PICTURESOF HEALTH

FALL 1998

Nonprofit Org.U.S. POSTAGE

PAIDPermit No. 155

Minneapolis, MN

AHC Office of Communications

Tel: 612/624-5100

Office of Communications420 Delaware Street SE, Box 735Minneapolis, MN 55455

change service requested

SCHOOL OF PUBLIC HEALTH FACULTY MEMBER

CARL PHILLIPS MAKES A STRONG CASE AGAINST

SMOKING FOR SPECTATORS AT THE STATE FAIR.

Side show

It was a side show of sorts, but you wouldn’t have found it alongthe Midway near the oversized iguana. It was at the Universityof Minnesota’s booth in the Education Building, where Schoolof Public Health faculty and staff were displaying used humanlungs to show the effects of smoking.

There were six lungs, two healthy lungs from nonsmokers,two affected by emphysema, and two from lung cancer victims.Ian Greaves, associate dean of the School of Public Health, saidspectators were surprised to see just how destructive smokingcan be to lung tissue.

Next year, the school plans to expand the exhibit with preserved organs that show effects of alcohol abuse and anunhealthy diet (such as eating too many Pronto Pups and cheese curds).

Earlier in the week, the Medical School attracted a crowdwith a collection of human and animal brains, which they usedto explain how the brain works and how neuroscience researchcan lead to cures for Alzheimer’s disease, Parkinson’s disease,and spinal cord injuries, among other brain disorders. Neuro-science faculty and staff gave a brain on a stick—a brain-shapederaser on a pencil—to spectators.

Each of the Academic Health Center’s seven schools had its day at the fair to showcase education, research, and outreachprograms. Physicians, pharmacists, dentists, nurses, veterinariansand other health care professionals were on hand daily to answerquestions. And “Health Talk & You,” the AHC’s health infor-mation talk show was broadcast live from the fairgrounds.

More than 130 faculty and staff volunteered their time tomake this event a success.

■ Peggy Rinard

Along with Minnesota’s finest

pickles and pigs, thrill rides and mini-

donuts, there was a new and unusual

attraction at the State Fair this year.

PICTURESOF HEALTH

FALL 1998

A pu b l ica t ion fo r f r iends o f t h e U n iver s i ty o f Minnesot a

Honey, I shrunk the lab

Page 4

Native Americanphysicians

Page 10

Professor lights uptobacco case

Page 13

DULUTH

MEDICAL

STUDENT

ROCHELLE

WOLFE

SHADOWS

COUNTRY

DOCTOR BOB

GARDNER, A UM ALUM,

AT A CLINIC IN

PAYNESVILLE,WHICH HAS A

POPULATION OF

2,275.

Rural health programs train doctors,

pharmacists, nurses, and dentists for

Minnesota’s small towns. Page 7

Country clinicians:

Pictures of Health is published four times a year for friends of the AcademicHealth Center. Suggestions and lettersare welcome. Please send to Pictures ofHealth, Academic Health Center, Box735, A-395 Mayo Building, 420Delaware Street, Minneapolis, MN 55455,or to rinard@mailbox.mail.umn.edu.

For more information about theAcademic Health Center and its sevenschools and colleges, refer to the Website at www.ahc.umn.edu.

EditorPeggy Rinard

PhotographerRichard Anderson

Graphic DesignPenfield Design Group, Inc.

Contributing EditorJack Hayes

Director of CommunicationsChristine Roberts

Associate Vice President Terry Bock

Senior Vice President forHealth SciencesFrank B. Cerra

School of DentistryMichael Till, Dean

Medical SchoolAlfred Michael, Dean

School of Medicine, Duluth Richard Ziegler, Dean

School of NursingSandra Edwardson, Dean

College of PharmacyMarilyn Speedie, Dean

School of Public HealthEdith Leyasmeyer, Dean

College of VeterinaryMedicine Jeffrey Klausner, Dean

PICTURESOF HEALTH

Amy DeLong is one of

13 Native Americans who

graduated from the Medical

School last year. After

completing a residency at

Hennepin County Medical

Center, where she recently

cared for triplets in the

neonatal intensive care unit,

she will practice at a tribal

clinic. See story page 10.

CROSSING DISCIPLINES

HONEY, I SHRUNK THE LAB 4The Biomedical Engineering Department is putting medical tests on microchips and creating an array of miniature electronic instruments.

PATHWAY TO PERFECTION 5Genetic mapping puts improvement of animals on a fast track.

YES, NURSES DO RESEARCH 6It may not make headlines, but nursing research improvesquality of life.

ACROSS CULTURES 10New Native American physicians bridge tribal and clinicalcultures.

STARTING AT THE TOP 11First-year medical student publishes in New England Journalof Medicine.

LEFT TO THEIR OWN DEVICES 12Bioneers Camp features blood, guts, and bioengineering.

COUNTRY CLINICIANS 7Health professions students learn to like practicing in small towns.

Back Page:Side ShowSchool of Public Health gives Fair-goers a good look at bad lungs.

PICTURESOF HEALTH

INSIDE THIS ISSUE

OUTREACH

EDUCATION

RESEARCHSEARCH

UP IN SMOKE 13Public health professor’s testimony torches tobacco industry’s case.

COPE SPRINGS ETERNAL 14Public health program in St. Paul’s Frogtown could save moneyand lives.

SATISFIED CUSTOMER 15Viola Pelfrey has been a Dental Clinic patient since 1927.

HMONG AND VIETNAMESE FAMILIES LEARN HOME SAFETY, PAGE 14.

GENETICS RESEARCH LEADS TO HEALTHIER ANIMALS, PAGE 5.

BIONEERS CAMP NURTURES YOUNG BIOMEDICAL ENGINEERS, PAGE 12.

3

4

In a light-filled laboratory on the seventhfloor of the new Basic Sciences and Bio-medical Engineering building, a technicianapplies a drop of blood to a tiny square ofetched silicon. In a few minutes, he willknow whether its owner carries a gene for a form of muscular dystrophy.

Genetic tests like this one usually requirea laboratory full of expensive equipment, costabout $1,000 dollars each, and are availableonly to people who live near or can travel to a medical research center. But RonMcGlennen, a genetics researcher, and DennisPolla, an electrical engineer, have reproducedthe capabilities of that laboratory on a disposable microchip that costs about $10.

The project is one of about two dozen being developed in the Department of Biomedical Engineering’s MicrotechnologyLaboratory. Using technology borrowedfrom the computer and engineering indus-tries, Polla and McGlennen, co-directors ofthe Microtechnology Laboratory, and theircolleagues, are creating an assortment ofminiature gadgets that could herald a newgeneration of smaller, better, and cheapermedical machinery.

Interest in applying new microelectronicstechnology to health care has been growingfor the past several years says Polla, whocreated the Microtechnology Laboratory and recently became head of the Departmentof Biomedical Engineering, a joint venturebetween the Medical School and Institute of Technology. But Polla believes theUniversity is leading the wayin the field, and may be theideal setting for this technologyto flourish.

Only a few other universities (Stanford,MIT, Cornell, Berkeley, andMichigan) have laboratoriesfor making integrated circuitmicrochips. None of those hasa medical school adjacent, asthe University does. The close proximity is areal advantage, Polla says, because engineers,scientists, and physicians are in contact witheach other on a daily basis. Added to that,UM has a legacy of bio-medical engineering

achievements and unmatched connectionswith local manufacturers such as Medtronicand St. Jude.

The new gadgets, the lot of whichwould fit in the palm of your hand withroom to spare, fall into a few categories:microchips for detecting everything fromblood pressure to hereditary diseases, tiny

fluid pumps for drug delivery, andmicrosurgical instruments. Some of the microchips are designed to beimplanted and torelay information to a laboratorythrough a modem.Fluid pumps and

microsurgical or micro-imaging devices often fit on the end of a very fine probe that can be used to reach the heart, brain,or other organs without surgery.

DENNIS POLLA, DIRECTOR OF THE DEPARTMENT OF BIOMEDICAL ENGINEERING,HOLDS A MICROCHIP THAT REPLACES AN ENTIRE LABORATORY.

The

Microtechnology

Laboratory

is leading development

of miniature electronic

medical devices.

RESEARCHSEARCH

An assortment ofminiature gadgets that

could herald a newgeneration of smaller,

better, and cheapermedical machinery

Honey, Ishrunk the lab

Here are a few examples:

• A pump on a pinhead-sized probe used to deliver drugs into the brain to treat Parkinson’s disease andAlzheimer’s disease;

• A sensor for monitoring pressure in the heart or brain;

• A fiberoptic probe for diagnostic imaging;

• A motorized microsurgical needle to inject sperm into an ovum for in vitrofertilization;

• Personal monitoring systems for bloodchemistry, blood pressure, and other vital signs.

Several devices have moved “serendipi-tously” from the Microtechnology Laboratoryto companies for further development, saysPolla, meaning that companies have contactedhim after reading about the new technologyin a journal or hearing him speak at a meet-ing. So far that’s led to collaborations withlocal, national, and international companies,including Medtronic, Elcor Surgery in Texas,(the world’s largest producer of ophthalmicsurgery instruments) and Sulzer Medical inSwitzerland, which has enlisted Polla’s helpto develop an implanted device that willminimize pain following spinal surgery.

In the future, Polla plans to work withindustry in a much more deliberate way, byenlisting industry scientists to work on teamswith University engineers, scientists, andphysicians to find innovative solutions tocommon medical needs.

Polla has been overwhelmed with thesupport he’s had from everyone from the leg-islature and the regents to biomedical com-panies, the Medical School and the Instituteof Technology, as well as from students.

“Everyone is on board,” he says.“This is the right time to be doing this, andMinnesota is the right place.”

■ Peggy Rinard

CONTINUED PAGE 65

Peering through the morning fog, PaulVrotsos could see that Lightning Babe, hispaint horse mare, had a fresh foal at herside. Eager as a kid at Christmas, he hikedacross the pasture to greet the new arrival—only to have his heart sink to the bottom ofhis boots when he saw it. Pure white, it wasobviously a victim of an inherited disorderknown as lethal white syndrome, whichaffects not only coat color but also digestivefunction. Like hundreds of paint horse foalsborn each year, this animal would be deadwithin hours.

Vrotsos, who had just lost a foal tolethal white the previous year, was crushed.

“I said, ‘All right, I’ve had it. Cansomeone help me, please?” he recalls.

Fortunately, Vrotsos, a manager at the College of Veterinary Medicine’s LargeAnimal Teaching Hospital, knew someonewho could. He called on Elizabeth Santschi,an assistant professor of veterinary medicinewho specializes in equine research.

Collaborating with colleagues StephanieValberg and Jim Mickelson, Santschi beganto search for the genetic roots of the problem.Within a year the team had found themutation that causes lethal white syndrome

and developed a blood test for it. Vrotsosand other paint horse breeders are now usingthe test to avoid matings likely to yield lethalwhite foals.

Santschi’s research is an example of one of the hottest areas in animal breedingtoday—the development of genetic tests to identify individuals likely to pass onparticular desirable or undesirable traits.Though still in the early stages of development,such tests hold tremendous promise forimproving breeders’ ability to rapidly andefficiently encourage desirable traits and cull undesirable ones.

“Farmers have been doing this forcenturies through selective breeding,” saysCharles Louis, a professor in the College’sDepartment of Veterinary PathoBiology.“We aren’t doing anything different.We’re just changing the rate of change.”

Louis led the College’s way into the fast-growing field of genetic testing in the late1980s when he discovered the candidate genefor porcine stress syndrome, a disorder thatcauses pigs to die suddenly when stressed.Today, a blood test that resulted from thatknowledge is saving the pork industrymillions of dollars each year, and developingfurther tests for improving swine has becomea focal point for research in the College.Louis is searching for bits of DNA, knownas markers, that can be used to locate genescontrolling desirable traits such as superior

Genetic mapping puts

animal improvement on

the fast track.

POLLA AND COLLEAGUES ARE WORKING ON

TINY IMPLANTED BIOSENSORS THAT CAN

MONITOR VITAL SIGNS.

PATHWAY TOPERFECTIONPATHWAY TOPERFECTION

EQUINE

RESEARCHER

ELIZABETH

SANTSCHI

LEADS A

PAINT

HORSE

TREATED AT

THE

VETERINARY

TEACHING

HOSPITAL.

6

RESEARCHSEARCH

Alice spends most of her days sitting alone in a nursing home, feeling tired and refusingto take part in activities. At age 83, sheknows her final years will be spent here.Like 30 percent of nursing home residents,Alice is showing signs of depression.

Depression is one of the most commonhealth problems in nursing home patients.And although it can be successfully treated,too often it isn’t even recognized. That’swhat led Muriel Ryden and Mariah Snyder,School of Nursing faculty members, to takeon a research project to study the cost effec-tiveness of using advanced practice nurses to diagnose and treat depression and othercommon nursing home ailments, such asincontinence.

During the course of their six-month study, they instructedadvanced practice nurses (nurseswith master’s degrees) to implementnational “best practice” guidelinesfor treating these health problemsin two nursing homes. A thirdhome was used as a control group.The experiment worked. Severityof depression and incontinencedecreased dramatically amongpatients in the two homes, and savings in equipment and labormore than paid for the cost.

Finding better ways to manage longterm illnesses,promote health, and pre-vent disease are the goals of many research projectsat the School of Nursing.

“Nurses do researchon the unglamorousaspects of illness,” says Dean

Sandra Edwardson. “Their work helpspatients with the very personal activities of daily living.”

Perhaps, she speculates, that’s why few people associate nurses with research.“Nurses aren’t often involved in developingthe sorts of life-saving procedures, drugs, orinstruments that grab headlines,” she explains.

But School of Nursing faculty bring inmore than $1 million dollars a year in researchfunding from the National Institutes of Healthand other government and private sources,as well as $2 million in training grants.

“Almost all tenured or tenure-track faculty members have at least one researchproject pending, active, or just finishing up,”says Laura Duckett, associate professor anddirector of research. “If they don’t, they arepreparing manuscripts or pursuing fundingfor new projects.”

Through the years, School of Nursingresearchers have made some remarkable discoveries that have changed the way nurses

deliver care. An example, Duckett says, is thepioneering research on home care for dyingchildren conducted by Ida Martinson, a for-mer University faculty member.

“When I first came to the University [in1977],” Duckett recalls, “the concept of car-ing for dying children at home was notwidely accepted. Ida showed that childrenfeel better and more secure at home. She alsoshowed that if parents can be taught care-giving skills, they prefer to keep their chil-dren at home.”

More recently, nursing research has ledto patient care improvements in many otherareas, including care of the elderly, breast-feeding, and pain management.

Examples of studies in progress include:

• assessing the effects of hope and guidedimagery on immune system response;

• developing techniques to prevent hearingloss in construction workers;

• helping Native American youths overcomefamily, social, and economic stresses, andavoid substance abuse and otherdestructive behavior;

• developing safe ways for bone marrowtransplant patients to discontinuemorphine use;

• and helping care-givers manage thedifficult behavior of Alzheimer’s patients.

In coming years, Duckett says, theschool hopes to increase research funding.“We have a lot of talent in the School ofNursing and we need to enable everyone to pursue research.”

■ Elaine Cunningham

Nursing research

may not lead to cures that

make headlines, but it

improves quality of life.

meat quality and decreased fat content.Larry Schook, associate dean for research, isheading efforts to find markers for improvedovulation and growth rates. And Schook andcolleague Craig Beattie recently began a five-year collaboration with the French departmentof agriculture to further improve knowledgeof the swine genome.

Though pigs are clearly the primaryfocus for genetics research here, the work ismoving out to other species. Encouraged bytheir success with lethal white, Mickelsonand Valberg are searching for the DNAdefects behind various equine neuromuscular

diseases. Vivek Kapur, an assistant professorin the Department of PathoBiology, isgathering genetic information he hopes willone day allow turkey breeders toselect for disease resistance anddesirable growth traits. And JaneArmstrong, a professor in theDepartment of Small AnimalClinical Sciences, is working withpostdoctoral associate Pat Wilkieto identify markers that might beused to encourage positive traitsor select against detrimental onesin various breeds of dogs.

“These efforts illustrate how we havebeen able to capture information fromcellular and molecular biology to solve real-

world problems,” Schooksays, adding that “recentlegislative support andPresident Yudof’s researchinitiatives will provideadditional opportunitiesfor outreach based onmolecular biology.”

■ Mary Hoff

Yes, nurses do research

“Nurses do research on theunglamorous aspects of illness,” says

Dean Sandra Edwardson.

MURIEL RYDEN AND MARIAH SNYDER ARE

IMPROVING CARE IN NURSING HOMES.

CONTINUED FROM PAGE 5

One Thursday last summer at the clinic inEden Valley, Minnesota (pop: 732), medicalstudent Rochelle Wolfe saw two dozenpatients with complaints ranging from chestpains to tonsillitis. That morning, she made a 12-mile trip to the hospital in Paynesville(pop: 2,275) to examine a newborn baby.At the hospital, she was asked to help with a case of Shy-Drager’s disorder, a rare neuro-logical disease that Wolfe had taken an inter-est in during her first year of medical school.

“I’m loving it here,” said Wolfe, a second-year student at the University ofMinnesota’s School of Medicine in Duluth.“The scope of practice in a small town is so broad I’m getting experience that I’dnever get in a clinic in the city.”

Wolfe is one of several students assignedto Paynesville through the Rural HealthSchool, a school without walls that placeshealth professions students in rural hospitals

and clinics. Based at the Duluth School of Medicine it was established by the statelegislature in 1996 to help small towns meettheir needs for health care providers. Theschool teams medicine, pharmacy, and nursingstudents with rural practitioners in MooseLake, New Ulm, Grand Rapids, Staples,Willmar, and Paynesville, the newest RHSsite. The 50 or so students who take part in the program annually have been well-received. In Moose Lake, for example, localvocational-technical students built a housefor the students to live in.

The Rural Health School is just one of a growing number of University healtheducation programs aimed at training (andwooing) clinicians for Minnesota’s smalltowns. The Medical School offers the RuralPhysician Associate Program (RPAP),

7

Health

professions students

get a taste of small

town practice

through the

University’s rural

health care

programs.

ROCHELLE

WOLFE, UM-DULUTH

MEDICAL

STUDENT,EXAMINES

A PATIENT

AT THE

PAYNESVILLE

CLINIC.

DISCIPLINESCROSSING

CONTINUED PAGE 8

8

Rural Family Practice Residency,and Rural ObservationExperience. The School ofNursing collaborates with sixother graduate nursing programsstatewide on MinnesotaPartnerships for Training, theCollaborative Rural NursePractitioner Project, and HealthInformation Access for RuralNurse Practitioners. The Collegeof Pharmacy offers the PharmacyRural Education Program(PREP). The School of Dentistryfeatures the Migradent programand rural “externships.” Andthe School of Public Health collaborates with state andUniversity partners on theMinnesota Migrant HealthPromoter Program.

All indications are that therural health programs are work-ing. The number of primary carephysicians sought by rural com-munities dropped from 266 in1995 to 169 last year, and thedemand for nurse practitioners,physician assistants, and certifiednurse midwives declined from106 in 1995 to just 51 last year,according to a 1998 report of the Minnesota Center for RuralHealth. Much of the credit goesto the University of Minnesota’srural health programs, saidTerence Hill, executive director.

The key to the success of these University programsmay be their interdisciplinaryapproach. Teamwork spreadsscarce human resources farther,

and it relieves the sense of isola-tion that discourages manyyoung health professionals fromworking in small towns.

“Traditionally, the doctor isthe commander of the team,”says Byron Crouse, director ofthe Rural Health School. “He orshe barks orders, and everybodyelse carries them out. In this

new model, leadership is sharedby various health professionals.”

In Paynesville last summer,for example, College of Pharmacyalum Laura Odell, Pharm.D.,headed a team of Rural HealthSchool students that includedUM Duluth medical studentRochelle Wolfe, College ofPharmacy student Todd Lemke,pharmacy resident Shara Mihm,nurse practitioner studentDebora Nugent, and RPAP student Carrie Fenna. Odell and her group all worked at thePaynesville Area Health Care

System, a single building thathouses a hospital, clinic, andnursing home. As they cared forpatients they looked for ways toredefine their roles and worktogether more effectively.

Odell also heads medicationmanagement teams for patientson anticoagulation drugs (bloodthinners) and for people being

treated for diabetes and osteo-porosis. Working with pharmacystudents, and with staff nursesand physicians, she monitorsdrug dosages, drug interactions,and patient compliance—doingwork, in other words, thatphysicians usually do. She rarelydispenses medication, the tradi-tional duty of a pharmacist.

Working in this small townhealth complex gives Odell,who grew up in a small town,a chance to get to know patientsin a way that just isn’t possiblein big cities. For her, that’s one

CONTINUED FROM PAGE 7

LAURA ODELL, COLLEGE OF PHARMACY ALUM, COORDINATES

THE RURAL HEALTH SCHOOL SITE IN PAYNESVILLE, POPULATION

2,275, WHERE SHE AND HER HUSBAND ARE BUILDING A HOUSE.

“I enjoy the slower pace and the warmth ofthe people,” she says. “When I got married,I got all kinds of gifts from my patients. Onewoman cross-stitched a beautiful picture forme. A 93-year-old guy whose daughter owns

the Ben Franklin store downtown broughtme a whole set of Rubbermaid products.Patients who hadn’t even been invited to

the wedding sent me cards.”

9

of the advantages of this kind of practice.

“I enjoy the slower paceand the warmth of the people,”she says. “When I got married,I got all kinds of gifts from mypatients. One woman cross-stitched a beautiful picture forme. A 93-year-old guy whosedaughter owns the Ben Franklin

store downtown brought me awhole set of Rubbermaid prod-ucts. Patients who hadn’t evenbeen invited to the wedding sentme cards.”

She and her students returnthe generosity. Odell is a Brownieleader and member of the Friendsof the Library. As part of theirprogram, Rural Health Schoolnursing, medicine, and pharmacystudents recently built a float topromote skin cancer awarenessfor a parade in nearby Roscoe(pop: 141).

Odell and her husband, aCollege of Pharmacy graduatefrom Willmar, never intended to live in a town as small asPaynesville, she says. But pharmacyprofessor Don Uden, a coordina-tor of rural pharmacy programs,talked them into giving the towna try. He persuaded Laura witha grant from the College ofPharmacy’s Peters Institute tostart the Paynesville pharmacyclinic, and lured her husbandwith promises of good fishing.

Having decided they are ashappy with Paynesville as localresidents seem to be with them,the Odells are building a housealong nearby Rice Lake wherethey plan to stay for a long, longtime. They hope that two orthree other graduates of theUniversity’s rural health programswill decide to join them in a lifefull of rewards and free of bigcity hassles.

■ Jack Hayes and

Peggy Rinard

ODELL TRAINED PHARMACY RESIDENT SHARA MIHM

AND COLLEGE OF PHARMACY STUDENT TODD LEMKE

TO MANAGE PATIENTS’ MEDICATIONS, WHICH RELIEVES

THE WORKLOAD OF RURAL PHYSICIANS. THE THREE

WALK TO LUNCH IN DOWNTOWN PAYNESVILLE.

DISCIPLINESCROSSING

PHARMACY STUDENT TODD

LEMKE TEACHES A PATIENT

TO USE AN INHALER.

Since its founding in 1971, the Rural PhysicianAssociate Program (RPAP) has sent morethan 850 third-year medical students to over 100small Minnesota communities for nine-monthinternships. A remarkable 64 percent of formerRPAP students who stayed in Minnesota aftermedical school now practice in rural areas. RPAP

has served as a model for the RuralHealth School and for many otherregional and national programs.

The Rural Family PracticeResidency, operated by the MedicalSchool’s Department of Family Practiceand Community Health, is a three-yearprogram to train rural family doctors.Residents spend the final two years inregional medical centers in Waseca andMankato, which serve outlying ruralcommunities.

The Rural ObservationExperience gives 50 incoming medicalstudents annually a chance to spendthree days working alongside ruralfamily physicians.

The School of Nursing collaborateswith six nursing and physician assistant

programs statewide on three programs to helpnurses living in rural areas become nursepractitioners, physician assistants, or certifiednurse-midwives, who carry out many of thefunctions of primary care physicians. Programsinclude Minnesota Partnerships forTraining, funded by a $1.3 million grant fromthe Robert Wood Johnson Foundation; theCollaborative Rural Nurse PractitionerProject; and Health Information Accessfor Rural Nurse Practitioners, funded bythe National Library of Medicine.

The School of Dentistry’s Migradentprogram sends teams of faculty, dental, anddental hygiene students to rural areas everysummer to provide care for migrant farm workersand their children. Last year the the School alsoprovided care for more than 250 Bosnian refugeesand migrant workers in the Fergus Falls area, andfor the Sisseton-Wahpeton Tribal Community andCanterbury Downs workers. The school plans toopen dental clinics and training sites in Hibbingand Fergus Falls.

The Minnesota Migrant HealthPromoter Program teaches migratory farmworkers how to promote good health in migrantlabor camps near Owatonna and BloomingPrairie. A collaboration among the School ofPublic Health, the College of Agriculture,Food, and Environmental Sciences, and MinnesotaDepartment of Health, the program certifiesparticipants in first-aid and cardiopulmonaryresuscitation, and educates them on a wide rangeof other topics. The program also sponsorsregular immunization clinics and nutritioneducation fairs.

Through the Academic Health Center’sTelemedicine Network, students, faculty,and medical specialists on the Twin Cities campusand at Fairview-University Medical Center canconsult with outstate physicians, students,patients, and administrators in a dozen locationsvia interactive television.

AcademicHealth Center

Ruralhealth

education and

trainingprograms

When 13 American Indian students stepped forward lastspring to receive M.D. degreesand beaded stethoscopes, theyset a University of Minnesotarecord as the largest single groupof Indians to become physicians.

In the past three years,the University has become anational leader in graduatingAmerican Indian physicians,producing a total of 26 with 12 more graduations expected in the next two years. If every-one stays on course, the U willgraduate more American Indianphysicians in five years than itdid in the 18 previous years.

Much of the credit for thissuccess goes to the University’sCenter of American Indian andMinority Health, directed byphysician Gerald Hill, whichseeks out gifted Native Americanhigh school and college studentsfor special programs at theSchool of Medicine in Duluth

and the Twin Cities MedicalSchool that prepare them tomeet the health care needs oftheir culture.

A member of theKlamath and Paiutetribes of Oregon, Hillcame to the program in 1991 hoping toincrease student enroll-ment and encouragegraduates to return to theirnative communities to practicemedicine. “Such a valuableresource shouldn’t be wasted,”says Hill. “That’s what I sawhappening.”

A physician practicing in an Indian community must learnto work with traditional healersand spiritual leaders, accordingto Hill. “If you don’t understandthe relationship between thespirit and healing, Indian peoplewill not trust you and will shutyou out.”

As a child, Hill neverdreamed of being a physician.During his senior year in high

school he worked 48 hours aweek in a plywood mill. He didn’t exactly know what collegewas, but figured a college gradu-ate could get a better job thanthe one he had at the mill.

Hill liked science because it explained the world. So hedecided to major in pharmacologyat the University of Washington,spending his spare time as a vol-unteer at a Seattle Indian HealthBoard clinic. One day an Indianabout Hill’s age walked bywearing a white coat and carry-

10

1998 Native American

graduates of theMedical School

and their tribes:Tiffany Beckman

Leech Lake Chippewa

Dennis BethelCreek/Cherokee

Debra BowkerCheyenne River Lakota

Leroy ClarkCheyenne River Lakota

Amy DeLongHo-Chunk

Kansas DuBrayCheyenne River Lakota

David HellTurtle Mountain Chippewa

Kristin QuinnRosebud Lakota

Susan SloanEastern Cherokee

Alec ThundercloudHo-Chunk

Amanda WarrenSalish

Katherine WhippleSpokane

Gladys WylesCherokee/Blackfoot

The Center

for American Indian

and Minority Health

recruits and trains

Native American

physicians to bridge

tribal and clinical

cultures.

“If you don’t understand therelationship between the spirit andhealing, Indian people will not trust

you and will shut you out.”

AMY DELONG, A MEMBER OF THE

HO CHUNK TRIBE OF WISCONSIN, WITH

THREE NEW FRIENDS IN THE NEONATAL

INTENSIVE CARE UNIT AT HENNEPIN

COUNTY MEDICAL CENTER.

EDUCATION

Across cultures

Most medical students dreamabout seeing their names in The New England Journal ofMedicine. Amy Hakim didn’thave time to do any dreaming.Her study on the health benefitsof walking, completed beforeshe even entered the University’sMedical School, was publishedin the prestigious journal duringher first year.

Hakim conducted the studylast summer, after completingmasters’ degrees in epidemiologyand economics at the Universityof Virginia. Her advisor, RobertAbbott, professor of biostatisticsat the University of Virginia,encouraged her to take the pro-ject on as an exercise in compil-ing statistical data and writing a successful academic paper.

She chose to look at healthbenefits of low-impact exercisein the elderly because there waslittle known about the subject.

Beginning with results of theHonolulu Heart Program, whichtracked the cause of death of alarge group of men of Japanesedescent over 12 years, shefocused on 707 nonsmokingretired men between the ages of61 and 81. In essence, she foundthat those who walked two milesor more a day had nearly halfthe mortality rate as those whowalked less than a mile a day.

When the article came outlast January, Hakim and Abbott,who collaborated with her onthe study, were thrust into themedia spotlight for weeks,answering calls from reportersacross the country. Hakim nowhas a pile of clips from more than300 newspapers as souvenirs ofher experience. The story wasalso reported on the CBS, NBC,and ABC evening news, byNational Public Radio, and by local television and radio stations across the country.

Hakim says it was the sim-plicity and practical value of thefinding that prompted the NewEngland Journal to accept thestory and triggered the flurry of media coverage.

“The key was that this issomething most older peoplecan do to improve their health,”Hakim says. “And it confirmed

what doctors and patients sus-pected. Now physicians have abasis for recommending dailywalking to their older patients.”

Hakim can’t predict whenher next study will be publishedin a journal as influential asNEJM, but she and her advisoraren’t resting on their laurels.They have already publishedtwo more studies. One, whichappeared in the June issue of theJournal of Clinical Epidemiology,looks at coffee drinking as a riskfactor for stroke in older menwith hypertension. Men whodrank three cups of coffee a daywere twice as likely to have astroke as those who didn’t drinkany coffee. Another, publishedin July in the American Journalof Cardiology, shows that men’scholesterol levels tend to declineafter the age of 65, regardless ofrisk factors such as hypertension,even though incidence of heartdisease increases.

Hakim says she plans to con-tinue her work as breaks in herMedical School schedule allow.

■ Peggy Rinard

11

First-year

medical student

publishes study

in New England

Journal of

Medicine.

Starting at the top

ing a stethoscope. In a flash Hillfound his calling. “I had neverconsidered medicine as an optionfor an Indian,” he recalls.

Amy DeLong, one of thisyear’s new physicians, had notconsidered medicine as an optioneither. A member of the HoChunk tribe of Wisconsin, sherarely even saw a doctor whileshe was growing up. Then as anhonors student in college, shewas inspired by a friend whoplanned a career in medicine.

DeLong applied to the U’sSchool of Medicine in Duluth,but lost interest after looking ata map and deciding Duluth wastoo far north, too far from homeand too cold. Hill recognized herpotential, however, and persuadedher to come to Duluth for aninterview. “Dr. Hill was the firstNative American doctor I’d evermet,” recalls DeLong. “I wasvery impressed with him andwith the program.”

At Duluth, DeLong discov-ered the study skills that got herinto medical school weren’t goodenough to keep her there, butshe wasn’t alone. “My classmatesgot me through,” says DeLongof the Native American studentswho helped each other over therough spots. Friends made a dif-ference, but the bright light atthe end of the tunnel was herinternship at the Black RiverFalls Clinic in Wisconsin, whichserves the Ho Chunk tribe.

“The clinic reminded methat I was not always going tobe taking classes and tests,” saysDeLong, who is now a familymedicine resident at HennepinCounty Medical Center. Whenshe completes her training sheplans to practice at the BlackRiver Falls Clinic.

As a medical school graduate,DeLong joins Hill as member ofa new tribe of Indian physicianswho share a special bond.

“We all took differentroutes,” Hill says of the pathsthat Indian physicians follow toreach their destination. But weshare the knowledge that some-how we got here, and that the‘somehow’ is a miracle.”

■ Karen Boros

AMY HAKIM NOW

HAS A PILE OF CLIPS

FROM MORE THAN

300 NEWSPAPERS

AS SOUVENIRS OF

HER EXPERIENCE.THE STORY WAS

ALSO REPORTED ON

THE CBS, NBC,AND ABC EVENING

NEWS, BY NATIONAL

PUBLIC RADIO, AND

BY LOCAL TELEVISION

AND RADIO STATIONS

ACROSS THE

COUNTRY

Editor’s note: The center wasrecently awarded more than $2million from the U.S. Departmentof Health and Human Services torecruit and train Native Americanhealth care practitioners.

Who says kids don’t like science? Certainlynot the Blood Gushers, a team of 10- to 15-year-olds who spent a couple weeks inAugust tinkering with brains, bones, hearts,lungs, and intestines in University labs.Nope, the Gushers love science, the ickierthe better as far as they’re concerned.

The Gushers were among 36 kids from St. Paul public schools who wroteessays to qualify for scholarships toattend the Bioneers day camp, funded by the Howard Hughes Medical Instituteand co-sponsored by the AcademicHealth Center and the Science Museumof Minnesota.

Participants broke up into teams, towhich they applied quaint and colorfulnames, and then devoted themselves to studyof the human corpus. For inspiration, theyviewed an actual human brain and skeleton.Then they got down to the serious businessof designing their own biomedical devices,another part of the program.

“There’s this guy who has lower back pain,” says 12-year-old Blood GusherEmmanuel who goes to Ramsey JuniorHigh School in St. Paul. He labors busily on a drawing of a man with an exposed

spinal cord. “We’re trying to make up some-thing that will cure it. So, what we did wasmake this thing so that if he’s jogging orsomething he can turn this dial that’s con-nected to his spine and it gives him a littleshock and the pain goes away.”

Emmanuel doesn’t know it but, with alittle scientific information about the spineand the electrical impulses that produce pain sensations, his group has reinvented theartificial pain suppressor, an actual medicalapparatus used to intercept pain signals.

But the Bioneers don’t stop at inventinga device. The next step is to market theirproduct as would be done with an inventionby a real biomedical scientist. The Gushers,who obviously have a gift for naming things,dub their device the Speedo Energizer anddevise a slogan: “A charge a day keeps thepain away.” Clearly, they’re on their way to careers as entrepreneurial biomedicalengineers.

“The idea here is to increase the kids’interest and awareness of science,” says NeilSpencer, director of the camp and head of

the Minnesota Educational Theatre. Anactor, Spencer plays a variety of charactersduring the camp, including Fig Newton,great-great grandfather of Sir Isaac Newton,and a stripe-shirted referee who enforcesrules by which the kids must abide.

He also helps kids put on anatomy-related mini-dramas. One recent afternoonSpencer led the kids in a version of the game Capture the Flag which they renamedHeart Attack. Some of the kids were disease-fighting white blood cells and some wereribs protecting the heart from injury.

Besides their visits to the Museum ofQuestionable Medical Devices, Medtronic,and 3M, the young Bioneers found the con-struction of edible white blood cells (ingredi-ents: sponge cake, strawberries, sugar glaze,Raisinets, and lots of whipped cream) especially edifying, according to 11-year-oldDavid of Woodbury Elementary School.

“It was practically a shortcake, so we ate it,” David says.

■ Jack Hayes

(For information about Bioneers camp, refer towww.mbbnet.umn.edu/youthbeat/biomedcamp.html)

12

Bioneers day

camp features blood,

guts, and bioengineering.

Who says kidsdon’t like science?

EDUCATION

The Gushers, who obviously have a gift for naming things, dubtheir device the Speedo Energizer

and devise a slogan: “A charge a day keeps the pain away.”

BIOMEDICAL

ENGINEERING

GRADUATE

STUDENT

ELIZABETH

CORWIN

HELPS THE

BLOOD

GUSHERS

DESIGN A

MEDICAL

DEVICE.

Wonder who got stuck reading the millions of tobacco company documents we kept hearing about during the Minnesota vs. BigTobacco trial?

Well, it was the AHC’s own Cheryl Perry, professor of publichealth and key expert witness on tobacco efforts to get kids to startsmoking. Okay, so she didn’t read them all, just a stack of them acouple feet taller than she is.

Having served as scientific editor of the 1994 U.S. SurgeonGeneral’s Report on “Preventing Tobacco Use among YoungPeople,” Perry caught the eye of the state attorneys as theywere preparing a lawsuit to recover costs of treatingsmokers. In late 1995 they asked her to be a witness.

“In the fall of 1996, I began to get tobacco industrydocuments,” says Perry who proved a formidable opponent of the tobacco interests during her three daysof testimony in March. “They were hand-delivered in alocked file cabinet. By strict confidentialityagreement, I could not talk about themto anyone.”

Month after month, she poredthrough the documents, often stum-bling across startling evidence of thecompanies’ determination to sell cigarettes to younger and youngeryouths. “Replacement smokers,”they called them. Perry kept afile of incriminating quotations.

“However intriguing smoking was at 11, 12, and 13,by age 16 or 17, many regrettedtheir use of cigarettes forhealth reasons and becausethey feel unable to stop smoking when they wantto,” read one 1977 documenttitled, “Project 16, Report ofImperial Tobacco Limited.”

“It was shocking,” Perrysays. “I had no idea thosecompanies had paid so muchattention to very young people.If such documents existed I just couldn’t believe thatthey wouldn’t have shreddedthem long ago.”

From mountains of documents, Perry culled 20 pages of incrimi-nating excerpts which she essentially committed to memory becauseshe would not be allowed to take notes to the witness stand. She alsowrote a 100-page expert witness report that tobacco industry lawyersworked hard to tear apart both at a six-hour, pre-trial deposition and in court.

They failed. By all accounts, Perry and her work held up beauti-fully during the deposition in which tobacco lawyers not only grilledher about her report but about her personal life. They were lookingfor anything they could use to discredit her future testimony.

Those who know her would tell you that you won’t find muchdirt in Perry’s life, except maybe on the bottom of her hiking boots.

An international authority on the prevention of alcohol andtobacco abuse as well as obesity and heart disease, she doesn’tsmoke, doesn’t drink more than a little wine with supper, and hasnever been caught up in a scandal, personal or professional. Sheclaims she tried a cigarette once in her life, when she was 29, forresearch purposes. (She couldn’t finish it.) In short, she was thetobacco companies’ worst nightmare.

During even the most frantic and demanding parts of the trial,when some lawyers and witnesses subsisted mostly on coffee andcandy bars, she swam or used the treadmill daily, ate “healthfully”(she’s a vegetarian), and tried not to drink much coffee.

She needed the strength that regimen gave her when she underwent witheringcross examination by tobacco lawyers.Luckily she’d been drilled by state lawyers forweeks before that. Toughened up, as it were.

“I actually had to become a little bitmean,” says Perry who is the personification of Minnesota nice. But she feels the hard workand temporary changes in temperament wereworth it, especially considering that the casewas ultimately settled out of court for between $5 billion and $6 billion, some of which will gotoward anti-smoking efforts.

“In thefield of publichealth, if we are going to continue to take onpublic issues

like smoking andalcohol abuse, weare all going tohave to learn these skills.”

She couldn’t have done it, she says, without the support of her public health colleagues, some ofwhom sat nervously biting their nails and shieldingtheir eyes during her testimony for fear she wouldbuckle under the pressure. She never did.

Expertise, collegial support, exercise, and goodnutrition helped get her through this test of wills,but Perry had a secret weapon that gave her the edge from the start.

“I really believed I was telling the truth,” she says.

■ Jack Hayes

13

CHERYL PERRY, SCHOOL OF PUBLIC HEALTH

PROFESSOR, WAS SCIENTIFIC EDITOR OF THE U.S.SURGEON GENERAL’S REPORT “PREVENTING

TOBACCO USE AMONG YOUNG PEOPLE.”

“It was shocking,” Perrysays. “I had no idea

those companies hadpaid so much attention to very young people.”

smokeUp in

smokePublic Health professor Cheryl

Perry torched the tobacco industry’s

case by revealing their brazen efforts

to lure underage smokers.

OUTREACH

For generations, Frogtown has been a startingpoint for immigrants—most recentlySoutheast Asians—on their way to theAmerican dream. That has shaped its uniquecharacter and produced a wealth of ethnicrestaurants and cultural organizations. Butas with any culturally mixed, largely low-income urban neighborhood, Frogtown hasits problems: the city’s highest rate of leadpoisoning in children, high unemployment,half of families living in poverty, deadlyhouse fires, abandoned property, many residents who do not speak English well,and high illiteracy.

In short, Frogtown is precisely the kindof neighborhood Jesse Goodman, professor ofmedicine, was looking for when he wantedto try an idea he had about preventing community health crises.

“When there’s a crisis in a neighbor-hood like Frogtown—a chemical spill at afactory for example—there is this collision of cultures,” Goodman says. “People don’tknow each other and can’t talk to eachother, so responses tend to be reactive andnot to lead to long-term solutions that bene-fit everyone. I wondered if the University,environmental agencies, health agencies,and neighborhood organizations could gettogether before there was a crisis.”

Before starting Frogtown-COPE: A Community Partnership for a HealthyEnvironment, Goodman consulted blockclubs; development organizations; Hmong,Lao, and Vietnamese associations; and othergroups. And he won the support of the U of M Medical School, the School of PublicHealth, St. Paul-Ramsey County Departmentof Public Health, Pew Trusts-Health of thePublic program, Allina and HealthEast foundations, and Northern States Power.

Then he signed on School of PublicHealth alumni Tim Burkhardt and PatriciaOhmans to work with community memberson door-to-door surveys of Hmong andVietnamese households. A separate survey of mostly non-immigrant residents was also done.

The Hmong and Vietnamesesurveys showed that their mostpressing environmental concernswere not chemical spills or aban-doned industrial property, buthousehold hazards. Forty-two percent of residents of Vietnamesebackground, the survey showed,had not heard of lead poisoning,54 percent of Hmong respondentshad never heard of carbon monoxide poisoning from furnaces, and 89 percent of Vietnamese surveyed said they didn’tknow what asbestos was, let alone that itwas hazardous.

The survey provided the substance foran action plan. Frogtown resident KhoiNguyen, a local Vietnamese leader who hadsingle-handedly done the initial survey in theVietnamese community, taught members ofthe 80 households he surveyed about fire

safety, hazardous chemicals, lead poisoningand other hazards. He installed smoke detec-tors and cabinet locks to protect childrenfrom toxic household chemicals, showed residents how to wash away lead-laden paintchips and debris, arranged home energyaudits, and passed along fact sheets inVietnamese on other dangers.

“Sometimes they send informationabout health to Vietnamese people, but theydon’t read it,” says Nguyen. “Some don’tspeak English and some cannot read well.You have to go explain to them.”

A dozen Hmong community memberscarried the word about home health andsafety to 300 Hmong households. By the

time the work in the Hmong communitywas finished late last year 200 smoke detec-tors had been installed and 369 more distrib-uted; 250 safety latches were installed oncabinets (600 were distributed altogether),and hundreds of 911 stickers were stuck on telephones.

Three months after the visits to Hmonghouseholds, two community educators wentback to 53 of the homes and found that allof them had at least one working smokedetector and 80 percent had two or more.Eighty percent had poison control informa-tion stickers posted, and 60 percent hadworking latches and locks on cabinets storinghousehold poisons. Goodman and colleaguesdeclared the project a success.

“We know that the kinds of things wedid in Frogtown reduce injury and death,”says Goodman. “And they save everybodymoney in the long run.” Before the COPEproject ended earlier this year, he says, tworeports were received of families alerted tofires by smoke detectors.

“If the efforts of Frogtown-COPE prevented even one fire, the entire projectlikely would pay for itself,” he says.

■ Jack Hayes

14

Forty-two percent of residents ofVietnamese background, the survey

showed, had not heard of lead poisoning;54 percent of Hmong respondents had

never heard of carbon monoxidepoisoning from furnaces.

Innovative public

health program in St. Paul’s

Frogtown neighborhood

could save money and lives.

COPEsprings eternal

PROJECT COPE COMMUNITY EDUCATOR KHOI

NGUYEN TELLS THE VO CHAU FAMILY HOW TO USE

A SMOKE DETECTOR.

OUTREACH

The year was 1927. Twelve-year-old Viola Nelson, whose teethwere so crooked they over-lapped, and her mother, Adla,had taken the streetcar upCedar Avenue, transferred atseven corners, and gotten off atChurch Street, where the first ofthree buildings that housed theSchool of Dentistry was located.

The clinic was a huge roomfilled with rows of patients inhard wooden chairs, studentsand professors in white coatsmoving among them. Viola likedthe busy atmosphere and thesound of buzzing machinerythat filled the air. When she was

seated, she watched with inter-est as dentists worked onpatients to either side of her.

Braces, which were rela-tively new in 1927, were quicklyprescribed for Viola. Ancestorsof today’s color-sparkled plasticmodels, these were heavybrownish wire affairswith heavy brownmetal posts anchoredto each tooth. Forthe next three years,Viola would betorn between hernatural inclinationto talk and smileand her desire tokeep her mouthclosed and herbraces out ofsight.

Viola andher mothermade weeklyvisits to theclinic to have herbraces tightened. Upon theirreturn home, Viola always had

soup and ice cream for lunchbecause her teeth ached toomuch to chew. After a while,she took the streetcar to theclinic by herself.

“I never felt a bit scaredbecause everyone was sofriendly,” she said. Although shesaw different student dentistsover the years, she came toknow the dental assistants whowere on staff and to think ofthem as friends.

Finally, when she was 15,her braces were removed forher confirmation. Even so,she remembers, she didn’tsmile for her confirmationphotograph because she wore a retainer. Not one to throwthings away, Viola still has theretainer in a trunk in the attic —the attic of a house on 17thavenue, where she has livedsince she was seven.

After the braces came off,Viola continued to go to theclinic for dental care, eventhough there were dentistscloser to home.

Although she now needsonly routine cleanings andcheck-ups, Viola has had cavi-ties filled, roots canaled, andseveral teeth crowned in gold atthe Dental Clinic. Amazingly,she has never needed Novacaine.Even in the days before high-speed drills. Even for rootcanals. “They tell me I have avery high pain threshold,” shesays with a big smile that showsher straight teeth. Now 83, shestill has all of her own teeth, an

achievement she credits tothe School ofDentistry.Both of herparents neededfalse teeth.

A contentedperson by nature,Viola clearlydoesn’t go out ofher way to makechanges in her life.She lives in thesame house whereshe lived with herparents in 1927. Shehas attended only

two churches, both in the samedenomination, both in southMinneapolis. And she and herhusband, Clyde Pelfrey, havebeen married for 53 years.But she doesn’t see a doctor on a regular basis, preferring to rely on vitamins, a healthydiet, and a positive attitude.

She says the reason she hasstayed with the Dental Clinicfor so long is because in 71 years she’s simply never beenunhappy with the care.

“The students have to dothe work right because the pro-fessors check it,” she says.

Viola now visits the clinicevery four months to have herteeth cleaned. She and Clyde,also a patient, take the busrather than the streetcar, andtheir destination is a little differ-ent than in 1927. While Viola haslived in the same place for 71years, the dental clinic hasmoved three times. It’s nowlocated in Moos Tower, a mod-ern steel-and-concrete structureat Delaware and Harvardstreets, about a block awayfrom the original site.

The clinic itself is still alarge room, but dividers betweenchairs give patients a little moreprivacy than they had in 1927.Viola misses watching what’shappening on either side of her,but says most of the otherchanges have been for the better.The reclining vinyl chairs aremuch more comfortable thanthe hard wooden chairs of the 1920s.

“They’re just beautiful, andso comfortable you could go tosleep in them,” Viola says. “AndI just love the water drills,” sheadds, her eyes lighting up.

■ Peggy Rinard

OUTREACH

15

Viola Pelfrey

has been faithful to

the School of

Dentistry’s clinic

since she got her

braces there in 1927.

Not one to throw thingsaway, Viola still has the

retainer in a trunk in theattic — of the house on

17th avenue, where she has lived since

she was seven.

Satisfiedcustomer

VIOLA AT AGE 15.

VIOLA PELFREY SHOWS OFF HER TEETH, STRAIGHTENED AT THE

DENTAL CLINIC IN 1927 WITH ADVANCED TECHNOLOGY CALLED

BRACES, FOR DENTAL HYGIENE STUDENT HEIDI MCFARLANE.