Tufts University School of Medicine

MAGAZINE OF THE TUFTS UNIVERSITY MEDICAL AND SACKLER ALUMNI ASSOCIATIONS
VOL. 66 NO. 1
MEDICINE
Have we gone too far
with hygiene?
P L U S : A M U S TA C H E C O N T E S T
■
PERUVIAN RESCUE
■
MY TEXAS HOME
WINTER 2007
V I TA L S I G N S
Type cast
APPARENTLY THE FIRST PERSON TO USE THE MANUAL TYPEWRITER AS A MUSICAL
instrument was American composer Leroy Anderson, who featured
the clackety, dinging office machine in a piece he wrote back in
1950. The Boston Typewriter Orchestra, a five-member ensemble of
graduate students and their pals, is building on what they call that
“cheerful and enjoyable” historic moment and carrying its promise
forward through their antic performances of keyboard syncopation.
The birth of the BTO came a couple of years ago in a barroom.
Tim, one of the original members, was idly tapping out a rhythm on
a kid’s typewriter in time to some tune playing on the radio. When a
waitress asked him to desist, he replied that it was OK because he
was, after all, the conductor of the Boston Typewriter Orchestra. His
improvised claim soon became the level truth.
Alex Holman, 27, a doctoral student in genetics at the Sackler
School of Graduate Biomedical Sciences, signed on about a year ago.
He is plainly a natural at it. Asked to describe his favorite instrument
of the 15 or 20 vintage machines that the BTO keeps on hand—typewriters generally found after being discarded somewhere along the
road—he replies, “I do like that Underwood Five model. They have a
good, solid bass sound to them.” Other typewriters in the collection
tend to ring more in an alto or tenor range, says Holman (below left),
a pony- tailed young man with flashing dark eyes and energy to burn.
Picture a half-dozen 20-something guys seated around a table,
dressed in shirts and ties and whaling away at their machines, with
rhythmic patterns repeating like the drumming of fingers on a countertop, and you have the heart of a BTO performance. (For more, see
http://go.tufts.edu/typewriter.) The band has seven or eight original
compositions that they play, in the process creating a droll tableau of
pre-1965 office productivity. It’s the Marx Brothers on company time.
The group has performed at street fairs in Worcester and Somerville
and at a handful of clubs around Boston, in addition to an appearance
on Fox News.
What does the group sound like? If their CD, The Revolution Will
Be Typewritten, is any clue, they sound like a tap dance, like car keys
tossed on a table or like an ice cream truck crossed with machinegun fire.
PHOTO: MELODY KO
CONTENTS
W I N T E R
2 0 0 7
I
V O L U M E
6 6 ,
N O. 1
F E AT U R E S
6 Local hero
Barbara Talamo, Ph.D., steps down after 11
years as chair of neuroscience, a department she
helped to build from scratch.
8
8 Deliverance
by Joseph Donroe, A98, M.D./M.P.H., ’07
This guy became a hero to kids with no future.
15 Close encounters
of the healing kind
by Lisa Y. Livshin, Ed.D., and Jacqueline Mitchell
How Tufts is teaching students to be more
effective doctors, one patient at a time.
COVER STORY
22 The good worms
Dr. Joel Weinstock argues that
intestinal parasites may be
essential to a healthy human
immune system.
illustrations by Ken Orvidas
28 Deep in the heart
by Lauro F. Cavazos, Ph.D.
A former dean of the medical school describes
growing up on the King Ranch in Texas.
D E PA R T M E N T S
2 Letters
3 From the Dean
4 Pulse I A scan of people and events
34
On Campus
38
University News
40
Beyond Boundaries
44
Alumni News
winter 2007
tufts medicine 1
LETTERS
MEDICINE
WHAT HE TAUGHT
I was so saddened to hear about Dr. Ernest
Grable’s death (Spring 2006). He is responsible for so many of us from Tufts becoming
surgeons.
His spirit, humor and dedication to
excellent surgical care and teaching were
exemplary. I think of him almost daily and
remember his teachings, not only about surgery but on how to be a good surgeon and
person. He and his wife, Cecily, mentored
me in the OR and even on parenting and
combining surgical life with home life.
He encouraged me to be good at listening, studying, operating and teaching. His
spirit, voice and legacy will continue through
the thousands of students he taught.
kerry bennett, j89, m.d./m.p.h.93, facs
attending surgeon, caritas
st. elizabeth’s medical center
boston, mass.
MY TIME IN AFRICA
I appreciated the “Letter from Zambia” by
Jeffrey Lazar, M.D./M.P.H. ’03, in the recent
issue of Tufts Medicine (Summer 2006).
I am a Tufts alumnus who went on, after
surgical residency and two years in the
Army, including Vietnam, to spend 32 wonderful years in Zambia in a rural 200-bed
general mission hospital. During those years,
HIV arrived about 1986, and several other
diseases morphed very noticeably. TB and
malaria became progressively resistant to
treatment. Deadly African trypanasomiasis
quickly and mysteriously vanished from our
highly endemic area in the 1980s, and our
once-packed leprosy settlement was bulldozed after several years of sitting empty for
lack of patients.
Africa is at the same time a place of
untold hardship and suffering and a wonderland of medical diversity and challenge.
Our rural Mukinge Hospital became a referral hospital for six other hospitals in our vast
province during my years there. What a
privilege it was to make that fascinating
journey, and never a dime of malpractice
insurance to pay!
Thank you for featuring Dr. Lazar’s article. Zambia needs an army like him, but
even more, it needs to find a way to keep incountry the medical graduates from Zambia’s own medical school.
robert l. wenninger, ’63
cranston, r.i.
LOOKING FORWARD
I feel I would be remiss if I did not write to
congratulate all those involved in the production of Tufts Medicine.
It is a magnificent magazine, both in its
extremely attractive format as well as in
content. The articles span many fields of
interest and serve to keep all of the Tufts
Medical family informed of the activities
of the student body, faculty and alumni. I
look forward to each issue.
The magazine continues to help continue my bond with the school 52 years
after graduation.
theodore a. labow, ’55
massapequa, n.y.
TALK TO US Tufts Medicine welcomes letters, concerns and suggestions from all its
readers. Address your correspondence, which may be edited for space, to Bruce Morgan,
Editor, Tufts Medicine, Tufts University Office of Publications, 136 Harrison Ave., Boston,
MA 02111. You can also fax us at 617.636.4075 or e-mail [email protected]
2 tufts medicine
winter 2007
volume 66, no. 1 winter 2007
Medical Editor
Dr. John K. Erban, ’81
Editor
Bruce Morgan
Editorial Director
Karen Bailey
Art Director
Margot Grisar
Designer
Betsy Hayes
Contributing Writers
Marjorie Howard, Jacqueline Mitchell
Mark Sullivan
Alumni Association
President
Dr. Betsy Busch, ’75
Vice President
Dr. David Wong, ’87
Secretary-Treasurer
Dr. David S. Rosenthal, ’63
Medical School Dean
Dr. Michael Rosenblatt
Executive Council
Drs. Joseph Abate, ’62, David Atkin, ’60,
Mark Aranson, ’78, Fred G. Arrigg Sr., ’47,
Paul Arrigg, ’82, Laurence Bailen, ’93,
Henry H. Banks, ’45, Richard A. Binder, ’64,
Kenneth E. Blotner, ’64, Leonard M. Bornstein, ’58,
Alphonse Calvanese, ’78, Stephen J. Camer, ’65,
Gina Ruth Carter, ’87, Barbara A. Chase, ’73,
Bart Cilento, ’87, Eric Cohen, ’86,
Michael F. Collins, ’81, Jeffery Cooley, ’84,
Francis A. D’Ambrosio, ’45, Paul D’Ambrosio, ’88,
Giacomo A. DeLaria, ’68, Salvatore A. DeLuca, ’58,
Gerard Desforges, ’45, Jane F. Desforges, ’45,
Elias C. Dow, ’53, Scott K. Epstein, ’84,
John K. Erban, ’81, Emil M. Ferris, ’46, David A.
Fisher, ’63, Charles Glassman, ’73, Brian M.
Golden, ’65, Sherwood L. Gorbach, ’62, Edward T.
Gordon, ’47, Michael A. Gordon, ’76, Thomas R.
Hedges, ’75, Joseph L. Kennedy Jr., ’59, Robert
Kennison, ’60, Frederic Little, ’93,
Kathleen M. Mark, ’80, Philip E. McCarthy, ’59,
Bruce M. Pastor, ’68, Richard A. Reines, ’76, Karen
Reuter, ’74, Barbara A.P. Rockett, ’57, Robert C.
Sarno, ’70, Laura K. Snydman, ’04, Paul Sorgi, ’81,
Susan J. Stein, ’85, Elliot W. Strong, ’56,
John G. Sullivan, ’66, Gerard A. Sweeney, ’67,
James A. York, ’92
Tufts Medicine is published three times a year by
the Tufts University School of Medicine, Tufts
Medical Alumni Association and Tufts University
Office of Publications. Send correspondence to
Bruce Morgan, Editor, Tufts Medicine,
136 Harrison Avenue, Boston, MA 02111 or
e-mail [email protected]. The medical
school’s website is www.tufts.edu/med
FROM THE DEAN
The next step
as we embark on our capital campaign for the medical school,
this seems an opportune moment to reflect on where we’ve been, what
we’ve become and where our aspirations lie. We have come a long way, but
we have a great distance yet to go. Although the chief mission for the medical school at its founding in 1893 was to produce practicing doctors for
New England cities and towns, we have long since transcended that simple
model. In the 21st century we are engaged in creating a multifaceted brand
of medicine that touches and transforms the world.
We still turn out our share of excellent,
caring physicians, of course. That will always
be our hallmark. But in recent years, we
have steadily broadened the scope of our
mission. In 2007, in addition to fine doctors,
we also take pride in creating superb policymakers, MBAs and talented researchers
and leaders of academic medicine who will
have an impact wherever they are. This is
medicine whose meaning and impact
extends far beyond the tumbled stone walls
of New England.
Consider research as one example. Working within the tradition of faculty members
Drs. Robert S. Schwartz, whose groundbreaking work on immunosuppression in
the 1950s made successful organ transplants
possible, and William Dameshek, recognized as one of the founders of modern
hematology, our medical school has grown
into a powerful research enterprise, with
special strength in infectious diseases and
microbiology.
We have found a critical new role for
ourselves in translational research that
touches more lives and serves more communities than ever before as we strive to
improve human health.
The composition of our student body
has undergone parallel dramatic shifts. From
the start, Tufts Medical School has made an
effort to forge classes as diverse as the world
our doctors serve. We enrolled women in
our first class, giving them the chance to find
a satisfying life in medicine at a time when
this opportunity was rare for women. Now
our classes are approximately half female.
Racial diversity is another recurring challenge. Dorothy Boulding Feribee, a member
of the Class of 1924, was a granddaughter of
slaves who later founded the Mississippi
Health Project to provide health care for
indigent blacks. We continue to make
enrolling well-qualified minorities a goal of
our outreach.
As I’m sure you know, the challenges we
face as a medical school are multiple. We
need funds to alleviate the financial pressure
on the hospital-based faculty who volunteer
to teach our students for little or no remuneration. We need to preserve the studentcentered culture for which we are known by
continuing to provide ready access to a rich
network of services and facilities for them.
We need to resist the tendency to become a
school solely for children of privilege by
providing more scholarship money for those
students we do want to enroll, but who cannot afford the high cost of attending medical
school at Tufts.
There’s more. As many of our senior faculty members retire over the next decade, we
will need to replenish the faculty. We must
stay competitive in the packages we offer
new faculty if we are to remain in the front
rank of American medical schools. This,
too, will require enhanced funding.
It’s easy to think a capital campaign is all
about money. But when you come right
down to it, it’s really about people and
vision. How do we go from where we are to
where we want to be? That’s the question
that drives and sustains us in our work. The
answers to that question go off in a thousand directions and involve you if you will
let them.
Tufts University President Lawrence S.
Bacow has said that great universities consist
of great faculty and great students, and the
same is true of medical schools. One example of the sort of extraordinary student that
we attract these days is Joseph Donroe, A98,
M.D./M.P.H. ’07, whose story appears on
page 8 of this issue.
Donroe, former captain of the Tufts basketball team and an Academic All-American
when he was an undergraduate, has created
an organization that addresses the physical
and mental health of street children and
orphans in Lima, Peru. Over the past two
years, during an extended leave of absence
from the medical school, he has managed to
bring purpose and hope to hundreds of kids
who were bereft of both when he arrived.
I am proud of the values exhibited by
students like Joe Donroe. I am proud of
what our school has become and what it
aspires to be in the coming years. Won’t
you join us as we seek to move to the next
level of excellence?
Michael Rosenblatt, M.D.
winter 2007
tufts medicine 3
PULSE
A S C A N O F P E O P L E & EV E NT S
Jackie Moss and Michael Hall rev it up at
The Kells. Ashwin Sridharan (right) won in
the “Sketchiest Mustache” category.
Student mustache contest has a philanthropic goal
Hair we are
malnourished kids adrift in the slums of bombay, india, owe a
small debt to students at Tufts Medical School, courtesy of something
called the Mustache Bash. Two first-year students, Peter Acker and
Pritesh Gandhi, were the co-organizers of the event, which solicited men
on the Boston campus, together with their female “coaches,” to compete
for tonsorial greatness this fall. Funds raised by the contest have been sent
to a site in India to help defray the costs of supplying basic medical services to a population of desperately poor children.
The competition was born as a blend of fun and sober purpose. “We
thought it was just something novel that people would be entertained by
and maybe raise some money for a good cause, too,” said Acker, before
admitting, “it’s been more popular than we thought it would be.” Some
60 students paid $10 each to enter the fray. That’s counting the coaches,
who played a largely inspirational role.
“We didn’t want to leave the women out, since they don’t really grow
mustaches,” Acker explained. “The coach is there as an encourager, to offer
words of advice and support you in your mustache-growing endeavor.”
The final judging was held at The Kells, an Irish bar near Boston University, on the night of October 28. Three volunteer faculty judges—John
Castellot, professor of anatomy; Peter Brodeur, associate professor of
pathology; and Andrew Wright, professor of microbiology—surveyed the
contestants, who each got 30 seconds or so to flash their ’stache and vie
4 tufts medicine
winter 2007
for honors in categories ranging from creativity and effort to style and presentation.
For his part, co-organizer Gandhi had a
luxuriant mustache under cultivation and
sounded ready to take the stage when contacted in late October. “Oh, it’s growing,” he
said, laughing. “I haven’t shaved for about six
weeks now.” Gandhi hadn’t decided what
his final look would be—a triple Mohawk,
maybe, making full use of his beard?—and
quickly referred all such stylistic questions to
his coach, Kate Anderson, ’10.
Anderson was smiling through it all.
“There’s a lot of responsibility—mainly
encouraging him not to shave off any facial
hair, because he’s getting kind of scrubby,”
she joked. Gandhi’s exact mode of presentation was still up in the air two days before the
judging.
The total receipts for the first-ever ’Stash
Bash, counting entry fees and a $5 cover
charge assessed at the door, came to about
$1,200. Money like that will go a long way in
India, said Gandhi, who spent last year in
Bombay on a Fulbright grant helping to supply elemental health care to slum residents
through the auspices of the Niramaya Health
Foundation, a local nonprofit provider. The
need for medical intervention is especially
acute among children two to six years old,
while the costs of this intervention are slight.
For less than $2, an Indian child can
receive a year’s worth of micronutrient supplementation—meaning that the donation
stemming from this one well-groomed event
had a shot at covering as many as 600 kids
for a year. “That’s significant,” said Gandhi.
PHOTOS: MELODY KO
NAVAJO TRAGEDY
Dr. Cannonball
doug brugge, ph.d., associate professor
of public health and family medicine, served
as editor for a book published this fall that
reflects his long engagement with the legacy
of uranium mining on Navajo reservations
out West. The Navajo People and Uranium
Mining (University of New Mexico Press,
2006) charts decades of neglect dating from
World War II, when the hazards of uranium exposure on the part of miners and
their families were brushed aside in a race to
build atomic bombs.
“This book is the documented history of
how these Navajo people lived, how they
worked, and now, sadly, how they died waiting for compassionate federal compensation
for laboring in the most hazardous conditions imaginable, and
which were known at
the time yet concealed from them,”
writes Joe Shirley Jr.,
president of the Navajo Nation. “These
Navajo miners and
their families became
expendable people.”
JEFFREY WILLIAM, ’10, PICKED UP A
CHE C K I T O U T
The website for the medical school has
a whole new look and feel. This fall, the
school’s Creative Services team, in partnership with University Web Communications, launched a fully redesigned and
restructured site at www.tufts.edu/med.
Aimed primarily at prospective students,
the new site features a dropdown-style navigation menu that simplifies a user’s
search for information by grouping content
under one of five categories: About Us,
Education, Admissions, Research and
Clinical Affiliates. Visitors to the site can
now readily find the information they want.
ILLUSTRATION: ELVIS SWIFT; PHOTO: MELODY KO
saxophone at age eight—and two years
later, the oboe—and has been playing
music ever since. It’s been a good gig.
As president of a 20-member jazz
ensemble at the University of Pennsylvania, he got the chance to swing and
rub shoulders with the likes of Wynton
Marsalis, John Scofield and Christian
McBride, jazzmen who stopped by campus to give clinics and provide instruction.
It’s unusual for a person to master two such differently flavored instruments,
but William says he’s found less distinction between the oboe and the sax than
between musicians and the rest of the world. “You have to concentrate on listening more than you might otherwise,” is how he puts it.
One of the nicest compliments William ever got came when he was in college and had just finished playing a jazz fund-raiser for a senior citizens’ home.
A resident approached and asked him who he thought he sounded like. William
volunteered that he was a big fan of Cannonball Adderley. “You sound just like
him,” said the man.
Soft drinks, soft bones
middle-age-and-older women may want to limit their consumption of colaflavored soft drinks, suggest the results of a recent study led by Katherine L. Tucker of the
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts. Her study linked
regular consumption of such beverages with reduced mineral density of hip
bones in women past menopause. No similar hip vulnerability to cola
appeared in men of the same age.
Researchers took bone-density readings at the spine and three sites in the hip
for 1,413 women and 1,125 men, all in their 50s and 60s. They correlated the
bone data with each individual’s diet patterns and lifestyle factors, including
smoking, physical exercise and coffee and alcohol consumption. Tucker’s
group reported in the American Journal of Clinical Nutrition that only
consumption of cola carried a risk of low bone density.
Tucker noted that cola’s health impact could be important, given that
carbonated beverage consumption has more than tripled between 1960
and 1990. More than 70 percent of the beverages consumed by participants in the study were colas, which
contain phosphoric acid. It’s possible, Tucker said, that low, regular
consumption of phosphoric acid, which
reacts with calcium in a way that neutralizes
the acid, might slowly leach calcium from bone.
Men have more bone and calcium to start with,
which may explain the gender effect seen in her study.
winter 2007
tufts medicine 5
the Builder
her voice is temperate and measured, while her eyes hold a peaceful, far-away look, like
someone gazing out to sea. “She’s a person who people rely on for her reasoned opinions, even if she
doesn’t agree with them,” a colleague observes. “She’s a bridge builder.” Barbara Talamo, 67, professor of
neuroscience and physiology, stepped down in July from her 11-year tenure as chair of the neuroscience
department. ■ After earning her Ph.D. in biochemistry from Harvard University in 1972, Talamo taught
for six years at Johns Hopkins Medical School. Widowed in her first marriage, she has been wed to John
Kauer, professor of neuroscience, for the past 21 years.
Q: How early did you want to be a scientist?
I think that I was always interested in science. My father was a
mechanical engineer and inventor, and he loved to fool around
making things, fixing things and explaining things, and I liked
to be with him. He built crystal radios, and he was interested in
astronomy and the stars. He was probably the greatest influence
on me in my early years.
Q: What were conditions like when you came to Tufts?
In 1980, when I arrived, there was a neurology department and
a neuroscience lab, but nothing in terms of a real neuroscience
research presence. There were a lot of things missing. I decided,
with a couple of other people, to make the best of it and build
something. In 1981 we started a seminar series. The graduate
program began in 1983.
And then we were successful in bringing in a big neuroscience grant from the Pew Charitable Trust. They had a competition that was a million-dollar grant, provided the institution
matched it, and the focus was on disease. And so we decided to
work on Alzheimer’s disease. We came up with a program, and
we got the grant, and Tufts Medical School kept the promises
that they’d made. We’re ever grateful.
Neuroscience became a separate department in 1994. By that
time, we had seven or eight faculty and an active graduate program and a very visible research program with national and
international recognition. What’s been important for me is the
collegial atmosphere I’ve found and the possibility of building
an intellectual group and a department in a place that hadn’t
planned it that way. The school was very open to recognizing
good ideas.
Q: Can you describe your own research?
I have focused it on regulation by the nervous system of signaling and secretory cells and hormonal cells, and how the history of the signaling alters the function and response of the
cells. In recent years, beginning with the work on Alzheimer’s,
6 tufts medicine
winter 2007
I began to work on the olfactory system in the nose as a model
for looking at Alzheimer’s in the brain.
I soon expanded my interest into looking at how nerve cells
in the nose detect odor molecules in the air. That’s carried on
to a continued interest in a company that my husband and his
colleague [Research Assistant Professor] Joel White have set up
where they’ve built an electronic nose as a “sniffer” device that
can detect molecules in the air the same way dogs do. It began
as a project to detect buried land mines.
Q: What’s your role in the company?
I’m the vice president for business. We’re in a very active stage
right now, trying to get a product into market within the next
six to eight months.
Q: How about working with your husband—what’s that been
like?
It’s been a wonderful thing to come in to work, talk about science on the way in, meet during the day and talk about science
or department problems, go home and talk about science
again [laughs], among other things, like sailing and family and
other delights. It’s like a conversation that never stops.
Q: Have you encountered much sexism in your career?
Not a lot. I’m aware that it happens, but I really haven’t
encountered a lot. Tufts has been remarkably free of it. We’ve
had perhaps 50 percent of our division and faculty members
who have been women throughout my time here.
Q: You mentioned sailing as a hobby?
We have done a lot of sailing, and we’re doing a lot more in our
new boat. We’re looking forward to spending a lot of time doing
that. We have a farmhouse on an island up in Maine, on
Penobscot Bay. We love to sail up around Penobscot Bay and
Down East—it’s just spectacular coastline. So there’s that, and
continuing to build a company is fun.
PHOTO: JOHN SOARES
LOCAL HERO
Delivera
photos by karel navarro pando ⁄ getty images
8 tufts medicine
winter 2007
nce
Getting orphans and children living on
the streets in Lima, Peru, to kick a soccer
ball around was just the start
by joseph donroe, a98, m.d. ⁄ m.p.h. ’07
as an undergraduate at tufts university, i held many jobs—from pizza
delivery to construction worker, security monitor to event staff coordinator—but
none was quite so influential as my work as a furniture mover, a job that I began my
sophomore year. ■ Not your typical bunch of movers, the men and women at Gentle
Giant Moving and Storage were an adventurous lot, many of them highly educated
individuals who moved furniture to support their travels around the world. It was
because of their stories of adventures in far-off places that, after finishing college, I,
too, decided to take time to travel. I did what many of my Giant friends had done,
move furniture, doing as much overtime as possible to quickly make enough money
to throw on a backpack and shoestring around the world. When the money ran out,
I would return to the United States and lug pianos and sofas around the greater
Boston area until once again there were sufficient funds to get back out on the road.
winter 2007
tufts medicine 9
m
y trips were always a mixture of
adventures and volunteer experiences,
whether that meant building homes on a
remote island in the Philippines, summiting
Mount Kilimanjaro and then scuba diving
with the hammerhead sharks off the coast of
Tanzania, interpreting for medical teams in
Ecuador or canoeing through the Brazilian
Amazon.
In early 2001, I found myself hitchhiking
across the Chilean Patagonia, fly-fishing
and mountain climbing along the way.
When the season turned to winter, I quickly
escaped north to Guatemala. There, I was
immediately struck by the impressive backdrop of colors—the greens of the landscape,
the rainbows of fabric woven and worn by
the Quiche women, the bright yellows,
oranges and reds of cement houses that line
10 t u f t s m e d i c i n e
winter 2007
the streets, accentuated by explosions of
bougainvillea.
I was also struck by the number of children I saw working and living on the streets.
Perhaps more than in any other place that I
had traveled, the street children of
Guatemala stood out. They were a constant
presence, asking for food or money, and
above all making you feel guilty as hell for
not handing over your quetzals. One could
not walk peacefully down the street or enjoy
a coffee in an outdoor café without the constant hassling of begging children.
Eventually you learn to ignore them. You
can’t keep giving away your pocket change,
and you soon get tired of feeling bad about
your inability to really help. It is human
nature to protect ourselves emotionally, and,
like most constant things, one becomes
accustomed to seeing the kids, and they soon
become part of the normal background,
much like the brightly colored houses and
bougainvillea. As they become part of the
normal landscape, they become less human,
and it is much easier to tolerate their presence and feel OK about ourselves. So powerful was this reaction that it even happened to
someone like me, who had entered medicine
precisely to help such children.
And so I passed my time in Guatemala,
with a backdrop of colors and street children, the one seeming just as normal as the
other, until an eight-year-old boy changed
my view of the world.
THE UNHAPPY MEAL
On the morning of Good Friday, I awoke
early and with camera in hand walked
through the city. I wandered the unusually
quiet, cobbled streets aimlessly, meandering
between the brightly painted houses. Shops
were closed. People were in their homes or
in church. The normally bustling city was
virtually empty. Without the pandering,
shoe-shining and soliciting, my pueblo took
on a whole new texture.
I walked past a crying young boy in a tattered beige jacket, which contrasted starkly
with the bright yellow wall that he sat
against. His shoeshine box lay on the ground
beside him, and he did not even look up to
see if I needed my sneakers polished. I
caught myself having walked several feet
beyond him, surprised by my own indifference. At eight years old, he was crying, he
told me, because he could not earn enough
money to return home.
He lived in a small village an hour and 40
cents away by bus, and he commuted here
every day to shine shoes. At worst he would
make enough money for his fare home and
then back again the next day; at best he
would also have money to eat. He lived with
his 11-year-old brother somewhere on the
streets of that far-off village, abandoned by a
family who could not afford to raise them.
On this Good Friday holiday, he had no business; there were no shoes to shine. He sat and
silently wept because at eight years old, he
Donroe plays with a child at
the LimaKids Street Clinic.
“A healthy childhood
is something that all are
entitled to,” he says.
could not earn enough money to go home.
I hoisted him up and together we walked
toward a nearby McDonalds. I made jokes
along the way to cheer him up, but he had a
sadness and a seriousness that no child
should know. We made it to the restaurant,
and I offered to buy him anything on the
menu he desired. He whispered, “Una cajita
feliz.” I had no idea what he meant, but the
woman at the register did and promptly
prepared him a Happy Meal, complete with
toy inside.
The boy sat, opened his toy, and despite
the fact that he had not eaten today, despite
the fact that he had the outward maturity of
someone forced to relinquish everything
good about being a child, of someone who
commuted two hours round trip a day to
work in the city streets—despite all this, he
unwrapped his toy, and it became at that
moment the most important thing in his
world.
I fought back the tears and sat, silenced
by what I had seen. In that instant, the street
kids who had become such a normal part of
the landscape suddenly became children. I
saw the images of every child I had allowed
myself to look beyond—how easily I had
succumbed to viewing their plight as normal. How quickly I became so tolerant. I was
brought back and taught such a lesson from
an 8-year-old child. Their childhoods are
stripped from them due to nothing more
than the unfortunate circumstances in
which they were born. They are forced to
fend for themselves, to endure beatings,
rape, hunger and abandonment. But given
something as simple as a small plastic toy
from a Happy Meal, a glimmer of what
makes childhood good can be seen in their
eyes, at least for a moment.
LimaKids had its roots on that day as the
search for solutions began. I learned that
street kids were not as uncommon as they
might seem from the vantage of Boston,
Mass. They number in the millions, globally,
including right here in the United States.
They have been called the world’s forgotten
children, and that they exist at all gives testament to the fact that they have been abandoned by both family and society.
I bore witness to communities of children living on a garbage dump in Guatemala City, read the reports of street children
in Brazil literally being exterminated by
police and of countless human rights abuses
to which the world seems to have turned a
blind eye. Sickness and disease is common—much more common, not unexpectedly, than in their home-dwelling peers.
Parasitic infections, sexually transmitted
diseases, malnutrition, skin infections and
psychological problems are the norm. This
is a truly vulnerable population, yet direct
access to health-care services is rarely available to them.
winter 2007
t u f t s m e d i c i n e 11
SOCCER AS CURE
Our mission became to create a program so
exciting that children would choose to participate and one so passive that they would
quickly forget that what they were involved
in what was actually a health intervention.
After having traveled through the developing world, it was clear that sports could provide such a medium—sports were the
common thread between children of Dar es
Salaam, Mindanao, Guayaquil and
Quetzaltenango. Sports connected children
living on the streets and children from poor,
middle-class and wealthy families, literally
leveling the social playing field. In Latin
America, the love that children have for soccer could make this sport an ideal intervention medium.
Sports had played an important role in
my own development, having grown up
playing multiple team sports and then later
serving as captain of the Tufts basketball
team. Aside from being a form of recreation
in which all kids should at least have the
option to participate, organized sports provide many other benefits. They can increase
self-esteem and psychological well-being
and can improve the symptoms of anxiety
and depression commonly associated with
childhood abuse.
12 t u f t s m e d i c i n e
winter 2007
PARTNERS FOR CHANGE
In the fall of 2001, I entered Tufts Medical
School, but it was not very long before I
found myself missing my work in those faroff places. Therefore, upon completing my
first clinical year of school, I traded in my
role as medical student for one of public
health researcher. There was a position open
to work with a non-governmental organization in Lima, Peru, and I quickly accepted
the opportunity. Once again I found myself
in the familiar position of working as a furniture mover to make enough money to
sustain myself abroad before heading off. I
did not go to Peru intending to work with
street children, but when offered the chance
to develop a project, the timing seemed
right to try to implement the ideas that had
been circulating in me since that day in
Guatemala.
By a fortunate turn of events, my mentor
through it all became David Moore, a British
physician and sports enthusiast working for
the same research group. He had been
touched in his own way by the children on
the streets of Lima, and he, too, had been
thinking of ways to make a difference.
Together we began to plan the early elements of the intended intervention. Not
long after, we met Rosario Arroyo, a
Peruvian physical education teacher who
already had years of experience working
with the street children and orphans of
Lima. The three of us worked to create the
“PRISMA Championship,” a mental health
intervention using soccer as our rehabilitation vehicle. We became partners, not knowing quite how far it all would go.
Our program was designed to address
both mental health and quality-of-life issues
of orphaned children in Lima, the capital
city. These children are a mixture of those
who have spent time living on the streets and
those who have not, but all have tragic histories of childhood victimization. Despite the
number of different medical problems that
these children enter into their orphanages
with, we chose to focus on their mental
health.
BIGGER AND BETTER
The original PRISMA Championship turned
out to be a great success, with 13 orphanages
and more than 150 boys and girls participating. We were able to show that when kids
participated under the rules of the intervention, their self-esteem improved and, despite
the very transient nature of our kids, we
managed to attain a more-than-90-percent
participation rate. The anecdotal evidence of
the program’s success was even more telling.
As one orphanage administrator commented, “These kids go through life looked
upon as being different—they live in orphanages; many lived on the streets; they
consumed drugs. The ability to participate
allows them to feel like regular kids.”
Since our beginnings in 2005, LimaKids
to health care. The most important element
Personally, I believe there was something
has begun several projects in addition to the
of the health clinic is our focus on transispecial about just giving kids a chance to play
soccer league. We have increased our efforts
tioning kids off the streets. The medical
and be surrounded by positive and caring
to improve quality of life within orphanages
services that we offer set the stage for the
role models. Whatever the case, we could not
by financing and organizing recreational
educational and social services provided to
visit an orphanage afterward without hearactivities such as birthday parties, trips to the
meet that end. While still very early in its
ing kids cry out, “When can we play again?”
movies and Christmas events. As a result,
development, the LimaKids Street Clinic is
This notion of givfast being recognized by
ing our kids the
children on the streets of
to encompass more
chance at a more norLima as a safe and caring
mal childhood is what
than sports and physical health. The organization place.
drove us to continue
LimaKids continues
has provided birthday parties, trips to the movies to grow and positively
our work. We since
have grown, and the
impact more and more
and Christmas gifts as well.
PRISMA Championchildren in Peru. I have
ship has become the
come to know many. I’ve
LimaKids organization. Our championship
some of these children have had their first
listened to terrible stories of lost childhoods,
has become a league, and the children
opportunity to celebrate a birthday or receive
and kids no more than half my size have
involved now number more than 350. We
a present on Christmas day.
become some of my greatest teachers. One
have developed a new set of rules whereby
Our newest project is the LimaKids
such child is Josue, a young boy with whom
games are won or lost not simply by countStreet Clinic, designed to bring health servI became very close while in Peru, who was
ing goals, but by playing in a fair and sportsices directly and free of charge to children
placed in an orphanage due to the abuse and
man-like manner. Some of our kids have
living on the streets. Like the right to a
neglect in his home. Last May, Josue invited
even gone on to play with semi-professional
happy childhood, a healthy childhood is
me to visit his home and meet his mother.
club teams, the scouts for which are consissomething that all are entitled to. In the
Having spent every other Sunday with Josue,
tently surprised by the level of skill and disclinic we see the most vulnerable of chilI looked forward to the chance to get to
cipline displayed by our children.
dren, children who otherwise have no access
learn more about his family.
LimaKids has grown
winter 2007
t u f t s m e d i c i n e 13
WHAT HARD MEANS
As I stepped down from the bus in one of
the poorest districts of Lima, Josue excitedly
met me and guided me through the dirt
roads to his uncle’s house. In a small home,
unkempt and with dirt floors and swarming
flies, we ate lunch, and I noticed that Josue’s
expression turned from excitement to
shame. His three younger siblings still live at
home, and from their physical appearances
and interactions with their mother, it was
apparent that abuse and neglect still continued. I listened to the mother’s own harrowing story of having grown up with abuse
and extreme poverty and reflected on the
terrible cycle that was being revealed.
I escaped to the backyard to play with
14 t u f t s m e d i c i n e
winter 2007
Josue and his younger siblings, and as I
threw each child high in the air, the view up
the side of the hill on which their home was
located gave me pause. I saw shacks stacked
upon other shacks, each additional level
representing a deeper stratum of poverty,
and children, dozens of children, dirty and
with ragged clothes, working or playing in
the few open areas along the hillside. This is
the reality of tens of thousands of children
in Peru.
For me, there was a time when medicine
actually seemed like a difficult path—the
long hours, the countless tests, the huge financial commitment. Every other Sunday I
was reminded, however, that hard is being
13 years old, facing a childhood within the
confines of a poorly funded Third World orphanage, having witnessed your father sexually abuse your sister and having yourself
been physically and emotionally abused.
Hard is being 13 and feeling responsible for
the care of your four younger siblings, of
having dreams without the means to achieve
them.
Yet each Sunday Josue met me with a
smile, and his strength assured me that
there is no other path for me to take than
that of medicine and service to these children. Josue and the children of Peru will
always be a part of me.
The work of LimaKids moves forward.
Not unpredictably, as we have grown as an
organization and the course of my own life
pushes ahead, my role within LimaKids has
changed. While I continue to direct its activities, I now do so from Boston rather than
Lima. Instead of coaching soccer teams, taking groups of children to the beach and making visits to deliver medicines to kids on the
street, my time is spent managing operations
and advocating for voiceless children so that
their reality may become exposed. There is
still so much left to do.
The author will graduate this spring. For
more, see http://go.tufts.edu/donroe
A TWO-PART FEATURE
close encounters
photo graphy by melody ko
of the
healing
kind
you are a seasoned physician. a new patient waits in
your office. After you shake hands and say hello, how will
you figure out what is wrong with this person and determine
the best treatment? ■ Although the problem is the essence of
the practice of medicine, the subtle detective work required by
such an encounter is not something you were born knowing how
to do. Instead, the relevant techniques had to be learned gradually,
by close observation and through the example of your instructors.
■ In this special double feature, we look at how our medical school
is teaching students to be more effective doctors, one patient at a
time. The first story gives the perspective of a veteran instructor of
the basic first-year course; the second examines the use of patientactors during third year to help students refine their skills.
winter 2007
t u f t s m e d i c i n e 15
FIRST STEPS
Livshin (center) leads her class.
A veteran instructor in patient interviewing
relates what she has learned
by l isa y. l iv s hin, ed. d.
i
i am squeezed into a patient
room at Tufts-New England Medical Center with my six students.
We are on North 4, the general
surgery unit. The student begins
the interview with a nice openended-lesson-one-question: “Can
you tell me what brings you
to the hospital?”
The patient, a 54-year-old woman lying in
bed, responds by saying that four years ago,
she was diagnosed with ovarian cancer, at
which time she had surgery, radiation and
chemotherapy. She was in remission for three
years. The patient tells us she is back in the
hospital because the cancer is back. My class
appears tense. When she finishes speaking,
my student pauses a moment. Then, straining for something to fill the void, he stam-
16 t u f t s m e d i c i n e
winter 2007
mers, “Do you have any hobbies?”
Welcome to the medical school’s “Patient
Interviewing” course, a mandatory firstyear, first-semester class for all students. It is
almost impossible to believe that I have
been teaching this course for 20 years, but I
began subbing as a doctoral psychology
intern in child psychiatry in 1986. I was 25
years old and merely a hair older than most
of my students.
Psychologists in training do a lot of
intakes—it is our rite of passage. Having
worked in hospitals, clinics and mental
health agencies for five years, I was an experienced patient interviewer. I had a knack
for interviewing and enjoyed the challenge
of learning as much as possible in the scarce
amount of time allotted. Also, my personal
history had its share of “bad-doctor experi-
ences,” so I was eager to teach future doctors
their lessons in treating patients with kindness and respect. The year after my internship, I became a full-fledged psychiatry staff
member and signed on for another year of
teaching the Patient Interviewing class.
This is a course, simply put, on bedside
manner. Students learn how to treat the
patient as a person, not a disease. They learn
about how an illness may impact a patient’s
life—such as the patient with irritable
bowel syndrome (IBS) who works on a construction site and has limited access to a
near-by bathroom. Students learn that
being an effective doctor necessitates
knowledge of their patients’ home lives—
for example, the elderly woman with
rheumatoid arthritis who lives alone, has no
support system and can no longer take care
of herself. They learn how to talk to the
patient like a doctor, which is not all that
different from the way they would talk to a
relative or friend. Most important, they
learn how to ask questions that will lead
them to an understanding of how the
patient experiences his or her illness.
STAYING WITH THE SILENCE
The weekly class convenes at 1 p.m. on Thursdays for a lecture by the course leader, Dr.
Jody Schindelheim, clinical professor of psychiatry. The lectures include guest speakers
and exposure to new and difficult topics such
as death and dying, domestic and substance
abuse, and talking to patients about sex. From
2 to 4 p.m., the students accompany their
instructors to classrooms in small groups of
six. Not all instructors take their students
onto the unit to interview a patient on the
first day, but I always do.
I always ask for a volunteer for the first
interview and reassure the students that I
will do the interview if they prefer. It is a fascinating exercise. The students immediately
break all eye contact with me, and many
begin searching the syllabus. Every few years
a student offers to go first—one who usually
has interviewing experience from working
in a medical setting. Occasionally, someone
volunteers who simply wants to get the interview out of the way and figures I can’t judge
him or her too harshly on Day One. Ninety
percent of the time, the class asks me to conduct the first interview.
And so, on this particular day, I do. I
begin interviewing a middle-aged woman
who has been hospitalized for a minor procedure on her foot. As the interview proceeds, the woman strikes me as clinically
depressed. I ask about her home life (lives
alone) and her work (she hates it) and about
what she does for enjoyment.
Then there is silence. I stay with the
silence. The class looks tense. I see them
looking at me, willing me to speak. More
silence. In a moment the patient is crying.
The new medical students are noticeably
uncomfortable with the tears, and several of
them reach for tissues at the same time. I let
her cry a bit and then say, “You’re sad.” Soon
the patient is volunteering information about
her depression. We talk about her extensive
family history of mood disorders as well as
her current symptoms.
The class is in awe of what has transpired.
Back in the classroom, we discuss the importance of learning to feel comfortable with a
patient’s emotions and how doctors can communicate that ease. However, somehow the
students walk away with the notion they need
to make a patient cry in order to get a good
grade. This is a rumor that has persisted
throughout all my years at Tufts.
A BADGE OF COURAGE
My group interviews one or two patients per
class. Every week I designate one primary
interviewer and one back-up interviewer per
patient. The back-up person takes over
when her classmate hits a wall and runs out
of questions. I assure my students that I am
there to rescue them should they get into a
difficult spot. I usually wrap up each interview by asking questions that have been
missed entirely or pursuing areas that have
not been fully explored. Sometimes I model
how to talk to family members who may be
in the room.
Often I am using this end-of-class time
to demonstrate how to ask a question about
the two toughies: sex and death. At these
moments I am reminded of the students’
relatively young ages and mixed cultural
backgrounds. Many grew up in homes where
it was considered rude to ask intimate questions. Or they came from cultures where it is
inappropriate to make personal inquiries of
an elderly person or someone of the opposite
gender. Simply asking a patient’s age can be
difficult for some students.
But my students sell themselves short.
Although they have been in medical school
for only a short while, their white coats and
their presence on the unit legitimize them in
the eyes of the patient. I think about all the
patients who had no modesty with the
class—the ones who didn’t care about which
body parts were exposed as they lifted their
gowns to show an incision or bruise.
For many patients, that incision is a
badge of courage to be shown with pride.
Or its display can be an attempt to work
through the trauma of having been cut
open—of bodily intrusion. Students often
encounter more graphic detail than they
expected. Three of my students have fainted
over the years, and two have vomited, all
claiming to be overcome by the heat in the
patient’s room.
Not all patients are willing to be interviewed. Many of them have had enough of
the teaching hospital environment and its
endless stream of students and interns. However, my experience has been that most
patients do agree to be interviewed. They
want to help teach. They have a story to tell
about their illnesses, and frankly, they are
eager to break the monotony of their long
days with our visit.
Often, it is the patient who primarily
teaches the students. One patient in her 30s
had a wheelchair by her bed. The student
interviewer astutely picked up on this (students are taught to observe the patient’s personal belongings to glean information) and
asked, “How long have you been in a wheelchair?” The patient gently corrected the
interviewer’s question and told us that she
had “used the chair for six years.” She made
sure we understood the distinction between
being in a chair—the dependency that this
implied—and using a chair as an aid.
Another instructive case concerned an
86-year-old man lying in bed in a silk robe
and monogrammed slippers; he had a Wall
Street Journal, briefcase and laptop by his
winter 2007
t u f t s m e d i c i n e 17
DEEPER IN
bed. The student began an excellent interview, learning a great deal about the
course of the man’s heart condition.
Then, missing all the clues, she asked,
“How long have you been retired?” to
which the patient replied that he still
headed up a large law firm.
WHEN TO BE QUIET
The lessons I impart to my students
haven’t changed over the past 20 years.
First, listen and make no assumptions.
One day you may be treating your 227th
heart attack, but it’s usually the patient’s
first. Be compassionate. Patients are vulnerable—lying in bed without the dignity of their clothes, feeling sick and
uncertain about their health, stripped
of the appearance they usually make
when meeting someone new. There are
many factors that influence how a
patient experiences illness—ask questions to find out.
Don’t be afraid to ask about age, sex
and death. If the patient is 50 and looks
70, that’s important information. If the
patient is practicing unsafe sex, you need
to know. The scariest part of being sick is
getting a little closer to the possibility of
death. You can help make all of it less
frightening for the patient to talk about
simply by being comfortable asking.
Then keep listening.
My favorite moments over the years
have been when I see students “get it.” At
these times, they are totally present during their interviews. Their eyes aren’t
looking off in search of the next question.
They are listening and responding to
what the patient has said. They’re not
thinking about me or their peers standing
behind them. They know when to be
quiet, wait a beat, and let the patient
show the way; they also know when to
steer. They let the patients know they are
listening by paraphrasing what has been
said and asking the next question that
begs to be asked. The interviews flow,
the patients open up, and we learn what
we need to know.
The author is an instructor in psychiatry
at the medical school.
18 t u f t s m e d i c i n e
winter 2007
Patient-actor Kia Scott plays
her role for Candace Barnes, ’07.
Patient-actors teach students
how to fine-tune their skills
m
mr. mchale, a 55-year-old construction foreman, sits fully clothed on crinkly
white tissue paper covering the exam table,
waiting for the doctor. He’s there to go over
the results of a recent blood test. At five feet,
six inches tall and 195 pounds, he’s a little
overweight. He has high cholesterol, and his
tennis partner just died of a heart attack.
Mr. McHale is nervous.
Mr. McHale is also fictional. A “standardized patient,” the McHale character
by jacqueline mitchell
helps train third-year students to take medical histories, make diagnoses, deliver bad
news, give advice and, most important,
hone their bedside manner. (For an introduction to the “Patient Interviewing” course
required of first-year students, see “First
steps,” page 16.) A means of teaching and
assessing clinical care, standardized patient
exercises are becoming increasingly important tools in medical education, and now
extend through all departments at the medical school.
Part of the family medicine clerkship, the
McHale exercise is known as a “nutritional
intervention.” Because McHale’s medical
and personal history put him at increased
risk for cardiovascular disease, the students
in training will have to counsel and moti-
M EE T A PAT I E N T - A C T O R
KA RE N FORA N DE MP SE Y
Growing up west of Boston, Karen Foran Dempsey always dreamed of getting married and having babies. But some doubted Karen, diagnosed with juvenile rheumatoid arthritis (RA) at just two-and-a-half years old, would ever realize her dream of
giving birth. Among the doubters: an OB/GYN who declined to give her a routine
exam, not wanting to put her through “any more suffering,” Dempsey recalls.
But Dempsey, 39, never let others’ ignorance get her down. She gave birth to twin
boys, Joseph Edward and William Edward on September 11th, 2006, their parents’
second wedding anniversary. The boys are named after both of their grandfathers.
Karen met her husband Mark, who has psoriatic arthritis, in 1999 when they both
worked for the MetroWest Center for Independent Living in Framingham. Karen has
been an advocate, peer counselor and consultant for various organizations for the
disabled—including the MetroWest Center—since she graduated from Regis College.
Mark works as a compliance officer for the State Department of Public Safety.
People often ask the new parents, who live with Karen’s mom, a beagle and a
cat, if the babies will inherit arthritis. Karen and Mark, who are volunteers with the
Arthritis Foundation, looked into it.
“Their chances [of having JRA] do not increase,” she says. “But if they do, what’s
the tragedy? Who better than us to deal with it? We’ll deal with whatever we’re given.”
vate the patient to make potentially life-saving changes to his diet and exercise habits.
Doing so will require a suite of abilities that
are hard to test on traditional exams: attention to detail, communication skills, empathy, problem-solving and even a dash of
motivational speaking.
DON’T BE AFRAID
Yaffa Vitberg, a third-year medical student
whose warmth and energy fill up the sterile
space, enters the room and introduces herself to McHale, a patient she’s not seen
before. Played today by veteran patientactor Jim Summers, the McHale character is
a method actor’s dream role. His medical
history and social back story have been
painstakingly fleshed out; his wife does the
shopping and cooking; his job requires him
to be on his feet most of the day, and he has
weakness for jelly donuts. (No wonder his
glucose level is slightly elevated.)
Registering her patient’s anxiety, Vitberg
asks McHale to sit in one of the chairs so
they can go over the print-outs together. As
the two review McHale’s LDL and HDL cholesterol levels, glucose and blood pressure,
the man’s face darkens. “How bad is it?” he
asks Vitberg, a 24-year-old from Setauket,
N.Y. “Your risk is elevated,” she says, then
changes tack. “I’m going to help you with
this. We can work together as a team.”
After Vitberg asks McHale to detail the
foods he eats and the physical activity he gets
on a typical day, she explains the difference
between healthy fats and trans- and saturated fats and cautions him to avoid the latter. She also prescribes 30 minutes of
exercise “most days of the week.” And with
that, the 14-minute exam is over.
“I needed more time,” she says immediately. “I wasn’t even able to get into smoking
and drinking.”
But Summers, a trained patient-actor
taught to evaluate the med students’ examination skills, is impressed by her performance, as are two other observers, Amy Lee,
’02, clinical instructor in public health and
family medicine, and another third-year student. All three praise her organization, her
upbeat attitude and her ability to establish
rapport with her patient. “You were an
enthusiastic cheerleader,” says Lee.“But when
he started asking about his risk, don’t be
afraid to tell him you’re concerned.”
“Get feedback from the patient,”
Summers suggests. “Have him tell you what
he plans to do. Have him write it down.
Because that’s where the rubber meets the
road.”
The students take the patient-actors’
advice very seriously. “Their desire to be
good doctors is so apparent, their willingness to hear specifically how to improve,”
says Ylisabyth (Libby) S. Bradshaw, D.O.,
M.S., assistant professor of public health and
family medicine, who oversees some of her
department’s standardized patient exercises.
“It’s humbling when you see somebody so
receptive.”
Young doctors’ clinical skills are traditionally assessed by attending physicians as
students go through rotations treating real
patients. That assessment, however, can be
hit-or-miss, because the interns and attending physicians might interact only sporadically. The standardized patient exercises
offer a much more in-depth and reliable
form of evaluation early on in a young doctor’s career.
“Teaching even a small group, you don’t
winter 2007
t u f t s m e d i c i n e 19
DEEPER IN
ME E T A PATI E NT- A CT O R
PAU L KA H N
Like any journalist, Paul Kahn’s beat sometimes takes him in unexpected directions. A contributor to New Mobility magazine, a monthly publication for wheelchair
users, Kahn at first took only a professional interest in the standardized patient
exercises he observed at Tufts. But after watching the students, “bright and young
enough not to think they know everything,” make striking progress in just one
afternoon, Kahn volunteered to be a patient-actor.
Kahn has centronuclear myopathy, a congenital neuromuscular disability, and
uses a wheelchair. A full-time writer and playwright, he lives with his wife Ruth and
their cat Cairo. Kahn edits two newsletters, including “Opening Stages,” a quarterly newsletter for people with disabilities pursuing careers in the performing arts.
His own plays have been staged in Massachusetts, Rhode Island, Maine and
Connecticut.
As a patient-actor, he uses his writer’s talent for observation to note what the
students do right and do wrong in their interactions with him.
really know how much the [individual] student is getting,” Lee notes. “And there are
just some intangible things you want every
doctor coming out of Tufts to be good at.
Whether they become clinicians or not, they
should come across as kind, be able to talk
easily with patients and explain things in
understandable ways.”
SPES HERE TO STAY
Using standardized patients in medical education is not new. Howard S. Barrows, a neurologist and professor at the University of
Southern California, pioneered the use of
patient-actors to train his third-year clerks in
the 1960s. Recognizing that the fairest way to
evaluate his students was to watch them handle the exact same case, Barrows based the
character of “Patty Dugger,” a paraplegic
woman with MS, on one of his actual
patients. The method was met with resistance
from the medical establishment, but as problem-based learning gained currency in medical education, so did the use of standardized
patients.
In 2004, the U.S. Medical Licensing Examination (USMLE)—the test all medical students must take to practice in this
country—instituted a standardized patient
exercise to evaluate students’ clinical skills.
“Standardized patient exercises are here to
stay,” according to Mary Lee, university associate provost and dean for educational affairs
20 t u f t s m e d i c i n e
winter 2007
at the medical school. “The clinical setting
has become so fast-paced that students must
enter with higher skill levels. The standardized patients are an excellent means to teach
better communication skills and cultural
competency.”
To ensure Tufts medical students attained
those skills, Margo Woods, D.Sc., associate
professor in the nutrition/infection unit in
the Department of Public Health and Family
Medicine, developed the McHale exercise in
2001. In the fall of 2002, Bradshaw launched
a standardized patient exercise with disabled
patients based on the same model.
A QUIET, CARING MANNER
Shortly after Vitberg leaves the exam room,
her classmate, Shreya Raj, conducts a “followup” with Mr. McHale. Six weeks supposedly
have elapsed, and McHale’s new blood work
results show he’s been diligent with his diet.
His bad cholesterol is down, but his new
low-fat menu leaves him hungry, and his
triglycerides are up—a clue to Raj that his
diet is now too high in simple carbohydrates.
What’s more, his wife’s new job leaves
him to fend for himself for dinner, and he has
been subsisting on low-calorie frozen entrees
that he doesn’t enjoy and don’t fill him up.
McHale is frustrated with the diet, and he’s
still nervous about his risk for heart attack.
Raj delves deeply into his new diet and
suggests he can make a low-fat diet more satisfying by increasing his protein and fiber
intake. You’d want Raj to be your doctor.
Her interview is organized; her quiet manner
inspires confidence, and she’s caring and
empathic—maybe too much so.
“Don’t absorb the patient’s anxiety. You
can be empathetic without being sympathetic,” Summers cautions her. “Don’t forget
to smile.”
RARE CASES
By the time the med students complete their
third year, they’ve already seen their share of
real patients. But the SPEs can give them
valuable experience with patient populations
they might see only rarely in a real clinic.
Today, third-year medical student Kate
Forssell is ready to see a standardized patient
named “Chris Walker.” Forssell knows she’ll
be problem-solving the patient’s sore shoulder. She does not know her patient will have
a disability.
“Anyone could have shoulder pain, but it
could have more importance to someone
who already has limited mobility,” says Linda
Long-Bellil, who worked with Bradshaw, Dr.
Wayne Altman and Paula Minihan—all of
the Department of Public Health and Family
Medicine—to develop the Chris Walker case.
Having dealt with juvenile rheumatoid
arthritis since she was just two years old,
Karen Dempsy, the “patient,” uses a motorized scooter to get around and has limited use
of her hands. She has seen her share of doctors, and she’s passionate about teaching the
next generation of doctors how to treat people with disabilities.
“A person with disabilities has complexities that need to be addressed by doctors,”
says Dempsey, who’s been involved with
patient-acting for the last four years. “So it’s
okay to ask questions, but don’t over-emphasize the disability. You have to see the whole
package.” Today Dempsey, in the role of Chris
Walker, tells Forssell her shoulder has hurt
her for two or three weeks and is getting
worse. Walker goes on to say that she’s leaving
her old doctor who “seemed uncomfortable
with my disability.”
Forssell uses the moment as a chance to
explore Walker’s disability. With her series of
questions, Forssell reveals that the patient
works as a data entry clerk, which often
requires her to heft heavy file boxes on and
off shelves she can’t quite reach from her
chair. Correctly diagnosing the patient with
tendonitis, Forssell advises Walker to lay off
the heavy lifting and offers to write Walker’s
boss a note. She prescribes ibuprofen, applying ice and heat to the shoulder and a round
of physical therapy.
“I’d like to see you back in two weeks,
unless the pain suddenly worsens,” she concludes.
Like her peers, Forssell impresses her
patient-actor and her faculty observer, Libby
Bradshaw. They applaud her diagnosis, her
organization and her transitions from topic
to topic.
But while Forssell established a good rapport with her patient, Dempsy points out
some questions a doctor might not think to
ask a disabled person. “You might touch a little more on social history,” Dempsy suggests.
“Does somebody help you? Do you have
transportation to the physical therapist?” As
with the McHale case, the patient-actor
advises, “You have to know what the patient
will do when she gets home.”
Jacqueline Mitchell is a senior health sciences
writer in Tufts’ Office of Publications.
M E E T A PAT I E N T - A C T O R
L ILLI A N JOHNS ON
Devang Dave, ’07, and Adam
Weston, ’07, meet with patientactor Betsy Laitinen.
Lillian Johnson is concerned about hybrid cars. It’s not that she’s opposed to conservation, it’s just that Johnson—blind since birth—can’t hear the hybrids’ quiet
motors when she’s poised to cross a street. Luckily, she has Keesha, her seeingeye dog, to keep her out of harm’s way.
“The dogs are taught not to go if it’s not safe. Words can’t begin to express the
independence she’s given me,” says Johnson, who lives with her sister in the
Arlington home her grandfather bought in 1948.
A graduate of the Perkins School for the Blind, Johnson loved participating in
track and softball and dreamed of being a Phys. Ed. teacher one day. Johnson never
lost her love for physical fitness. Among her many volunteer efforts, Johnson is an
active member of Ski for Light, an international non-profit that pairs sighted and
blind cross-country skiers. In 1995, Johnson was chosen to represent the United
States in a 22K race in Norway, where the program originated.
“I felt so exhilarated, I just wanted to do it again,” said Johnson.
A standardized patient-actor with Tufts for four years, Johnson is the only blind
role-player and the only one with a guide dog. “It’s a wonderful experience for me
and I look forward to these sessions every time,” says Johnson. “At the end of the
day, I hope I made a difference.”
winter 2007
t u f t s m e d i c i n e 21
by bruce morgan
I illustrations by ken orvidas
The
GOOD
Worms
A gastroenterologist at Tufts argues that intestinal
parasites may be essential to a healthy immune system
parasitic intestinal worms and human beings have a relationship
that goes way back. The two have been inseparable since Adam and Eve
strolled through the Garden of Eden. Calcified worm eggs have been
found in the internal organs of mummies dating from 1200 B.C., and
Egyptian medicine contains descriptions of what are almost certainly
parasitic infections long before that. Worms love dirt and thrive in dirty
places. Lucky for the worms, human beings have generally been a messy
lot. As Dr. Joel Weinstock, professor of gastroenterology and immunology and chief of the Division of Gastroenterology at Tufts-New England
Medical Center, puts it succinctly, “Most people have lived in filth.”
22 t u f t s m e d i c i n e
winter 2007
F
or a homegrown example, he asks us to consider
an American boy living in a small Midwestern town on
a summer morning in 1872. The boy runs outside to play
in the street. There are horse droppings and raw sewage
there. He cuts through a field barefoot to reach a friend’s
house. Worms lie in wait along the earthen path. He races home for lunch.
His sandwich and water, unscreened by any health agency or government
office, are likely rife with parasites.
Often on a microscopic scale, parasitic
worms (or helminths) wriggle into their
hosts directly through exposed skin or by
being ingested in food and drink. There are
about 90 relatively common species of
helminths, many of which live in harmony
with their hosts. “Most worms have minimal negative effects, but there are a few
really bad actors,” Weinstock notes. The
nasty batch includes tapeworms, which
inhabit the human gut and may reach up to
35 feet in length; ecchinococcus and schistomosa, which can cause significant liver
disease in their hosts; and onchocerca,
known for blinding people in Africa and
parts of South America, where the worms
are transmitted by sand flies.
Worms have lost some ground lately.
Starting in the 20th century, it has been
taken as a general rule among public
health officials in industrialized nations
that eradicating the parasites through better hygiene is a smart move. Worms have
suffered from bad press forever, and you
can understand why. They creep people
out, and every so often, they make people
retching sick. But, according to Weinstock,
the prevailing bias against worms was
never really based on hard evidence. It was
more of a cultural habit of revulsion carried on unthinkingly.
He snatches a textbook off a shelf and
shows a densely printed chapter in a current
medical textbook that discusses intestinal
worms in entirely negative terms. “There,”
he says. “Look at that,” indicating the three
or four brief citations at chapter’s end.
“There’s not much data behind those assertions.” Not that it ever mattered much to
24 t u f t s m e d i c i n e
winter 2007
public health activists. “The consensus has
been, ‘these things are awful—we’ve got to
get rid of them,’ ” says Weinstock, who grew
up in Michigan and retains a certain
Midwestern openness, a willingness to be
surprised, on his features.
And so, with the best of intentions, we as
a society have roared down that antiseptic
path. Beginning with immense public works
projects that encircled American cities
around 1900, but even more emphatically
since the hygiene craze of the 1950s, when
household germs in suburban kitchens were
viewed as a threat akin to communism, our
water has been filtered, our food purified
and our sanitation improved dramatically.
The operating room of modern life has been
scrubbed clean.
Many infectious diseases have been drastically reduced or altogether wiped out
along the way. That’s the good news. But in
a hypothesis that is at once counter-intuitive and queasily unexpected, Weinstock
argues that we may have gone too far with
our clean-up efforts. In the process of ridding ourselves of stubbornly resistant, even
deadly pathogens, he says, we have also
eliminated a batch of naturally occurring
agents that play a vital role in regulating the
health of our immune systems.
“We’re not saying all worms are good,
but the bad side might be overemphasized,
especially for some worms,” offers Dr.
David Elliott, Ph.D., a former colleague of
Weinstock’s at the University of Iowa who
has co-authored a number of articles with
him on the science of immune regulation
by intestinal worms. “We seem to have
thrown the baby out with the bathwater.”
LACK OF EXPOSURE
The background here is ominous. For whatever reason, something is clearly out of
whack with immune response among residents of industrialized nations around the
world.
Rates of occurrence for asthma, Type I
diabetes, multiple sclerosis and inflammatory bowel disease (or IBD, which comes in
condition remains practically nonexistent
in underdeveloped countries with poor
sanitary conditions.
A common presumption on the part of
observers has been that the cause for the rise
in autoimmune diseases is environmental,
linked to chemical exposure of some kind,
perhaps, or more dust in the air, or the
greater use of vaccines in places like the U.S.
Weinstock needed some hard numbers
to buttress or refute his working hypothesis
that people and worms historically have
enjoyed what he calls, without the least hint
of irony, a “good parasitic relationship.” To
gather evidence, he pored through public
health data gathered across the American
South in the 1930s that showed that as
many as 70 percent of the residents carried
Weinstock’s pivotal question took the scientific inquiry
in a whole new direction. The mental leap involved had
the effect of rendering a negative print of a familiar scene,
whereby black goes white and white black, reversing the
figure and ground.
two principal forms, Crohn’s disease and
ulcerative colitis)—the Big Four diseases
that involve a malfunctioning immune system—have risen sharply in industrialized
nations over the past half-century. “They’ve
gone up like this,” says Weinstock, flicking a
thumb toward the ceiling, while remaining
rare in the developing world.
The proof of the disparity is everywhere.
Each year, for example, about 600,000
Americans are diagnosed with IBD. “It
turns out that countries where IBD is common are those industrialized, developed
nations like the United States, where there
are no intestinal helminths,” confirms Dr.
Robert Summers, director of clinical programs for the gastroenterology division at
the University of Iowa, and like Elliott, a frequent past collaborator with Weinstock.
“Conversely, where helminths are prevalent,
the incidence of IBD is very low.”
Asthma supplies another intriguing case
study. The incidence of asthma among children living in the United Kingdom has
gone from less than 5 percent in 1964 to
more than 25 percent in 2001. By late 2004,
asthma was touching one in five households in the U.K.—one of the highest rates
for the disease of any country in the
world—and killing a British citizen, on
average, every seven hours. Meanwhile, the
and the U.K. that are solidly built up and
civilized.
In a moment of inspiration that resembled a comic book lightning flash,
Weinstock turned this idea on its head. Back
in the early 1990s, he happened to be working on two book projects at the same time.
One book concerned parasitic worms, and
the other addressed inflammatory bowel
disease. Weinstock noticed that the first had
declined in number as the other rose. “Deworming and the rise in IBD are inversely
related,” he said. In contrast to what practically everyone in the world believed, the
missing worms seemed to be having a deleterious effect on human health.
“What if,” he asked recently as he sought
to replay his thinking from 10 or 15 years
ago, “the increase we see in autoimmune
disease is due to a lack of exposure? What if
it’s caused by something that we’re no
longer exposed to that we should be
exposed to? Let’s start from scratch. Can
something affect the immune system
because you’re not exposed to it?”
Weinstock’s question took the scientific
inquiry in a whole new direction. The mental leap involved had the effect of rendering
a negative print of a familiar scene, whereby
black goes white and white black, reversing
the figure and ground.
worms without any ill effect. During this
period, only about 400 people had died
from parasitic infections—mostly from
trichninosis—out of a rural population of
millions.
“That’s a pretty small number, given the
sample size,” Weinstock points out. “So just
how dangerous were these worms?”
A LID ON INFLAMMATION
Consider the lowly parasite. This is a minicreature—could be a flea, a tick or a nematode—that attaches itself to a host and relies
on that host for survival. Although in general parlance we put the parasite in a lower
box than the host, and shift our tone of
voice to something derogatory whenever we
utter the word, nature doesn’t really work
that way. The relationship between the two
is symbiotic. As Weinstock explains, “The
first law of parasitology says that the parasite must impart a survival advantage to the
host.” And this makes perfect sense, because
evolution has nothing judgmental about it.
Any worm that gets into the body faces a
huge, immediate problem. How can the
intruder survive when the body’s immune
system is poised to destroy it? One tactic is
to hide. “Through co-evolution,” Weinstock
suggests, “the worm has learned our
immune system better than we know, and it
winter 2007
t u f t s m e d i c i n e 25
modulates our immune system to make
itself essentially invisible.” The hypothesis is
that this modulation stems from a cellular
network of “regulatory pathways” that the
worm triggers within the host. In effect, the
pathways put a lid on the immune system’s
tendency to flare up over infection, holding
the response in check.
“We’re better off having these pathways,”
Weinstock says. “Everything has to be kept in
balance with the immune system or it will
destroy you.” David Elliott, his colleague back
in Iowa, concurs. Turning to electricity for
his analogy, Elliott describes the role of
worms in the host’s body as supplying “safety
circuits that prevent the immune system
It’s not all theoretical. In Brazil recently,
doctors noticed that a group of children
began suffering from asthma once they had
been removed from their parasite-rich bioenvironment and purged of worms. When
the children returned home and were once
more exposed to the processes of their
fecund natural milieu, the asthma went
away.
Many gastroenterologists have followed
Weinstock’s work with keen interest. Dr. J.
Thomas Lamont, for one, sounds willing to
be persuaded. “I think it’s a very original and
unique idea he has,” says Lamont, chief of
gastroenterology at Beth Israel Deaconess
Medical Center in Boston and an associate
muttering, “You want to do what with these
worms?”—but eventually the agency said
yes, and the studies in Iowa began.
In 1999, six patients with either Crohn’s
disease or ulcerative colitis who had not
responded to conventional treatment volunteered to participate in an experiment at the
Iowa lab. They were asked to swallow capsules containing a low dose of microscopic
whipworm eggs suspended in liquid. The
helminth used in the study was carefully
chosen for its benign characteristics: It could
not penetrate the skin or multiply within the
body, and had the capacity to colonize for
several weeks at most. The hatched eggs
were shed harmlessly in the stool.
Scientists have determined that parasitic worms can
suppress allergy by inducing a class of immune cells known
as regulatory T cells, which interact with inflammatory
cells by sending them “off ” signals.
from going haywire.” There’s your host’s survival advantage right there, in the implications of that last, loaded word. By being
intimately involved with each other, both the
parasite and the host have improved their
odds of living to see another day.
It’s a classic win-win.“The parasite downregulates the immune system for its own
benefit,” explains Rick Maizels, an immunologist at the University of Edinburgh in
Scotland who is familiar with Weinstock’s
work. “But doing so has wider ramifications,
because it also dampens unrelated immune
responses such as allergic responses.”
Scientists have determined that parasitic
worms can suppress allergy by inducing a
class of immune cells known as regulatory T
cells, which interact with inflammatory cells
by sending them “off” signals.
“These regulatory T cells may exist naturally to prevent us from suffering autoimmune disease,” Maizels told a British
reporter recently. “We think the mechanism
that is protecting us from our immune system is also protecting the parasite from our
immune system.”
26 t u f t s m e d i c i n e
winter 2007
editor of The New England Journal of
Medicine. “If this idea has legs, it’s going to
be a breakthrough.”
SOME WHIPWORM EGGS
Who would have figured a town in pastoral
eastern Iowa to be the locus for people burrowing into the niceties of the human
immune system? But that’s the way things
panned out because that’s where our guy
happened to be, and he soon got those
around him excited about his pet notion.
“We were first to the gate,” says Weinstock
bluntly, referring to his University of Iowa
colleagues. “No one else was ready for this.”
Roughly 10 years ago, the Iowa team
(Weinstock, Summers and Elliott, among
others) began with animal studies, initially
conducting experiments using mice and
pigs. These studies generally confirmed
their working hypothesis. The logical next
step was human studies, which required
approaching the FDA and winning the
agency’s approval through normal channels. One can only imagine some poor FDA
administrator sitting at his or her desk and
Researchers found that the Crohn’s disease got better in all six patients. For five
patients, the disease went into remission for
up to five months, while in the sixth, the
condition “improved substantially but did
not obtain clinical remission,” according to
Weinstock. The patients experienced no
negative side effects from ingesting the
worm eggs, and after about three weeks,
when the patients gradually relapsed, their
symptoms did not appear to be any worse
than before the experiment.
More recently, the University of Iowa
team asked a group of 29 Crohn’s patients
to swallow whipworm eggs every three
weeks for six months. Once again, these
were patients for whom standard treatments had failed. Results were just as
impressive as before. By the end of the
study, all but one of the patients had shown
improvement, with 21 reporting no symptoms at all. The results were published in
Gut in 2004.
For anyone who can’t imagine anything
more repulsive than popping a vial of whipworm eggs into your mouth, bear in mind
that these are patients under duress.
Common symptoms of Crohn’s include
abdominal pain, bloating, fever, persistent
diarrhea, rectal bleeding and weight loss,
among other torments. “It was almost never
a problem” convincing patients to swallow
the worm egg capsules because of how desperate they were for relief, Summers relates.
“They would say, ‘Well, if it has a chance, I’ll
do it.’ ”
A double-blind study published in
Nature Clinical Practice Gastroenterology &
Hepatology in 2005 further confirmed the
merit of the Iowa team’s approach. In this
study, which involved 60 patients suffering
from ulcerative colitis, those treated with
whipworm eggs fared demonstrably better
than those who took placebos.
Summers, who believes that Weinstock’s
hypothesis “may have important implications for other autoimmune diseases not
related to gastroenterology,” is more convinced than ever of the gold that lies inside
the mountain. Over the past decade, he has
seen more than 100 Iowa patients treated
effectively with helminth eggs without side
effects of any kind. Asked if he knows of any
refutation of the team’s hypothesis from
experiments done anywhere, he answers
simply: “Not really.”
NOT DONE YET
The world is waking up to the news. Maizels,
the Scottish immunologist, has been a true
believer since he came across Weinstock’s
papers on the topic of helminths and immune regulation a number of years ago.
Maizels calls Weinstock, whom he has invited
to speak at the University of Edinburgh,
“a leading force” in the emerging field. The
two men joined to organize the first international conference on the topic last year,
attracting 150 scientists to Germany, where
the groundswell of excitement was palpable,
according to Maizels.
Could worms have a healing effect comparable to what they have already demonstrated in the treatment of Crohn’s disease
and ulcerative colitis on other autoimmune
disorders such as asthma, Type I diabetes
and multiple sclerosis? For now, that’s only
one of many questions looming over the
field. Gastroenterological treatments based
on Weinstock’s research are currently in
development.
In an expansive moment in his office,
Weinstock suggests that worm therapy
stands a chance to reduce the prevalence of
autoimmune disease in Western societies by
as much as 90 percent. “We’ve done a lot of
work over the past 10 years, and we’re not
done. It’s not time to open the champagne
yet,” he cautions, “but I don’t think we’re
wrong. It’s not too early to say, ‘Yeah, these
puppies have an effect, and they could play
a role in the treatment of disease.’ ”
Elliott, his Iowa colleague, rings the victory bell more forcefully, like someone calling the world’s doctors and scientists to
dinner from the farmhouse porch. “You’ve
got all these diseases of developed countries,
all these illnesses of development. Why?” he
asks rhetorically. “Ours is the strongest
explanation. It’s the helminths, guys.”
Bruce Morgan is editor of this magazine.
winter 2007
t u f t s m e d i c i n e 27
A former dean of the medical school describes growing up on the King
Dean Cavazos in 2006
28 t u f t s m e d i c i n e
winter 2007
Ranch in Texas as the foundation for his accomplishments in later life
at a ceremony in the last room of the white house, on september 20, 1988, Vice President George H.W. Bush swore me in as U.S.
secretary of education. I was the first Hispanic appointed to the
Cabinet in the history of the United States. A few weeks before,
President Ronald Reagan had asked me to join his Cabinet, and I was
unanimously confirmed by the U.S. Senate. My wife, Peggy, and I were
very pleased that our 10 children, most of their spouses and one grandson—none of whom had visited the White House before—could be
there. Their presence made the ceremony a family affair.
Richard Mifflin Kleberg Jr.
in the foreground and
Lauro Cavazos Sr. to the
rear. Roping on Anita
Chica, King Ranch, 1960.
by l auro f. cava zos , ph. d.
JOHN A. CYPHER/MAIN PHOTO; MELODY KO/CAVAZOS PORTRAIT
winter 2007
t u f t s m e d i c i n e 29
President Reagan looked on while Vice
President Bush read the oath of office. Peggy
held our family Bible, on which I rested my
left hand while I raised my right one to
repeat the oath. I felt great pride, not because
of any personal accomplishment or achievement, but because this event marked a new
beginning for Hispanics in our nation.
During the swearing-in ceremony I
remembered my parents. They would have
been so proud to see their son at the White
House on a beautiful day in September. I
remember thinking how my parents spoke
Spanish to each other and how I had started
my education in a two-room schoolhouse. I
tried to recall what events, circumstances
and good fortune had shaped my life in
such a way as to result in my appointment
as secretary of education.
I decided that the many excellent lessons
I learned while growing up on the King
Ranch in Texas had played a big part. It was
on the ranch where I was taught the value of
hard work, the importance of learning, the
significance of commitment and dedication
to worthy causes, how to make decisions
and the great value of family. Honesty, loyalty, integrity and love of country were
instilled in me. In other words, on the King
Ranch I learned how to live. During my
childhood years it was mostly my parents
who fashioned my life, but the men and
women working and living on the ranch
were also my teachers.
So my journey to the White House began
on a ranch in Texas.
A CARING PLACE
I was born on January 4, 1927, on the
825,000-acre King Ranch in South Texas.
The ranch is about the size of the state of
Rhode Island, and at one time it comprised
approximately 1,250,000 acres. The King
Ranch has always been home to me, even
though I have been away from it for many
years. Just the thought of the King Ranch
stirs grand memories in my mind. When I
think about growing up there, I recall my
childhood days, my parents, brothers and
sister, relatives and many of the fine people
who worked on the ranch. It was a remarkable place, so it is not surprising that the les-
More than a million
acres at its peak, the
King Ranch is today
about the size of Rhode
Island and remains
legendary. “People were
born on it, worked there
all their lives and died
on it,” says the author.
“It was a remarkable
place.”
sons I learned there about life are still
deeply ingrained in me.
In the late 1920s, ’30s and ’40s, my childhood years, the King Ranch was fertile
ground for the growth and development of
children. Parents and those who lived on the
ranch stressed education. The Great Depression had slowed the nation’s economy
to a crawl. Money was short everywhere,
and across the nation people were out of
work. But on the ranch, in the face of these
economic difficulties, the emphasis was on
people. It was a caring place.
In those days, people who worked for the
King Ranch and did their jobs well had
work for life. They could expect the King
Ranch to educate their children and provide
health care, housing, money and food for
the entire family. They knew that when they
died, the ranch would bury them.
One worked long hours helping to
improve the ranch. People were born on it,
worked there all their lives and died on it.
Their children followed in their footsteps,
and some families on the ranch, including
mine, had been there for several generations. They were Kineños, King’s People. I
am a fourth-generation Kineño.
Running the ranch were members of the
Kleberg family, the driving forces who eventually developed it into the greatest cattle
ranch in the world. They instilled the tradition of caring and looking after those who
worked there. This tradition of caring was
in the spirit and commitment of the
founder of the ranch, Capt. Richard King.
As a child, I remember seeing the Klebergs working side-by-side with the men on
the ranch. All the Klebergs were fluent in
Spanish, had superior equestrian skills and
knew the cattle business. They cared so
much about the people working there that
to them the ranch was a family with many
skills and talents. Some stayed on the ranch
to help enhance its excellence in cattle and
horses. Others left but carried with them the
values and the teachings of the Kineños. No
other ranch in this nation has produced a
four-star general and a Cabinet secretary—
my brother Richard and me, respectively.
TWO LANGUAGES AT HOME
My father was Lauro F. Cavazos and my
mother, Tomasa Alvarez Quintanilla. Like
my sister, Sarita, and my brothers, Richard,
Robert and Joseph, I was born at home on
the King Ranch. No one back then saw any
reason for Mother to go to a hospital; she
30 t u f t s m e d i c i n e
winter 2007
ILLUSTRATIONS: CYCLONE DESIGN, INC.
uring my childhood years it was mostly my parents who fashioned my life, but
the men and women working and living on the ranch were also my teachers.
was not sick, just giving birth to a child. The
local country doctor attended her. My
maternal grandmother (Mama Grande Rita)
and aunts helped out. They lived in the barrio in Kingsville, three miles away, and as was
the custom, they came to the ranch to help
Mother and Dad on the day I was born.
On the Santa Gertrudis Division of the
King Ranch, Dad’s work was typical for
young cowboys: riding fences, breaking
horses and herding and working cattle. In
1913, Caesar Kleberg, the foreman of the
Norias Division of the ranch, had Dad transferred from the Santa Gertrudis to the Norias
Division. There, he worked as a member of
the corrida, or cow camp. Dad brought his
many skills as a cowman to Norias. Many
believed that when Dad rode a horse, he and
it were as one. Dad and Robert J. Kleberg, the
manager of the ranch, were considered two
of the best horsemen in Texas.
My parents were remarkable people.
They had great love for their children and
worked to ensure that we would be nurtured and educated. They taught us ethics
and values, not from a book, but by their
example of day-to-day living. Their formal
education was limited. Mother’s education
PHOTOS: JANELL KLEBERG
was perhaps limited to the second-grade
level, so she was functionally illiterate. Dad
attended high school. Still, they were very
intelligent people who knew the value of
education and the difference it could make
in the lives of their children.
Our roots were Hispanic, and we were
raised in the Hispanic traditions and language but taught always to have deep loyalty
to the United States. Dad and Mother spoke
Spanish to each other. However, from the
time we were very young, there was a rule
that we children speak English to Dad and
Spanish to Mother. And so we followed
their directions, all their lives. We children
usually spoke English to each other, but the
working language of the ranch was Spanish.
The first bilingual press conference held
by a Cabinet officer occurred because I
spoke two languages. At my first press interview after I became secretary of education,
most of the questions were in English, but
the Latino networks were there and asked
their questions in Spanish. I responded in
Spanish and translated for the rest of the
press corps. One of the journalists from the
Hispanic media asked what message I might
have for Hispanics. I replied, “Niños, por
favor, no dejen la escuela” (Children, please
stay in school).
HUNGRY WANDERER
Our house was less than a quarter-mile from
the highway. Often people driving through
the ranch entered by the gate near our
house, stopping to ask for directions, or food
or work. The economy was desperate. The
depression was at its height, and jobs and
money were scarce. Mother was quite willing
to give directions or provide food for a
needy person or family. She made it a rule to
never turn anyone away who asked for food.
Mother told me that one morning, as she
was cleaning the living room, she glanced
out the window and saw a man approaching. She did not recognize him. His clothes
were ragged and dirty, and he looked like a
tramp. Mother was certain the stranger was
up to no good, so she reached into the closet
and got one of Dad’s pistols. They were
always loaded. She told us children to stay
together in the main bedroom, to be quiet
and not to come out.
Mother held the pistol behind her back.
When [the stranger] knocked, she kept the
screen door locked but opened the door. He
winter 2007
t u f t s m e d i c i n e 31
looked at her, appeared somewhat startled,
mumbled a few words Mother could not
understand, backed off, turned around and
quickly went out the front gate. The last she
saw of him, he was headed for the highway.
Then she realized what had happened. There
was a large mirror on the wall behind her.
The man must have seen the reflection of the
pistol in the mirror, and he was scared off.
I asked Mother if she had been frightened. She said she was, but most of all she
worried about her children and herself.
That was the only time I remember a
threat of any kind in all the years we lived
on the ranch. Who knows? The man coming
to our door may not have been a troublemaker. He may have been hungry and looking for a meal, but realizing he faced a
woman holding a pistol behind her back
and with a determined look on her face, he
must have lost his appetite.
SOME BOOTS TO POLISH
Dad worked on the ranch seven days a week,
year after year. He took half of the day off on
Thanksgiving and all of Christmas Day.
There was never a vacation for him or for
King Ranch yearlings
32 t u f t s m e d i c i n e
winter 2007
Mother. Work and family consumed the
entire calendar. Dad left the house about 4:30
a.m. every day. He was up early, bathed daily
and had coffee. He was gone before I even
stirred in the morning and did not return
until after dark. By then you could not see to
work cattle, so it was home to dinner.
Dad always wore boots. I never saw him
in a pair of shoes. He changed boots every
day, just like most men change their shirt
daily. Some pairs Dad wore only for daily
work on the ranch, and others, his dress
boots, were for special occasions. Dad’s
boots were not ordinary, off-the-shelf boots
either. A boot-maker named Rios down in
Raymondville made them for him. Rios was
well known for high quality boots, and he
made many pairs for ranch notables
throughout Texas, the Southwest and
Mexico. They were exquisite.
[My brother] Dick and I had the job of
saddle soaping and polishing Dad’s boots
every Saturday. The idea that he could work
cattle in unpolished boots must never have
occurred to him. So, for Dick and me, polishing boots was a Saturday ritual. On
Saturday morning when Dick and I stepped
out on the back porch, there were at least six
pairs of Dad’s boots lined up awaiting our
attention. Mother did her part by reminding us we had to polish Dad’s boots. There
was to be no debate or discussion, no escaping the job.
Some evenings Dad came in from working cattle in stormy, raining weather, his
boots muddy and soaking wet. Dad would
ask Dick and me to take care of the muddy
boots immediately. It was a job that could
not wait till the next day. We scraped off as
much of the mud as we could and took the
boots to the washhouse, where [our ranch
hand] Vallejo stored 50-pound sacks of
grain to feed our chickens. We filled each
boot to the top with grain. When filled with
grain, the boots would not shrink as they
dried. The next day, if the boots were dry,
the grain was emptied out of the boots and
back into the feed sack. Nothing was
wasted, and Dick and I had another pair of
boots to polish.
BASIC SCHOOLING
In the 1930s there were no kindergarten
classes on the ranch. Therefore, by the time
n Saturday morning when Dick and I stepped out on the back porch, there
were at least six pairs of Dad’s boots lined up awaiting our attention.
I was four years old, Dad had tried to teach
me the alphabet and how to count. I was
not a scholar, and my preparation to start
school “ready to learn” was minimal. When
I turned six years old, however, it was off to
school, where I joined my sister, Sarita, a
third-grader. The school was about a mile
from our home. Mother usually drove us to
school, but sometimes we walked. The
school building was wooden and was one
room split into two classrooms by a
portable divider. The schoolhouse had windows on three walls. To young people, the
windows provided a major distraction
because they gave us a grand view of activities around the ranch headquarters.
Although the winters are mild in South
Texas, the schoolhouse was cold and drafty.
It was not insulated, and a small wood stove
in the back of the room provided heat. At
the noon hour we were dismissed to go
home for lunch. There was not a blade of
grass in the schoolyard, and only one large
mesquite tree and a couple of live oak trees.
Two privies, one for the boys and one for
the girls, stood in back of the schoolyard. As
we went out to recess, invariably the teacher
would tell us to be careful and to watch
where we stepped, because there were
plenty of rattlesnakes.
During my time at the Santa Gertrudis
School, I received a fundamental education.
I learned how to read, write and do basic
mathematics, and I learned basic geography
and history. Discipline was never a problem
for the teachers, for we knew better than to
misbehave. I went to school on the ranch
for two years, and although we continued to
live on the ranch, my parents then moved
me to a school in Kingsville.
I believe that the most important decision about my education was made when
my parents decided that their children
should be educated at the Flato Elementary
School in Kingsville. Flato was about three
miles from our home on the ranch.
The Flato School was an impressive
building. In the 1930s, elementary or “grammar” schools generally had seven grades,
and high school had four grades. Thus, I had
an 11-year elementary- and secondaryschool education in contrast to the 12 grades
plus kindergarten most school districts offer
today. The building was stucco and had two
wings and a central portion. The first, second and third grades were in one wing, and
grades four through seven were in the other
wing. The one-room library and the principal’s office connected the wings. The halls
along the wings had balconies, and the floors
were wooden and highly polished.
When Sarita and I arrived at Flato, Miss
Ruby Gustavson was the principal. She was
the principal from 1935 until her retirement
in 1970 and as a result knew thousands of
students from Kingsville. Miss Gustavson
was an attractive woman with light brown
hair and blue eyes. I remember her as about
six feet tall. An imposing figure, she had great
poise. Her speech was rather soft, but precise.
There was never any doubt in our minds
what Miss Gustavson meant when she asked
us to do something for her. Miss Gustavson
was a wonderful teacher and administrator
who knew every student in school.
Applying a fundamental tenet of education—involving parents in the education of
their children—she made it a point to visit
the homes of her students. I remember seeing her come to our house in Kingsville and
telling Mother how Sarita and I were doing
in school. I knew I was doomed. A discussion of my educational progress (or lack
thereof) at Flato was bound to be bleak,
with perhaps a few bright spots.
THE DEBT OWED
Miss Gustavson was an educational constant
in my life. All through elementary school,
she watched and encouraged my education.
Frequently, she told me I could do better in
school or praised me when it was clear I
understood the lesson. As a principal, she
found time to be not only an administrator
but also a teacher and friend to every child
in Flato. After I left Flato for high school, I
occasionally stopped by for a visit.
After I graduated from high school in
1944, I joined the Army. When I was home
on leave, I asked Mother about Miss
Gustavson, and she said she was fine and still
principal. Miss Gustavson finally retired in
1970. For a time I lost track of her, but in
1981, when I was president of Texas Tech
University, I gave a brief speech in Kingsville.
Miss Gustavson was there, and I was very
pleased to see her. Although she had aged a
bit and used a cane, she still stood straight
and gracefully, and her speech, as always, was
precise and proper. We had a brief visit.
The next time I saw Miss Gustavson was
soon after my appointment as U.S. secretary
of education. The first formal speech I gave
after my appointment was in October 1988
on the campus of Texas College of Arts and
Industries in Kingsville (now Texas A&M
University–Kingsville). I do not recall the
topic of my talk, but the highlight for me
was seeing Miss Gustavson again. Prior to
my speech, we talked briefly about education, but she wanted to talk about me. I
could not get her to talk about herself; it was
always about her students.
Miss Gustavson told me how proud she
was I was giving leadership to education in
this country as secretary of education. She
told me she had to admit she never dreamed
I would be in the president’s Cabinet. I told
Miss Gustavson that she and my parents
placed me on the path of learning. I owed
her and them so much.
As I began my speech, I saw her on the left
front row of the auditorium, where they had
reserved a seat for her at my request. To the
audience, I acknowledged her presence and
told them of my debt to Miss Gustavson for
the education she initiated in my life. I said
that I asked but one thing from her: not to
tell the press what a terrible student I was at
Flato.
I remember her smile as she shook her
head.
The author, professor of public health and
family medicine, was dean of Tufts Medical
School from 1975 to 1980, following a term as
acting dean from 1973-75. Excerpted from
A Kineño Remembers by Lauro F. Cavazos,
copyright 2006. Published by Texas A&M
University Press. Used with permission.
winter 2007
t u f t s m e d i c i n e 33
ON CAMPUS
ME D I C A L S C H OO L N E W S
Institute of Mental Health, Dr. Ellen C. Perrin, professor of pediatrics at Tufts, and her
colleagues will evaluate the effectiveness of
their Advanced Parenting Education Program in nine pediatric practices and three
urban health centers in eastern Massachusetts. Pediatricians will give parents a short
questionnaire to screen their two- and threeyear-olds for elevated impulsivity, aggression, oppositionality (willfulness) and
diminished attention.
Dr. Ellen C. Perrin and her research
team will determine if educating parents
of toddlers with significant behavior problems
can prevent an ADHD diagnosis later on.
ADHD intervention
Researchers will test parenting education program
in pediatric practices by Jacqueline Mitchell
most toddlers go through the “terrible twos,” the developmental stage marked by temper tantrums, willfulness and aggression. But
researchers have found that children with significant behavioral problems
at this young age are at increased risk of developing Attention Deficit
Hyperactivity Disorder (ADHD) later on. ■ Researchers at the Floating
Hospital for Children are evaluating one possible intervention. By teaching parents of at-risk toddlers advanced parenting strategies, they hope
to improve children’s behavior problems at a young age, thereby reducing their risk of developing ADHD or another behavior problem, Oppositional Defiant Disorder, characterized by uncooperative and hostile
behavior. ■ With the support of a $3.3 million grant from the National
34 t u f t s m e d i c i n e
winter 2007
NASCENT EVIDENCE
“We’re not making any diagnoses,” says Perrin, director of the Floating Hospital’s Division of Developmental-Behavioral Pediatrics
and of the Center for Children with Special
Needs. “We’re screening for early evidence of
the kinds of behavior that eventually might
lead to a diagnosis” of ADHD or Oppositional Defiant Disorder (ODD).
Parents of kids with these behaviors will
be invited to join a parenting education program. Based on the well-tested “Incredible
Years” program developed by psychologist
Carolyn Webster-Stratton, the education
program gives parents guidelines for reducing their children’s aggression and behavior
problems and increasing their social competence. Though Incredible Years has a
proven track record, it’s never been tested in
clinical pediatric settings before or with children at such a young age.
The parenting groups will meet for two
hours each week at the pediatric offices
where two instructors—one a member of
Perrin’s team, one an office employee—will
present the course in 10 sessions. To measure
parents’ success with the program, they will
fill out self-assessment forms, and three
times during the 10 sessions, they will be
video-taped interacting with their children
under a set of structured circumstances. “It’s
a snapshot, but it does seem to represent the
reality of children’s interactions with their
parents,” says R. Christopher Sheldrick, assistant professor of pediatrics and the project’s
primary co-investigator.
THE POWER OF THE GROUP
To perfect the methodology for the trial,
Perrin’s team conducted a three-year feasibility study in one suburban practice and
PHOTO: JODI HILTON
one urban health center. Jannette McMenamy, assistant professor of behavioral science at Fitchburg State College, helped
design the original project and instructed
one of the parenting groups in Leominster,
Mass. “I’m completely amazed by the power
of the group,” says McMenamy, who
remains involved in the project as a coinvestigator. “The whole equals more than
the sum of its parts. When [parents] meet
other parents in the same boat, the stigma
decreases; the anxiety and the stress
decrease.”
The research team also hopes to demonstrate that the program decreases the economic burden of ADHD and other
disruptive behavior problems on the healthcare system. Though statistics vary widely,
the National Institute of Mental Health estimates that ADHD affects five to 10 percent
of children. That’s some two million American school kids, or about one child in every
classroom in the country.
“Our belief is there could be some savings,” says Perrin, who believes that parents
who have gone through the program will be
less likely to seek mental health counseling
for their children. There is evidence that
depressed and distressed parents take their
children to hospital emergency rooms and
the doctor more often than parents who
are more content and have better support
systems.
Though the researchers acknowledge
that maintaining the program after the
study will incur some cost to the pediatric
practices—while saving parents and insurers money—their hope is that the educational model will remain in the pediatric
practices long after the five-year study ends.
“Anybody can do this. It’s not magic,” Perrin
says, noting that the program is designed so
that when the study is completed, the pediatric practices “can do these [parenting]
groups just as we do them.”
If the parenting education program is
successful, Perrin hopes public funding or
insurance reimbursement will make it economically viable in pediatric practice. But
the team’s main goal is to learn whether
parent education alleviates—and possibly
even staves off—the impairments kids with
ADHD and ODD experience.
PHOTOS: KRISTEN OLSON
WHI TE CO AT
CEREM ON Y
In early September, Dean Rosenblatt
addressed first-year students and their
parents in the Cutler Majestic Theatre
at Emerson College. At left, students
await their moment. This year’s featured speaker was Donald Vereen, Jr.,
M.D./M.P.H., ’85, special assistant to
the director and medical officer at the
National Institute on Drug Abuse.
Zucker prizes
Aviva Must, Ph.D., professor of public health and family medicine, and Abraham
“Linc” Sonenshein, Ph.D., professor of molecular biology and microbiology, are the
recipients of the 2006 Zucker Research Prizes.
Must was awarded the Milton O. and Natalie V. Zucker Prize, given to a woman
scientist for outstanding research. She studies the epidemiology of obesity, focusing
on its long-term physical and psychosocial consequences. Sonenshein, whose
research focuses on gene transcription regulation in spore-forming bacteria, received
the Zucker Family Prize, which also recognizes outstanding research.
winter 2007
t u f t s m e d i c i n e 35
ON CAMPUS
ME D I C A L S C H O O L N E W S
L AP T O P L O A N E R S
WALK AROUND, FIND A SPOT AND PLUG IN.
Since early this fall, that’s been the drill at the Hirsh Health Sciences Library, which
has been loaning laptops to students who prefer the light, portable option. “All our
computers are heavily used,” explains Eric Albright, library director, “and the laptops
work well for those students who want to check them out and settle into a comfortable
nook somewhere around the library.” These laptops don’t travel far; for security reasons, their use is restricted to library premises.
Concerns about durability led the library to select IBMs that were neither the cheapest nor the most expensive model. The IBMS come with a sturdy carrying case that
protects them from damage in case they get dropped now and then. “They can take
more abuse than a cheaper model,” says Albright, who sees the purchase of the first
five laptops—at about $1,500 each—as reflecting the library’s desire to be responsive
to a variety of learning styles.
Albright has already ordered another five laptops. “I’ve had two people come up and
thank me for doing this, and you never get thanked for anything,” laughs the director.
Breast
cancer work
charlotte kuperwasser, ph.d., assistant
professor of anatomy and cellular biology,
has been awarded a $200,000 grant from the
Breast Cancer Research Foundation. The
funding will support her research on the role
of estrogen in cells other than breast carcinoma cells.
Kuperwasser seeks to identify the bone
marrow cells that are the target of estrogenmediated angiogenesis and tumor promotion, and to determine how these cells may
respond to estrogen. Kuperwasser theorizes
that a better understanding of estrogen’s
effect on bone marrow cells, as well as on
stromal fibroblasts and endothelial cells,
could lead to anti-estrogen breast cancer
therapies.
Charlotte Kuperwasser
C O U R S E D I R E C T O R N AM ED
Ralph Aarons, M.D., Ph.D., assistant professor of pediatrics, has
of one of three Educational Strategic Planning working groups. In
been appointed course director of the Problem-Based Learning
his new role, he will broaden faculty participation in PBL mentor-
(PBL) Program at the medical school.
ing activities and will guide PBL’s transition into the school’s new
Aarons, who succeeds Luisa Fertita, M.S., R.N.C., has been
actively involved in the school’s educational program since he
began serving as a PBL facilitator in 1998. He also is a member
36 t u f t s m e d i c i n e
winter 2007
curriculum.
Aarons is a neonatologist at Caritas St. Elizabeth’s Medical
Center and associate chief of the Division of Newborn Medicine.
PHOTO: MARK MORELLI, ILLUSTRATION: ELVIS SWIFT
Hail to the chief
M EET THE
CLA SS OF ’ 1 0
Dr. Joseph Corkery, assistant clinical professor of medicine, has been appointed
chief medical officer of the Lahey Clinic, overseeing Lahey’s quality and safety
programs and leading the hospital’s efforts to advance evidence-based medicine
and improve patient outcomes. He has been a member of Lahey’s Board of
WHO THEY ARE
Completed applications
Admitted
Enrolled
6,694
453
171
Trustees since 1993.
PROGRAM ENROLLMENT
NEW DEAN
janet hafler, ed.d., has been appointed dean
for educational development in the Office of Educational Affairs. Hafler has been at Harvard Medical
School for the past 17 years, most recently as director for faculty development and associate professor
of pediatrics.
At Harvard, she ran an active research program,
applying qualitative research methods to medical
Janet Hafler
education. Hafler will bring her extensive expertise
to many areas of curriculum development, evaluation and scholarship as the medical school develops and implements its educational
and strategic plans. The main focus of her work will be on faculty development
throughout the school’s programs, including admissions, problem-based learning,
standardized patient care and clinical teaching.
M.D.
M.D./M.P.H.
M.D./M.B.A.
M.D./Ph.D.
M.D./M.S.E.
140
16
8
4
3
MEAN GRADES
Total GPA
Science GPA
3.61
3.56
TOP FEEDER SCHOOLS
Tufts
Brown
BC
UMass
Penn
Cornell
Brandeis
MIT
Berkeley
Colby
BU
Holy Cross
Harvard
29
13
11
10
8
8
8
6
5
4
4
4
4
WHERE THEY CAME FROM
Other 19%
Massachusetts
44%
California 10%
New Jersey 4%
New York
13%
Other
New
England
states 10%
winter 2007
t u f t s m e d i c i n e 37
The Sharewood Project held its 10th anniversary online auction in late November,
raising nearly $8,000 to support its work providing free medical care to underserved
populations around Boston. Some 100 bidders participated in the auction.
HAFLER PHOTO: JODI HILTON; SHAREWOOD: JOANIE TOBIN
UNIVERSITY NEWS
THE WIDER WORLD OF TUFTS
Al-Walid I El-Bermani teaches
anatomy to students. Two medical
school faculty members are among
the first group of CELT fellows.
New center will help faculty teach to a diversity of
learning styles By Marjorie Howard
brought PACE to Tufts and has augmented it
with a new university-wide program: the
Center for the Enhancement of Learning
and Teaching (CELT), which will draw on
research at PACE.
when arts & sciences dean robert sternberg took his first
college psychology course, he got a C—not an auspicious start for
someone who eventually earned a Ph.D. in the field. The problem, he
recalled more than 30 years later, was that his tests were all based on what
students could memorize, and Sternberg is lousy at memorization. To add
insult to injury, most of the material he had to learn isn’t even being
taught in psychology anymore.
Sternberg may not have fared well on tests that relied on good memorization skills, but he did do well on tests that involved creativity or verbal ability. “I can tend to be very good in writing, but I’m relatively poor
in spatial visualization, so in my life, I capitalize on my verbal skills: I write
a lot of articles, read a lot, give a lot of talks,” he said. “But I bought a GPS
system for my car, and I always make sure that I have verbal directions
when I go to a place because I don’t read maps that well. Nobody is good
at everything, and people have to learn how to make the most of their
strengths and get by—either by compensating for or correcting weaknesses.”
Sternberg’s longstanding interest in different styles of learning resulted
in his founding the PACE Center at Yale University, where he taught
before coming to Tufts a year ago. PACE, which stands for Psychology of
Abilities, Competencies and Expertise, advances the notion of abilities as
modifiable and capable of development over a lifetime.
Now Sternberg is taking his scholarship one step further. He has
THE FIRST 12 FELLOWS
CELT will help faculty members become
better teachers through seminars, newsletters, discussions and workshops. “It’s not
that we are saying people here don’t know
how to teach,” said Sternberg, who is CELT’s
director. “The goal is to enhance already
good or even excellent teaching skills. We’re
saying no matter how good you are you can
always be better.”
The signature program of the new center
will be a weekly seminar for faculty fellows
led by Molly Mead, the Lincoln Filene Professor at Tisch College, and Linda Jarvin,
CELT’s deputy director, who did research in
psychology and education at Yale before
coming to Tufts. A group of 12 fellows from
across the university will participate in the
first seminar, starting in January. Participants either will be granted a stipend or
given a one-course reduction in their teaching loads.
Dr. David E. Ricklan, assistant professor
of pathology, and Dr. Scott J. Gilbert, assis-
Out of the box
38 t u f t s m e d i c i n e
winter 2007
PHOTO: MELODY KO
tant professor of medicine, are among the
first group of fellows, chosen from a university-wide pool of 36 applicants who
described challenges they are facing in the
classroom. One faculty member wrote that
he’d like help in making a dry, fact-based,
introductory course more interesting; a second is planning to team teach and wants
help in establishing the course.
Sternberg said that while some students
learn analytically, others may learn more
practically or creatively. The idea, he said, is
to “teach kids in varied ways so that at any
given time, some are capitalizing on
strengths and others are remediating weaknesses. The fellows will be encouraged to use
this principle in at least one course they
teach. They will bring actual teaching materials to the seminars and see how they can be
improved to reach a diversity of learners.”
“We’re not offering remedial training,”
Jarvin said. “We’re not saying people don’t
know how to teach and that we have to
revamp the system. But we want to offer
opportunities to faculty to think about their
teaching and to enhance their teaching.”
DUAL MISSION
While PACE has been funded primarily with
grants, CELT’s funding comes from a seed
grant from the Office of the Provost as well
as a $250,000 grant from the Davis Education Foundation of Falmouth, Maine.
“Our dual mission as a university is
teaching and scholarship,” said Jamshed
Bharucha, provost and senior vice president. “At Tufts we pride ourselves on valuing
both. Even as we advance our research and
scholarship, we must continue to strive for
excellence in teaching and renew ourselves as
teachers in light of new research on the
process of learning, rapid developments in
the fields we teach, changing demographics
of our students and new technology.”
Bharucha said Associate Provost Mary Lee
will work on behalf of his office to encourage all campuses to participate in the new
center.
Anne Gardulski, associate professor and
chair of geology and one of the first fellows,
said she sometimes teaches courses of 70 to
125 students and is trying to find ways to
better assess students in such a large course.
“One of the huge challenges in such
courses is to construct exams or other
assessment tools that indeed test what the
students have learned,” Gardulski said.
“Some students can respond well to essay
questions, others to short answer tests, and
others may have completely different ways
of learning that traditional exams cannot
evaluate.
CLASSROOM CREATIVITY
“I am looking for ways to be more creative
in devising exams, although there are time
constraints imposed by the fact that I do not
have teaching assistant or grad student help
for grading, thus I cannot offer essay exams,”
she said. “I also want to ensure that I am
requiring students to think about the science. Graphs, maps, charts and other representations of data are an integral part of
science, so I feel I need to include these
mechanisms for data work on exams. Ultimately, I suspect I will want to modify how
I teach so that I can be more creative and
develop new ways to assess how students are
synthesizing the material.”
Louise Maranda, who teaches biostatistics at the Cummings School of Veterinary
Medicine, applied for a fellowship, in part,
she wrote in her application, to try to find
ways to reach students who come into her
course with different backgrounds and at
different levels.
She said she hopes to learn how to assess
her students’ prior knowledge, how to better
develop lecture topics, and “understand the
learning process to better develop fun,
meaningful and efficient examples, homework and exams.”
Jarvin said the center also will serve as a
central clearinghouse for information about
teaching initiatives. “There really isn’t a
space for faculty members, especially those
who are very committed to their teaching, to
reflect on these practices and meet with
other faculty to discuss them,” she said.
L EE A S S UM ES NEW, WI DER ROL E
ASSOCIATE PROVOST MARY LEE, J75, M83, WILL BE MOVING TO THE PROVOST’S OFFICE
full-time, starting in January. For the past five years, Lee has done double duty as
associate provost and dean for educational affairs at the medical school.
Lee completed her residency in internal medicine at Tufts-New England
Medical Center and was hired by Dr. Sheldon Wolff in the Department of Medicine
to run the internal medicine clerkships. Since then, she has worked both as a clinician at Tufts-NEMC (until 2004) and as an administrator at the school, most
notably as dean for educational affairs over the past 12 years. In her tenure as
dean, Lee has helped to promote a culture of teamwork and collaboration.
“Mary Lee has been a legendary dean for educational affairs at the medical
school,” said Dean Michael Rosenblatt. “Her innovations in curriculum and information technology have put Tufts Medical School in a leadership position in medical education. Few educators, no matter how talented, are known beyond their
institution. Mary is recognized internationally for her achievements.”
In her new role, she will be focusing on providing university-wide leadership on
several fronts, including the library system, educational resources and faculty
development. “Among the educational resources she will be increasingly engaged
with is the Tufts OpenCourseWare project, which has been a tremendous success,” said Provost Jamshed Bharucha in announcing the change. “Through this
project, our educational resources are being accessed by tens of thousands of
people across the globe. OCW promises to become a signature program for Tufts
as Mary focuses more time on it.”
winter 2007
t u f t s m e d i c i n e 39
BEYOND BOUNDARIES
P R O V I D I N G T H E M E A NS F OR E XC EL L E NC E
Fund-raising effort is part of university’s historic $1.2 billion campaign
A $225 million goal
the school of medicine is seeking to raise $225 million as part of
a five-year university-wide $1.2 billion fund-raising campaign, the
largest in Tufts’ history.
Beyond Boundaries: The Campaign for Tufts was officially launched on
November 3 at Boston’s Wang Center. The fund-raising endeavor, which
seeks to raise double the amount of the university’s last capital campaign,
targets key priorities such as financial aid, endowed professorships,
research facilities and initiatives in citizenship and public service. Sixty
percent will be directed to the Tufts endowment, which now stands at
$1.2 billion.
“Building upon our strength and reputation as a premiere medical
school, we are committed to preparing the institution to meet the challenges and seize the opportunities presented in this dynamic period of scientific discovery and medical care,” said Dean Michael Rosenblatt.
40 t u f t s m e d i c i n e
winter 2007
“A successful campaign will enable us to continue admitting the finest students, to attract
and return the best faculty.”
Highlights of the campaign for the medical school include:
Scholarships. When students choose Tufts
Medical School, they shoulder tuition that is
one of the highest in the nation. The campaign seeks new gifts and pledges totaling
$65 million to bolster scholarships and
stipends so that outstanding students may
have the opportunity to pursue medical and
biomedical graduate education. The goal
PHOTO: MELODY KO
will fulfill a critical need to endow 80 halftuition scholarships for students in the
School of Medicine and 40 stipends for
first-year Ph.D. students in the Sackler
School of Graduate Biomedical Sciences.
Teaching hospital partnerships and clinical
faculty. More than 2,000 skilled, voluntary
clinical educators at 14 affiliated Tufts teaching hospitals devote uncompensated time,
often at the expense of their practices, to
train the next generation of physicians. The
campaign seeks funding to support this vital
experience by raising $10 million to support
a “Community of Clinical Educators.” This
initiative will reward the contributions of
outstanding clerkship directors by providing
financial support to the directors of the five
core clerkships. In addition, to recognize
and retain outstanding clinical leadership,
the school will earmark $9 million to
strengthen funding for clinical department
chairs by endowing professorships for three
or more clinical department leaders.
A NEW WAY TO S UPPOR T THE
UNI VERSI TY Y OU LOV E
Are you 70 1 ⁄ 2 years of age or older? Are you required to take distributions
from your IRA (Individual Retirement Account) that you don’t need?
Until December 31, 2007, you can make a donation to Tufts University
School of Medicine by directly transferring money from your IRA, tax free.
The Pension Protection Act of 2006 allows individuals with traditional
or Roth IRAs to make tax-free charitable distributions in any amount up to
$100,000 per year.
To make your gift and for more information, please visit
www.tufts.edu/giftplanning, or contact the Gift Planning Office by phone
at 1.888.PGTufts or by e-mail at [email protected].
Please note that this information is not intended as legal advice, so
please consult with your tax advisor if you are considering this type of
gift. Restrictions may exist.
Research and basic science faculty. The
school will make targeted investments
toward achieving distinctive capabilities in
four research areas: infectious disease, neuroscience sensory and disease biology, cancer and heart disease. Funding will also be
focused on elevating the school’s expertise in
“platform” fields of study: genetics; clinical
research and evidence-based medicine; drug
discovery and development; and regenerative and stem cell medicine.
Some $25 million of the school’s campaign goal will benefit distinguished basic
science research faculty. This goal will translate into five full professorships and 10 assistant/associate endowed professorships. In
addition, the school seeks science faculty
recruitment packages to attract talented
investigators who translate scientific discovery at the bench to the bedside. Recruit-
Robert Goldstein, a student in the medical
school’s combined M.D./Ph.D. program,
conducts research on the health sciences
campus, where research facilities to
support investigations into infectious
disease and other issues of importance
are a campaign priority.
ment packages include start-up funds, lab
renovations and salary support for three to
five years.
Campus identity and educational facilities.
The school aims to raise $31 million for a
campus center. The facility will include a
cafeteria to foster daily student and faculty
interaction, a large function space for ceremonies and other events and space for students to meet. Due to the growing use of
technology in medicine, the school also will
construct a network of simulation centers on
campus and at teaching hospitals. The Medical Skills and Simulation Center will require
$23 million in funding. To create a distinctive
campus setting, $5 million is needed for Tufts
University School of Medicine signage,
expanded lighting, improved walkways and a
well-integrated landscape architecture.
The Fund for Tufts Medicine. Already one
of the strongest-performing medical school
annual funds in the country, the Fund for
Tufts Medicine is experiencing unprecedented growth, thanks to the generous and
visionary support of alumni, parents and
friends. The annual fund touches every
aspect of education and research at Tufts
and will remain a cornerstone to our success. The campaign seeks to raise $14 million
in annual funds.
The medical school’s campaign, said
Rosenblatt, is an opportunity to celebrate
the achievements of the school and to
heighten the important role of philanthropy.
Throughout the course of the effort, he will
be meeting with alumni and friends to talk
about how Beyond Boundaries will transform the school.
“Philanthropy has always been a critical
part of the medical school’s progress,” Rosenblatt said. “We are grateful that the level of
support has been steadily growing, both sustaining and strengthening our preeminence.
We still, however, have much to do to ensure
that our excellence in education and research
meets the enormous needs of a rapidly
changing world. I’m excited by our
prospects, and I hope others will be too.”
For more about Beyond Boundaries, go to
www.tufts.edu/giving.
winter 2007
t u f t s m e d i c i n e 41
BEYOND BOUNDARIES
P R O V I D I N G T H E M E A NS F OR E XC EL L E NC E
Open to the world
Students gain public health experience in
developing nations By Mark Sullivan
dr. harris berman was on duty in a
New Hampshire emergency room in the
middle of flu season a few years back when
an Indian man arrived complaining of aches
and fever. Something about the man’s symptoms led Berman, a former Peace Corps
physician in India, Nepal, Fiji and Western
Samoa, to do some additional tests—and
indeed, the man was found to be suffering
from malaria.
“His case easily could have been passed
off as the flu,” recalled Berman, now the
Morton A. Madoff Professor and chair of
Public Health and Family Medicine and
dean of public health and professional
degree programs at the medical school.
The global travel that has made ours a
small world also has increased the chances
that a tropical disease will turn up in a New
England emergency room, Berman said. A
new initiative launched by his office trains
medical students to spot diseases from
around the world by sending them out into
42 t u f t s m e d i c i n e
winter 2007
the world. The Global Health Initiative
includes student clerkship opportunities in
developing countries and a new global
health concentration in the master’s program in public health.
“These exciting new programs are being
established to respond to the needs
expressed by our students, to learn and
experience public health and medical care in
a global setting,” said Berman, who is now
working to attract philanthropic support
for the initiative.
“As the world becomes much more of a
global community,” he continued, “the diseases of the developing world travel to our
borders in a matter of hours, and the diseases of developed countries are becoming
more common in the developing world.
These new programs will deal with these
important issues and add an important
dimension to the education at Tufts.”
Fellowship programs began this past
summer. Several opportunities are available
for students in the M.D./M.P.H., D.V.M./M.P.H., M.P.H. and M.S. in health communications degree programs:
■ In Panama, under a partnership with
the School of Medicine at Panama University, student fellows will divide their time
between language school, with an emphasis on medical Spanish, and a community
health center.
■ In East Africa, students will work on
public health and environmental projects
at the Institute of Public Health at Makerere University in Kampala, Uganda, and
at the School of Public Health at Muhimbili University College of Health Sciences
in Dar es Salaam, Tanzania. Students also
will assist faculty at the participating institutions to link with Tufts via TUSK (the
Tufts University Science Knowledgebase).
The project will be expanded next year to
the Christian Medical College in Vellore,
India.
■ In Mangalore, India, student fellows will
gain community health experience under a
collaboration with Father Muller Medical
College.
■ The Hickey-Peyton International Travel
Fellowship is awarded annually to firstyear medical students to support public
PHOTO: MICHEL DE NIJS FOR ISTOCKPHOTO.COM
health research and activities in a foreign
country of their choice.
■ The new Global Health Concentration
to be introduced in the M.P.H. program in
September 2007 will entail four global
health courses in addition to core degree
requirements.
L E TTERS FROM A BROA D
This past summer, six students traveled
to India under the Global Health Initiative,
while seven traveled to Panama and seven
went to East Africa, Berman said. Since their
return, the students have made presentations
on their experiences to medical school classmates and alumni, to Tufts University’s
international overseers and to the medical
school’s overseers.
Already, one alumnus inspired by their
accounts has pledged to sponsor a student
traveling to Vellore, India, this winter,
Berman said. Six M.D./M.P.H. students are
slated to do their practicum in public health
at the Christian Medical College there in
February and March. Each student is given a
stipend of $2,500.
Right now, the initiative is being funded
on a year-to-year basis, Berman said. “What
we need is about $100,000 a year to run the
program,” he said. “What we really need is an
endowment to run this in perpetuity.”
Berman hopes potential benefactors see
this initiative as an outstanding investment
in global public health education and active
citizenship. “They’ll be helping to expand
opportunities for students, to spread good
will for the United States at a time we really
need it, and to make better doctors and
public health practitioners,” he said.
“These students who have seen the world
will be better able to help the world when
they become physicians and public health
professionals.”
Sarah Gottfried, ’09
“Each day brought a new experience. A
new sub-health center to visit, new doctors
to work with, new patients and some medical conditions we would have never seen
here in the States. We got a true taste of
general medicine, pediatrics and gynecology. We gained insight into the medical conditions that are common, that are seen
every day all over the world, and those
that are more unique to Panama.
“Every time I perform the Leopold
Maneuvers on a pregnant woman, palpate
Gottfried in traditional garb with children of
an abdomen for possible appendicitis,
the Kuna Indian tribe of Panama
look down a throat for exudate or deliver a
baby, I will think of the patients in Panama who let this new, awkwardly bumbling
Doctora Americana treat them.” www.tufts.edu/med/medissue/sacklerb/
panama.htm
Mark Sullivan is a senior writer for
Advancement Communications.
If you are interested in sponsoring a
global health student internship, or
making a contribution to the Fund for
Global/Public Health, please contact
Joshua Young at 617.636.3604 or e-mail
joshua.young @tufts.edu.
Tufts medical students’ reports from the field best convey the flavor of the public
health experience they have gained around the world through the Global Health Initiative. Some excerpts:
Practicando la
medicina en Panamá
My summer in India
Jessica Heath, ’09
“Weekdays were fairly structured. In the morning, we’d go to class. We were in twoweek rotations between general medicine, OB, pediatrics and surgery. Class consisted
of a topical lecture followed by a trip to the general wards and a case presentation or a
visit to the OR. On Thursdays we visited primary health-care centers that catered to
rural and low-income patients.
“This approach was a good way to get an overall perspective on diseases, especially
those endemic to India, like leprosy, tuberculosis and malaria.www.tufts.edu/med/
medissue/sacklerb/india.htm
The sadness of the developing world
Anita Sarathi, ’09
“Sadness, helplessness, anger, guilt. All emotions I encountered in passing the street
children of Kampala, Uganda. Although this was my first time to travel abroad, I had
heard of these young children in the streets throughout the developing world. I had
been warned by various American citizens not to hand out money to these children as
a matter of safety. I felt as if this advice was more than a little heartless, but I kept it
in mind nonetheless. I wondered at myself as I passed a small girl with a baby on her
back. How could I just ignore this beautiful child? Who gave me the right, with all of my
riches and blessings, to just walk on by? www.tufts.edu/med/medissue/sacklerb/uganda.htm
winter 2007
t u f t s m e d i c i n e 43
ALUMNI NEWS
S TAY I NG C ON NEC T E D
Now more than ever
tufts university has just launched a new
capital campaign. As part of this campaign,
the medical school has the ambitious goal of
raising $225 million over the next five years.
Consider just a few of the challenges and
opportunities that we face:
■ Scholarships: The medical school
always has been rich in ideas, with wonderful
students and faculty. But for too long, our
tuition has been very high (and for some, prohibitive). With an endowment that permits us to fund half-tuition
scholarships for one-fourth of our students, we can attract and train a
highly diverse student body, not just the privileged, well into the future.
■ Medical Skills and Simulations Center: Creation of this center would permit the school to integrate the recent breakthroughs in
technology, digital art and game development into new, virtual-reality
simulations for medical education.
■ Faculty Recruitment: These days, to be competitive in attracting
and keeping world-class scientists and teachers, we need to be able to
offer comprehensive recruitment packages. Several faculty members
are now approaching retirement age. With new funding for recruitment of young scientist-teachers, we have a wonderful opportunity to
build the school’s future faculty over the
next eight to 10 years.
■ Curriculum Initiatives: A creative redesign of the medical school curriculum is
under way. The new curriculum will have
interdisciplinary, translational medicine as
its common perspective and will teach our
students to integrate cutting-edge basic science discoveries into the practice of clinical
medicine.
We all receive a number of philanthropic
requests each year. But at this exciting time,
the medical school needs you more than
ever. Would you consider elevating your giving to Tufts to a higher priority this year?
Please give serious thought to what you
might be able to do to help us to take this
giant leap forward in advancing medical
education so that Tufts is poised to train
the medical leaders of tomorrow. Many
thanks.
Betsy Busch, ’75
[email protected]
TRAVEL TO EXTRAORDINARY PLACES WITH EXCEPTIONAL PEOPLE
From Antarctica to Santorini, from China to
the Nile, the Tufts Travel-Learn Program combines
intellectual inquiry with leisure and exploration.
There’s a perfect trip for every taste.
Call Usha Sellers, Director,
at 800-843-2586 or visit
our website for updated
details and itineraries.
travel-learn
www.tufts.edu/alumni/ed-travel-learn.html
44 t u f t s m e d i c i n e
winter 2007
PHOTO: BRIAN LOEB
C LA SS N O TE S
47
Lawrence Coleman of Rindge,
N.H., spends his free time working with the state’s Department
of Environmental Services to
prevent deterioration in his local
community. Among his proudest
lifetime accomplishments, he
cites having assisted in the
physiological testing of the lifesupport system for the “moon
suit” used by astronauts in their
first landing on the moon. Coleman and his wife, Ernestine,
have a son, William, and a
granddaughter, Sara.
Salvatore Mangano of Hingham,
Mass., writes that he is happily
settled in a wonderful, carefree
community by the sea. Together
with Ted Gordon, he will be
planning the 60th reunion for
the Class of 1947. “Hope to
see our classmates of the
Golden Era at Tufts Medical
School,” he writes.
57
Joel Berman of Southborough,
Mass., who spends his time
playing golf and bridge and taking postgraduate courses, is
planning to attend his class
reunion this spring. “Is it only
50 years?” he writes half-mockingly. “Seems more like 500!”
Basil Pruitt of San Antonio,
Texas, has been awarded an
international prize for his outstanding contributions to the
field of burn care, research and
education. The Tanner-VandeputBoswick Burn Prize for 2006,
named for three physicians
prominent in the field, was presented to Pruitt in September at
a global conference in Brazil.
The award carries a cash value
of approximately $100,000.
“Dr. Pruitt was selected for his
remarkable and enduring contributions to the field of burns,”
said the chair of the International Burn Foundation, which
awarded the prize. “He remains
one of the most influential
physicians in the field of burn
treatment.”
Ann Grumley Lester of Miami,
Fla., jokes that having graduated from medical school in 1957
is her proudest medical accomplishment. More seriously, she
notes that Tufts provided her
with “a wonderful general background for general pediatric
practice.” These days, Lester
enjoys playing chamber music.
60
Robert D. Kennison, professor
of obstetrics and gynecology,
retired on December 31 after
more than 40 years of service
to Tufts-New England Medical
Center and Tufts School of Medicine. Kennison became chief
resident in gynecology at NEMC
in 1964 and a teaching fellow
in obstetrics and gynecology at
the medical school. He has held
positions at both institutions
ever since, including several
leadership roles in the hospital’s Department of Obstetrics
and Gynecology and as part of
the school’s administration,
where he has played a key role
in curriculum innovation. He is a
past president of the Tufts Medical Alumni Association and a
member of the University Alumni Council. A frequent recipient
of teaching awards, Kennison
won the medical school’s
Zucker Teaching Prize in 2000.
He is also a captain in the
Army Medical Corps and
served in the Womack Army
Medical Center’s Department
of Obstetrics and Gynecology
from 1965-67 and in 1995.
62
Frank Calia of Grasonville, Md.,
is an internal medicine and
infectious disease specialist
at the University of Maryland
School of Medicine, where he
is the Theodore E. Woodward
Professor of Medicine and chair
of the Department of Medicine.
He reports that students have
named him Teacher of the Year
at graduation for the past 24
years.
Richard Gardner of Cape Coral,
Fla., an orthopedic surgeon,
has invented four medical
devices now commonly found in
hospitals around the world. One
of these, the “Gardner Arm Elevator,” is a sling that has been
used by both friendly and
opposing forces to speed rehabilitation of soldiers during the
military operations of Desert
Storm, Desert Shield and Iraqi
Freedom. Gardner and his wife,
Ingrid, have two sons, Adam
and David.
67
David Bass of Glastonbury,
Conn., is a plastic and reconstructive surgeon in the
Hartford area. He has volunteered repeatedly as a medical
missionary to sites in the
developing countries of Latin
America, including Honduras,
Bolivia and Peru, and plans to
continue his service in the
years ahead.
John Buckley of Glen Arm, Md.,
writes that he is “still alive and
still practicing” psychiatry. For
fun, he says he tries to “patch
the old house and avoid golf.”
Buckley and his wife, Sharon,
have four children and seven
grandchildren. He asks classmates to stop by when they are
in the Baltimore area.
71
Samuel Berkman of Encino,
Calif., has written an historical
novel, The American Student,
about an American teenager’s
struggle in Europe during the
Berlin crisis. Excerpts and
source materials from the book
can be viewed on the book’s
website at www.samuelberkman.com.
73
Arthur Fournier of Miami, Fla.,
associate dean for community
health affairs and a professor
at the University of Miami’s
WE WANT TO HEAR FROM YOU!
Have a new job? Is your family growing? A special project or
appointment? Getting together with classmates? Keep your
fellow alumni/ae posted by dropping us a line.
Send to:
Tufts Medical Alumni Relations
136 Harrison Avenue
Boston, MA 02111
e-mail: [email protected]
CLASS NOTES DEADLINE FOR NEXT ISSUE IS MARCH 1, 2007
winter 2007
t u f t s m e d i c i n e 45
ALUMNI NEWS
Miller School of Medicine,
published The Zombie Curse
(Joseph Henry Press, 2006),
which recounts his 25-year
journey into the heart of the
AIDS epidemic in Haiti. Fournier has pledged to donate all
author proceeds from the book
to Project Medshare, a nonprofit
organization dedicated to improving the health of the Haitian
people. He can be reached
at [email protected].
77
David Geffen of Beer Sheva,
Israel, is director of the oncology ambulatory care unit at
Soroka Medical Center and
serves on the faculty of health
sciences at Ben Gurion University. He writes that he is proud
to have helped establish a modern cancer treatment program
for the residents of southern
Israel. Geffen and his wife,
Mitzi, have four children and
three grandchildren.
Patricia McShane of Breckenridge, Colo., is an ob/gyn
specialist who served as medical director of the Reproductive
Science Center in Lexington,
Mass., from 1988 to 2006.
She writes that she found a
measure of satisfaction in
“growing my practice over 18
years and bringing several new
techniques into the program.”
Norman Yanofsky of Hanover,
N.H., is an associate professor
of medicine and chair of the
emergency medicine section at
Dartmouth-Hitchcock Medical
Center. He and his wife, Kathleen, have two sons, Benjamin,
19, and David, 17.
46 t u f t s m e d i c i n e
winter 2007
CLASS NOTES
82
Daniel Driscoll of Milton,
Mass., is a clinical assistant
professor at Tufts and an
instructor in community medicine at Boston University School
of Medicine. He and his wife,
Elaine, have four children, Matt,
Alicia, Danny and John. “All is
well,” he writes. “The first of
four is off to college.”
Connie Jackson of Chestnut Hill,
Mass., assistant clinical professor of obstetrics and gynecology,
recently joined the medical staff
at Winchester Hospital and is
practicing at Dowd Medical
Associates in Reading. She previously worked as an obstetrician-gynecologist with the
Southboro Medical Group.
89
Lisa Stellwagen of San Diego,
Calif., is a specialist in newborn
medicine at the UC/San Diego
School of Medicine. She and her
husband, Marc Montminy, ’84,
have three children. Stellwagen
writes: “Marc and I have been
married for 22 years! He is
doing molecular biology at the
Salk Institute. We would love to
hear from anyone who comes to
San Diego.”
Peter Rosenblatt of Newton,
Mass., an innovator in the field
of operative laparoscopy and
pelvic reconstructive surgery,
has been named chair of the
newly formed Female Health
Advisory Board at Andover
Medical Inc. He has been
director of urogynecology and
pelvic reconstructive surgery
at Mt. Auburn Hospital in
Cambridge since 1995.
84
92
Marc Montminy, see ’82.
John Donahue of Attleboro,
Mass., is a neurologist on staff
at Rhode Island Hospital in
Providence, R.I., as well as an
assistant professor of pathology
and laboratory medicine at
Brown Medical School. His
favorite memory of medical
school involves “doing surgery
at St. E’s, even though I hated
surgery and the long hours. It
was a fun group of house staff
and students.”
86
Robert Harrington of Apex, N.C.,
a cardiologist at Duke University
Medical Center, has been
named director of the Duke
Clinical Research Institute, the
world’s largest academic clinical
research organization. Harrington was most recently the institute’s co-director of cardiovascular research and the leader of
cardiovascular clinical trials. He
joined the Duke faculty in 1993.
87
Anita Honkanen of Palo Alto,
Calif., is chief of the division of
pediatric anesthesia and director
of anesthesia services at Lucile
Packard Children’s Hospital at
Stanford University.
97
Maria Rhee and her husband,
Kory Tray, ’97, of Cheshire,
Conn., are keeping busy. She
works as a clinical instructor in
ob/gyn at Yale-New Haven Hospital and has a private practice
on the side. He is a nephrologist
at Hartford Hospital and
is also a partner in a medical
practice. Together, they have
three children under the age of
six. “You can still work full-time
and raise a family,” Rhee tells
current medical students.
“Don’t fret, ladies!”
02
Josh Riff of Tucson, Ariz., an
emergency room doctor, suffered a bicycle crash that put
him out of the running for the
Ironman World Championship
in Hawaii this fall—an event for
which he was training when a
pickup truck struck him, breaking his leg, in early October.
Riff and his wife, Jennifer, are
expecting their first child in
February. “Someone once told
me you can do a lot of things,
but only three things really
well,” Riff reflects. “The last
few years, it’s been being
husband, doctor and Ironman.
Next year I’m going to be a
dad, husband and doctor.”
Karen Sullivan of Arlington,
Mass., is working at Lexington
Pediatrics in Lexington, Mass.,
and is affiliated with Children’s
Hospital in Boston.
Rakesh Talati of Wilbraham,
Mass., is an assistant professor
of emergency medicine at Baystate Medical Center. He writes
that he has continued his interest in volleyball that he cultivated while a medical student.
03
Cathy Beland of Slingerlands,
N.Y., has joined Martha’s Vineyard Hospital as an emergency
room physician. Beland, whose
interests include hiking and
wilderness medicine, completed
her residency at the Albany
Medical Center in June.
O BI TUAR I E S
D'Agostino (center) with children
from the Nyumbani Orphanage
in 2004. “He reached out to
everybody,” said a friend.
Jesuit doctor founded AIDS
orphanage in Kenya
ANGELO D’AGOSTINO, S.J., ’49, OF NAIROBI, KENYA, WHO OPENED ONE OF THE FIRST
orphanages for HIV-positive children in Kenya and fought to make AIDS
drugs affordable to the poor, died November 20 of a heart attack. He
was 80.
D’Agostino trained in urology at Tufts-New England Medical Center,
served in the U.S. Air Force as a surgeon and became the first Catholic
priest to be a psychiatrist specializing in psychoanalysis. But his true
legacy, his colleagues say, was built in a rented home in a suburb on the
outskirts of Kenya’s capital city.
He grew up in Providence, R.I., one of six children of Italian immigrants.
His father, a construction worker, professed an antagonism toward religion. Despite this, two of the D’Agostino children became priests, another
a Christian brother and one a nun. He attended St. Michael’s College in
Vermont before entering medical school. During the Korean War, he joined
the Air Force and worked in a military hospital near Washington.
His calling to the priesthood began with a retreat led by a Jesuit
priest. “I finally realized there was more to life than cutting up, and
sewing up, people,” D’Agostino told the Washington Post. He was
PHOTO: AP PHOTO/KHALIL SENOSI
ordained in 1966. At the
prompting of his Jesuit superiors, he trained in psychiatry at
Georgetown University and the
Washington Psychoanalytic
Institute before traveling to
Thailand to help set up a
refugee camp in 1980. He went
to Africa the following year.
D’Agostino opened the
Nyumbani Orphanage in 1992,
when it welcomed three HIV-positive children. “He was mirroring
the compassion of God. He
reached out to everybody,” said
Sister Mary Owens, who had
worked beside D’Agostino for
the past 14 years. Nyumbani is
the Swahili word for “home.”
With aid from the Jesuits and
from fund-raising trips he made
back to New England, D’Agostino, known around the orphanage as “Father Dag,” gradually
expanded the site into a compound that cared for scores of
children.
At the time of his death,
D’Agostino had just returned
from Rome and the United
States, where he was raising
funds to support Nyumbani
Village, a self-sustaining community to serve the orphans
and elderly left behind from the
AIDS pandemic in Kenya, where
more than 1 million children
have lost their parents to the
disease. The goal of the village,
which will include 100 houses,
a school, a clinic and a community center, is to create new
blended families for 1,000
orphaned children being cared
for by their grandparents. In
2001, Nyumbani was the first
place in Africa to import deeply
discounted AIDS drugs.
winter 2007
t u f t s m e d i c i n e 47
ALUMNI NEWS
OBITUARIES
BELOVED MENTOR, OBSTETRICIAN DELIVERED 15,000 BABIES
PHILIP MCGOVERN JR., OF WINCHESTER, MASS., CLINICAL
professor of medicine and chief of obstetrics and gynecology
combining his professional efforts with Catholic Charities.
Born in Cambridge, he graduated from Boston College
at Cambridge City Hospital for more than 30 years, died on
in 1951 and New York Medical College in 1959. McGovern
October 20 after completing his last delivery at Mt. Auburn
had lived in Winchester since 1963. In addition to his work at
Hospital in Cambridge. He was 72.
Cambridge City Hospital, he maintained a private practice at
“He did what he loved, right up to the very end,” said Kate
Harney, ’90, chief of obstetrics and gynecology and women’s
health at Cambridge Heath Alliance, who had worked with
Mt. Auburn Hospital and Caritas St. Elizabeth’s Medical
Center. During his career, he delivered some 15,000 babies.
McGovern was a beloved mentor to students at the
McGovern since 1986. “What was so amazing is the way that
medical school and had been awarded Professor of the Year
he took care of every patient regardless of background or abili-
for 17 years in a row. The award now bears his name. He is
ty to pay.” McGovern was well known for referring patients
survived by his wife, Kathleen, and by three sons, two
who were financially struggling to places that could help by
daughters and four grandchildren.
Charles Bates, ’36, of Calais,
Maine, died on April 1. His
43 years of medical practice
included caring for the Canadian communities on Deer
Island and Campobello Island
and in the adjacent communities of Eastport, Maine. He
was instrumental in reestablishing the Eastport Memorial
Hospital in 1944, which had
been closed during World
War II.
affairs. For more than 40
years, he was on the faculty of
the University of Connecticut
School of Medicine. He was a
founder of the Connecticut
Public Broadcasting Network.
Albert Pearson, A39, M43,
of Middlebury, Vt., died on
November 10 at age 89. Born
in Medford, Mass., he entered
the U.S. Army following medical school and served as a
captain in England, France and
Germany, participating in the
Battle of the Bulge. In the
1950s, following several years
of practice in Vermont, he
settled with his family in Mass-
48 t u f t s m e d i c i n e
winter 2007
achusetts. Pearson retired in
1982. After he lost his wife,
Priscilla, in 2004, he lived quietly with his daughter and her
husband in Middlebury, where
he was surrounded by love,
basset hounds and cats, for
the remainder of his life. He is
survived by his daughter, a
son, seven grandchildren and
two great-grandsons.
Bernard Krasner, ’45, of
Scottsdale, Ariz., died on
August 10. He is survived by
his wife, Phyllis, and a son,
Stephen.
Harold Wetstone, ’51, of
Bloomfield, Conn., died on May
24. He had a 35-year career at
Hartford Hospital, including
serving as director of outpatient clinics, director of the
emergency room and vice president of corporate medical
Julian Pearlman, A48, M52, of
Lexington, Mass., died on
August 23 at age 84. He had
worked for 33 years at Lexington Pediatric Associates and
was associated with Children’s
Hospital in Boston throughout
his career. Pearlman was born
in Boston, the son of a pharmacist, and served in the
Army Air Corps during World
War II. After graduating from
Tufts University and completing
his medical training, he
opened a practice in Lexington
in 1955, which he operated for
16 years. There he became
known for close, gentle attention to patients and their fami-
lies. Pearlman loved sailing,
the Boston Symphony and
reading. He is survived by his
wife, Dorothy, a son, a daughter and four grandchildren.
Gilbert Klickstein, ’55, of
Wayland, Mass., died on
August 24. He was a surgeon
at Central Michigan Community Hospital in Mt. Pleasant,
Mich., from 1972 until his
retirement in 2002. Klickstein
is remembered by his medical
colleagues in Mt. Pleasant as
a caring, supportive surgeon
with a strong sense of community. He is survived by his
wife, Adele, two sons and
three grandchildren.
GREGORY CAMPBELL
Look ahead & give back
“ My
wife, Esther, and I wanted to give something back to the academic
institutions that helped us to achieve our professional goals. So, we both
”
established charitable gift annuities to benefit our alma maters.
DR. MICHAEL LEVINE, A56, M60, and Mrs. Esther Levine, of Atlanta, Georgia, have both
established charitable gift annuities to benefit their alma maters. Dr. Levine is one of Northside
Pediatrics’ longest-practicing physicians and also volunteers as a docent at Atlanta’s High Museum
of Art. Mrs. Levine is considered a book maven and is president of Book Atlanta, Inc., a company
that specializes in escorting authors when they are on national book tours.
For information about charitable gifts annuities and other gift-planning options,
contact Tufts’ Gift Planning Office toll-free at 1-888-748-8387 or via email to
[email protected]. Visit us online at www.tufts.edu/giftplanning.
HEARTFELT
MEDICINE
PHOTO BY MELDOY KO
Once she graduates, Candace
Barnes, ’07, wants to be the best
doctor she can be. The intensity
of her listening to the case history
presented by patient-actor Kia
Scott shows that she is well on
her way. Beginning on page 15,
we look at how Tufts is teaching
students to be more effective
physicians, one patient at a time.
School of
Medicine
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