your family in the experience, then this might be for you.
delivers aid did not. I began to doubt the method in which intermittent, unmarked medications are freely handed out with little background knowledge of the patient and with no followup. I questioned the use of the number of patients seen in a week as the sole measure for team success. And I began to feel that perhaps additional handouts within Port au Prince, with little attached education, is not what this hurting nation needs. In 2011, utilizing Haitian friends as interpreters, drivers and hosts, I travelled to Haiti independently with the goal of better understanding Haiti through the eyes of its people. I travelled deep into the mountains, far beyond any visible outside aid, and was introduced to an entirely different nation. Beyond a different culture and a much greater level of poverty, there were also many lessons to be learned, among those the understanding that to an impoverished people, education is key. Accordingly, I began teaching classes on Cholera prevention and treatment in hard hit areas where such education had not previously been provided, and where the nearest hospital is often a further walk than the time it takes Cholera to overtake its victim.
Joel Sears, MD at a post-op visit.
Learning Haiti: A Medical Student’s Effort to Transform Aid through Education and Record Keeping
But while my mind had suddenly been shifted to empowering the people in rural Haiti, still on my heart was the broken system many of the travelling, intermittent clinics use. While such clinics are staffed by well-intentioned individuals, I could not help but feel that with very small adjustments, the medical care provided on a community-wide, long-term scale could be drastically improved. And such started my efforts to implement a simple paper-based patient record system in temporary clinics that use none.
By Analiesse Isherwood, University of Washington School of Medicine 1st Year Medical Student Two and a half years ago I was a pre-med student at Western Washington University anxious to see third world medicine first hand. After much research, in December 2009 I found myself part of a medical mission team in Port au Prince, Haiti. I returned from Haiti full of both confusion at the face of poverty and a new found love for the country and its people, as well as with a desire to soon return. However, only two weeks after flying home, on the afternoon of January 12, 2010, I walked out of Biology lab, turned on my cell phone, and with a dozen missed calls learned of the earthquake. I quickly reassured friends that no, I was no longer in Haiti, and over the next several hours I sat numb as information about the earthquake filtered in. Among the damaged structures was the guesthouse my team had stayed at and two of the churches where we had held clinic; of the nearly 300,000 killed, were many of the individuals I had worked with and come to love. After overcoming my initial paralyzing distress, I was able to return to Port au Prince in March 2010, and again in December 2010, in order to take part in the relief efforts throughout the tent cities. But as my love for the people of Haiti intensified, my approval for the ways in which the travelling medical team
Medical student Amaliese Isherwood providing medical care in Haiti In early March, the same medical mission organization I worked with during my first three trips to Haiti, used a patient record system I created on a trial basis during a weeklong clinic in two rural villages. Following its successful use, the organization has since agreed to implement the entirety of a system of my creation. Resources permitting, I am currently making plans to travel to Haiti in June in order to finish the implementing of the record system and the training of the permanent staff on the use of such.
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Continued from page 5 In late March I had the privilege of traveling to Washington, D.C. in order to discuss my efforts with other young leaders from around the world at the Clinton Global Initiative University. On the back of such, two additional medical mission organizations in Haiti have agreed to work with me this summer in the implementation of their first patient record systems! While this is just a first step, if temporary, mobile clinics in Haiti can transform from treating a patient on the basis of a single snapshot to treating a patient on the basis of a greater picture, we are one step closer to ideal. What’s the next step? Working to incorporate the local clinic in the travelling clinic’s work. This provides for the continued care of the patient after the foreign volunteers have returned home, and creates an immediate leap forward in the long-term recovery of the entire country, medically, structurally and economically, as it recovers from the combined disasters of recent years. If you have any information or other help to offer that could assist in my modest, but quickly growing efforts to implement patient record systems in the travelling clinic, please be in touch! isher@u.washington.edu
The clinic was funded by P4P and built in 2008. It is the only significant structure, seen in a countryside dotted with plots of corn, tobacco and other local crops. The clinic is made of mud bricks with a stucco finish and a red tin roof, whereas most other structures in the region are mud huts with a thatched roof. Water is drawn from a nearby well that P4P funded and electricity recently reached the clinic. It’s about a 45-minute drive on a windy, bumpy, dirt road from the closest town and an eight-hour drive from the major city of Nairobi. The clinic has several rooms, connected by an open-air walkway, including four exam rooms, a lab, a pharmacy, a larger observation room for overnight hospital stays and a storage room for medical supplies. A two-stall outhouse nearby serves as the latrine. The clinic has a profit margin so it can become self-sustaining. The visit fee while the P4P team is at the clinic is 50 shillings ($.50) and this includes all medications. If a patient needed to be admitted to the observation room, the charge was 250 shillings ($2.50) per day. Patients arrived at the clinic as early as 6:30 in the morning and some would wait to be seen until late afternoon without water or lunch. By mid-morning, the "waiting tent" (see photo) would be at full capacity.
Kari's Perspective - Pediatrics in Kopanga
From Spokane to Kopanga, Kenya By Debbie Stimpson, PA-C and Kari Holman, PA-C “Coming together is a beginning. Keeping together is progress. Working together is a success.”--Henry Ford.
With this in mind, Physician Assistants Kari Holman and Debbie Stimpson joined a Spokane based non-profit organization, Partnering for Progress (P4P). Debbie specializes in HIV and Kari in pediatrics. They traveled to Kenya, where they provided medical care for both adults and children. The two PAs spent a week at the clinic, along with two other medical providers. The team examined and treated over 400 patients in one week! In addition to providing medical care, there were 10 other volunteers on the team who provided health education, eye care, water sanitation and engineering consultation and administrative support for the clinic. The mission of P4P is to help provide access to healthcare, basic health education and clean water to people in developing nations. For the past four years the focus has been on the remote village of Kopanga located in western Kenya. P4P aims to be a catalyst for change, rather than a crutch. The goal is to enable communities to break the long-standing cycle of poverty and poor health, with the ultimate goal of creating a sustainable future for the people of Kopanga.
It was not uncommon for as many as nine mothers, with babies swaddled to their backs, to be patiently waiting in my exam room for their turn to be seen. Often, the older children were tending to their infant siblings. No tantrums. No fussing. No screwing around. They would just wait quietly. The Kenyans taught me a true lesson in patience. Extreme patience! Malnutrition seemed less prevalent than I anticipated. From my observation, many older children and adults were undernourished, not malnourished. The highest risk group for malnutrition was children from 6 months to 2 years old. In fact, in this age group there were several cases of severe malnutrition. The most common causes for malnutrition were that the mother couldn't keep up with the child’s nutrient demands (for example, twin gestation, exclusively breast feeding when a child should be on solids and breast milk or poor caloric density of breast milk) or the child's metabolism and nutrient requirement was increased secondary to disease (most commonly malaria, typhoid, or intestinal parasites). The climate there helps prevent famine; since Kopanga is near the equator they grow crops all year around. Common crops include maize (corn), cabbage, bananas and tomatoes. They can get fish from Lake Victoria. Beef, chicken, and eggs were a treat. The cash crop was tobacco—thankfully, I never saw anyone smoking it! Continued on page 7
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Continued from page 6 As you look out across the fields there are women and children tending to the crops. Since many women are doing intense physical labor in the fields, in addition to packing water on top of their head for miles to provide for their family, they often burn more calories than they can consume and this leads to poor breast milk supply. Thus far, our approach to combating malnutrition is to provide formula supplementation after each breast-feeding for infants less than 11 months. Children six months and older can also receive high calorie oral supplement packets. We also instructed mothers with prevention tips, such as starting solid food intake at six months of age, continuing to take prenatal vitamins and increasing mom’s calorie intake while breast-feeding.
I was able to show Alice Wasilwa, the Kenyan nurse who founded the clinic, how to improve nutrition assessments by weighing and measuring each child and plotting their growth curve. Although that sounds simple, keep in mind that the clinic lacks so many basic tools and equipment we take for granted in the USA. In fact, we supplied them with a measuring tape this visit. Alice is also doing a good job with childhood immunizations that are supplied by the government. They are virtually the same as here, with the addition of yellow fever.
Debbie's Perspective - HIV/AIDS in Kenya When we arrived at the clinic the first day of our November 2011 trip, Alice immediately ushered me in to see a very sick patient. As the “HIV Specialist”, she hoped I would have some answers. This man was end-stage AIDS with a severe headache, fever and dehydration. He had received some IV fluids but needed IV medications along with head imaging and a definitive diagnosis! All I could do was treat empirically with available local medications. It was too little too late; he passed away during the night. HIV infection rates are reported to be 7% of the population in Kenya. In the Migori region, the rate is estimated at 14%. In the village of Kopanga the infection rate is above 20% during one three-month period 54 adults and 50 children were diagnosed with HIV. The rationale for the higher rate in this rural community includes a number of factors - immigration from neighboring Tanzania, vicinity to Lake Victoria and its fishing trade, as well as poverty are among those identified. Nine months ago the clinic was designated as an "antiretroviral therapy" clinic (ART) by the Kenyan government. This was happy news as Alice and her staff can provide HIV medications and HIV care to the patients they diagnose. Continued on page 8
Kari Duclos Holman, PA-C talking with mother and child
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Continued from page 7 Prior to this designation, Alice had to send all newly diagnosed HIV patients to clinic 5 km away to receive HIV medications and care. Alice’s clinic had so many new HIV diagnoses that the other clinic could not handle all the new patients. After someone is diagnosed with HIV/AIDS, there is extensive counseling provided on follow-up visits to help the patient adjust to the diagnosis, tell sexual partners about the HIV diagnosis and learn about the strict adherence needed for the lifetime of HIV medications.
As we expected, there were many stories of extreme poverty, but nothing prepared us for how warm the embraces and greetings were from everyone we encountered in Kopanga. We’ve never seen so many smiles or shaken so many hands -- and we’re not talking about a cursory, two-shake, howdy greeting – this is a warm grip that doesn’t let go until the greeting is completed with a hand-to-the-wrist signifying respect. By the time you meet someone a second time, the handshake was usually converted to a full hug! No matter the age, a greeting is an event in itself! An event that we may be missing out on here in our American culture, with our fast paced life. For an overview on P4P and to learn how you can be involved and offer your support, visit: www.PartneringForProgress.org. If you would like to hear more about our personal experience in Kenya, you can contact Debbie Stimpson at stimpsd@ intmedspokane.org or Kari Holman at kariduclos@yahoo.com.
Spokane Physicians Sponsor Children in East Africa By Sam Palpant, MD Debbi Stimpson, PA-C with patients
As resources have improved in Kenya, the more toxic HIV medications have been phased out and less toxic medications have become the standard of care. Medications are provided free of charge by the government. There is not a second line treatment for those patients who fail first line and medication failure with resistance is emerging. Resistance testing and additional HIV regimens will need to be added. I have worked with Alice and her staff to enhance HIV/AIDS care in many areas including antiretroviral toxicities, how to decrease HIV transmission to infants post delivery and identification of physical exam findings that suggest HIV and opportunistic infections.
Seven year-old Philip Kivunike and his parents waded across the Malaba River between Uganda and Kenya during the night, with Idi Amin’s soldiers in pursuit. Philip’s dad found a teaching job at the lowest salary as a refugee. Philip and his siblings attended school in Kenya. They returned to Uganda after the overthrow of two brutal dictators. Philip proved to be an able student. When he was accepted to Kampala’s Makerere University, a Spokane physician agreed to pay his tuition. Now a prominent architect in Kampala with his own business and about 10 employees, Philip is project manager on a government contract to build a giant hangar for C140 transport planes and jumbo jets.
I have seen a noticeable change in the attitude, awareness and education regarding HIV/AIDS since my first trip to Africa in 2006. The new generation of young people are addressing the challenge and becoming leaders in the fight against HIV/AIDS. At the high schools when the team visits to provide education, they clamor for in-depth information and ask hard questions. They seem intent on winning this battle.
In Conclusion- by Kari and Debbie Overall there were very few chronic illnesses, but there is a huge need for preventive medicine and simple acute treatment regimens! Malaria, typhoid and HIV are common diseases. We must admit that it was refreshing to never see childhood obesity, metabolic syndrome, COPD, or drug addiction!
Philip Kivunike and family
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Continued from page 8 When Byrone’s father died, his mother worked as a maid and sold used shoes to make ends meet. When Byrone scored in the top few percent in the country on the national exams, he was admitted to top-rated Alliance Secondary School in Kenya. He climbed to a top position in his class but could not manage the fees. Even the local teachers took up a collection for him, but failed to come anywhere near his actual fees. The prospect of being dismissed loomed large when his case was presented to a Spokane physician, a former graduate of the same school. Byrone’s fees are fully paid now and he is successfully continuing his studies. Jonah lived in rural Uganda, languishing in a school without certified teachers. With sponsorship however, he flourished in an excellent boarding school near Jinja. His bright smile and friendly personality made him a natural leader. In February of this year the principle of his school said he was doing very well. Even as an average student, he will have many more future opportunities than if he had stayed in his rural village. He is deeply grateful to the Spokane physician and her family who have sponsored him over more than 10 years. Dinah, a sponsored AIDS orphan, graduated from Makerere University this year. She subsequently married Mark, a bright and energetic poet and English teacher. She is optimistic about the future. With her degree in hand Dinah aspires to run an orphanage for homeless children in the Kampala, Uganda area. Her physician sponsors are proud of her achievements and goals. Richard Mukasa, sponsored from grade school through high school, took a course in welding and car maintenance. “He can fix anything,” said an adult who works with him now. He is engaged to be married once he comes up with the bride price of three cows, three goats and one rooster.
Vanessa
When physicians think about service overseas, they might personally travel there using their medical talents to provide a service in a hospital or clinic. They often teach their skills and knowledge to nationals who will serve others long after the original mentor is gone. As in the cases above, some have never travelled to developing countries, but their service to the same needy people is done by sponsoring young people for training in those countries. In any given venue, most of the long-term benefits from cross cultural exchanges come in the form of relationships. These often become lasting friendships that mold the character and life views of both the giver and receiver. The long-term impact on the young people mentioned above is clear, thanks to the generous hearts and minds of physicians in our region. If you want to sponsor a child or development project for $40 a month through the Africa Fund, contact Sam Palpant, MD at 509.474-3022 or palpans@intmedspokane.org. All donations are tax deductible with 100% of all funds going to the designated project or sponsored child.
Louis Mukasa, an articulate and gregarious 14 year-old, is one of the top freshmen students at a high school in Jinja, Uganda. He hopes to become a doctor someday just like his sponsor, a physician from our region.
Louis Mukasa
Shadrack Wangoliko
Vanessa is a beautiful young Ugandan woman nearing the end of high school. She will take her national exams soon to find out what doors are open for her future career. She is excited as she hopes and prays for those possibilities. She would not have reached this point of opportunity without a local physician who paid her school fees over the past 10 years.
Shadrack Wangoliko’s dad died in 2009 and left a widow without home or resources. Her local church helped her build a small mud home. Two of the children were sponsored for their school fees and money was contributed to help their mother establish her own business. Mother and children are now doing well with Shadrack in an excellent primary school academy. He is happy and prospering. May SCMS The Message 10
Clinical Elective in The Gambia By Tim Meyer, MD
For a month at the beginning of this year, I traveled back to The Gambia as a preceptor for Marcia Paddock and Hannah Qualls, two fourth-year UW medical students. Both women wanted an international elective which would afford them the opportunity to experience the challenges of practicing medicine in a developing country. After many months of multiple e-mails and phone conferences, the development of a medical curriculum of goals and objectives with a global health orientation and approval for University credit for the elective, the three of us were off to The Gambia. Where, you might ask, is The Gambia? The Gambia, the smallest country on mainland Africa, is located in West Africa. It is a small, narrow country (only thirty miles wide at its widest point) surrounded by Senegal on three sides. We were based at Sulayman Junkung General Hospital in the village of Bwiam in the central area of The Gambia. The staff of this ten-year-old facility is a family of caring individuals who see about 32,000 patients each year in their “OPD” or emergency walk in center; they average about one hundred admissions per month. On our first day of hospital rounds, we faced multiple issues including the complexities of malaria, malnutrition and making diagnostic decisions with limited lab facilities and the lack of an X-ray machine. We were reintroduced to the old technique of counting drops per minute for IV solutions as there was not reliable electricity to power the IV pumps, even though progress has been made to provide consistent power to the hospital via the installation of solar panels. Additionally, we quickly discovered the complex professional and cultural issues with HIV and the confidentiality of that information in the hospital and outpatient setting. The students treated patients in the OPD, administered inpatient care, worked in the lab and assisted with maternal and child health clinics. In the clinics we saw nearly two hundred newborns and toddlers in a day, providing immunizations and basic health maintenance care. Maternal care involved intermittent malaria prophylaxis, occasional admissions for PIH and preterm labor as well as assisting the midwives with deliveries. We worked with community organizers who provided medical education to rural communities where the literacy rate is less than 50% and developed an understanding of how complicated the delivery of medical care becomes when your patients can neither read nor write. Throughout those medical encounters, we were challenged to reassess our preconceptions, sharpen our problem-solving skills, identify barriers to healthcare in a low-resource setting and clearly recognized the relationship between social/cultural/ environmental factors and one’s personal health.
We took a break from our medical duties to join forces with my daughter’s nonprofit, A Hand in Health, which partnered with Books for Africa to highlight the need to improve literacy in The Gambia. The main event was a walk across the country, stopping by communities along the way to deliver around 44,000 books to schools and libraries. We were joined off and on throughout the trek by about 5,000 school children who were so excited to receive the books. Seeing the enthusiasm of the students who wanted to learn was both heartwarming and inspirational. On an earlier visit in 2010 to Bwiam, I helped my daughter set up a medical dental library (7,000 volumes) which supports Sulayman Junkung as a teaching hospital. We had the opportunity to practice our Spanish with doctors from Cuba who regularly staff the hospital. We worked alongside Gambian medical students, allowing us to learn some phrases of local dialect (Jola, Mandinka, Wolof ), although we depended on interpreters for most patient interactions. We were challenged with the integration of our Western medical advice with the Gambian cultural philosophies regarding medication and standards of practice. In the end it is difficult to retell the “experience” of Africa and the hard realities and basic simplicity of the countryside. There were deaths in children and adults that were difficult to assimilate, but seemed routine to the providers who work there on a regular basis. But we were encouraged by the successes directly related to our treatment in spite of the medical limitations. We lived without electricity in our housing unit for all but a day of our stay, treated the water, lavishly slathered on insect repellent and slept under mosquito netting. We had to be open-minded and flexible! However, I believe we left with a more realistic understanding of another culture and its medical challenges as well as a broader understanding of our own. In the end, we all agreed that our Gambian journey was personally rewarding and hoped that our involvement would encourage others to contribute their time and skills on a global level.
Tim Meyer, MD and medcial students Marcia Paddock and Hannha Qualls with medical staff in The Gambia
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Rwanda 2011 By Barry Bacon, MD
They say it gets into your blood. For me, you might say that it has gotten somewhere more profound. You might say it has gotten into my soul. It started right after my residency training, this notion of using my medical skills to bless the world in some way, in a culture and place where I could never be paid back, at least not in money. My wife and I had the chance to spend three years in Malawi from 1987-90 before moving to Colville, Washington where we now make our home. But after returning to the U.S., I couldn’t shake the feeling that I needed to find a way to go back to Africa, to somewhere. Over the 22 years since moving to Colville I have worked hard in my practice and found ways to volunteer in the community here, but have also kept my ear open for chances to tag along with or create our own medical mission trips. I found several such opportunities, but I realized that I wanted to do more than to go for a couple of weeks at a time. In 2011, I decided to go with my wife to the country of Rwanda to teach in the newly formed family medicine residency. Teaching physicians in Africa is one of the most effective ways of improving healthcare. The result of what you are doing will have far more permanence because you have shared your knowledge with other physicians who will continue to care for patients after you are gone. I taught at Musanze (Ruhengeri) District Hospital in the north of the country, 10 miles from the world renowned Volcanoes National Park, home to the endangered mountain gorillas. Meanwhile, my wife Shelley found her own ways to volunteer. She taught English to deaf students, music to grade-schoolers and computer, English, music and leadership skills to genocide orphans at the Imbabazi Orphanage. (You can read the story of Imbabazi in Rosamond “Roz” Carr’s book Land of a Thousand Hills: My Life in Rwanda). During my four month stay, I would make rounds with one or more of the Rwandan residents, discuss cases, guide through procedures or surgeries, observe during clinics and present didactic sessions. In addition, I helped to develop the community health portion of training for the family medicine residents, since public health training is vital to their work. In Rwanda, many children with chronic osteomyelitis languish in the hospital for months because of failed therapy. Many end up with amputations. I have a plan to change the outcome for these children, and hope to put into practice the use of a simple, low tech solution that should considerably improve the effectiveness of treatment: antibiotic impregnated plaster of Paris beads (see work by Steven Gitelis, MD of Rush Medical College on this subject).
Another challenge in the country of Rwanda is lack of insurance, with perhaps 30% of patients unable to afford health insurance. I recall a young woman who sat gasping for air on her hospital bed one morning as we made rounds, bloated with ascites and edematous throughout her body. She had delivered a baby three months before, and now was suffering from congestive heart failure. We were told that she had no insurance, so could not pay for the medicine that could save her life. I remember the feeling I had as I looked around the circle of physicianssome in training, some more seasoned. We had been told by the hospital administration that if we treated a patient who had no money, we would be personally charged for the hospital care. It is a tough spot to be in, knowing that we could save her life, but only if one of us decided that she was worth the cost. We paused awkwardly for a moment. Then I watched as someone in our circle pulled out his wallet and gave some money to the nurse to purchase medicine for our patient, in effect saying, “Today it’s my turn. I will save this one.” There are many challenges on the continent of Africa, some far more basic than lack of medicine and insurance. Starvation, drought, deforestation, poverty, poor hygiene and addictions all vie for attention. Yet the physicians are overwhelmed, pinned down in the hospital, relentlessly trying to care for the urgent while neglecting the necessary and significant. More than many of us realize the singular presence of one person with the skills that we professionals take for granted can make a measurable difference. Here are a few facts to chew on: in Rwanda, 75% of the people live on $1.25 per day and 90% of people live on $2 per day. Lest you think that the cost of living is cheap, gasoline is $7 per gallon. Many cannot afford to educate their children, because while school is free, the cost of school uniforms is significant, and the older children are needed to do their part in earning money to feed the younger ones. Up against the national park, nine villages totaling 3,500 people share one spigot for water. The villagers walk as long as one hour each way to fill a jerry can. Most use the runoff streams from the volcanoes, resulting in frequent typhoid outbreaks. They trek up into the park to scavenge firewood, putting pressure on the wildlife and endangering them with human disease. The typical nurse who runs a clinic will deliver babies, make diagnoses and give immunizations and medicines, all with only one year of training beyond high school. There is one physician for every 40,000 people, but many are in government work or employed by NGOs, so they do not directly provide clinical medicine. As much as I would like to, I cannot repeat the same schedule this year as I did last year. I was hoping to make this four-month commitment a regular part of my practice, but I can’t make it work. It is hard on my patients and hard on my partners.
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Continued from page 13 I decided that I would work hard for five years and spend one month of my vacation time each year teaching in Africa, until I can step out of my practice five years from now and devote four to six months each year on a regular basis without troubling my patients or my partners. It seems like it will work. The trouble is that I keep getting urgent messages now from Africa. One message in particular is troubling me. The message comes from a remote part of northern Kenya, from a tribe called the Pokots. They live in a desert area between Nakuru and Lake Turkana. It seems that a devastating drought has occurred this year, and neighboring tribes, notably the Turkanas, are raiding their cattle and goats to fend off starvation and to trade for weapons across the South Sudan border. They ask, could I help them? Build three dams to store water for livestock? Build a school? Revive the clinic? Train some nurses? Drill a borehole? Maybe do something about the cattle rustlers? It’s crazy, I know, but the gentle persistence of the requests and the devastating circumstances they find themselves in keep me awake at night. What if I saved some money? What if I said no to what I want for myself? What if I seriously partnered with these good people in their desperate situation? What if I refused to simply ignore them because they are too far away or the project is too much trouble or too logistically impossible? What if I found a way? So, I have started what I have called the Pokot Project. Crazy as it sounds, I’ve decided that I’m not going to write these people off. We’ll find a way to build a dam as phase one of the Pokot Project. It doesn’t matter if other people want to help, though there are others who do. I can’t let the chance to do this good thing pass me by. I’m not asking for money. I’m asking you to consider something far more profound and meaningful. I’m asking you to live differently. Take the Pokot challenge. Find a noteworthy project somewhere in the world, run by people that you trust, and carve out time and energy for them from your busy schedule. See how it changes your life. Then I’d like to talk to you.
Orthopedic Missions in Myanmar By John Shuster, MD Myanmar (Burma) is a unique country situated at the crossroads of China, India and Southeast Asia. It has been overrun by nearly every neighboring and Western power during its long history. Most recently, a coup in 1962 resulted in a socialist state under a military dictatorship. This isolated Myanmar from the world, not unlike North Korea. In 2008, my partner and friend Jonathan P. Keeve, MD went to Burma with Surgical Implant Generation Network (SIGN), an international foundation that educates impoverished countries on the use of orthopedic trauma implants and sets them up with a low-cost procurement program. In early 2011, Dr. Thit Lwin, the president of the Myanmar Orthopedic Society, invited Dr. Keeve and his designates to come present at their annual Orthopedic Conference. This would be attended by nearly all of the country's 200 orthopedic surgeons. Bear in mind, that this is a country of 55 million or so, which in the U.S.A. would have around 3000 "orthopods"! Dr. Russell Vanderwilde and I immediately signed up, along with some other surgeons from around the West that Dr. Keeve knew. With his usual preparedness, he procured an entire donated arthroscopic set (all 140 pounds of it) and I collected spine instruments and implants. We cleared our schedules and departed in late October 2011 for two weeks. After 27 hours of travel we arrived in Myanmar to a throng of people and a burning car right outside the terminal. Yangon, formerly the capital, is a gritty city of eight million people, where the inhabitants are embarrassingly polite. No horns are honked, nobody yells and people on the street do not beg. I was never sure whether it was due to their Buddhist faith or the ever-lurking military Myanmars first arthroscopy police, but I suspect the former. I was “apprehended” briefly, and politely, by hotel security for taking unpermitted pictures of a floor in the hotel. The night of our arrival we went to Yangon General Hospital, a dilapidated open-ward 120- year-old British-built hospital housing 1500 inpatients.
Residents at work in Rwanda
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Continued from page 14 50-60 patients lay on wooden beds, some with traction on a 1930s Bohler frame that I had only seen in books. Indications for admission ranged from a sore knee to a threeweek old hip fracture dislocation. The operating rooms have no intra-operative X-ray capability. Myanmar has been subjected to severe economic sanctions due to human rights violations and this is discussed daily, but with no ill-will toward the West. They have two western-built MRIs in the country, purchased through black market channels, and do not understand what we know as usual indications for an MRI. They have Radiation treatment equipment, but can’t get the isotopes due to IAEA sanctions against them. We heard about all of these during the daily British “Tea” that interrupts any hope of productivity in the middle of the day.
At the end of our first week we attended and presented talks at the three-day Orthopedic Conference. Dr. Keeve wisely advised us to speak on locally relevant, and achievable, orthopedic goals. We were saddened by some Asian countries that presented on subjects that were completely unrealistic in the Myanmar environment. The Burmese physicians are actively interested in bettering things, especially with recent political change that is occurring, but leaving the country for additional education is still difficult due to government restrictions and finances. The average physician earns about $400 per year but still treated us nightly to lavish multi-course dinners, over which the heart-wrenching discussions of hope for the future would take place. I hope to return soon and continue with these wonderful people.
Russell Vanderwilde, MD adjusts a 1930s Bohler traction frame We all split up the next day to help with each of our areas of expertise. Being gracious guests is sometimes trying, due to extreme differences in what we would define as the standard of care. I helped with a trans-thoracic vertebrectomy done without any intraoperative X-ray "just find the pus and drain it", with implantation of an iliac crest graft and three months of bed rest. This patient was paraplegic to start, so the long-term outcome is not favorable, especially in light of the fact that anterior spinal decompression is an unknown concept to them. Use of instrumentation and early mobilization is also foreign to them, even on the instrumented fracture dislocation case I walked them through. Drs. Keeve and Vanderwilde performed what may be the first two arthroscopies in Myanmar. Treatment seen as routine here, such as an ACL reconstruction in a soccer player, is several years away for them, at best. This was driven home by the fact that they had no way to hang the irrigating fluid for gravity feed, but my resourceful colleagues figured out a way.
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Beyond the Mountains, There are Mountains.
to this hospital. One little girl had sustained an above-knee amputation on one side and a femur fracture on the other. Her entire family of eight, save her father who was at work, died around her in her collapsed house.
By John K. Shuster, MD, and Michael D. McDonald, MD Having no military connections, Dr. Michael McDonald and I sought any relief agencies that would take us. On Sunday, February 21, Mike and I received a call from a coordinating physician at Apostolic Christian World Relief, affiliated with Lumeire hospital “The Hospital of Light”. On four days’ notice, our wonderful secretaries cleared our schedules, and we bought tickets on American Airlines’ recently restored service to Port-auPrince. From the moment we approached Port-au-Prince, I could tell this would be no vacation. Every third or fourth building was visibly destroyed or heavily damaged. The airport control tower looked like it had been shaken, with huge cracks in the walls, no intact windows and a jumble of cables hanging from the ceiling. Just getting out of Port-au-Prince required navigating destroyed roads, piles of burning rubble and garbage, avoiding armored personnel carriers from the United Nations and other military agencies intermixed with loose livestock in the streets. People were living in miles of tin shacks literally in the street to avoid being near damaged buildings. The infamous dump trucks of bodies were entombed in an old military runway, now a rubble pile 10 feet deep by a half mile long being packed down by steamrollers to prevent wild dogs from digging up human remains. Reaching our original destination of Bonne Fin an orthopaedic hospital built in the ’70s, and has since fallen into disrepair, initially proved impossible due to the washed out roads and mudslides that blocked our path. We decided to work at the city hospital in Les Cayes on the southwestern coast of Haiti for the time being. We spent a busy 30 hours there rounding, setting up surgeries such as skin grafts on quake victims and finding dispositions for the quake victims they had at this hospital. On short notice, we received word that the road to Bonne Finn hospital was hike able. We drove as far as we could and carried gear the rest of the way with donkeys. In this hospital, with 80 beds in a dozen open wards, they had 300 inpatients and 300 outpatient visits in the weeks following the quake. No running water was to be had, and the families cook for the patients. The age of the wounds was also something we had never seen before. Seven-week-old open femur fractures with fixators, bone exposed in the depths of the wound, were not uncommon. Many amputations had become gangrenous. One nurse, trapped in her house by concrete, was rescued by her brother. He reportedly completed her amputation to extricate her and dragged her out. She had ended up with a very short-stump above-knee amputation, which would make prosthesis-fitting difficult even in the United States. Another lady, whose husband was paraplegic from the quake, had been rescued by the United Nations from her house and left on the street, as there were no treatment facilities available. Her brother had brought her, with her open tibia and femur fractures, 100 miles in a wheelbarrow
What impressed us after less than a day was the resilience of the Haitians. There is an old Haitian proverb, “Beyond the mountains, there are mountains,” revealing that they are aware of the continual struggle that life in that country brings. Despite multiple examples we saw daily of entire families having been wiped out by the quake, people still smiled and sang in the wards at night. Many are deeply religious, and when we would attend devotional in the morning, the teachings would be about focusing on the solution and not the problems in life. Also, one does not have to look too far to find humor, even in a place such as this. With the outdated equipment, the huge tarantulas, the large roaches, the rats in the hospital, the gate to keep the chickens out of the wards and the intermittent power and water, keeping a smile during brutally sad and draining work hours was not hard. The Americans who travel there and the locals who are doing what they can in horrible conditions all revive you psychologically. It made us happier physicians, husbands, fathers and Americans when we returned home. We are fortunate to work in a large, talented and supportive group that makes such endeavors possible
Orthopaedic Medical Missions in Haiti By Jonathan Keeve, MD The Caribbean island nation of Haiti is familiar with weather-related disasters. The country had not yet recovered from the havoc wreaked by catastrophic storms in 2008 when a devastating 7.0 magnitude earthquake struck on January 12, 2010, at 4:53 p.m. The massive tremor’s epicenter was approximately 10 miles southwest from the capital, Port-au-Prince, and was the most powerful to hit in 200 years. There were 3 million people in need of emergency aid after the earthquake, and the Haitian government estimates that some 230,000 people were killed in the earthquake — though the exact number may never be known. In the months following, scores of doctors and nurses from across the United States put teams together to fly to Haiti and lend their expertise. Three Northwest Orthopedic Specialists Orthopedic Surgeons were fortunate enough to be able to help. I am an active member of the Orthopedic Trauma Association and had worked with the U. S. Military at Langstuhl Hospital in Germany a few years before, taking care of injured military personnel from the Middle East conflicts. . After hearing of the horrific conditions in Haiti following the earthquake in January, 2010, I was desperate to help in some way. A few weeks after the quake, I was asked to join a team of 10 orthopaedic trauma surgeons and be in Florida on three days’ notice. They did not have to ask twice.
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Continued from page 17 We assembled in Jacksonville and flew into Port-au-Prince on a military charter during the evening with bonfires visible amongst the searchlights and wreckage. We unloaded our plane by flashlight and rode a bus through the shattered remnants of the Haitian capital. A small tender took us through stormy seas on a trip to our home for the next two weeks. Sitting at anchor was the Comfort, a 910-foot-long hospital ship built from a 1970s era oil tanker. It had been on station for two weeks when we arrived with a crew of approximately 700. Our mission was to treat the most seriously injured patients who were not able to be managed at one of the 140 land-based medical facilities. There are no windows on the Comfort, so day and night were only punctuated by meals. We ran a night shift for the first five days in addition to the 14 to 16-hour day shifts. Since the Comfort was the best-equipped hospital in Haiti, we received many patients that had received prior treatment or inappropriate treatment in small clinics or mission-operated surgical facilities. Unfortunately, many surgical facilities sprung up after the quake, run by ill prepared NGOs operating in sub-sterile conditions. Many injuries had become infected when the intended surgical goals were unrealistically complex. On the Comfort, we had lights, antibiotics, X-ray, anesthesia, surgical instruments and well-trained personnel. Those working on Haiti were not so fortunate. Many of the "big names" in trauma were present on the Comfort with me, and I was privileged to serve with them in such unusual conditions. When working in that environment, it was important to remember that what can be done for a patient was not necessarily what should be done due to the fact that infections are rampant and life and limb-threatening complications can result from the best intentions. The work in Haiti continues, as it has for hundreds of years, trying to bring this country up to something approaching Western living standards. For those interested the book Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World is a worthwhile read.
Volunteering with Healing Hearts Northwest By Hal Goldberg, MD Volunteerism is the core of Healing Hearts Northwest (HHNW). Since its inception in 2009 it has organized and provided open-heart surgery in April 2010 and 2011 in Kigali, Rwanda. We are returning for our third trip in April of 2012. HHNW volunteers, comprised of physicians, nurses, medical technicians, a biomedical engineer, a pharmacist and volunteers work jointly with Rwandan physicians and nurses. In 2010, the team completed 16 open-heart surgeries that included 14 rheumatic valve cases, repair of two congenital heart defects and four pacemaker placements. In 2011, we operated on 17 patients, completing 12 rheumatic valve cases and five congenital heart cases. We implanted two pacemakers and completed two heart catheterizations. Each year this dedicated group, which now includes approximately 100 volunteers, raises money for supplies, equipment, medicines and shipping. Continued on page 19 May SCMS The Message 18
Continued from page 18 The Spokane community, as well as our vendors and many businesses, have been extremely generous in both monetary and in-kind donations. Without this help we would not be able to complete our surgeries. Our team organizes fundraising events and orchestrates planning and packing throughout the year. Each year 6,000 pounds of supplies are shipped to Rwanda prior to our departure. The staff then uses their personal vacation time and pays for their own flights to get to Rwanda. So why do we go? And go again? The “why we go there?” is answered by one of our interactions with a patient. In our first mission in 2010 we operated on a young woman named Josee. On our second trip, one of our physicians recalled his meeting Josee again. “Following surgery, we hadn’t heard much about Josee’s progress. On day two of our 2011 trip, Josee walked into the ICU at about 5 p.m. The sun was barely still up… She walks in and initially I don’t recognize her until she restates her name and indicates that we operated on her last year for valve surgery. She stirs her image in my mind when she begins to talk about her baby. Yes, Healing Hearts Northwest had operated on her just 3 months after having her baby. Somehow she made it through her delivery and yet was extremely symptomatic afterwards with her valvular disease from rheumatic fever. Caring for her in February 2010, we dealt with the unusual problem of finding a breast pump in the postoperative period. We planned for a lot, but that did not include being prepared for a breast feeding mother. Besides the postoperative issues of rhythm and fluid excess that we worry about for all patients, we were struck by her apparent lack of bonding to her baby. Grandma and the baby clearly had bonded, but not Josee. In retrospect, it was because she was not well enough to care for the baby. But, now with enthusiasm, she described her life as a mother of a 17-month-old baby. She looked so good that day and told us how well she felt and she thanked Healing Hearts Northwest for giving back her life. “God bless you”. Her words and her appearance were inspiration and all the thanks any of us would ever need!
Spokane’s Medical Education Advancement By John McCarthy, MD Assistant Dean for Regional Affairs UWSOM As we move toward warmer weather, less snow and the end of another academic year, the growth of medical education in Spokane marches forward with a quickened pace. As most of you have likely heard, WWAMI-Spokane will begin training secondyear medical students in the community. WWAMI (Washington, Wyoming, Alaska, Montana & Idaho) just celebrated its 40th anniversary of service to the five-state region, Spokane has completed four years of offering first year medical education in the community and now is rapidly transitioning to plans to have four years of medical education in the community. Similar to our first year offering, we will have twenty positions available for second year medical students beginning August of 2013. This class will not be funded by tax dollars; rather by community dollars that are committed to growing medical education for eastern Washington. While the numbers are small, the impact is significant and will only be growing if successful. In reflection, what has changed in the last four years that we can attribute to having the campus in Spokane? Four years ago we had no University of Washington students enter our residencies this year we had nine. We now have a student and a resident on the Spokane County Medical Society (SCMS) Board of Trustees. Students are doing research in the community between the first and second years. There are admissions being done in eastern Washington to accommodate our east side students. Students have affiliated with the House of Charity to provide care on Saturdays to this disenfranchised population. The School of Medicine is doing a curriculum review and Spokane is able to pilot new approaches to the distribution of the curriculum. There are interprofessional educational activities occurring on the Riverpoint campus. Dental students have been introduced to the campus. The School of Pharmacy is moving to Riverpoint from Pullman. The 2009 SCMS survey on primary care suggested there was a paucity of providers with greater needs expected to manifest in the future. The community and school are working to step up to meet those needs. WWAMI’s 40th anniversary this year gave us time to look back and reflect on what has changed in medical education in Spokane and the region. Looking forward, there are many changes in store which makes this an exciting time to be involved in medical education. As we continue to grow, we anticipate there will be increasing needs for faculty, instruction, community support and engagement. We would ask that you consider this if you are approached or would like to investigate how you might become involved.
Two happy recipients of care from Healing Hearts Northwest
The enthusiasm these medical students bring to our profession and to the community is a gift that we are just beginning to appreciate.
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Project Access and the Ongoing Search for Sustainable Funding
In 2011, Project Access served 651 clients, up from 571 in 2010. The value of donated medical services totaled $7,214,394 in 2011, up from $6,315,708 in 2010. The totals since the organization started in 2003 - $44 million of free care has helped 5,500 residents of Spokane County!
By Lee Taylor Director, Project Access Spokane
The Project Access Return on Community Investment (ROCI) is $14.96, (up from $12 in 2010). ROCI is a ratio of the value of services provided to Project Access clients and the total operating expenses of $482,203 in 2011, (down about 6% from $510,854 in 2010). This high ROCI makes Project Access an outstanding investment of social services dollars.
The Need is Great . . . and Increasing! Project Access provides basic healthcare services to low-income people who have no access to private health insurance or other public programs that cover healthcare. In a December 2011 report on the state of the uninsured, the Washington State Office of the Insurance Commissioner (OIC) refers to Washington’s health insurance picture as “bleak” since 2008 and worsening, based on year-end 2010 data. The statistics are referred to as “grim”! • Total number of uninsured in Washington grew by 180,000 to an estimated 1 million people • Charity care by hospitals and healthcare providers rose a staggering 36 percent • Uninsured people in Spokane increased from 11 percent to 13.6 percent • Total uninsured people in Washington is expected to increase by at least 100,000 by 2014 The OIC report states that there is relief in sight. In 2014 the Affordable Care Act will expand Medicaid coverage to hundreds of thousands of Washington residents, reducing the percentage of uninsured people from 15 percent to 6 percent. But how do we make it to 2014, and what will we do about the estimated 20 to 30 thousand people in Spokane who will still be uninsured even if the improvements from the Affordable Care Act do happen?
Here is the Good News Over the past year Project Access has been working very hard to trim unnecessary expenses, improve efficiency and develop an aggressive fundraising plan. The fundraising plan includes demonstrating the efficiency of our operation, demonstrating patient outcomes, demonstrating the community value of our services, and building relationships with key medical community and business community partners. • Project Access is operationally strong and we can prove it • The network of providers and organizations donating services is still very strong • Nearly everyone in our community believes that Project Access is a much needed program • Project Access is a very good investment of community services
Sustainable Funding is Still the Biggest Challenge! The tough part of this work is that no matter how good you are, funding is still a challenge! Project Access has been searching for sustainable funding since it began in 2003. Like many other organizations providing essential safety-net services to our most vulnerable residents, Project Access faces funding sources that change like shifting sand. Foundation support was strong at the beginning, then waned. State and Federal funds were a huge help from 2007 through 2010, yet those sources have dropped to zero. Support from hospital organizations and others in the medical community is good, but very difficult to grow in a business environment that is challenged by healthcare reform. Support from local municipalities has been consistently strong, but for the first time since 2004, we will not be funded by Spokane County or the City of Spokane. We are working hard to build relationships in the medical community and looking for new ways to improve access to care and reduce the cost of care by improving efficiency. Our collaborative project with the four emergency department medical directors is one example of our important community work. This project will establish a strong community network of clinical and medical services providers that will better manage the care of people who frequently visit our community’s emergency rooms. We believe this work will lead to new opportunities to add value in the community and new sources of funding.
Project Access is looking for New Investors! When there are so many challenges in our society, in our economy and in our community, it is very difficult to determine how to allocate limited resources to help our most vulnerable neighbors. Our current economic conditions put citizens of our community in the very difficult position of making decisions to provide financial resources to some people in need while denying support for others who are equally needy. This forces us to make decisions about funding social programs by treating them like investments and analyzing the return on the investment of community dollars.
dollars, returning nearly $15 in medical services for each dollar invested in operating funds May SCMS The Message 20
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There are very few organizations in our community that can leverage free services, create tremendous value in the community, and create such a high return on investment. The cost of not making this investment is huge. Few things are more essential for our vulnerable neighbors to be stable and productive. Poor health can stop everything! Restoring health can be the beginning of the road to recovery and sustainable productive living.
We are looking for investors who demand a high return on their investment. We are looking for people who want to support hundreds of medical services professionals in providing essential medical services to our most vulnerable residents in the most cost-effective way. We are looking for people and organizations to help ensure that Project Access can continue to leverage the altruism and generosity of Spokane’s medical community! Do you know people who are potential investors in community causes? Can you help us get in front of people and organizations that are in the position to make investments in our community? We are interested in using our Medical Society network to make those connections. It will make a difference in Project Access funding and in the medical services available for low-income uninsured people in our community! If you can help us make those important connections please contact me. I would be thrilled to receive a wave of calls and emails from all of you! Please call me at 220.2651 or email me at lee@spcms.org.
Having a Rational Conversation about Health Care Reform Symposium Summary
healthcare and how much that change is being affected by the politics of our time, whether you are a student or a participant in the real world happenings. So let me try and paraphrase a few of the comments from the panel members. Mary Selecky, Secretary of Health, started the first panel with a significant focus on prevention as you might imagine; both the gains such as tobacco free campuses and nutritional support for populations, and the difficult work ahead to deal with ongoing issues such as her recent declaration of a whooping cough epidemic in the State of Washington. She was quick to point out, a common theme from most presenters that much public health activity was necessary and needed ongoing attention regardless of the outcome of the ACA but without appropriate funding, significant issues lay ahead. She also noted that Spokane was very important to the work of Public Health in our much larger geographic region east of the Cascades led by the Spokane Regional Health District. Dr. Tom Schaaf began his comments by noting that significant health system re-design was not only necessary but was occurring regardless of the disposition of the ACA. He felt that health care providers could address the three platforms of the Triple AIM; experience of care, health of populations, and reducing cost, if the system is re-designed properly. Population fragmentation has affected the current system where coordination of care, aligned incentives and patient centered medical home models, will all be necessary to improve the patient centered “value stream.” Important attributes of the Medical Home 2 model will be a patient focus, teams with protocols and checklists, clinical integration, leveraging of technology to improve communication and payment reform which is population based and uses a shared decision making model. John Pierce, General Counsel of Premera Blue Cross, felt the focus needed to be on cost of care if there was going to be any chance for a sustainable health care system. He felt that the ACA doesn’t address cost well; rather its focus is on expanding access and subsidizing the benefit exchanges which require the individual mandate to perform properly. Of most concern are mandated plan benefits driving up cost and the fragmented coverage for different populations.
By Keith Baldwin, SCMS CEO Recently the Thomas S. Foley Institute for Public Policy and Public Service and the WSU College of Liberal Arts sponsored a public symposium “Having a Rational Conversation about Health Care Reform.” Several members of the SCMS were presenters as part of two separate panels regarding “The Challenges of Implementing the ACA” with Tom Schaaf and “The Politics of Healthcare Reform Going Forward” with Glen Stream. Before the panel convened I browsed the Foley Institute Report to see what other events were taking place as part of the Institute’s activities. I was interested to see Cornell Clayton’s, Institute Director, leading statement in his update, “It is an interesting time to be a student of politics.” I think that is clearly an understatement of the type and pace of change occurring in
Patricia Butterfield, Dean of Nursing at WSU, was primarily focused on workforce issues of nurses and physicians and how the ACA may impact them in such a way as to create significant shortages of these two disciplines. Paul Pierson, John Gross Professor of Political Science at the University of California at Berkeley, started off the second panel with remarks about the obstacles to the current political environment especially as they relate to the ACA. He feels that with the “vote in lockstep” partisanship, the large ideological distance between the parties and the playing of a zero sum game, have led to a dramatic increase in the minority being able to block majority legislation.
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Continued from page 21 He also talked about the role of “concentrated interests” versus diffuse interests, who are more organized and focused, include more producers of services over consumers, and which ultimately impact policy decisions because producers have such a strong advantage. The broad context of fiscal austerity currently also leaves subsidies in the ACA in jeopardy, especially those which may come in the future. Chris Faricy, Assistant Professor of Political Science at WSU Pullman, theorized about the implications of the political environment and its impact on the ACA as well. I am not sure I understood all the implications of his theories. Glen Stream, Family Practice Physician and President of the American Academy of Family Practice, was clear about the competing principles in the ACA, e.g. cost and access, and that improving and expanding the delivery of primary care services would address both issues. The ACA has specific financial incentives from 2011 to 2015 for primary care physicians and also provides for Medicaid reimbursement parity with Medicare as well during that same time period. Although, he noted that the rules are still in process. He also mentioned that there are a number of other initiatives being driven by the CMS Innovation Center including quality improvement and comparative clinical outcomes. The U.S. workforce challenge right now is to increase primary care providers from 30% of all physicians in the U.S. to at least 50% which is the norm in all other industrialized countries. He ended his remarks with the Peter Drucker quote, “the best way to predict the future is to create it.” And to finish the panel presentations, Jae Kennedy, Associate Professor in Health Policy and Administration at WSU Spokane, ,mentioned that there are three classes of problems in the current health care environment; access, quality, and cost. They are each separate issues and need different policy solutions. And, access may be the biggest issue which until addressed, won’t allow the other two issues to be addressed. So, is there room for or a place where we can have a rational conversation about health and payment reform or will the ultimate decision be made in the courts, the legislature, or somewhere else? Will Physician leadership take a significant role or be a part of the equation which will lead to solutions?
Dr. John McCarthy in his comments regarding the activities of the Eastern and Central Washington GME Expansion Committee. Several major issues remain at the forefront including the number of residents per 100K population is 29.8 in western Washington as compared to 6.8 in eastern and central Washington. The goal is to reach the western Washington number of residents per 100K population. The second issue is funding the slots for residents, which involves complex issues related to Medicare payments to hospitals, caps on slots and COGME guidelines. Mary Beth Pohl, from the Maryland Health Services Cost Review Commission, enlightened the audience about this alternative approach to funding GME and other parts of the healthcare system for public good. You may remember the Rate Commission experiment from the early 80s in Washington State. Dr. Ramsey went on to further state, “change is needed in GME to meet the future demands for medical professionals.” He added, “Funding and resources are mal-distributed, e.g. the differences in residency slots from western to eastern Washington.” Dr. Rockey noted the complexities of physician supply with a formula (see graph) emphasizing that GME is currently the limiting factor in the future supply formula. He also mentioned that gender matters as a number of factors will reduce the overall supply of physicians in the future as women and their particular needs will become prominent factors. He summarized by saying, “that prevention will not eliminate disease, only delay it; hence the need for more physicians as the population increases and ages.” In his comments about specialties, the fact that 23 specialties reported shortages and that the number of physicians has not grown proportionately with the population, serves to reinforce the need for an increased emphasis on the expansion and enhancement of GME. Finally, Dr. Ramsey was emphatic about using the WWAMI model to enhance and expand GME in the future. Its high quality, cost effectiveness and efficiency in delivery, are characteristics well respected on a national level. The WWAMI model should be the ideal model for enhancing and expanding GME in our area. You can contact John McCarthy, M.D. Assistant Dean Regional Affairs, WWAMI Clinical Coordinator, Eastern/Central Washington at 509-358-7795 (office) for further information.
Graduate Medical Education Summit Summary By Keith Baldwin, SCMS CEO On Friday, March 23, 2012 at the Riverpoint Campus in Spokane Dr. Paul Ramsey welcomed participants to the second GME Summit in Spokane in as many years. He emphasized three important points for the Summit. He said, “GME is the critical link for workforce improvement for the medical profession when you consider the whole continuum of medicine.” His comment was supported by May SCMS The Message 22
Continuing Medical Education Promoting Healthy Families (Practice Management Alerts from the American Medical Association ) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org. Clinical Performance Improvement Network – WEBINAR Patient Experience with Medical Care – Results from the Puget Sound Region Thursday, May 24, 2012 – from 12:15 until 1:15 PM This webinar will present the results of the recent survey of patient experience conducted in the Puget Sound region by the Puget Sound Health Alliance, and explain how those results can be used to improve practice performance to better meet the needs of patients. Patient experience results will be publicly released on May 11 for 40 Puget Sound-area medical groups with 156 clinic locations (clinics with 3 or more primary care providers). Patient experience definitely matters to patients – it’s most often how they define “quality.” Patients with positive experiences return; patients with negative experiences often find a different physician. Further, positive patient experience has been shown to correlate with improved clinical outcomes. Physician members of WSMA may register online at www.wsma.org/foundation/CPIN/. Anyone can register by sending an e-mail titled CPIN May 24 to kho@wsma. org, with the following: Name, Phone, Clinic/Group Name and Number of Participants. Free for all physicians, medical group staff or other care providers. $75 for non-clinical participants. CPIN is a collaborative effort of the WSMA Foundation for Health Care Improvement, the Puget Sound Health Alliance, and the Washington Academy of Family Physicians. This activity has been approved for AMA PRA Category 1 Credit™; AAFP Prescribed credit is pending application. Questions about registration call Kesley Howard at (206) 956-3620 or kho@wsma.org about content or CPIN call Lance Heineccius at (206) 956-3657 or Lance@wsma.org.
Meetings, Conferences and Events
Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees. Contact Bob or Carol at 509.624.7320 for more information. No Pay/Slow Pay: Health Care Collections Workshop (WSMA Practice Management Seminar) Tuesday, June 12 Spokane Valley Hospital 12:30–4:30 p.m. In challenging economic times, more and more physicians’ practices experience delays in payment or get no payment at all from some patients. As your patients struggle to make ends meet, it’s increasingly important that you engage with them, and in a timely manner. Find workable financial strategies to keep “good” patients coming to your practice, and learn how to manage those relationships appropriately. Join us as we cover the essentials of efficient and effective medical collections, to ensure a steady revenue flow to your practice. Seminar registrants will receive with their registration confirmation an assessment tool for submitting questions to the presenter in advance of the seminar. WSMA and WSMGMA members $149 per person (may sponsor staff in the same practice for the member rate). Three or more members or sponsored staff from the same practice may register for a group discount of $129 per person. Non-members: Please call for pricing. Space is limited, so register early! Register online at www.wsma.org.
In Memoriam
Harry Carnahan Green, Jr., MD Born on July 24, 1919 in Richmond, Virginia Harry Carnahan Green, Jr. passed away on April 9, 2012. He grew up in Richmond and Louisville, Kentucky. Harry graduated from the University of Louisville before enlisting in the Army Air Corps in 1941, where he served as a pilot instructor throughout WW II. He and Peg were married in San Antonio in 1941. First son Harry C. Green, III (Butch) was born in 1943 while Harry served as a flight instructor at West Point. In 1945, Harry continued his education at the University of Louisville Medical School, where he graduated in 1949. In July of 1949, the family, including 2- month- old Penny, left for Hawaii where the newly minted physician began work at Tripler Army Hospital, first completing his internship and then pursuing a residency in general surgery. While they were stationed in Hawaii, son Jim was born in 1952. In 1953, Harry began duty as a general
Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at 509.358.7631. Caduceus Al Anon Family Group – Meets every Thursday evening from 6:15 pm until 7:15 pm at 626 N. Mullan Road, Spokane, WA. Non-smoking meeting for spouses and significant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact 509.928.4102 for more information. Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental illness, addictions, work-related stress, life transitions, and relationship difficulties. The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred
surgeon at the hospital at Wright-Patterson Air Force Base, where he was appointed Chief of Surgical Services. In 1968, Harry retired from the Air Force, moving with Peg and Jim to Spokane, WA, where he joined Dr. Edward Clanton in the practice of proctology. Following the end of his medical career in 1984, he and Peg traveled extensively, while still maintaining their active lives in the Spokane community. Harry's beloved wife Peg predeceased him in November, 2009. Surviving him are his sister, Nancy Harris; his three children, Harry C. Green, III (Butch) (Linda Hart Green); Penny Reid and James Green (Charlotte Green); grandchildren Emily Routt (Bryant), Megan Jankovsky and Nathan Miles, Kate Jankovsky (Barry Weidenbenner) and Christy LeLait (Alain) and Harry C. Green IV; and great-grandchildren Logan Weidenbenner, Bradley and Marianne Routt, and Sam Pitts (Abby).
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In the News
In Memoriam
George M. Momany, MD is at Selkirk Interventional Pain Physicians in the SHMC Doctors’ Building located at 105 W Eighth Ave, Suite 250, Spokane WA 99204.
Richard Bourne Byrd, MD Richard Bourne Byrd, 82, died on April 3rd, 2012 during a hiking accident while touring Cuba. He was born on November 17, 1929 to Charley Lee and Elizabeth Byrd, in Lentner, Missouri. In 1954 he earned his medical degree from the St. Louis University School of Medicine. Dr. Byrd completed an internship at the St. Louis Children's Hospital, his residency in Internal Medicine at the Mayo Clinic Graduate School of Medicine, University of Minnesota in Rochester, Minnesota and a few years later in pulmonary disease at the same facility. He was board certified in Internal Medicine and Pulmonary Disease. He served for over 20 years as a physician in the United States Air Force, retiring as a Colonel in 1980. He then joined the Pulmonary Medicine Department of the Rockwood Clinic in Spokane, where he continued to practice medicine and compassionately serve his patients until his death. Dr. Byrd was a pulmonary disease specialist with a particular interest
His practice continues to offer consultations and recommendations, while concentrating on interventional procedures. His practice does not prescribe medications, but will make recommendations to referring physicians if requested. Scheduling can be arranged by calling Kristin Ankerbrand at 509.838.1547. Check in is at Inland Neurosurgery and Spine in Suite 200.
Physician Leadership Resources Book A link for any of the resources listed can be found at the SCMS website (www.spcms.org) Leadership Resources tab. Prescription for Lasting Success: How to Diagnose Problems and Transform Your Organization By Susan F. Reynolds, MD, PhD President and CEO, The Institute for Medical Leadership
in asthma and served as a clinical associate professor at the University of Washington School of Medicine in Seattle, WA. In addition to his dedication to his patients, Dr. Byrd also had a passion for travel and adventure. His explorations took him from the top of Mt. Kilimanjaro and the base camp of Mt. Everest to treks in such places as Nepal, India, and Bhutan. Throughout the course of his journeys, all seven continents were reached.
In an approach similar to the way a doctor reads a chart and runs tests to diagnosis an illness, Prescription for Lasting Success offers a practical system for solving problems in an organization. Leaders can get back on track and increase their effectiveness in spite of significant change. Readers learn to diagnose the 4 Ps: purpose, passion, planning, and people. Using the 4 Ps model, the book gives practical suggestions to help teams, businesses, and associations increase their effectiveness and help organizations transform into dynamic, profitable entities.
He was preceded in death by his parents and his daughter, Linda. He is survived by his wife of nearly 59 years, Laurie (Lauretta); his two sons, Robert (Lynda) and Dean (Jean); his granddaughter, Heather Zarn (John); as well as his younger brother John Frederick Byrd and his partner, Jack Poquette. He will be missed by his family and friends.
Membership Recognition for May 2012 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.
40 Years G. Bruce McClelland, MD
5/6/1972
30 Years Timothy J. Gardner, MD
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5/25/1982
The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.
Reddy, Gautham P., MD Diagnostic Radiology Med School: George Washington U (1991) Internship: U of Southern California, LA (1992) Residency: Thomas Jefferson U Hospital (1996) Fellowships: U of California, San Francisco (1997), (1999) Practicing with Radia, PS 5/2012
PHYSICIANS
Steiger, David, MD Internal Medicine/Critical Care Medicine Med School: Wayne State U (2007) Internship/Residency: U of Florida (2010) Fellowship: Oregon Health Science U (2012) Practicing with Spokane Critical Care dba Spokane Respiratory Consultants 7/2012
Chilcott, Margaret E., DO Family Medicine Med School: Lake Erie College of Osteo Med (2005) Internship: Doctor Hospital West (2006) Residency: Doctor Hospital Family Practice (2008) Practicing with Rockwood Family Medicine 5/2012
Tickman, Ronald J., MD Anatomic and Clinical Pathology/Cytopathology Med School: Emory U (1984) Internship/Residency: Emory U Affiliated Hospitals (1989) Fellowship: MD Anderson Cancer Center (1990) Practicing with Pathology Services (Deaconess) 4/2012
Coco, Dominique P., MD Anatomic & Clinical Pathology Med School: Louisiana State U (2001) Internship/Residencies: U of Florida (2003), (2007) Fellowships: Brigham & Women’s Hospital (2008), (2009) Practicing with Pathology Services (Deaconess) 4/2012 Holbert, Daniel V., MD Diagnostic Radiology Med School: Albany Medical College (2006) Internship/Residency Providence Sacred Heart Medical Center (2011) Fellowship: U of Washington (2012) Practicing with Radia Inc., PS 7/2012 King, Scott N., MD Diagnostic Radiology Med School: U of Nevada (2006) Internship/Residency: Maine Medical Center ((2011) Fellowship: U of Wisconsin (2012) Practicing with Inland Imaging Associates (2012)
PHYSICIANS PRESENTED A SECOND TIME Bell, John W., MD Diagnostic Radiology U of Utah (2006) Practicing with Inland Imaging Associates, PS 7/2012 Cheek, Andrew G., MD Ophthalmology Med School: Loma Linda U (2007) Practicing with Spokane Eye Clinic 8/2012
King, Sarah R., MD Internal Medicine Med School: U of Nevada (2006) Internship/Residency: Main Medical Center (2009) Practicing with Rockwood Clinic, PS 8/2012
DeMars, Patrick D., MD Anesthesiology Med School: U of Minnesota (1981) Practicing with Shriner’s Hospital for Children 3/2011
Kneller, James R. W., MD Internal Medicine/Cardiovascular Disease/Clinical Cardiac Electrophysiology Med School: McGill U (2004) Internship/Residency: McGill U (2007) Residency: Columbia U (2010) Fellowships: U of California, LA (2001), Virginia Commonwealth U (2012) Practicing with Inland Cardiology Associates 8/2012 Nguyen, Khanh L., MD Neurology Med School: U of Oklahoma (2002) Internship: U of OK, Tulsa (2003) Residency: U of Texas, Southwestern (2006) Fellowship: U of Texas, Southwestern (2007) Practicing with Providence Neuroscience Center (5/2012)
Wade Newell, Heather J., MD Pediatrics Med School: U of Iowa (2006) Internship/Residency: U of Colorado Children’s Hospital (2009) Practicing with Rockwood Clinic, PS 8/2012
Gopaluni, Srivalli, MD Medical Oncology/Hematology Med School: Gandhi Medical College (2002) Practicing with Cancer Care Northwest 7/2012 Lee, Thomas K., MD, PhD Anatomic Pathology Med School: The George Washington U (2006) Practicing with Pathology Services (Deaconess) 4/2012 Magee, William T., MD Orthopedic Surgery Med School: Louisiana State U (2002) Practicing with Rockwood Main Clinic 4/2012
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Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, oncall shifts, overhead and case file administration. Please contact Gia Melkus at 1-800-260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company.
Nackos, Jeffrey S., MD Diagnostic Radiology Med School: U of Utah (2006) Practicing with Inland Imaging Associates, PS 7/2012 Nelson, Kelly M., DO Family Medicine Med School: Des Moines U (2005) Practicing with Rockwood Liberty Lake Clinic 5/2012
PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@ palousemedical.com. Contact us today and discuss your future at Palouse Medical!
Ray, Erik S., MD Diagnostic Radiology Med School: Chicago Medical School (2001) Practicing with Radia, Inc. 5/2012
PHYSICIAN ASSISTANT Biondo, Natale “Nat” J., PA-C Physician Assistant School: U of Washington, Medex Northwest (2001) Practicing with Deaconess Hospital 4/2012
PHYSICIAN ASSISTANTS PRESENTED A SECOND TIME Boice, Nicole C., PA-C Physician Assistant School: U of California, Davis (2011) Practicing with Spokane Obstetrics & Gynecology, PS 2/2012 Lukes, Janie D., PA-C Physician Assistant School: U of Washington, Medex Northwest (2011) Practicing with Heart Clinics Northwest, A Division of Kootenai Medical Center 1/2012 POSITIONS AVAILABLE PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs. Contact: Mark Rearrick, mark.rearrick@providence.org, (509) 4746605, www.providence.org/physicianopportunities. PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Toni Weatherwax at (509)444-8888 or hr@chas.org. QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General
FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at 509-459-0688 or e-mail at BorgwaD@ fammedspokane.org. CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide. OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma.com! APPLY TODAY! Apply today by sending your resume/CV to Careers@ OctapharmaPlasma.com! PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com.
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REAL ESTATE
PROVIDENCE SACRED HEART CHILDREN’S HOSPITAL (Spokane, WA) is seeking a BE/BC Pediatric Hospitalist to join our inpatient team. Be part of an exceptional care-team serving children from four inland Northwest states. Work closely with the Pediatric Trauma Center, general pediatric unit, PICU, NICU (level III), and Pediatric Surgery known for exemplary care. Strong cross-specialty support, state-of-the-art equipment and technology, and wonderful quality of life in sunny eastern Washington. Competitive compensation and excellent benefits package, including relocation. Sacred Heart Medical Center and Children’s Hospital has 623 beds, a medical staff of more than 900 and a service area population of about 1.5 million. The children’s hospital alone includes more than 90 pediatric subspecialists. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearric@providence.org, www.providence.org/ physicianopportunities.
Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including fullsized washer and dryer. Wired for cable and phone. For Rent $ 850/ month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.
PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane. We are recruiting for BE/BC Urgent/ Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply). This is a great opportunity to join a growing employed medical group in beautiful eastern Washington. The exceptional Providence care team is implementing a system-wide standardized EHR and providers benefit from shared best practices and robust clinical and business support. Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane. Competitive compensation and excellent benefits package, including relocation. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearrick@providence.org, www.providence.org/ physicianopportunities. SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PAC N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider. Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org. PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income! We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380.
For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres. For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen. For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker. Everything to accommodate you & your equestrian needs. Offered by John L Scott Real Estate – John Creighton at (509) 979-2535. For a virtual tour www.tourfactory.com/709316. MEDICAL OFFICES/BUILDINGS Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820. Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services. For more information, call (509) 981-9298. South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860. Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com. Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.
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PRSRT STD
SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202
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PHYSICIANS / RESIDENTS Part Time/ Weekend Opportunities Available
Internal Medicine, Family Practice, Neurology & Physical Medicine
Great opportunity to supplement your income while you build your practice.
Work 1-2 days a month doing IMEs or physical exams for disability applicants. Competitive pay. No call. No ongoing patient care responsibilities. Training Provided.
WE WANT YOU! Northwest Medical Specialty Evaluations
Ph: (509) 588-7340 Email: efax@nwmse.com
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