Western University of Health Sciences

Volume 13 • 2010

Connections: PARTNERS IN HEALTH Contributing Authors

Table of Contents Volume 13 • 2010

2 Editors’ Greeting | Suliman Rastagar, DO ’12, Angelene Ng, PharmD ‘12, Sandy Saekoh, PharmD ’12, Lana Grinberg, DO ’13, Huyenlan Nguyen, DO ’13 3 Advisors’ Greeting | Beth Boynton, DVM & James Martin, Dr.rer.nat. 4 President’s Message | Philip Pumerantz, PhD, President, Western University of Health Sciences Dennis Ancheta, PharmD ’13 Ronald Armando, PharmD ’12 Sheree J. Aston, OD, MA, PhD Andrew Ayre, DVM ’11 Allan Belcher, DO ’11 Kimberly Bridges, DVM ’11 Lony C. Castro, MD 6 Photo Gallery | Nancy Chang, DO ’12 8 Connections: Partners in Health | Joan Sandell, DMD, Assistant Provost for Strategic Operations and Clinical Services 10 The Missing Link in Health Care Education | Huyenlan Nguyen, DO ’13 12 Interprofessional Education: History in the Making | Sheree J. Aston, OD, MA, PhD, Susan Mackintosh, DO, and Jordan Orzoff, PhD 14 Photo Gallery | Tim Snyder, DPT ’10 16 Lobby Day 2010: Standing Up For Our Beliefs! | Amanda Hinrichs, DO ’13 and Julia Hamilton, DO ’13 18 Health Care Reform: A WesternU Perspective | Lana Grinberg, DO ’13 and perspectives by Stephanie Bowlin, EdD, PA, Dean, College of Allied Health Professions, Clinton E. Adams, DO, MPA, FAAFP, Dean, College of Osteopathic Medicine of the Pacific, Karen Hanford, EdD, MSN, FNP, Dean, College of Graduate Nursing, Carise E. Charles, DNP ’10 Roslyn Davis Nogie Demirjian, PharmD ’13 Maureen Duffy-Lewis, JD Morgan Faggard, DO ’12 Sadia Ghaffar, DO ’11 Chirag Gandhi, DO ’13 James J. Koelbl, DDS, MS, MJ, Dean, College of Dental Medicine, and Elizabeth Hoppe, OD, MPH, DrPH, Dean, College of Optometry 23 Photo Gallery | Andrea Mann, DO ’10 24 Children | Thomas Gray, DO ’12 25 AIDS Walk | Dennis Andrew Ancheta, PharmD ’13 and Toy Drive | Ronald Armando, PharmD ’12 26 APhA in the Community | Nogie Demirjian, Stephanie Gleiberman, Hazel Hang, Charles Lam, Angelene Ng, and Nichelle Nguyen, all PharmD 28 RAVS Experience — Two Students’ Perspectives | Andrew Ayre, DVM ’11 and Kimberly Bridges, DVM ’11 30 STEER Program: Health Issues at the U.S.–Mexico Border | Sadia Ghaffar, DO ’11 32 Photo Gallery | Gina Johnson, DVM ’12 Stephanie Gleiberman, Thomas Gray, DO ’12 Lana Grinberg, DO ’13 Julia Hamilton, DO ’13 Amanda Hinrichs, DO ’13 James James, DO ’12 Elizabeth Knierim, DO ’13 PharmD ’12 34 Reawakening in the Redwoods | Kristen Sharpe, DO ’09, PGY-1 at Loma Linda University Medical Center for OB/GYN 37 More T han Minutia | Allan W. Belcher, DO ’11 38 Photo Gallery | Lara McMahon, Manager, Pre-Clinical Education MSI & 2, Office of Medical Education, COMP 40 Interprofessional Health Care: Pomona Community Health Fair | Lana Grinberg, DO ’13 42 The Case of the Student and the Patient with Preeclampsia | Lony C. Castro, MD, Professor Obstetrics & Gynecology, COMP 45 Trust: With Trust Comes A Grave Responsibility | Dorothy Schoonmaker, RN, MSN, Assistant Professor, College of Graduate Nursing 46 In the Face of Change There is One Constant | James James, DO ’12

Charles Lam, PharmD ’13 Diana Lithgow, PhD, FNP-C Barbara Lopez Susan Mackintosh, DO Angelene Ng, PharmD ’12 Huyenlan Nguyen, DO ’13 Nichelle Nguyen, PharmD ’13 47 “Partners in Health” | Carise E. Charles, DNP ’10 48 “Tribute to Cadavers” | Munira Rahman, DO ‘13 and Photo Gallery | Kristen Sharpe, DO ’09 49 “Translocate” | Munira Rahman, DO ’13 and “Pledge Through Tradition” | Chirag Gandhi, DO ’13 and Photos | Tiffany Stillian, DVM ’11 and Sheetal Patel, DO ’12 50 Photo Gallery | David Nguyen, PharmD ’12 52 Pharmacy in Thailand | Sandy Saekoh, PharmD ’12 54 International Medicine in Cameroon | Elizabeth Knierim, DO ’13 56 International Medicine in Belize | Khasha Touloei, DO ’12 58 International Medicine: DO Students in India | Sheetal Patel, DO ’12 Milind Parikh, DO ’13 Sheetal Patel, DO ’12 Munira Rahman, DO ‘13 Sandy Saekoh, PharmD ’12 Joan Sandell, DMD Dorothy Schoonmaker, Kristen Sharpe, DO ’09 60 Out Of America: Ah, Where All Things Are Possible | Judge Maureen Duffy-Lewis, Member, Western University of Health Sciences’ Board of Trustees RN, MSN 62 Photo Gallery | Coleen Galindo, Faculty Credentialing Assessment Assistant, Office of Medical Education, COMP We would also like to acknowledge the support and contribution of Dr. and Mrs. Philip Pumerantz; 64 A Journey from Ultrasound to Pathology | Roslyn Davis, Library Clerk for Harriet K. & Philip Pumerantz Library, Western University of Health Sciences Debra Nelson, Graphic Designer, WesternU Communications/Publications Department; university 67 “I Am A Nurse” | Diana Lithgow, RN, FNP, PhD, Assistant Dean of Distance Education, CGN and Photo | Crystal Rivera, Media Web Specialist, COMP photographers Jess Lopatynski and Jeff Malet; Jeff Keating, Executive Director of Public Affairs; and all 68 Tattwajnana Vidyapeeth: Connections in the Making | Milind Parikh, DO ’13 creative individuals who submitted photography and artwork. Without them, this issue would not have Photo | Joey Bradley, DO ’13 and Poetry | Barbara Lopez, Administrative Assistant, Office of Medical Education, COMP been possible. 71 72 Photo Gallery | Jackie Pham, DPM ’13 Cover photo by Jackie Pham, DPM ’13

Khasha Touloei, DO ’12 Hazel Hang Tran, PharmD ’13 WESTERN UNIVERSITY OF HEALTH SCIENCES 1 EDITORS’ GREETING ADVISORS’ GREETING

Suliman Rastagar, DO ’12 Beth Boynton, DVM As I gaze across our ever expanding campus, it strikes me Professor of Wellness, Director of Hill’s Wellness Center, over and over again how we students and faculty have College of Veterinary Medicine maintained our principles of humanism and service to humankind throughout this supercharged evolution of We live in a world intricately connected. As health care sorts. With new colleges and the constant buzz of even providers, we have enhanced connection with our more colleges to be added to Western University of Health Interprofessional Education curriculum, where students Sciences, nowhere is the spirit of cooperation and service from every college converge to solve issues relating to more apparent than right here in the pages of the Photo from left to right: Suliman Rastagar, Angelene Ng, Sandy Saekoh, individual, family, and community health. The One Health Humanism Journal. It is with this perspective that I Lana Grinberg, Huyenlan Nguyen. Initiative mission states, “that human and animal health welcome the new colleges to the already existing family and mental health are inextricably linked and to promote, and take pride in the knowledge that together we are well Lana Grinberg, DO ’13, Editor-In-Chief improve, and defend the health and well-being of all underway to fulfilling our promise to our community. A very wise friend of mine once said that “Power without species by enhancing cooperation and collaboration humanity does not make a hero, but a thug.” Humanity is between physicians, veterinarians, and other scientific Angelene Ng, PharmD ’12 not simply our species, it is our creed, and we must protect health professionals and promoting leadership and management to achieve these goals.” We are making This is my second year as co-editor for Humanism Journal, the humanity within us all, or perish in the darkness of ego profound steps in this direction. and as a pharmacy student at WesternU. In the past two and malaise. It is a battle fought daily within us and among years, I’ve become a part of the WesternU family, learning us. We must rise each day anew, bracing ourselves, and We seek to go further. We celebrate the humanistic from professors, working with teammates, and interacting bonding with our fellows to look wrong in the eyes and outreach by so many on these pages, in this community with students from other schools. Appropriately, our theme send it on its way. We are stronger together, united as a and around the world. As individuals and as a country, we this year is “Connections: Partners in Health,” and it profession of healers, realizing that alone we are but one must address the myriad of factors affecting health, incorporates not only how we interact and work together drop, but together we can create a tidal wave. It is a including environment, access, population, and economics. at school, but in our profession. With WesternU’s opening fascinating time of great change and debate. Throughout We cannot escape the face that the health of this planet of the Health Education Center and initiation of the these times we must believe in that one universal and affects our health and future profoundly. As we enjoy the Interprofessional Education (IPE) program, our school is uniting truth – humanity is within us and among us. We beautiful images and prose in these pages, we celebrate the still growing, and expanding interprofessionalism in our must choose to embrace it completely and wholeheartedly. humanistic efforts by so many at this university, and daily lives. I’m excited with this year’s issue, as it reflects It has been an honor working on this issue of Humanism continue to work and advocate for a better tomorrow. our school, and allows our WesternU family to get a magazine and witnessing the humanity among the Thank you to all the editors who made this publication glimpse of what other students and faculty have to share WesternU community and my peers. I deeply hope that you possible. ultimately end. Harvard professor E.O. Wilson argues that from their fields. enjoy our efforts! a new way of understanding human endeavor is needed – a way to unify humanism and science and a way to embrace Sandy Saekoh, PharmD ’12 Huyenlan Nguyen, DO ’13 James Martin, Dr.rer.nat. nature as a part of our identity. He called these concepts consilience and biophilia. The health of our species can This year’s theme is “Connections: Partners in Health,” This year has truly been a remarkable year for WesternU. Professor of Physiology and Behavioral Sciences, improve, if we can extend empathy for other individual and with the new schools that just started, WesternU has From our new building to the new professional programs, College of Osteopathic Medicine of the Pacific persons to empathy for individuals of other species and to become one of the universities advancing Interprofessional the WesternU family has had a busy year. Through it all, one thing remains unchanged: a strong commitment to concern for the living world around us. It is the Education. In my second year as co-editor, I am very proud Humanism and empathy, combined with science, are the humanism. As a first year co-editor, I was impressed with responsibility of all health care providers to embrace a of the opportunities that were given to me in building my cornerstones of modern health care. Humanism is, the number of submissions we received from students, staff concept of human health that recognizes the dependence of character and professionalism as a student and, in the obviously, all about us – the most successful and dominant and faculty members. Every time I came across a beautiful human health on environmental health. Not to do so future, as a pharmacist. Many of us will become health species on the planet. Does universal health care or One photograph, an intriguing poem or a heart-warming story, I represents a failure of science and humanism. In this care professionals as well, and I hope that we all treat each Health mean we are a healthy species? Probably not. As was reminded of why I joined the Humanism magazine magazine, we hope that Wilson’s ideas of consilience and other with respect and with professionalism, keeping in human populations have expanded, human endeavor is team. Being able to appreciate the fine details of a piece of biophilia will resonate in the essays and photographs and mind that our patients are our No. 1 concern. It is increasingly in conflict with the biological and ecological art, or share in one’s personal journey, is essential when will find expression in the lives of all of our students. We important that we don’t lose track of why we worked so foundations that sustain our existence. Should we continue approaching life in a humanistic way. It is easy to get caught hope you will enjoy this effort by our student editors and hard to become who we are today, and become even more in this direction, all human endeavor including art, up in the hustle and bustle of an academic lifestyle, so I contributors. for our patients as life-long caregivers. architecture, literature, and science, will decline and hope this year’s magazine allows you to take a moment to relax, learn and enjoy.

2 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 3 WesternU is firmly connected on several levels with its institution, COMP-Northwest, will train doctors from the home community of Pomona, as well. Our Pomona Northwest, in the Northwest, to practice in the Northwest. CONNECTIONS: PARTNERS IN HEALTH Community Health Action Team (PCHAT) participates in WesternU’s presence in the region reaffirms its relationship health fairs and visits schools to provide glucose – its connection – with the Northwest osteopathic medical screenings, blood-pressure checks, and a variety of other community, which was so important in the establishment health-maintenance care to anyone in the community. The of COMP in Pomona more than three decades ago. he theme of this year’s Humanism magazine, Pomona Homeless Outreach Project offers similar services “Connections: Partners in Health,” is an especially All of these connections are important, and are keys to the targeting the city’s homeless population. Tfitting one for the WesternU community. The continued growth and success of WesternU. But none are connections between our students, faculty and staff are Connecting with young people – tomorrow’s health- more important than the connection all of our graduates paramount to the successful operation of an institution sciences professionals – also is an important part of must make on a daily, sometimes hourly, basis – the bond that produces the very finest health-care professionals, and WesternU’s mission. The Pomona Health Careers Ladder, a between patient and caregiver. This one-on-one connection to creating an environment that fosters teamwork, partnership between WesternU, Pomona Unified School between a caring, compassionate, expertly trained health- innovation and compassionate care. District and California Polytechnic University-Pomona, care professional and the person seeking his or her care is offers monthly, on-campus workshops for sixth- and paramount, and is the foundation for all that we teach and But our campus is only the most visible outward sign of seventh-graders to acquaint them with health-careers all that we do at Western University of Health Sciences. how WesternU is “connecting” each day. Countless other options and to put them on a path to graduating from high critical connections – less obvious to the casual observer, school, earning a bachelor’s degree from Cal Poly, and but important nonetheless – are being made here and ultimately earning a health-sciences degree from WesternU. everywhere WesternU students, faculty and staff carry out our mission. Our University also is making connections far beyond the boundaries of our Pomona campus. In addition to the On campus, we have embarked on an Interprofessional many partnership agreements we have struck with sister Education (IPE) curriculum that perfectly captures the universities throughout the United States and across the essence of “Connections: Partners in Health.” WesternU’s Philip Pumerantz, PhD globe, WesternU is establishing an altogether new IPE program is putting students from the University’s President osteopathic medical school in Lebanon, Oregon. This various disciplines together in the classroom, in small group venues, and in clinical experiences with patients. Top row left to right: New students from different programs participate in a neurology Bottom row left to right: DVM students and faculty provide free/low-cost pet vaccinations The goal is for WesternU graduates to demonstrate an practice exam during the Summer Medical Sciences Prep Program (SMSPP), August, 2009; and spaying in the VACS van; Optometry students provide vision screenings at Philadelphia understanding of other health professions, and to provide DO and PA students participate in PCHAT health screenings at Philadelphia Elementary Elementary School, September, 2009; Dental students practice clinical skills in the dental School, January, 2010; PA students at the Health Fair on the WesternU Campus, January, simulation lab; Veterinarian lab technicians Omar Alvarado, left, and Andrea Wournell work and promote a team approach to patient care and health 2010; Physician Assistant students administer vaccines at the WesternU Flu Shot Clinics on in the University Research Center — The Graduate College of Biomedical Sciences (GCBS) management. campus, October 2009; Podiatry students participate in a homeless outreach shoe drive, opened in January, 2010; Pharmacy students practice clinical skills; Podiatry students meet in December, 2009 (Photo by Michael Corpuz, DPM ’13); Pomona Health Career Ladder small groups to study podiatric cases; Physical Therapy students practice using crutches and (PHCL), January, 2009; Pharmacy students help seniors with Medicare Part D prescription wheelchairs; Dr. Susan Mackintosh welcomes students to the Interprofessional education coverage, October, 2009; a DO student screens a patient at the Montclair Clinic. curriculum, January, 2010.

4 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 5 “You can stand under my umbrella.” Madrid, Spain Photo Gallery: Nancy Chang, DO ’12

“Ready for takeoff.” Central Park, New York

“Not much further.” Croton-on-Hudson, New York

“Forget the light, head toward the music at the end of the tunnel.” Barcelona, Spain

“Camel s (do or don’t spit) — true story.” Sahara Desert, Africa 6 7 By Joan Sandell, DMD Assistant Provost for Strategic Operations and Clinical Services

ne of the many children’s songs that we we understand the connections of a complex physiologic Connections: sang when we were young was one about the “foot bone’s system, our health care providers are taught to have a connected to the ankle bone and the ankle bone’s knowledge, appreciation and understanding of what the PARTNERS IN HEALTH connected to the leg bone...” The intent of the song was to other health care professions can offer their patients toward keep thinking of the next bone connection, finally joining all of the benefits of optimal health.” the body as a whole. Seeing the body’s skeleton as the A successful global economy needs experts that know how complete framework, connected with ligaments and to connect and partner as they integrate the multifaceted muscles as it houses the internal organs, is an image that aspects of economics. A successful health care system and dates back to Hippocrates, with the circulatory and team demands the same. Not only is disease a complex nervous systems drawn as the pathways to and from the web of systemic factors, optimal health is also a product of body’s organs. complex and interrelated factors, many of which can be As medical knowledge expanded and disease processes controlled by daily lifestyle choices. At the WesternU drew scientists and physicians into the miniscule Patient Care Center, we embrace and practice patient characteristics, functions and idiosyncrasies of each of the education that allows individuals to learn and encourages bodies’ organs and systems, “specialists” emerged as them to make the right lifestyle choices for a healthier Eye Care Center experts of these individual entities. This appeared to be the existence. We also recognize and put into practice the Pharmacy scientific and philosophical process that shaped western necessary partnering and connections of both the patient medicine from the 1970s-’90s. and other appropriate health care providers that will result in optimal health care solutions and management for each Consequently, it was not so long ago that diabetes was of our patients. singularly described to a patient as a disease that affected their pancreas’ ability to produce enough insulin or to The Patient Care Center houses five distinct centers where regulate the appropriate amount of insulin released. Hence, patients will receive specific services. The Eye Care Center the treatment was to educate the patient about blood sugar and Pharmacy are on the first floor. The Medical Center, monitoring and diet, and to prescribe the adequate amount Foot & Ankle Center, Interprofessional Suites and of insulin or other pharmacological substitute to help the Pomona Valley Imaging Center are on the second floor, Interprofessional Suites pancreas in its regulatory function. People would say, “I and the Dental Center is on the third. have a sugar problem” as if it was a singular entity to While the faculty and students in each of these centers are track. The diets given to patients from the 1970s-’90s Dental Center examining and providing care to their patients relative to focused on sugar intake, with little regard to fat intake or their specific professions, they are doing so with the fresh vegetables and whole grains. In fact, the simple versus discerning knowledge and perspective of partnering with complex carbohydrate relationship to sugar metabolism the other professionals in the building, a natural step was not part of the picture. Medical Center toward providing the finest health care for their patients. Over the past 15-20 years, the picture has changed. So when President Pumerantz asks, “What will the patients Unfortunately, this new picture is of a population in our Patient Care Center get that they might not get struggling with obesity, diabetes, high blood pressure and elsewhere? Why will they come to us instead of going high cholesterol (the metabolic syndrome), all factors that somewhere else?” I answer him in his own words. increase the risk of heart disease. “By living the founding philosophy of this institution — T. Rowe Price’s newest commercial asks, “How can the oil medical excellence through science and humanistic, industry in the North Sea impact fishing markets in Japan? compassionate care — we will never go out of style. Marine legislation in the U.S.? And food consumption in Indeed, what we offer will become more critical with each Italy? At T. Rowe Price, we understand the connections of passing day. We are here with the overarching goal to a complex global economy.” improve the lives of our community.” Seeing this commercial immediately made me think of using At the WesternU Patient Care Center, we know that the the human body as the globe: “How can a malfunctioning ankle bone is connected to a whole lot more than the pancreas impact the vision of the eyes? Circulation and leg bone. I wound healing in the feet? Periodontal tissues in the mouth? At Western University of Health Sciences, because Photos of the Patient Care Center by Jeff Malet

8 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 9 medicine, physical therapy, physician assistant, nursing and establishing relationships with different health care IPE allows us to work pharmacy. Western University is the first school to ever professionals in order to create community-based medicine. incorporate an interprofessional course consisting of this This was not something that she was taught in her first two collaboratively, communicate, many professions. More than 80 faculty members, headed years of medical school; it was knowledge that she gained discuss, and assess health by Vice Provost/Academic Affairs and Chair of IPE, Dr. through her residency training and experience in public care issues. Sheree Aston, developed the course. health. The IPE course was created to allow students to gain this vital experience early in their professional education. Students are broken up into small groups and presented with case studies that we must all work through together, Given that this is the first semester of IPE, student feedback bringing to the table knowledge from each of our has been central to assess perception of the course. Students respective backgrounds. I initially thought IPE would be an are encouraged to give honest opinions as to what they have extension of what I was already experiencing with the learned and what aspects of the course could improve. Led combined classes, except that it would include more by Dr. Orzoff, collection of this data is important in students from the other health professions. However, after determining whether the course objectives are being met. the first meeting with my group, I soon learned that IPE Some of the objectives include communication and incorporated more than just general knowledge and collaboration, knowledge of health professions, awareness, awareness of each other’s professions. IPE allowed us to and resolving ethical conflicts. Continued communication collaboratively work, communicate, discuss and assess from students will help faculty members make the necessary health care issues. adjustments to the curriculum.

The first case study involved a patient who came in for a All in all, IPE has been a refreshing experience in our busy dental appointment. It was later revealed that many other and packed schedules. It is meant to be a stress-free, health issues needed to be addressed, such as primary care, Apreso-free course because we are simply graded on optometry and podiatry. The case also shed light on attendance and participation. It is more than just another cultural, ethnic, and socioeconomic differences that we, as class weaved into our curriculum; IPE is an opportunity to future health care providers, would need to be sensitive to. grow in our knowledge of the connecting health care As a team, we were encouraged to research any learning system and to establish relationships with one another. issues that we thought would be pertinent to the patient’s The small group environment especially fosters this case. The suggestions ranged from “What caused that relationship. Similar to how osteopathic physicians are specific symptom?” to “What other professional should we trained to treat patients holistically, emphasizing that all refer this patient to?” to “How does the patient’s personal systems of the body are interrelated, IPE trains ALL of us background and community affect the treatment plan?” to approach patient care together, as partners in health. I This opened the door for each of us to express our opinions, I would like to thank Dr. Aston, Dr. Mackintosh, and Dr. Orzoff for sharing with personal experiences, and ideas as to what could be done. me their insights on IPE and to Jeff Malet for allowing me to use his photos. Through the discussions, it was evident that there is an Opposite page: IPE Day One, January 13, 2010. advantage to approaching health care in a team-based Below left: IPE Grand Rounds, January 27, 2010. manner. Dr. Susan Mackintosh, the course director of IPE, Below right: IPE Day One, January 13, 2010. expressed the importance of open communication and

By Huyenlan Nguyen, DO ’13 When I first came to WesternU, I thought it would be like any other typical medical school. Medical school would be a challenging endeavor consisting of hours of lectures, library dates with classmates, coffee, studying, stress and Apreso. Little did I know that WesternU had something different planned for all first-year students: an interprofessional curriculum. This year the colleges of Optometry, Podiatry and Dentistry welcomed their first classes. Since some of our courses overlap, we are taking them together. Through this integration, we are able to learn together and build friendships with one another. However, the concept of combined classes is not where the interprofessional curriculum ends; instead, it became an introduction to WesternU’s newest course, Interprofessional Education (IPE).

The IPE course incorporates nine colleges from the WesternU family: medicine, optometry, dental medicine, podiatric medicine, veterinary

10 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 11 Interprofessional Education: HISTORY IN THE MAKING By Drs. Sheree J. Aston, Susan Mackintosh and Jordan Orzoff While this may seem like the culmination of years of work, the IPE journey has just begun for WesternU. As Photos by Jess Lopatynski and Jeff Malet a stone dropped in a pond creates a ripple effect, we believe the ripple of WesternU’s IPE program will help Wednesday, January 13, 2010, marked an important date in the history of Western University of Health Sciences change the face of health care. (WesternU). This day saw the launch of the Interprofessional Education (IPE) program at WesternU, with the much-anticipated unveiling of IPE 5100 – Patient Centered Cases – An Interprofessional Approach. The end of this picture-book story is really just the beginning... For more than two years, teams of faculty from all nine health professions programs at our university tirelessly collaborated to develop and test the unique IPE cases.

Since a picture is worth a thousand words, we offer you a “behind the scenes” look at the preparation and implementation of IPE 5100. Orientation day is finally here, January 6, 2010!

Orientation for the initial Week two: the case pilot study in the spring of In the fall and winter of continues and concludes. 2008 set the stage. First-year Faculty from all nine Final revisions for the three 2009, 182 faculty and Week one: 851 students and Students can still anticipate students from all nine health programs, acting as first-year cases were tested with actual administrators completed 94 faculty facilitators begin Grand Rounds for Case 1 care programs participated students, field-tested the students in the summer and large and small group IPE case-based learning on and two more cases for the in the study. cases in February 2009. fall of 2009. facilitator training. January 13, 2010 2010 spring semester course.

12 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 13 “Butterfly in Admiration” Photo Gallery: Tim Snyder, DPT ’10

“Oceanside Sunset”

“The Copper Sunset”

“San Clemente Pier”

“Splash” 14 “The Red Sunset at Dana Point” 15 At medical school orientation last year, University advocates from around the state in order to express a basic idea: health care is about the patient, not about profit. As staff explained that although the next four years student health care professionals, it is important to go beyond LOBBY DAY 2010 of training may feel daunting and challenging at our studies and become involved with policy, reform, and times, we must remember what the end goal is: improvement of the health care delivery system. Great Standing up for our beliefs! practitioners need to understand how to treat a patient’s the patient. Health care is about the patient. disease and how that treatment will impact the patient’s life, Story and photos by Amanda Hinrichs, DO ’13 and Julia Hamilton, DO ’13 On January 11, 2010, you could hear the boasting chants of including their wallet and financial well-being. “Hey hey, ho ho, health care greed has got to go!” ringing out During Lobby Day, we were able to meet many victims of the throughout most of the day around the capital building in failing health care system, who chanted along with us on the Sacramento. Well over 1,000 health care students, health care Capitol steps. Some of these victims were thousands of dollars workers, and supporters met in Sacramento for Lobby Day to in debt due to health care bills; others had ailments they could promote SB 810, the single payer universal health care bill. not afford to treat. These mothers, fathers, brothers, sisters, This bill, which had been vetoed twice by the governor, called neighbors and friends were fighting for change. We as for a drastic overhaul of the California health care system, students of health professions need to fight for what we ensuring complete coverage for all California residents. believe in and stand up for our professions and our patients, The opposition argued that the proposed bill was indicative of whether it is in support of SB 810 or a completely different a socialist system. This is far from the truth. The bill would issue. Not only is it necessary to train to be the best implement a single public insurer with the existing private physicians, podiatrists, optometrists, dentists, physician delivery system. In other words, everyone would have the assistants, physical therapists, nurses, health care freedom to choose health care providers without the administrators, pharmacists, veterinarians and researchers we limitations of private insurance plans. Under this bill, can be, but we must also critique and improve the professions administration and prescription drug costs would drastically we are joining and the health care system as a whole. I decrease, and California families would have more money in their pockets thanks to the extinction of skyrocketing Opposite page inset: WesternU COMP students Kavitha Swaminathan, Rebecca premiums and monthly payments. Flanagan, Jason Lam, Amanda Hinrichs, Chirag Gandhi, Jennifer Dac Nguyen, Dayanthi Kurukulasuriya, Jessica Lattos, Huyenlan Nguyen, bottom row: Leigh Lobby Day was a great way for students to get involved with, Rios, Julia Hamilton, and Melissa Johns, all DO ’13.

and express their ideas about, the non-medical issues in This page: WesternU students and SB 810 supporters demonstrate outside of the medicine. The event was organized by the California Health Capital building in Sacrament, Calif. Professional Student Alliance, which successfully united

16 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 17 From the College of Allied Health Professions Stephanie Bowlin, EdD, PA, Dean

The College of Allied key issue in the President’s plan is preventive health care, Health Professions is and the PA profession continues to lead this charge. tracking the constant Accreditation standards for PA schools require preventive movement of health care health care and health care delivery systems in their reform. training curriculum. WesternU’s Department of Physician Assistant Education has taught students health promotion President Obama’s plan for and disease prevention as a formal topic for more than 15 health care reform is years, and within the health promotion context, believes in attempting to address the importance of reaching out to local schools to address expanding health care health care concerns. Over the years, our PA students have costs, the rising number of provided informative talks on health issues to many of the uninsured Americans, and the underinvestment in elementary, middle, and high school students in the prevention and public health. To lower the costs of the Pomona Unified School District. current health care system, he wants to use electronic health information technology, coordinate and integrate The changes in the president’s health package are many, care, improve access to prevention of disease, decrease and the PA profession will be among the practitioners health disparities, allow drug completion, promote generic ready to take health care to the next level. HEALTH CARE drugs, and provide incentives to employers and school The American Physical Therapy Association (APTA) systems to promote healthy lifestyles. represents 72,000 members and their patients, and stands A WesternU Perspective To meet the growing health care needs of the United States, ready to assist the administration and Congress in Introduction by Lana Grinberg, DO ’13 the health workforce must change in size, distribution and achieving reform that will enhance patient care, access and REFORM: preparation to better reflect the diversity of our value. As a bipartisan health care provider association, the population. Increasing student and faculty diversity in the APTA has identified the following top priority areas: repeal health services is critical to the success of any health care of the therapy cap, direct access, adequate workforce, and or the past year, we have all watched as Congress has money, it is no wonder that medicine resembles more of a delivery strategy. Traditionally, most come to health care student loan repayment. struggled to decide the fate of medicine in this business rather than an art these days. Add to that the education through clinical disciplines. However, The House of Delegates of the APTA hopes to see the country. It is obviously not a simple undertaking to inevitable aging of the baby boomers, and we are left Department of Health Sciences Education graduates excel F elimination of payment policies that impede patient access disassemble and subsequently reassemble the machine that wondering when and how the goliath will fall. in the art of adult education, program planning and to cost-effective rehabilitation services provided by physical the medical industry has become in the United States. implementation, and educational research, and can address We at Western University of Health Sciences have nine therapists. Further, it supports provisions that ensure There are countless interested parties, not the least of health care needs by addressing community health, health professionally related colleges that will all be affected by rehabilitation services enhancement, and that a distinct which is the American citizen striving to be healthy and care administration, and systems management needs. the decisions our current and future politicians make. In an physical therapy benefit is available to all. Finally, the getting lost in a system that has long forgotten its purpose. effort to unravel the impending changes, we solicited The changes that the president recommends are already APTA would like to see the development of a national With the powerful insurance companies looking over the comments from several deans. coming to pass in the physician assistant profession. Ninety strategy to ensure that an adequate health care workforce shoulders of trained professionals, attorneys corralling percent of physician assistant (PA) students in clinical exists to meet the needs of patients. This entails incentives clients outside of delivery rooms, and the politics of big rotations are already using electronic medical records. One such as student loan repayment.

A BRIEF HISTORY OF HEALTH CARE REFORM IN AMERICA 1920’s 1930’s 1940’s 1950’s 1960’s 1970’s 1980’s 1990’s

1929 – A local teachers’ 1934 – President Franklin 1945 – President Truman 1946 – Congress passes the 1954 – The Internal Revenue 1962 – President Kennedy 1973 – President Nixon signs 1986 – Congress passes the 1993 – President Bill Clinton privacy, protects people in union in Dallas, TX, D. Roosevelt signs the Social proposes a system of public Hill-Burton Act to provide Act exempts employee calls for but fails to create a the Health Maintenance Consolidated Omnibus presents the Health Security group health insurance plans contracts with Baylor Security Act as part of the health insurance. It is federal grants and benefits, including health universal health care system. Organization Act. Among Budget Reconciliation Act Act to Congress. It calls for from being excluded for pre- Hospital to create a pre-paid New Deal. The Act provides denounced as a socialist guaranteed loans to finance insurance, from taxes and other provisions, this (COBRA), an ammendment universal coverage and existing conditions, and program in what is thought benefits to retirees and the approach to medicine by the the construction of hospitals. allows deductions for certain 1965 – President Johnson requires employers with 25 or to the Employee Retirement government regulation to prohibits employment to be the nation’s first unemployed, and a lump- American Medical The Act requires hospitals medical expenses. signs legislation creating more employees to offer Income Security Act (ERISA) keep medical costs down. discrimination based on example of modern group sum benefit at death, but Association (AMA) and does receiving funds to provide a Medicare and Medicaid federally certified HMO of 1974, which allows The bill is defeated. health status. Employer-based health health insurance. The model does not include a health not pass. “reasonable amount” of programs, which provide options if they offer employees to continue their insurance coverage increases health care coverage to 1996 – The Health Insurance 1997 – Children’s Health becomes popular across the insurance component that charity care, and prohibits dramatically. This sh traditional health insurance group health plan up to 18 ift often seniors age 65 and older, the Portability and Accountability Insurance Program, an country and is the was initially proposed. discrimination based on race, leaves the unemployed and to employees. The dual choice months after losing their jobs. disabled, and the poor. Act (HIPA) becomes law. It expansion of the Medicaid predecessor of Blue Cross religion or nationality. retired without health provision expired in 1995. mandates patient record program is established. organizations. insurance.

18 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 19 From the College of Osteopathic Medicine of the Pacific From the College of Dental Medicine Clinton E. Adams, DO, MPA, FAAFP, FACHE, Dean James J. Koelbl, DDS, MS, MJ, Founding Dean

The College of Osteopathic Medicine of the Pacific is most concerned about the future of our While the prospects for a would include community dental health coordinators, students. The broad spectrum of topics covered in the proposed health care legislation range complete overhaul of the advanced practice dental therapists, independent dental from financing student education to health care policy potentially impacting care at the end health care system are hygienists, supervised dental hygienists, primary care of life. Yet the real substance is simple insurance reform, not health care delivery reform. uncertain, there are still physicians and dental therapists. elements in legislation Health care for all is a noble and laudable goal. I practiced in the United States Navy for 30 Increasing Teaching Capacity: This legislation would being proposed that could years and the joy of practice was equal access and quality of care for the general or the provide grants for teaching health centers to establish new have an impact on dental private. We truly had no incentive to do otherwise. The medical bill was paid at the same accredited or expanded primary care residency programs. education and the dental rate for all. We did not worry about availability of prescriptions or procedures and fully General and pediatric dental residency programs would profession implemented wellness care activities. We did have strict formularies, vanilla furnishings, and be eligible. many young people learning how to care for patients, called corpsmen or medics. The at large. Community-Based, Interdisciplinary Care: This legislation commitment to educating the next generation and caring for the active duty family created such a wonderful sense of Title VII Health Professions Programs: Funding is belonging and service that our weakest links became stronger and more engaged in their responsibility as health care would help fund community-based teams to support proposed that would provide federal grants to dental and providers and not just health care workers. patient-centered medical homes. This would include grants allied dental schools and advanced education programs for aimed at the following: to primary care providers for How can we salvage or move in an incremental way toward this type of care for all Americans? Does the current legislation training in general, pediatric and public health dentistry for support services; to community-based, interdisciplinary, move us along that continuum? Will the final product, if there is one, just be a reshuffle of the chairs on the Titanic? Until dental students, residents and dental hygienists. It would interprofessional teams to support patient-centered medical we get answers to health care professional education financing, loan repayment opportunities, residency development funds also provide financial assistance to dental students, homes; support collaboration with local providers to and an understanding that the practice of health care delivery cannot be legislated, it must be inspired and rewarded in the residents and dental hygiene students, and would provide coordinate disease prevention and case management and to “place of care” both financially, and more important, emotionally. Otherwise, we will only have health insurance reform, not funding for training programs for oral health providers develop and implement interdisciplinary care plans; and to health care reform. who plan to teach in general, pediatric, public health or provide resources to local primary care givers to provide dental hygiene. From the College of Graduate Nursing cost-effective, patient-and-family-centered culturally This legislation also would create a separate funding line, appropriate care. Programs would need to include all Karen Hanford EdD, MSN, FNP, Founding Dean distinct from medicine, for training programs in general, stakeholders in program design and oversight. pediatric, and public health dentistry, and it would make This legislation would also fund a new program to support While the recession has made it difficult for new registered nurses to find an entry level dental schools eligible for federal grants for programs for Community-Based Collaborative Care Networks to position, this is temporary. The future of nursing is very bright, and nursing is considered which currently only medical schools are eligible, namely, provide coordinated, integrated health services to low- to be the No. 1 job for employment nationally. National health reform, if passed, will only pre-doctoral and post-doctoral training in primary care, income and medically underserved populations through a increase the number of jobs for advanced practice nurses to provide primary care. dental faculty development in primary care, and academic consortium of health care providers. administrative units (departments, divisions, units). Despite these challenging times, this is an exciting time for the College of Graduate Oral Health Prevention Program: Funds would be provided Nursing (CGN). Enrollment in all CGN programs continues to expand, and graduates are National Health Care Workforce Commission: This to the Centers for Disease Control to implement a national highly sought after. Since 2008, we have offered a Doctor of Nursing Practice degree. legislation would provide a resource to Congress, the prevention program. This would include demonstration These graduates will be the change agents that will drive transformation in health care. president, states and localities by disseminating grants to community providers for research in management Due to the complexity of health care, nurses who are prepared at the highest level will be information on current and projected workforce supply of dental disease. It would also provide grants to 50 states, in greater demand. Quality and safe health care is America's agenda, and nursing is key to and demand, workforce education and training capacity, territories and tribal governments for oral health the success of our health care system. best practices in health care career pathways and leadership; to build oral health data systems; to improve education, and a fiscally sustainable integrated workforce oral health delivery; and to implement dental sealants, that meets the needs of patients and populations. water fluoridation and other prevention programs. Representatives would include health care workforce and health professionals, employers, third-party payers, Training Programs: This legislation would fund grants to 2000 – Today individuals with experience in health care-related research, facilitate the development of cultural competency training consumers, labor unions, and educational institutions. programs and interdisciplinary training programs to 2003 – President George W. discounts with drug through private insurance most Americans to have Opponents immediately vow promote cultural/linguistic competency training for health Bush expands Medicare with companies. plans and often includes a health insurance coverage to repeal the bill or weaken it This legislation also would fund 15 demonstration projects professionals to address health disparities and to promote the Medicare Modernization significant gap in drug and will regulate private by eliminating key provisions for programs to train or employ alternative dental health Act, the largest overhaul of 2006 – A prescription drug coverage often referred to as insurers more closely, through legal challenges. delivery of care through an interdisciplinary, team-based benefit, called Medicare care providers to increase access to dental services in rural Medicare in its 38-year “the doughnut hole.” banning practices such as model that coordinates care across settings. history. Key provisions Part D, is added. While the denial of care for pre-existing and underserved communities. These types of providers include the creation of a federal government is 2010 –President Obama conditions. The public pretax Health Savings prohibited from creating signs the Patient Protection option, or government-run Account (HSA), and it rules drug formularies, private and Affordable Care Act on health insurance plan as an against the federal health insurers are not. The March 23, 2010. Most alternative to private government negotiating benefit is offered only notably, the measure requires insurance, is eliminated.

20 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 21 “One of the challenges posed by the health-reform bill is, simply put, supply: Our nation’s health care workforce is not adequate to meet the new demands that will be produced by this legislation, and the health system will be playing catch-up for some time. I am heartened by the fact that our track record in this area is exemplary – for example, some 60% of our College of Photo Gallery: Andrea Mann, DO ’10 Osteopathic Medicine graduates go into primary care, which is one of the main areas addressed by the legislation.”

Philip Pumerantz, President Benchmarks of Value, March 24, 2010

From the College of Optometry Elizabeth Hoppe, OD, MPH, DrPH, Founding Dean

The ultimate structure and recommendations for federal investment in “cross- potential impact of health professional” training within health professions schools and insurance reform legislation through graduate internships and the development of remains uncertain. And we interdisciplinary teams. know from the sage The second perspective comes from the American Public philosopher Yogi Berra that Health Association (APHA). The APHA is the oldest and “It's tough to make most diverse organization of public health professionals in the predictions, especially about world, and has been working to improve public health since the future.” So instead of 1872. APHA represents a broad array of health professionals making predictions, or striving to promote the scientific and professional foundation discussing a snapshot of of public health practices and policy. The Association has 27 current legislative initiatives, I will take this opportunity to primary sections that represent major public health disciplines share some of the work being done to frame the “ideal future” or public health programs, including each of the different of a health care system. We here at Western University of disciplines working together at WesternU. Health Sciences are used to approaching complex problems with optimism and idealism, so keeping our eyes on the best Through its analysis and advocacy processes, APHA has also and most desirable future can serve as a valuable guide. developed recommendations for health care reform. Its policy states that we must ensure coverage for high-quality, I would like to share the perspectives of two national affordable health care for all, emphasizing that this means associations, both of which are dedicated to improving and covering the more than 46 million individuals who are protecting the health of the public, while supporting uninsured, while also improving the quality and safety of the collaboration between health disciplines. I am proud to say health care system and building a modern health information that I am a member of both organizations. I find the infrastructure. information that I receive from the associations to be extremely helpful, and I would encourage every member of The association makes a number of recommendations for the WesternU community to learn more about what these reform, including several that have the potential to impact organizations have to offer. WesternU. APHA asserts that health reform legislation must significantly increase support and funding for programs that The first perspective comes from the National Academies of provide loan repayments, scholarships and other grants for Practice (NAP). The NAP is an interdisciplinary organization the training of public health personnel, primary care of health care professionals representing 10 disciplines, and its physicians, nurses and other health providers. It must also mission is to serve as distinguished advisors to health care improve the distribution and diversity of health professionals policy makers in Congress and elsewhere through the in medically underserved communities, as well as ensure there development of public policy papers, interprofessional is a capable health workforce able to provide care for all dialogue, and interprofessional forums. Through its analysis Americans and respond to the growing demands of our aging process, the NAP has put forth a recommendation for an and increasingly diverse population. accountable, coordinated health care system that promotes and supports a variety of health care professionals in I don’t know what to expect as we continue to observe the providing integrated patient-centered care and optimal legislative process, but I do know that I have the opportunity outcomes across all settings, types of care, and throughout a to stay informed about what is happening in Washington. I patient’s lifespan. also have the opportunity to work toward a brighter future, where we are able to make these recommendations a reality The NAP has several recommendations regarding the steps through our ongoing interprofessional collaborations here at necessary to achieving an accountable, coordinated health WesternU. care system in the U.S. Most relevant to WesternU are

22 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 23 Children Story and photo by Thomas Gray, DO ’12 “Daddy’s home, Daddy’s home, Daddy’s home,” is a duet I On Sunday morning we make colored waffles in the waffle hear almost every night, sung by Aiden (6) and Thomas iron. Each child alternates putting in an ingredient. (3), silhouetted in the door to the garage. I stir up a frenzy Sometimes we mix up all the batter without making a food screaming “Aiden, Thomas, Aiden, Thomas, Aiden, coloring mess, but Mommy is usually still sleeping, so we Thomas” as fast and as loud as I can. In the background, have plenty of time to clean it up before she wakes. Then my wife, carrying a near-term baby boy, sighs in relief that we pour our colorful creation into the waffle iron and wait Dennis Andrew Ancheta, their energy is directed at someone else. Life lesson #1 is to in total silence for about 3 minutes for the light to turn AIDS WALK PharmD 2013 show proper enthusiasm. green. My children are always very excited, but this A number of WesternU students came out to This humanistic event was a great experience for moment is a little sad for me because after breakfast I go to support the 25th Annual AIDS Walk on October WesternU student health care professionals to On Tuesday nights, we go to a local pool an hour after school and study for the rest of the day. Any kid can teach 18, 2009. It was a spectacular event to see promote living a life of good health and to dinner for a bit of family time. My wife taught the kids to you life lesson #4: Enjoy the moment. different organizations, health care providers, maintain the essence of quality care. We jump into the pool on the command “butter, butter, pop.” and students unite and walk 6.2 miles to raise encourage other students to get involved with But once they learned to swim on their own, they started Monday morning, I am sitting in lecture learning about the funds for AIDS research. From the College of such events to represent what WesternU strives yelling it for themselves. When they are old enough, I will numerous ways genetics and our immune system can let us Pharmacy, the Class of 2013 and one of its for in the health care community. challenge them to swim 50 laps to get a treat, like my down. My focus is up a notch, knowing I need to learn respected faculty members, Dr. Khasawneh, mother did for me. For now, I will settle for a single trip much of this information the first time because there might worked together and donated well over $400. across the pool. Life lesson #2 is to keep practicing. not be a chance to learn it later. My mind drifts back home; the little baby kicks my wife from the inside and On Saturdays we go on family adventures. We’ve been to reminds her that it is almost time for him to come out and almost every Southern California beach, Sea World, play with us. I repeat the cardinal motions of labor over Disneyland and Palm Springs. But a quick drive up Mt. and over in my head. Then I return my attention to the Baldy with a lunchbox full of peanut butter and jelly task at hand: becoming a doctor. Life lesson #5: With sandwiches brings me close to heaven. I think playing with proper balance, you can have it all. I stones in a creek is a microcosm of life. The never ending stream of water shows us that there are powers greater than ourselves. But the careful placement of river stones teaches us life lesson #3, that we may not change the whole world, but with hard work we can make a Ronald Armado, difference. TOY DRIVE PharmD 2012 During the month of December, I had the the toys to the hospital. We were greeted by pleasure of working with Mike Trillanes, PharmD Lindsey Medina, the volunteer coordinator, who 2013 Class President. We took part in a toy drive explained what the toys were for and how much for Pomona Valley Hospital Medical Center, they appreciated our efforts. We thought we benefitting the Sick Baby and Hospital Assistance were just collecting toys for children to play Fund. Combined, our two classes filled each of with; we did not realize that these toys were our donation boxes and collected more than 35 given to children coming out of surgery, and toys and stuffed animals. The toys were ultimately, how much these toys could impact distributed to children coming out of surgery these vulnerable children. Through this because they are soft items for them to hug and experience, we gained a new perspective that to hold while they are recovering. the diseases we are treating are actual people, with real feelings and real fears. Realizing this, As future pharmacists, we are the front line of we were enlightened to know that these toys the medical profession, as we are the most would help these children, who might be lying in accessible to the community. When we are in that hospital bed afraid of their surroundings. lecture or working on SOAP cases, we are often We learned that the best thing for these children so caught up in treating the disease that we to do is to smile, to know they have a friend, and forget that our priority is to treat the patient. be assured that they are in good hands. We were both fortunate to take part in this philanthropy because we were able to deliver

24 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 25 Nogie Demirjian, PharmD ’13 Stephanie Gleiberman, PharmD ’12 APhA IN THE Hazel Hang Tran, PharmD ’13 Charles Lam, PharmD ’13 COMMUNITY Angelene Ng, PharmD ’12 Nichelle Nguyen, PharmD ’13

The American Pharmacists Association (APhA) AIDS AWARENESS Communities Everywhere, or CHANCE. CHANCE was the first established pharmacist association allows us to collaborate with a 340B-eligible facility UNAIDS estimates there are now 33.4 million in the nation, and the root of many pharmacy (STD or TB clinic) to design a plan to help patients people living with HIV, including 2.1 million organizations that branched off thereafter. receive counseling, as well as medications at a children. During 2008, some 2.7 million people Composed of pharmacists, pharmaceutical reduced cost rate. became newly infected with the virus, and an scientists, pharmacy students and technicians, estimated 2 million people died from AIDS. Health events are an integral part of our organization, and others dedicated to advancing the Around half of all people who become infected and our goal is to be as interprofessional as possible. profession, we have become partners in health. with HIV do so before they are 25, and are We want to collaborate with other student As WesternU students, we would like to remind killed by AIDS before they are 35. organizations on campus to bring about a more the community that pharmacists are educators, unique experience for patients. By reaching out to the health care providers, and an important On Dec. 1, 2009, we promoted World Aids community through health events and being more connection to the health profession, and not Day by encouraging students to participate in a “hands on,” we hope that our services will motivate just pill counters. “Wear Red” campaign. The idea was simple: people to live healthier lives and be aware of the risk Everyone just had to wear something red. We MRM 2009 factors that can lead to disease. passed out red ribbons to spread awareness of On October 16-18, 2009, members of the ongoing devastation that is caused by Our health events are also great opportunities for WesternU’s APhA attended the APhA Midyear HIV/AIDS, and a photo was taken of everyone student pharmacists to practice their skills and work Regional Meeting (MRM) in Albuquerque, wearing red ribbons. The red ribbon is an within their community. We encourage our students to NM. This student-focused conference was a international symbol of AIDS awareness to provide patient education that is more interactive, to great opportunity for students from several demonstrate care and concern about HIV and ensure that it is memorable for patients. As always, we states to meet and learn from each other. The AIDS and to remind others of the need for their are focused on showing the community that main highlight was the legislative component. support and commitment. pharmacists are great health advisers and caretakers The APhA-ASP Policy Process was initiated due to our accessibility and medication knowledge. ONGOING GOALS here, with students given an opportunity to We hope to further build that bond with our debate their positions on a variety of proposals, We are focused on elevating our community community through our health events. I then vote on the measures. The proposals dealt work by incorporating innovative ways of with issues pertaining to pharmacy students, educating our community about various health practicing pharmacists, and the medical problems. We have four subcommittees that are profession as a whole. Proposals accepted will focused on specific health issues (Diabetes, move on to be debated at the APhA Annual Hypertension, Heartburn and Immunizations) Meeting & Exposition this year in Washington, and a subcommittee on a project called D.C. Chapters Helping Advocate Needy

26 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 27 Andrew Ayre, DVM ’11 turn, we shared stories about how we view animals. This mutualistic relationship permitted us to expand our It’s 5:30 a.m. The first of our perceptions of our cultures and connect with people from alarms rings violently, different backgrounds. One evening, sitting on the bleachers resounding off the concrete of the high school gymnasium, a father and his daughter walls of the garage where we are presented the history of their people – the Apache tribe. His sleeping. With stacks of wood daughter wore a traditional dress and a baby basket, both and tools piled near a large hand-made with materials from the land. He described their garage door, this home away history, their triumphs and how they dealt with modern life. from home was one of many This gesture by a father and his daughter was the highlight of where we laid our heads during our trip. It showed us how grateful the community was to the Arizona trip with Rural Area have our help, and allowed us the opportunity to better Veterinary Services in May, understand the Apache people. A gymnasium transformed into a RAVS clinic complete with intake, anesthesia, 2009. RAVS provides veterinary care for animals in and surgery accommodations. communities where no other animal services exist, including Reflecting back on my RAVS experience, some of my favorite Inset left: Our purpose — helping families provide care to their pets. communities on Native American reservations. Unfortunately, interactions were with the children in the community. I Inset above: Veterinarians and vet students providing spay and neuter procedures to reservation animals. this alarm was mine. The sun had yet to rise, but I needed to distinctly remember a group of three boys who came by so start my day early to prepare for the rush at 7:30. After a often on our second week that we knew them by name. All of very swift, cold shower (since there was no hot water) I the children were curious about our lives and would visit just Kimberly Bridges, DVM ’11 practice “good” medicine, you must offer the best dressed into scrubs. As I began across the hardwood floor of to see what was going on, asking us questions like, “Where diagnostic tools and services. After serving as a RAVS In the sweltering heat, they walk their two canine the meeting hall where we had set up our clinic the night are you from?” “Why are you helping the animals?” “Why volunteer and extern, I now understand that high-quality companions to our clinic with their man-made rope leashes before, I noticed other clinic volunteers beginning to stir. We do you care so much about the animals?” “Can you play medicine begins with educating the family on how to and collars. This may be the only chance for this family to all had similar responsibilities that morning — caring for basketball with me?” Several times, after a hectic clinic day provide “basic” care for their pet. Through the connections obtain veterinary care for their pets. I notice that one of the overnight patients and those animals who were coming to and before dusk, we would join the children on the basketball you establish with these families and their pets, you realize children isn’t wearing shoes; the mother states that they have California to find new homes. court to throw a ball or play jump rope with them. As we that simple topics such as nutrition and shelter need to be walked two miles so their dogs can get medicine for their battled with lack of sleep and exhaustion from the excitement addressed. This family and I bonded over a small plastic Each day we interacted with many families and their animals. skin. Both dogs are covered in ticks; I notice patches of hair during the day, our interactions with the children fueled our measuring cup that I used to demonstrate how much food Dogs, cats and sometimes horses were treated, and while are missing as my eyes glide over their emaciated frames. It is enthusiasm to continue reaching out to new people and each dog should receive every day. most were pets, others were working animals whose families evident that neither dog has been seen by a veterinarian or helping their animals. relied on them for their livelihood. They came to our free ever received any medical care. As a RAVS volunteer, you are also assigned to administer clinic to receive wellness exams, vaccines, parasite control, I cannot imagine a more fulfilling way to spend my free time. vaccinations, flea/tick preventative, deworming medications, As a RAVS volunteer, this is your chance to make a difference and surgery for spays and neuters. Community members These short trips present meaningful opportunities for us to etc. Many of the community members are burdened with in this family’s life. Your dedication to the long hours, your visiting the clinic were reaching out for help, hoping we could connect with people through their animals. The information providing care to 10-15 pets, and you provide relief to these caring heart, and your passion to educate others on animal provide comfort to their sick animals. Many individuals were we learned from being in that environment not only families by performing spay and neuter procedures. Your husbandry takes over as you evaluate this family and their concerned with protecting their families from zoonotic improved our ability to practice dedication and assistance to the pets do not go unnoticed by pets’ needs. This experience is once in a lifetime. What you diseases, while others recognized the tribe’s dilemma with pet medicine, but it also increased the community members. Many times they ask to shake your take away from a RAVS trip will stay with you forever. Your overpopulation and the need for a solution. These sites were our understanding of American hand, present you with smile and a thank you, or offer you a connections made here with the veterinary community of hand-picked by RAVS with the intent to serve communities culture and enhanced our piece of hand-made jewelry. students, technicians, and veterinary volunteers will influence most in need of veterinary support. While the premise seems spiritual growth. I your life-long goals. We work together as a devoted family, a As you can see, RAVS is more than just a social experience, simple — giving medical care to animals — the group of well-oiled working unit, to provide veterinary care and relief more than just an opportunity to perform surgery. As a RAVS volunteers gave so much more. Above: Andrew Ayre providing two puppies with some reassurance before to animals in need. volunteer, you feel empowered to make a difference, to As each owner came with their animal, we sat down with they receive their first vaccination. change the life of a family and pet in need. If there is one As a veterinary student volunteer, I learned how to practice them to ask questions about the animal’s history, but also to piece of advice I could offer to a student colleague, it would Right: A young Sioux girl from a South good medicine with limited resources. This aspect of create a dialogue and establish a relationship of trust. This be to volunteer one summer with the RAVS program. The Dakota reservation who aspires to veterinary medicine is often overlooked in vet school and individualized attention often allowed us to discover stories become a veterinarian. experience is invaluable, one that will strengthen you as an practice because many veterinarians believe that in order to about how the families interacted with their animals and, in individual both mentally and physically. I

28 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 29 I was curious about how people and vehicles going across and more affordable health services compared to the U.S. I the border were managed and controlled. Having never don’t think many people are aware of how Mexico’s health been to the border, I learned that the Laredo, Texas-Nuevo care system, in many ways, is pretty strong. Laredo, Mexico border plays a huge role in imports and Learning about proper sanitary waste disposal, landfills, exports, and learning about it gave me a much better idea air quality, water pollution, drinking water safety, lead and of what goes on. I never knew that border traffic was so pesticide exposure, and food quality was a great part of the complex. Many people, agencies, organizations, experience, as we need to know more about how these PROGRAM: government groups, and rules and regulations are involved things affect us on a daily basis. With an interest in steer in dealing with what comes in and out of the country. Health Issues at the U.S.-Mexico Border primary care, preventive medicine, and public health, I can One thing I definitely did not expect prior to STEER was better educate my patients about these issues, and I can try Story and photos by Sadia Ghaffar, DO ’11 the number of animals and wildlife I would see and learn to gather information from my history-taking of patients. I about during the rotation. We learned a lot about wildlife also have a better idea of possible programs that may help and domesticated animals in South Texas through visiting patients.Wherever I end up practicing, I will be sure to the river, the ranches, sessions at Laredo Community explore the programs available that can help my patients (South Texas Environmental Education College, and visiting Mirango City. Learning about the Oral and their families in terms of providing them with STEER and Research) transformed me as an Rabies Vaccination Program was an eye-opener. I never even additional resources. aspiring health professional, as it provided me with a knew that such a program existed in the U.S., and I never People from various parts of the community taught us, and community-based educational experience, allowing me to knew about the scope of problems from different animals this connected with the Humanism theme of “Connections: learn about public health and environmental health issues (foxes, dogs, raccoons, coyotes, skunks and bats), extensive Partners in Health.” Actually getting out into the facing the border communities of U.S. and Mexico. Offered border crossings, and rabies. I realized how implementation community and learning directly with firsthand, on-site through the University of Texas Health Sciences Center at of the program was crucial toward controlling rabies within individuals was amazingly effective. The “take home” San Antonio, STEER has been running for more than 14 the area. message that I learned from STEER is that I want to be a years, and more than 500 health professions students have The water quality segment was fascinating. Not only do we physician who is community-friendly, one who is aware of completed the program. A dedicated team of faculty have to worry about contaminants that edible fish may have, public and environmental health issues facing the members, instructors, and community health workers work patients were raising children in low-income families, and but we also have to be concerned about the contaminants in community, and one who wants to become involved in together to make the course very successful. We learned many were pregnant teenagers. Just like we learned at the the smaller fish and sea organisms the edible fish may these issues. I about different topics, including health and economic issues city of Laredo Health Department, programs need to be consume. Our natural ecosystem works in a cycle that facing the border, pesticide exposure and subsequent health implemented to encourage healthy sexual behaviors and encompasses cause and effect, and this concept was also effects, binational health programs, barriers to health care precautions, screening for STDs, hotlines for information, demonstrated in other areas of the course. The Rio Grande access, food sanitation and inspection, and indoor and and resources for HIV patients. I did not know that River plays a tremendous role at the border, as it separates outdoor air quality issues. communities like the colonias existed along the U.S.-Mexico border. Visiting the colonias made the experience more real, the two countries. We learned about protecting this great I enjoyed the program from day one! Many of the issues and I could see the obvious challenges in accessing basic source of water, which has been susceptible to heavy covered in STEER affect communities elsewhere, as well. services like health care, water, electricity, and sewage pollution in the past. Thus far, my health experiences have been in California, disposal. We visited the community center and learned how Through visiting ranches and learning about local plants and where there are numerous clusters of immigrant and they managed to run certain aspects of their system on a their medicinal uses, I was amazed that such a variety of underserved communities. I did my OB/GYN rotation in small budget. Visiting a family in the colonias and addressing herbs exist and how they play an important role in Hispanic Santa Maria, where most patients were Spanish-speaking, their dietary issues also helped me learn about how diet, culture. Many patients rely on these herbal medicines, and it and where there is a large community of migrant farm income, and food perception play a role in the lives of people is crucial for us to know about them. Through the overview workers and their families. Teenage pregnancies, prevalence in the colonias and in other low-income families. of Mexico’s health care system, I found it interesting that of sexually transmitted infections, pesticide exposure, and air many people cross the border into Mexico to receive faster quality were all of concern in this particular city. Many

30 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 31 “Fire and Neon,” Photo Gallery: Gina Johnson, DVM ’12 Pomona, CA, 2008

“Proboscis,” Los Angeles, 2009

“This Modern Grime,” Claremont Hills Wilderness Park, overlooking Los Angeles, CA, 2009

“The Red and the Gold,” Portland, OR, 2009 Pastel drawing, “The Colors”

32 33 osteopathic and homeopathic medicine, a silent day for reflection, a video stream lecture on green medicine, a day of gardening at the local homeless shelter, discussions on racism and poverty, art therapy…the list continued. Every day, I recorded the days’ events and lecture notes in my journal, and in the evenings I articulated my reflections. Without publishing the entire journal, I wanted to share a few of the most enlightening moments from my month at HEART. I wish all medical students had the opportunity to experience the HEART elective, because it provided me with the tools and enlightenment I needed to practice medicine the way I intended when I wrote my personal Story and photos by Kristen Sharpe, DO ’09 statement four years ago. Thus, I pass along these “top PGY-1 at Loma Linda University Medical Center for OB/GYN ten” insights that I learned from medical school, clinical rotations, and the HEART elective.

1) Have an agenda for self care. First detox. Find a way to fter driving up the central California coast, through restore a healthy body and mind. It took at least two weeks a 17-mile drive in Monterey, into the Santa Cruz for me to identify the negative habits and thoughts that Amountains, and along a windy single-lane road in developed during medical school. I needed to relearn how 3) Sleep well but wake up and be present. Sleep, sleep, Ben Lomand, I finally arrived at my destination. I wheeled to enjoy a meal, how to be present with nature when I was sleep. You will look better, feel better, learn better, and drive my luggage across a dirt trail to my A-frame cabin, humbly outdoors, how to exercise for pleasure, and how to better! Sleep so you can be present with your patients. nestled within the majestic redwood forest. This was home recognize my own prejudices when meeting a new person. Learning to be present was the most difficult skill for me to for a month for me and 24 other privileged medical Then create a plan for achieving balance. I had to ask, acquire, since my mind is always in the future, anticipating students from U.S. medical schools as we embarked on the “What am I like at my best, and what is preventing me the next task. My body seems to be in constant motion, HEART elective. Appropriately named, this fully from being there?” One morning we had a spontaneous running from rounds to surgery to clinic and back to accredited elective is offered annually by the American session of laughter yoga, and I found myself surrounded by rounds. The ability to be still and quiet is a persistent Medical Student Association (AMSA). It stands for a group of hyenas but unable to laugh myself. I quietly struggle for me; sometimes the only time this happens is Humanistic Elective in Alternative Medicine, Activism, and smiled, which comes naturally for me; but my complete when Mother Nature calls. I try to make a daily practice to Reflective Transformation. Little did I know I would silence shocked me, as I painfully realized that I had slow down, connect to my surroundings, awaken all five rediscover my heart at HEART. nothing to laugh about. I could not even remember the last senses, and remember who I am, where I am, and what I am time I indulged in a chuckle. Had I lost my sense of doing. In doing this, you will ground yourself so you can be I settled into my cabin, laying my sleeping bag out on the humor? Fortunately for me, I rediscovered the ability to present to make the human connection and fully offer bed that promised the most abundant morning sunshine, laugh by the end of HEART, but I had to release all of the yourself as an ally to your patients. since I was sure this rotation would let me sleep past grief and sadness I encountered during medical school that sunrise. Excited to meet the other participants, I quickly 4) Be thankful. We are incredibly privileged to have our was overshadowing my ability to celebrate joyfulness. Give followed the aroma of dinner to find the lodge where the education and training. We are freely granted trust and yourself permission to be happy, because nothing is more group was beginning to gather. The kitchen crew directed respect from most of our patients and their families. We refreshing than a happy person. me to the dining room, where folks were making name are given the autonomy to make life-changing decisions for tags, placemats, and mailboxes. Flashbacks of kindergarten 2) Know your limits. One person can make a difference, others. As a whole, we are generously compensated and rushed to me as I toiled over whether to use glitter, puffy but one person is just one part of the larger picture. In our will likely never struggle to feed our families. However, we paint, beads, pipe cleaner, or buttons to decorate my items. lecture, “Green Medicine,” we learned the Intergovern- are not entitled to any of this. You may have hundreds of The excitement in the room was palpable as we exchanged mental Panel on Climate Change made a recommendation thousands of dollars in student loans, sacrificed your routine details about ourselves; where we grew up, where for ways that each person can help combat global climate hobbies to make time to study, and missed celebrations we went to medical school, and where we matched for change: ride a bike, be a frugal shopper, and refrain from with friends and family to be on call. We all have. But residency. The room quieted momentarily as the chefs entered with industrial- eating meat. Not everyone can do those, not everyone can never forget that you chose this path, and thus accepted sized pots and pans, which were labeled as vegetarian, vegan, or gluten-free. In buy a hybrid, not everyone can convert their homes to these responsibilities. Our degree does not define us; rather, that moment, I knew I was in good company. solar power, but everyone can do something. Similarly, we we define our degree as a Doctor of Osteopathic Medicine. cannot always cure our patients, but we can play a part in We are no more important than other health professionals The first group meeting occurred in the living room, surrounded by a brick helping to reduce suffering in every patient encounter. As or the patients we serve. Be thankful for the amazing fireplace and large picture windows that exposed the grassy meadow, budding physicians, we are just one member of the global team for opportunities you are given each day and for the people spring flowers, and carefree wildlife outside. We sat atop pillows on the floor in a health care. Use your energy to move in the right direction. who support you. large circle, and spoke about how each person ended up in that moment, our Know when it is your responsibility to act, pass it on or let hopes for HEART, and our plans as healers. The planners distributed our it go. schedule, and I was delighted to run through the lineup: workshops on

34 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 35 7) Contribute to your community. Just as a chain is no stronger than its weakest link, we are no stronger than the community where we practice. On our last day at HEART, while discussing our excitement and fears about residency, the speaker shared, “Residency is about learning to be one spoke in the wheel so it can continue turning.” I think about this often, mostly when I am exhausted. It reminds me that I am not alone, nor am I the first person to work so hard. It reminds me to smile, lend a hand to my fellow residents (like doing a discharge summary on a patient they discharged over the weekend but you followed the More Than Minutia preceding week), and thank others for their help. Never forget the power of a compliment. Outside of medical By Allan W. Belcher, DO ’11 school or the hospital, find a way to meaningfully connect to your community. For me, it is doing events to support Coming from Southern California, the clean piercing air of actor). We go patients with breast cancer and raise money for breast Vernal, Utah, came as something of a shock to me. Being through the cancer research. back in my hometown for the first time in a year, I found awkward first myself going to the nearest 7-11 and, like some forgotten words and 8) Keep an open mind. This one is simple to explain but ritual, picking up a soda with my dad. As I was deciding introduction, but then 5) Make a plan but allow for flexibility. One of the complex to practice. Do not assume anything. Ask whether to “inject” a shot of lemon, lime, or cherry into slowly transition into exercises at HEART involved writing a life mission questions when it is relevant and apologize when you make my diet coke at the soda fountain (what a decision!), a man conversation, and learn that making small talk makes a big statement and a five-year plan to begin fulfilling these an inaccurate assumption. The first step toward being non- slightly older than me walked in and approached my dad. difference. Now, in advanced classes, I still can’t help but goals. For most of us, that started out simply as graduate judgmental is acknowledging the judgments we make. medical school and complete residency. We were probed to My father, a high school football coach of 30 years, was chuckle when I receive a card from the actor’s back pocket go deeper. If your vision is to maintain loving relationships 9) A lifelong learner is always learning. We cannot know excited to see him. that reads “you hear wheezes, rales and rhonchi.” I find everything, and there will always be someone who knows myself half-heartedly wishing that the patient did have and a healthy weight, you must create a plan to make it What happened next reminded me of a lesson I had filed more. As a medical student, this frustrated me greatly, these findings so I could actually know what they sound happen. Both of these require a conscious effort and action away in my “not pertinent to the exam” file from my first because I constantly felt my knowledge was inadequate. I like! Conversely, the true value of these encounters comes now, not later. Making a plan is generally not difficult for three semesters of medical school. As they chatted, the man never knew more than the person who was “pimping” me, from rapport-building in that first uncomfortable moment. medical students and physicians, but flexibility remains a explained that with my dad’s help in getting his license to but then again, why should I? The entire purpose of challenge. When we are faced with an interruption, we drive semi-trucks (his post-retirement job), he was now I have read books and editorials that make it evident that it medical school and clinical rotations is to learn! And the must choose to continue to move forward toward a goal, employed for the first time in six months and was taking often isn’t possible to have evocative conversations with learning does not end when you graduate, since the or create a new goal. This sounds simple, but is much care of his wife and three small children comfortably. It patients, given the limiting time restraints. This is an practice of medicine is constantly changing. The modalities harder to practice. Remember that a more flexible muscle was a very warm conversation, but I had missed the greater obstacle that appears difficult to circumvent or alter. for learning are changing also, as more journals are absorbs shock more readily. significance. As I walked out, my father stopped and very However, the lesson I learned while being back in my published online and simulation labs are established for candidly said, “That is what no amount of money can buy hometown was that our humanistic skills must be 6) Being a healer does not always require providing a practicing technical skills. treatment or a cure. Health is achieved by the coexistence you, the privilege to feel good about helping someone’s life developed because that is what people can relate to and are of happiness, vitality, and wholeness, not just by the 10) Remember why you chose this path. To me, this is the improve.” Unfortunately, in the first two years of school, comfortable with. I find no common ground with my absence of disease. One speaker emphasized this point by most important insight of all. At the end of the day, after while becoming experts in the minutia of medical father when I tell him I scored well on my 130-question literature, we have a tendency to forget the power of the respiratory exam, but I discover my footing in discussing stating “My healthiest patients are dying from cancer.” phone calls to pharmacists, requests for authorizations, Being a healer requires one to be a team player with all and endless paperwork, I chose this path for the patients. human connection. basic principles that govern our daily lives. It is my hope Though each day presents new administrative hurdles, it that throughout my professional training I will be persons involved in patient care. It means ignoring the From this experience, I was reminded that throughout the also provides more opportunities to help a patient discover reminded that little triumphs inside and outside the ranking and respecting all members of the team for their demanding advancement of our medical careers, the wellness. As physicians, we are not promised success medical field are what can unite us and help us to form helpful contribution. Make an effort to understand your human experience is a component that cannot be taken for because of the rigorous education, laborious training, or meaningful, lasting relationships. patients’ needs. Sometimes a patient needs a medication granted. It is what mattered in a small town on a Saturday protracted work hours. That is part of the job description. refill, sometimes a patient needs a diagnosis, and night, and it is what may matter even more in busy urban WesternU has greatly expanded, including dental, podiatry, And as long as I can still remember why I am on this path, sometimes a patient just needs an active listener with an populations. and optometry programs that started this fall. I have I will continue the journey. I empathetic heart. confidence that students will receive a high-quality I found it disheartening in my first year of school to listen experience because of those little early encounters with to a physician express that slowly, cynicism and jadedness actors. What I have come to appreciate is that first “Being a healer requires one to be a team player with all persons involved in creep into the hearts of many doctors. Perhaps it is because rapport-building exercise, when taken in the right mind, I am young in my training that I can so transparently write could steady my foundation in humanism and could prove patient care. It means ignoring the ranking and this essay. At Western University of Health Sciences, we are to be my greatest tool in assisting in overall health. I thrown (they say “guided”) into a “Patient Encounter” respecting all members of the team for their helpful contribution.” within the first two weeks of landing on campus, and here Photos by Jess Lopatynski and Jeff Malet we are to learn to build “rapport” with our patient (an

36 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 37 Photo Gallery: Lara McMahon, Office of Medical Education, COMP Rancho Santa Ana Botanic Garden Sunset in Alta Loma, CA

Washington Coastline off 101 Freeway

Mt. Shasta off 5 Freeway

October in St. Helens, Oregon

38 Rancho Santa Ana Botanic Garden 39 1

1 2 3

2

Interprofessional Health Care: Pomona Community

Health Fair 3 4 4 By Lana Grinberg, DO ’13

Opposite page, clockwise from top left: I am one of the lucky ones. I have been chosen to be part of the first group to 1. Physician Assistant student Tamara Rath er Optometry student Anne Song and Physical participate in WesternU’s phenomenal interprofessional learning module. Therapy student Lindsey Machado provide nutrition and exercise information. Throughout this year, I have thoroughly enjoyed working side-by-side with 2. COMP student Jeffery Lee checks a girl’s blood pressure. future physician assistants and health care professionals from podiatry, 3. Physician Assistant student Kim Pham tests a patient’s blood glucose to check for signs dentistry, optometry, and veterinary medicine at many different health clinics of diabetes. 3. Optometry student Anne Song performs a stereo acuity test. and events held by university clubs. My favorite event, however, has to be the 4. Veterinary Medicine student Megan Dundas provides information and hands out treats. Pomona Community Health Fair held in January of this year on our own campus. The event was put on by students and organized by students, and This page, clockwise from top left: many students received hands-on experience consulting and examining the 1. Dental Medicine student Marvin Chan provides oral health information and hands out travel packs of toothpaste. community. In addition, a few of us were given the opportunity to make 2. COMP student James Min performs a vision assessment. presentations to the community on topics such as the flu, diabetes, and 3. COMP student Sheetal Shukla and PA students Shirin Kazemi and Kathy Hu fill out health nutrition and exercise. Thank you, WesternU, for the many opportunities that screening forms with patients. you extend to us. It was a monumental experience that I will treasure for the 4. Physician Assistant student Tamara Rath er discusses nutrition. rest of my career. I 5. Kierstyn Napier-Dovorany, OD, FAAO, Assistant Professor, CO, and Kristy Remick-Waltman, OD, FCOVD, Assistant Professor, CO, perform a vision screening. 5 5 Photos by Jess Lopatynski.

40 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 41 By Lony Castro, MD, Professor Obstetrics & Gynecology College of Osteopathic Medicine of the Pacific Photos courtesy of shutterstock.com

HE ASE OF THE TUDENT AND THE done an exam, reviewed all the lab data and had tried to consequences of their clinical decisions if they don’t know T C S formulate an assessment. I was impressed. what happened to the patient? PATIENT WITH PREECLAMPSIA After rounds, I went back to see the patients myself. When I This particular medical student seemed oblivious to these got to Patient X’s room, I asked the student to come in with all too common barriers to patient care. For the next few me so I could determine if his presentation was accurate. It days, the student rounded on “his” patient twice a day: in was spot on. “Are you interested in Ob-Gyn?” I asked. the morning, before rounds, and again in the evening after t was seven a.m. and time for “change of shift” on the OB he finished whatever else he had been assigned to (clinic, He laughed, “Well, I’m interested in it, but I’m going to service. The night call team had been inundated with new labor and delivery, etc.) He was always knowledgeable apply for a residency in orthopedics.” Iadmissions. On Labor and Delivery, all the rooms were full, about what was going on with the patient medically — and cesarean section deliveries were underway in each of the two What a shame, I thought, and proceeded to review with him symptoms, blood pressure, labs, and fetal heart rate tracing. operating rooms. Across the hall on the ante-partum ward, I was the signs and symptoms of severe preeclampsia: headache, Even more important, he got to know the patient in a way making rounds with a new team of medical students and residents. visual changes, right upper quadrant pain and severe that no one else on the team did. He found out that she had Most of the new admissions were for preterm labor or preterm hypertension, and heavy proteinuria, among others, as well immigrated to this country only a few years ago and, ruptured membranes, and I was having difficulty distinguishing as potential effects of the disease on the fetus. We discussed although her husband and some of his family were with her, between the individual patients admitted with these diagnoses. how a patient with severe preeclampsia should be stabilized, her own parents were still in their native country and she The way the cases were being presented, none seemed unique. Oh the role of magnesium sulfate for seizure prophylaxis and longed for her mother’s support and presence. She was well, I thought — I’ll go back after rounds and sort them out. the use of betamethasone to accelerate fetal lung maturity. afraid — afraid of what was going to happen to her and her Things changed when we got to Patient X’s room. A third-year The student had clearly read about the problem and was unborn child in what to her was a cold, strange place filled medical student who had been on the night before asked if he eager to apply his knowledge to the care of the patient on with unfamiliar faces. The student was able to spend the could present her case. hand. He then asked if he could follow the patient. I was time required to rephrase many of the things we said on “She is a 24-year-old primigravida at 25 weeks of gestation who pleased that he asked but wasn’t sure if he would actually rounds so that she had a clearer understanding of what was was transferred from a midwife clinic to the hospital yesterday follow through. going on. In addition, he listened to her, allowed her to because of recent swelling of her hands and feet, an elevated blood express her concerns and tried to be a comforting presence. Continuity of care is frequently missing from the clinical pressure of 150/80 and a urinalysis showing proteinuria …” he After a few days she came to expect to see him each training of students and residents. Often, when I ask said, reading from his note. I paid close attention because this case morning and evening and considered him “her” doctor as students (or even residents) for follow up information was different. This was not another case of preterm labor. This much as anyone else on the team. regarding a particular patient in whose care they have been was preterm preeclampsia. The immediate clinical questions were: involved, I am told, “Oh, I don’t know the details of what About four days later the student reported on rounds that Was the disease severe enough to be life threatening to the mother happened to the patient because I never rounded on her the patient’s repeat 24-hour urine collection now contained or fetus? Did the patient need to be delivered? If delivered at this again,” or “I was post-call so I went home and didn’t find six grams of protein. There was no longer any question stage of pregnancy, the baby would be extremely premature, and out what happened,” or “I was assigned to clinic—I didn’t about the diagnosis. She clearly had severe preeclampsia even if it survived was likely to suffer from major complications. go to the hospital wards.” These answers reflect the fact and the renal manifestations were worsening, although With these thoughts in mind, I peppered the student with that their clinical activities are constricted by work hours otherwise she and the fetus seemed relatively stable. We questions—both to test his knowledge and because I needed the and multiple divergent responsibilities that make continuity discussed whether or not the patient should be delivered. answers in order the make the right management decisions. The of care difficult. But how, I wonder, do they learn the student was prepared. He had clearly taken a careful history and

42 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 43 I was hesitant. Although delivery is the only “cure” for neonatal intensive care unit. We then went quickly to the preeclampsia, in this case it appeared that delivery would patient’s bedside to explain to her what was going on and benefit the mother potentially to the detriment of the fetus. why she needed to be delivered by an emergency cesarean Such is the conflict one faces in the management of high- section. It helped tremendously that the patient had seen risk pregnancies — there are two patients, the mother and both of us every day for the past four days. She knew us the fetus, and with multiple gestations there can be even and trusted us to make the right decision. more. One has to consider the implications of any clinical Everything went like clockwork. The Labor and Delivery decisions on both. In this particular case the patient was team — consisting of the Ob attending, the resident, the still less than 26 weeks gestation and the estimated weight OR nurse and the anesthesiologist — worked with speed of the fetus was only a little over a pound. All of our tests and care. The patient was delivered expeditiously — a 700- of fetal well-being were reassuring, even the fetal heart rate gram male — and handed off immediately to the neonatal tracing. Each day the fetus could remain in-utero at this team standing by. Exam of the placenta showed the stage of gestation increased its chances of survival and, beginning of an abruption. The baby was very premature, even more important, it’s chances of survival without but did better than expected because, in the opinion of the severe disability. I explained that we were walking a neonatologist, of the additional days spent in-utero tightrope and had to watch the mother and fetus even combined with the ante-partum administration of more vigilantly for signs of deterioration if we were to time betamethasone and magnesium sulfate. The mother the delivery correctly — in other words, deliver the mother improved rapidly. Post-partum she had a significant before any permanent damage occurred to either herself or diuresis, her blood pressure returned to pre-pregnant levels the fetus from preeclampsia, but not so soon that the baby and her proteinuria resolved. We had waited as long as we was more preterm than necessary. could, but not too long. I could breathe a sigh of relief. We decided to get laboratory studies twice a day on the Before she was discharged, the patient thanked everyone mother, looking for signs of the HELLP (hemolysis, on the team for the care they gave her and would continue elevated liver function tests, low platelets) syndrome, to give to her baby. In addition, she and her family gave increase the frequency of her blood pressure monitoring special thanks to the medical student. I also thanked him. and follow the fetal status more closely with continuous His role was as important as mine, the obstetrician, the fetal heart rate monitoring. I reminded the team that one neonatologist and everyone else on the team involved in feared complication was placental abruption — or the care of this patient and her child. The student’s premature separation of the placenta. This unfortunately behavior exemplified the saying attributed to Sir William could occur with minimal warning. The clinical signs of Osler, “The secret in the care of the patient is in caring for vaginal bleeding and abdominal pain do not always present the patient.” It was also a clear illustration of putting into until late. One of the only signs might be a change in the practice WesternU’s motto: “The discipline of learning. TRUST With trust comes a grave responsibility. fetal heart rate pattern — a decrease in fetal heart rate The art of caring.” Because of his interest, caring and variability, change in baseline, or the onset of commitment, the student found a way to provide decelerations, which are often subtle and difficult to detect By Dorothy Schoonmaker, RN, MSN continuity of care to “his” patient while she was in the early on. We wrote the orders, reviewed the plan with the Assistant Professor, College of Graduate Nursing hospital, even though it was not something strictly required patient and her nurse, and then left the hospital to see of him. This allowed him to learn a great deal about patients in the Women’s Health Clinic. Trust. The annual Honesty and Ethics of Professions thought he should do it. I responded affirmatively and preeclampsia, not just from articles, chapters, lectures and Gallup poll reveals that 83% of Americans say nurses have shared that my father had recently scheduled a similar About five hours later, when everyone went to lunch, the rounds, but directly from the patient with the disease. It either very high or high ethical standards, positioning them surgery with good results. At this point, the gentleman student went back to the hospital to see his patient. When also gave him the all-important opportunity to “give back” at the top of Gallup’s 2009 ranking of various professions. took a deep breath, grasped my hand, and asked me to he returned to the clinic he had a worried expression on his to the patient he learned from by positively contributing to This survey recalls a never-to-be forgotten incident. pray with him. face and a copy of the fetal heart rate tracing in his hand. her care. “Are these the changes you were talking about?” he asked The gentleman in this story is a senior citizen who had An hour or so later, the daughter of the patient called. She Students in the health care professions need to recognize as he put the copy down on the desk. I stared at the tracing been admitted to the hospital for abdominal pain. During stated that her father had talked with her about the early that clinical training offers the privilege of learning — there they were! — shallow “u” shaped decelerations of the course of admission, it had been decided that an upcoming surgery, and that he was very worried about directly from the patient and the team caring for the the fetal heart rate, accompanied by a rise in the baseline exploratory laparoscopy would be the next step. On this having a lobotomy. This gentleman had come to the patient. Along with privilege comes responsibility. Students from 150 to 165 beats per minute and a decrease in day, I was his nurse. hospital for abdominal pain and thought that he may have have the responsibility of making the commitment to try to variability. The changes were subtle and had just recently part of his brain removed. Horrified, I immediately went contribute to the care of the patients they learn from, as He had many questions, the first of which being whether begun. Neither the patient’s nurse nor the automated alarm to his room, and we cleared up the misconception. well as the team they are a part of. Put more succinctly, he should have the surgery. He talked to me and was system detected them. We still had time to get this baby clinical training is a balance between taking and giving. nervous about the surgery. He asked me for my opinion. With trust comes a grave responsibility. I delivered before there was a full-blown placental abruption When a student puts that principle into practice, wonderful We had developed a therapeutic relationship throughout and hypoxia ensued, but we had to move fast. We both ran Photos by Jess Lopatynski and jeff Malet. things can happen, even if they decide not to specialize in the day, and he did not want to hear a clinically competent, back to the hospital, and notified the L&D team and the Ob-Gyn. I professional response. He wanted to know whether I

44 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 45 that such a diagnosis for her was unlikely. At that point a Partners in Health wave of relief surged across her face. As the exam continued, she proceeded to share other health concerns A cry goes out from across the sea apparently bottled up for years. Most of her concerns were diffused through my modest range of knowledge. By the An earthquake has ravaged little Haiti. end of the appointment, instead of appearing burdened by Images appear around the world on TV irrational worries of illness, she presented with a comfort On cell phones, computers Xbox and Wii, more warranted by her healthy lifestyle. Tens of thousands are dead, 6 million displaced Through a simple demonstration of humanism, I nurtured an environment of trust and honesty. In response, the The images show many horrible sights. patient allowed me to provide her with a service that Where will these people sleep tonight? would otherwise have been overlooked. The patient would Who will comfort them and ease their pain? still have received the reassurance of a healthy physical, but When there is little access for airplanes? an examination remiss of humanism would not have Who will bring them food and care? allowed treatment of the whole patient. Though no court or ethics committee would find me guilty of negligence, nor Many wish that they were there would any tangible adverse outcome likely precipitate from To help those in despair. a lack of humanism in the above example, it is my belief that an interaction devoid of true humanism would have Some wish to help from origins of poverty and wealth, been negligence nonetheless. Treatment of my patient in They know that we are all partners in health. such a way would have left her burdened with It does not matter your station in life unreasonable doubts about her well-being and health, Helping those in need may ease strife. thereby reducing her ability to live a life as rich and fulfilling as she deserved. People have traveled from around the planet Humanism must be at the core of everything we do as To ease the Haitian hunger, pain and panic physicians. It is central to a fully functioning patient- physician relationship. When humanism is removed from For we are all creatures of man In the Face of Change There is One Constant this interaction, one can expect incomplete reporting, We can lead a helping hand. Story and photo by James A. James III, DO ’12 misinformation, mistrust, the overlooking of patient needs, As partners in health, joy and sorrow and non-compliance. On a global level, such interactions We should help those people to have a better tomorrow. blemish the medical community and diminish the trust and Call the Red Cross and give what you can t is health care’s very nature to be in constant upheaval humanism, health care becomes a cold, machine-like respect the public has for our profession — a trust and You may not be able to visit the Haitian land. as it strives to fit new, better treatment paradigms. New industry, speeding through and pumping out sub-par respect I believe our profession both deserves and requires. Itechnology begets technology that seemed new only results and poorly cared-for patients. No matter how But, you can show that you care yesterday. New treatments are offered up as addendums or inconsequential it may seem at times, humanism should I know each of us has chosen this profession because we By giving to those who are going there. replacements of the old. New evidence becomes the basis guide every thought, every evaluation, every conversation, seek the challenge of medicine, the excitement of change, and the satisfaction of healing. To fulfill this role, I hope of new practice. Change is one of the quintessential traits and every cut. God bless us all of health care that makes it appealing to many who seek its that each of us is devoted to humanism and caring for each A few weeks ago, I was working at a clinic for the embrace. Change makes health care exciting, challenging patient individually and holistically. Our ability to stay true underserved. One of the patients I met was in her late By Carise E. Charles, DNP ’10 and rewarding. Presently, systemic reform is posing the to this devotion will be challenged time and again by busy fifties and was impressively applying to join the Peace Photo courtesy of shutterstock.com greatest changes health care has seen in most of our schedules, stressful encounters, and personal matters. This Corps. For this she needed a physical, but had no insurance lifetimes. You may find yourself in support of this change, is all the more reason that we must consciously center and no provider. In fact, she informed me that she had not against it, or somewhere in between, but not one of us is ourselves. I recommend that each of us find that seen a physician in longer than she could remember. As we disengaged. inspiration for humanism in life, whether it is a personal began interacting I noticed that she appeared timid and a experience or a patient encounter. Hold on to that memory While everyone is justifiably focused on this change, I bit preoccupied. As I performed and explained my and use it to remind yourself during those rough patches would like to redirect the conversation a moment to examination, I began to also inquire about her interest in why you are here and what you owe to each patient. We consider a part of health care that deserves more vigilance the Peace Corps. The conversation moved to her family have committed to more than simply a prestigious and and focus than any form of change. This one thing, this and then on to diabetes. Her uncle was recently diagnosed exciting profession. We have committed ourselves to a one constant, is humanism. Often overlooked and under- and she was terrified at the prospect that she may be sacred pact with our fellow man. To ensure the future of practiced, humanism is the foundation for medicine’s diagnosed with diabetes as well. Being a fit marathon medicine remains bright, we must make good on this oath existence and remains the beacon for its bright future. It enthusiast who makes impeccably healthy lifestyle choices to our brethren. Through every interaction and every directs us to be ever mindful of our obligation to treat the such as abstaining from the use of any intoxicants and decision made, we must embody the very humanism that patient and not just their presenting illnesses. Without maintaining the most un-American of diets, I assured her unites each and every one of us. I

46 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 47 Tribute to Cadavers | Lyrics to the tune of “I Hate This Part” By Pussycat Dolls. Translocate | Lyrics to the tune of “Apologize” by One Republic Tiffany Stillian, DVM ’11 By Munira Rahman, DO ’13 By Munira Rahman, DO ’13 “Life Persists” We’re walking in through the doors of cadaver lab The world slows down I can’t take it any longer Blank white sheets as they’re covered row by row But my heart beats fast right now Thought that we were stronger I’m holding on P-site Cause of death, unknown words and bewildered looks I see the skin, feel shivers Listen to the sniffles Got a peptide bond away Lift the shroud, and we see that Down my back Slipping through our fingers I’m ready for attack I don’t wanna try now And I wait for tRNA The world slows down I can’t take it any longer All that’s lefts good-bye I have an ester waiting But my heart beats fast right now Thought that we were stronger Coping as I can tell you Pe-ptidyl transferase, but wait I see the skin, feel shivers Adipose and fluids Down my back Slipping through our fingers I can’t take it any longer RF-1 reaches I don’t wanna try now Thought that we were stronger The UAA stop codon, and now I can’t take it any longer All that’s left is learning All we do is linger Thought that we were stronger Coping as I can tell you Slipping through our fingers It’s too late to translocate, it’s too late Scalpel, probe, and scissors I hate this part right here I don’t want to try now Yeah it’s too late to translocate, it’s too late Slipping through our fingers I hate this part right here All that’s lefts good-bye I don’t wanna try now Remember all my fears To find a way that I can tell you Water takes a shot, makes a break, All that’s left is learning I hate this part right here Coping as I can tell you I thank you from my heart in the peptide chain I hate this part right here Time flies by, the end draws near For all your precious parts Release factor 3 I hate this part right here I realize I’ve conquered fears No matter where you are GTP Remember all my fears Thanks to you more lives are saved I thank you from my heart binds RF1 I hate this part right here And I owe you my career Hydrolyze and release RF1 And now you have GDP, on RF3 Everyday, everyday, every single day Ribosome Recycling Factor, and Learning muscles, bones, nerves, and blood supply I forget that you once walked among us EFG -GTP And that you have a family grieving are coming in

So it’s too late to translocate, it’s too late Yeah it’s too late to translocate, it’s too late Kristen Sharpe, DO ’09 So it’s too late to translocate, it’s too late “Kauai, December ‘09” Yeah it’s too late to translocate, it’s too late So it’s too late to translocate, it’s too late Yeah it’s too late to translocate, it’s too late

All the factors release and now I’ve Got a free ribosome

Pledge Through Tradition | By Chirag Gandhi, DO ’13 The day has shifted now, the morrow in new plight. Circling red and white around witnessing embers My shadow was to precede this faulty lead. An ancient practice in all seven rounds.

In first my sustenance shall stem from you alone. A second my strength through you. Third, my wealth and warmth be your embrace. “Road Trip ‘08” At quarter, all sorrow and joy take your form. Sheetal Patel, DO ’12 A fifth, of progeny, a rouse of destiny. “India” For sixth of wish-less longevity In finality, my step is first in accepting eternity. Through love of friendship we two shall turn to one.

48 49 “Ba” Photo Gallery: David Nguyen, PharmD ’12

“Scars of Survival”

“Maternal Instinct”

“Paper Brilliance ”

“Bo vo”

“Ông”

50 51 A BRIEF LOOK AT Pharmacy in Thailand

Story and photos by Sandy Saekoh, PharmD ’12

During this past summer, I had the opportunity to travel to pharmacy to help them with their problems and needs. the city of Bangkok, Thailand. It was a unique city and Many of us, including me, take for granted our very different from the typical American city. Food carts, neighborhood pharmacy, but the people of Thailand rely malls, stores, and McDonalds lined the city streets. And of on them to cure and heal the ailments that they or their course, being a pharmacy student, I decided to check out loved ones may have. I believe that they are the most the local pharmacy because I ran out of mosquito repellent. critical providers of health care service there because many people cannot afford to see a doctor when they are sick, This pharmacy was like a mini-Walmart, because but they can go to the pharmacy they trust. The dynamics everything and anything could be sold there, including were certainly different from what I have seen in the U.S., cosmetics, fresh produce and beer. Although all prescribed but I know that as health care providers, we should not medications are kept behind the counter, some medications stop at providing medical care for our patients, but we like antibiotics, which require a prescription in the U.S., should also take the time to care for their well-being and may be bought without one in Thailand. Also, there is no be that person who can make a difference in their lives. I requirement that a pharmacist be present in every pharmacy. Obviously, the laws are different in Thailand, but one thing is for sure—the people trust their local

52 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 53 International Medicine in

CameroonStory and photos by Elizabeth Knierim, DO ’13 With its fields of plush green vegetation and immense take part in this wonderful experience. He has been trained banana plantations, with its frantic, busy cities, with its as a specialist in tropical medicine and is thus an expert on handsome and strong women and men and its playful tropical diseases. We encountered many tropical diseases in The most powerful part of the trip, however, was simply the chance to children, with its hope and its beauty amidst cries of Cameroon, such as tinea versicolor and onchocerciasis touch these people and be touched by them. Looking into the eyes of the hunger and sickness, Cameroon has wrapped her fingers (river blindness). Dr. Ngo is a pastor who started out in woman whose baby cries of burn wounds or the man who has been around my heart and drawn me in. Cameroon, growing up in a small crowded house with a suffering abdominal pain for years, one can see the oppressed pain and the dirt floor. After moving to the United States and becoming faith and strength within. After using our very basic supplies, our I had never experienced Africa nor had I observed health a Christian pastor, he realized his true calling was to return education, and our own hands, all of which we take for granted, we care in a developing nation until the spring of 2009, when I to his roots and serve the people of Cameroon. Hence, HTI watched their hope grow. They would say thank you to us and mean it in a joined a team of physicians, dentists, hygienists, nurses, was developed, an interdisciplinary group of health care way more sincere than we can comprehend, and we’d watch them go while and their families on Health Team International’s (HTI) professionals came together, and the work began. hoping, deep within our beings, for the best for each and every one, twelfth trip to the West African nation of Cameroon. HTI wishing only that we could do more. is a Christian organization that brings free medical aid and In each village, our team worked in either the local clinic Christian teachings to impoverished nations throughout or a schoolhouse. The conditions were not exactly ideal, This experience taught me the value of working as a team, a value that is the world, focusing on Southeast Asia, China, South but we did the best we could. In one village, we performed emphasized at WesternU with its interprofessional curriculum. With each Africa, and Cameroon. HTI seeks out the most remote surgeries inside the chief’s small meeting room, with a of us having different strengths and expertise, we were able to bring areas and this past trip brought us far into isolated villages dusty table as the bed and one miniature window and our effective, comprehensive health care to those needing it most. This outside of the major city of Douala. headlamps for light. I often assisted the team’s surgeon, a experience also reconfirmed my choice to pursue osteopathic medicine, Cameroonian who runs a busy hospital in Nigeria and where the whole human being is considered and not merely his symptoms. Drs. Dan Wiklund, MD, and John Ngo led this mission works ceaselessly. We removed lipomas and did many Moreover, I witnessed more poignantly than ever the resilience of the trip. Dr. Wiklund has served as an incredibly inspiring hernia repairs, and it was amazing – I will never forget my human body and spirit, and I will carry this appreciation with me into my mentor to me throughout my pursuit of medicine, and it first suture! career and throughout all of life. I was due to his encouragement and care that I was able to

54 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 55 also learned suturing techniques, giving injections, and collected rain water in a well and ran water pipes through writing out and filling prescriptions. the village. People drank this unfiltered rain water. It was Story and photos by n July 14, I arrived at the airport in Belize. The weather was the most humid I amazing to me. I remember one house with holes in the On the third day, we went to our first village to let them Khasha Touloei, DO ’12 have ever experienced. The airport was about half the size of a supermarket with roof and water just raining into the house. One family O know of the free medical services we would provide them only one baggage carousel. As I walked through customs, I had a hard time conversing hadn’t eaten in two days and did not have money to buy the next day. Walking through this village was very with the lady, as she did not understand English and I did not understand Spanish. drugs to control their son’s seizures. When I asked him difficult for me, as I had not seen poverty like this before. After ten minutes of miscommunication, I figured out that she wanted to hold on to my how he was doing, he replied “I want to die.” Another Most houses had families with more than seven kids all passport until I figured out where I was actually going. The people who were going to patient was 24, with a family of 6. He had damaged a enclosed in a space as big as a standard U.S. family room. pick me up were not arriving for two hours, so I took the risk. Next, I went to baggage nerve in his neck by falling from a tree at age eight and had One of the homes had 29 kids! None of the houses had claim to find my luggage, only to find my luggage missing with no one to help me had a headache every day of his life for the past 10 years, running water, the toilet was not very hygienic, and they figure out where it was. I now realized I was in a third-world country with my luggage and he could not afford to get a CT scan or to fix his did not have showers, so they washed where they got their missing and my passport being held. Luckily, my baggage arrived several hours later problem. Most of the patients we saw were kids between water – the river. This is also where they washed their and I was able to retrieve my passport. two and 10 years old, who were covered in rashes and clothes. We inspected the river and found it to be full of infections from head to toe. Some of the kids had never parasites and worms. What affected me the most was not As we drove to our destination, I came to realize that Belize did not have many roads seen a flashlight before. made of tar. Most of the roads were composed of dirt and rocks, and every bus trip seeing these people living in these harsh conditions, but the required travel at 30 mph. If it rained, we would go even slower and take alternate fact that they were still so happy. routes to get to our destination to prevent the bus from getting stuck in mud. It took us We came back to their community center to set up our two hours to get home, a trip that would have taken us less than 30 minutes in the U.S. clinic the next day. We arrived at 9 a.m., and there was a The walls of the place had holes to the outside which allowed line longer than for “Transformers” on opening night. easy access for all creatures, including scorpions and lizards. Each patient came in, and we took down their history and The mattresses were just one big piece of sponge. It was like did a physical exam. Most of the people we met had sleeping outdoors. I went to take a shower only to find out parasitic, fungal and bacterial infections. Some of the there was no water, something that was common to the lower people we interacted with had never seen a physician. I class of Belize. It was time to go to sleep, and I was having a could tell we were making a difference because before each hard time shutting my eyes because of the fear of a creature patient left, they would give us a hug. coming to bite me, not to mention the humidity made me feel The next day, we set up clinic again, and once again there like I was sleeping in a warm bath. When I went to use the was a long line. People wanted to get into the clinic to get toilets, the toilets would not flush if you put toilet paper in free medications. One of the patients I examined was a them, since the pipe system was not strong enough. mother who had a fungal infection that had lasted more The next morning we had water! Thank God. I turned on the than four years. The infection had travelled, taken over her shower knob and there was absolutely no water pressure. body, and her right arm was the only unexposed region Basically, the faucet was spitting out a few sprinkles of water. In left. For the past three years she had lived her life itchy, Overall, the trip was a life-changing experience. I realized addition, the shower floor was dirty, and most mornings I morning ’til night. There was no medication to stop what that in America we take things for granted. I realized that showered with toads. To add to our fun, we had no hot running the fungal infection had done to her body, but we had little things make a big difference. I also realized how water and no mirrors. Throughout the two weeks, no matter how much mosquito medication to stop her itchiness. The sad part was that if fortunate I am, and I have learned to stop complaining repellent I sprayed, I still got bit, and Belize’s humidity caused me to sweat profusely. she was able to see a physician when it started, it would about minor things! Thank you to everyone who have been easier for her to live a better life. Most of the sponsored me! Your donations provided the people with The second day of my trip we had a crash course in taking a patient history, people we treated had chronic problems that had gotten medication and care as well as contributed to my own performing a physical exam and diagnosing the patient’s complaint. While performing out of control due to not being treated earlier. personal growth. I the physical exam on these patients, I gained exposure to taking blood pressure/pulse, using a glucometer to screen for and monitor diabetes, performing eye/ear/throat As the next few weeks went by, we visited more villages exams, and listening for abnormalities in the heart and lungs using a stethoscope. We and provided more services. One of the villages we went to

56 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 57 INTERNATIONAL MEDICINE: DO Students in By Sheetal Patel, DO ’12 India

A group of six DO ’12 students — Christine Ayoub, Chelsea Chung, Morgan Faggard, Sheetal Patel, Radhika Sood and Jessica Weiss — and attending physician Zuhra Musherraf, DO ’04, Assistant Professor of Family Medicine, COMP, went on a 16-day medical trip to the northeast state of Bihar, India. We set up camps in three villages. All three of these villages are close to the border of Nepal. The villages, along with hundreds of others, suffered major flooding in August 2008 when a dam on the India-Nepal border breached its walls and submerged everything in its path. During the five days that we held our clinic, we saw about 1,500 patients. The most common patient diagnoses besides malnutrition were respiratory illnesses, gastrointestinal infections and musculoskeletal dysfunctions.

The population in this part of India is well below the Indian poverty line. Going to these villages and providing them with medical care is the least we could do. Unlike the United States, their problems are a lot bigger than just being unable to pay for medical care. Getting to a doctor itself becomes a problem, because the closest clinic is four hours away and the only way to get to it is by walking for over an hour to catch a very unreliable public bus. It is hard to avoid illness when the animals live on the front porch and children play with the animals’ excrement because parents are uneducated about the diseases they can catch. One cannot expect these people to support themselves and each other when fields that once grew crops to feed the family are covered in sand brought in by the flood. Malnutrition is endemic in these regions, and health understandably loses its priority over hunger. Paying for a pair of shoes to cover and protect a 1-year-old septic wound is not an option when one cannot even manage two meals a day. Two out of the three Top left: Sheetal Patel instructing the villagers in Kesopur on how to villages we went to still do not have electricity in every home. use bleach to clean their drinking water to avoid getting gastrointestinal diseases. Photo by Morgan Faggard The only way to get to them is on dirt roads that diverge away from the paved road long before the village. The concept of Top right: Jessica Weiss assisting Dr. Musherraf in examining an infant with severe malnutrition and dehydration, Day 2. Photo by running water might as well be unknown in these regions. Christine Ayoub Being born and raised in India, I thought I had seen the tough Middle left: Morgan Faggard interviewing a patient with Sheetal Patel at Kesopur, Day 2. Photo by Radhika Sood life some people have to live. My perception of their condition would have been luxury compared to what I saw in these Middle right: Radhika Sood listening to a patient’s lung in Kesopur village clinic, Day2. Photo by Christine Ayoub villages. The experienced humbled me. It reminded me of the Bottom left: Christine Ayoub with Dr. Musherraf listening to a power I have, we all have, to make a small change, bring one patient’s lungs, Day 2. Photo by Jessica Weiss smile and touch one heart. These villages screamed for help Bottom middle: Jessica Weiss demonstrates how to use an albuterol from people like us. We fortunate few have the skill and inhaler to an older man in the Kesopur Village. He, as well as many resources to do something for people who literally do not have of the villagers, had decreased breath sounds bilaterally, along with anything other than a lot of faith and some hope for their better some localized wheezing. The number of people needing inhalers was overwhelming, and we quickly ran out. Photo by Morgan Faggard future hanging from a fine thread. I Bottom right: Part of the crowd waiting to be seen by us in the village of Bhantekti, Day 5. Photo by Chelsea Chung.

58 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 59 OUT OF AMERICA: Then I dropped a bomb. “Well, learning can be fun. We are going to perspective has proved very valuable in my ability to advise and assist the have fun, even if it hurts.” They started to laugh. One asked shyly, “Do Bulgarian courts. Ah, Where All Things Are Possible, A Fulbrighter Finds Home we really look like students in America?” and I said, “Honestly, except It was very clear to me that because I came from the world’s largest for the surfer board shorts that the Malibu students at Pepperdine are court, my opinions were held in very high regard. I was often asked to By Judge Maureen Duffy-Lewis, Western University of Health Sciences Board of Trustees probably wearing right now, yup, you look like them!” They were my participate and assist in programs due to my long tenure on the Los immediate fans, and we have been off and running ever since. Angeles Superior Court, and many Bulgarian judges whom I regard as Judge Maureen Duffy-Lewis was a Fulbright Lecturer at Sofia University (we communicated via email months earlier as she encouraged me to Every class has been rigorous and challenging, because everyone has to colleagues in justice, were grateful I was able to share my perspectives. I Law Program. She took a sabbatical leave for the fall semester of 2009 come to Sofia University on my Fulbright) and gave me a big hug. get involved and open their mouths. If they have not read their have enjoyed meeting colleagues from around the EU and Bulgaria, all from her position at the Los Angeles Superior Court. A judge for 23 “Welcome, dearest Maureen,” she said. “I want to introduce you to assignment, I sometimes grill them for a well-reasoned answer until they working simultaneously to improve justice. years, she has handled a wide variety of cases from major felonies to everyone including the Law dean.” People could not have been nicer, but sweat bullets. They are always well read the next time. I require I have gained a renewed sense of the enormous importance of justice as it complex civil cases. While in Sofia, Judge Duffy-Lewis was requested by I could see a few of the secretaries looking askance at me, likely interaction, hand raising, and thinking out loud. For those who give an is dispensed on a day-to-day basis to the average citizen and business Tom Peebles, a representative of the United States Department of Justice, wondering why I kept smiling like an idiot but not saying anything. Few answer, any answer, as long as it is a good faith attempt, I throw candy. looking to fairly resolve disputes. When justice is delayed to a degree that to assist with developing the Judicial Mentoring Initiative for the acknowledged that they spoke any English, so I resorted to the usual The first time I did, this the students looked stunned, like I was attacking it inhibits a timely resolution of disputes, the public begins to question Bulgarian Courts. In her capacity as a Fulbright Professor and member party games for word substitution. them. Then when they realized that I had thrown some pretty cool sour of the law faculty at Sofia University, she taught and mentored law the fairness of the system, and asks the question “For whose benefit does Within a few days, I was knee deep in walking around the University, balls, licorice and a few pieces of chocolate (my personal fav), they were students. While working with the Bulgarian courts, she guest lectured at the justice system exist?” The Bulgarian courts suffer from a public observing students change classes, and the process of “begging” (students becoming darn near ventriloquists. Speaking out has become common Bulgaria’s National Institute of Justice and participated in judicial perception of corruption because the public is suffering from a “Justice convincing a professor or secretary to let them enroll in an already closed place and is encouraged even by other students, who challenge seminars for judges on judicial ethics, mediation, case management, delayed is justice denied” syndrome. class) had begun full steam. Quite frankly, I wonder how students classmates to give their opinion. It is the darnedest thing, candy, and who court administration and judicial education reform. While in Bulgaria, separated by thousands of miles can come up with the same fabulous said that it does not make everything better … one class and one big One of the accomplishments of which I am most proud is being Judge Duffy-Lewis was named a Visiting Fellow at The Bulgarian approaches or persuasive stories. It was amazing how persistent they handful of candy, it is THE CURE. associated with and assisting with the founding and opening of a wholly Institute for Legal Initiatives, a think tank for democratic improvements Bulgarian-funded and supported Mediation Center. The Mediation were, and I could pick out all the future lawyers in one second. If they Well, the semester is in full swing, and the students are working on their in the legal system. Judge Duffy-Lewis was a featured speaker at the Center provides services to the Sofia Regional Court, the largest court in “crashed” (successfully enrolled) into a class that three people had been trials. I have six groups of students, and each one of them is working as a European Union Model Courts Program and guest lecturer at other law the country. It occupies a historic building in Sofia and has more than 30 turned down for, I immediately approached them to see if they were team on a murder case. They are full of excitement and know that what programs in Bulgaria. Judge Duffy-Lewis, a legal author, also published mediator judges and lawyers participating. The goal of the Mediation available for my class. I was actually out fishing for students who they have learned in this class will make them special in the legal world “Lost in a World of Social Networking,” an article on the perils of social Center is to assist the court in case management issues, and to improve displayed that special lawyering skill known as “persuasion.” My of Bulgaria — the new Bulgaria of the European Union. This fine and networking and its legal implications, in Bulgaria’s leading legal the public’s access to early dispute resolution. The grand opening enrollment started with seven students, and within two weeks I ended ancient culture that has survived so much in history now has re-entered magazine, Law World (June 22, 2009). occurred on Jan. 27, 2010, to much public fanfare and substantial press with close to 50. I am not kidding. Fifty students, and every one of them Europe as a full partner. And with that comes the opportunities and the coverage. I, along with my judicial colleagues in Sofia, are hopeful that The following article is a snippet from Judge Duffy-Lewis’ first day on so eager for knowledge that I quit registering students and just let them obligations to stand up and be heard in the public square, to be this center is a first step in addressing the public’s negative perception of campus, thousands of miles from home. audit. Oh, and did I mention that I modified my class after the second contributors to justice and to be ready to participate in the newly meeting? Yup, that is correct. After my first class, “Criminal and Civil the judiciary in Bulgaria. As I crossed the campus quad at Sofia University, I was amazed at how at expanding justice courts of Europe. The advocacy skills they have Law in the Courtroom,” began, it became apparent that these students home I was on this faraway campus. Of course, smiles and hand signs learned in my class will serve them well as they span Bulgaria and My Fulbright was truly a gift from the American people. The wanted to be heard in the public square of ideas, and a future courtroom passed for language (since my Bulgarian was sparse at best) but things Europe, being honest brokers of justice. They know how to present a Fulbright Program is the premier flagship international academic and was to be their square. So that is when the “Art of Oral Advocacy” felt familiar. As I tried to put my finger on it, it happened right in front of clear and concise argument and be persuasive without being insulting. cultural exchange program of the United States. Its purpose is to became a huge component of the class curriculum. me. It was opening day of the fall semester, and students were arriving on They now understand the saying “People’s perceptions are their reality.” “increase mutual understanding between the people of the United campus, some with their parents. Some excited parents appeared to lead The first day of class was ridiculously fun. Of course, I had already We have had extensive conversations about how people perceive justice States and the people of other countries.” The Fulbright Program by hand their nervous students, and a few exuberant students appearing tripped in a hole on the street, I was wearing high heels … enough said. I and how they, as lawyers, jurists and prosecutors, will be the caretakers was established in 1948 by Congress at the urging of Senator J. to lead their nervous parents around campus. The little individual was a little wet from spilling coffee on my pants and then trying to wash of Bulgaria’s justice and will influence their communities’ view of the William Fulbright. Initial funding was derived from the sale of war- bookstores were filled with parents and students concerned about the it off in the bathroom when I was unexpectedly attacked by the cold justice system. I often end class by asking them, “What is the first related materials. The Fulbright Program is sponsored by the U.S. cost of books, and the pen and notebooks sellers adjacent to campus water faucet. But there I was, in front of 50 students who could have obligation of a lawyer” and they will loudly respond in unison, “To be Department of State’s Bureau of Educational and Cultural Affairs. were doing a heck of a job selling out of student supplies. Yup, that was been from Any University U.S.A., including my beloved alma maters the voice of the voiceless!” And with that answer I am the last person to The Scholarship Board is composed of 12 members from the it I had found my answer. This was college and the aroma of hope and USC and Loyola Law School. Pepperdine University, and Western slide out the classroom door. academic and public arena appointed by the president of the United States. They set the policies and criteria for candidate selection. The future fulfillment filled the air. I was home, back in academia, where all University of Health Sciences, where I have strong board affiliations, A post script: things are possible. were equally on my mind as I viewed this fresh-faced group of exuberant program has many world leaders as esteemed alumni. My selection learners. Each face was eager with anticipation. I took a deep breath and As a result of my Fulbright experience, I have a greater appreciation of was truly a humbling honor. I I made my way to the Law Program Office to meet with a professor who said that I could not tell them apart from students back in the United the knowledge gained by participating on various court committees. would be influential in my life, Dr. Mariana Finkova, chair of the States, and that we were going to have fun learning this semester. A look Working with colleagues on approximately 30 committees throughout Constitutional Law Department. When I opened the door, I must have of confusion crossed their faces. “Fun?” one of the students asked. the years provided me with an understanding of many aspects and looked like the quintessential Amerikanski. She instantly recognized me “How could that be, since this class is required for law school credits?” considerations of major court operations. This information and a wide

60 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 61 Photo Gallery: Coleen Galindo, Office of Medical Education, COMP

“Hindu Monastery Kauai,” Kauai, Hawaii

“Red Footed Boobie in Flight,” Crater Hill / Kilawea Point Lighthouse in Kauai, Hawaii

“View from a Cruise,” Pacific Ocean along the Mexican Riviera

“Napali Coast Aerial View,” Napali coastline in Kauai, Hawaii

“HPC Bldg Flower Bed,” Outside the HPC building on WesternU campus, Pomona, California

“Opaekaa Falls Kauai,” Kauai, Hawaii

62 63 following day that the full weight of my medical condition went on to learn many other things from him. I learned would hit me like an uncontainable nightmare. that cancer tumors of the kidney were very rare, especially A Journey for someone of my age (in their 20s) and four months Tuesday, day two … Other than the fact that I was going pregnant. Most cases were diagnosed among those in their for my appointment to see the high-risk OB-GYN, the next 80s, so very little was known or had been written about Ultrasound to Pathology day was like any other normal, cool San Francisco renal cancer of the kidneys. I learned that I was then the afternoon in March. As I sat in the examination room 43rd known case in the United States to be diagnosed, and waiting for the doctor I was a little on edge, a little nervous, I learned that the tumor attached to my right kidney was just not sure how to feel. Then the doctor walked in and By Roslyn Davis, Library Clerk for Harriet K. & Philip Pumerantz Library the size of a football. I learned that the only doctor he remained standing as he spoke these words after greeting Photos courtesey of shutterstock.com knew of that could best perform the surgery was in New me: “Yesterday I looked at your CT scan, and I also York, and that the hospital was going to fly him in the next showed it to the urologist. He says by what he can see, Monday, day one… In the fourth month of pregnancy After getting dressed, I entered the doctor’s office. He week to perform the operation, because in my case, time there is a large tumor growing on your right kidney, and he carrying my third child, my life was literally interrupted immediately began to speak in a solemn tone, trying not to was of the essence. The urologist explained to me that my highly suspects that by the looks of it, it is cancerous. Since while lying on a hospital ultrasound table. Spotting the day make eye contact with me. “There is a very large mass right kidney would have to be removed along with the you are only in the first trimester of pregnancy you need to before had caused me (on the advice of a physician growing on your right kidney. Now, this mass, which tumor because it looked as if there was no way to separate get an abortion, because if we have to give you assistant) to go in for what I thought would be a normal appears to be a tumor, can either be benign or malignant it from the kidney. During the operation, they planned to chemotherapy the baby will be affected. I’ve made you an ultrasound examination. During the exam, the technician … so you need to go upstairs immediately to get a CT scan first tie off the main artery going to and from the kidney appointment for tomorrow to see the urologist, but now I began to move the … I’ve already called them and they’re then hope that no other cancer cells had gotten out. want you to go downstairs to get a chest X-ray to make ultrasound probe away expecting you … you need to go up there “Now,” the urologist continued, “you need to go sure the cancer is not in your lungs.” By now my head was from the lower part of my right now, immediately.” In that moment, I immediately next door to see the anesthesiologist, and he swimming in all the words this doctor was speaking to me, abdomen upward to the had no idea of the journey I was about to will explain everything that is going to be happening with swimming around and around my head. I felt like I was top of my rib cage area, all embark upon. I did as I was instructed and you on the day of your surgery.” spinning on a merry-go-round in an unbelievable story, like the while snapping went upstairs. After drinking some thick the ones you’ve seen on television where the doctor tells the I obeyed and went next door. The anesthesiologist and I sat pictures. Then she asked awful stuff, I was slowly rolled into the CT patient they are going to die and you sit there in your living in his office, and he very carefully explained to me the me the strangest question, scan. While I was still partially inside the room watching and wondering just what that person must events of my surgery day. “You will be having major one I had never been machine, I could see the doctor across the be feeling. Well, for me, at that moment, it was a great surgery. At the minimum your surgery will last four hours, asked before. “Do you room as he viewed the images. Soon one FEAR … FEAR like I had never felt before, a force gripped but most likely it will be longer so we will book the have two uteruses?” I doctor turned into two doctors, then three, my heart. So overwhelmed and stunned with shock, the operating room for the whole day. We don’t really know immediately replied, then four … all viewing my images. They only thing I could manage to say to the doctor was, “No, what to expect because you are also pregnant, so the OB- “No.” The technician then were pointing at the images and pointing at I’m not going to have an abortion.” I walked out of his GYN will be in the operating room during the entire exited the room and me, quickly turning away office, got on the crowded elevator, and tears began to operation just in case the baby tries to abort. Listen to me returned with an attending to avoid making eye stream down my face. With each descending floor this … You are going to bleed massively. You are going to bleed physician. The physician picked contact with me and FEAR-GRIP! grew tighter and tighter around my heart. so much that I know you’re going to need at least eight up the ultrasound probe and shaking their heads. It was units of blood, so I’m going to have 10 units in the room, began his examination. He started at this point I knew For the next 24 hours, I was numb; and my appetite for just in case, so I won’t have to run out to get more in the at the lower part of my abdomen something was really wrong food had left. I couldn’t eat, I couldn’t think, I couldn’t middle of the surgery, because again, you are going to and also worked his way up to with me. Finally, one of focus, I couldn’t speak much and I couldn’t sleep. All I bleed so much.” the top part of my rib cage. The them decided to come out could feel was FEAR, and a sorrow that made my heart whole time he was looking at the and speak with me. I came ache at the thought that I might be dying and leaving my 2- Now, after what he said about blood and bleeding, you screen the technician was saying face to face with another and 3-year-old sons behind. At three a.m., praying for have to understand what was going on in my mind right to him, “Do you see that, do you doctor who gave me little comfort, I found some in the Bible next to the bed. then. Here we are in San Francisco, in 1986, at the height see that … look there … see there eye contact (I really knew of the AIDS epidemic, so I wasn’t feeling too comfortable Wednesday, day three … My appointment with the … do you see it?” The physician then that something was about a blood transfusion from the blood bank, which urologist was very enlightening. The first thing the kept replying back to her, saying, “Yes … yes … yes, I see wrong). Nobody wanted to look me in the eyes as they caused me to ask, “Can I give my own blood?” He urologist said was, “You are so lucky to have found this it.” By now, as you can imagine, I was getting puzzled, and searched for the correct words to say. He finally said to immediately replied, “No, you don’t have time. It takes tumor at such a perfect time, at 16 weeks of pregnancy. the only thing that came to my mind was that I had gall me, “We have made you an appointment for tomorrow months to save up your own blood. You are having your Any sooner and we would have missed it.” (which they stones, just like the person laying on the next table over with the high-risk OB-GYN… You have to go see him surgery on Thursday of next week. You don’t have time for had, in my earlier ultrasound) Then, he continued, “And from me. Then, with great concern — and lost in his immediately.” There was that word again, “immediately.” I that. I know you are concerned about receiving blood any later and you’d be dead. Finding this tumor now is so thoughts — I saw the physician reach up, turn off the then replied, “I’m not going to see the Physician transfusions, but the blood banks have been pretty much perfect, you are so lucky. You are so lucky.” I then said to overhead light, take off his glasses, put his face in his hands Assistant.” “No,” he replied back, “you won’t be seeing cleaned up now.” him, “No, it is not luck, it is the divine timing of God.” I and rub his forehead as he said to the technician, referring any more physician assistants. You have to see the high- then questioned him as to why I had felt no pain from the Needless to say, from Monday to Friday, including getting to me, “What are we going to do with her?” Then, not risk OB-GYN now, immediately. He will explain tumor. He replied, “Because this is the silent kind of tumor. a second opinion at University of California San Francisco looking at me, he said to me, “Go get dressed and come to everything to you.” I went home that day a little on edge, You don’t know you have it until you’re dead.” I then Medical Center, my whole world had suddenly taken an my office. I need to talk to you.” not fully knowing what to expect. It would be on the

64 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 65 unexpected turn. In five days I lost 11 pounds. FEAR had understand … I don’t understand … she didn’t bleed … In 1995, I was approached by Western University’s administration to stolen my taste for food. That’s when I learned a powerful why didn’t she bleed? I’ve never seen this before. Why build the curriculum for a new College of Graduate Nursing. I lesson about FEAR. It will kill you quicker then disease. didn’t she bleed? I never had to give her a drop of blood. wanted to give back to the profession that I loved, and helping to Yet, above all, I still trusted in God, and in the very midst She was supposed to bleed. I don’t understand.” Next, the create the nurses of the future seemed just the thing. I had been a nurse for 25 years and my mother had just celebrated her 50-year of everything I prayed and believed that He would deliver OB-GYN walked out and said to my husband, “I don’t anniversary as a registered nurse. I was halfway there. She wrote this Crystal Rivera, Media Web me and heal my body. I prayed for a divine miracle. I know what kind of baby you guys got, but after we lifted poem when I was young, and the sentiments she expressed inspired Specialist, COMP prayed that the tumor would go away; I prayed that I the uterus out and laid it to the side, so we could get to the me to be that person … a nurse. didn’t have cancer and kidney, he played the whole time we operated!” “Window” She was at my first code blue in ICU as the nursing supervisor. Years I prayed that I would The one thing I can vividly remember about that later, she volunteered at a community clinic as my nurse, assisting me not have to have day was waking up briefly while I was still in the with procedures that I performed as a nurse practitioner. Now, she is surgery. The weekend operating room, right after surgery, and looking my role model of how to mentor those who follow in our health care was long, and the three up at the surgeon footsteps, and I hope I make her proud. days before my surgery standing over me, were even longer. both of his hands Diana Lithgow, RN, FNP, PhD raised high in the air, Thursday, day 11… The Professor of Nursing, College of Graduate Nursing holding up a large morning of the surgery, Assistant Dean of Distance Education clear plastic container before I left the house with my removed to go to the hospital, I I Am A Nurse kidney and tumor was in prayer, and God inside of it, shouting I am a Nurse beautifully arrested my FEAR completely by speaking with excitement, “We and I am Special because… these words to my spirit “Perfect love casts out all fear.” got it … We got it!” He reminded me that He was that “perfect love.” And I rejoice with you when you hear your The next thing I as for the divine supernatural healing miracle I was baby’s first cry, remember is a massive desperately praying for that wouldn’t include surgery, pain that hit me in my I help you when you are in pain, He said to me plainly this: “I stomach, and I began heal three ways: instantly, to groan in pain. The I wash you when you cannot slowly, and through surgeon quickly said help yourself, physicians.” So with that said to me, “OK, OK, on the morning of my surgery, I cry with you when you lose your we’re putting you back out now.” Those I had my peace and my loved one… were the last words I heard him saying as answer. His answer was that I faded back under the anesthetic. My From birth, through illness, He had chosen to connect and eight-day stay in the hospital ended with through death, partner in health with the final pathology report findings: everyone I had met along my I am your support…I am special… “Removed was a clear-cell carcinoma journey — the technicians, the I am your Nurse tumor along with the right kidney and a doctors, the urologist, the cluster of involved lymph nodes.” anesthesiologist and the By Helen Georges, RN Afterward, I continued on with my nurses — all of them, from 50 years a Registered Nurse pregnancy and delivered a healthy baby ultrasound to pathology. Photo below: Diana Lithgow and Helen Georges. boy. Therefore, He had chosen to heal me through physicians. In conclusion… I know we all go through different things in life, some good things, and some bad things. We all get That morning, I placed myself into the skilled hands and our share of them, and no one is exemp. That’s a fact of learned minds of caring doctors in line with God’s plans life we can’t avoid. But in the end, it will always be the for that time in my life, and it produced tangible miracles connections we forge with one another in our journey that that day. That day, my family witnessed doctor after doctor will define the outcome, when we remember that every one walk out of my operating room amazed and shaking their of us has an appointed part to play. And so, today, 24 heads, because the operation that was supposed to take all years later, I remain cancer free thanks to God and the day went so smoothly and took only two hours to perform. connected partners in health dream team He used! I Next out was the anesthesiologist, saying, “I don’t

66 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 67 adjust and grasp, and I found that if I truly push myself, I can accomplish what seems impossible. Education means “to draw out.” The education of TVP, living simply, drew out of me the confidence to overcome any situation I may face. As Aristotle claims, the goal is to “actualize the potential.” TVP gave me the opportunity to realize my potential. It is a potential which exists within us all.

Unity in Diversity: Residential Education By Milind Parikh, DO ’13 “Where are you from?” I asked my roommate. “A village in Maharashtra (India). You are from “The key to living We are all born human. However, humanism is a characteristic, a quality. It must America, right?” he asked as he saw me fumbling be cultivated and developed. For me, Tattwajnana Vidyapeeth helped do just that. with my mosquito net. together in harmony, to

Tattwajnana Vidyapeeth (TVP) is an international school of philosophy inspired “Yeah. As you can see, the last time make a connection with by Revered Pandurang Shashtri Athavale (known as “Dadaji,” or “elder I came to India was nearly eight another individual, is to brother”), winner of the Templeton Prize for Progress in Religion in 1997 years back.” and the Ramon Magsaysay Award for Community Leadership. focus on similarities rather Athavale was not just concerned about whether a person could “It’s OK. The last time I went outthan of my differences.state was … never.” This was develop skills, but rather for what purpose a person would use His native language was Marathi;one I spokeof the Gujarati. most valuable We those skills. Athavale’s thinking echoed Einstein, who told continued the conversation, barely understanding one another. teachers and students at New York University, “It is essential As time went on, we becamelessons very close, I learned sharing ourin my family that a student acquire an understanding of and a lively backgrounds, what we wouldtwo yearslike to doat inTVP.” the future, and feeling of values … Otherwise, he with his specialized what kind of life we would like to live. He came from a knowledge more closely resembles a well-trainedConnections dog in the Making family of farmers who earned less than $170 per month. than a harmoniously developed personality.” Similarly, He had never seen an iPhone, never had a computer, TVP’s goal is not only to teach philosophy, but also to and never owned a car. On the other hand, my other inspire students to strive to become humanistic roommate from south India came from a family of individuals with moral courage and a sense of duty millionaires. He was used to having servants do to society; to build character, not merely careers. everything for him — cooking, cleaning, washing. Consequently, TVP is modeled upon an ancient He spoke Malayalam. Indian practice called “tapovan” which seeks to develop character through simple living and high TVP brings together 160 students from at least thinking. four different countries, and 15 different states, who speak more than a dozen different languages, The Struggle: Simple Living, have studied in a variety of fields, and have High Thinking household incomes ranging from hundreds to millions of dollars per year. TVP is the TattwajnanaFrom the very first night at TVP, I slept on the Vidyapeeth: embodiment of diversity. It opened my eyes to a hard tile floor. After waking up at five in the world beyond America, teaching me that every morning, I took a freezing cold shower, and until background and culture produces a unique lunch, my stomach hungered for food. During individual. TVP emphasized the importance of lunch, I sat on the floor. During class, I sat on the making a connection with every person, regardless floor. While in my room, I sat on the floor. My of the fundamental differences each of us possesses. right arm felt drained after I individually scrubbed This process made me realize my own faults and each piece of clothing for one hour. When I walked strengths, and that there is something to learn from into my room, I met my five roommates, who spoke every human being. The key to living together in five different languages that I did not understand. harmony, to make a connection with another individual, There was no TV; there was no computer; there was no is to focus on similarities rather than differences. This was mp3 player; there were no electronics whatsoever. It was one of the most valuable lessons I learned in my two years hot, really hot, but there was no air conditioning. Within at TVP. my first day, I had at least 10 mosquito bites on each limb. All I could think is, “What the heck did I get myself into?” Along with living together, every one of us worked together. Part of the residential education included fulfilling duties. The The challenges I faced for the first three months made me realize entire institution was maintained by us — everything from cooking that through struggle one develops character. I had never truly pushed and cleaning to electrical work. It was inspiring to see a farmer cutting myself before coming to TVP. I had underestimated my capacity to

68 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 69 vegetables at 5 a.m., side by side with an engineer, artist, The teachers were vital to this education. They would and physician. All would clean bathrooms together, sweep inspire us students to observe and analyze our own actions, Joe Bradley, DO ’13 the floors together, and eat together. I can honestly say to think about what moral courage means, and to ponder cleaning the toilets has given me a better appreciation and about spirituality, true happiness, and the goal of life. understanding for the value of labor and the inherent Every professor took a special interest in every student, worth of all human beings, better than any economics, developing their confidence, making them mentally strong, sociology or political science class I have ever come across. and instilling in them a will to live. The main thing the What I found most amazing at TVP was that no single classes and the character of the teachers gave to us is the duty was ever considered superior or inferior than another. attitude of being a student for life, so that after two years, Each individual fulfilled the duty given to him with honor. one continues to develop spiritually, building character and Performing my duties taught me the importance of taking understanding what life is truly about. This was a responsibility for my actions, sincerity in work, and what it cornerstone lesson of TVP. takes to thrive in a group. Conclusion: True Knowledge: The Classes In my small experience of stepping into the medical field, I Although the coursework at Tattwajnana Vidyapeeth was have witnessed much disconnect between health titled “comparative philosophy and religion,” our studies professionals, their colleagues, and patients. This did not engage in the traditional comparative practice of observation became confirmed when during one of our critiquing differences between cultures. There was a strong Interprofessional Education sessions, a discussion arose emphasis on regarding the issue of health professionals not being open cultivating the best to listen to or believe in one another, especially in regard to qualities and ideas different types of treatment options for a patient. Dr. Lester found in the world’s Jones, Executive Associate Dean of the School of Podiatric traditions. For Medicine, commented that “this problem arises due to example, the search philosophy, and it’s difficult to change one’s philosophy.” for truth has been This reminded me of Tattwajnana Vidyapeeth. TVP gave common to all me a philosophy to live by. Through the classes, lifestyle, civilizations. The and interactions with a diverse group of individuals, TVP West has looked to instilled within me the philosophy that to be human means Poetry by Barbara Lopez, Administrative Assistant, Office of Medical Education, COMP the outside world to to make connections. It cultivated in me a way of thinking It cultivated in me a way find truth, that helps me value others’ views rather than discrediting Blinded by Time Seasons of My Soul cultivating the spirit them, so that as a physician I remain open to my colleagues of thinking that helps Blinded by time as if in a tunnel From head to toe, without ever being seen, of scientific inquiry. and my patients. It ingrained within me the value of Swept up and swallowed in a raging funnel. The non-existent organ that is so vital to my being me value others’ views The East has looked relationship, bringing man closer to man, man closer to Days disappear without a thought Runs through my body, without control, within, developing the practice of spirituality. Each one nature, and man closer to a universal power. Days we anguish, battles we fought. My heart with love forever it will hold. hasrather contributed than greatly discrediting to society and the development of Days of seven turn into a week Pandurang Shashtri Athavale, the founder of the school, man. Through ideas such as these, TVP embedded in me a New ideas are given, answers we seek. Betrayal of a loved one, can destroy in many ways, them, so that as a began the Swadhyaya (Sanskrit for “self-study”) mutual respect for each culture, religion, and philosophy. Young bodies and minds empower the forces While the tears flow within, for hours and many days. physician I remain open movement, inspiring millions of people to live by the Old minds of wisdom seem slow, are true sources. Time becomes endless as hours of darkness takes us away. The classes were not strictly academic. They were more philosophy of building connections with others, regardless Weeks roll over into months then years Not knowing if this pain will ever see a brighter day. than that. They taught values. They taught character. One of race, religion, or status, simply because we all arise from to my colleagues and Common we share the human strife, everyday fears. Pain of a dark grey season cannot be taught those things by simply reading a book or a common cosmic energy. Once we come to realize the Let the days be, that we remember Tries to seek a day of reason bmyeing patients.presented a slide show. Values must be transferred connection we all share, the quality of humanism will Each day we start a burning ember. No explanation to give us thought from teacher to student. Therefore, the classes at TVP were simply have to follow. I Bodies we pass and some we touch A life so precious, years I fought taught in a completely different way than the regular Be not blinded by time, we have so much. education system. Rather than an emphasis on knowing I would like to express my utmost gratitude to Pandurang Shastri Taking the wrong road, down a dreadful path, the material, there was an emphasis on making the Athavale (Dadaji) for giving me the thoughts to develop my life and Nature’s Instruments Cannot untie the bondage of evil’s wrath. showing me what it truly means to be human. I am equally grateful to The invisible force of a driven composer Praying every un-spent moment, that we will heal, material applicable to life. It was taught not straight out of Dhanashree Talwalkar (Didiji) for giving me the opportunity to be a part plays upon nature’s instruments. Frail we become, as darkness takes over my body of steel. any book, but was borne out of a combination of deep of TVP. I would like to express my gratitude to the teachers of TVP for study and life experiences of the teacher. The spirit of great dedicating their lives to this school and to students like me. Finally, I Thick, thin, prickly, fat, high and low characters, such as the sacrifice of Socrates, the would like to convey my sincere thanks to Dr. Clinton Adams, DO, Dean full of spring’s green, surround me with music. Silence of obstacles filter in the detailed sharpness of life, perseverance of Abraham Lincoln, and the boldness of of the College of Osteopathic Medicine of the Pacific, for his advice, motivating words, and cooperation; without him, my journey to medical Which I find unavoidable. Swami Vivekanand, were studied to give substance to school would not have been the same. Within the boundaries I’ve enforced, values and embed them within each student. complete peace fills me until I cannot hold more. WesternU Health Care Mandala by Debra Nelson, Graphic Designer

70 HUMANISM IN THE HEALTH SCIENCES 2010 • VOL. 13 WESTERN UNIVERSITY OF HEALTH SCIENCES 71 James A. James III, DO ’12 Photo Gallery: Jackie Pham, DPM ‘13 “Deer”

“Second Street”

INFORMATION FOR AUTHORS AND ARTISTS Humanism in the Health Sciences (HHS), an award-winning journal of Western University of Health Sciences (WesternU), accepts the work of students, alumni, faculty and staff of WesternU or their families. Friends of the university also are welcome to submit their work. HHS is managed and edited by WesternU students and faculty. It is published annually and distributed free of charge to interested individuals and institutions worldwide. The next issue is scheduled for publication in May 2011; deadline for submissions is February 15, 2011. HHS publishes essays, short stories, art, photography, poetry, case reports, literature reviews, and letters. All articles are reviewed by the editorial board; content experts review scientific and other appropriate submissions. Stories, articles and essays should be relevant to the theme of the journal, health care practice, or WesternU. Letters to the editor may address new topics or respond to subjects presented in previous issues of HHS. Manuscripts should be submitted as a Microsoft Word file. Photographs, illustrations and artwork may be submitted in Adobe Photoshop (PSD), Adobe Illustrator (AI), EPS, JPG or TIF format on disc or via email. Articles and artwork accepted for publication become the property of HHS and Western University of Health Sciences. To request copies of this or previous editions, please write to: Western University of Health Sciences, ATTN: Publications, 309 E. Second Street, Pomona, CA 91766-1854, call (909) 623-6116, or e-mail: [email protected]. “Splash”

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Photo by Garrett Jeffrey, DO ’12. View of the San Gabriel Mountains from WesternU campus

Western University of Health Sciences is a private, non-profit institution of higher learning that offers post-baccalaureate degrees in several health and medical fields. More than 2,600 students study to become osteopathic physicians, physical therapists, physician assistants, advanced practice nurses, pharmacists, veterinarians, dentists, podiatrists, optometrists, and researchers. The University is located in the Pomona Valley on 22 acres in the city of Pomona, Calif., 35 miles east of downtown Los Angeles.

For more information regarding WesternU and its programs, visit the University’s Web site at www.westernu.edu.

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