Thursday, October 17, 2013

Shout Out to PT Professionals for National Physical Therapy Month

A note from Alex:   It is National Physical Therapy Month.     I am interrupting the series on "The Impact of Impact" and will follow up with Part III soon.   In the meantime I wanted to acknowledge National Physical Therapy Month with a shout out to our own PT program.  I also am taking this moment to express some thanks for special attention I have received from the PT profession over the past year or so. I don't usually use this blog for highly personal matters, but I am violating that rule today.   In any case, I hope that you will join me in saluting and thanking our PT colleagues-faculty, students and staff.    We have a phenomenal department here at the IHP, remarkable students and alums, great PT colleagues at Mass General, SRH, and BWH who are all part of our clinical education enterprise.    We are truly privileged to have so many rehabilitation clinicians, educators, and scholars in our midst.  Say thanks to PT!

Dear Physical Therapists,

 
I am taking this opportunity to give a public thank you for your work.   I have worked with great PTs for most of my clinical and academic life.  Since joining the Institute, I have learned more and more about the significant contributions beyond the obvious.  Some of these include the highly creative curricular leadership of the IHP,  the dynamism and maturity of our PT students,  the respect of our programs in PT by others,and the great alumni involvement,  Our PT colleagues at the IHP do so much to contribute to the life of the Institute community.   Our last two Faculty Chairs (Drs. Tracy Brudvig and DJ Mattson)  have come from the Physical Therapy Department, with several more preceding them in earlier years.  Much of the energy and leadership around IPE has come from our PT Faculty, including the current leader of IMPACT, Dr. Mary Knab.   In almost every activity at the IHP, the strong positive, and gifted Physical Therapy "voice" can be heard.     For all of these contributions (and I could go on and on) I am grateful and appreciative.  I know our whole IHP community is so proud of these obvious reasons to shout out "Happy PT month."

However, I want to take a moment to be much more personal.   Over the past year or so I have been the personal recipient of physical therapy.   I was and continue to be "the patient."   I have experienced the continuum of care in PT in a highly individualized and focused manner.   I want to use this experience to share a bit of what I have learned about PT and why I am so grateful  Bear with me.

My first direct experience with PT started over a year or so ago when I experienced a "frozen shoulder."   The pain was the worst part.  I listened to my physician ("let's wait and see"), took some meds for a while, and tried to wait it out.   It improved enough to function, but it hurt all the time. When I finally got around to seeing Mr. Jon Hagan, PT, OCS  at the MGH Charlestown Community Center for therapy, I was quickly amazed.   Boom... a few sessions- no more pain, over time increased range of motion, and some simple follow up visits to make sure all was on track.   At the time, I was so grateful for the relief and the rehab.   I hope that Jon knows how much I appreciate him and the great care.  I also hope he knows that his talent and encouragement are remarkable.  Happy PT Month to Jon Hagan. 

The lessons I learned from Jon provided a simple preface to  a book that is not quite finished.   Last February I had a "little" neurosurgery for an acoustic neuroma at the Massachusetts General Hospital.   Before surgery, I knew that I would be deaf in the left ear, and "might" experience a few other problems.   Due to the size of the tumor, the ultimate complications included a number of of the "mights".  Among those were vision problems (double vision), balance problems, facial weakness, and some "minor" speech and swallowing problems.   Yes, my "benign" tumor hit the sweet spot where all those cranial nerves come together.  Sort of the trifecta for a speech language pathologist, wouldn't you say?   

So, the first chapter of PT, post surgery, was the part where you realize "Dude,  I am in the Neuroscience ICU at MGH and I can't get out of bed.  In fact, I don't want to even try!"   I can't recall the names of the Physical Therapists from the MGH PT Department who came to my rescue.  I wish I could.  They were all so amazingly skilled.   They knew how to get me up (gently at first), help me get into the chair, start walking around the ICU with all kinds of bells and whistles attached, and how to educate the hospital staff about what I needed to do.   Their knowledge of my condition, of the environment, and the link between my health status and what I needed to accomplish in order to get home were all amazing.   While these skills that I am acknowledging have to be the most routine and the most basic for PT clinicians in the acute care setting, they are far from routine from the patient's perspective.   I know that these PT neuro experts were the ones who helped me every day for that week, who pointed out little (and I mean tiny) steps toward the goal of discharge from the ICU and then the hospital, and who reassured me every "step" of the way.   One of the most impressive pieces of all of this was the way that the PT team communicated with each other as I progressed in my stay.   They were skilled at keeping each other aware of all "my"  details and they didn't need to keep asking me the same history questions at every visit.   All clinicians have something to learn from that!  So, to all of the Physical Therapists at Mass General, especially my therapists in the Neurosciences Unit, thanks for helping me to get home safely and with a bit of confidence.  You are all stars in my book.  (Just so you know, I am walking all over Boston now!).

Chapter II moves to my home.  About a week before my operation, I was contacted by two of our faculty members, both neurology PT specialists (Janet Callahan, PT, DPT, NCS and Anne McCarthy Jacobson PT, DPT, NCS).  They generously volunteered to check in on me after discharge and to see if there was anything I would need.   (Ha!  They didn't know what they were in for).    I was grateful (so grateful) for the attention, but assumed that after surgery I would need some rest, but why would I need PT?  Those balance problems were a possibility but I had confidence I wouldn't need them.    My first words, on the way home from the hospital, to my wife were " could you see when Janet could come over?"  Most fortunate for Anne and not so much so for Janet, her schedule allowed her to be "the one."   Janet spent several hours with me over the next few weeks.   In terms of symptom management for double vision and balance, she is a pro.   In terms of kindness, humor, clinical skill, encouragement, and generosity she is gifted.    I will spare the details about all we went through, but my progress was swift and within 10 days or so, I was starting to take a walk outside along the harbor.   My gratitude to Janet is immeasurable.   While some of those balance exercises, could qualify me for the flying Wallendas if mastered, I learned so much about the neurological system, balance, and about physical therapy.   I am still using what Janet helped me learn and practice.   P.S-  I would put the day that the double vision cleared among my best life rewards!   So Janet, Happy PT month.  You are remarkable!   Anne Marie, thanks for making yourself available too.   For both of you, your advice and support to people with balance and other neurological problems is a gift to rehab.  Our students are so fortunate to learn from you!  

Chapter III (apologies for length, but my PT story is sort of like Harry Potter-lots of volumes).   I mentioned my facial weakness, similar to Bell's Palsy.   There was very limited movement on the left side of my mug.   My surgeons (and they are the best) recommended that I wait for about six months before starting therapy for my facial muscles.   There is a rationale (I am still arguing with them about the rationale), but I waited.  That was a very long six months.   In late July, I began to see a new therapist, Mara Robinson, PT, MS, NCS at Mass Eye and Ear Infirmary.    Notably, (Mara is a 1997 graduate of the MS program at the Institute) Mara is a facial PT specialist and sees patients in the Facial Nerve Department at MEEI.   She is a star.  My guess is that she has seen more folks with acoustic neuroma complications and Bell's Palsy than about anyone else. Her knowledge of the unique and challenging facial musculature is beyond belief.  She knows it all.   We started with some facial exercises (again I will spare the details) .  Doing these exercises daily in the mirror is somewhat comical, yet highly logical.  At times, when I am exercising I feel like a facial contortionist .   However, within a few weeks of starting, I started to see lots of improvement.  Do you know what it feels like to lose a smile and get it back?  Do you know what it feels like to again feel comfortable when you are out or have to meet strangers?  Do you know how good it is to hear from family and colleagues that you look so much better?   For all of this and so much more, Happy PT month to Mara.   

I am happy to celebrate PT month this year and I will be for every year to come.   I say this as I walk, smile, and see more clearly.   I know that I am better for having had the opportunity to benefit from the expertise offered by my physical therapists.  Thanks (and Happy PT Month) to all Physical Therapists!

Tuesday, October 1, 2013

Part II: What Impact Means To the IHP


In my last post I described the IMPACT program.   Anyone who has been at the IHP for the past two semesters has certainly heard of IMPACT and what we are trying to accomplish.   This interprofessional set of experiences for our students, clustered under this new logo, is providing a fresh  and welcomed approach to our long time commitment to interprofessional education.    

For the IHP community, and the larger community, this new image and new set of activities is designed to impact all of us by imprinting within our lexicon and within our day to day teaching and learning a highly principled approach to our practice.   Our long standing discourse about "working together" has taken on a new level of commitment that is far reaching.  

For our newest students, IMPACT means that they were being approached (electronically) about interprofessional issues prior to their arrival on campus.   Their enrollment in the new HP course assured that from day one they were exposed to this new hybrid curriculum as the centerpiece for the development of their new professional choice as a nurse, nurse practitioner, physical therapist, or speech-language pathologist.   Next year, occupational therapists and then physician assistants will join the mix.   Every new student, assigned to an online group of 10 colleagues from diverse backgrounds and disciplines will have the chance to work together to develop knowledge and skills in leadership, communication, patient focused care, and ethics.   As a kickoff this year, over 260 new students joined IHP faculty and staff in providing community service all over Charlestown and beyond on Friday August 20.   Pictures and a detailed story about community service day are available on the web site (www. mghihp.edu).

A week later, these same entry level students participated in the Institute's Annual Infant Development Day organized by the Physical Therapy Department.   This event, now in its 17th year provides the opportunity for entry level students to interact with typically developing children and their families, while learning to assess/observe motor, cognitive, language, and social development in very young children.  This hands on interprofessional experience is one that students find enjoyable and memorable.   I should add that it's one that their faculty members find exhausting!

Beyond this focus on first year students, the discussion that has begun has brought faculty members together, has generated discussions with colleagues from  the Boston Architectural College and the Harvard Medical School about the future of health care education.

In addition to our core values in diversity and in quality education, this area of interprofessionalism is emerging as both essential and distinctive in the IHP experience.    While the IMPACT curriculum is the central mark of the IPE student experience,  the "impact" goes well beyond this curricular focus.  Examples of the IHP interprofessional focus are seen in our Interprofessional Dedicated Units at Mass General Hospital (increasing to two this year), particpation by our NP students in the Crimson Care program with HMS students, the interdisciplinary grand rounds conducted by SHRS,  monthly Schwartz Rounds for compassionate care,  our own IHI chapter which has representation from several disciplines, and on and on.  Faculty members are busy planning multidisciplinary global travel and education experiences and research projects.

 Out distinctiveness will be seen and felt in our unique ability to produce remarkable new professionals who can practice "at the top of their professional license" while working with individuals from all health disciplines in putting the patient front and center.   That's the impact of IMPACT.

Wednesday, September 4, 2013

Thinking About Our IMPACT: Part I

Part I:  What is IMPACT?


Founded on principles of interprofessional education and practice, the Institute is now ready to live into its next generation of education and excellence.   

 Dr. Mary Knab is ready to launch an entirely new curriculum for entry level students in the masters programs in Nursing, Speech-Language Pathology and the doctoral and masters programs in Physical Therapy, starting in September.  A team  of three faculty members (Gail Gall, Chuck Jeans, Laura Plummer) have created the first course for the program to be launched next week .  The new program, called "IMPACT PRACTICE" is a two year curriculum that focuses on team based learning and leadership, ethics, and interprofessionalism. (IMPACT is an acronym for Interprofessional Model for Patient-and Client-Centered Teams).   Over 250 students starting at the Institute this week (along with the DPT students who started last June) will be assigned to groups of 10, with each group including students from each of our programs.   Over the next two years, each group will study professional formation, ethics, and leadership together and will experience interprofessionalism as they experience their  own professional education.  This "co-curriculum" runs side by side with each of our entry level graduate programs.   

The Institute academic leaders (deans, program directors) have all been part of this discussion and have embraced it wholeheartedly.  I believe that as this program rolls out it will be a model for others looking to design curricula that address the critical issue of interprofessional education and practice.   Thanks to the Center for Interprofessional studies and Innovation (CIPSI) under the leadership of Dr. Peter Cahn, the hard work and creativity of Mary Knab, and the entire IHP community for embracing this huge effort.  It will clearly have an IMPACT on all of us.

In the next blog post we will discuss what IMPACT means to the IHP and to the education of health professionals for the future. And in the final blog of this three part series we will discuss the future of interprofessional education at the IHP.

  

Tuesday, June 25, 2013

Aphasia Awareness

Aphasia is a communication disorder that occurs frequently after someone experiences a brain insult;the most common cause is a stroke in the left hemisphere of the brain.  More specifically, the communication impairment experienced by people with aphasia includes problems in spoken language, understanding, reading and writing; while for the most part thinking remains clear.     The MGH Institute of Health Professions has a long standing treatment program for people with aphasia.

In honor of Aphasia Awareness Week,  the staff and faculty of the Institute produced a video to educate others about aphasia and the services available for this important group of patients and their families.  Enjoy!

Wednesday, June 5, 2013

May WAS Better Hearing and Speech Month


 If you read the “IHP News” you know that in May each year, associations and professionals and patients that care about speech and hearing celebrate these functions.   I have procrastinated on a well-intentioned blog about May being “Better Hearing and Speech Month .  I have lots of excuses:

1.  I already wrote a blog about Nurses Week earlier in the month.

2.     Since I recently have experienced my first personal experience with speech and hearing problems, it’s just too hard to talk about in a blog.

3.    !Having spent the last 30+ years focused on this particular set of conditions, there is just too much to be said

4.    None of the above

Number 4, none of the above, is my reason.   Actually, I have been struggling for weeks.  I have really thought about the personal angle, the life experience and patient experience angle, and the perspective of how important our own Department of Communication Sciences and Disorders is to the Institute.   Each of these topics is particularly meaningful to me.   As I thought and thought about what to write, none of these topics “did it” though.  I just couldn’t become inspired enough to write about them.To be honest, they were too simple and trite.    Writing on these topics, somehow couldn’t touch what I know with great confidence:  The profound impact of the discipline of human communication sciences and disorders is yet to be realized in society.  Let me say that again, this time with italics: The profound impact of the discipline of human communication sciences and disorders is yet to be realized in society.  (Can you hear violins in the background?).


Is this an admonition and a warning?  Is this a cautionary moment? Am I attempting to overstate? 

Think about it for a moment.  160,000 or so speech-language pathologists  and audiologists in the US spend their time studying, thinking about, diagnosing and treating  patients with speech, language, hearing, reading, cognitive, and swallowing problems.   Additionally, basic scientists from CSD, but also from medicine, rehabilitation, engineering, psychology and a myriad of other disciplines devote their work to understanding how it is that people carry out these functions.  Where does communication originate in the brain?   Can it be reorganized in the brain?  What is the genetic basis?  How does something as “simple” as the human voice mechanism produce thousands of different adjustments to produce everything from perfect musical tones to the most primal sounds associated with fear or pain (and everything in between)?  How do blind people learn to read?  How do deaf people learn to speak?  How can a child go from a few vocalizations to adult-like speech in matter of a few years?  How do people, who cannot move, learn to communicate using technology?  

Here in Boston, we are lucky to be surrounded by people who provide wonderful examples of best practice in clinical care for many patients with speech, language, swallowing, and hearing problems.   The legacy of the Boston VA, Boston University, Children’s Hospital, Mass Eye and Ear Infirmary, Spaudling and Mass General ,( and more recently, the IHP)  in developing and applying innovative treatments for people with these conditions is well known in the speech and hearing community.

Similarly the great work of teams of speech and hearing scientists, neurologists, SLPs and audiologists at these institutions, as well as at Harvard and MIT,  have been significant at answering questions about aphasia, voice, swallowing, augmentative communication, hearing loss, head injury, and so forth.   In our MGH Institute community we are honored by the presence of remarkable leaders like Gregg Lof, Howard Shane, Marjorie Nicholas, Bob Hillman, Charlie Haynes and others who have left indelible marks on the timeline of communication sciences and disorders and will continue to do so.

So, given the environment in which we work, why does society continue to undervalue these important contributions?   I have come to believe that the answer is an evolutionary one.   At our most primitive moments we focus on survival and on satisfying those needs that are most basic.   Living in a society where health care and education, the primary environments where SLPs and audiologists work and study, are undervalued is clearly  a piece of the puzzle.   How can one say that the most human of functions (talking/understanding) is vital when  we have trouble identifying these as central to primary care in the health system or see them as non-essential to education?   

I have lots of ideas about why this has happened and how it needs to change in a progressive society.   I hope to hear your ideas as a follow up to this blog.   Let’s talk and listen to each other about speech and hearing.  What are your thoughts? I hope that YOU will take a few moments to comment below.   

Wednesday, May 8, 2013

Thinking About Nursing

It's National Nurses Week. I am not sure why there is only one week where the nursing profession is celebrated, as so many other job categories have a whole month. If it were up to me it would be National Nursing Year, celebrated 365 days a year.

Recently, I experienced a week-long hospital stay after a very long surgical procedure. My stay was in our own Mass General. For me, the nursing professionals with whom I interacted and from whom I received care were transformational. I was prepared to write a blog about this personal experience and I will do that in the future. I have tried to capture my own experience in several drafts that are not yet complete. It's still a bit too personal and a bit too narcissistic for that type of reflection at this moment. I will keep working on that message.

Having put off this reflection for a couple of months, I was brought up short by the tragic events of April 15, 2013. This was the date of the running of the 117th Boston Marathon. This is the date when runners, children, observers, and others were injured and killed in this city that I now call my home. The role of nurses in the unfolding of the now-never-ending story of the aftermath of the Boston Marathon 2013 is pivotal. We all have heard the story of nurses (and others of course) who were alongside the finish line or were in the medical tent as the bombs went off. We have read how they rushed toward victims of the bombing with skill and bravery. As the days progressed with repeated news stories of Emergency Rooms, ICUs, and in-patient care, I knew what kind of professional nursing care was being provided. As time progresses and now those patients most gravely affected have moved onto rehabilitation settings, I know what skilled nursing leaders are doing in Spaulding and other rehab hospitals and also in home care.

So often, the image of nursing as a "caring" profession produces predictable images of strong individuals offering a gentle smile, a soft touch, and the like. I want to present another image. It does not replace the "kind and gentle" picture that we all can easily conjure. I believe it complements that view and for me, it supersedes the image. In my nursing narrative, the nurses at the site of the bombing almost reflexively made critical life saving decisions about injured people. They decided where and when to stop hemorrhaging wounds, provide CPR, and get people to an ambulance. I would guess that in some of these decisions and actions they were supported by other nurses and physician colleagues. I would also guess that many of their decisive actions were carried out in solo, using critical clinical knowledge. It was just the nurse and the victim together at that particular horrifying moment.

In my version of the story, nurses in the Emergency Departments and in the inpatient units of our various Boston hospitals all played a key role in making moment-to-moment decisions about the care of their patients. Their role in keeping these patients alive and making progress cannot be emphasized enough. Their monitoring of the patient's condition, keeping patients safe and stable, and calling on colleagues from medicine or other health professions when needed is essential in achieving the best outcome. And now, when many of our eyes have moved on from the immediate crisis of the event, they continue to make critical decisions and provide mintue-to-minute monitoring for those dealing with long term loss and disability, including the untold number of residents of our community who are dealing with the psychological wounds caused by this trauma. From the bedside to the top of the leadership ladder in patient care, nurses were (and are) making THE important decisions about the care of their patients. It is these decisions and their resultant actions that are frequently ignored in descriptions of the "caring, sensitive nurse" that are most common.

In this blog I want to celebrate Nurses Week as a tribute to the critical and important judgements and skilled actions of nurses everywhere, but particularly here in Boston. I want to hold up these examples for our students in the MGH Institute of Health Professions School of Nursing and their faculty. While all health professionals have the responsibility for compassionate and caring interactions with patients, it is the specific knowledge and skill of the professional nurse that assures patient safety and the best outcomes for all patients. Many of us interact with select subgroups of patients in rehabilitation, mental health, and so forth. It is only the nurse who provides care to every patient regardless of their diagnosis or presenting problem. To our students in the School of Nursing at the IHP: Congratulations on entering such a remarkable discipline. To our faculty and administrators in the School of Nursing: Thanks for preparing this remarkable group of students, all who have the opportunity to become leaders. To our colleagues in nursing around our community and beyond: Thank you for becoming leaders in critical decision making and exhibiting best practice all of the time, but especially during times of crisis.

Monday, April 1, 2013

Thoughts on my visit to Partners in Health (PIH) in Haiti

I am happy to share this information from our former Associate Provost, Bette Ann Harris, who recently spent a week in Haiti with colleagues from Partners in Health.  Her comments highlight the wonderful work being done, as well as the opportunity to provide important services and support to those most deserving of our attention!    Thanks to BA for these wonderful comments and pictures!

A. Johnson, Provost.

Blog Prepared by Dr. Bette Ann Harris

The view at Mirebelais Hospital - note
 the beautiful medallions depicting life in Haiti-
 all artwork done by local artists
I recently had the opportunity to visit Haiti to see first hand the health care clinics and hospitals run by Partners in Health (PIH) and their sister organization Zanmi Lasante (ZL) . The work done in Haiti is PIH’s flagship project—the oldest, largest, most ambitious, and most replicated. PIH/ZL operates clinics and hospitals at 12 sites across Haiti’s Central Plateau and lower Artibonite.

I am a huge fan of PIH because of the extraordinary work they do in providing health care to the poorest of the poor both locally and around the world.  Their work is a true partnership with the locals, and a large part of their mission is to educate locals to create sustainable programs, provide jobs and improve the standard of care. 

The rehab techs and me 
The entrance to the PT Clinic at
St. Nicholas Hospital in St. Marc--
All sings are in French or Creole
The primary purpose of my visit was to see the work that is being done in rehabilitation at the various clinics.  Given how many pressing needs there are for health care in poor countries, rehabilitation services are not a huge priority because of limited funding.  It is impossible to do everything one would like without an unlimited flow of monies. Although no one disputes the need – just other things are more pressing like improving infant mortality rate, controlling infections (I am sure you've all read about the cholera epidemic, TB, HIV) and improving nutrition but after the devastating earthquake in Haiti, it was clear that rehabilitation and basic physical therapy is necessary to help maximize function.

The entrance at Mirebelais Hospital

I have been a PH supporter for a long time and I got more actively  involved shortly after the earthquake, and with some wonderful Haitian graduate students from Suffolk University, helped to put together a teaching manual for those who care for or have had amputations.  I am also developing a curriculum (along with PTs from Spaulding, MGH and the IHP) for training rehabilitation technicians and accompagnateurs (community health workers).  To make a long story short, I am now part of an advisory board on rehabilitation and the long-term plan is to have a Center for Excellence in Rehabilitation and Education (CERE) as part of the new academic teaching hospital in Mirebalais.   Currently,  there are small programs in Cange (the original clinic started in the Central Plateau), St. Nicolas Hospital in the port of St. Marc and rehabilitation technicians provide home visits to provide follow up care throughout the Central Plateau. Just in case you are wondering, the results are impressive for those that are able to get services and there is a push to expand care in these programs.

Dr Andre Leroy, Director of Rehab with Jordan, 
a medical student at the clinic in Cange

We had a whirlwind 5-day visit that included hospital and clinic visits to L’Hôpital Bon Sauveur  in Cange, L’Hopital Saint Nicolas (HSN) in St. Marc and the magnificent new academic teaching center Hôpital Universitaire de Mirebalais (HUM), in Mirebalais.  I was travelling with my friend Jody Adams who is on the board of PIH and a well-known Chef,  her husband Ken Rivard, and her children Oliver and Roxanne.  I spent time with the rehab team while Jody spent time in the kitchens (and the family also did the hospital visits and visited schools while we were tied up). I was lucky enough to go on rounds with Dr. Andree LeRoy, who is the Director of Rehabilitation for PIH and spent time with the patients and rehabilitation techs.  I was able to meet with these rehab techs and we reviewed cases together, problem solving difficult challenges.  It all felt so natural to me knowing that I could be so helpful (after 40 plus years as a PT, I had the experience of dealing with some of the types of problems that those younger clinicians who work in more modern facilities don’t see anymore).  We all got a chance to meet with the doctors, nurses (including Sheila Davis, who is the director of nursing and her seeing her in action is impressive), volunteers, administrators and many patients.  I was struck by the dedication, enthusiasm and commitment of all those involved plus the pride of the Haitians who work at PIH.  Although the clinics and hospitals are not sophisticated and many procedures we take for granted are not routinely done, the commitment to providing compassionate, humane care is there.  We also spent a long time visiting HUM which is beautiful and clearly will raise the standard of care and health care education in Haiti.  The facility has state of the art operating rooms, imaging equipment, spectacular teaching and patient facilities plus it’s almost 100% solar powered. (it just recently opened and eventually will have 300 beds as the funding increases).  This hospital is truly a major game changer.

The courtyard at Mirebelais Hospital
These lovely mosaics are
 throughout the hospital
 












Now, I don’t want to give you the impression that life in Haiti is easy.  I am still struggling to make sense of it all…I have never been so up close and personal with people who literally don’t have enough to eat and essentially no resources.  Walking through the markets where the poorest of the poor are trying to make ends meet nearly broke my heart….seeing little kids who are starving  and Moms’ desperate to feed them and people who look like they are 90 when they are only in their 40s is a jolt to one’s soul.  Yet,  most of the Haitians we met were kind, welcoming and always praying for you.  One of the driving forces for my visit, was to better understand the culture and country of Haiti given how much we hear about what a hopeless situation it is….a country that lacks infrastructure with a storied history of massive failures.   Many of my friends have asked me why am I involved in Haiti because the situation is too dire and trying to effect change there is like beating your head against the wall.  Well, the visit confirmed my belief in everyone’s right to health care (and basic necessities ) and although it’s a long uphill battle, I am hooked on the work that PIH does and with all my heart, I know it’s making a difference. Their model of care and developing joint partnerships is translatable worldwide, including this country.  When Paul Farmer (and Ophelia Dahl, Jim Yong Kim and others) started the clinics in the central plateau 25 years ago, the area was deforested….not only did these visionaries work out a wonderful model of using accompagnateurs and partnering with the Haitians, they planted trees…25 years later, the area is beautiful and to me  a testament, that small steps do make a difference… I am in!

     Cange - 25 years later -
    note the beautiful foliage
A little girl that I had the chance to
 work with and her mom














There is no way in this short piece, that I can tell you everything that happened in our whirlwind trip, so I am linking you to my friends Ken and Jody's blog, the Garum Factory who put together a reflective photo journal of our trip on their blog (Ken is both a writer and a photographer) which  includes some of the cultural experiences we had the chance to do.


If you want to learn more about Partners in Health and the work in Haiti, please visit


Click here if you’d like to learn more about the proposed CERE.

And finally, to really understand Haiti and what happened after the January 12, 2010 earthquake you should read the book by Jonathan M. Katz:  The Big Truck That Went By:  How the World Came to Save Haiti and Left Behind a Disaster.

Tuesday, February 19, 2013

Dear Colleagues and Friends,

I hope that you are off somewhere enjoying this long weekend as a respite from your busy and important work. It is Sunday afternoon and it's a snowy blowy day around the harbor. As many who read this will know, I am home recovering from surgery and so I am taking time to express some appreciation. I will write more about all of this in the future.

My personal gratitude for your many expressions of connection/concern/and affection is intense. I enjoy (love!) hearing what is going on at School, with our students and Faculty, and of course, with you. Heather and Peter are keeping me on the grid with regular updates and news.

I am even more grateful for all of the cards, letters, notes, flowers, etc. I promise to get to thank you notes as soon as I can, but know that each point of contact is highly cherished by both Linda and me. Please don't let any delay on my part suggest that I am not noticing all your loving attention!

As anyone who has been through major surgery and healing knows, the process is rarely expedient! I am living that truth for sure, but know that I can't wait to be back at the office with all of you. Perhaps most gratifying is to know that your work, our work, goes on as planned. I see it every day via email, the web page, office notes, minutes, etc. And why wouldn't it? We have such a fantastic leadership team, group of faculty and staff, and students.

Special shout out to Heather, Jorge, and Susan who have produced our unbelievable new calendar. I am so proud and happy for this accomplishment, identified as the number one request from those who use Faculty Compass! Also, the collective work of our admissions committees, OSA, and Marketing in assuring full enrollment over the next term is so great. Thanks to everyone who is making it all jive.

I promise to write soon with some more reflections about what I am learning these days. Again, I hope that you are having a nice holiday weekend! See you soon!