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Pulse Magazine Summer 99 Issue

In this issue...

Global Perspective

Donor Program Growing, But Not There Yet

A Rite of Passage

Destiny Fulfilled

The Road Taken

A Perfect Match

Question & Answer

The Last Word: The Cover Says It All

GLOBAL PERSPECTIVE: The American Journal of Kidney Diseases Connects the World to Texas Tech
By Sue H. Jones

An e-mail from Macedonia pops up on the computer screen beside the message from Italy. Using cyberspace as the shortest distance between two worlds, the European nephrologists pays a friendly electronic visit to the Texas offices of the American Journal of Kidney Diseases.

While the AJKD may be Texas friendly, it's not necessarily, or even uniquely, American. Last year physicians and scientists from 37 countries submitted nearly 800 manuscripts to the Journal's editorial offices at the Texas Tech School of Medicine. For the first time in the Journal's 18-year history, international nephrologists are submitting more manuscripts than their North American counterparts.

Located in the Department of Internal Medicine, the AJKD is the official journal of the National Kidney Foundation and generally viewed as one of the most important scientific resources available to nephrologists worldwide.

Every day is filled with e-mails, phone calls and mail deliveries from scientific investigators, contributing authors and the general public. One author sends a report of 10 patients who underwent renal transplants after repeated consumption of diet pills containing a toxic Chinese herb. Another author submits a new study on the risk of death among chronic dialysis patients infected with Hepatitis C.

Just as quickly as each month's articles appear in the printed issue, they also appear on the Journal's electronic pages ( The AJKD internet site had an average of 514 user sessions per day during the first quarter of 1999 and 1,599 daily hits.

"Because the AJKD has the most clinical information of the top three competing nephrology journals, it is not an exaggeration to say that worldwide our journal is the most meaningful to practitioners of nephrology and others interested in management of kidney disease," says Neil A. Kurtzman, M.D., AJKD editor-in-chief and Arnett Professor of Medicine at the Texas Tech School of Medicine.

With an aging population and an increased incidence of diabetes and hypertension, "meaningful" may be the key word. Everyone from the federal government to the suffering patient is looking for preventive ways to address kidney disease and improve dialysis and transplantation therapies.

"Dialysis costs nearly $50,000 per year per patient," explains Donald E. Wesson, M.D., chief of Texas Tech's combined program in nephrology and renal physiology and one of four AJKD co-editors. "The latest data we have show that the incidence of kidney disease is increasing at a rate of about 8 percent per year."

Kidney and urologic diseases affect 20 million people in the United States alone. Worldwide the incidence of end-stage renal disease in patients with type 2 diabetes has increased so dramatically that some doctors refer to it as the silent epidemic.

"Our articles emphasize diagnosis and treatment," Kurtzman says. "Other journals have large basic science components of more interest to medical scientists, but physicians and caregivers turn to our journal first."

With a circulation mainly comprised of NKF members in the United States and abroad, the Journal generates more than $2.2 million in revenues annually and provides significant royalties to the NKF. Published by the W.B. Saunders Company in Philadelphia - the world's largest medical publisher - the AJKD is a peer-reviewed journal publishing nearly 200 pages a month. The peer-review process requires at least two medical experts to critique every original article prior to acceptance or rejection. To access the names and addresses of potential reviewers, the editorial staff maintains a database of more than 3,300 physicians and scientists worldwide.

"In 1998 we used 828 individual reviewers," Kurtzman says. "A reviewer can live anywhere - Boston, Vienna, Rome, New Delhi, Toronto, Barcelona. It's not unusual for us to spend $1,000 a month for express delivery to international reviewers and authors."

Since 1996 when the Journal's editorial offices moved to Lubbock from the Washington School of Medicine in St. Louis, the editors and editorial staff have compiled an impressive list of achievements:

  • 61 percent rejection rate (all-time high)
  • 66 average submissions per month (all-time high)
  • 107 percent rise in the number of international authors
  • 35 percent rise in published pages
  • 33 percent rise in manuscript submissions
  • 14 percent rise in circulation
  • 28 percent rise in advertising revenues (highest of any renal journal in the world)

The Journal was founded in 1981 and has been located at medical schools in Portland, Cincinnati, and St. Louis. Every five years the NKF's Scientific Advisory Board selects a new editor with both a national and international reputation in nephrology. The editorial offices then relocate at a medical school associated with the new editor. As the former chairman of the Department of Internal Medicine and a past president of the National Kidney Foundation, Kurtzman is the AJKD's fourth editor.

When the AJKD editorial offices opened in Lubbock, Kurtzman named four Texas Tech medical faculty members as co-editors: Wesson, Dr. Melvin Laski, Dr. Sandra Sabatini and Dr. Thomas Pressley. He hired four staff members to operate the Lubbock editorial office, and then appointed Dr. Hirotoshi Morii of Osaka, Japan, as international editor for Asia and Dr. Walter Hörl of Vienna, Austria, as international editor for Europe.

In addition to an editorial board of 102 physicians from 14 countries, the Journal has five off-campus editors of feature sections and 10 off-campus associate editors.

"Last month we had the second highest month of manuscript submissions in the history of the Journal," Kurtzman said. "One of the biggest challenges we will have in the days ahead is being just as enthusiastic and motivated two years from now as we are today."

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By Danette Baker

At any given time, there are about 3,000 people searching the National Marrow Donor Program's registry of about 3.5 million potential donors. About 80 percent of those will find a match.

While those odds are greater than when the registry was established in the late 1970s, a growing need remains for potential volunteer donors, especially within the minority communities, says Linda Dorton, donor center manager for the National Marrow Donor Program at Cook Children's Medical Center in Fort Worth.

Characteristics of bone marrow are inherited, Dorton explains, making the most likely match for a transplant recipient one of his or her own ethnic group. According to information published on-line by the National Marrow Donor Program, the most critical need for donors are among minority groups such as African American, Asian/Pacific Islander, Hispanic and American Indian/Alaskan Native.

Bone marrow is a substance found in the cavities of the body's bones. It resembles blood and contains stem cells, which produce red cells, white cells and other blood components.

For many illnesses, such as anemia, lymphomas and a number of other life-threatening blood diseases, bone marrow transplants are not only a treatment, but also are the only real chance for a cure. Patients who have these illnesses often turn to a relative first to seek a match. Those who do not have a match within the family turn to an unrelated marrow donor.

Donors range in age from 18-60 and must be in good health. People join the registry by giving a blood sample, which is then tested to identify protein molecules called antigens that mark the cells. Human Leukocyte Antigen, the name given to the system to identify the antigens that the immune system recognizes, are classified into six markers - three antigens inherited from the mother and three from the father.

The results from a donor's blood sample are entered into the Registry's database, which can be accessed worldwide. When a patient needs a transplant, the database is searched for a donor with complementary antigens.

If a match is found, the donor is then contacted and further testing may be conducted to determine the complete match.

Typically, the potential donor pays screening and harvesting costs, Dorton says. But there is support from private and public entities from the local, state and national level. Harvesting, or removing bone marrow cells from the donor, is performed in a hospital under anesthesia. Marrow is extracted from the pelvic bone using a special needle and syringe. The marrow extracted from the donor is then injected into the patient, where it multiplies. The donor's marrow then replenishes itself within a few weeks.

For more information on becoming a donor, call (800) 617-7692 to find the donor center in your area.

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A RITE OF PASSAGE: Almost 400 Students Graduate in Allied Health, Medicine, Nursing

The 1999 graduates of Texas Tech University Health Sciences Center celebrated the end of years of hard work and studying with commencement ceremonies on May 21-22 in the Lubbock Memorial Civic Center.

The School of Nursing awarded 85 undergraduate and five graduate degrees to smiling students as they walked across the stage to shake hands with President David R. Smith, Dean Pat S. Yoder Wise and Chancellor John T. Montford.

Montford praised the graduates for completing their education and being among the nation's best, and he urged them to remember their alma mater. "Through this time of your life, you have forged a beginning for your career. As you leave the stage today, please remember how you accomplished this feat with a little help from your friends and family."

The School of Allied Health handed out 177 degrees to students in occupational therapy, physical therapy, communication disorders and clinical laboratory sciences. In his remarks, Smith told the class, "We wish to welcome our newest graduates into the Health Sciences Center's tradition of excellence. We are proud to have been a part of your educational experience, and we are proud of you."

Smith also charged the graduates to be proud and worthy ambassadors of the profession. "Don't forget us, because we are dependent on you - and from now on, you will be the measure of our success."

In School of Medicine ceremonies, the first Distinguished Alumni Award was awarded to Larry Alexander, M.D. (Class of '89) by Dean Joel Kupersmith, M.D., for his effort in fighting heroin and drug addiction in the Dallas-Forth Worth area.

Alexander told the graduates that the importance of medicine is applying knowledge to care for and serve others.

"I challenge each and every one of you to go out there and make a difference in your own lives, because that is the only way you'll ever make a difference in the world," he said.

In the annual presentation of the Gold-Headed Cane, symbolizing excellence in the art of medicine and the treatment of patients, the award went to James Matthew Ross of El Paso.

Diplomas were awarded to 126 medical students. Three students received doctoral degrees and one student received a master's degree.

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DESTINY FULFILLED: For At Least One Medical Student, Match Day'99 was a Peach of a Day
by Kent Best

Fourth-year medical student Gayla Medina knew she wanted to be a doctor as far back as the fourth grade.

"I wrote a paper about what I wanted to be when I grew up," she said. "Since then I've known that I would be a doctor."

So the only mystery that remained as Medina approached the final few weeks of her School of Medicine training was this one: Where would she conduct her residency training?

The culmination of a bachelor of science degree in clinical laboratory science, followed by four years of medical school - all at Texas Tech University Health Sciences Center in Lubbock - pointed to Match Day, when senior medical students learn where they will spend the next few years of their lives.

Medina, a West Texas native from Littlefield, already had made her wish list of preferred residency programs weeks before. Among her top six were programs in Norfolk, Va., Boston, Macon, Ga., and at Texas Tech in Lubbock.

"I put in nine, but my top six I really liked," Medina said.

As the pivotal hour of 11 a.m. (CST) approached, Medina had Georgia on her mind.

"I had a phone call from Macon, and the guy there said that I was high on their list and that he hoped that they were high on mine."

Medina's parents, John and Ninfa, had traveled from Littlefield to be with their daughter on Match Day morning, but only John accompanied his daughter to the envelope-opening ceremony. Ninfa Medina was worried that her emotions would get the best of her and opted to remain by the phone at her daughter's Lubbock apartment.

"But I promised her I'd call just as soon as I knew," Medina said, laughing.

John Medina stood several steps away as his daughter mingled with friends and faculty, his demeanor one of unabashed pride.

"She has a kind heart," he said. "She's going to be great doctor because she's always wanted to help people."

What apprehension Medina felt as the minutes ticked away was heightened by two factors. First, her chosen field of surgery happens to be one of the most competitive of residencies, and second, she had completed all of her academic training - from grade school to medical school - within 30 minutes of her hometown. Now there was a good chance that she would be moving from West Texas for an extended period for the first time in her life.

When the white envelopes were distributed, Medina held hers tentatively, looking alternately at her dad and at her classmates and friends.

Finally, the rip.

"Macon, wow," Medina said as she looked up from the white sheet smiling. "I'm going to Macon."

"We've got to call mom," she said excitedly to her father who said, to no one in particular, "She's going to Georgia. Just like I told her."

"Macon, Macon. We're going to Macon mom," she said on a lobby telephone outside the McInturff Conference Center.

With shouts of congratulations amid hugs and high fives, Medina and her 1999 colleagues soaked in the moment that seemed so long in coming.

"I'm excited and happy and nervous all at the same time," she said as friends and classmates clustered in groups of threes and fours, sharing their news. "In some ways this is a bigger moment for me than graduation, because it determines where I will spend the next few years of my life."

Perhaps the only person happier to know that Medina would soon be packing bags for an extended southern exposure is Martin Dalton, M.D., chairman of the surgery department at the Mercer University Medical Center of Central Georgia in Macon. It was Dalton who had made the phone call to Medina confirming his interest in her candidacy.

"She's a real winner," Dalton said. "We look at three things when we are choosing our residents. First, we look at their grades on the national boards. Next, we consider letters of recommendation, and then the personal interview.

She scored tops in all three. In fact, she was tremendous in her interview. She was our top choice. We feel very lucky to have attracted her here."

Medina's roommate, Gina Page, a graduating medical student from Brownfield bound for Oklahoma City to begin a pediatrics residency, said her friend has the makings of a special physician.

"She's really driven, but she's also caring and compassionate. She's going to be a great surgeon," she said.

As the festivities continued, John Medina stood quietly watching his 26-year-old daughter and reflected on her days in Little Dribblers and pee-wee baseball. "She's always excelled because she works hard and because she's considerate of people.

"I'm happy for her," he said softly.

Editor's Note: The name of Martin Dalton, M.D., surgery chair at Mercer University's Medical Center of Central Georgia, should be familiar to many Texas Tech Health Sciences Center alumni, faculty and staff. Dalton was the first chairman of thoracic surgery at TTUHSC, and he and his wife, Alice, established a need-based student scholarship at the university.

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THE ROAD TAKEN: A Resident Alumnus is Helping Texas Tech Fulfill It's Mission the Old-Fashioned Way
By Michael Hughes

When Route 66 was stamped on the American collective consciousness in 1926, Wildorado was just a tiny town on the famed ribbon of asphalt that runs through rural Oldham County - home to a few farming families and maybe a cafe or two.

Back then, doctors made house calls from 30 miles away in Amarillo. Today, not much has changed. Wildorado still is home to a few families, a school and a restaurant, but for the first time in the townspeople's history, a doctor lives among them.

Dr. Michael Okogbo began his career in medicine the way many people do, and for many of the same reasons. He wanted to help, and to heal the people of his native Nigeria. Public service, it seemed, was the best way to do that.

Thus began a long road that eventually brought Okogbo to this tiny farming community of less than 300 people, yet another rural and medically underserved area in a world filled with too many such places.

He says the people of Wilderado have welcomed him, his wife Mary and their five children.

"All of us looked forward to living in a quiet community, so both Amarillo and Wildorado were easy decisions for us to make," he says. "The reception we were given has exceeded our wildest expectations. I feel very glad to have made the decision to come and live here."

Okogbo finished his pediatrics residency at Texas Tech School of Medicine in Amarillo in 1997. Since August 1998, he has lived and worked in Wildorado, helping to fulfill one of Texas Tech at Amarillo's primary missions - to train doctors who will practice primary care in underserved areas.

A search through the files of the Amarillo Globe-News reveals that Okogbo may be the first medical doctor who has ever called Wildorado home. The town is so small that, until three years ago, residents dialed just four digits to reach each other on the telephone. Currently, Okogbo is the only doctor in the entire county.

Ironically, for a town that has had limited access to health care throughout its history, the people of Wildorado probably have better access to a doctor's care these days than many of their neighbors in Amarillo.

Okogbo's office is open from 8 a.m. to 8 p.m., but in reality, his practice never closes. From Monday through Thursday, Okogbo practices medicine out of the modest clinic located in his home, the walls of which are adorned with notices of community blood drives and school board elections. Thursday afternoons through Saturday, Okogbo practices in Amarillo with Amarillo Pediatric Associates.

Okogbo's days are long enough when everything goes as scheduled. And although he doesn't complain about it, many an evening or late night is punctuated by sick children being brought to his home.

When a snow storm forced the closing of Interstate 40 this winter, a mother brought her infant son to Okogbo's clinic. The baby, suffering from a respiratory syncytial virus, was having difficulty breathing. Because of the weather, a trip to an Amarillo emergency room was virtually impossible. And, as it turned out, not needed. Okogbo provided a nebulized breathing treatment and waited hours into the night with the mother as the child's condition improved.

"Some situations have arisen in which the patient either had to go to the emergency room in Amarillo or wait until the next day," he says. "Our being here makes it possible for such patients to be seen after office hours. But that's what I'm here for."

Although old-fashioned, Okogbo says his way of practicing medicine works well in Wildorado.

"I don't know if medicine could be done more efficiently in a rural community than with a home/office. Even if you wanted to, there's really no way to distance yourself in a community like this. It involves the everyday lives of people.

"It's more than just a doctor-patient relationship. To that extent, practice out of the home is the most appropriate way to do things."

When a farmer collapsed down the street at Jesse's Cafe, the proprietors called Okogbo, who immediately rushed to his aid. Okogbo expected to find the victim of a heart attack.

On site, he learned that the man was a long-time diabetic who had been working too hard. The patient's blood sugar was out of balance with his insulin. Okogbo stabilized the man until an ambulance arrived.

"I've told my children more than once that a doctor cannot plan his life," Okogbo says.

"We were getting in the car one day to go to church when we got a call from a neighbor who had slashed her hand in the kitchen. She had been opening a can of tuna and cut herself really quite badly.

"I brought her here, changed my clothes and did the stitches. I told the children that although we may have been late for church, the good Lord knew where we'd been and what we'd been doing."

Okogbo says he now jokes with the neighbor that she should steer clear of tuna whenever possible.

Okogbo hails from a town called Ekpoma in the state of Edo, Nigeria. Born to a civil servant and his homemaker wife, he has four sisters and three brothers, one of whom also is a physician.

Okogbo attended the University of Lagos College of Medicine in Lagos, Nigeria, from 1969 through 1974, and completed a pediatric residency at University College Hospital in Ibadan in 1985. As part of his training, he also completed a one-year pediatric neurology fellowship from 1983 to 1984 at McGill University/Montreal Children's Hospital in Montreal, Canada.

Following that training, Okogbo served as an attending pediatrician at Murtala Mohammed Specialist Hospital in Kano, Nigeria. He became head of pediatrics there in 1988.

Okogbo retired from government service in 1990 and went into full-time private practice until 1995. Then, on a visit to New York, he called one of his former professors from University College Hospital in Ibadan, who recommended Okogbo for a residency position opening at Texas Tech in Amarillo.

"It was one of those happenstances of life," Okogbo says.

The former professor, Dr. Abi OK Johnson, also came to Amarillo as a professor of pediatrics at the School of Medicine, where he now heads the division of gastrointestinal medicine.

Johnson says Okogbo played a role in his own decision to accept a faculty position at Tech. "It always helps to be around people you know," he says. Robert Rumph, who refers to himself as Wildorado's superintendent, principal and just about any other title that relates to jobs needing to be done at the local school, says Okogbo easily fits into the community.

"He's been a blessing to this town. No doubt about that," Rumph says. "We drive to Amarillo for a lot of things, but having a doctor in town is something we can be proud of."

Rumph says Okogbo has been known to care for patients away from his office - most recently at a high school girls' basketball game when a player was injured.

"They called him and he just brought his kit. He may have been planning to come to the game anyway, I don't know, but it was still a nice thing for him to do."

Jackie Cleavinger, mother of the injured basketball player, says her family has been leaving Wildorado to see doctors for more than 20 years. But Cleavinger says she's never known a doctor like Okogbo.

"I know kids who have been sick at all hours of the day and night, and he's there whenever he's needed. He pays close attention to what's going on in the community. And he and his family are extremely thoughtful and kind people. It's great to have them here."

Aside from the added convenience of having a doctor in town, Rumph says Wildorado residents are encouraged by that fact that Okogbo has hospital privileges in Amarillo.

Since he came to Wildorado, Okogbo has, on occasion, even revived a custom not practiced in the community since Route 66 was transformed into Interstate 40 - the house call.

"I was driving home from Amarillo one night and received word that a gentleman wanted me to come by and see his wife, who was too ill to get out. For three consecutive days, I continued to go to the home and she eventually recovered enough to come to the office for a follow up."

Timma Gruhlkey, Wildorado resident and a mother of three boys, says Okogbo is the most accessible doctor she's ever known - a man who truly goes where he's needed.

"If he's not there, Dr. Okogbo gets back to see our kids," Gruhlkey says. "He even met me at 10 o'clock one night. It's wonderful that he's so convenient and that he moved here and really became a part of the community."

Perhaps Wildorado's sentiments toward Okogbo are best summed up by Johnson, who says he is pleased most of all that Okogbo is "doing a good job in a community where he is needed."

For a country doctor navigating a ribbon of asphalt, traveling when and where he's needed, Okogbo could receive no higher compliment.

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A PERFECT MATCH: How One Woman's Timely Decision Saved a Girl's Life
By Danette Baker

About six months ago, Tammy Kreger's lunch was interrupted by a phone call from a stranger.

"Thank you for saving my baby's life," said the tearful woman on the other end.

That was the first time Kreger and Gail Nowicki had spoken, although the women had exchanged letters.

"I just sat there for a moment," Kreger said of the call. "How do you reply to that?"

In October 1997, Kreger, an accounting analyst in cell biology and biochemistry at Texas Tech University Health Sciences Center, had donated bone marrow to Nowicki's daughter, Jessica.

Jessica was born healthy, but six years later was diagnosed with leukemia. After two and a half years of chemotherapy, doctors believed the disease was gone, said Nowicki of Eastpoint, Mich. "They told us she was cured."

Two months later, in June 1997, the cancer had returned - only this time it had attacked the bone marrow cells.

During a routine checkup, the physician found a few cancer cells in her spinal fluid, Nowicki explained. "He told us then that relapses are usually taken care of with another round of chemotherapy. But he wanted to check her bone marrow as well.

"The test came back showing almost 100 percent cancer cells, and within a few days the cancer was evident again in her blood."

At that point, Nowicki said, the family opted for a bone marrow transplant.

In 1992, two years before Jessica was diagnosed with leukemia, another little girl, this one in Lubbock, also was in need of a bone marrow transplant. Kreger heard of a local marrow drive being held for her.

"I felt such a tug to go, but at that time we were facing some tough financial situations in our family and I really didn't have the money to pay for the screening," she recalled. "I called the blood bank and they said that a local bank had paid for a certain number of screenings so I told them, 'Sign me up, I'm on my way.'"

Kreger wasn't a match for that patient, but decided to remain on the registry. In July 1997, a representative at the National Marrow Donor Program at Cook Children's Medical Center in Fort Worth called to ask if she was still interested in becoming a donor.

Two months later, a second call came. There was a 10-year-old girl in Michigan who needed a transplant and Kreger had passed the preliminary testing as a possible donor. Further testing proved Kreger to be an ideal donor candidate, because she matched all of the major criteria, said Linda Dorton, donor center manager.

Kreger traveled to Fort Worth for the bone marrow harvest. The procedure, done under local anesthetic, took about an hour, Kreger said. "There was very minimal pain. In fact, the next day I felt like you do when you get the first nice day in the spring and you spend the afternoon gardening. There was a little soreness, but oh, it was worth it."

Upon returning home, Kreger was advised to reduce her work day by half for the next week. "I didn't have that much leave time, but Dr. (David) Smith (TTUHSC president) allowed it. I was so touched that this institution recognized that medical need and granted me the time to help in it."

Meanwhile, Jessica was undergoing the transplant procedure at the Barbara Karmanos Institute in Detroit's Harper Hospital. After about eight hours, the transplant was complete and the situation became a waiting game, her mother said.

"I knew very little about bone marrow and what it did in the body," she said. "But during the wait for a donor I read a lot. It was such a shock to be told your child has cancer and now I'm just so thankful for Tammy and all the people at the transplant center because without them Jesse wouldn't be here today."

For the next year, Kreger prayed for the little girl she knew only as Jessica. "I just kept saying, 'God you've got special plans for her. Please take care of her.'"

And she called the bone marrow center for any news. Because of regulations, the donor and recipient can communicate only through center representatives for a year after the transplant, Dorton said. "After that, upon mutual consent, their names and addresses can be released."

"At six months I told them I wanted to know something, even if it wasn't good news," Kreger said. Two days later, she got the reply. "Linda said, 'Tammy, she's doing great.'"

At nine months, Kreger inquired again. And one year to the day, she said, "I want to know more about Jessica.

"I wasn't sure how to approach them. What if I call and they really just want to be left alone? So I decided to write a letter."

A few weeks later, Kreger left work at lunch, something she said she rarely does, and went home. Not long after arriving home, the phone rang and she heard Nowicki's thank you.

"I wasn't sure what to say when I dialed the number," Nowicki said. "But I had to thank her and let her know Jesse was OK."

The phone call began a series of correspondence between the two women and their families. Now Kreger said it's unusual to go more than a couple of weeks without getting a letter or phone call.

But something still was missing.

"I really wanted with all my heart to be able to see her, to put my arms around that little girl and tell her how special she is."

In February, Kreger got that opportunity. Jessica and her mom flew to Lubbock for an appreciation dinner, sponsored by the National Donor Program. At the event, Nowicki said, "I wanted to meet the person who saved my daughter's life. To try in some way to say thank you; I can't imagine my life without her.

"It takes a very special person to do what Tammy's done. A lot of people don't understand donors. But let me say this: For everyone who signs up to give, you're giving someone a second chance at life."

Amid the throng of adults, Jessica sat politely at the table, sipping a Coke and answering questions to small talk: She has two sisters, 13-year-old Katy and 15-year-old Lauren. She likes hanging out with her friends, going to movies, in-line skating and listening to music.

"The joy of Jessica's life is just living each day as it comes," said her mom.

Still she dreams of the future, like any child. "I want to be a children's doctor," Jessica said. "And work with kids who have cancer. I think I'll be good at it because I know what they're going through."

Kreger, an avid bear collector, sent a furry, brown bear with the message, "You're beary beary special," to Jessica. When Jessica came to Lubbock, she likewise brought one to Kreger.

"I don't think I did anything special," Kreger said. "I'm glad God allowed this to happen. It's opened my eyes to be thankful for what he's given us and to realize that when he tells us to be there, it's because someone else needs you."

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Shane and Teena Wimmer (Allied Health classes of '94) have their own perspectives on life in a small town. Shane, from Muenster, and Teena, from Sudan, understood and appreciated the benefits and challenges of living in small communities long before they found their way in 1997 to the West Texas town of Seminole. With an economy fired in equal parts by oil and agriculture, Seminole is much like the rest of West Texas - prosperous when outside forces are favorable, struggling when they are not. For the Wimmers, Seminole is also the place they've chosen to practice their physical therapy profession. And it's their home.

Q: Why did you decide to go into physical therapy?

Teena: I wanted to work closely with people, and be a part of a growing, exciting profession that allowed for advancement as well as flexibility for a family. My mother, who was diagnosed with MS when I was 1, encouraged me to use my talents to work directly with people to help improve their environments and make a difference.

Shane: My mother, who is an R.N. in Muenster, convinced me to consider a career in medicine just prior to registration at Texas Tech. After observing in several health care settings, I spent some time over a Christmas break with the therapist back home and fell in love with it immediately.

Q: Why did you choose Seminole?

Teena: Larry ('94) and Carissa Rossi ('93), friends of ours from physical therapy school, had begun a partnership with the hospitals in Seminole and Denver City and were looking for other physical therapists to take over in Seminole. Shane and I knew we would like to move to a smaller town (than Lubbock), and this seemed like the perfect opportunity. Another reason we moved here was that the medical facilities in Seminole are second to none for a small town. In the hospital complex, there is a fitness and wellness center, a swimming pool, P.T. offices and treatment areas, the health care center that is attached to the hospital, and an in-house daycare.

Q: What are some of the challenges you face in a small-town setting?

Shane: The challenges of working in a rural area are numerous. We are forced to be generalists as there is no room for specializing. We must be able to treat every patient for whom we receive a referral - be it pediatrics, geriatrics, orthopaedics, neurological, woundcare and even some cardiopulmonary rehabilitation.

Another challenge comes in the area of home health care. Finding some of the patients' homes can be quite an adventure. I remember the directions to one of my first home health patient's home. The nurse told me "You need to go about four miles out on telephone road to the draw. Just after you go through the draw, you'll see a deer crossing sign. Turn left at the first gravel road you come to and go to the fork in the road after you cross the first two cattleguards. Take the right fork until you cross another cattleguard and you'll see a house to the right - well that's not his house. His will be on the left in the next draw you come to - there will be a pond in the back." I knew then I was practicing "rural" physical therapy.

Q: What are some of the benefits of living and working in Seminole?

Teena: There is not a whole lot (as far as Physical Therapy goes) that the big city can offer that we can't. Our facilities make much of that possible. For example, the indoor pool offers a great addition to our therapy program. The nursing home is connected to the hospital and clinic, and we can utilize all of the outpatient equipment and resources for these patients also.

Part of our success here is a result of us being involved. There have been several rehab companies that have had contracts here and have not worked out. These therapists didn't live here or have any intentions of a long-term commitment here.

Shane: The support of our board of directors and hospital administrator are unmatched. The fitness center not only improves physical therapy delivery, but it also provides for a comprehensive wellness and preventive medicine program.

Another good aspect of Seminole is the support we have of the physicians both locally as well as in the Lubbock and Midland/Odessa areas. We have a general surgeon, OB/Gyn, and two family practitioners on staff in Seminole.

Q: What would you tell 1999 physical therapy graduates?

Teena: If I had any training and could do any job that I wanted, I could not think of anything that I would rather do than what I am doing now.

Shane:I would tell recent graduates not to be too discouraged by the tightening job markets. The important thing to remember is that although there are many therapists out there, there are not that many great therapists. That is what we need more of in the rural areas. If they can establish themselves as such, there will always be a place for them.

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The Last Word: The Cover Says It All
By David R. Smith

Texas Tech's mission extends like an interstate across West Texas and even across other parts of the nation, touching the lives of people in both remote rural communities and metropolitan cities of glass and steel offering a healing and helping hand to all generations.

Route 66 has long symbolized the American dream of happiness and a prosperous future. Thanks to the work of our alumni, students, faculty and staff, we keep that same dream alive in many of the small towns across America.

Because we have been so successful in this effort, we were rewarded in the recently concluded session of the Texas Legislature for our continuing strides to fulfill our mission. As we entered this session, our goal was to raise TTUHSC's base funding and achieve equitable infrastructure support for all TTUHSC campuses. With the help of the entire West Texas legislative delegation - particularly Senator Robert Duncan, Representatives Delwin Jones and Carl Isett, House Speaker Pete Laney and House Appropriations Chairman Rob Junell - we have accomplished our goal.

The Legislature increased TTUHSC's state appropriation for FY 2000-2001 by more than $17 million for the biennium. In addition, the Legislature included as a part of TTUHSC's base budget another $8 million that was added in last session as a one-time appropriation. As a result, the total increase in TTUHSC's base budget for the 2000-2001 fiscal years will exceed $25 million. This critically needed base budget increase will allow TTUHSC to accommodate its rapidly expanding pharmacy education programs and clinic sites, retire debt on tuition revenue bonds and commence TTUHSC's newly approved physician assistant program in Midland. The base budget increase will also allow TTUHSC to increase library and computer support at all four TTUHSC campuses and will also provide funding to assist us in providing merit-based salary increases for TTUHSC faculty and staff.

In addition to the significant increases in its base budget, TTUHSC will also reap substantial benefits from the proceeds of the tobacco settlement. The Legislature has deposited the tobacco settlement funds into a series of endowments, a number of which provide funding for TTUHSC. Only the proceeds from the endowments will be available to the various beneficiaries, therefore, funds will not be available for expenditure by TTUHSC until FY 2001. We will benefit directly from three tobacco-funded endowments. TTUHSC will be provided with funding for two $25 million endowments and will also receive a portion of another $350 million endowment established by the Legislature to support reasearch at all the state's academic health centers. These endowment proceeds will support TTUHSC research in aging, diabetes, health services research, border health and a number of other areas. This funding will also have the added benefit of allowing TTUHSC researchers to leverage additional funding from the National Institutes of Health and other federal agencies as well as from private foundations and industry. These leveraged dollars are essential to moving Texas Tech into contention for designation as a Carnegie Tier I research university as envisioned by Chancellor Montford

Other high notes from the session included enabling legislation that allows us to move forward with a healthy aging program. With this program, TTUHSC expects to become a national leader in healthy aging research and teaching that will improve the quantity and quality of life for the elderly, particularly those in rural Texas. TTUHSC also received legislative authorization for representation on the University Medical Center Board of Managers, and we believe that will be a great asset in solidifying our partnership with our Lubbock teaching hospital.

For all these reasons, we are appreciative for this investment by the Texas Legislature in TTUHSC, recognizing our institution as one of the state's and nation's major health sciences centers. We believe the Legislature's increased level of support is a vote of confidence for TTUHSC's strategic vision and the steps we have taken and are taking to make that vision a reality. TTUHSC remains committed to the people of West Texas, and with our dedication to education, service and research, we are the caring safety net that supports this broad landscape with services such as trauma I and outreach programs.

As we begin a new academic year, we are rededicating ourselves to our West Texas roots. In the coming year, we intend to reinvest in a patient-first philosophy. We are all about taking care of West Texans. TTUHSC is committed not just to high tech, but to high touch as well. We intend to make certain that the old-fashioned hospitality for which West Texans are so well known is amply evident in all we do.

For the past quarter century, TTUHSC and its thousands of graduates have saved and improved lives across West Texas and in doing so have helped to make West Texas a bit healthier, a bit safer, and a bit more secure place to live. Take another look at the cover. It says it all about the Texas Tech University Health Sciences Center.

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