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PUBLISHED BY THE WORCESTER DISTRICT MEDICAL SOCIETY

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Worcester Medicine is published by the Worcester District Medical Society321 Main Street, Worcester, MA 01608, 508.753.1579

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WORCESTER DISTRICT MEDICAL SOCIETY OFFICERS

Richard Aghababian, PresidentBruce Karlin, Vice PresidentJoseph Cohen, SecretaryRobert Lebow, TreasurerJoyce Cariglia, Executive DirectorMelissa Boucher, Administrative AssistantFrancine Vakil, WDMS Alliance

EDITORIAL BOARD

Paul Steen, MD, EditorGary Blanchard, MDCarol Bova, PhD, RN, ANPGeorge Brinnig, MDAnthony Esposito, MDRobert Finberg, MDMichael Hirsh, MDPeter Lindblad, MDJane Lochrie, MDMichael Malloy, PharmDThoru Pederson, PhDJoel Popkin, MDRobert Sorrenti, MD

Contents

Worcester Medicine does not hold itself responsible for statements made by any contributor.Statements or opinions expressed in Worcester Medicine reflect the views of the author(s) and notthe official policy of the Worcester District Medical Society unless so stated. Although all adver-tising material is expected to conform to ethical standards, acceptance does not imply endorsementby Worcester Medicine unless stated. Material printed in Worcester Medicine is covered by copyright.No copyright is claimed to any work of the U.S. government. No part of this publication may bereproduced or transmitted in any form without written permission. For information on subscrip-tions, permissions, reprints and other services contact the Worcester District Medical Society.

Inside this Issue:4 Editorial

Jane Lochrie, MD

5 Dialysis in AfricaWayne Trebbin, MD

7 International Initiatives at Massachusetts College of Pharmacy and Health SciencesGeorge E. Humphrey, PhD

8 Working Globally:Lessons Learned from Conducting an HIV Education and Prevention Project in ArmeniaCarol Bova, PhD, RN, ANPCarol Jaffarian, MS, RN, ANP

9 International Medical Education atUMASS Medical SchoolMichael Godkin PhD

11 Medicine and Citizen DiplomacyRoyce Anderson, PhD

12 Cultural Adjustments forInternational ResidentsGary Blanchard, MD

14 Science CornerKatherine Luzuriaga, MD

15 Off CallMichael Hirsh, MD

18 Financial Advice for PhysiciansJohn F. King

20 In MemoriamGeorge Rodgers Dunlop, MDRichard A. Gleckman, MD

22 Society Snippets

May/June 2007 • WORCESTER MEDICINE 3

Editorial

The noun “globalism,” from which the word“globalization” is derived, was first coined byHarvard economist Raymond Vernonaround 1970. The economic phenomenonof globalization has broadly affected thehealth care industry and the medical profes-sion in general. It has brought to light theworld’s biggest health problem ~ worldpoverty. A huge gap exists between the richand the poor in our world and the chasmwidens. In 1960 the income of the wealthi-est fifth was 30 times greater than the poor-est fifth; it is now 80 times greater. It isagainst this background that humanitariantragedies like that in Kosovo occur.

In 2004 WHO reported that the average life

expectancy in the U.S. was 69.3 years; inSierra Leone it was 28.6 years. While popu-lation segmentation according to health sta-tus is a global socioeconomic reality in bothindustrialized and developing countries, it isnot morally defensible if it excessivelyrations or completely restricts health caredelivery to some sectors. In addition, physi-cians are being actively recruited to leavetheir country and take a more lucrative jobabroad. This “brain drain” severely limits adeveloping country’s ability to deal with itshealth care problems.

As I reviewed the articles for this issue ofWorcester Medicine, I felt fortunate to be partof the Worcester medical community. I am

proud of the efforts of this city in helping tobring health care to numerous developingcountries.

Wayne Trebbin, M.D. tells of his relation-ship with WORTH (World Organization ofRenal Therapies), a non-profit organizationwith the intent of placing dialysis units incountries where the diagnosis of chronicrenal disease previously was a death sen-tence. Yet there is still a need for erythropoi-etin, vitamins, phosphate binders and anti-hypertensive medications.

George Humphrey, PhD describes theMassachusetts College of Pharmacy andHealth Sciences’ relationship with universi-ties in Asia, Latin America and Europe thatshare a common interest in fostering crosscultural competencies among their facultyand students.

Carol Bova, PhD, R.N., ANP and CarolJaffarian, M.S., R.N., ANP report on the les-sons learned from their innovative, nursepractitioner managed HIV education andpreventive program in a rural village inArmenia.

Royce Anderson, PhD informs us of theInternational Center of Worcester’s hardwork in providing citizen exchanges as a wayto break down political and cultural barriers.

In his powerful article, Dr. Mick Godkinnotes with justifiable pride that 47% of theUniversity of Massachusetts medical stu-dents have completed an elective abroadcompared to the national average of 27%.

Gary Blanchard, M.D. once again entertainsus with his “man on the street” interviews ofinternational medical graduates as theyrelate their first experiences in a U.S. med-ical system.

As you read these compelling and effectivearticles, I hope that you realize all the out-standing work that the physicians, nursesand pharmacists of Worcester are doing tohelp close the gap in health care delivery inmany developing countries.

Worcester’s Endeavor toImprove Global Health

Jane Lochrie, MD

4 WORCESTER MEDICINE • May/June 2007


The air in the clinic was hot, humidand stale. The last patient of the dayentered the room when the nurse beck-oned to him to do so. At 60, he was oldin his world. The man was tall and car-ried himself well, emanating dignityand leadership although he had not yetspoken. The corners of his eyes wereenhanced by lines created from his kindsmile that he now bestowed on me ashe approached, and his mouth wasedged by the lines of wisdom. Dressedin a blue, long tunic shirt typical of thestyle of his culture, with matchingloosely fitting trousers, he was the pic-ture of Africa itself. He moved with aslow stately stride towards us, and myfirst gut reaction was to like him imme-diately.

My colleague, who was hosting myobservational visit to the clinic, leanedsideways toward me, and said in a quietflat tone, “He is a dead man.”

My head snapped towards her, and Iasked her to repeat what she had justsaid, although I had heard it perfectlywell.

“He’s a dead man. But he does notknow it.” My hostess was the only realnephrologist in the entire city ofYaounde in Cameroon, and she wastired. In her richly accented English sheexplained that the man had severe renalfailure, but there was no dialysis avail-able to him in the entire country. Ilooked at the man again, and I felt atightening of my spirit as I realized shewas right. He just didn’t know it yet.

That is a statement as to the state ofnephrology in Cameroon as it was then,two years ago: a handful of poorly rundialysis units with poorly trained staffand machines that constantly broke

down with no hope of repair. Peoplewould receive dialysis once every twoweeks if they dialyzed at all. Althoughthis was well intended, all it did wasprolong their dying. This is a countrywhere the average income equals 640dollars per person per year, where theaverage man is dead by 47 years of ageand the average woman by 49. Povertyis everywhere, and death stalks the pop-ulace.

That is the country where I came toaffirm my belief that individuals dohave the ability to affect change. That isthe country where I affirmed my beliefthat it is morally reprehensible in theWest to see tragedy and shrug one’sshoulders while watching the news ontelevision, then dismissively reach foranother helping of potatoes at the din-ner table.

WORTH (World Organization ofRenal Therapies) officially came into

existence only two years ago. It is anAmerican based non-profit organiza-tion with the goal of placing dialysisunits in the third world in locationswhere end stage renal disease is essen-tially a death sentence. WORTHquickly gained an energetic, upbeat,dedicated core group of men andwomen, and I am pleased to say that ~through their untiring work and againsttremendous odds ~ as of November2006 we have a well functioning dialy-sis unit in the city of Yaounde. It oper-ates on modern standards and so far itsquality, as gauged by mortality, morbid-ity and morale, is every bit equal towhat we have here in the United States.It functions in collaboration with theCentral Hospital University of Yaounde(CHUY), and is generously supportedby Davita and other donors.

To date we have accrued eight patientsas we approach our capacity of 24. It isour intent to make this unit the pol-ished flagship of our efforts, and when itis ready we will begin to build moreunits of its kind in Africa.

Our lines of contact span 9,000 miles,from California to Central Africa.Hundreds of dedicated people havebeen recruited. American andCameroonian lawyers, government offi-cials, the medical establishments of twocountries, and industry have allhelped…and, incredibly, they have, forthe most part, done so as volunteers.Yes, we do live in cynical times, but itdoes not always have to be thatway…not by a long shot. Sometimesmy fellow human beings show what canbe when people really aim for the good.

Our nursing staff in Cameroon has beenincredible. Many of them had no con-cept of what dialysis even was when they

Global Health

Dialysis in AfricaWayne Trebbin, MD, Program Director and Director of Nephrology, Salem Hospital

Founder of WORTH (World Organization of Renal Therapies)

Our first patient after her first dialysis session with us


joined us. However, they were eager tolearn and approached their tasks withunabashed enthusiasm. Teamed withAmerican instructors who worked tire-lessly with them, they have emerged as ahighly competent group, gaining inexperience and confidence each day.

We are gathering data so that we canreport our experience to the rest of themedical world. We want people to knowwhat we have done because we wantthem to know that it can be done.Imagine if other disciplines take up themantle of our efforts. Imagineendoscopy suites, open heart surgeryand the myriad of other high tech med-ical support systems we take for grantedin the west. I was told by experts beforeI started WORTH that what I intendedto do could not be done. The thirdworld was not conducive to, could inno way support, and would in facterode, what I wanted to build. Theexperts were wrong.

Despite all this progress there remainneeds. We have a great need for ery-thropoeitin, appropriate vitamins andintravenous iron. We need antihyper-tensives and will need more phosphatebinders in a few months. And of coursewe need continued funding to perpetu-ate our work.

Some have leveled criticisms at what weare doing. “That’s a lot of money for sofew patients,” said one such person tome. What I was tempted to say to herwas, “Let’s pretend it is your child beingdialyzed. You tell me when we havespent enough money and should stopdoing the procedure.” What I said wasthe simple fact that we have neverdrained (and never will) money going toother health care projects. The funds wehave generated were from sources dedi-

cated to what we are doing, neverintended for anything else.

Another comment has been, “It’s hope-less; it’s a drop in the bucket.” I answerwith a parable a friend of mine told meabout a man throwing starfish that werewashed up on the beach back into theocean. When a passerby said to himthat it was a hopeless task, that it wouldnot change anything, the man bentdown, threw another starfish back intothe sea, and, smiling at his critic,replied, “It made a difference for thatone.”

So how will this play out? No oneknows the future. All I can say is that aslong as I am breathing I will be in thestruggle, and many of my colleagues inWORTH feel the same. I have caredfor patients in Cameroon, I have friendsthere, and I have even had the honor ofbeing made a member of a tribe there. Iam a loyal American, but a part of myheart will forever be in Africa. Change ispossible. It often comes slowly, with alarge price in effort, energy, fatigue, dis-couragement, but ultimately therecomes the thrilling realization thatsomething wonderful has unfolded, notby accident but by the efforts of indi-viduals. Everyone can make a difference.The only question is will they try.

Staff in a corridor outside of the unit.

A view of part of the Worth-Chuy Dialysis Unit.


In response to the rapid globalization ofhealth care education and delivery,Massachusetts College of Pharmacy andHealth Sciences has developed collabo-ration agreements with universities inAsia, Latin America and Europe. Thepurpose of these “sister college” relation-ships is to create a network of interna-tional partners who share a commoninterest in fostering cross-cultural com-petencies among their faculty, studentsand alumni.

Formal pacts have been signed with theSchool of Pharmacy and PharmaceuticalSciences, Trinity College Dublin;University of Havana, Cuba; CatholicUniversity of Santa Maria, Arequipa,Perú; Niigata University of Pharmacyand Applied Life Sciences, Japan;Faculty of Pharmaceutical Sciences,Chulalongkorn University, Bangkok,Thailand; and Hangzhou MedicalCollege, Hangzhou, China. The agree-ments provide a framework for facultyand students to engage in individualresearch and study projects. In recentyears, students have presented scholarlyposters in Cuba, taken summer electivecourses on tropical medicine and med-ical anthropology in Perú, and partici-pated in service learning trips toGuatemala during summer break. TheCollege has also hosted pharmacy stu-dents from Perú and Spain, as well asguest faculty from Ireland, Cuba, Japanand China.

For example, during their holiday breaklast December seven nursing studentsfrom MCPHS-Worcester traveled toThailand to volunteer in rural healthclinics and one city hospital for a periodof three weeks. Students were especiallyimpressed with the autonomous role ofthe nurse within the Thai health caresystem, and they returned with a first-

hand understanding of the culturalaspects of health care delivery. Last sum-mer, an MCPHS pharmacy student didan advanced practice rotation in theNetherlands, working with theInternational Pharmaceutical Students’Federation (IPSF) on projects forWHO.

In the area of research, the College’sDivision of Graduate Studies enrolls stu-dents, from several foreign countries,who are pursuing doctoral degrees inpharmacology, medicinal chemistry andpharmaceutics. A PhD candidate fromPerú, for example, is conducting a studyof the Maca plant, known for centuriesamong Andean peoples for its medicinalproperties, which may be useful as aneuroprotective agent for the preventionor treatment of stroke. In the area ofpractice, MCPHS faculty have conduct-ed workshops in Cuba, Perú, Japan andIreland on the role of the clinical phar-macist and the practice of pharmaceuti-cal care.

For Latin American pharmacists inter-ested in practicing in the United States,MCPHS has created a certificate pro-gram that prepares foreign graduates for

licensure in the USA. To date, fifty phar-macists from Perú, Venezuela andColombia have completed the programand most have either begun internshipsor have become licensed inMassachusetts, Michigan, Florida orWashington State.

MCPHS President Charles F. Monahan,Jr. recently led a delegation of trustees,faculty and administrators to Hangzhou,China in order to launch a new collabo-ration agreement with HangzhouMedical College. Among the projectsunder development with Hangzhou areinternational programs in nursing,Chinese traditional medicine andWestern pharmacy. As a first step, fivenursing and pharmacy faculty will bevisiting the College this summer to learnmore about the MCPHS curriculumand to improve their English languageskills. The two institutions have alsoagreed to co-sponsor an internationalconference on the globalization of healthcare, to be held in Hangzhou in earlyNovember 2008.

George E. Humphrey, PhD is Associate VicePresident for External Affairs at MassachusettsCollege of Pharmacy and Health Sciences.

International Initiatives at MassachusettsCollege of Pharmacy and Health Sciences

George E. Humphrey, PhD

Global Health


In 2003, we were given an excitingopportunity to work with the ArmenianRelief Society, Inc. (ARS) to bring aninnovative HIV education and preven-tion program to a health clinic in a ruralvillage in Armenia. Our initial projectwas funded by the World AIDSFoundation and included delivering HIVeducation to over 310 physicians, nurses,teachers, and community members. Ourwork continued with funds from privatedonations and Sigma Theta Tau andresulted in HIV testing and counselingservices in the rural clinic. The followingis a brief summary of some of the lessonswe learned while conducting this project.

First, we learned that a strong workingrelationship with an in-country organiza-tion is essential for success. We were for-tunate to work with the ARS. Our col-leagues from the ARS arranged meetingswith major stakeholders, facilitatedmoney transfers, and provided in-countrysupport for our project. Through thispartnership we were able to meet regular-ly with members of the Health Ministryand other non-government organizations(NGOs) working on HIV-related issuesin Armenia.

Second, we found that repeated visits overtime were necessary to establish trust andcommitment within a transitional coun-try. Repeated short trips (e.g. 2 weekstays 3 or 4 times per year) worked well tomaintain relationships and sustain theproject momentum. From our observa-tions (and reports from in-country col-leagues) we became skeptical of the bene-fit of single trip projects. Admittedly, itmay be useful to expose U.S. students andfaculty to different cultural contexts;however, we doubt the efficacy of projectswith limited ongoing individual commit-ment. It has taken us four years andapproximately fifteen in-country visits toestablish trust and a genuine sense of

commitment between our project teamand that of our in–country collaborators.

Third, it is important to “…never pass upa free lunch.” Many of our importantideas about future projects and insightsabout the culture and working inArmenia came from informal lunch meet-ings with members of the community aswell as major stakeholders. Although youmay want to say, “Not another meal,” wefound that more is said over dinner thanin an office or board room.

Fourth, an often overlooked but impor-tant issue to consider when working in atransitional country is where to stay.There are typically two ways to thinkabout this issue. Many either head for themost “western” hotel they can find or liveamong the villagers. We decided to doboth. We found that living in the villagehelped us forge relationships with thecommunity itself and added to ourunderstanding of the day-to-day issuesfaced by the people we worked with there.However, staying at the hotel allowed usto meet important officials (e.g., RedCross, USAID, and other NGOs) whowere doing work in Armenia. Over thepast several years we have developedexcellent working relationships with thesecolleagues that would not have been pos-sible had we stayed exclusively in the vil-lage.

Fifth, we learned that it is important to“…boldly go where no man has gonebefore.” In the world of HIV, there arenumerous academic, non-profit, andNGOs involved in international HIVwork. Funding for HIV programs hasbeen largely earmarked for the highprevalence countries and therefore theprograms many go where the funding isavailable. We chose to work in a countrywith an unknown HIV seroprevalence(at least that was the case at the start ofour project; now we know it is approxi-mately 1% of the population) and limit-ed access to funding resources. Thischoice afforded us unlimited access tohealth care providers and policy makerswho enthusiastically embraced our effortsto conduct HIV prevention work in theircountry. In addition, it gave us a break-through presence in the internationalarena. We helped fund, organize, and runthe first two National HIV Conferencesin Armenia, were invited to present ourproject findings at the United Nations,and currently hold (Ms. Jaffarian) a seaton the United Nations NGO Committeeon HIV/AIDS.

In summary, as Nurse Practitioners withmore than 15 years of experience caringfor HIV-infected adults in the U.S., wethought we were well prepared to take onthe challenge of implementing an HIVeducation and prevention project inArmenia. However, we were not preparedfor the roller-coaster ride associated withconducting a major health project in atransitional country. Although this paperhighlights only a few of the lessonslearned, others will have to wait for later(e.g. always carry diphenhydramine, don’tdrink Armenian brandy before giving apresentation, etc.), we hope that thissummary will be useful to others whoplan to begin similar work.

Working Globally:Lessons Learned from Conducting an HIV

Education and Prevention Project in ArmeniaCarol Bova, PhD, RN, ANP, Associate Professor of Nursing and Medicine, University of Massachusetts Worcester

and Carol Jaffarian, MS, RN, ANP, Instructor, University of Massachusetts Worcester

Global Health

Young peer educators attending a training session in Akhourian,Armenia.

In academic year 2005-06, ninety twoUniversity of Massachusetts MedicalSchool (UMMS) students participated ininternational learning experiences in 23countries. In the Association of AmericanMedical College’s GraduationQuestionnaire (GQ) for the Class of2006, 47% of UMMS students reportedhaving completed an elective abroad,compared to the national average of 27%.Why is it important for students to havethese experiences? Increasingly, studentsare recognizing the importance of devel-oping cultural and linguistic skills thatthey can use with rapidly growing for-eign-born populations in the US. In ashrinking world it is also in the best inter-est of the US and its doctors to beinvolved in the eradication of diseasesthat are a mere plane ride from ourshores. Tommy Thompson, a formerSecretary of the Department of Healthand Human Services, has even said med-ical diplomacy is our best weapon againstterrorism

1. And then there is what has

been called our moral responsibility as awealthy country to help resource-poorcounties, including through a MedicalPeace Corps

2.

U.S. Census data indicate that the for-eign-born population in Massachusettshas increased by 34.7% since 1990 andconstitutes 12% of the population

3.

Massachusetts is now the eighth leadingstate for the number of foreign-born resi-dents. The same data source reports thatin Worcester, a city of 172,648 inhabi-tants, 15% are foreign-born and justunder 30% speak a language other thanEnglish at home. Recent immigrant pop-ulations, including children, also accountfor a substantial number of people wholack insurance in MA, e.g., 27% of chil-dren of non-citizens are uninsured com-pared to 12% of citizen children. InWorcester, 18% of its families are belowthe federal poverty level compared to 9%statewide.

Separate international electives are oneway to enhance the interest and abilitiesof medical students to serve foreign-bornpopulations. Our own data show thatthese electives are related to the develop-ment of cultural sensitivity and idealism

4.

They also facilitate learning second, if notthird, languages. Sixty percent of UMMSstudents in the Class of 2006 reported onthe GQ that they had learned anotherlanguage during medical school, com-pared to 26% of U.S. medical students.

An Optional Enrichment Pathway onServing Multicultural UnderservedPopulations at UMMS provides a morecomprehensive global education program

that, over four years, combines interna-tional and domestic experiences withprevalent foreign-born populations inMA. These include international elec-tives, an assignment to a local foreign-born family, a local community serviceproject with an immigrant group, and afamily medicine clerkship in aCommunity Health Center. An initialanalysis of this program provides encour-aging evidence that it may help sustainpositive attitudes toward the medicallyindigent in Pathway students that declineat a high rate in non-Pathway students

5.

Some students have become leaders ofsignificant projects abroad. These include

International Medical Education atUMASS Medical School

Michael Godkin, PhD, Professor of Family Medicine and Community Health and Director, International Medical Education

Global Health


a sustainable community developmentproject in Tanzania (www.malaikapro-ject.org), a boarding school program forchildren at risk for abduction in northernUganda (www.thechildisinnocent.org), aliteracy project in the DemocraticRepublic of Congo-DRC (www.gomastu-dentfund.org), a revolving loan programin Zambia, an HIV intervention programfor street orphans in Zambia, a world-wide quilt-making project for orphans(www.patchesoflove.org ), and alternativeSpring Break brigades to the DominicanRepublic in which around 40 studentswill participate this year. (www.umass-mission.googlepages.com )

In describing her project in the DRC,Alison Lee (Class of 2007) says, “As amedical student it’s very easy to beextremely self-focused. This project helpsme keep my eye on the reason why I wentto medical school in the first place.”

Students have brought home skillslearned abroad and started projects herewith immigrant groups. One Africanmentoring program initiated by a student

provides weekly one hour, one-on-onetutoring by medical students with over 40African children in Worcester. This year,the same student, working with Africancommunity leaders, started the AfricanCommunity Education program, an all-day school on Saturdays for about 45African students. Other UMMS studentsare starting Well Being, a health educationnewsletter in Spanish and Portuguese thatwill provide important health informa-tion and tips on how to access resources.After studying Portuguese in the Azores,another group of students worked with alocal physician to start the free clinic inHudson.

It is clear from the reflections that stu-dents are required to write that many aregreatly affected by their experiencesabroad. One such student, an AlbertSchweitzer Fellow in a hospital in Gabonthat Dr. Schweitzer himself founded,describes her three month elective as“…overwhelming but extremely reward-ing. Interacting with patients in a foreignlanguage to diagnose and treat illnesses Ihad never seen, while trying to under-

stand the patient in the context of a cul-ture I wasn’t familiar with, forced me tobecome a stronger, more competent andresourceful physician.”

References:1. Thompson TG. The cure for tyranny.Boston Globe 2005; October 24.2. Rotberg RI, Salinas VI. Needed: amedical peace corps. Boston Globe 2005;May 10.3. U.S. Census Bureau. Census 2000.Washington, D.C.4. Godkin MA, Savageau JA. The effectof medical students’ international experi-ences on attitudes toward serving under-served multicultural populations. FamilyMedicine 2003; 35:273-8.5. Godkin MA, Savageau JA, FletcherKE. Effect of a global longitudinal path-way on medical students’ attitudes towardthe medically indigent. Teaching andLearning in Medicine 2006; 18: 226-33.


In December, 2006 I received a call askingthe International Center of Worcester(ICW) to arrange a 1-day program for agroup of 16 Iranian physicians travelingon a professional exchange sponsored bythe U.S. Department of State’sInternational Visitor Leadership Program.This was an unusually difficult requestbecause I had only a few days to organizethe program. I immediately got on thephone and began calling many of ourmedical contacts in the Worcester areawith whom we regularly work. Somecould not accommodate us on such shortnotice, but others made an heroic effort tohost our Iranian guests.

Dr. Frances Anthes, Director of the FamilyHealth Center of Worcester, provided ameeting and break-out sessions with sever-al of her medical staff, selected to reflectour visitors’ medical specialties. Dr.Richard Aghababian, Chair of theDepartment of Emergency Medicine atUMass Medical Center, was travelingwhen I called but gave approval for his staffto organize a tour of the EmergencyDepartment ~ which he led on his first dayback. Dr. Joel Popkin at Saint Vincent’sHospital welcomed them to the WorcesterMedical Center. Edla Bloom and JoeMcKeen showed them their operation atAIDS Project Worcester. Although allthese visits were planned at the last minute,they exactly targeted the needs of theIranian doctors. I was struck by theIranians’ friendliness, gentleness, curiosity,and excellent English. They all expressedtheir appreciation for the warm attentionand useful information they received inWorcester.

I later received letters of appreciation (seeour website) from the U.S. StateDepartment and the Institute forInternational Education. The Iranian doc-tors had other stops on their junket,including Washington, D.C. and theCenters for Disease Control in Atlanta,attending high level lectures and confer-

ences. But they wanted to see medicineworking at the grass roots level. When theyarrived early at the Family Health Center,just waiting in the lobby and watchingpeople come and go taught them a lotabout medical services in the US. Theirtrip was under high security, and we couldnot reference the State Department on anydocuments they might take with themback to Iran. But their experience in theU.S. and contacts with their Americancounterparts made a tangible contributionto improving international understandingbetween our two countries.

Citizen Diplomacy is simply the power ofordinary people meeting ordinary peoplefrom other cultures. Whether governmentor privately sponsored, citizen exchangesare a vital way to break down political andcultural barriers “…one handshake at atime.” As thousands visit the U.S. eachyear, stay in our homes, spend time in ourworkplaces, and visit our schools, we builda growing network of international com-munication and friendship. We are livingin a time of rising international tensions;whatever your political orientation, youcan’t help but be concerned about the cur-rent trends and the deteriorating trustamong the peoples of the world.

ICW has hosted many groups of profes-sional people in its 44 year history.Worcester, including its medical commu-nity, has opened its doors to welcomethem. ICW’s very first programs in the1960s assisted wives and families of inter-national doctors and scientists at theFoundation for Experimental Biology inShrewsbury. More recently we have hostedgroups from the independent countries ofthe former Soviet Union. We make aneffort to stay in contact with our alumniafter they return home.

Medicine, as a profession, has an inherent-ly global perspective. Physicians havealways shared research and medical knowl-edge across international boundaries. Wefind that ICW’s medical alumni, upontheir return to their home country, discov-er that their colleagues are receptive to theideas they bring from the U.S. and, as aresult, are able to implement change. Incontrast, many of our other alumni returnto encounter resistance from their profes-sional colleagues to “foreign” ideas fromthe U.S. Doctors seem much more open tothe global exchange of ideas.

The global medical community has, there-fore, a special role in fostering internation-al cooperation and peaceful interaction.While political, economic, and culturalbarriers can impede communication andthe exchange of ideas among nations,physicians can maintain mutual respectand more open channels of communica-tion, giving them a special opportunity toput Citizen Diplomacy to work.

ICW appreciates the willingness of theWorcester medical community to partici-pate in international exchanges. We lookforward to continuing our efforts and wel-come any dialogue exploring ideas and ini-tiatives for future programs.

Medicine and Citizen DiplomacyRoyce Anderson, PhD, Executive Director, International Center of Worcester

Global Health


The International Center of Worcester


Forests have been razed to chroniclethe culture shock faced by DaisukeMatsuzaka, our most prized Japaneseimport since sliced sushi:

• Dice-K only has one Japanese-speak-ing buddy on the team (and the waitcontinues for Curt Schilling to master“Japanese for Dummies” …)!

• Dice-K might have to figure out howto break $51.1111 million for a tokenon the Red Line to get authentic pick-led plums and sakuban in PorterSquare.

• *wink* Dice-K *wink* needs the RedSox to hire his wife’s good friend toserve as his “personal media liaison.”

But on April 11th, when Matsuzaka-santoed the rubber at Fenway for the firsttime, it was still 60 feet, 6 inches tohome plate. As Gene Hackman mightsay, “I think you’ll find these exact samemeasurements in our dome back inTokorozawan.”

Now compare that to a foreign medicalschool graduate, unquestionably a for-mer star in his or her own right backhome, taking the field in an Americanhospital for the first time ~ on his or herfirst day as a physician, no less. EvenAmerican-born interns, after all, withtheir built-in home field advantage,have been known to lock themselves ina janitor’s closet after getting two simul-taneous pages on Day One.

But imagine on your first day as a doc-tor that they suddenly changed thenames of many of the medications youspent years assiduously learning in med-ical school (thank you, AmericanBigPharma). Now, the patients notonly openly disagree with you but also

question your authority ~ a develop-ment especially stunning to Indian doc-tors, who are used to being venerated asgods back home, their opinion so sacro-sanct their patients dare not utter aword of dissent to even the most cock-eyed of treatment plans. Oh, and thenthere’s also the small matter of quicklyassimilating a second language and awholly different culture in order toeffectively treat patients.

For international medical graduates(IMGs), their first day on the job issomething like tumbling down the rab-bit hole ~ and awakening to a world runby machines using humans as Duracellbatteries… paved in yellow brick roads.

That is a culture shock.

And, oh yeah, Dice-K could kill myfantasy baseball team. These guys couldactually kill someone.

Yet they keep coming ~ fromColombia, Syria, New Zealand, partsnear Transylvania (Romania), and, ofcourse, India, to name but a few coun-tries among the six continents from

where our hospital’s residents hail (St.Vincent’s is even reportedly laying thegroundwork for an Antarctic outpost tosign promising 16-year-old rookiephysicians.). In 2007, 11,262 IMGsapplied for a residency or fellowshipthrough ERAS last year ~ nearly doublethe 5,912 IMG applicants using ERASas recently as 2003. During this cur-rent application cycle, IMGs accountedfor 40 percent of the total applicants ~compared to 30.8 percent only fouryears ago.

The difference in working in a U.S.hospital is immediately and starklyapparent to an IMG. “Everyone here isso educated and Internet savvy,” saidDr. Anupama Gandhe, a second yearresident from Osmania Medical Collegein India. “It is almost like [the patients]know what they have and are coming toyou only to confirm!”

“Sometimes I feel like they know morespecific details about their diseases and[just] wanted the most up-to-date infor-mation,” added Dr. Ananth Vadde,graduate of Kasturba Medical Collegein India, also a PGY-2 internal medi-cine resident at St. Vincent Hospital. “Istill remember one of my patients ask-ing me, ‘I am told that there were newguidelines for afib. Can you tell memore about [them]?’”

Entering a world of unbridled,unapologetic capitalism, where dollarsare spent often, liberally, and unequally,also makes for a kind of Wonderland.IMGs are flabbergasted to learn that adoctor can order lab work and imagingstudies almost on command. InRomania, for instance, only one CATscan exists for five hospitals ~ with awaiting list as long as the one for RedSox season tickets. Obtaining an MRI

Cultural Adjustments forInternational Residents

Gary Blanchard, MD

Global Health


in New Zealand was “…mission impos-sible,” according to Dr. BognaTargonska, an intern from theUniversity of Otago in New Zealand.“It was therefore quite an odd feelingordering a whole body CT and nobodycommenting on that.”

But with such easy access to imagingstudies, many IMGs fret the loss ofreliance on physical exam skills in mak-ing a diagnosis and adjusting treatmentplans (You have to get good at auscul-tating murmurs pretty fast when it takesa month to get an echocardiogram.). “Ido feel that doctors are forced to dosome unnecessary testing just to coverthemselves since patients are not alwayseasily satisfied,” said RadhaRaghupathy, a PGY-3 at St. Vincent’s.

Some IMGs do adjust more quicklythan others. “I think if you are a foreigndoctor you just need a few days to adjustto the system, and, in the end, it will bebetter than the one you were used to in

your own country, mainly if you comefrom a third world country like mine,”said Dr. Maria Hincapie-Marquez, asecond year resident from the Juan N.Corpas School of Medicine inColombia.

But for others, even fundamental, inte-gral tasks such as interviewing patientsremain daunting. Some sense bias frompatients who sometimes muse aloudhow “It would be nice to be able to pro-nounce my doctor’s last name for once.”

Regardless, feeling overwhelmed on thefirst day of any occupation is nearly uni-versal. “The first day was a combinationof curiosity and excitement about theunknown, as well as a feeling of pressureto prove myself in a new environment,”said Dr. Raghupathy.

For an IMG, it doesn’t get much moreunknown than on your first day as adoctor on foreign soil.


Dr. Luzuriaga is Professor of Pediatricsand Molecular Medicine; Chief ofPediatric Immunology, Infectious Diseases,and Rheumatology; and Director of theMaternal-Child HIV Program at theUniversity of Massachusetts MedicalSchool

Since the onset of human immunodefi-ciency virus type 1 (HIV-1) pandemic25 years ago, 60 million individuals havebeen infected and 39 million individualsare currently living with infection.Nearly 5 million individuals acquireinfection each year[1]. Most (4.2 mil-lion; 84%) newly infected people arebetween 15 and 49 years of age and livein sub-Saharan Africa. Since infectioncommonly occurs during the peak pro-ductive and reproductive years, HIV-1related morbidity and mortality haveadversely affected the social, political,and economic stability of the regionshardest hit by the pandemic.

Heterosexual transmission is the pre-dominant mode of transmission globallyand 50% of new infections occur inwomen. In sub-Saharan Africa, HIV-1seroprevalence rates in antenatal clinicsrange from 10-40%. Mother-to-childtransmission (MTCT) is the predomi-nant mode of pediatric infection.Approximately 2.5 million children areborn to HIV-1 positive women per yearand are thus at risk for infection;700,000 children are newly infected peryear. One third of HIV infected chil-dren in Africa die by their first birthdayand half die by their second birthday

2.

The high mortality associated with pedi-atric HIV infection has reversedadvances in child mortality achievedover the latter decades of the twentiethcentury through immunization andpublic health programs.

Maternal and perinatal antiretroviraltherapy (ART) regimens can markedlyreduce MTCT. In 1994, Connor andcolleagues

3demonstrated that zidovu-

dine (ZDV) therapy of women through-out pregnancy and delivery, along withpost-partum ZDV treatment of theirinfants, resulted in a decreased transmis-sion rate to 8.3% compared with a trans-mission rate of 25.5% in the placebogroup (67% reduction in MTCT). Asmore women in the United States andEurope have received continuous combi-nation ART to optimize their ownhealth, overall MTCT rates havedropped to under 2%

4.

MTCT can occur in utero, during deliv-ery, or post-partum through breast milk,with the majority of transmissionsoccurring during vaginal delivery orthrough breastfeeding. A single dose ofnevirapine (NVP) administered to awoman during delivery, followed by asingle dose of NVP to the baby, can alsomarkedly reduce the risk of intrapartumHIV-1 transmission

5However, while

NVP’s manufacturer (Boehringer-Ingelheim) has provided NVP free ofcharge to MTCT prevention programs,fewer than 10% of HIV positive womenin limited-resource settings around theworld actually have received prophylac-tic NVP

6.

What can be done to advance our abili-ty to prevent mother-to-child transmis-sion of HIV in limited-resource settings?First, there is a great need for operationalresearch to define and optimize healthcare delivery systems that will ensurethat women and infants have access to acontinuum of pre-, peri-, and post-natalcare ~ including HIV testing and accessto antiretroviral therapy ~ if needed.Secondly, currently available ART regi-mens do not prevent MTCT through

breastfeeding and clinical trials must bedone to evaluate the efficacy of ART inpreventing breastmilk HIV transmis-sion. Finally, given the scope andimpact of the pandemic, the develop-ment of an effective prophylactic vaccineis a major priority. An infant HIV vac-cine regimen, begun at birth, would notonly prevent MTCT but might also pro-vide the basis for lifetime protectionagainst HIV-1 infection

7. Booster vac-

cines could be administered in latechildhood to protect against sexualacquisition of HIV-1. Utilization of theexisting health care infrastructure thatalready successfully delivers routinechildhood vaccines could enhance thefeasibility of this approach.

References:1. United Nations Programme on HIV/AIDS(UNAIDS); http://www.unaids.org. 2. Newell ML, Coovadia H, Cortina-Borja M,Rollins N, Gaillard P and Dabis F. Mortality ofinfected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis.Lancet 2004; 364:1236-1243.3. Connor EM, Sperling RS, Gelber R, et al.(What is our house style for listing authorsbeyond a certain number?) Reduction of mater-nal-infant transmission of human immunodefi-ciency virus type 1 with zidovudine treatment.Pediatric AIDS Clinical Trials Group Protocol076 Study Group. N Engl J Med 1994;331:1173-1180.4. Mofenson LM. Advances in the prevention ofvertical transmission of human immunodeficien-cy virus. Semin Pediatr Infect Dis 2003; 14:295-308.5. Guay LA, Musoke P, Fleming T, et al.Intrapartum and neonatal single-dose nevirapinecompared with zidovudine for prevention ofmother-to-child transmission of HIV-1 inKampala, Uganda: HIVNET 012 randomisedtrial. Lancet 1999; 354:795-802.6. Piot P. AIDS: from crisis management to sus-tained strategic response. Lancet 2006; 368:526-530.7. Luzuriaga K, Newell ML, Dabis F, Excler JLand Sullivan JL. Vaccines to prevent transmissionof HIV-1 via breastmilk: scientific and logisticalpriorities. Lancet 2006; 368:511-521.

Global Challenges in the Prevention ofMother-to-Child Transmission of

Human Immunodeficiency Virus (HIV)Katherine Luzuriaga, MD

Science Corner


Parents know that the first year in collegeis a tumultuous one for their kids. Mydaughter’s first year at Trinity has beengoing swimmingly well, eerily so. Not thatwe had worries about her academically orsocially, just the natural worry any parentsending off their baby girl to the wilds ofHartford, Connecticut might feel. Sowhen she popped up with excruciating eyepain in the middle of a rare weekendhome, a crisis truly was at hand. Of coursewe tended to the midnight visit to the ED,though I must admit that as a pediatricsurgeon used to responding to all differentkinds of emergencies through all hours ofthe night, I was really pushing for mydaughter to take two Tylenol and ridethings out to the morning. Fortunately,cooler heads (i.e. Mom) prevailed and wegot the diagnosis of corneal ulcer made at5AM. A subsequent visit to an ophthal-mologist got us confirmation of this non-life threatening but potentially problemat-ic diagnosis ~ which can result in cornealscarring if not aggressively treated with thesubject of this essay, the dreaded eye drop.In my daughter’s case, not just one butthree were originally needed. We were alsogiven extremely close follow-up by theophthalmologist, whose concern forcorneal scarring led him to recommendaggressive treatment including daily visitsthat forced us to start an almost daily com-mute to Hartford for about 5 days untilthe ulcer had stabilized and the eye wasout of danger. My daughter took it all likea trooper, managing to stay on top of herstudies despite considerable discomfortand the hassle of every 2 hour administra-tion of those blessed little eye savers.

You might be asking what I am leading upto; there really is a point to this tale if youare willing to bear with me a bit longer.When the ophthalmologist backed off onhis requests for daily follow-ups to weekly,my wife and I figured out a way that shecould retrieve my daughter and I couldthen pick her up from the ophthalmolo-

gist and return her to Trinity College inthe evening. This was predicated on greatsupport from my partners at work andcooperation from the ophthalmologisthimself in giving us an appointment lateenough in the day to accomplish the nec-essary pick up/drop off of my daughterwithout interfering with her classes. Onthe particular day that this story seeks todetail, I was assigned to pick her up at 5Pfrom the eye doctor’s suite. He had pre-scribed another set of eye drops that shewould need to take twice daily only forone month followed by once daily for asecond month. My daughter, having limit-ed pharmacy access on her college campus,

asked if we could pick up the new pre-scription on the way home to Trinity. Wethought we would be very proactive aboutthis, so I called the prescription in to adrive-thru pharmacy. They told me itwould be an hour ‘til the scrip was ready,so we went to a nearby restaurant to dineprior to the pharmacy pickup.

Of course any private time with mydaughter is a rare treat, as most of the timewhen we see her on campus it’s at verypublic and noisy parent events, footballgames, or crew races. Time at home is usu-ally stolen by old high school friends ornew college friends living around Central

Wiping Out Eye Drop AbuseOne Case at a Time

Michael Hirsh, MD

Off Call

MA who want to see their newly madebuddy from Northboro. So we enjoyeddinner and a schmooze, and then hoppedinto the car to pick up the goods (i.e. eyedrops) from the pharmacy drive thru, thenhead on our way to Connecticut. Thedrive-thru had quite a long line, and mydaughter had a tutorial at get to forCalculus ~ so the pressure was on since westill had a 75 minute drive ahead of us.But this too was a great time for father-daughter bonding. No complaints fromthis end.

When we reached the window, the phar-macist furrowed her brow, called over sev-eral colleagues, and created the obviousimpression that there was something seri-ously wrong. I recalled the scene in “It’s AWonderful Life” when George Baileysaved his boss in the drug store from inad-vertently sending out poison to a cus-tomer. Perhaps the ophthalmologist hadprescribed poison eye drops for my daugh-ter. What was up? When the drive-thruwindow opened, all was revealed. No poi-soning was involved. My insurance com-

pany had denied reimbursement for themedication, although the pharmacist saidif I came back tomorrow, they could put itthough then. I said I could not wait ‘tiltomorrow, and from the looks I was get-ting from my daughter as her tutorial classtime approached I probably could notwait for the end of this transaction. I askedhow much the out-of-pocket cost wouldbe without the insurance coverage. “Onehundred dollars,” replied the pharmacistwith a look that made me think she wasreally wondering if the 5cc of steroid eyedrops were made of Ponce De Leon orHoly Water of some sort. Having noviable choices, I handed over the creditcard and filled the prescription.

I turned to my daughter and explainedthat the father-daughter bonding was over,that we would have to spend this drivetime fighting for our rights as insuredpatients. I donned my Bluetooth hands-free headset and had my daughter assumethe role of designated dialer of the cellphone. So first the call went out to ourhealth plan. After several prompts, eachresulting in a period of hold time pepperedby some lovely classical Musak (including“Memories” from the Broadway musical“CATS”), I reached a human being. 20minutes later, the word came down. Mygroup practice plan’s PPO had subcon-tracted pharmaceutical management toanother company, which I needed to call.So my daughter dialed that second num-ber. This time, the MUSAK for the hold-ing period was Barry Manilow’s “OhMandy, you came and you gave withouttaking.” O would but were true for mypharmaceutical management company.

After another 15 minute wait, anotherhuman appeared on the phone. Iexplained the situation. This part of theconversation revealed what thePharmaceutical Management Company’sgripe with my attempt to obtain the eyedrops was all about. You see, the originaleye drop prescription written by the oph-thalmologist for my daughter was for a 14day supply. We had come back 12 dayslater for more eye drops. The big bad com-pany computer kicked out the request assomething that might indicate drug-seek-ing behavior or drug abuse. So for that rea-son, if we waited ‘til the next day, therequest would have been OK’d. However,since I had proceeded with the purchasewithout authorization, the company couldnot approve it and the $100 I laid out was


my responsibility. Translation:I was out of luck. I asked tospeak to a supervisor and, afterbeing serenaded by a lovelyMusak rendition of EltonJohn’s “Someone Saved myLife Tonight” (that would notbe referring to thePharmaceutical ControlCompany to which I wasspeaking), I reached one. Iexplained in as dispassionate away as I could what the situa-tion was, that my daughter wason a college campus andcouldn’t wait to get the drugtomorrow, that failure to becompliant with the medicationcould cause her permanentvisual impairment, that Iunderstood that the big badcompany computer was flag-ging early refills for the compa-ny to prevent drug abuse, butthat common sense would dic-tate that as a recreational drugsteroid eye drops would proba-bly never catch on. The super-visor listened, put me on holdfor one last round of Musakpresents Sammy Davis singing“I Got to be Me” (which Iheartily agree is a great song tohear when you are joustingwith a bean-counter), thencame on to tell me that thepart of the story that got herwas my daughter being aloneon the lonely Trinity Campusin Hartford without pharmacyaccess (What could be morelonely??). “Just this one time,”she told me, “the company willoverride the computer’s warn-ing. If you go back to thePharmacy, they will refundyour purchase minus the co-pay.” Perhaps she thought Iwould break down and cryover the generosity of this deci-sion. Since a total of over 2.5hours had elapsed since I firstcalled in the scrip for the 5ccvial of this witches’ brew, I didnot feel particularly grateful.But taking a cue both from mydaughter, who discouraged mefrom “flaming out,” and fromHarry Chapin’s “Taxi” wherehe talks about how “…anotherman might have been angry,

but I stuffed the bill in myshirt,” I merely said my thanksand dropped my daughter offat her dorm. We said goodbyeand she ran off to her tutorialyelling, “Sorry about the has-sle!” as she hurried off…

I drove the long way back toWorcester thinking about thedays when my father-in-law,who ran a small-town pharma-cy in Western Massachusettsfor almost 40 years, wouldhave fielded a problem likethis. He would have knownthat there was no possibilitythat we were up to no good byasking for a refill of eye drops aday early. If the insurance com-pany had hassled him, hewould have given us the drugand submitted the bill with theinsurers the next day so thatthe claim would have beenapproved. I drove straight backto the drive-thru window anddiscovered that the pharmacistwho served me earlier wasalready off. I explained whathad transpired to a new phar-macist. He reprocessed the pre-scription and found that thistime, the insurance claim wasindeed approved. I received an$85 refund. After all this com-motion and discussion, Iarrived home full of satisfac-tion that I had beaten “TheMan.” I just had to call and tellmy daughter that all the awfulposturing and verbal sparringhad yielded some positiveresults. She replied, “Wow,Dad, strong work. This wasprobably good for you to seewhat your patients have to gothrough with worse insuranceand less medical knowledgethan you.” Don’t you hate itwhen the kids show more wis-dom than their parents?Maybe their generation will beable to undo all the crazythings we’ve put into place inour health care system to pre-vent eye drop abuse.

In recent years, PIAM has developed moreand more resources for physicians lookingat issues associated with retirement andaging. Recently, we had the pleasure tomeet with Stever Aubrey, President ofDovetail Health, and with MedicalDirector Michael Cantor, MD, JD to dis-cuss the new company.

Physicians understand that most seniorswant to remain in the home as they growolder. Many medical conditions and theircomplicated list of medications can makethat goal a challenge. This problem isexacerbated as adult children get squeezedbetween raising their own children andcaring for aging relatives.

Data from the AARP indicates that nineout of ten Americans age 60 and olderwish to remain in their own homes andcommunities as they age. Needham-basedDovetail Health was launched earlier thisyear to help seniors live independently athome as long as possible by personallymonitoring and managing their healthand medication needs.

To help seniors stay in the homes theyknow and love, Dovetail Health has devel-oped an in-home care management modelthat takes into account the reasons seniorsoften have to move into care facilities ~medication errors, deteriorating chronicillnesses, and falls and injuries. The resultis a service that combines personal carewith easy-to-use technology. Starting witha thorough in-home assessment by a regis-tered nurse, Dovetail creates a comprehen-sive, personalized care plan for each client’shealth and medication management.

The nurse remains at the heart of theDovetail care team throughout the year,calling clients regularly and performing atleast six in-home follow up visits. Dovetailclients also work with a licensed pharma-cist who will come to their homes and isavailable by phone to help them under-stand their medications. Personal assis-

tants are also available to clients by phoneto coordinate these services and to providehealth and lifestyle referrals that help sen-iors live safely and well at home.

Dovetail clients and their assigned careteam are also supported by simple tech-nology from Philips Electronics, whichmonitors clients’ weight, blood pressure,and blood sugar. This information isreviewed by the Dovetail nurse every day,helping her assess client progress anddetect problems before they become emer-gencies. The in-home device is also tai-lored to send messages, health and well-ness tips, and reminders to each clientabout his or her medications, exercises,and other health-related needs.

“Long-term care has traditionally consist-ed of two options for older adults ~ movein with a family member, or move into anursing home,” said Leslie Hoyt, ChiefCare Officer, Dovetail Health. “Buttoday’s seniors are living longer and theywant the same level of choice and inde-pendence that they’ve had all their lives.This is what Dovetail Health will helpprovide.”

The company does not take the place ofolder adults’ physicians or caregivers,including their adult children. Instead,through telemonitoring and personal con-tact from the care team, Dovetail strength-ens these relationships by collecting andsummarizing valuable information about a

Using Technology and On-Site Care, a LocalCompany Helps Seniors Remain in Their Home:

Introducing Dovetail HealthJohn F. King, President of Physicians Insurance Agency of Massachusetts

Financial Advice for Physicians


client’s health needs and status. Withclient approval, Dovetail shares this infor-mation with designated providers andcaregivers, helping them to remotely andconfidently monitor the older adult’s well-being.

“With Dovetail, everyone benefits,” saidStever Aubrey, CEO and ManagingPartner, Dovetail Health. “Seniors stayhealthy and are confident about their deci-sion to live at home. Their children feelless worried, and their doctors get theinformation they need to make informedcare decisions.”

Dovetail Health hopes to make it possiblefor seniors to fulfill their desire to liveindependently in their later years despitecertain health conditions. The companyhas created a new way for seniors toremain in their own homes with hope anddignity. For many, this willdefer the need, worry andexpense of moving into asenior care facility.

Dovetail’s ClinicalAdvisory Board is made-upof the following physicians:

Juergen Bludau, MD,GeriatricianActing Chief, Brigham &Women’s/Division ofAgingActon, MA

Len M. Finn, MDPCPNeedham, MA

Richard Dupee, MDChief Geriatrics –Tufts/NEMC, Wellesley MedicalAssociatesMarlboro, MA

Alejandro Mendoza, MDChief Psychiatry, CaritasGood SamaritanN. Easton, MA

Kim Saal, MDChief Cardiology, MountAuburn CardiologyAssociatesWatertown, MAMichael D. Cantor, MD,JD,

Medical Director, Advisory BoardNewton, MA

PIAM, a subsidiary of the MassachusettsMedical Society, is currently working withDovetail Health to help make their services

available to Massachusetts physicians, theirfamilies and patients. For more informationplease call Dovetail Health at 866 566DOVE (3683).

May/June 2007 • WORCESTER MEDICINE 19May/June 2007 • WORCESTER MEDICINE 17


George Rodgers Dunlop1906-2007

A distinguished surgeon and engagingman, George Dunlop has departed us.We shall not see the likes of him again.

George was born on March 31, 1906 inSt. Peter, Minnesota. His family latermoved to Cincinnati, Ohio and he wasfond of telling how awestruck both heand his father had been as they watchedthe first motor car come along their streetone day amidst the horse-drawn vehiclesthat were soon to be no more.

Throughout his life, those of us who werefortunate to know him heard George pas-sionately tell of his upbringing. He con-veyed it with gratitude for its supremequalities of family and ideals. Many of uslistening to our friend tell of those timesfound ourselves wishing we had knownhis parents, or even wishing we had beenborn in those days, a tribute to thedescent he had been privileged to haveand to his eloquence in reciting it.

After medical school, George trained insurgery at New York Hospital-CornellMedical Center and was an immediatestandout. His skills became legend and,in an era in which surgical specializationwas then becoming a new career option,it is fitting to recall that he was amongthe last of that “top breed” - what wasthen called a general surgeon, one whoseskills were so great that he was the sur-geon to summon for virtually any caseimaginable.

When George came to Worcester he wasamong the first in the 20th century tobring here the highest caliber of surgicaltraining. He understood that residentsand fellows were the precious future ofthe profession and he loved teaching. Inshort order he became Chief at ourMemorial Hospital and took Surgerythere to a new level. He subsequentlywas elected President of the AmericanCollege of Surgeons. But while on the

zenith of his career, on the nationalheights, he never forgot his beginnings inMinnesota and Cincinnati, nor hisbeloved Worcester.

George was an early advocate of the then-controversial idea that the University ofMassachusetts might open a medicalschool and was among those who foughtfor Worcester as its location. He was alsoa surgeon who knew what basic biologi-cal science could offer to medicine and,toward that goal, he was a catalytictrustee and Chairman of the WorcesterFoundation, championing the cause of itsscientists who were delving into the celland its molecular biology.

Many of us who knew George socially, asI did, joyfully encountered a man whosecommanding presence went beyond hismedical stature. He was a brilliantraconteur who deserved, and got, rivetedattention. Never boastful but always incontrol, George’s stories and “teachings”were simply too wonderful to ever elicitanything other than profound admira-tion. There were some among us whohad differences with him on politics butI know of no one who ever took offenseat his strongly argued views. He did notlook down upon those with whose opin-ions he disagreed, but looked them in theeye and tried his best to argue his case.No one ever looked away.

Sometimes in the company of GeorgeDunlop we, his friends and colleagues,felt like a piece of music should be play-ing as he walked in, so attractive was hisbearing. Perhaps something likeBeethoven’s majestic “Consecration ofthe House.”

George Dunlop truly consecrated medi-cine in Worcester. In his way, he alsoconsecrated us. We shall be forever in hisdebt, and his memory will long beremembered in this house.

Thoru Pederson, PhD

Richard A. Gleckman, MD1934 - 2007

His intense gaze marched along the rowof nameless ice cream containers perchedalong the desk’s edge, and after peering along moment at the last, he rubbed hisnarrow chin, furrowed his bushy browsand pursed his lips.

“The first controlled trial of ice creamsupremacy is now closed,” crooned oneof the medical residents. The VA houseofficers standing to either side of lankyProfessor Gleckman laughed approvingly. “This is harder than I thought it wouldbe,” Dick murmured.

“But worthy of scientific inquiry, Dr.Gleckman, no?”

Wincing, Dick Gleckman nodded.

“If you’ve taught us nothing else, Dr.Gleckman,” observed a resident, “you’vetaught us to be skeptical of senior physi-cians who answer every question with thevacuous phrase, ‘In my opinion...’”

“Yes, you’ve been incredibly passionateabout the importance of controlled trialsin expanding medical knowledge…”

“Or,” interrupted another, “in support-ing claims…claims about patient careor…” - here the resident grinned mis-chievously - “…or claims about the bestice cream in Boston. You’ve told us overand over that the Ice Cream Worksmakes the best vanilla in Boston. Well,here’s your chance to prove it once andfor all…scientifically.”

“But,” Dick protested halfheartedly, “Ididn’t realize there were so many varietiesof vanilla…”

“The time for data collection is over,”someone shouted. “You’ve tasted each ofthe ice creams…twice.” She pausedbefore adding, “Time to select, Dr.Gleckman.”

In Memoriam

WDMS Remembers its Colleagues

Dick shook his head slowly, perhapsunsettled by the thought of choosing oneof the commercial brands. He raised hisarm and extended his index finger, butbefore pointing to any of the containers,he glanced right and then left at thebright, expectant faces. And then hesmiled broadly, pleased to see his passionfor critical thinking and scholarly inquiry~ and his own playfulness - lighting theexpressions of the physicians-in-training.“Well,” he said slowly, “I see severaldesign flaws…” - the residents groanedwith resignation - “…and I don’t thinkthe results will be statistically signifi-cant…”

Dr. Richard A. Gleckman died at hishome in Worcester on February 22, 2007of gastric cancer. An AOA graduate ofTufts University School of Medicine,Dick interned at Walter Reed ArmyMedical Center and subsequently servedas a Captain in the US Army MedicalCorps. He completed his medicine resi-dency at University Hospital in Bostonand the Wadsworth VA Hospital in Los

Angeles and his infectious diseases fellow-ship in Boston. Between 1979 and 1990,Dick was on the staff of Saint VincentHospital, where he served as the Directorof the Division of Infectious Diseases andthe Chief of Medicine; he was also aProfessor of Medicine at the University ofMassachusetts Medical School. Dickauthored over 150 publications and sev-eral infectious diseases texts and over hiscareer held academic appointments atTufts, Harvard, Boston University andMt. Sinai Schools of Medicine. Duringhis tenures in Worcester and beyond,Dick was recognized as a savvy diagnosti-cian, a mentor to students and residents,a beacon of integrity, a vocal advocate forquality and compassionate patient care,and an uncompromising champion ofscholarship. And while Dick certainlytook pride in his exemplary professionalaccomplishments, his abiding love -which he unfailingly displayed in meas-ures large and small - was for his wife,Brenda, his children Emilie, Philip andAaron, and his grandchildren.

Anthony L. Esposito, MD


Society Snippets

2007 Call for Nominations

:

on the cover - wdmswdms.org/html/womed_may-jun07/womed_may-june07.pdfon the cover: the union...

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