REMEMBERING GRAVELY The building and the family 6 FOR THIS, I AM THANKFUL An alumnus shares his Haiti experience 10 WHATâ€™S UP, SHAC? Rural health programs increase access across NC 36
Invisible wounds An increasing number of soldiers are coming home safe from the war zones only to face a new, elusive enemy. P2
Creating a C a r o l i n a l e g a C y
Photo by Fred Bennett
An Exponential Gift y
M ore head alumnus and retire d heart surgeon honor s Unive r sity foundations that shape d him
If you’re interested in creating your Carolina legacy, please contact Jane McNeer, vice president of The Medical Foundation of North Carolina, Inc., at 919-966-3946 or 800962-2543 or Jane_McNeer@med.unc.edu. You may also contact Candace Clark, associate director of planned giving, at 919-962-3967 or 800-994-8803 or email@example.com.
Joe Craver ’63, ’67 (MD) just retired from a 31-year career as a full-time cardiac surgeon and professor of surgery at Emory University School of Medicine. Reflecting on his life, Craver felt that there were some pivotal moments for which he was very grateful. The first big one, he said, after being born to and reared by his parents, was attending Carolina as a Morehead Scholar. “This award presented significant opportunities as well as challenges to me — to justify their selection,” he said. “I endeavored to meet those, and I’m now even more grateful for their support and for UNC.” Leadership became synonymous with Craver on the Carolina campus. He co-captained the football team and received numerous awards as an undergraduate as well as a student at the UNC School of Medicine. Craver felt that he would like to make a tangible gift to UNC to express his gratitude. He and his wife, Amelia, decided that they were not as dependent on his 401(k) retirement funds as expected. Also, because these funds are taxed at the maximum rate if used personally or passed as inheritance, they seemed ideal for a charitable gift. Craver sought a creative way to use these funds while he was still alive. He learned he could buy a commercial annuity within his IRA rollover account and name the UNC Medical Foundation and the Morehead Scholarship Foundation as charitable beneficiaries. Upon his death, they would receive the full corpus (currently valued at $1.25 million, plus their growth) as endowment funds.The UNC Medical Foundation will use $250,000 of these funds to establish the Joseph M. Craver Teaching Professorship. He also will make annual gifts from the annuity income he receives to provide each foundation with current resources during his lifetime. “This way, the benefits start now for both of us,” Craver said. Craver also purchased life insurance policies for each to protect the values of the ultimate principal distributions to both foundations. The son of teachers, Craver enjoyed teaching every single day of his professional career, and thinks of teaching as a way to “extend one’s life’s work exponentially.” He is now taking that legacy of teaching in another direction by showing others how to discover creative ways to use their resources.
CONTENTS UNC Medical Bulletin Summer 2010 Vol. 57, No. 2
ON GRADUATE MEDICAL EDUCATION
The UNC Medical Bulletin is published for the alumni and friends of the University of North Carolina School of Medicine and UNC Health Care.
EXAMINING THE LIFE OF A FORGOTTEN FOUNDING FATHER DEPARTMENTS 18 PHILANTHROPY 20 RESEARCH BRIEFS 26 NEWS BRIEFS 32 ALUMNI NOTES
FOR THIS, I AM THANKFUL
WHATâ€™S UP, SHAC?
ON THE COVER More and more soldiers are returning from combat with mental health issues few health care providers are prepared to treat. UNC is working to change that. For the story, turn to page 2.
More than ever, soldiers are coming home with traumatic brain injuries and stress disorders, flooding our mental health facilities and often defying conventional treatments. What can we do? by Whitney L.J. Howell
or Robert and Holly Mullis, both staff sergeants in the Army, Robert’s return from frontline combat wasn’t the happy homecoming that they envisioned. The anticipated family picnics and laughter never materialized. In their place, Robert and Holly found their lives were full of anxiety and loneliness. “I have a constant ringing in my ears. I can’t sit in a group unless I know everyone. I can’t sit with my back to the door,” Robert says. “I have to know everything that’s going on all the time.” It wasn’t until the night he took at least four Ambien sleep aid pills that he realized he needed help for his mental condition. While the pills didn’t help him sleep, he said, they did make him black out. He has no memory of his actions over a 32-hour period during which he dressed for work, filled his truck’s gas tank, and then returned home to crawl in bed with his loaded pistol. Holly discovered him and, fearing he would try to hurt himself, called an ambulance to take him to the hospital. He woke up laying in an intensive care unit and surrounded by police officers.
For Holly, though, the biggest issue was isolation and loneliness. Rather than concentrating on rekindling their married life, she says, Robert wanted to see his “battle buddies” to make sure they were safe. She felt that her experiences paled in comparison to his, so she didn’t want to burden Robert with her emotions. “I just had to keep all my feelings bottled up,” Holly says. “But having anyone to listen to me would just help so much.” Similar conversations play out in doctors’ offices across the country on military bases, in veterans’ hospitals, and in private practices every day. Since Operation Iraqi Freedom (OIF) in Iraq and Operation Enduring Freedom (OEF) in Afghanistan began in 2001, more than 1.9 million men and women have served abroad. Many return home unscathed. However, others aren’t so fortunate. According to the New England Journal of Medicine, mental health problems are the second most common ailment behind orthopedic needs for returning military personnel. Technological advancements in medicine and military
UNC MEDICAL BULLETIN
equipment save lives and limbs with up to 90 percent of wounded service members surviving their injuries. But, it’s the unseen injuries—the invisible wounds of war—that now plague returning service men and women the most. In 2007, the RAND Center for Military Health Policy Research estimated that 300,000 military personnel currently suffer from post-traumatic stress disorder (PTSD) or major depression, and roughly 320,000 individuals potentially sustained a minor traumatic brain injury (TBI) during deployment. More recent RAND statistics published in the February 2010 Journal of Traumatic Stress
3 community psychiatrist, the military community in North Carolina mirrors the same provider shortage. “For the nearly 400,000 service members at Fort Bragg and Camp Lejeune, there are only five psychiatrists,” Weisler says. “When you compare that to the data from RAND or other organizations, you see these men and women simply don’t have enough resources for mental health care.” Not being able to schedule an appointment is only one obstacle service members face. Military culture itself will often dissuade someone from asking for help, said
For the nearly 400,000 service members at Ft. Bragg and Camp Lejeune, there are only five psychiatrists. These men and women simply don’t have enough resources for mental health care. indicate that at least 15 percent of returning personnel have symptoms specifically of PTSD or depression. “The best indicator for PTSD is the amount of combat exposure a service member has,” says Lisa Jaycox, PhD, a RAND senior behavioral scientist and clinical psychologist. “It affects their relationships, their ability to work, their physical health, and can contribute to substance abuse.” Overall post-deployment psychological problems, not only depression and possible TBIs, but also various psychoses, are more prevalent. A 2007 Department of Defense (DoD) Task Force on Mental Health stated that 38 percent of soldiers, 31 percent of Marines and 49 percent of National Guard reservists revealed they developed a mental health issue associated with their service. The DoD postulates that National Guard reservists have a greater proclivity to report problems, accounting for their seemingly higher incidence level of mental health issues. Unfortunately, admitting to a mental health problem doesn’t mean a service member will actively seek help. Only 30 percent of OIF and OEF service members with an official mental health diagnosis endeavor to do so, according to RAND statistics from the February study. Those who don’t are putting themselves at greater risk for unemployment, lower incomes, chronic health conditions, and homelessness, Jaycox says. The decision to get help isn’t an easy one for a service member, and it also doesn’t mean that he or she can. Barriers to care Despite the growing mental health needs in the US, clinical investigations show there simply aren’t enough licensed providers. A 2009 Psychiatric Services study conducted at the UNC Cecil G. Sheps Center for Health Services Research found that 96 percent of counties nationwide have too few mental health practitioners to meet the needs in their respective communities. According to Richard Weisler, MD, adjunct psychiatry professor at the UNC School of Medicine and a practicing
Harold Kudler, MD, a mental health services coordinator for the Department of Veterans’ Affairs (VA). It’s important that providers learn to “speak military,” he says. “We don’t often think about the military as a distinct culture in society that requires a certain cultural competency,” he says. “But individuals in this culture are less likely to ask for help. They don’t want to be stigmatized or ‘admit they’re crazy,’ and they don’t want to be taken out of the field because they would feel like they let their buddies down.” In fact, Kudler says, many service members refer to mental health providers as “wizards,” not because they miraculously make the problems disappear, but because service members who make appointments suddenly vanish from the field. Many don’t even think of themselves as veterans because they didn’t experience gunfire or were never in the most dangerous positions. This viewpoint can prevent a service member from seeking the care they need, Kudler says, because they do not feel their experiences were traumatic enough to warrant medical attention. Service members also fear their commanding officers will find out if they seek help for a mental health issue and will consider them unfit to serve, Kudler says. This concern is large enough that the DoD allows individuals to deny, on official forms, any previous mental health services they’ve received, and many service members will forego the medical care available on a military base or at a veterans’ clinic simply to keep their needs a secret. Seeking help from a provider in the community, though, can also be an obstacle due to cost. Care in the community is often more expensive, and many nonmilitary physicians do not accept TriCare, the militaryprovided insurance program, because it provides lower reimbursements than most coverages. Providers farther away from a military installation, particularly those in rural areas, are less likely to accept TriCare despite the presence of service members in the community.
4 The women’s issue OIF and OEF are the first military engagements in which women were allowed to serve on the front lines, although there is still an official restriction against women being in the line of fire. Based on VA statistics, 12 percent of the more than 45,000 OIF and OEF servicewomen have sought some type of mental health care. They experience many of the same symptoms as men, but some problems are unique to women. According to Kudler, servicewomen are more likely to develop depression rather than PTSD when they return home. They also develop more personality disorders than men and, often, become hyper-protective of their children. Women also experience different barriers to care
remember to ask the gateway question: “Have you or anyone in your family ever served in the military?” Without the answer to that question, he said, mental health specialists and primary care providers (who are the first to see 70 percent of these problems) cannot appropriately treat a patient’s needs. One of CSSP’s biggest achievements, Goodale says, is its provider database. Practitioners who are qualified to address military mental health needs, who accept TriCare, and who want to make their services available, register with this database. Service members looking for a provider can search the database and easily find someone in their area who can give the treatment they need. To ensure community providers know how to treat
What Agent Orange was to Vietnam, post-traumatic stress disorder and traumatic brain injury will be to the Iraq and Afghanistan conflicts. when searching for treatment. Although the VA system is the traditional health care setting for returning veterans, the system has been slow to accept women as military personnel, and, thus, doesn’t offer the myriad of primary and specialty care services most women require. But women can also work against themselves by holding the belief that a PTSD diagnosis carries a stigma. They believe PTSD makes them bad mothers, so they refuse to acknowledge it and get help. Carolina’s contribution North Carolina has a base for every military branch and is among the most military-friendly states. Approximately 700,000 people, nearly 10 percent of the state’s population, have served or are serving in the military. The state’s contribution to the OIF and OEF efforts is unique, because roughly 30 percent of NC service members belong to the National Guard and do not live close to a large base. The result is that up to 50 percent of veterans live in rural or highly rural areas that are historically underserved and far away from most veterans’ clinics or other health care environments designed to help them. Consequently, many forego the treatment they need. UNC, its clinicians, and its researchers are working to improve the services available to these men and women, as well as make them more accessible. The Citizen Soldier Support Program (CSSP) at The Odum Institute for Research in Social Science connects the military to the services available in the community and trains providers the most effective ways to treat military personnel suffering with mental health problems. “We need to train clinical providers so they truly understand the issues of returning reservists and their families,” says Bob Goodale, CSSP director. “It’s never been more important. Providers need to understand military culture— they need to know what military conflict is really like.” First and foremost, Goodale said, providers must
service members effectively, CSSP partners with the North Carolina Area Health Education Centers Program (AHEC) to provide educational sessions across the state. Some sessions are offered as in-person seminars, but others are webinars or podcasts devoted to specific mental health problems, including PTSD and TBI. In 2008–2009, these courses were offered 15 times and trained more than 1,000 health care professionals, says Karen Stallings, associate director of AHEC. One of AHEC’s main concerns, she says, is to educate more providers and encourage them to choose to become resources for mental health care in rural settings rather than urban ones. According to Sheryl Pacelli, director of mental health and disaster preparedness at the South East AHEC, AHEC and CSSP are developing a DVD toolkit that will guide other organizations through creating a PTSD or TBI training course, securing logistics and designing the education aspects. “We want our programs to be a cultural eye-opener for providers,” Pacelli says. “With the face-to-face trainings, we open the day with the color guard, we play the national anthem, and we do the schedules in military time.” Rather than teach providers to understand the intricacies and idiosyncrasies of war, she said, the AHEC/ CSSP partnership hopes to train them to listen to military personnel more effectively to really hear their concerns and understand the events behind them. Many of these providers take this training back to the VA system to treat returning service members. The initial therapies for TBI and other mental health issues predominantly occur at the VA because the system is smoothly connected to military bases. There are, however, times when the VA simply doesn’t have the physical capacity to provide care for a veteran despite the individual’s right to access. These are the instances when these same service members will arrive at the UNC Health Care System, says
UNC MEDICAL BULLETIN
AHEC/CSSP training sessions are scheduled in military time, and commence with the color guard and the national anthem, in an effort to create a military culture “eye-opener” for providers. Photo courtesy of the Citizen Soldier Support Program.
Harry Marshall, MD, assistant professor of surgery in the UNC School of Medicine’s Division of Trauma and Critical Care Surgery. UNC had nearly 30,000 visits from service members with TriCare insurance in 2009. In many cases, the individual experienced an accident in the civilian world that exacerbated his or her old mental health issues. “Sometimes simple things unrelated to war cause difficulties, like the headaches, trouble sleeping, and depression associated with a TBI or PTSD, to flare up. And these individuals are likely already dealing with decreased motility, lost limbs or, maybe, a facial deformity,” says Marshall, who also served two tours of duty as a National Guard reservist. “What Agent Orange was to Vietnam, PTSD and TBI will be to the Iraq and Afghanistan conflicts.” Just as UNC offers all manner of mental health services, from counseling to cognitive therapy to prescriptions for antidepressants, its researchers are also delving into the causes of mental health issues in returning service members but with a twist. Eric Elbogen, MD, assistant professor of psychiatry at the UNC School of Medicine and researcher at the VA Hospital in Durham, NC, investigated what protective factors could improve a service member’s readjustment into civilian society. His study was published in the May 2010 issue of the American Journal of Psychiatry. Through a survey of 676 OIF and OEF service members, Elbogen determined that service members do not all experience PTSD the same way. Instead, there
are three symptoms: flashbacks, avoidance of anything that reminds the individual of the trauma, and a state of hyperarousal and jumpiness. Within these symptoms, he said, anger also manifests itself differently as either typical anger, aggressive impulses, and, at the extreme end of the spectrum, an inability to control violent behavior. Knowing the difference is important to properly treat the patient. “If we know what factors are related to each symptom, we will know how to target effective therapies,” Elbogen says. “This research gives clinicians the skill set to tailor their treatment just because one vet who walks into the office has anger, it doesn’t mean it’s an identical situation to the next vet who comes in.” It will be several years, however, before the medical community understands the details of the mental health issues OIF and OEF veterans face. The higher survival rate among wounded service members vaulted health care providers into unchartered territory because long-term studies on the effects of PTSD and its treatments haven’t been possible to date. Over the next few years, however, the health care field hopes to have more definitive data to create evidence-based care for suffering veterans. “There is one aspect of therapy that we know is fact now,” Elbogen says. “It’s clear that veterans who have the chance to speak with someone about their feelings and problems have better outcomes than someone who never gets the opportunity.”
Remembering Gravely I have tried through the years to help provide facilities for the care and cure of those who suffer from tuberculosis. The great pleasure I get out of seeing the new buildings go up and the new beds provided is in the knowledge that, in days and years to come, many of my fellow men will be given a better chance of life, a better chance to get well, because of them.
â€” L. Lee Gravely, Sr.
uberculosis (TB) was such a problem in North Carolina that many young men were rejected for service in World War II because of it. By the 1950, more than 3,000 new cases were diagnosed in the state each year. It was around this time that UNC School of Medicine Dean Reece Berryhill, the State Health Department, and leading citizens and physicians worked in concert with leaders in the state sanatorium system to provide treatment for people with TB, one of the thenleading causes of death. North Carolina Sanatorium System Medical Director Dr. Henry Stuart Willis and General Administrator Ben Clark were already developing the concept of a consulting, teaching and research hospital in conjunction with the UNC medical center. The early years Through the leadership of this group, the planning and construction of the Gravely Sanatorium coincided with the expansion of the School of Medicine and the opening of North Carolina Memorial Hospital in 1952. Gravely, one of four state sanatoriums in the state (McCain, Black Mountain and Wilson being the others), was opened as a 100-bed hospital in fall 1953. The systemâ€™s administration offices were moved from the McCain-based sanatorium to Gravely to facilitate the relationship with UNC.
UNC MEDICAL BULLETIN
So many people were touched by their time in Gravely. Some told me they took pictures of the building because their experience there made such an impact on their lives. Gravely Sanatorium had a very strong role in patient care, greatly expanding the teaching and training of young physicians. Leadership by Drs. Thomas Barnett, Richard M. Peters, Janet Fischer, William Cromartie, Derwin Cooper, and Willis created a learning atmosphere equal to that occurring in the neighboring hospital. The faculty was later joined by Drs. William Wood, Mario Batigelli, Irvin S. Perry and Peter Munt for varying lengths of time. Internal medicine and thoracic surgery were the initial medical services, while a pediatric service was added several years later. In early spring 1954, Dr. Charles Burnett, chair of the Department of Internal Medicine, asked Barnett, professor of medicine (pulmonology), to assume the leadership position and, although there was no official pulmonary division, to develop a student and house staff residency program in pulmonary diseases. Wood, professor of medicine and associate dean emeritus of the UNC School of Medicine, has many memories of the staff at Gravely in its early years. He worked as an intern and was a colleague of Barnett and Peters, professor of (thoracic) surgery, who led Gravely surgical services. Wood himself later served as director of the pulmonary laboratory. Betty Hornaday, a longtime supervisor of the pulmonary laboratory, completed her UNC degree while working at Gravely. “She was very devoted and the best investment in the laboratory,” says Wood. “She learned and developed procedures, trained other technicians, and supervised the expanded pulmonary lab, which she also helped design and develop.” Wood also remembers Willis, a native North Carolinian and UNC graduate with a Johns Hopkins medical degree, who was a nationally acclaimed scientist in TB immunology and pathogenesis. Of Willis, Wood says, “He was a longtime medical director of the NC sanatorium system and was largely responsible for the establishment of [Gravely Sanatorium] in the newly expanded medical center at UNC.” Willis became a professor of medicine at UNC in 1959. Ben Clark was the general administrator for the North Carolina sanatorium system for many years before Gravely was built, says Wood. “Mr. Clark was a most forward-thinking administrator, always a few steps ahead of the medical staff in innovation and advancement in patient care facilities. His excellent negotiating capability was instrumental in bringing about the construction of Gravely and its incorporation into the UNC health education and care center. Ben Clark always worked for the greater good.”
Over time, treatment for TB became more successful and fewer patients needed therapy. In 1974, the state transferred Gravely to UNC medical center to be utilized in a variety of ways, including as a chest hospital, a pulmonary and infectious diseases clinic, a family medicine clinic, and a rehabilitation facility, among others. The way to a physician’s heart Many UNC physicians passed through Gravely, and a common fond memory is of the cafeteria. Wilbur Partin, with experience in food service at the Carolina Inn and for the US Navy V-12 Infirmary, directed the Gravely food service that prepared and served food to patients and physicians and staff. William McLendon, MD, professor emeritus, UNC School of Medicine, says, “As a medical student in the early 1950s, I remember that we all looked forward to our clinical rotation to Gravely, for that meant we could eat lunch in the Gravely cafeteria. The food was certainly not gourmet, but [the cafeteria] served some of the best southern cooking anywhere, with its fried chicken, mashed potatoes and gravy, vegetables, and homemade biscuits.” Wesley Fowler, Jr., MD, Palumbo professor of obstetrics and gynecology, Division of Gynecologic Oncology, says, “Gravely had the best food on the planet at that time. The cafeteria was in the basement, and all meals were home-cooked. Best biscuits you ever had.” Jim Donohue, MD, professor of medicine and chief of the Division of Pulmonary Diseases and Critical Care Medicine at UNC, says, “It had the best cafeteria, steak dinners for only one dollar.” A new beginning Gravely Sanatorium’s ultimate use for more than two decades was as a treatment facility for another leading cause of death: cancer. UNC oncology nurse Pat Decator, RN, says, “My best memory of Gravely is that of entering a fortress and haven where our ‘community of cancer care’ existed for brief moments, days and for some years in time. This community was not isolated to the patients experiencing their diagnosis, but included the families, caregivers, physicians, nurses, clerks and volunteers. Though of brick and mortar, the heart and soul of Gravely gave us support, compassion, knowledge, and strength to continue to grow to where we are today.” The building, replaced in August 2009 by the new NC Cancer Hospital, was demolished and the space will be used as a garden and labyrinth for the UNC Health Care medical campus.
A March 2010 photograph of the Gravely Building demolition. The new, state-of-the-art NC Cancer Hospital stands in the background.
“I’m sad to see Gravely destroyed, for it contained many pleasant memories for me,” says Donohue, who first started at Gravely as a resident and then was a pulmonary fellow in 1973-74. “I took care of many of the people who worked there for many years until they passed away. Gravely was a world-famous chest hospital and the flagship of the NC Tuberculosis sanatoria centers. Many famous physicians rotated through there, and a number of important discoveries were made on site and the little lab we called the ‘rat shack,’ which was [a small building] in the parking lot.” The Gravely family The Gravely Sanatorium was named in honor of Lloyd Lee Gravely, Sr., and his wife, Clark Hoofnagle Gravely. Lloyd, a former state senator and successful international businessman in Rocky Mount, NC, served as chair of the board of directors of the NC sanatorium system and was a tireless advocate for tuberculosis treatment and
facilities. He was an active fundraiser to secure the funds to construct Gravely. Lloyd knew the effects of TB on a family. He himself suffered from the disease for many years. His wife, Clark, known as “Mother Clark” to their grandchildren, had suffered from the disease throughout her adult life; she spent time at a sanatorium in Saranac Lake, NY, in the 1930s, followed by many stays at the Black Mountain Sanatorium in NC. Clark died in 1945, and Lloyd in 1953, just months before the Gravely Sanatorium opened. The Gravely’s eight grandchildren, three of whom still live in the Chapel Hill area, knew the building well over the years. Granddaughter Frances Gravely first saw the inside of the Gravely building in 1976 when she was working in the pathology department at the hospital and visited during a lunch break. Her husband, NC State industrial design professor Haig Khachtoorian, was successfully treated for cancer there, and Frances had her mammograms performed in the breast imaging area.
UNC MEDICAL BULLETIN
about the action of the Board of Directors naming “The Gravely building was relatively small, compared the Chapel Hill Sanatorium the Gravely Sanatorium. to the other hospital buildings, and set off,” Frances Needless to say I am very proud of it and feel it is recalls. “It had its own personality, an independent charprobably the greatest honor ever conferred upon acter, like my grandfather.” Frances’ sister Susan adds, me. What I have done on “So many people throughbehalf of the sufferers out our lives were touched from tuberculosis I have by their time in Gravely: done with no thought of people who received their reward but because I was training there, were there inspired to do it by the as patients, or had family courage, the big heart, members there as patients. the thoughtfulness, the Some told me they took love of your Mother Clark. pictures of the building It was first suggested in because their experience the Board of Directors there made such an impact that it be called the Lee on their lives.” Gravely Sanatorium and Granddaughter Clark I told them she deserved Lee Merriam, who was presthe tribute much more ent at the groundbreaking than did I because, after ceremony in 1951, rememall, she was the motivatbers her grandfather’s ing spirit back of all that “humility and pleasure at I have done. The resoluthe honor and his conviction naming the sanatotion that [grand]mother rium provided for placClark was the true force ing in the sanatorium behind it.” She can remema tablet dedicating the ber vividly how frequent sanatorium to both your hospitalizations for tuberMother Clark and me, for culosis flare-ups took her which I am deeply grategrandparents away from This photo, taken at the groundbreaking for the Gravely ful. Needless to say this their home and lives. Sanatorium in 1952, shows L. Lee Gravely (left), then chair action was taken without The Gravelys had two of the board of directors of the North Carolina Tuberculosis any request or suggeschildren: Lulu Carrington Sanatoria, and his granddaughter, Clark Lee Shuff, accepting tion on my part. I plan Gravely and Lloyd Lee a container of “Gravely Grit” (dirt from the site) from William now to have a portrait Gravely, Jr. Carmichael, Jr., then vice president and finance officer for painted of her and one of Lula and her husband, UNC-Chapel Hill. Photo courtesy of Clark Lee Merriam. me that the Board may Landon Earle Shuff, had hang them in an appropriate place in the sanatofour children: Clark Lee Shuff Merriam, of Norfolk, Va.; rium; that will be somewhat symbolic of the manner Elizabeth Carrington Shuff, of Richmond, Va.; Landon in which she and I went along Life’s way together, Earle Shuff, Jr., of Rocky Mount, NC; and Greyson Shuff meeting its problems and enjoying its pleasures Tucker, of Raleigh. together.” Lloyd Lee Gravely, Jr. and his wife, Lee Stevens Gravely, had four children: Frances Carrington Gravely, The tablet Lloyd Sr. mentioned in the passage above of Chapel Hill; Susan Everett Gravely Ross, of Chapel did in fact hang in the Gravely Building throughout its Hill; Ronald Stevens Gravely, of Pittsboro; and Page Keen lifetime. The tablet is to be relocated to the NC Cancer Gravely, II, of Middleburg, Va. Hospital later this year. Lloyd Sr. kept a journal for his granddaughter Clark from her birth to his death. “He called it ‘just a talk between us—one-sided surely—but you will answer it in Editor’s note: Thank you to Dr. William Wood for his many your heart,’” she explains. contributions to this story. In a journal entry dated October 5, 1951, he wrote: “I have pasted in this book a couple of newspaper clippings, one from the Wilson Daily Times and one from the Rocky Mount Evening Telegram telling
For this, I am thankful A UNC School of Medicine alumnus puts his training to the test in post-earthquake Haiti
am an American emergency medical physician and ground. Jeeps and motorbikes sped along the runways have spent a lot of time traveling and working in diffiand to and from a tiny card table, set up at the edge of cult conditions all over the world. But as my plane apthe field, where three American soldiers were acting as proached Port Au Prince one afternoon this past January, the control tower for the planes coming in by the minute. I could sense that something catastrophic had occurred The sights of all the helicopters, the smell of fuel, as well before we landed. well as the massive amount of chaotic activity at that airAs I looked out of the plane window, the roads and field, reminded me of my experiences five years prior in structures appeared more discommy home city of New Orleans in bobulated than usual. Though I had By Richard Vinroot, MD, MPH the aftermath of Hurricane Katrina. been to Haiti several times before, The days and months following I had never seen such a large collection of aircraft at the that natural disaster were very fresh in my memory as I airport. The pilot told me that, on that morning alone, waited to board the plane that would take me to La VallĂŠe there were 1,400 planes requesting clearance to land. I de Jacmel, in the southern part of Haiti. As I waited and knew this was going to be a big mess. guarded my gear, one pilot asked me for a water purificaUpon landing, the pungent smell of aviation fuel was tion system for the blatantly unprepared doctors he was everywhere. There were also massive tent cities, each shuttling into the rural bush. An aid worker asked if he with a flag or banner designating the nationality or comcould bum a ride to wherever my plane was going. He pany of the relief workers who had claimed that patch of wanted out of the country and would go wherever the
UNC MEDICAL BULLETIN
plane would take him. I arrived in La Vallée de Jacmel later that afternoon. The airport was being managed by the Canadian Army and was just a small shell of a place. The flight control center was, again, a card table with a bunch of radios and a couple of soldiers wearing headphones. A plane that had crashed hours before, while attempting to bring in other doctors, sat on the side of the runway. The flights were coming in so quickly that accidents were bound to happen. There was, however, some organization at the airport for medical and humanitarian staff on arrival. I was asked to provide my identification and medical specialty. After a quick briefing, I found my transport, hurriedly waded through the masses of people flooding the streets, and made my way up into the mountains to La Vallée de Jacmel. As we headed up the mountain, I was amazed by the condition of the roads outside of the city. Though poorly maintained by American standards, the roads were much better than I remembered when I was in Haiti ten years earlier. Still, the roads could not hide that this was a very broken country. La Vallée de Jacmel is a small mountain town with a dispensary and a catchment area of 60,000 Haitians. The first aftershock hit thirty minutes after my arrival there. It was enough to make me feel uneasy, but I realized quickly that these short vibrations of the ground were more terrifying to the locals who had experienced the two massive earthquakes a few days before. Some laughed uneasily to disguise their fear, while others had tears streaming down their cheeks. All ran out of the buildings and away from any structure. Even toddlers ran as if something was chasing Opposite: Dr. Richard Vinroot, flanked by two young boys in La Vallée de Jacmel, Southern Haiti. This page, top: A ground crew unloads supplies from a Canadian them. No one ran quicker than our cook. He lost his wife, brother, and four of his six C130 at the Canadian-controlled Aerodrome de Jacmel. Dr. Vinroot flew to this airfield from the US-controlled airport in Port au Prince. Above: Dr. Vinroot assesses a children as a result of the earthquake. He female patient as her granddaughter looks on, St Joseph’s Dispensary, La Vallée de was still waiting to hear about a few other Jacmel. Photos courtesy of the author. missing family members. His grief was obthe earthquake and the daily aftershocks had created in vious; but he had to survive, and work was the only way the Haitians. This was puzzling to all who watched me rehe could get through. act so slowly to the shaking of the ground that occurred Haitians are resilient survivors. Their frightened reeach day. sponse was additional proof of just how bad the earthThe small Dispensary and Hospital of St. Joseph of La quake had been. These smaller, brief earthquakes continVallée de Jacmel was a relic with a couple of wards and ued for weeks and became less frequent as time went on. an operating room suite. There were also clinic consulMy response was never as quick, purposeful, or emotional, tation rooms, a small emergency room, a pharmacy, and as theirs. I had yet to develop the protective instinct that
who lost their homes in the earthquake or who didn’t want to stay inside the structures for fear of another earthquake. We had several tents in our courtyard, and they multiplied as the days progressed. It was in these tents that I would admit patients too sick to leave. There had been no medical care in the community and we sensed a great deal of relief among the population now that we were there. My first patient was a young boy, Emile, who had developed a tropical ulcer on his leg from being trapped under the rubble of his house. He was carried in by relatives and sat stoically as I assessed the infection and cleaned, prodded and debrided. I explained, in French, my concerns and the care I would provide. The boy never said a word that day—he just stared at the ground. He did not cry. He did not move. He did not acknowledge my treatment. He did, however, prove to be my most compliant patient and I saw him every day for several weeks. He was always carried by a caring male relative. Sometimes in their arms, sometimes on their back, but always carried. Each day, I unwrapped the bandages, which had become wet and dirty during the night, cleaned the wounds, and applied new, clean bandages. Before he left, I always asked him to come back in two or three days. He always came the next day. I imagine he came partially to heal and partially to break up the monotony of a Haitian day. Coming to the hospital was an event for Emile and whoever accompanied him. Late one night, a few days after my arrival, I sat outside of the obstetrical room as a woman gave birth to a stillborn child. There were no lights other than a small lamp sitting on an old school desk, most likely discarded from some US clinic or Top: The courtyard and ambulance of St. Joseph Dispensary. The tents were for Dr. Vinroot’s admitted patients, as no one, for fear of more quakes, was willing to school. I sat on a bench and watched and stay under the roof of the small hospital. Above: Dr. Vinroot assesses a patient he waited. I wasn’t there to take part in the believes has typhoid. One of Vinroot’s early patients, he was admitted to the tents, delivery. That was the job of the midwife. I fared well and was able to go home two weeks later. Photos courtesy of the author. was there to control hemorrhage or assist with any other complications. A dog wanan obstetrical suite. This would be my base for the next dered in and out of the suite. The woman was wailing. She few weeks, as it was the center of health care for miles was in physical and emotional pain. Her skinny husband around. Once word was out that we were there, many sat beside the bed, sighing and looking at the floor. He walked long distances to be seen. Our arrival was the recould do nothing for any of his wife’s pain, and I could see turn of health care to the region—an important event. In his feelings of helplessness as he shook his head and, at the common yard, surrounded by benches hundreds sat times, patted his wife’s head. He looked like a child with in every day, were the same type of tents that dotted the his donated baseball hat, too big for his head, easily covroadside and fields throughout the region. These tents, ering his scared eyes. The labor lasted several hours and sent by humanitarian and other groups, housed those
UNC MEDICAL BULLETIN
resulted in a mottled stillborn—an appearance alarming and uncommon to most of us in the US, but a common sight to any Haitian, as many births end in fetal demise. The young girls sitting next to me did not bat an eye as the body was wrapped in a cloth. They instead laughed at a small boy who fell down while relieving himself in the bushes. Josephine, the obstetrical patient, became my patient in the morning when I determined that her anemia, which added to the demise, was at a dangerous level. I had no ability to type blood or transfuse. I had no blood to give her. I put her in a tent and monitored her every day. I fed her whatever I could buy in the streets. I gave
13 to not do so could be tragic. He rambled throughout the day about things that did not make sense, his mother told me, and she cried by his bed all that first day. The family wanted to go home after a few hours. The boy also lucidly agreed. He wanted out of the small, three-bed ward. I could not understand this at first, as he was so sick. But his desire to leave was easy to understand after I learned of the boy’s experiences during the earthquake. My nurse translated the family’s concerns to me: They did not want to stay in the building because they feared it would cave in. The boy and his sister had been living in Port Au Prince to attend school. Their house caved in during the earthquake, trapping all. His sister died instantly.
Their house caved in during the earthquake, trapping all. His sister died instantly. The boy clung to life, trapped under the rubble next to her body, for three days before he was finally rescued. her iron tablets and folic acid. It was all I had. I also injected her with an injectable iron used in Haiti. Her family got it from a Cuban doctor who returned following my arrival in town. They had seen it work and were sure it would work again. Who was I to say differently? I was only a visitor. She improved and went home after several days under my care. Later that night I delivered two babies. Life went on among all of the sadness and tragedy. A man named Jean Paul was carried in by two brothers from the valley five kilometers away. He was a skeleton. He looked sicker than any I had seen during my last year in Africa—diffuse wasting with sunken temples and skin stretched against his white teeth. Although initially I was sure he was immune deficient, his immune system was intact. He had typhoid for several weeks, and was slowly dying. He couldn’t talk because he had little reserve or energy. I placed an IV and began giving him fluids. I began several antibiotics to cover for all other possible causes for massive fluid loss. He was placed on an old army stretcher and brought to a tent in which he would remain throughout my stay. I checked in on him often. He was so fragile that he didn’t speak for three days, but slowly he became stronger. Soon, his diarrhea ceased and he began to eat. He walked home 13 days later. He hugged me and asked me about my home. He told me he loved me. His wife said she did as well. They asked me to stay in Haiti forever, and told me that I would be good for Haiti. They did not know how good Haiti would be for me. A 13-year-old boy came in with a headache, neck pain, dizziness, and a fever he had had for several days. He could not walk unassisted. He looked like he had been a strong child and appeared healthy, but he was very weak. He had a large scab on his forehead and several more on his body. I was sure he had some form of meningitis, but I didn’t have the resources to confirm this. It didn’t matter to me; I treated him as someone with meningitis because
The boy clung to life, trapped under the rubble next to her body, for three days before he was finally rescued. He told me that he held her hand at times because he was scared and missed her. He wanted to bring her body back to La Vallée, but the soldiers in Port Au Prince wouldn’t let him. For three days he walked alone, made it back to La Vallée, found his family, and told them about his sister. During the long trek home, his headaches began. He said he could not stop thinking of his sister. I put him in a tent to rest and he improved somewhat. I wanted to keep treating him, but the family didn’t like being in the hospital. They were afraid of others hearing the boy’s senseless speech and crying in the night. They were afraid others might say he is insane—a very undesirable label in Haiti. His family would rather risk his health than the family’s reputation. Although I pleaded for them to stay, their mind was made up, and they left in the middle of the third night. In the end, I could not blame them. My nurse said she was sure they’d be calling on a houngan or traditional priest for further care. One night, a man with a gunshot wound arrived at St Joseph’s. Family members quickly carried the young man in and left just as quickly to avoid the police and, most likely, to search for the shooter. He had an entrance and exit wound in the lateral aspect of this neck. I knew he would do well and survive. He was a taxi driver from Port Au Prince. He had been paid by a family to bring a deceased family member’s body back to La Vallée. They wanted to insure a proper burial. However, the taxi driver was intercepted by a group of men blocking the road. They shot him and left him for dead. He feigned lifelessness and it saved his life. The thugs pulled the dead body from the car and burned it in the middle of the road. They wanted to make certain that the dead man received the most disgraceful form of funeral. The dead man had CONTINUED ON PAGE 35
Graduate medical education and the values of
rank C. Wilson, MD, Kenan professor and chief emeritus of orthopaedics at the UNC School of Medicine, has written a new book titled “Graduate Medical Education: Issues and Options,” published by Radcliffe Press. In the foreword of the book, David C. Leach, MD, executive director emeritus of the Accreditation Coucil for Graduate Medical Education (ACGME), writes, “This is an important book about this most formative time in a physician’s life, the history of graduate medical education, the key issues that consume present interests of medical educators, and the options that the profession and the society have for going forward. It is timely. Workforce shortages, financial constraints, new knowledge and technologies, and dramatically changing demographic patterns in society pose challenges. Changes are needed; will wisdom or reflex actions inform the changes?” We recently spoke with Dr. Wilson about his book and his insights into graduate medical education.
a system of supplemental coverage was needed for the full-time staff. Although the number of residents grew rapidly between 1940 and 2000, movement in GME prior to 1985 was largely academic and specialty specific. Curriculum, accreditation and certification, and duration of training were issues for resolution within the house of medicine. Since the mid 1980s, influences outside of medicine, fueled by explosive population growth, technologic innovation, and social concerns, have become dominant players, threatening the foundations of the educational bridge between student and practitioner. Resident education, being less well established and more fragmented than medical student education, has received less attention, which makes a critical look at GME both compelling and timely. What are the major challenges facing graduate medical education today? There are pressing issues in almost every area of GME, including teaching and learning, performance evaluation, professionalism, supervision, research training, funding, and manpower. Each of these issues are explored in the book, with options for their resolution.
What prompted you to write a book on graduate medical education? I thought it was a book that needed to be written. It’s a bit surprising, given the exploCould you give examples of points you sive growth in the field, that no one had writ- Frank C. Wilson, MD make about some of these topics? ten a book on graduate medical education In the area of teaching and learning, we should first reex(GME) before. GME has been around for over 100 years, amine the values underlying the profession. Values shape during which time more than 8,500 residency programs the world; they should hold pride of place in the inteland 127 specialties and subspecialties have been devellectual community and drive the educational enterprise. oped. Having worked through many of the issues in GME Unfortunately, the ethos that determined them in the at one time or another, I thought it would be but a short past has been blurred by contravening trends of the presstep to update and integrate this material. I was wrong; ent. Propelled by the explosive escalation of knowledge much more was needed. and technology, too little attention has been given to the humanistic values that should determine their use. Why is graduate medical education such an important With specialization, the educational pendulum has area of concern? swung toward verticality in learning. To provide the broad GME is the critical link between medical school and pracbase necessary for vertical growth, courses in philosophy, tice. It is the 3- to 7-year period when newly minted MDs literature, history and expository writing, along with law select and acquire the skills to practice a particular branch and public policy, should be imbedded in the premediof medicine. Their choices have major manpower implicacal curriculum to enhance our sense of the world around tions, since they determine the distribution of physicians us and to inculcate the clarity and brevity of expression by specialty. needed to avoid the muddle of medical writing. Quality in education, like quality in research and What can you tell us about the early years of graduate patient care, requires time for reflection, preparation, medical education? assessment, and adjustment in addition to the activGraduate medical education began at Johns Hopkins ity itself. The expansion of clinical effort driven by manHospital in the late 1800s under the aegis of Sir William aged care has reduced the time needed to protect these Osler, MD, CM, and William S. Halstead, MD, who felt that
UNC MEDICAL BULLETIN
expertise to serve others before self. At the heart of this aspects of quality. Quantity, beyond a certain critical obligation is ethics, and at the heart of ethics is the welmass, undermines quality. fare of the patient. Finally, resident education should be expanded from a patient-specific approach to include a systems-based Are we going to be able to produce enough physicians, perspective that includes other disciplines and health especially in areas of need? care professionals, preventive medicine, and broad patProbably not. Manpower, which involves issues of resiterns of health care delivery. dent numbers and their distribution by specialty and Performance evaluation is difficult; it involves more location, is closely related to the funding of GME. In addithan a multiple-choice test. A complex array of knowltion to shrinking physician-to-population ratios and the edge, skills, and attitudes must be assessed; but as Dr. maldistribution of doctors by speciality and geography, David Leach said, “Whatever we measure, we tend to other determinants also complicate manimprove.” By improving assessment, we power needs and projections: gender and improve learning, and by improving learngenerational issues, migration and immiing, we enhance patient care. gration issues, variation in the use, effiTo improve competence evaluation ciency, and cost of medical services, the in medicine, several steps are necessary: role of non-physician providers, and the first, competence must be defined by consurge in demand produced by an aging tent objectives that are expressed in what population. the learner must be able to do upon conWith specialty choices determined clusion of a defined learning experience; largely by issues of income and lifestyle, second, valid and reliable evaluation techfewer medical students choose careers in niques must be devised to measure the primary care. High-tech specialties offer level of achievement. exciting opportunities for cure; but older With respect to the supervision of patients, having chronic conditions, are residents, they must understand that often more in need of care than cure— asking for help or guidance is a sign of for someone to be there to guide them strength rather than weakness; confident through the complex world of health care and secure residents are able to say “I and to manage multiple diseases and don’t know.” And of course when they depression. Despite the fact that most of call, someone must answer. Even when Graduate Medical Education: the problems for which a physician is conthe decisions made by residents are not Issues and Options sulted can be handled by generalists, they critical, the opportunity to discuss their By Frank C. Wilson, MD have become an endangered species. judgements with someone who has more 2009, Radcliffe Press Medical care for the aged drives, and experience and a broader perspective will continue to drive, health care in the US for the foreusually results in more effective patient management, seeable future. By 2020, some 20 percent of Americans as well as a better learning experience than that which will be over 65, and people over 85 constitute the most occurs when such information is offered in a lecture forrapidly expanding segment of the population, for which mat—or not at all. all physicians must be prepared. Professionalism is not just a philosophic ideal, nor can Population trends must be studied, and planning for it be marginalized by the need for efficiency or producanticipated growth closely coordinated with the capactivity. It should be defined according to its characterisity of the US health care system for expansion. Since tic traits, its cognitive base made clear, and opportuniresources are finite and expansion of the physician pool ties provided to gain experience in its application to daily very costly and time consuming, joint planning is essential medical care. to meet short- and long-term needs for medical services. Among the core competencies needed for all physicians, professionalism is perhaps the most critical and among the most difficult to quantify. It is the attribute Graduate Medical Education: Issues and Options is which, possessed in full measure, gives rise to the other available online at amazon.com or radcliffe-oxford.com; or competencies. A professional possesses and maintains a at the Bull’s Head Bookshop on the UNC campus. Wilson unique body of medical knowledge and uses it to provide is a past president of the American Orthopaedic Assoeffective, safe, compassionate and ethical patient care, ciation, the American Board of Orthopaedic Surgery, the including the communication skills necessary to help Association of Orthopaedic Chairmen, and the Thomas patients navigate through complex health care systems. Wolfe Literary Society. He received UNC’s Thomas JefProfessionalism is founded on the pillars of science ferson Award and the Distinguished Clinician-Educator and service, upon possession of a specialized body Award from the American Orthopaedic Association. of knowledge and skills, and the obligation to use that
A surgeon examines the life of a forgotten founding father
ho is the most fascinating founding father forgotten by history? The undisputable answer, for George Sheldon at least, is Hugh Williamson. Sheldon, professor of surgery and social medicine in the UNC School of Medicine, produced a remedy for the historic slight with his recently published biography, “Hugh Williamson: Physician, Patriot and Founding Father.” How Sheldon found out about Williamson—and ended up spending a decade to research and write the book—is a story of unfolding serendipity that dates back to Sheldon’s undergraduate years at the University of Kansas more than a half-century ago. It began at the end of his first year when he received the highest test score for a course in Western Civilization that all students in the liberal arts had to pass before they could graduate. The next fall, Kansas made the decision to make the course a requirement, which created an immediate shortage of instructors available to teach it. That led administrators to hire Sheldon, then a sophomore, as an “assistant instructor” to teach eight classes. That same year he served as student body president while taking a full load of pre-med courses. His experience teaching history not only paid his way through college, but it also led to an offer during his first year of medical school to work with medical historian L.R.C. Agnew to explore the life of Philip Syng Physick, considered “the father of American surgery.” The article the two men co-authored, which appeared in June 1960 in The Journal of Medical Education, remains the authoritative source of information on Physick cited in the Dictionary of American Biography. Physician turned historian Sheldon’s work as a medical historian—and his path to Williamson—might well have ended that summer. After graduating from the University of Kansas School of Medicine, Sheldon’s career as a surgeon took off, first as a fellow in internal medicine at the Mayo Clinic, then as a resident in surgery at the University of California-San Francisco (UCSF), followed by a fellowship in surgical biology at Harvard Medical School. He returned to UCSF to serve as professor of surgery and chief of the trauma service before coming to Chapel Hill in 1984 to serve as chair of the Department of Surgery, a position he held for the next 17 years. Over the course of his illustrious career, Sheldon served as president of all major surgical organizations. It
was in this capacity that he managed to keep his interest in medical history alive, Sheldon said. As he was called upon to deliver major lectures at annual meetings, he used them as an opportunity to research topics he wanted to know more about. Sheldon’s earlier scholarly work on the life of Physick led to a lifelong fascination with John Hunter, a leading biologist and surgeon of the 18th century whose anatomical school in London became a destination point, not only for Physick but for many other aspiring doctors from the colonies. Hunter kept a register of all the students who worked with him, and for one of his lectures, Sheldon decided to travel to Philadelphia to search the archives and trace the life of each student upon his return to America. As Sheldon gathered his material, Hugh Williamson was first just another name on the list. Then it became the one name he could not check off, primarily because the rich trail of information about Williamson abruptly ended at the start of the Revolutionary War—almost as if Williamson had fallen off a cliff. Two weeks before Sheldon’s lecture, in a random visit to Davis Library, he stumbled upon a lithograph of Williamson that showed the man had ended up in North Carolina during the war. That discovery led to another mystery Sheldon felt compelled to reveal: Why? A patriot accused Williamson helped plan, and even witnessed, the Boston Tea Party. Immediately afterward, John Hancock—the wealthy ship owner and statesman from Massachusetts— put Williamson on one of his fastest ships to report news of the event to King George III and the Privy Court. Williamson stayed in London to spy for Benjamin Franklin, with whom he corresponded regularly. Over the course of their long lives, Williamson’s relationship with Franklin endured its ups and downs, Sheldon said. In a 1764 pamphlet, “What Is Sauce for a Goose Is Also Sauce for a Gander,” Williamson indirectly accused Franklin of abetting passage of the Stamp Act. Franklin responded by calling Williamson “one of the most detestable skunks in human history.” Four years later, though, Williamson was elected to membership in the American Philosophical Society, which Franklin founded. In 1774, Williamson co-wrote with Franklin and Hunter a paper on the electric eel that was presented to the Royal Society of London, a learned society for science founded
UNC MEDICAL BULLETIN
in 1660 by King Charles II. Just two years later, Franklin endorsed the false charge that Williamson was a British spy. The charge, leveled in a letter by Silas Deane, the first official envoy to France from the Continental Congress, was made as Williamson returned to the colonies that October. Off the Delaware coast, Williamson’s ship was captured by the British. Williamson managed to escape by rowboat and make his way to the Continental Congress where he applied for, but was denied, a military commission because of the charge that he was a spy. Under this cloud of suspicion, Williamson left for Charleston, SC, to join his brother in the George Sheldon, MD, professor of surgery and social medicine in the School of Medicine, business of shipbuilding and and his recently published biography, “Hugh Williamson: Physician, Patriot and Founding commercial trading. Father.” Photo by Dan Sears. Williamson planned to center his commercial operations Carolina in the first session of the US House of Reprein Philadelphia, but a British blockade in the Chesapeake sentatives, then moved to New York City after his term Bay forced him to dock his ship in the port of Edenton off expired. the North Carolina coast. Throughout his life, Williamson held faculty positions For whatever reason, Sheldon said, Williamson stayed at what became the University of Pennsylvania, the Uniin the Tar Heel state—and remained loyal to the cause of versity of Delaware, Princeton University and Columbia independence. In a 1778 letter, Williamson chafed at the University. On Feb. 6, 1795, when the bylaws of the Uniquestion of his loyalty: “There was not in America a man versity of North Carolina were adopted, he took on a new who served it more faithfully or disinterestedly.” role by serving as the first secretary of the Board of Trustees, a position he held until 1798. In service to country and state Like many of his contemporaries, Williamson was That service to country found deep and multifaceted many things: physician, surgeon, scientist, rebel, statesexpression in Williamson’s adopted home of North Caroman and accused spy. lina from 1777 to 1793, Sheldon said. Thanks to Sheldon’s diligent labors, UNC President In 1779, a year after affirming his loyalty to the coloEmeritus William Friday wrote in the foreword to the nies by signing the Book of Allegiance in Edenton, Wilbook, those works can no longer be so easily forgotten. liamson was appointed surgeon general of the North Car“Williamson came by his role as patriot out of service olina Revolutionary War militia. As an army surgeon, he as a university professor; a scholar of medicine and scirecommended inoculation against smallpox for civilians ence; colleague of Jefferson, Washington, Madison and and military troops before they entered active service. Franklin; and a molder of government in North Carolina in In 1782, Williamson returned to Edenton and was the late eighteenth century. elected to the NC House of Commons. In 1787, the gov“George Sheldon’s scholarly work clearly established ernor appointed Williamson to serve as a delegate to the the vital relationship Hugh Williamson had to the emerConstitutional Convention. And on Sept. 17, 1787, he was gence of the fledgling democracy in the New World. In one of the 39 delegates (out of the 55 delegates in attenNorth Carolina, he stands with William R. Davie and othdance) who signed the United States Constitution in the ers who gave this state its very proud role of builder of a city where a decade earlier he had been accused of being new nation of free people.” a Tory spy. Williamson was also a member of the Fayetteville Convention where North Carolina ratified the US ConstiThis story originally appeared in the April 28, 2010 issue of tution and became a state. He later represented North the University Gazette. Reprinted with permission.
Distinguished professorship created in honor of Edward Norfleet To honor the service of Dr. Edward A. Norfleet (MD ’70) to Carolina and to the Department of Anesthesiology, the Medical Foundation of North Carolina has established the Edward A. Norfleet, MD ’70 Distinguished Professorship in Anesthesiology. The Foundation aims to raise $1 million, which will be matched by $500,000 from the state of North Carolina to create an endowment of $1.5 million. The Norfleet Professorship will provide financial support for a nationally recognized physician-scholar who will continue Dr. Norfleet’s commitment to education. “We are already approaching $638,000 so far in gifts toward our $1 million goal, which reflects the enormous positive influence Dr. Norfleet has had on so many people,” says Jane McNeer, vice president of the Medical Foundation. Since 1973, Norfleet has dedicated his professional career to the Department of Anesthesiology at UNC. During that time,
Memorial fund established for Patricia Gregory On Sunday, June 13, 2010, surrounded by family, Patricia Gregory, MD, passed away at UNC Hospitals. She was an assistant professor of physical medicine and rehabilitation at UNC. She is survived by her husband, Ray Lynch, and their three children: Alexandra, Gabriel and Elizabeth; her father, Lt. Col. Spruell Gregory, US Army (Ret.); sister, Deborah Richards, RN; brother, Milan Gregory, Esq.; and nephews Gregory and Michael Richards. “Dr. Gregory was an outstanding physician-scientist, and a national leader working to reduce health disparities,” says Michael Y. Lee, MD, MHA, chair of UNC PM&R. “She was one of a limited number of physiatrists engaging in health services research, and was finishing a Master of Public Health to promote interdisciplinary research. Her passing is a loss to multiple fields of study working to improve access to care.” Gregory’s sub-specialties included stroke rehabilitation, geriatric rehabilitation, adult telemedicine and rehabilitation research, which she also mentored to PM&R residents and others. Memorial contributions may be made to The Medical Foundation of NC, Inc., 880 Martin Luther King, Jr. Blvd., Chapel Hill, NC, 27514. Please note on the check that it is “In memory of Patricia Gregory, MD in PM&R.”
he has educated and inspired hundreds of medical students, residents, CRNAs and other professionals. “Dr. Norfleet exemplifies the physician-scholar,” says UNC School of Medicine Dean and CEO of UNC Health Care Dr. Bill Roper. “His love of and dedication to UNC Anesthesiology is clear to all who talk with him. His enthusiasm in seeing young men and women mature into capable clinicians has set the tone in the department that will last for many generations to come.” David Zvara, MD, professor and chair of UNC’s Department of Anesthesiology, says “The professorship is pivotal to the life of the program, the trainees, and also the citizens of North Carolina. It will continue Dr. Norfleet’s vision of quality anesthesiology education for the students so that they may provide anesthesiology services to their future patients in the safest manner possible.” A distinguished alumnus of the UNC School of Medicine, Norfleet began his career at UNC as a scrub nurse at age 18 and joined the faculty at UNC as an instructor in 1973. He has received many honors over the course of his illustrious career. In 1989, he became only the third recipient of UNC Hospitals’ H. Fleming Fuller Award, which honors members of the medical staff who demonstrate “the highest standards of patient care, teaching and community service.” Other awards include the Medical Alumni Association’s Distinguished Faculty Award (1999) and the Norma Berryhill Distinguished Lectureship (2001). Dr. Norfleet is currently battling a serious illness. Anyone interested in honoring Dr. Norfleet and his tremendous career is encouraged to make a gift or pledge to The Edward A. Norfleet, MD ’70 Distinguished Professorship in Anesthesiology. For more information, please contact Jane McNeer at (919) 966-3946 or Greg Duyck at (919) 966-6745, or visit www.med.unc.edu/medfoundation.
Couple honored with volunteer award from UNC Lineberger Jean and Woody Durham of Chapel Hill received the 2010 Outstanding Service Award from the UNC Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. The Durhams were honored during the spring meeting of the Lineberger Board of Visitors. The award is given to a volunteer who provides dedicated service and outstanding leadership to UNC Lineberger. They are the 25th recipients to be recognized since the award was established in 1988. Jean Durham was cited for her strong volunteer leadership as chair for three years of Tickled Pink, one of UNC Lineberger’s signature fundraising events, by center director Shelley Earp, MD. Earp says, “The Tickled Pink events attract more than 600 people each year, and organizing the volunteers, decorating the venues, and staging the events require countless hours. Jean’s steady leadership has made these events shine,
UNC MEDICAL BULLETIN
attracting more participants and increasing the amount raised in support of our patients and families.” Woody Durham was cited for his tireless work with Fast Break with Roy Williams, another signature annual fundraising event. Earp explains, “Fast Break with Roy Williams is a hugely popular event. People get up early for this event, often driving some distance to attend, and Woody’s familiar, mellifluous voice as he emcees the event, makes for a fast-paced, fun morning. Woody has been involved with Fast Break from the beginning when it started five years ago. Without question his
skills as an auctioneer increase the amount raised by this event that supports UNC Lineberger treatment programs.” Earp says, “We are indeed fortunate to have two such stellar volunteers married to each other who share a commitment to improving the lives of those diagnosed with cancer and to eradicating this disease by supporting research into cancer’s causes. We thank these two wonderful volunteers.”
Steelman estate creates professorship, student endowments Thanks to the generosity of the late Sanford L. Steelman, Sr., three new endowments have been established at the Medical
railyards of Asheville, NC—strenuous, low-paying work that was usually only reserved for local American Indian men. It was here
Foundation of North Carolina for the UNC School of Medicine. that the young Steelman became aware of the plight of AmeriThrough his estate, Steelman provided funds to create the can Indians, a learning experience he would not forget. After Sanford Steelman Distinguished graduating from Lenoir-Rhyne Professorship in Pharmacology, College, Steelman entered the the Sanford Steelman Graduate UNC School of Medicine, where Student Fund in Pharmacology, he earned a doctorate in bioand the Sanford Steelman Gradchemistry and physiology in uate Student Fund in Cell and 1949. Molecular Physiology. Steelman Following his graduation, he also provided funds to create the joined Armour Pharmaceutical Sanford Steelman Graduate StuCompany and earned distinction dent Fund in Chemistry for the as a biomedical research scienUNC Department of Chemistry. tist. Two years later, he assumed Steelman bequeathed leadership of the biochemistry $100,000 for each graduate department. In 1956, he became student fund and $333,000 for associate professor of biochemthe distinguished professorship. istry at Baylor College of MediThe professorship qualifies for a cine in Houston. From there, state match of $167,000 from the From left: Dr. Matt Redinbo, Department of Chemistry; The Steelman joined Merck Research State of North Carolina’s Distin- Honorable Sanford Steelman, Jr.; Brian Steelman; Dr. Carol Labs and worked in various leadguished Professors Endowment Otey, Department of Cell and Molecular Physiology; Dr. Gary ership capacities, including servTrust Fund. ing as director of international Johnson, Department of Pharmacology. “We are very grateful to the clinical pharmacology. He wrote Steelman family,” says Dr. Gary Johnson, chair of the UNC Demore than 100 articles in scientific publications and obtained partment of Pharmacology. “For a basic science department five patents. He retired as senior scientific investigator from like ours, this endowment is key to helping us compete for the Merck & Co. Inc. very best pharmacology students. Likewise, the professorship In 1988, Steelman was recognized by an international comgives us an edge in recruiting and retaining top faculty.” mittee as one of 200 people, living or dead, who had made a The graduate student funds will be used to support stumajor contribution to reproductive and endocrine medicine. He dents with demonstrated financial need, as well as academshares this honor with more than a dozen Nobel Prize winners. ic merit. It was Steelman’s wish that preference be “given to He passed away on November 1, 2008. students born in the State of North Carolina, or to American “These graduate students are our future leaders. We hope Indians.” that what they accomplish will make what came before them Carol Otey, associate chair of the Department of Cell and look small in comparison,” says Steelman’s son Sanford, Jr. Molecular Physiology, says “There are very few American IndiAbout the professorship, Steelman’s son Brian says, “My father ans or underrepresented minorities in the basic sciences. This always felt it was important to expose students to great minds, opens a lot of doors for them.” to inspire them to do great things themselves.” Steelman, a native of Hickory, NC, had a strong work ethic. When his family ran into hard times in the early 1940s, Steelman, then only a teenager, went to work loading boxcars in the
Study: Specific PTSD symptoms related to anger and aggressiveness among Iraq/Afghanistan veterans Focusing on certain PTSD symptoms may be key to treating anger among Iraq/Afghanistan veterans, according to a study led by UNC and Veterans Affairs researchers. “Most returning veterans don’t have PTSD or difficulty with anger or aggressiveness, but for the small subset who do, this study helps to identify related risk factors,” said Eric Elbogen, PhD, lead author of the study, an assistant professor of psychiatry in the UNC School of Medicine and a staff psychologist at the VA Medical Center in Durham, NC. “The data showed that PTSD symptoms such as flashbacks or avoiding reminders of a trauma were not consistently connected to aggressiveness,” said Elbogen. “Instead, we found that post-deployment anger and hostility were associated with PTSD hyperarousal symptoms: sleep problems, being ‘on guard,’ jumpiness, irritability, and difficulty concentrating.” From interviews with 676 veterans, Elbogen and his VA colleagues identified features associated with anger and hostility, which result in increased risk of post-deployment adjustment problems as veterans transition back to civilian life. Veterans who said they had difficulty controlling violent behavior were more likely to report witnessing pre-military family violence, firing a weapon during deployment, being deployed more than one year, and experiencing current hyperarousal symptoms. There was an association with a history of traumatic brain injury, but it was not as robust as the relationship to hyperarousal symptoms. “Our data suggest the effects of traumatic brain injury on anger and hostility are not straightforward,” Elbogen said. Veterans with aggressive urges were more likely than others to report hyperarousal symptoms, childhood abuse, a family history of mental illness, and reliving a traumatic event. Difficulty managing anger was associated with being married, having a parent with a criminal history, and avoiding reminders of the trauma, as well as hyperarousal symptoms. “As we learn more about risk factors and how to manage them, we’ll be helping not only the veterans but their families and society at large. Veterans with these adjustment problems should seek help through the VA so we can best serve those who have served our country,” Elbogen said. The study appeared in June in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association. Funding for this study was provided by the Department of Veterans Affairs, UNC, and the National Institute of Mental Health. Research provides new insights into deadly brain cancer New findings by researchers at UNC Lineberger Comprehensive Cancer Center suggest that the most common form of malignant brain cancer in adults, glioblastoma multiforme (GBM), is
probably not a single disease but a set of diseases, each with a distinct underlying molecular disease process. The study, published by Cell Press in the January issue of the journal Cancer Cell, provides a solid framework for investigation of future targeted therapies that may improve the near uniformly fatal prognosis of this devastating cancer. “Previous work has established that gene expression profiling can be used to identify distinct subgroups of GBM,” says senior study author, Dr. D. Neil Hayes from the Division of Hematology/Oncology at UNC. “However, the exact number and clinical significance of these was unclear.” Dr. Hayes and colleagues at UNC Lineberger expanded on previous GBM classification studies and used expression profiling techniques to comprehensively analyze hundreds of GBM patient samples. The group was able to reliably identify four distinct molecular subtypes of GBM tumors. The researchers then went on to perform a unique integrative analyses across multiple platforms to look for defining characteristics associated with each subtype. Their findings were quite striking, implying that there are distinct types of GBM and that each one is associated with a specific molecular process. “We discovered a bundle of events that unequivocally occur almost exclusively within a subtype,” explains Dr. Hayes. The researchers also report that the nature of these events indicate that the underlying disease process for each subtype may involve distinct cells of origin at a specific stage of differentiation. This is finding has potential clinical significance as determining the cells of origin of GBM is critical for establishing effective treatment regimens. Clearly, given this new information, it makes sense that some drug classes would be expected to work for some tumor subtypes and not other. In support of this conclusion, Dr. Hayes’s group found that response to aggressive chemotherapy and radiation differed by subtype. Taken together, the findings represent an important step towards more rational therapies for GBM. “It appears that the simple classification into these four subtypes carries a rich set of associations for which there is no existing diagnostic test,” says Dr. Hayes. “This comprehensive genomic and geneticbased classification of GBM should lay the groundwork from an improved molecular understanding of GBM pathway signaling that could ultimately result in personalized therapies for groups of patients with GBM.” Significant work on this project was shared by Dr. Roel Verhaak of the Broad Institute of MIT and Harvard in Boston and Dr. Katie Hoadley of UNC Lineberger and the Department of Genetics at UNC. Other UNC Lineberger team members include postdoctoral fellow Matthew Wilkerson, Dr. Ryan Miller, and Dr. Charles M. Perou. Other collaborating institutions include the Dana-Farber Cancer Institute in Boston, MA; The Genome Center at Washington University School of Medicine in St. Louis; MO, the Lawrence Berkeley National Laboratory in
UNC MEDICAL BULLETIN
Antiretrovirals effective in preventing HIV transmission The largest study to date to examine methods to prevent After their babies were born, women in the maternal antiHIV infection among breastfeeding infants concludes that givretroviral group received a single tablet twice a day containing antiretroviral drugs to HIV-infected breastfeeding mothers ing the drugs zidovudine and lamivudine. They also received a in sub-Saharan Africa or giving an HIV-fighting syrup to their dose of nevirapine by mouth once a day for 14 days and then babies are both effective. twice daily from 2 to 28 weeks. “Our study found that both methods are effective in preIn the infant prophylaxis group, each infant received a venting HIV transmission, but given dose of liquid nevirapine by mouth a choice between the two, I’d say that increased with age, ranging that the baby regimen is the more from 1 milliliter a day in the first two successful method,” said Charles weeks to 3 milliliters a day for weeks Chasela, PhD, coordinator and lead 19 through 28. Study personnel author of the study, which was pubmeasured these doses into syringes lished in the June 17, 2010 issue of the which were given to the mothers, New England Journal of Medicine. who then squirted the contents into “The antiretroviral regimen for their infants’ mouths. treating the mothers is much more Mothers in the study were asked expensive and requires access to to wean their babies from breastmedical facilities that aren’t widely feeding by 28 weeks after birth and available in developing countries the study results were calculated such as Malawi, where our study Clockwise from top left: Charles Chasela, PhD, nurse after each participant in the treatwas conducted,” added Charles van Bertha Chisale, Charles van der Horst, MD (holding a ment arms had completed 28 weeks der Horst, MD, a professor of infec- BAN study baby), and the baby’s mother, at Kawale of treatment. The results showed tious diseases in the UNC School of clinic in Lilongwe, Malawi. that infant nevirapine was 74 percent Medicine and senior author of the effective in preventing HIV transmisstudy. “The baby regimen, in comparison, is incredibly cheap sion while maternal antiretroviral therapy was 53 percent effecand much easier to implement.” tive. In addition, the study found that infants had significantly These findings are important, van der Horst said, because increased HIV-free survival no matter which intervention was each year about 200,000 infants worldwide become infected used. with HIV through breastfeeding, and in the developing world Based in part on these results, the World Health infant formula is both prohibitively expensive and associated Organization (WHO) has recommended that HIV prevention with increased infant deaths. guidelines for breastfeeding HIV-infected mothers, who were In the study, called the Breastfeeding, Antiretrovirals and still in the early stages of HIV infection, be modified to offer Nutrition Study (BAN), 2,369 breastfeeding mother-infant pairs them the choice of either dosing their uninfected infant with in Lilongwe, Malawi, were randomly assigned to one of three nevirapine syrup during breastfeeding or taking a triple drug groups: a maternal antiretroviral therapy (ART) group, a secregimen themselves. ond group in which infants were treated with nevirapine liqThe study was conducted as part of UNC Project-Malawi, uid and a control group for whom medications were given at a program of the UNC Institute for Global Health & Infectious the time of delivery only. None of these women had developed Diseases that was established in 1996, and was funded by the AIDS yet and thus did not need treatment for their own health. US Centers for Disease Control and Prevention.
Berkeley, CA; the University of California, San Francisco; Mayo Clinic, Rochester, MN; SRA International, Fairfax, VA; and the Walter and Eliza Hall Institute, Victoria, Australia. UNC physicians lead new radiation treatment guidelines The culmination of a two-year effort to review available studies and establish new guidelines for the safe treatment of cancer with radiation therapy was published earlier this year in the International Journal of Radiation Oncology, Biology and Physics. Several UNC radiation oncology faculty members participated in the process establishing the new Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines.
These guidelines replace standards established almost 20 years ago, before the widespread use of 3-D imaging technology that allows the more precise targeting of radiation to cancerous lesions. “The new standards have resulted from a systematic review of radiation therapy dose/volume/outcome data on 16 organs. The new data was made possible by the more general use of 3-D imaging during radiation planning. These new standards provide a logical framework to assess the risks of complex 3-D doses that we now routinely consider,” said Lawrence B. Marks, MD, chair of the Department of Radiation Oncology and coeditor of the QUANTEC study. Noting the overall trend in the US toward improved practice
through evidence-based medicine, Marks adds, “Our goal is to make the practice of radiation oncology more standardized and efficient, less open to interpretation and ultimately as safe and effective as it can be, using state-of-the-art technology to treat cancer.” Teams of physicians, physicists and statisticians/modelers reviewed the available literature for each organ to compile general dose/volume/outcome data, and make recommendations on regarding the selection of dose/volume prescriptions. “We are pleased that UNC physician-investigators played pivotal roles in this important analysis, which establishes new standards for this vital cancer treatment technology,” said Richard M. Goldberg, MD, physician-in-chief of the NC Cancer Hospital. “It is a privilege to treat patients with these outstanding experts on our multidisciplinary teams.” David Morris, MD, clinical associate professor of radiation oncology and member of the UNC Lineberger Comprehensive Cancer Center, was part of the American Society for Radiation Oncology’s Health Services Research Committee, which originally recommended a review of the standards in light of new research and clinical experience. He helped to jump-start and obtain funding for the effort. Marks, who is also a member of UNC Lineberger, served as a co-editor and provided oversight to the entire project in addition to leading the group that established guidelines for radiation therapy to the lung. Abused children more likely to suffer unexplained illness Children who have been abused psychologically, physically or sexually are more likely to suffer unexplained abdominal pain and nausea or vomiting than children who have not been abused, a study led by UNC researchers concludes. “Therefore, when young patients complain about unexplained gastrointestinal symptoms, their doctors should ask questions to determine if they might have been abused,” said Miranda van Tilburg, PhD, lead author of the study, an assistant professor of gastroenterology and hepatology in the UNC School of Medicine and a member of UNC’s Center for Functional GI & Motility Disorders. The study is published in the March/April 2010 issue of Annals of Family Medicine. In the study, van Tilburg and her co-authors analyzed data that was obtained as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Their analysis included 845 children ages 4 through 12 years. Every two years, they collected information about the childrens’ gastrointestinal symptoms from their parents and maltreatment allegations concerning these children from child protective services agencies. Then the children, at age 12, gave
their own reports of GI symptoms, lifetime maltreatment and psychological distress. A statistical method called logistic regression was used to analyze the data. The results showed that among children in the study, sexual abuse preceded or coincided with abdominal pain in 91 percent of cases. In addition, in children who said they recalled ever being abused physically, psychologically or sexually, there was a statistically significant association between abuse and both abdominal pain and nausea/vomiting. An additional analysis aimed at separating the effect of psychological distress alone from physical or sexual abuse showed that most effects dropped below the level of statistical significance, except for the relationship between physical abuse and nausea/vomiting. This is consistent with other results reported in the medical literature, van Tilburg said, but psychological distress was only partly responsible for weakening the relation between physical abuse and nausea. Other factors, such as permanent changes in the nervous system due to injury associated with physical abuse, must play a role as well, she said. In addition to van Tilburg, UNC co-authors of the study are Desmond K. Runyan, MD, DrPH; Adam J. Zolotor, MD, MPH; Denesh K. Chitkara, MD; and William E. Whitehead, PhD. Co-authors from outside UNC include J. Christopher Graham, PhD (University of Washington); Howard Dubowitz, MD, MS (University of Maryland); Alan J. Litrownik, PhD (San Diego State University); and Emalee Flaherty, MD (Northwestern University Feinberg School of Medicine). Most dialysis patients not prepared for emergency evacuation A survey of kidney dialysis patients by UNC School of Medicine researchers finds that most have not taken the emergency preparedness measures that would enable them to survive a hurricane or any other disaster that disrupts power and water services. Immediately after Hurricane Katrina in August 2005, the survival of more than 5,800 Gulf Coast kidney dialysis patients was threatened as the storm forced closure of 94 dialysis units. Within a month 148 of these patients had died. Now nearly five years later, a survey of North Carolina kidney dialysis patients by UNC School of Medicine researchers finds that most have not taken the emergency preparedness measures that would enable them to survive a hurricane or any other disaster that disrupts power and water services. North Carolina ranks fourth among the states in hurricane landfalls, behind Florida, Texas and Louisiana. “End stage kidney disease patients are dependent on medical treatment at regular intervals for their ongoing health, and, as such, are particularly vulnerable to the effects of a disaster. We found that patients on dialysis are largely unprepared for such an event, whether they are forced to stay in their homes or evacuate,” said Mark Foster, lead author of the study. Foster, a UNC medical student, presented the results June 3 at the annual meeting of the Society for Academic Emergency Medicine in Phoenix. His mentor in the project was Jane Brice, MD, MPH, associate professor of emergency medicine and
UNC MEDICAL BULLETIN
medical director of Orange County EMS. Dialysis is a treatment for kidney failure. Dialysis filters the blood of harmful wastes, extra salt and water. Patients who need dialysis typically must go around 3 times a week to a dialysis facility that is equipped with dialysis machines and staffed by medical professionals. Dialysis machines require both electricity and sterile water, both of which may be unavailable for several days or even weeks in disaster-impacted areas. If dialysis cannot be provided for an end stage kidney disease patient, then toxic molecules and electrolytes will accumulate that can lead to a number of serious health problems, including death. In the survey, 311 dialysis patients receiving treatment at six regional dialysis centers in central North Carolina answered questions about their demographics, general disaster preparedness, dialysis-specific preparations for “sheltering in place” at home, and preparations for a forced evacuation. Both the general disaster preparedness and dialysis-specific preparedness of most respondents was poor, regardless of their sex, race, age, income or level of education. With regard to general disaster preparedness, 58 percent said they had enough bottled water at home to last for three days while 54 percent said they had enough food and water for three days. Forty-eight percent said they had 75 percent of the items on a disaster preparedness checklist recommended by the Department of Homeland Security while 38 percent said they had both food and water for three days and 75 percent of the checklist items. Only 31 percent said they had collected all of these items into a disaster preparation bag or kit, as this checklist recommends. In terms of dialysis-specific preparations, despite annual disaster preparedness education provided by the dialysis facilities, only 57 percent of patients understood what they needed to do for a renal emergency diet and only 6 percent had kayexalate, a drug used to treat increased amounts of potassium in the body, at home. Forty-three percent knew of other dialysis centers where they could get treatment if their current center was out of service and 42 percent said they had sufficient medical records at home with treatment information that they could provide to a new center. The study concludes that most survey respondents were unprepared for a potential disaster and therefore more efforts to address preparedness education techniques are warranted. The study authors note that the unpreparedness found in their study is in all likelihood not unique to North Carolina and is thought to be similar to the level of preparedness found among dialysis patients across the country. In addition to Foster and Brice, authors of the study were Maria Ferris, MD, MPH, PhD, director of UNC Health Care’s pediatric renal dialysis program; Stephanie Principe, an undergraduate student at Davidson University; Frances Shofer, PhD, director of research in the Department of Emergency Medicine; and Ronald J. Falk, MD, division chief of nephrology and hypertension and director of the UNC Kidney Center.
23 The study was funded by a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Disaster preparedness tips for people with chronic kidney disease are available at www.kidney.org/help/ and www.kidney.org/atoz/pdf/DisasterBrochure.pdf. Study pinpoints new role of molecule in the health of body’s back-up blood circulation When the arteries delivering oxygen to our vital organs are obstructed by atherosclerosis or clots, the result is almost always a stroke, heart attack or damage to a peripheral tissue such as the legs (peripheral artery disease). But the severity of tissue injury or destruction from a choked-off blood supply varies from person to person, and may depend in large part on whose circulatory system has the best backup plan to provide alternate routes of circulation. This “back-up system”—called the collateral circulation— involves a small number of tiny specialized blood vessels, called collaterals, that can enlarge their diameters enough to carry significant flow and thus bypass a blockage. Researchers at the UNC School of Medicine have now discovered that the abundance of these vessels in a healthy individual and their growth or remodeling into “natural bypass vessels” depends on how much of a key signaling molecule—called nitric oxide—is present. The study, conducted in animal models, suggests that nitric oxide not only is critical in maintaining the number of collateral vessels while individuals are healthy. It also is key in the amount of collateral vessel remodeling that occurs when obstructive disease strikes. The research findings were published in the journal Circulation Research on June 25th. They could one day enable researchers to predict people’s risk for catastrophic stroke, myocardial infarction, or peripheral artery disease. Such knowledge could inform individuals with poor collateral capacity to adopt a lifestyle that can help reduce their chances of getting diseases that could further lower their number of collateral vessels. “If you’ve got a good number of these natural bypass vessels, you have something of an ‘insurance policy’ that favors you suffering less severe consequences if you get atherosclerosis or thrombotic disease” said senior study author James E. Faber, PhD, professor of cell and molecular physiology at UNC. “And if you were born with very few, the last thing you would want to do is subject yourself to environmental factors that might further cut down the number of these vessels.” Faber also is a member of the McAllister Heart Institute at UNC. Earlier this year, his team reported that these vessels form early in life and that genetic background has a major impact on how many you end up with. The factors that put people at risk for developing stroke,
heart attack, or peripheral artery disease include the usual suspects—smoking, diabetes, hypertension, high cholesterol, family history, age. Until recently, researchers didn’t know what linked those risk factors together, when it comes to insufficiency of the collateral circulation. Faber says studies have shown that all of these factors cause the endothelial cells that line blood vessels to produce less nitric oxide, a “wonder molecule” that protects vasculature from disease. Now, he says, his group’s findings indicate that this molecule is also critical to maintaining the health of the collateral circulation. So Faber and lead study author Xuming Dai, MD, PhD, of UNC’s departments of medicine and physiology, wondered whether collateral vessels would be lost if the levels of nitric oxide were suppressed. They counted the number of these vessels in the brains of mice genetically engineered to lack the enzyme—called eNOS—that makes most of the nitric oxide in blood vessel walls. Researchers found that from the ages of three months to six months (equivalent to about 21 to 45 years of age in humans) there was a 25-percent reduction in collateral vessels in the mutant mice compared to normal ones. They also saw the same decrease in vessels supplying the legs, where they were trying to model peripheral artery disease. Next, the investigators wanted to know if a lack of nitric oxide would affect the way that existing collaterals respond to an obstruction in a main artery. By blocking an artery in the legs of these genetically engineered mice, Faber and Dai were able to reroute circulation through the collateral vessels. Over a period of 2-3 weeks, the flow of detoured blood usually causes the little collaterals to enlarge their diameters by 3- to 4-fold through a process called collateral remodeling. But the researchers found that such remodeling was impaired in the mutant mice that produced less nitric oxide when compared to their normal counterparts. In the first such experiment of its kind, Dai then succeeded in surgically removing these tiny collaterals from the mice and scanned their entire genomes for differences between the mutant and normal rodents that might explain this variation in remodeling. “The only category of genes that was dramatically different between the two was the cell cycle control genes, genes that are involved in the proliferation of cells in the vascular wall—a process that’s required for collaterals to remodel,” said Dai, a clinical cardiology fellow receiving basic science training in Faber’s laboratory. “This is an important function of eNOS that had not been discovered before.” “If we can figure out how these unique vessels are made and maintained in healthy tissues, we hope we can then uncover how to induce them to be made with treatments in patients who don’t have enough,” Faber said. The UNC research was funded by the National Heart, Lung and Blood Institute of the NIH.
Control of cell movement with light accomplished in living organisms A precise understanding of cellular growth and movement is the key to developing new treatments for cancer and other disorders caused by dysfunctional cell behavior. Recent breakthroughs in genetic medicine have uncovered how genes control whether cellular proteins are turned ‘on’ or ‘off’ at the molecular level, but much remains to be understood about how protein signaling influences cell behavior. A technique developed in the laboratory of Klaus Hahn, PhD, the Thurman Professor of Pharmacology at UNC and a member of UNC Lineberger Comprehensive Cancer Center, uses light to manipulate the activity of a protein at precise times and places within a living cell, providing a new tool for scientists who study the fundamentals of protein function. In a paper published recently in the journal Nature Cell Biology, a team led by Denise Montell, PhD, of Johns Hopkins School of Medicine, describes how researchers used the technique, which controls protein behavior in cells and animals simply by shining a focused beam of light on the cells where they want the protein to be active, in live fruit flies. “This finding complements an additional collaboration with Anna Huttenlocher, PhD of the University of WisconsinMadison, published earlier this year in the journal Developmental Cell, showing that this technique could be used to control cell movement in live zebrafish as well,” said Hahn. “We have now shown that this technique works in two different living organisms, providing proof of principle that light can be used to activate a key protein. In this case the protein controls cell movement, enabling us to move cells about in animals. This is particularly valuable in studies where cell movement is the focus of the research, including embryonic development, nerve regeneration and cancer metastasis. Now researchers can control where and where particular proteins are activated in animals, providing a heretofore inaccessible level of control,” said Hahn. The new technology is an advance over previous lightdirected methods of cellular control that used toxic wavelengths of light, disrupted the cell membrane or could switch proteins ‘on’ but not ‘off.’ Unlike some approaches it requires no injection of cofactors or other unnatural materials into the animals being studied. The research was the work of a team including Montell, and Xiaobo Wang from Johns Hopkins and Hahn and Yi Wu, PhD, research assistant professor of pharmacology, both from UNC. This research was supported by the National Institutes of Health and the Cell Migration Consortium. Large study helps clarify the genetics of autism A large international consortium of researchers, including scientists at UNC, have announced new discoveries that could help clarify the genetics of autism.
UNC MEDICAL BULLETIN
Their findings published online June 9 in the journal Nature, support an emerging consensus among scientists that autism is caused by many “rare variants” or genetic changes found in less than one percent of the population. While each of these variants may only account for a small fraction of autism cases, collectively they appear to account for a greater percentage of individuals within the autism community. They are also providing into possible mechanisms involved in the disease. The Autism Genome Project collected genotyping data from 1,000 individuals with autism spectrum disorder, or ASD, and 1,300 without ASD. They found that people with the disorder tend to carry submicroscopic insertions and deletions called copy number variants, or CNVs, in their genome. Some of these variants appear to be inherited, while others are considered new because they are found only in affected offspring and not their parents. These CNV in individuals with ASD tend to disrupt genes previously reported to be associated with autism or intellectual disabilities. The study also identified new genetic risk factors for autism (genes known scientifically as SHANK2, SYNGAP1, DLGAP2 and the X-linked DDX53–PTCHD1 locus). Some of these genes belong to nerve synapse-related pathways, while others are involved in cell proliferation, cellular movement, and intracellular signaling—functional targets that may lead to the development of new treatment approaches. “These findings provide further evidence that autistic behavior is the result of many rare, small genetic changes,” said Joseph Piven, MD, study co-author and a lead AGP consortium investigator. Piven is also Sarah Graham Kenan Professor of Psychiatry at UNC and director of the Carolina Institute for Developmental Disabilities. “While genetic abnormality or relevant CNV identified appears to account for only a handful of affected individuals, taken together these various CNVs in different locations throughout the genome are beginning to account for a significant number of occurrences of autism in the population. Identifying the genes and biological pathways associated with these genes will eventually lead us to new treatments for autism based an understanding of the underlying biological causes.” Geraldine Dawson, PhD, research professor of psychiatry at UNC, also coauthored the new study. The AGP consists of 120 scientists from more than 60 institutions representing 11 countries who formed this first-of-its-kind autism genetics consortium. Since 2002, the AGP researchers have shared their samples, data, and expertise to facilitate the identification of autism susceptibility genes. The first phase of the AGP, the assembly of the largest-ever autism DNA collection and whole genome linkage scan, was funded by the autism advocacy group Autism Speaks and the National Institutes of Health and
25 completed in 2007. The consortium is also co-funded by the Medical Research Council, Canadian Institutes of Health Research, Health Research Board (Ireland), Genome Canada and the Hilibrand Foundation. NAFLD patients at increased risk after liver transplant Non-alcoholic fatty liver disease (NAFLD) is a bigger risk factor for liver transplant patients than obesity, high blood pressure and high cholesterol, according to a UNC study. Patients with NAFLD are significantly more likely to die or suffer transplant failure during the first 30 days after transplant than patients without NAFLD. Of the comorbidities frequently associated with NAFLD, namely diabetes, obesity, high blood pressure and high cholesterol, only diabetes was associated with worse outcomes; diabetes was independently associated with poorer survival at three years after transplant said study lead author A. Sidney Barritt IV, MD, a fellow in advanced hepatology and liver transplant at the UNC School of Medicine. “NAFLD is a rising epidemic in the field of hepatology and liver transplantation, fueled by the dual epidemics of obesity and diabetes in the United States,” Barritt said. “As NAFLD increases in incidence and prevalence, we expect it to become the leading indication for liver transplant in the next two decades. “Unfortunately, the same risk factors for NAFLD—diabetes, obesity, high blood pressure and high cholesterol—are also risk factors for heart disease. We are concerned that this group of patients may not be the best candidates for liver transplant,” Barritt said. In the study, Barritt and study co-authors analyzed data from the cases of 118 liver transplants performed at UNC Hospitals from 2004 to 2007. Of these patients, 21 (18 percent) were transplanted because of NAFLD. In addition, 28 percent of the 118 had diabetes, 29 percent had high blood pressure, 13 percent had high cholesterol and 4 percent had coronary artery disease. Among the patients without NAFLD, the reasons given for transplant included hepatitis C (HCV), cirrhosis due to HCV and alcohol consumption, cirrhosis due to alcohol alone, hepatitis B, and other indications such as primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. Thirty days after transplant, 81 percent of the NAFLD patients were still alive, compared to 97 percent of the nonNAFLD patients. One year after transplant, 76 percent of NAFLD patients were still alive compared to 90 percent of non-NAFLD patients. Three years after transplant, the difference was 76 percent survival among NAFLD patients and 84 percent survival in the non-NAFLD group. Overall, NAFLD patients had a 9 times greater rate of death at 30 days after transplant compared to non-NAFLD patients. The rate of death was higher at 1 and 3 years, but the difference did not reach statistical significance. Study co-authors, all from the UNC School of Medicine, include Evan S. Dellon, MD, MPH; Tomasz Kozlowski, MD; David A. Gerber, MD; and senior author Paul H. Hayashi, MD, MPH.
Pisano recognized for role in academics and science Etta Pisano, vice dean for academic affairs and Kenan Professor of Radiology and Biomedical Engineering in the School of Medicine, and director of both the Biomedical Research Imaging Center and the UNC Translational and Clinical Science Institute, has won the 2010 Mary Turner Lane Award. Established in 1986, the award recognizes people who make outstanding contributions to the lives of women students, faculty, staff and administrators at Carolina. It is named after Mary Turner Lane, founding director of the Curriculum in Women’s Studies and the first recipient of the award. The University’s Association for Women Faculty and Professionals (AWFP) presented the award April 29 at the group’s annual banquet. Pisano, who is known internationally for her research in breast imaging, was described by one nominator as “the epitome of the successful woman clinician-scientist, mentor, teacher and engaged community participant.” Throughout her 20-year career at Carolina, Pisano has demonstrated a commitment to enhance women’s health. Her work demonstrating the efficacy of digital technology for breast cancer screening has led to improvements in the accuracy of mammography and breast cancer diag- Photo by Steve Exum nosis. She has directed 16 postgraduate education courses on breast imaging for radiologists, medical physicists and technologists, a nominator said, and she has mentored countless medical students, radiology and internal medicine residents, breast imaging fellows and graduate students in biomedical engineering, physics and public health. Informally, she has served as an adviser to many junior medical school faculty.
Pisano has held leadership positions in many University and national professional organizations, including chairing the UNC Committee on the Status of Women and serving as president of the Association of University Radiologists. Last year, Pisano was chosen to receive the UNC Advancement of Women Award. She has been actively involved in community service and was instrumental in developing the University’s Working on Women in Science initiative to enhance recruitment, retention and promotion of women faculty. “Her service in University and school committees has often been focused on advancing the position of women at UNC specifically, and in academics generally,” a nominator said. “She continues to be an exceptional presence, both on campus and nationally for the role of women in academics and in science.” Anne Whisnant, this year’s president of AWFP, said the organization felt it was important to honor Pisano as she prepares to leave Carolina, both because of Pisano’s staunch support of AWFP and to reinforce the importance of attracting and retaining respected, capable women in leadership positions. “Through consistent and deep involvement in University-wide committees, Etta has been the epitome of a ‘faculty patriot’ – someone who has looked beyond her own interests and immediate realm and has led a number of significant efforts to bring structural changes that address ongoing problems faced by women across our campus,” Whisnant said. On July 1, Pisano will become dean of the College of Medicine and vice president for medical affairs at the Medical University of South Carolina.
Board of Governors seeks input from UNC system alumni and friends in search for Bowles’ successor The UNC Board of Governors is seeking suggestions and nominations as it searches for the next president of the UNC system. Earlier this year, UNC President Erskine Bowles announced his plans to retire after five years of service at the end of 2010, or whenever a successor can be in place. “We are intent upon finding the very best candidates in the nation, and we welcome your suggestions and nominations for this critically important leadership role,” BOG Chair Hannah Gage said in a May 14 letter to alumni and friends of the 17-campus UNC system. The board has hired Bill Funk of R. William Funk & Associates to assist in the recruitment and selection process. The Dallas-based firm specializes in conducting searches at the senior
leadership level for major universities and university systems around the country. Funk was involved in the search process that led to Holden Thorp being named as Carolina’s 10th chancellor in 2008. “The next president must be an experienced and visionary leader who understands and appreciates the unique relationship the university shares with the state and its citizens,” Gage said. “More than ever before, North Carolina’s economic future will depend on the teaching, research and public service our UNC campuses provide, so the importance of this presidential search cannot be overstated.” The UNC system has a total budget of $7.4 billion, enrolls more than 220,000 students and employs more than 47,000 faculty and staff.
UNC MEDICAL BULLETIN
The BOG invites input about the personal characteristics, type of prior experience and skill sets needed for the next president as well as feedback on the greatest challenges and opportunities facing the UNC system. To learn more about the search process and to provide feedback or make a nomination, refer to http://tinyurl. com/2ago73m. Matthews named urogynecology & reconstructive pelvic surgery division chief Catherine Matthews, MD, has been named division chief of the Division of Urogynecology & Reconstructive Pelvic Surgery in the Department of Obstetrics & Gynecology. She will join the department on July 1, 2010. Matthews graduated from medical school at the University of Virginia, where she was valedictorian, and went on to complete her residency at the Medical College of Virginia. She joined the faculty and worked closely with Glen Hurt, MD, developing her skills in pelvic surgery and urogynecology. She is recognized internationally for her expertise in robotic surgery and is also a superb vaginal surgeon. She has a particular interest in fecal incontinence, rectovaginal fistulae and anal sphincter injury. One of her first objectives is to create a “Pelvic Floor Center of Excellence” in collaboration with urology, gastrointestinal medicine, and colorectal surgery. Matthews anticipates developing a robust clinical research program in collaboration with others at UNC. Goldstein named UNC Hospitals’ executive VP and COO Brian P. Goldstein, MD, MBA, will become UNC Hospitals’ next executive vice president and chief operating officer (COO) effective July 1, 2010. In this position, Goldstein will oversee UNC Hospitals’ operations, including an annual operating budget of over $1 billion and a staff of more than 7,000. Goldstein, who currently serves as UNC Hospitals’ chief of staff and as the UNC School of Medicine’s executive associate dean for clinical affairs, is uniquely suited for his new position given his history at UNC and his diverse background. He has served as a member of UNC Health Care’s leadership team and served as chair of the Medical Staff Executive Committee, Liability Insurance Trust Fund Council and Teaching Physicians Oversight Committee. He also supervised the Performance Improvement Division, the Patient Safety Office and the Office of Graduate Medical Education. He has a reputation for building strong relationships with physicians, health care professionals and colleagues at UNC Hospitals and beyond. Goldstein will follow Todd Peterson as UNC Hospitals’ executive vice president and COO. Peterson, who retired June 30, 2010, directed UNC Hospitals’ operations since 1989. In addition, Christopher S. Ellington, MBA, will be assuming the role of executive vice president and chief financial officer beginning July 1, 2010.
27 Runge honored by American College of Cardiology Marschall S. Runge, MD, PhD, received the 2010 Distinguished Scientist Award on March 15, 2010. Runge, Charles Addison and Elizabeth Ann Sanders distinguished professor, chair of medicine and vice dean for clinical affairs, was selected by the Awards Committee and the Board of Trustees of the American College of Cardiology to receive the 2010 Distinguished Scientist Award in recognition of his contributions to the advancement of scientific knowledge in the field of cardiovascular diseases. This award has been given since 1982, and past recipients of this include the world’s leading cardiovascular investigators over the past three decades. He received the award on March 15, 2010, at the annual ACC Convocation in Atlanta. Newton elected chair of American Board of Family Medicine Warren P. Newton, MD, MPH, chair of UNC’s Department of Family Medicine and executive associate dean of medical education at UNC’s School of Medicine, has been elected chair of the American Board of Family Medicine (ABFM). He was elected at the ABFM annual meeting in April and assumed the role of chair-elect. He will serve one year as chairelect, one year as chair and one year as immediate past chair. Newton joined the UNC faculty in 1990 and has been the Wiliiam B. Aycock distinguished professor and chair of the Department of Family Medicine since 1999. He has served as executive associate dean for medical education since 2008. Newton is also chair of the Board of Advisors for the Cecil G. Sheps Health Services Research Center, founding chair of Community Care of Central Carolina (CCCC), and director of the Carolina Health Net uninsured initiative. He leads the North Carolina Health Quality Alliance, the pilot of a national effort by the specialty societies and boards of family medicine, internal medicine, and pediatrics to improve the quality of chronic disease care in primary care practice. He also leads the I3/PCMH (Patient-Centered Medical Home) Initiative in North Carolina, South Carolina and Virginia. Nationally, he has served as president of the Association of Departments of Family Medicine (ADFM) and was the founding chair of the Council of Academic Family Medicine (CAFM). He currently serves on the Board of Directors of ABFM, the Family Practice Inquiries Network, Up to Date, and the North Carolina Health Quality Alliance. ABFM is the second largest medical specialty board in the United States. Founded in 1969, it is a voluntary, notfor-profit, private organization whose purposes include improving the quality of medical care available to the public; establishing and maintaining standards of excellence in the specialty of family medicine; improving the standards of medical education for training in family medicine; and determining by evaluation the fitness of specialists in family medicine who apply for and hold certificates.
UNC’s Buse recognized with award for clinical excellence John B. Buse, MD, PhD, recently received a Clinical Excellence Award at the Castle Connolly National Physician of the Year Awards ceremony. Buse is a professor in the UNC School of Medicine, chief of the Division of Endocrinology and Metabolism and director of the UNC Diabetes Care Center. He also serves on the steering committee for the North Carolina Translational and Clinical Sciences (NC TraCS) Institute—the academic home of the NIH Clinical and Translational Sciences Awards (CTSA) at UNC—where Buse is a principal investigator extender in clinical research. He is also an active clinician who treats patients both at UNC Hospitals and at the Highgate Specialty Center in Durham, one of UNC Health Care’s community practices. The awards ceremony took place in New York City on March 22. Additional information about the Castle Connolly National Physician of the Year Awards is available at www.castleconnollyawards.com. A native of Charleston, SC, Buse received his bachelor’s degree in biochemistry from Dartmouth College and his medical and doctoral degrees from Duke University. He completed his internship and residency in internal medicine and his fellowship in endocrinology at the University of Chicago. He has been a member of the UNC faculty since 1994. He was also the American Diabetes Association’s president for medicine and science in 20072008. Buse is a former associate editor of the ADA journals Clinical Diabetes and Diabetes Care, which provide information on state-of-the-art care and prevention of diabetes to clinicians across the globe. His commitment to developing breakthroughs in the prevention and treatment of both type 1 and type 2 diabetes is further evident in his many research initiatives. Buse is the vice chair of the National Institutes of Health’s (NIH’s) largest ever diabetes study, ACCORD, which is aimed at determining optimal treatments for diabetes, blood pressure, and cholesterol in type 2 diabetes. He is a co-investigator in the HEALTHY study, an NIH trial aimed to demonstrate that changing school environments can produce weight loss in school children. UNC allergist elected to national board David B. Peden, MD, of the UNC School of Medicine, has been elected to a three-year term on the Board of Directors of the American Academy of Allergy, Asthma & Immunology (AAAAI). Peden is chief of the allergy division, associate chair for research and professor of pediatrics, director of the Center for Environmental Medicine, Asthma and Lung Biology, and deputy director for Child Health Research of the CTSA of UNC. He directs the UNC Allergy/Immunology Fellowship (recipient of the 2004 Phoenix Award), and is listed in the Best Doctors’ physicians listings. He is currently serving on the Allergy/Immunology RRC as vice chair (chair from 2011-2014), as associate
editor of The Journal of Allergy and Clinical Immunology (JACI), and served on the American Board of Allergy and Immunology (ABAI) from 2003-2008 (chair in 2006). Peden has served the AAAAI in numerous capacities, including leadership positions in the Environmental and Occupational Respiratory Diseases (EORD) Interest Section (chair 2005-2007), as chair of the Workshop Committee, and is currently a councilor of the Program Directors Assembly. Peden’s research program examines the impact of air pollution in asthma, and he is PI on grants of more than $5 million annually from the EPA, NIEHS, NHLBI and NIAID. Peden has authored over 115 original and review articles, including the chapter on air pollution in Middleton’s Allergy: Principles and Practice, now in its seventh edition. He has served on several NIH study sections, and was appointed to the NC Environmental Management Commission in 2008. Peden received his BA (1980), MS and MD degrees (1984) at West Virginia University, where he was a resident in pediatrics (1984-1987, chief 1986-1987). He trained in allergy/immunology at the NIAID from 1987-1992 (chief, 1988-1989). Occupational Science’s Coppola receives AOTA recognition Susan Coppola, associate professor in the Division of Occupational Science in the UNC School of Medicine, has been elected by the American Occupational Therapy Association (AOTA) membership to serve a four-year term as the USA Delegate to the World Federation of Occupational Therapists (WFOT). Coppola was officially bestowed with the honor on April 1, 2010, by AOTA Nominating Committee Chair Gloria Lucker. “My decision to seek the position of AOTA Delegate to the WFOT was inspired by my interest in international health and the learning that can take place through cross-cultural exchanges,” Coppola said. “Recently I had the opportunity to work in Thailand on inclusive tourism in the post-tsunami region. This opportunity built connections with international leaders in OT and disability rights. Collaborations in Denmark several years ago led to a National Institutes on Aging funded research grant on preventive home visits for older adults in North Carolina.” This summer, Coppola will work in the National Association of Applied Anthropology—Occupational Therapy Field School in Guatemala supervising interns working with older adults. WFOT is the official international organization that represents and promotes occupational therapy. Founded in 1952, WFOT currently has over 50 member associations including AOTA. As the WFOT Delegate, Coppola will work closely with her international colleagues to advance occupational therapy research, education, and practice, to better serve the needs of individuals and communities. The Division of Occupational Science is one of seven
UNC MEDICAL BULLETIN
Academy of Educators recognizes five for teaching excellence The UNC School of Medicine Academy of Educators recognized five faculty for teaching excellence at their annual Evening of Scholarship event on May 18. Amy Weil, associate professor in the Department of Medicine was chosen to receive the Clinical Preceptor Excellence in Teaching Award. This award recognizes faculty who are excellent teachers and role models for medical students during their clinical training. Weil is the quintessential clinician educator. She is the intelligent, knowledgeable and compassionate role model to which all clinical faculty Cook aspire. She teaches superbly, using the methods validated by the very best educators. She approaches her work with a passion that inspires her students. Jeanette Cook, assistant professor in the Department of Biochemistry & Biophysics, was chosen to receive the Basic Science Excellence in Teaching Award. This award recognizes faculty who are excellent teachers in the basic science courses during the first two years of med- Fitzpatrick ical school. Cook is a master at identifying the core material that the students need to understand the basic principles and arranging this material in slides and syllabi in a way that facilitates student learning. She invests considerable effort in preparation for her teaching and it is this preparation, as well as innate talent, that have made her an outstanding teacher. Such effort is unusual for a young faculty member building a competitive research Woosley program. Douglas Fitzpatrick, assistant professor in the Department of Otolaryngology, was chosen to receive the Medical Student Research Mentor Award. This award recognizes excellence in training medical students in the fundamentals of medical research and research ethics. Although demanding in his
scientific rigor, Fizpatrick is thoroughly welcoming and engaging in his interactions with his students. They love working with him. Another important indication of Fitzpatrick’s excellent mentorship is the regularity with which his trainees have gone on to productive academic careers. John Woosley, professor in the Department of Pathology and Laboratory Medicine, was chosen to receive the Innovation in Teaching Award. This award recognizes innovation in medical student teaching. John Woosley is a truly exceptional educator who is nationally recogCross nized for his innovative approaches to teaching pathology, as well as his willingness to share these innovations with others. His achievements have been in both undergraduate and graduate medical education, but their impact, locally and nationally, has been greatest in undergraduate medical education. Alan Cross, a professor in the departments of Social Medicine and Pediatrics, was chosen to receive the Lifetime Weil Achievement Award. This award recognizes faculty who have demonstrated sustained excellence in teaching and mentoring medical students over 10 years or more. Cross has contributed to the school’s education mission in every way. As a member of the UNC School of Medicine faculty since 1978, Cross has dedicated himself to medical students and their education—didactic, clinical, experiential, and personal. His 32 years of teaching and mentoring has resulted in a long legacy of patient-centered, dedicated clinicians who serve the citizens of North Carolina, and indeed the world, through global outreach. More importantly, Cross is beloved by the generations of medical students who have passed through the school since his arrival. And many students come to him for his advice and support because their classmates from previous years have told them to seek him out when they need a friend, a mentor or just a friendly ear to listen.
divisions of the Department of Allied Health Sciences in the UNC School of Medicine. The division administers a Master of Science program in occupational therapy as well as a PhD in occupational science, and conducts multiple research, clinical and service projects through our faculty collaborations. UNC’s Division of Occupational Science is ranked fifth out of 81 master’s in occupational science programs by US News & World Report.
American Association for Cancer Research and the Kirk A. and Dorothy P. Landon Foundation. The awards were presented at the AACR’s 101st annual meeting last April in Washington, DC. Rathmell, a member of UNC Lineberger Comprehensive Cancer Center, will receive the INNOVATOR Award for Research in Personalized Cancer Medicine. In its inaugural year, the award provides support for a physician-scientist who conducts meritorious studies that hold promise for near-patient benefit to accelerate progress in the area of personalized cancer medicine. Rathmell’s project, “Advancing Prognostic Algorithms for
Rathmell receives inaugural award from AACR Kim Rathmell, MD, PhD, assistant professor of medicine, received one of three INNOVATOR awards given by the
Renal Cell Carcinoma,” focuses on renal cell carcinoma, a type of kidney cancer. This cancer spreads easily and many patients already have metastases at the time of diagnosis. Although surgery is an effective treatment for this cancer, incidence is increasing and more patients are presenting with metastatic disease. Very little information is available to identify those patients at risk of recurrence. With specific biomarkers, it will be easier for clinicians to determine those patients that are low risk and can be reassured of a good outcome and those that are at high risk and should be managed with more aggressive treatments. Rathmell’s proposed work will build on her already compelling preliminary studies to determine a gene signature biomarker profile for renal cell carcinoma. This unique biomarker profile has the potential to provide increased information regarding clinical outcomes and effective treatment planning. Once she has defined the biomarker profile, she will validate it using tissues from a large number of patients with renal cell carcinoma. Baric elected to American Academy for Microbiology Ralph Baric, PhD, professor of epidemiology at UNC Gillings School of Global Public Health and a member of UNC Lineberger Comprehensive Cancer Center, has been elected to the American Academy for Microbiology. He will be recognized at the Academy Fellows luncheon in San Diego on May 26, 2010. Baric and 77 other microbiologists will join the academy. Fellows are elected yearly after going through a highly selective, peer review process. Candidates are analyzed in terms of their records of scientific achievement and original contributions that have advanced the field of microbiology. Baric has dedicated a lot of his research to vaccine development and the study of RNA virus transcription, replication and recombination. He has also written or appeared in several professional articles. Chiang selected as 2010 Alfred P. Sloan research fellow Derek Chiang, PhD, assistant professor of genetics in the UNC School of Medicine, has been named a 2010 research fellow by the Alfred P. Sloan Foundation. Chiang is one of 118 recipients of the prestigious award. The Sloan Research Fellowships seek to stimulate fundamental research by early-career scientists and scholars of outstanding promise. These two-year $50,000 fellowships are awarded yearly to 118 researchers in recognition of distinguished performance and a unique potential to make substantial contributions to their field. Chiang is a member of the Carolina Center for Genome Sciences and the UNC Lineberger Comprehensive Cancer Center. Chiang will use the fellowship funds to support his work in understanding how the mistakes in the DNA and RNA of tumors can be analyzed to help design better cancer therapies. Chiang’s lab develops computational tools to address critical gaps
in the biological interpretation of cancer genomics datasets. Chiang’s UNC Lineberger collaborators are Chuck Perou, PhD, and Neil Hayes, MD, and all are involved in The Cancer Genome Atlas Research Network, a National Institutes of Healthfunded initiative that seeks to identify the critical genes of several cancers. Chiang, a Morehead-Cain Scholar, earned his bachelor’s degree in chemistry with highest distinction and honors from UNC. He earned his PhD in molecular and cell biology from the University of California, Berkeley, where he was a Howard Hughes Medical Institute predoctoral fellow. He completed a postdoctoral fellowship at the Broad Institute in Cambridge, Massachusetts. Zolotor receives James W. Woods Junior Faculty Award Adam Zolotor, MD, MPH, an assistant professor in the Department of Family Medicine in the UNC School of Medicine, has received the school’s prestigious James W. Woods Junior Faculty Award. The award supports promising young members of the medical school’s clinical faculty early in their academic career. Zolotor will receive $3,000 to use at his discretion in support of his research and scholarly activities. Zolotor has a great deal of experience in research and clinical evaluation of child abuse and medical neglect. His research has focused on causes and consequences of abuse and neglect, and he has a particular interest in prevention programs. Two main focuses of his research at present are the evaluation of a statewide shaken baby prevention program and the development of a new high tech prevention program for adolescent parents. The Woods Award was established through the generosity of the late James Watson Woods, MD, a cardiologist and professor in the School of Medicine from 1953 to 1983. Med student honored by Soros Fellowships for New Americans Naman Shah, a student in the UNC School of Medicine, has been awarded a 2010 fellowship by the Paul & Daisy Soros Fellowships for New Americans. Shah is one of 30 young scholars granted a fellowship, which supports the graduate studies of immigrants and children of immigrants. The two-year awards provide cash grants of up to $50,000 and tuition support of up to $40,000. Shah is a third-year MD/PhD candidate in the UNC School of Medicine’s Medical Scientist Training Program (MSTP). He also received a Bachelor of Public Health degree from UNC, graduating from the Department of Environmental Sciences and Engineering with highest honors and distinction in public service. He was a North Carolina Leadership Fellow and an IBM Watson scholar as an undergraduate. Shah was born in 1985 in Charlotte to parents who emigrated from India and are now US naturalized citizens. They reside in North Carolina.
UNC MEDICAL BULLETIN
Cancer support program, American Cancer Society partner for Latino “Look Good ... Feel Better” sessions The UNC Comprehensive Cancer Support Program (CCSP) and the American Cancer Society (ACS) co-sponsored the first Latino “Look Good ... Feel Better” (LGFB) program last February. LGFB is a free, non-medical, brand-neutral national public service program created to help individuals with cancer look good, improve their self-esteem, and thereby manage their treatment and recovery with greater confidence. Beth Fogel, resource nurse navigator for the CCSP’s Patient and Family Resource Center, worked with Rosa Mayorga, ACS bilingual mission delivery representative, and Claudia Rojas, Latino clinic manager of the UNC Center for Latino Health, to initiate the program. Mayorga recruited and trained Spanishspeaking cosmetologists, and Rojas recruited Spanish-speaking cancer patients at UNC. Pam Baker, program coordinator for the CCSP Patient and Family Resource Center, oversees the monthly LGFB sessions. “We’ve long had a successful program in English for numerous patients over the years in our Patient and Family Resource Center,” says Baker. “It’s wonderful that we’re now able to offer it in Spanish.” “ACS is very pleased to partner with UNC to offer this beautiful program serving a population of cancer patients in great need,” says Mayorga. “The LGFB Latino sessions at UNC would not be possible without the dedication and expertise of our exceptional cosmetologist volunteers: Nelson Ross, Luz Palomo and Elvia Herrera.” Patient participant Juana Ramirez says (translated from
Citing his parents struggles as new immigrants, Shah has committed as a responsibility to give back to his family, his home country of India, and the U.S. and world. To achieve these civic and scientific goals, Shah sought out experience in the field, working in a polio eradication program after college, and focusing his MD/PhD work on combating malaria in India. Shah intends to become a medical research scientist, focusing on infectious disease, with a goal to “safeguard the health of the world from epidemics.” He has submitted/published ten articles in peer-reviewed journals, received 19 competitive research grants, and created and maintains one of the only two dedicated malaria blogs on the internet (http://topnaman.com). Most recently, he created a social enterprise lab called VeerLabs, LLC. Bae-Jump receives James W. Woods Junior Faculty Award Victoria Bae-Jump, MD, PhD, an assistant professor in the department of obstetrics and gynecology in the University of North Carolina at Chapel Hill School of Medicine, has received the school’s prestigious James W. Woods Junior Faculty Award. The award supports promising young members of the medical school’s clinical faculty early in their academic career.
From left: Claudia Rojas, Latino clinic manager for the UNC Center for Latino Health; Rosa Mayorga, ACS bilingual mission delivery representative; and cosmetologist Elvia Herrera prepare materials for a LGFB session last February. Photo by Dianne Shaw.
Spanish), “You really feel good during these sessions, like a normal person. I recommend to women to take advantage of this opportunity. You will feel different and beautiful. I liked that they encourage people to feel good.” The program has been held quarterly. The remaining 2010 dates are August 16 and November 15. To register, please contact Claudia Rojas at the UNC Center for Latino Health, at (919) 966-5800.
Bae-Jump will receive $3,000 to use at her discretion in support of her research and scholarly activities. Dr. Bae-Jump is a translational scientist with a research focus on novel targeted therapies for endometrial cancer and their interactions with critical cell signaling pathways implicated in the pathogenesis of this disease. She received her both her Doctoral in Pathology and Doctor of Medicine degree from the Medical College of Virginia. In 2000 she joined the UNC Department of Obstetrics and Gynecology to start her residency training in OB/GYN. After residency she stayed here to complete her fellowship in gynecologic oncology and eventually joined the faculty in 2007. The Woods Award was established through the generosity of the late James Watson Woods, MD, a cardiologist and professor in the School of Medicine from 1953 to 1983.
Benson R. Wilcox, MD 1932â€“2010
Benson Reid Wilcox, MD, a heart surgeon who served 29 years as chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, died May 11, 2010, at his home after a courageous battle with brain cancer. He was 77. Wilcox served as chief of cardiothoracic surgery at UNC from 1969 to 1998. During that period, which was a time of dramatic advances in heart and lung surgery, the UNC hospital began offering coronary artery surgery, heart and lung transplantation, surgery for congenital heart defects in newborns, and a comprehensive treatment program for lung and esophageal cancer. Wilcox was primarily a pediatric heart surgeon whose specialties were congenital heart disease, pediatric cardiac morphology, pediatric chest disease, and pulmonary circulation. Wilcox, known as Ben, was born May 26, 1932, in Charlotte, NC, the son of James Simpson Wilcox and Louisa Reid Wilcox. He was raised in Charlotte and graduated from the Darlington School in Rome, Ga., in 1949. He was named a 1997
Distinguished Alumnus of the Darlington School. He earned an AB in history from UNC in 1953 and an MD from the UNC School of Medicine in 1957. During medical school, he was president of his class and was inducted into the Alpha Omega Alpha medical honor society in 1957. After serving as a surgery resident at Barnes Hospital in St. Louis (1957-1959) and North Carolina Memorial Hospital in Chapel Hill (1959-1960), he spent two years as a surgical clinical associate at the National Heart Institute, part of the National Institutes of Health, in Bethesda, Md. He then returned to UNC as chief resident in cardiovascular and thoracic surgery (1962-63) and as chief resident in surgery (1963-64). He joined the UNC Department of Surgery in 1964 and was appointed as chief of the Division of Cardiothoracic Surgery in 1969 and as a full professor in 1971. He was named a Markle Scholar in Academic Medicine in 1967. After he retired as chief of cardiothoracic surgery, Wilcox remained on the faculty as a professor of surgery from 1998 until his death. He held leadership positions in prestigious professional organizations, including president of the Nathan A. Womack Surgical Society and president of The Society of Thoracic Surgeons. He received the Distinguished Service Award from the Society of Thoracic Surgeons in 2003. He was instrumental in establishing the Thoracic Surgery Directors Association (TSDA) whose members are directors of cardiothoracic surgery residency programs across the United States. In 2009, the TSDA honored him by establishing the Benson Wilcox Award for Best Resident Paper, to be presented each year at The Society of Thoracic
Surgeonsâ€™ annual meeting. In 1980, Wilcox began a collaboration with Robert H. Anderson, MD, a pediatric morphologist at Royal Brompton. He and Anderson worked together on many projects, including the book Surgical Anatomy of the Heart (Raven Press, 3rd edition, 2004). The two physicians established a program that for many years enabled UNC cardiothoracic surgery residents to spend time in London studying with Anderson. Wilcox also was co-author of Atlas of the Heart (Gower Medical Publishing, 1988); and a co-editor of Diagnostic Atlas of the Heart (Raven Press, 1994). He was an author of more than 100 scientific and clinical articles published in medical journals. Wilcox established a support group for families of children who are undergoing heart surgery. The Carolina Parent Network, begun in 1986, enables parents of children who are facing heart surgery at UNC to talk to parents who have already had the experience, and it also educates families about what to expect before, during and after surgery. As a medical student at UNC, he helped found the Bullitt Club for the study of the history of medicine. He began collecting old and rare books about the history of medicine, particularly books about thoracic surgery and the specialties that preceded it. In 1984, he began presenting a rare book to the UNC Health Sciences Library each year in honor of his chief resident. In 1998 and 1999, he donated most of his medical book collection to the library. Since then, the Benson Reid Wilcox Collection has grown to more than 1,400 books, journals, reprints and other items. Wilcox is survived by his wife, Patsy Davis, and by his four children: Adelaide, Sandra, Melissa, and Reid. He is also survived a brother, Bob; two stepdaughters; and 11 grandchildren. He was predeceased by his parents and his brother Jim.
UNC MEDICAL BULLETIN
H. Robert Brashear, MD 1921–2010 Harry Robert Brashear Jr., MD, Professor Emeritus of the UNC Department of Orthopaedics, died peacefully at Carol Woods Retirement Center on March 28, 2010 following a brief illness. Brashear joined UNC Orthopaedics in 1953 and his legacy of excellence in teaching of orthopaedic residents and medical students remains with our training program today. No faculty member in the history of UNC Orthopaedics has equalled Brashear in devotion to or excellence in teaching. For 55 years, he taught each of the more than 6,000 medical students who have passed through the halls of the UNC School of Medicine. In the musculoskeletal course alone, he logged over 1,400 teaching hours. Among the innumerable contributions Brashear made to musculoskeletal education at UNC are his development of a comprehensive musculoskeletal pathology library for the residency program; his numerous MSK Course Best Teacher Awards (he won so many times that the Department began excluding him from the competition); his production and narration of all the streaming videos for the current MSK course; and his instrumental role in the organization and adminstration of the anatomy course for first-year medical students. His talent and effort have led to three additional awards by the sophomore class as Best Basic Science Teacher, one by the Whitehead Society for overall excellence in teaching, and election by the students to honorary membership in Alpha Omega Alpha. Up until the last couple of years, he had been the keystone in the basic science education of the approximately 150 residents who have finished the pro-
gram in Orthopaedics. The alumni of the UNC Department of Orthopaedics established the H. Robert Brashear, MD Distinguished Professorship in his honor in 2005. “Dr. B” was born in St. Louis and attended college at the University of California at Berkeley and medical school at the University of California at San Francisco. He interned at Georgetown, then spent two years as a medical officer in the Army. His interest in basic science was undoubtedly stimulated by an orthopaedic residency and research fellowship at the University of Pennsylvania—and certainly by his own research at UNC, which ranged from fundamental work on broken epiphyses to broken necks. In addition to coauthoring the last five editions of Shands’ Handbook of Orthopaedic Surgery with R. Beverly Raney Sr., MD—for many years the students’ bible in the field—he has written approximately 20 chapters in other texts dealing with an aspect of basic science. On the national scene, he chaired the American Academy of Orthopaedic Surgeons’ Committee on Basic Science and its Board of Editors. He was vicepresident of the American Orthopaedic Association, served as a director of the American Board of Orthopaedic Surgery, and was an associate editor and member of the Board of Trustees for The Journal of Bone and Joint Surgery. Brashear is survived by his wife of 62 years, Grace (Gay) Roberts; five children, H. Robert III, William, Thomas, Richard, and Grace; and seven grandchildren.
In Memoriam Gerald W. Fernald, MD ’60, age 76, of Chapel Hill, NC, died on March 1, 2010. He was a native of Rochester, NH, and attended the University of New Hampshire, the University of North Carolina School of Medicine, and completed his pediatric residency at the Children’s Hospital in Boston, Mass. Fernald worked for 33 years in the Department of Pediatrics at UNC Hospitals, where he specialized in Cystic Fibrosis and infectious disease. Dr. Alan Stiles, current chair of the Department of Pediatrics said, “Dr. Fernald established the Cystic Fibrosis program for children at UNC and was the director from the early 70s to the late 90s. Under his direction the program developed to one of the top programs in the country.” “Beyond medicine,” Stiles said, “his true passion was for his family and in his spare time he was an avid gardener. Dr. Fernald was a good friend and will be greatly missed.” In his retirement, Fernald was active in pediatric resident recruitment and selection, the UNC Retired Faculty Association, the Seymour Center in Chapel Hill, and the Triangle Youth Orchestra, in which he participated with his grandsons, Matthew and Robert Fernald. In addition to his widow, Anne, he is survived by his son Pete, his daughter Susan, and four grandchildren. The Fernalds were featured earlier this year in The Daily Tar Heel’s Valentine edition for celebrating 54 years of marriage. Arvid Charles Sieber, MD ’60, age 76, of Woodbury, beloved husband of Helen Curtis Sieber, died at Waterbury Hospital on March 25, 2010 after a brief illness. He was born in Jersey City, NJ, on December 1st, 1933, son of the late Charles Sieber and Paula (Neuberger) Sieber. After growing up in Hendersonville, NC, he attended Mount St. Mary’s College in Emmitsburg, Md. and the University of North Carolina in Chapel Hill, where he graduated from medical school in 1960. After completing his medical internship at St. Vincent’s Hospital in
Toledo, Ohio, he served in the Air Force in Kansas City, Mo., and then started a general medical practice in his hometown of Hendersonville. He later served as a corporate medical doctor at Olin Corporation in Stamford and as a staff physician in the Emergency Department at Danbury Hospital. In 1978, he went into private practice in family medicine in Ridgefield, and remained there until his initial retirement in 1998. He later served as a staff physician at the Southbury Training School, where he completed his rewarding medical career in 2005. Sieber and his family lived in Ridgefield from 1968 until 2001, at which time he and his wife moved to Woodbury. He greatly cherished spending time with his large family and many friends, and also enjoyed gardening, and playing the piano and organ. He was active at St. Teresa’s Parish in Woodbury, and was recently professed into the secular Franciscan order. Besides his beloved wife of nearly 50 years, he is survived by his seven loving children, Steven, Michael, James, Christopher, Elly, Mia, and Laurie; 17 grandchildren; two brothers, Hal and Peter; and several nieces and nephews.
UNC Medical Bulletin
Summer 2010 — Vol. 57, No. 2 Executive Editor William L. Roper, MD, MPH Dean, UNC School of Medicine Vice Chancellor for Medical Affairs CEO, UNC Health Care System
Editor/Art Director Edward L. Byrnes Director of Development Communications The Medical Foundation of NC, Inc.
Contributing Writers Will Arey, Ellen DeGraffenreid, Tom Hughes, Patric Lane, Leslie H. Lang, Katie O’Brien, Dianne Shaw
Editorial Advisory Committee David Anderson President The Medical Foundation of NC, Inc. Georgette A. Dent, MD Associate Dean for Student Affairs UNC School of Medicine Brian Goldstein, MD, MBA, FACP Executive Vice President Chief Operating Officer, UNC Hospitals James R. “Bud” Harper, MD ’60 Associate Dean for Medical Alumni Affairs UNC School of Medicine Suzanne Herman, RN, MSN Director of External Affairs Public Affairs & Marketing
Clifford R. Wheeless, Jr, MD ’64, started a second career repairing “birth trauma” in developing countries. Says Wheeless, “It’s great. No overhead, no malpractice lawyers, and no accounts receivable!”
UNC Hospitals & School of Medicine Peter Johnson Board of Directors The Medical Foundation of NC, Inc. Leslie H. Lang Director, UNC Medical Center News Office Public Affairs & Marketing UNC Hospitals & School of Medicine
Robert J. Tallaksen, MD ’76, was the recipient of the Distinguished Teaching Award presented in April 2009 by West Virginia University School of Medicine. Dr. Tallaksen is vice-chair and residency director for the Department of Radiology at WVU in Morgantown, WV.
Dee LeRoy Board of Directors The Medical Foundation of NC, Inc. The UNC Medical Bulletin (ISSN 1941-6334) is published three times annually by The Medical Foundation of North Carolina, Inc. Address correspondence to: Editor, UNC Medical Bulletin, 880 Martin Luther King Jr. Blvd., Chapel Hill, NC 27514; or e-mail: firstname.lastname@example.org. edu. The views presented in the UNC Medical Bulletin do not necessarily reflect the opinion of the editor, the
Nicole Maria D’Andrea, MD ’96, MPH ’97, an obstetrician-gynecologist in Morehead City, NC, became chief of staff of Carteret General Hospital in Morehead City on January 1, 2010.
official policies of the University of North Carolina at Chapel Hill, or The Medical Foundation of NC, Inc. ©2010 The Medical Foundation of NC, Inc. _ Printed on recycled paper
UNC MEDICAL BULLETIN
UNC School of Medicine gives Distinguished Service and Distinguished Medical Alumni Awards The UNC School of Medicine recently announced the 2010 recipients of its Distinguished Service Award and Distinguished Medical Alumni Award. This year’s recipients of the Distinguished Medical Alumni Award are Peter C. Agre, MD, Daniel L. Crocker, MD, and Robert N. Golden, MD. Agre, who is director of the Johns Hopkins Malaria Research Institute and an elected member of the National Academy of Sciences, won the 2003 Nobel Prize in chemistry for his discovery of biologic water channels. Crocker was recognized for his tireless efforts to care for the people of his hometown of Rocky Mount, NC, and his efforts to cultivate and support the arts. Golden, who completed a residency in psychiatry at UNC and later served as chairman of UNC’s Department of Psychiatry, is now dean of the school of medicine and public health at the University of Wisconsin-Madison. This year’s Distinguished Service Award, which is given to recognize governmental and community leadership that has contributed significantly to the mission of the medical school, was awarded to North Carolina Senate President Pro Tempore Marc Basnight. Through his leadership in the North Carolina legislature, Basnight has transformed the capacity of the UNC School of Medicine and UNC Hospitals to understand, prevent and treat diseases, particularly cancer. His leadership of the
Senate and partnership with the House of Representatives has catalyzed unprecedented investments by the State of North Carolina for the benefit of the health of its citizens and beyond. Established in 1955 on the 75th anniversary of the founding of the School of Medicine, the Distinguished Service Award was created to recognize those who had made important contributions to the establishment and early growth of the four-year medical school. The award was designed to honor alumni and friends whose distinguished careers and unselfish contributions to society have added luster and prestige to the university and its school of medicine. A committee appointed by the dean of the school of medicine selects the recipients from nominations solicited from medical school faculty and members of the Medical Alumni Association. In 2009, the committee transformed the Distinguished Service Award to the Distinguished Medical Alumnus Award. The purpose of the Distinguished Medical Alumnus Award is to honor alumni who have significantly enhanced the reputation and prestige of the school of medicine through their lifelong careers of service and accomplishment. The Distinguished Service Award will be awarded to nonalumni to recognize governmental and community leadership that has contributed significantly to the mission of the medical school.
For this, I am thankful continued from page 13 obviously done some unforgivable act. No one could tell me what it could possibly have been, but they were all in agreement that it must have been something very, very bad. A little elderly man came in wrapped in a blanket. His grandsons slid him out of the back of the pickup truck. He was covered in dust. His granddaughter told me he was sick, weak and had stopped eating and drinking. I placed an IV and began fluids. All I knew was he was severely dehydrated. He rattled each time he breathed. I had seen and heard this many times—he was not going to live much longer. My goal was to make him comfortable while he laid on the old stretcher wrapped in an old, faded Disney blanket. The family had a laugh later that afternoon when he asked a passing nurse if she would be willing to lay next to him in the stretcher. He responded to the fluids for a while and the family said he looked better that he had in weeks. He slowly went to sleep a few days later and never woke up. The family and I exchanged hugs when I entered the tent. They thanked me, even though I failed. I did not fix the old man, but his last days had been comfortable. The granddaughter held my hand for what seemed like an
hour. She cried and smiled at the same time. My medical expertise had been valuable in Haiti. While I was there, I was the surgeon, obstetrician, pediatrician, cardiologist, orthopedist, and psychiatrist. The people thanked me over and over. They put their hands on me as I walked by. They deeply appreciated me and my profession. To become a physician was the greatest decision of my life. Haiti will not be fixed by me. Haiti may never be fixed. But Haiti reinforced why I went to Carolina to become a doctor. It is a huge privilege to have the skills required to care for people who have known so much misery. I may not have made a huge impact in Haiti, but Haiti will continue to have a huge impact on me. Haitians are a kind and generous people. They deserve and need good medical care. Being a part of the emergency response for Haiti would not have been possible without my years at the UNC schools of medicine and public health. To be able to help and take care of others is all I ever really wanted to do. I continue to realize every day, whether working in Haiti, New Orleans, or Africa, that I am a very fortunate man. For this, I am thankful.
What’s up, SHAC? UNC’s Student Health Action Coalition (SHAC) is the oldest studentrun free clinic in the US and still growing, introducing opthalmology and SHAC on Wheels services in the past year. By Raphael Louie Student Co-Director, Student Health Action Coalition
s a state university, UNC focuses on providing a quality education for North Carolinians while actively seeking out ways to improve the quality of life within the state as whole. While this is apparent within the classroom, UNC also trains future leaders through student volunteerism and commitment to the community. UNC’s Student Health Action Coalition (SHAC) is the oldest student-run free clinic in the US. Founded in 1968, SHAC’s mission is to provide student volunteers an interdisciplinary service-oriented experience to complement and enrich their classroom experience while learning from faculty devoted to improving our local community. Faculty advisors represented from each of the Allied Health Sciences programs (dentistry, medicine, nursing, public health, pharmacy, physical therapy and social work) provide experience and guidance to create a service environment that is appropriately attuned to our community’s needs. Rooted in community engagement and social justice, SHAC also exemplifies student initiatives that apply knowledge and skills obtained in the classroom in a practical setting. More importantly, SHAC cultivates student leadership to practically apply their education and to give back to the local community. The SHAC experience enables students to learn from each other and engage cooperatively with students across all disciplines represented in the Allied Health schools. This interdisciplinary model cultivates and prepares students to respect and work with different health disciplines in their careers. SHAC’s unique interdisciplinary approach Aside from providing an interdisciplinary learning approach, SHAC strives to provide opportunities for students to serve UNC’s surrounding community. SHAC often is recognized for its dental and medical clinics in providing free services to the uninsured and underinsured population in Orange and Chatham counties, but these two clinics only represent a portion of SHAC’s mission in providing health services in our community. SHAC is composed of five branches that uphold values
of interdisciplinary service learning: Beyond Clinic Walls, Dental Clinic, Medical Clinic, Community Outreach, and Health for Habitat. Beyond Clinic Walls exemplifies interdisciplinary service learning by bringing students from different health disciplines together to work at a local retirement community to provide social services to homebound clients. Through the Community Outreach branch, students work closely with local organizations and events, such as El Centro, Club Nova, and the Interfaith Council homeless shelter, to provide health education and health screenings to underserved populations in the area. In a partnership with University Presbyterian, SHAC Health for Habitat brings students out of the classroom and into the community for weekly work days to build a home with Habitat for Humanity. All these experiences reflect SHAC’s quest to identify and pursue innovative ways for students to make a healthy impact within their community. SHAC medical clinic services Over the past year, the medical clinic has seen more than 1,300 patients, a third of which are under the age of 18. Through the Wednesday night clinics and four Saturday well-child clinics throughout the year, SHAC Medicine provides vaccination services and physical examinations for the pediatric population to keep these children in school and allow them to participate in extracurricular activities. These initiatives have allowed SHAC to develop strong relationships with Chapel Hill-Carrboro City Schools (CHCCS), the health department, and UNC Hospitals’ pediatrics and family medicine programs. The beginning of SHAC Ophthalmology Last year, with the help of UNC’s ophthalmology department, second-year medical students Emily Roemer and Anna Berry designed a new specialty clinic: The SHAC Ophthalmology Clinic (SHAC OC). Medical students, after completing ophthalmic equipment training, are now able to work with ophthalmologists to provide basic and comprehensive ocular exams, treatment of some acute problems, and screenings for visual acuity,
UNC MEDICAL BULLETIN
macular degeneration, glaucoma, diabetic retinopathy, and cataracts. “It is essential to identify degenerative eye diseases early to be able to effectively slow their progression, and we are able to do just that at our clinic,” says Emily Roemer. Referrals to UNC ophthalmology are provided if more thorough medical management and evaluation is needed. Esteemed faculty adviser Dr. Maurice Landers, of the UNC Department of Ophthalmology, has been instrumental throughout this process and continues to provide his expertise as the clinic matures. In addition, Dr. Landers and ophthalmic assistant Wendy Marbury provided a generous donation, which allowed the purchase of new ophthalmic equipment and secured the future of the clinic. Thank you, Dr. Landers, Ms. Marbury, and the UNC ophthalmology department, for helping SHAC to continue to meet the diverse needs of the community. Providing quality eye care to underserved populations Since its inception in March 2009, the SHAC OC has focused on its mission of providing quality eye care and screenings to medically underserved populations in Chapel Hill and the surrounding communities. Operated
37 more children and families and also builds upon the organization’s interdisciplinary framework. SHAC on Wheels has allowed SHAC’s leaders to actively partner with community stakeholders within the school system to jointly develop and enhance current services that assist our pediatric population. This initiative embraces the notion of meeting and engaging the community in order to break down structural and social barriers to health care. SHAC on Wheels aims to take the well-child clinic model and adapt it to take place within local schools within southern Orange County. The goal is to improve access for working parents and to ensure that children and adolescents are able to meet school vaccination and physical examination requirements. The main services provided in this model are vaccinations, well-child exams, public health education (including nutrition, oral hygiene, and exercise), and guidance to social services such as Women, Infants, and Children (WIC) and the State Children’s Health Insurance Program (SCHIP). Students are challenged to think about innovative methods of working in an interdisciplinary model and to think creatively to improve current care models in this setting. The SHAC on Wheels initiative has allowed UNC stu-
Our experience suggests there is a significant unmet need for eye care in North Carolina, as our appointments are typically filled more than a month in advance by patients who live as far away as Greensboro. out of SHAC’s main location in Carrboro on the first Wednesday of every month, the clinic is managed by UNC medical students and supervised by UNC ophthalmology resident and attending physicians, including Dr. Landers. To date, SHAC OC has served more than 50 patients from Alamance, Orange, Guilford, Chatham, and Wake counties, evaluated complaints such as eye pain, red eye, and decreased vision, and provided screenings for glaucoma, cataracts, macular degeneration, and diabetic retinopathy. Our experience so far suggests that there is a significant unmet need for eye care in North Carolina, as our appointments are typically filled more than a month in advance by patients who live as far away as Greensboro. In an effort to meet this demand, we have endeavored over the past year to streamline our clinic flow, and we anticipate further expansion of our patient capacity in the future. As we enter our second year, SHAC OC looks forward to integrating its services with the rest of SHAC and expanding the scope of our operations to include outreach work at area health fairs. SHAC’s newest project In line with its goal to provide innovative approaches to addressing health needs in the community, SHAC began SHAC on Wheels this past January. This initiative takes SHAC’s current well-child services and improves access to
dents to develop skills to bridge academic resources with community needs. Despite student energy and creativity that helped bring the concepts to reality, the SHAC on Wheels initiative would not have been possible without partnerships and guidance from the university and community. Specifically, this initiative would have not been conceptualized without being approached by Michele Bailey from UNC Health Care’s infectious disease department. Without Ms. Bailey’s initiative to provide SHAC with a portable laboratory unit, providing safe vaccinations to the community would not have been possible. Just as importantly, the partnership with CHCCS is crucial for the development and implementation of SHAC on Wheels. Our conversations with Stephanie Willis, health coordinator for CHCCS, and Debbie LaMay, president of the Central Chapter of the School Nurse Association of North Carolina, helped us understand the strengths of SHAC’s current operations and provided direction so that we may appropriately tailor our services to better serve the greater Orange County area. As SHAC continues to grow, the organization continues to seek new opportunities to provide health services to our community. Our interdisciplinary model allows us to adapt to its changing needs; but our success would not be possible without the tremendous support we receive from UNC and our community.
Nonprofit Organization U.S. Postage PAID Chapel Hill, NC Permit No. 177
The Medical Foundation of N.C., Inc. 880 Martin Luther King Jr. Blvd. Chapel Hill, N.C. 27514-2600
MEDICAL ALUMNI ASSOCIATION
Fall Alumni Weekend & Homecoming October 29 & 30, 2010 For more information, call the Medical Alumni Office at (919) 962-8891 or visit www.med.unc.edu/alumni. Sponsored by The University of North Carolina at Chapel Hill School of Medicine
Published on Jul 29, 2010