June 13, 2014
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 32, No. 41
Neurosurgeons and psychiatrists join ranks Brain stimulation therapies open new fields of research, treatment and career paths BY DAWN BRAZELL Public Relations
partnerships.“The more input you get from more people, it can only be good. When you get to work perating on patients’ brains with people who chose to work on a daily basis, neurosurgeon in a completely different field of Istvan Takacs, M.D., can be hard to medicine, and then you spend impress. decades of your lives learning things When he talks of one unusual in different directions, and here we case at MUSC, though, there’s are. We are in this thing together wonder in his eyes. The for the same ultimate case involves a patient purpose.” WATCH who has four electrodes Nolan R. Williams, A VIDEO in his brain to create “an M.D., who is chief electric cloud” to treat resident of Combined Visit MUSC’s his obsessive compulsive Neurology and News Center disorder and Parkinson’s Psychiatry and the to see the disease. patient’s interventional multimedia “It rocks to be a psychiatrist, agrees. package at www. neurosurgeon when “There were probably musc.edu/pr/ you get to do things 15 psychiatrists and newscenter/2014/ like this,” he said neurologists and dbs-case-study. of his collaboration neurosurgeons packed html. with interventional into Dr. Takacs’ office psychiatrists at MUSC. planning the surgery. Traditionally, psychiatrists and Everybody was equally excited, and neurosurgeons have approached the everybody knows their role in all of treatment of the brain from polar– it and respects one another for each opposite perspectives. other’s role,” he said. “That tells us a “You traditionally think lot about how medicine is moving in of psychiatrists as talkers or general to a much more collaborative medicators. These psychiatrists mentality.” are all beyond that,” he said of the It’s a shift patients, such as this brain stimulation techniques that one with the bilateral DBS implant, are transforming the field and See Brain on page 6 creating powerful, new therapeutic
Resident Reflects Anesthesia physician travels to Tanzania to mentor residents.
Waring Library staff win kudos for Porcher Medicinal Garden exhibit.
2 THE CATALYST, June 13, 2014
PEOPLE David B. Adams
Swing for a Cure Golf Tourney
David B. Adams, M.D. will serve as interim chairman of the Department of Surgery effective July 1. Adams will step into this role as MUSC President-elect David Cole, M.D. assumes the MUSC presidency.
The Fourth Annual Swing for a Cure Travis Branch Memorial kick–off Party and Golf Tournament will be held July 18–19 at Alhambra Hall and Patriot’s Point Links in Mount Pleasant. The kickoff party will be from 6 to 9 p.m., July 18 with the tourney shotgun start at 9 a.m., July 19. Branch died in 2010 after a four– year battle with hemangiopericytoma, a rare form of sarcoma cancer. Proceeds will benefit HCC’s Comprehensive Sarcoma Cancer Program. Visit http://hcc.musc.edu/giving/events/ swingforacure/.
Maria Buse Maria Buse,M.D., Distinguished University Professor, Division of Endorcrinology, was awarded the honorary title of Distinguished University Professor Emerita.
Angela Egner has been named the new MUHA Chief Learning Officer. Egner will be responsible for maximizing all MUHA training and
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723 Interim editor: Cindy Abole firstname.lastname@example.org Catalyst staff: Mikie Hayes, email@example.com
Skin Cancer Screenings photo by Amanda Ritsema, Risk Management
WCBD weatherman Rob Fowler, far right, leads a panel discussion along with hurricane preparedness experts at the May 20 Annual Hurricane Awareness Day event. Representatives from the United Way, National Weather Service, MUSC emergency management staff, Charleston Emergency Management Division and other agencies spoke. development resources. Egner comes from Genesys Learning Instiute of the Genesys Health System in Grand Blanc, Mich. She assumes her role July 14.
Willliam (Bill) Moran, M.D., McNight Professor of Aging and Division of General Internal Medicine and Geriatrics, has been The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: firstname.lastname@example.org.
elected presidentof the Society of General Internal Medicine. The society is composed of 3,000 physician-members who serve as primary internal medicine faculty at medical schools and teaching hospitals in the U.S. Moran is past president of the Association of Chiefs of General Internal Medicine and is a Fellow of the American College of Physicians. Moran has been at MUSC since 2005.
The Hollings Cancer Center Outreach Services and Mobile Health Unit will sponsor its annual skin cancer screening from 9 a.m. to 2 p.m., June 14 at Folly Beach. The event is free and open to the public. No appointment is necessary. Aadditional screenings are scheduled July 12, Isle of Palms, and Aug. 9, James Island County Park. Call 792-0878.
Charleston County Growth
Charleston County government will hold a series of public workshops to gather input for the County’s Comprehensive Five–Year PlanReview. The next meeting is from 6 to 8 p.m., June 16, James Island Elementary School. For information, visit http:// www.charlestoncounty.org/departments/ Planning/CompPlanUpdate/index.htm.
Parking rate increase effective July 1 The Office of Parking Management has announced a parking rate increase and other changes to the employee parking fee structure. Changes will be effective July 1. In May, the MUSC board of trustees approved a five-year parking schedule of increases. Rates are indexed to employee salary. Employees who park at the Harborview Tower Garage or Lockwood lot will continue to receive
a discount over the on–campus rate. Employees working at Harborview Tower and park at the Harborview Tower garage or Lockwood lot will be migrated to the on–campus rate over a period of five years. MUSC Parking will continue to provide free parking in the Hagood system with shuttle bus service around campus. For information contact Melinda Anderson, 792-2597.
THE CATALYST, June 13, 2014 3
Chief resident reflects on residency visiting Tanzania BY BRYSTOL HENDERSON, M.D.,
Anesthesia & Perioperative Medicine
fter multiple plane changes and more than 60 hours of total travel time, we landed safely in Mwanza late in the evening. Anesthesia attending physician Ebony Hilton, M.D. and I arrived to find that the Serengeti house, our intended destination, was “full” with other visiting residents and medical students, so we were placed in a nearby hotel just down the road from Bugando Medical Center. This was the first of many lessons on adaptability that I would come to learn during my time in Africa. Completely exhausted from travel, I was happy to settle into what would be my new home for the subsequent four weeks. I was excited and nervous to find what awaited us the next day. After a much needed night’s rest, we arrived at Bugando early the next morning. We passed through several “security guards” with metal detectors that seemed to beep continuously without consequence. We
were initially stopped at the gate because we didn’t have hospital badges. After stumbling through communication barriers with hand signals and broken Swahili, we finally made it into the hospital with a substantial amount of medical equipment donated from
The Epic Team is offering Q&A dropin sessions open to all faculty and staff who have questions related to the Epic project, Epic training, etc. Sessions are scheduled for 9 to 10 a.m., June 13, 20 and 27, first floor ART Auditorium; and July 3 and 10, first floor ART Auditorium. These informal sessions are hosted by the Nursing Informatics team. Anyone with questions is encouraged to attend any of these sessions.
For information, contact Rebecca Freeman, email@example.com or visit http://mcintranet.musc.edu/epic. Announcements In addition log–in labs will be held from June 17–19 at various locations throughout the hospital. Stop by and test your login. Users can also sign up for a personalization lab for one–on–one, tailored coaching, etc. Search using the term “Epic provider personalization.
Anesthesia Chief Resident Dr. Brystol Henderson and husband, Josh Cagle, took some time to visit the Serengeti National Park in Tanzania.
Epic Q&A drop–in training set for June
MUSC. We arrived in time for morning report. This lasts for several hours each morning, and is an opportunity for each of the anesthesia students to present the upcoming day’s cases along with their intended anesthetic plan. It is
meant to be a learning opportunity for the students. The plans are directed to and critiqued by Dr. Matasha, the only permanent year–round anesthesiologist at Bugando. They also discuss all of the emergent cases that were done overnight, in addition to a brief presentation of all of the current ICU patients. This was my first exposure to the program at Bugando, and despite what I thought was adequate preparation from my predecessors, it was quite an eye– opening experience. The students’ lack of background medical knowledge was evident, and I quickly understood how large the task was that stood ahead of us. Dr. Selby, a visiting anesthesiologist from Australia, was present that morning. He sporadically devotes many months each year to teaching at Bugando, and became instrumental in orienting us to the hospital. He allowed for a seamless transition by introducing us to the right people and obtaining our hospital badges all
See Africa on page 9
4 THE CATALYST, June 13, 2014
OVERHEARD AT MUSC Hooks was pragmatic about her approach to her workshops. She knew if she shared
Jennifer Hooks, manager of MUSC Performance Improvement Department
information the “old–fashioned way,” she would lose the audience and they may never have
Accolades for superlative presentations at
had the opportunity to embrace the innovative processes she had to share. “When you’re dealing with physicians, the last thing you want to do is stand at the front of the room, show a PowerPoint and put them to sleep. So, I decided to shake things up and
the 2014 American College of Medical Quality conference held March 27-30 in Alexandria, Va. Hooks was recognized for bringing an entirely new energy and model for presenting to the annual conference.
Speaker who engages her audience
Think about the typical medical conference… It’s 10:45 a.m. You’re there to get continuing education credit or because the meeting was located in a city on your bucket list. You’ve been there since 8:30 a.m. and the speaker is still droning on about something tedious in a tone that would lull Ferris Bueller’s teacher to sleep. Audience members shift uncomfortably in their chairs. Stomachs growl, eyes glaze over. People post to Facebook, check their watches and search for the closest exit sign or nearest coffee urn. But Jennifer Hooks had radically different ideas about what makes for a good presentation when she prepared to host two preconference workshops at the ACMQ conference. Hooks gave no lectures. Standing in front of the room pontificating is not her style.
MUSC Performance Improvement manager Jennifer Hooks, center, and her team.
college’s leadership was highly impressed. With attendance at an all–time high, Hooks received the highest marks for both the information she shared and the dynamic way she engaged the audience. She generated such a buzz that Lyles feels Hooks may now be MUSC’s worst kept secret, on radar screens across the country as a much sought-after speaker on the national health care scene. “The annual meeting of the American College of Medical Quality was an incredibly successful event thanks in large part to our colleague,
make my presentation entirely interactive,” said Hooks. “I had the participants get up and go through a number of thought-provoking activities throughout the session. Not only did they have fun and do great work, the best part was the feedback I received. It appeared to be a real winner.” Hooks brought to the conference a way of problem solving that is relatively new to the health care world. Applying two process improvement methodologies that have long been used in manufacturing, the business world and the military, Lean and Six Sigma, Hooks was able to provide to conference attendees a practical model they could take back to their respective institutions and practices. According to Hooks, many businesses, hospitals included, tend to move too quickly and
In fact, the word used most to describe her presentations was “interactive.” And it was no
Jennifer Hooks. Over a two–day period of time, she presented pre–conference workshops on
wonder: Her teams were moving about the room
quality improvement. Not only was she the star
collecting data and conferring with teammates,
of the entire meeting, she was the person who
rush to solve an issue without having all the facts and data, looking at the root causes and effects or going through a well–defined process. Her
brainstorming at lightning speed and competing
generated the most buzz and positive audience feedback. Her presentation was excellent. She broke the audience into teams and gave them
goal was to provide a way to evaluate a problem using these tools and arrive at solutions that were not based merely on opinions or anecdotal
assignments — an exercise never before done at this usually ‘didactic’ meeting. I couldn’t have been more impressed,” he said.
information. The assignments she gave them pertained to
with fellow colleagues to create the biggest “fish” possible. The other word most used was “effective.” According to Mark Lyles, chief of Strategic Planning and vice president of the ACMQ, the
See OVERHEARD on page 10
THE CATALYST, June 13, 2014 5
Melanie Slan Department Hollings Cancer Center Outreach Services How you are changing what’s possible at MUSC By providing cancer screening services via HCC’s mobile health unit which reaches out to people in communities who have difficulty accessing health care and follow–up services and who are at risk of developing cancer How long at MUSC 7 years Children Darryl, Willie, Stephanie and Stephen. Our youngest left home a couple of months ago so now my husband and I are getting used to being empty-nesters. First thing you notice about a person Their smile Favorite place in the world Okinawa, Japan A must-have in my fridge Iced tea How would you spend $1 million Start a foundation to support services to the medically underserved population; travel
6 THE CATALYST, June 13, 2014
BRAIN Continued from Page One
“Whatever you use it for, whether it’s for psychiatric application or a movement disorder, it’s a reversible procedure.” Dr. Istvan Takacs
“We’re trying to help people who are barely living or dying.” Dr. Nolan Williams
Next week: Part II
Novel brain stimulation techniques help reduce stigma of mental illness. Story explores new educational track for psychiatrists to take advantage of the growth in the field of interventional psychiatry.
depression for most of his life that medications have failed to treat adequately. Several rounds of electroconvulsive therapy also have failed to relieve his symptoms. In his 50s, the patient faced a new challenge: Parkinson’s disease. He agreed to have deep brain stimulation treatment, with two electrodes placed in his subthalamic nucleus. When the procedure brought him relief from his Parkinson’s symptoms, he wondered if it also could treat his lifelong obsessive compulsive disorder that has been so intense it compelled him to check the garbage, retrace his footsteps and feel hopelessly depressed. Takacs, Williams and their colleagues thought it was worth a try since implanting the second set of electrodes would offer a unique opportunity to see how the bilateral electrodes would interact, especially given the placement into the patient’s nucleus accumbens, or reward circuitry portion of the brain. Beyond treating his OCD, the hope was this also could relieve the man’s depression and apathy, symptoms often seen in patients with Parkinson’s disease. In July 2013, he received his second set of electrodes. Interventional psychiatrists have been adjusting his electrode settings through a “brain pacemaker” that is implanted in the chest and monitoring his reactions and progress. It takes months to see what effect treatment will have. Williams said the patient is no longer having suicidal thoughts, his levels of depression and apathy have improved and the severity of his OCD has lessened. “He is doing much better. He went from compulsively calling the office daily to now checking in only during his scheduled visits. He states that his mood is better and he has been able to find joy in his life again.” NEW PARADIGM Takacs said he’s glad to see the growth in the field of interventional psychiatry. “It’s a whole new paradigm that’s been adopted. It’s very rare to have a psychiatry department and a neurosurgery department in sync where there’s an agreement that, on a carefully selected subgroup of patients, invasive procedures are OK and helpful and move both the patient’s lives and science forward. It is not something that exists in very many
These were computer-generated planning pictures used in planning the surgery, which requires precision placement of the electrodes. places, not in the United States and not worldwide.” Williams said the strength of MUSC’s brain stimulation research and lab is one reason MUSC is offering a new interventional psychiatry fellowship. It is for residents and psychiatrists who want to have an additional year of training in the wide variety of both invasive and noninvasive brain stimulation technologies that now are available, some of which have been pioneered at MUSC. MUSC also has a curriculum within the residency program called the interventional psychiatry track. Attracted by a field that is fertile ground for the next leap in what psychiatric treatment can offer, Williams said the interventional fellowship program will expose trainees to all the latest brain stimulation technologies, teaching them how to use them so they will be able to push the field forward and reach patients who unfortunately have been unresponsive to traditional treatments. “What we’re trying to say is that we still have a couch and a prescription pad, but we have other types of technologies including brain stimulators that we’re using to treat various psychiatric disorders. This is not to replace talk therapies or medications, but it’s an augmentation for people who are not responding to traditional treatments.” It’s also a shift in how the brain is
viewed — how it is an electro-chemical organ. “We’re looking at the electricity primarily, the circuits and how the circuits behave. There are ways to directly and focally intervene on those circuits. We’re interested in making sure that we educate doctors, psychiatrists and the public on these types of technologies to let them know where the current state is, and where we’re going. We’re interested in people collaborating and synergizing to evolve these technologies to help people. We’re trying to help people who are barely living or dying.”
ELECTRIC CONVERSATIONS Inside the three–pound gray mass that is the brain, there is a rhythm of electrical oscillations among the billions of neurons. When an electrode probe is implanted, it adds to this electrical conversation going on among the cells. Takacs said DBS is an invasive procedure not to be done on a massive scale, but for certain carefullychosen cases, it has advantages. One is the current can be directed, unlike systemic medications that may cause side effects. And, it’s reversible, Takacs said. “Whatever you use it for, whether it’s for a psychiatric application or a movement disorder, it’s a reversible procedure. You don’t destroy anything, so if something doesn’t work, then you can tone it down.
THE CATALYST, June 13, 2014 7 “You can switch the electrode contacts. You can change the shape, size and scope of the electric cloud that you’ve created around your target structure. Under proper and experienced supervision, it allows you to explore these things.” For the bilateral DBS patient, the treatment opens a window into how the brain’s circuitry does work. Since this has never been done before, doctors will have to find out if the simultaneous stimulation of several target structures is better than the selective stimulation of a few, and how it all will interact, he said. “Will one device interfere with the other device and, if it does, will it interfere in a negative way or in a positive way? Our hopes have been that either the two devices will not interfere with one another or that they will interfere with one another in a synergistic way. One is a turbo charger for the other. This is a long–term project where you first start to tweak his OCD electrode settings to try to optimize that and then you try to create some cross talk between his Parkinson’s implants and his OCD implants.” Takacs said it’s well–known DBS can be effective in treating a movement disorder such as Parkinson’s disease, however, electro–neuromodulation gets much more complicated when talking about treatment-resistant depression or other emotional states. “Walking straight is a very primitive or simple thing, but your general state of mind — if you’re going to be happy or if you’re going to be sad — it’s probably a sum of a lot of different functions. It’s just like a Monet painting. If you look at it from far away, it looks like a sailboat, but if you go close up, it looks like a bunch of dots, so the gestalt of the whole is made up of a lot of inputs. To have just one electrode somewhere and hope that that will color the expression of your whole mind, to think that there is one single switchboard to happiness, to curing depression, I think that is a vain hope to have because we are more complicated as thought machines than that.” Researchers are exploring if there may be ways to create some sort of triangulation between electrodes that are fairly distant from one another to generate a larger amount of input.
Claude Monet’s The Japanese Footbridge |Courtesy National Gallery of Art, Washington
Dr. Takacs compares the emerging field of interventional psychiatry to artwork in how it has to be viewed from broad perspectives. Selecting the reward circuitry area in the brain as a target for OCD opens new research territory. The thought is that the stimulation will give the patient relief from the anxiety that is being felt if he doesn’t get to perform the repetitive task.“What does the repetitive action do for you? It gives you brief relief. By going to the reward circuit and trying to keep that stimulated — and in a sense we don’t even know if you’re stimulating the reward circuit or if we’re inhibiting a feedback loop that turns off the reward circuit — we are messing with the reward circuit in some way,” he said. There’s wide interest in the current bilateral DBS case since it’s thought that some patients with Parkinson’s disease also may have dysfunction in the rewards circuitry. “So this is a really unique and exciting case because not only does he have two sets of stimulators for two sets of diseases, but he’s also the first Parkinson’s patient in the world to have a deep brain stimulation electrode in the rewards circuitry.” REDUCING STIGMA Seventy percent of Parkinson’s patients have depression at some point in the course of the disease and having depression prior to Parkinson’s makes
them 2–3 times more likely to develop Parkinson’s disease, Williams said. “We also know that depression is the most disabling part of Parkinson’s. If you survey Parkinson’s patients, they’ll say that depression is the thing that is the most disabling of all of their symptoms. We don’t have a crystal ball to tell the future, but we’re really monitoring a lot of things closely, certainly monitoring the obsessive compulsive disorder, which was the primary reason for the implantation, but also other things like his mood and his Parkinson’s-related apathy.” Williams said the patient’s mood and anxiety improved, and he’s been able to maintain those gains and need fewer doctor visits, which is exciting. It’s an exciting time in more than one way, said Baron Short, M.D., clinical director of MUSC’s Brain Stimulation Services, part of the Department of Psychiatry & Behavioral Sciences. MUSC’s brain stimulation services include a wide array of treatments: Electroconvulsive therapy, transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation and epidural cortical stimulation that are being used successfully for a variety of treatment-resistant disorders.
“We’re trying to be advocates for other people with various psychiatric disorders and say that these are conditions that people are not causing,” Short said. “They are conditions related to how their brain and body are functioning and there are some similar modalities that we already are using for other disorders, in this case, various neurological diseases such as Parkinson’s that may be effective for psychiatric disorders. It’s ironically playing a role of reintegrating psychiatry with the rest of medicine.” Revolutionizing the view in psychiatry of how circuit-based certain types of suffering or certain types of disorders can be, brain stimulation techniques can be used to focally intervene on those circuits. “We’re not as focused on medication that has an effect throughout the body on multiple organ systems,” he said. “There’s more of a focus of trying to find changes in the brain through neuroimaging, through understanding how the brain is behaving with certain disease states and then directly intervening.” That type of paradigm shift will help reduce the stigma of mental illness in many ways a change psychiatrists and colleagues welcome. “It’s hard to make an argument that these things aren’t problems within the brain when you can put an electrode in the brain, stimulate in a specific targeted area in the brain and then the symptom goes away,” Williams said. “That’s a very powerful statement for saying that these are truly brain-based disorders, and there shouldn’t be any more stigma about having obsessive compulsive disorder than having something like Parkinson’s disease or suffering a stroke. We feel that these are very similar conditions in the sense that they’re all happening in the brain.” It’s also making other doctors, such as neurosurgeons, take note. Takacs said the field of neuroscience is taking a giant leap forward. “Here at MUSC, we have the neurosurgical expertise to get patients wherever they need to go inside the head, and we have members of the psychiatry department, such as Mark George, who are distinguished in having pioneered these newer neuromodulation type of procedures. It’s an exciting place to be.”
8 THE CATALYST, June 13, 2014
Waring Library wins online resource award Staff Report MUSC Waring Historical Library received the 2014 Online Resource Award from the Archivists and Librarians in the History of the Health Sciences. The award was presented to Waring curator Susan Hoffius at the annual ALHHS business meeting, held on May 8 at the American College of Surgeons in Chicago. The ALHHS Online Resource award honors the work of MUSC's Waring Historical Library Curator Susan Hoffius and Digital Archivist Jennifer Welch for their online exhibit of the Porcher Medicinal Garden. The exhibit website and its corresponding garden serve to increase public awareness of the holdings of the Waring Historical Library and, specifically the archival collection of Dr. F. Peyre Porcher. Award committee reviewers noted that the exhibit was an interesting and creative use of archival resources. It was noted that this online resource could rightfully stand as an important example of the possibilities that exist for an online exhibit to engage new users and serve in tying together a connection between virtual, physical and special collection resources. Hoffius and Welch have shown how archives and their collections can be used to educate the public in non–traditional venues, which
Curator Susan Hoffius with the ALHHS award. connect historical events to current research and inquiry. In accepting the award, Hoffius recognized the many people who contributed to the physical and online exhibit, particularly Sherman Paggi, Thomas Hamm II, Robin Smith and the Porcher Medicinal Garden advisory committee. "We wanted to do something special with this exhibit, and we feel that the combination of historical content and contemporary drug information provides a complete user experience of Dr. Porcher's work. Being able to include the thousands of pages of Dr. Porcher's published and unpublished work in the online exhibit enhances its utility for researchers."
The MUSC Waring Historical Library announced the completion of its second National Film Preservation Foundation basic preservation grant that preserved Mechanical Measurement of Heart Force in Situ, a film of an early heart research experiment using the strain gauge arch. Filmed circa 1950—1955 by Robert P. Walton, M.D., Ph.D., professor and chairman of the Department of Pharmacology, the film shows an early strain gauge arch sewn outside a dog’s heart. The strain gauge measures the force of the heart’s contraction, beat by beat, after the dog was given the drug
epinephrine. It was used experimentally in animal studies, as depicted in this film, and was ultimately used in patients undergoing open–heart surgery. At the time of his death in 1971, Dr. Walton was the principal investigator of one of the oldest continuous research grants of the National Heart and Lung Institute, National Institutes of Health. The NFPF grant supported the creation of a film preservation master and two access copies of Mechanical Measurement of Heart Force in Situ. The film is now available to the public for on–site research.
Library completes preservation grant
THE CATALYST, June 13, 2014 9
AFRICA Continued from Page Three within our first day (a task that had taken others weeks due to the “red tape” that existed in the hospital system). He was also able to give us an idea of where the students stood academically, and which topics to focus on during our time in Mwanza. Unfortunately, he had to leave shortly after our arrival, so it was our responsibility to pick up where he had left off. After a day of learning the ropes, we quickly joined in on leading morning report, and formulated a lecture series that included two to three hours of lecture per day, supplemented with operating room teaching in the afternoons. The anesthesia program at Bugando has grown substantially over the last few years and currently has close to 50 students. They are divided into three groups based on their time of enrollment: the September intake, the Kigoma group (a group of midwives from the Kigoma area that joined the program in December), and the largest of the three, the January intake. All three groups rotate throughout the week and have two to three days of lectures. The other two to three days or weeks are spent in the operating theatre under the guidance of their practicing nurse anesthetists. Unfortunately, the knowledge base did not vary significantly amongst the three groups, and their understanding of basic physiology and pharmacology was minimal. This became one of the major focal points of my lectures throughout the month. I quickly learned that the traditional “African way” of teaching was one of intimidation and fear. Incorrect responses often resulted in belittlement and embarrassment in front of the group. As a result, the students were extremely timid. It took some time, but I feel that overcoming this obstacle was one of our greatest achievements throughout the month. This allowed us to eventually make significant progress in their knowledge base and level of understanding. As the students became more comfortable with me, I was able to pinpoint the disconnect that existed between book knowledge and clinical correlation. I finally began to see light bulbs going off as I attempted to
A group of anesthesia students pose in their new scrubs (donated by MUSC) in front of the Bugando Medical Center in Mwanza, Tanzania. Thiopental, Pancuronium, Atracurium, correlate these textbook concepts to and Halothane, which I had only read specific cases. It was encouraging to about in the past. I also learned a lot watch the students’ enthusiasm and progress over the subsequent four weeks. about flexibility and adapting to my surroundings. The operating theatre was an entirely One afternoon, just prior to induction different experience. I was warned for an exploratory laparotomy for a about the lack of monitors, drugs, and suspected small bowel obstruction, resources in general, but nothing really I learned that the last vial of prepares you for these things until you Suxamethonium was used earlier see them first hand. I was extremely that day and there would be no more thankful for the presence of a pulse available until the following Monday. oximeter machine in each OR as well The only neuromuscular blocker as the PACU (thanks to MUSC’s prior available through the weekend was donations). However, when the power Pancuronium. As I adapted, I learned to in the entire hospital goes out (which happens frequently), we are forced to rely work with the few resources that were at our disposal. on physical exam skills alone. Outside of the hospital, I enjoyed On one of my first days in the getting to know the city of Mwanza. operating theatre I walked into an Several other attendings and residents OR mid–induction. As Ketamine were staying at the G&G hotel with and Suxamethonium were being us. There was also a constant rotation administered, I noticed that there of visiting physicians and students in was no one at the head of the bed, no the Serengeti House down the road. I pre–oxygenation, and the pulse ox and enjoyed getting to know these people and BP cuff lie idle at the patient’s side. hearing stories of how things were done I scrambled to help attach monitors in different areas of the hospital. as one of the students began to mask Most stories were filled with the patient. The patient ended up frustration and fear for patient safety; intubated without complication, and sadly, there seemed to be little realization however, it was encouraging to know that we were all there with a common goal — that anything should have been done a hope that we would make some small differently with induction. impact on these providers and improve I made it a point to focus on the medical care delivered in Tanzania. respiratory physiology and the We enjoyed exploring the city of importance of pre–oxygenation at my Mwanza together. The hustle and bustle next lecture. I learned that I was not of the central market was exciting and going to be able to change every little overwhelming at times, but it was the thing that I felt was done incorrectly, and I began to home in on just a few key natural beauty of the surrounding landscape that really amazed me. concepts that would hopefully improve The sunsets over Lake Victoria with overall patient safety. It was exciting for me to be able to use medications such as its scenic mountainous backdrop were
stunning. I was fortunate enough to go on a safari into the Serengeti and Ngoragora Crater one weekend during my stay. I was able to see practically every wild animal imaginable in their breathtakingly beautiful, natural habitat. Zebras, wildebeests, elephants, and giraffes were close enough to reach out and touch. It was an experience that will be difficult to match. The people of Mwanza were friendly and welcoming. They were excited to share their language and culture with us. The hospital personnel were extremely grateful for our presence. Dr. Matasha constantly stressed that “education is the most important thing.” I was sad to learn that in our absence, the students simply do not have lectures or any formal didactics. They are lucky to have Dr. Selby sporadically throughout the year, and our presence certainly appears to make a difference. There was constant praise and gratitude at the end of each lecture, and the disappointment was evident when we had to announce our departure. I can only hope that our program and the presence of foreign educators continues to grow and prosper over the years as rapidly as their class size is increasing. Another contribution that was made by MUSC was approximately 100 pairs of scrubs for the anesthesia students. Despite the many sacrifices that most of the students had to make in order to come up with tuition for the anesthesia program, OR attire was not provided by the hospital. Most of the students had only one pair of OR appropriate scrubs that they wore every day. They were so excited and grateful to receive a pair of scrubs from MUSC. A contribution that seems so minimal made such a significant impact on these students. Overall, the rotation in Tanzania was an amazing, life–changing experience. It not only made me a better clinician and teacher, but also changed my perspective on the many things that we take for granted in the U.S. I am so grateful to the department and to Dr. Reeves for this wonderful opportunity, and I would encourage everyone to get involved in similar ventures if ever given the chance. Editor’s note: Reprinted with permission from the Department of Anesthesiology & Perioperative Medicine’s Sleepy Times.
10 THE CATALYST, June 13, 2014
Employee Wellness Whether you call it alternative, MUSC leads this session. 12:15 to 12:45p.m., complementary or integrative, there Wednesday, June 18, Room 109, Colbert Library is a group of healing resources that is • Acupuncture & Elements of Chinese considered “outside” the mainstream Medicine: Join an informative discussion about Western, or conventional, medicine for the use of food, essential oils and acupuncture specific conditions or overall well–being. to keep the body healthy during the heat of Many modalities fall within this realm summer. Lisa Abernathy and Lauren Becker including reiki, herbology, homeopathy, of Blue Heron Acupuncture and Apothecary chiropractic, nutritional counseling, explore the Five Elements and how they are used yoga, acupressure, massage treatment, in this traditional treatment. Event is from 12:15 reflexology and meditative exercises. to 12:45 p.m., Wednesday, June 25, Room 115, While there is much debate about the Colbert Library. Email firstname.lastname@example.org efficacy of these approaches with varying to register. Susan Johnson amounts of research conducted, some of q Fit Family Challenge — MUSC has these practices appear to hold promise partnered with Coca–Cola, Lowcountry in pain management and side effects from cancer Parent magazine, DHEC, S.C. Hospital treatments as well as other benefits according to Association and CVS in an 8–week program the NIH’s National Center for Complementary in which S.C. residents are challenged to get and Alternative Medicine. Several hospitals are out and get active. Register at http://www. now combining these tools into their offerings fitfamilychallengesc.com. Families earn points for acknowledging the mind–body–spirit connection a chance to win prizes during the challenge period, to treat the whole patient. May 15 to July 10. Throughout June, MUSC Employee Wellness q MUSC Quits! — an eight–week tobacco cessation will be sponsoring a series of Lunch and Learns to program to help MUSC students and employees explore complementary and alternative medicine quit smoking — free of charge from May 27 to and therapies under the heading of Holistic July 18. 7:45 to 8:45 a.m., Tuesdays or 7:45 to Wellness. (See Event listings below). 8:45p.m., Thursdays. Register at woodarda@musc. These sessions are an opportunity to explore edu. these disciplines with local practitioners and q Employee Fitness Series — 4:15 to 4:45 p.m., June see how they may fit into your own health and 18; Pilates: a total body non–impact workout that wellness practice. Additionally, the June Mindful stretches, strengthens and lengthens the entire body Challenge will invite participants to try an with emphasis on core muscles. Participants should alternative diet by going meat–free at least one day check in at the Wellness Center membership desk for a week (meat–free Monday). directions to the free class and receive a free one-day pass to the Wellness Center. Register at musc-empwell @musc.edu. Wellness Events q Worksite screening — The next worksite screening q TrySports MUSC VIP Night 7 to 9 p.m., June will be held June 20, Room 125, Gazes Building 18, 1708 Towne Centre Way, Mount Pleasant. Auditorium. Screening is valued at about $350, Customers can enjoy a 20 percent discount off is available to employees of the State Health Plan their entire purchase; Events scheduled: 7 to 7:15 (including the MUSC Health Plan) for only $15 p.m., Lindsey Clark, an MUSC certified athletic (covered spouses also can participate for $15). trainer, leads a clinic on injury prevention for the Employees and spouses without this insurance can recreational athlete; 7:15 to 7:20 p.m., 5 Steps to participate for $42. To register, go to www.musc.edu/ the Perfect Fit employeewellness. q June Mindful Challenge — Try an alternative q Chair massages: Free massages are offered to diet at lease one day a week: Meat–free Monday. employees on midday Wednesdays. Look for broadcast Take the survey at http://rtinyurl.com/oqehj4a. A link to the final survey will be sent at end of the messages for locations and times. q Farmers Markets: Fresh fruits and vegetables are month to survey participants. available from local farmers from 8 a.m. to 4 p.m., q MUSC Holistic Wellness Month Lunch and Learn Wednesday, Harborview Office Tower lobby; from 8 Series — Bring lunch and interact with local or MUSC a.m. to 6 p.m., ART; and from 7 a.m. to 3:30 p.m., practitioners specializing in complementary health and MUSC Horseshoe wellness disciplines. Email email@example.com to For information about employee wellness or the register. • Mindful Meditation: Have you noticed how the mind MUSC Urban Farm, email firstname.lastname@example.org or Suzan B. Whelan, email@example.com in the Office of seems to never quiet down; how it jumps from one thing to another? J. Ramita Bonadonna, Ph.D., R.N., of Health Promotion at MUSC or like us on Facebook.
Health at work
Continued from Page Four
problem solving around a particular issue. She had them involved in every facet of exploring the problem, analyzing the root causes and collecting the data so they would be in the best position to devise far–reaching solutions. Prior to the workshops, she displayed dozens of poster–sized Post–it notes Hooks that were pre–printed with the steps, diagrams and processes so they could better understand how to dive in and get to the work at hand. The groups built process maps and fishbone diagrams and filled the bones of the fish with information. Once the exercises were completed, the participants were amazed at the work they were able to accomplish. “Each team worked together to come up with the most and the best solutions,” Hooks said. “It caused a lot of fun competition as everyone wanted to have the biggest fish and best solutions. When the workshop was over, they also had a concrete way to solve issues at their institutions.”
THE CATALYST, June 13, 2014 11
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12 THE CATALYST, June 13, 2014
Psychiatrist to receive inaugural innovator award
Carla Kmett Danielson, Ph.D., an associate professor and director of training at the National Crime Victims Research and Treatment Center in the Department of Psychiatry & Behavioral Sciences, is being awarded the inaugural Mid–Career Innovator award from the Association for Behavioral and Cognitive Therapies. Danielson, a native of Cleveland, will be honored at the 2014 ABCT Convention to be held in Philadelphia in November. The award, designated for significant innovative contributions to clinical practice or research on cognitive or behavioral modalities, is given in honor of the late Dr. Alan Marlatt. Marlatt’s pioneering research changed the face of clinical practice in the addiction field.
The award is in recognition of her innovative research in developing creative mental health treatment approaches for difficult–to–treat populations, Danielson particularly adolescents with co–occurring traumatic stress and substance use problems. ABCT is a national organization committed to the advancement of scientific approaches to the understanding and improvement of human functioning and the enhancement of health and well–being.