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Pulse Magazine Summer 00 Issue

In this issue...

Wide Open Spaces(Cover Story)

Remote Access

Lost In America

Building A Bridge

Answering The Call

A Day In The Life of a Lubbock EMS Team

Rounds - News, Views and Trends

The Last Word: Health Care & The Bottom Line

WIDE OPEN SPACES
By John Walls

Movies and novels have glamorized life in the Old West, where pioneers carved their lives out of the earth and built cities from previously barren lands. With their hands and hearts, they staked their claim to a new way of life.

The Old West is a romantic notion for many Americans, revealing a glimpse of the character of our ancestors who made something where there had been nothing before.

Years later, there are those who remain fast on the family farm or in the small rural cities that dot the West Texas landscape like stars in the evening sky.

Rural America is a reminder of days gone by, where people know each other, courtesy is common, and community matters. Where conversation between old friends over a cup of coffee at the local diner is routine, fashioned from years together in the town's schools, churches and fellowship. Where the character of a face has been forged from years of fighting sand on the farm and irrigating the fields.

The heart of America beats in the small towns far removed from the bigger cities. But that heart needs trauma care. Many small towns hover precariously on the edge of extinction, in large part because of increasing health care needs and decreasing resources.

Fewer physicians and other health care providers remain to take care of an increasingly older population. And cutting-edge health care facilities seem to be concentrated in metropolitan cities.

As a native of Hale Center, Texas, (population 2,087), Patti Patterson, M.D., has a unique perspective on rural health. Patterson, the new vice president for rural and community health at the health sciences center, believes that resuscitating small town America is possible. But the answer won't be simple and quick.

"There's no magic bullet for it," Patterson said. "It's really intertwined in agriculture economics. If the community is economically weak, it's unlikely to be able to sustain health care providers or to be able to sustain itself. If a community is thriving economically, then there would be a clinic or a hospital for doctors to remain there or locate there. But without that continuing economic force, it is extremely difficult to maintain a health care system." The demographics of rural America are a problem, she said. Rural America is growing older.

Many towns have higher uninsured rates, and many young people leave their hometowns to seek their fortunes elsewhere, sometimes from personal preferences, other times from necessity. As a result, rural health care providers are more dependent on government funded programs such as Medicare or Medicaid instead of private insurance for payment.

For doctors finishing their residencies, there is little incentive to locate in a small town and then work long hours while worrying about payment, she said.

"At the health sciences center, we can do a better job of finding folks who would be inclined to practice in these areas and help them be successful and prepared when they go there. I think it's also scary to practice there. Particularly if you're a solo practitioner. Some of these people have been out there years and years, 7 days a week, 24 hours a day. There's only one person on call in some situations. Are there ways to make lives better for the people who are willing to do that?" she said.

Just supplying primary health care is difficult for most providers in a rural town. But realize that many people require specialty care, and it's easy to see how the problem can grow, she said.

"I think one of the big concerns in a small town is the aging issue. As folks get older, there are more aches and pains and heart attacks, and more health concerns. So they're going to be more concerned about their access to health care."

David R. Smith, M.D., president of Texas Tech Medical Center, says that, as a whole, "West Texas is graying at a more accelerated rate than the rest of this nation. The bolus of an aging population here means we have increasing needs for attention to problems such as Alzheimer's and quality of life issues, as well."

Smith notes that Texas Tech has looked to address these issues by partnering with Sears Methodist Retirement System Inc. to develop a geriatric care and education center. "The Mildred and Shirley L. Garrison center will be a great treatment center and educational facility all rolled into one," Smith said. "But for us to improve rural health care, we must address health issues that run from the cradle to often decades after retirement."

Patterson noted, "Trauma death rates are higher in rural areas and highest in frontier areas, so you can't just look at trauma as an ambulance that gets you to a hospital. It's a system. University Medical Center is the only level one trauma system west of I-35. So how do you have a system when trauma care is very expensive? How do you utilize those resources and make decisions? Where do people go for primary care? What about when people have cancer and heart attacks? Is there a designated place for them? What's the best way to design overall health plans for all regions?

"We also need to be concerned about things beyond primary care such as mental health services. That's one of the things that's not out here. People in rural areas also suffer from depression. They have kids with alcohol and substance abuse problems. Farmers and suicide rates? I think they're probably quite high."

Jim Rohrer, Ph.D., chair of Health Services Research Management, is researching the accessibility and quality of care for rural Texans. The issues are intertwined, he said. "If you don't have access, you certainly don't have quality," Rohrer said.

Rohrer's group currently is surveying rural areas to determine the many factors involving rural health care, such as the variety of health problems, the frequency of visits to health care professionals and patient satisfaction. The answers are providing an insight into the many issues facing small town residents.

"We're finding that many elderly in rural areas are ill and depressed, but they are not receiving treatment because their problems aren't recognized," Rohrer said. Rohrer's group also is studying the cultural and social issues that may affect health care service delivery to Hispanics in rural and border areas. "There are many things we don't understand about why people don't go to the doctor," Rohrer said.

Joel Kupersmith, M.D., dean of the School of Medicine and vice president for clinical affairs, says that Rohrer's study will have national implications. "We'll have significant data that pinpoints the primary factors affecting rural health care. This will be instrumental in helping us find better solutions to the current crisis in rural health care."

It's important to remember that many factors affect rural health care, whether they are related to the patient or to the health care practitioner. No one solution can take care of the problem, Rohrer and Patterson agree.

For years, some futurists have pointed to telemedicine as a potentially great resource for rural America. Patterson believes that telemedicine provides hope for use in rural areas, but it isn't a silver bullet to addressing the issues.

"Telemedicine is one of those things we're going to have to learn about," Patterson said. "We 're going to have to do experiments, and some of them will fail and some will be good. You have to have some examples. It does work beautifully in some areas. It may be an answer in search of a problem. It's not the answer to everything."

And not every aspect of telelemedicine will be practical in rural communities, she said. "We have to be selective about it. At some point, the reimbursement policies have to be such that it can be self-sustained long-term. It can't just be pilot programs.

"I think there may be some beneficial things that work well on distance education. Lab workers and nurses in Alpine and in many smaller towns across Texas and the United States get their continuing education credit through distance education. We must continue to push nursing and medical education, including Internet-based education. We need to ask: Are there ways that we can support health care for the aging population? Are there applications where folks could support big consults in nursing? It's a tricky one because you don't want to be undermining people. Our goal always is to support local docs, not undermine them. We need to be real clear on that because some organizations haven't. It's never our job to undermine local infrastructure or to compete with local infrastructure, but to support it."

However, one hope for improving rural health care is to use existing technologies to transmit patient images and data to practitioners in metropolitan areas. "I think we can use our technology and improve our prevention efforts to more effectively prevent major diseases and illnesses in rural America," Kupersmith said.

Another possible application for telemedicine is bringing back the physician home visit, Smith said. "We have to think big, and this is a logical extension of taking the technological creations and inventions we have and applying them to the households across rural Texas. To have interactive communication between patient and physician through a television may seem like a pipe dream to some people. But predicting the birth and success of the personal computer business a few decades ago would have caused a few cynical comments then, I suspect."

In the short term, experts agree that it is not logical or cost effective for an entity such as a health sciences center to extend services to all small towns. As is the case with most businesses, supply and demand will dictate exactly what level of health care services go into which towns, Patterson said.

"If there's enough of a population to support a practitioner, then there's probably one there and we don't need to be doing clinics. If there's nobody there, it's probably not economically viable to be trying to do a clinic out there. So distance and sparse population make it very expensive to extend services from a hub."

For years, rural health has been a vague term, Patterson said. Many people don't understand what it means. In large part, the lack of emphasis comes because many people don't understand how rural health care impacts them.

"Fifteen percent of the Texas population lives in rural America," Patterson said. "Fifteen percent of 20 million is still a lot of people. This country has a history of trying to address special populations. What will happen to the state's economy if we don't support it? Agriculture is not the big economic driver for Texas that it was 50 years ago, but it's still significant. And it's absolutely critical for this area."

Rohrer added that urban cities should be concerned about rural towns because of their own interest in survival. "These rural towns provide agriculture, mining and other services that are critical to city economies. It's not like they can cut off rural areas and say, 'To hell with you guys.' Because you need the agriculture and other services that come from the rural areas, the urban areas can't afford to neglect those areas. That would be like shooting yourself in the foot.

"Some people say it is actually reversed," Rohrer said. "That urban areas exist to serve the region."

For those rural communities to survive, reality demands practical ingenuity focused on a holistic approach, Rohrer said. "Each city may have a different approach to addressing the problem. In one case, a town may have a population that is predominantly elderly. If that's the case, basic medical services should be partnered with a nursing home. If the town has a younger demographic, partnerships could exist with the school system."

Each community must develop a game plan to best use current assets to establish a collaborative advantage, Rohrer said.

"It takes leadership. It takes commitment to community collaboration. It takes trust. And you must have all three of these to work. And any progress toward the ideal is success because it's improvement," Rohrer said.

Kupersmith adds, "Rural health care is a big problem, and it won't be easily solved without a comprehensive commitment from all aspects of health care. This country must be prepared to step forward and address this growing national concern." Guaranteeing quality health care to rural areas is an essential part of preserving this country's heritage and history, Smith said.

"Without quality rural health care, small towns will begin to die, and we will lose part of our national legacy. We must be committed to improving the quality of life for those who choose to remain in rural Texas and America. That's a path our forefathers would be proud we have chosen."

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REMOTE ACCESS: Telemedicine Links Rural, Urban Health Care Facilities
By Danette Baker

Maria Porras describes her daughter, Aida, as a typical 10-year-old in that she adores popular solo artists Britney Spears and Christina Aguilera and can lip-sync with the Backstreet Boys. She's danced ballet, played basketball and soccer and loves hanging out with her best friend, Gabriella.

But in their hometown of Presidio, people refer to the Porras' only child as me'ha, the miracle baby. That's because she's alive today thanks in part to a technological partnership born shortly before she was.

In early 1990, Big Bend Regional Hospital in Alpine and Texas Tech Health Sciences Center had joined forces as part of a pilot project to link rural health care facilities with the university's main medical campus through emerging technology known as telemedicine. That arrangement, made available through a grant-funded research project, was under the direction of MedNet, which proved the first successful attempt with telemedicine in the public sector, although Tech had utilized the technology with the state's prison system since 1994. TTUHSC's Center for Telemedicine, created in 1997, now serves as a clearinghouse for the medical center's telemedicine consultations.

Texas Tech chose Alpine as one of its first telemedicine sites because of its remoteness and because it serves as the medical center for the Big Bend region, said Don McBeath, director of TeleHealth, Rural Heath Care and Special Projects. Ten years later, the partnership is still instrumental in helping physicians in that remote hospital, as well as sites in Hart, Terlingua and Presidio.

"We've always been a pretty isolated rural area and that proved difficult to get access to tertiary care," said Dr. James Luecke, a general practitioner at the Alpine hospital. "There are no specialists for the most part. Our closest access to them is to drive about three hours to Midland/Odessa or five to Lubbock."

Generally speaking, physicians shy away from rural settings because they are not accustomed to professional isolation, lags in technology and the degree of responsibility, said Dr. Joel Kupersmith, dean of the School of Medicine.

Those issues coupled with a frail agricultural market, the mainstay for rural America, and dwindling economies driving younger income-earning families into urban areas, are the main reasons rural areas don't have or can't afford full-time physicians, said Glen Provost, vice president for Health Policy and Planning. "I just don't think you can talk about the future of rural health care without talking about telemedicine."

In Presidio, just keeping a school nurse proves challenging, said Mrs. Porras, a para-professional in the high school computer lab. "So you can see why we have no hospitals and very limited health care."

Until about five years ago, the town's only medical facility was a part-time clinic ran by the Texas Department of Human Resources. "Now we have a clinic (Presidio Family Health Clinic), that mainly looks after minor emergencies and common illnesses," Mrs. Porras said. "The doctor comes once a week, but if you get real sick other than when he's here, you have to go to Alpine or across the border."

The choice is made based on whether one has insurance or not, she said. Those with insurance go to Alpine, which is about an hour drive, while those without make a three-hour trek into Ojinaga, Chichuahua, Mexico, where there is a hospital.

Fortunately, Mrs. Porras said they were able to give birth to their daughter in Alpine. After an uncomplicated pregnancy and delivery, Aida Aidee Porras was born a healthy 7 pounds on June 29, 1990.

"I had always dreamed of those pictures you see on TV when they bring the baby to you all wrapped up and place her in your arms.

"But instead they took my daughter away," she said. "I wasn't sure what had happened. I waited for them to wrap her up and bring her back, but instead they told me she was real sick."

Within hours of her birth, little Aida went into respiratory distress. Luecke said he had delivered the Porras infant and then proceeded with a scheduled surgical telemedicine consult. As he was completing the case, he received word of Aida's condition and asked the doctor online at Tech if a neonatologist was available for an emergency consult.

"Her heart rate had begun to drop and there was a question of myconium aspiration or congenital heart defect," said Luecke, who was on call at the time of Aida's birth. "We just weren't sure which it was."

Dr. Marian Myers, a neonatologist at TTUHSC diagnosed Aida's condition as acute respiratory distress due to aspiration pneumnoia and prescribed emergency treatment. And within a couple of hours, Luecke had administered the treatment and Aida was stabilized and headed to the neonatal unit in Odessa for observation.

"It was a life-saving consult," Luecke said. "I think I could have stumbled through it OK, but it was a big relief not having to. I could have described the infant's condition, but instead I was able to show it instead.

In an instant, he said, "I realized that sometimes a picture is worth a thousand words, and that's where telemedicine is at its best - when you can't describe well enough in words the exact situation. But fortunately, we were able to show the neonatologist the x-rays and she could immediately identify the problem.

In the past 10 years, he said no other emergency consults such as Aida's have been necessary, but the physicians at Alpine have used Tech's Center for Telemedicine for about 200 consultations.

"It's provided that necessary link we need to the specialists found oftentimes only in urban areas, Luecke said. "And the technology has helped me learn the thought processes of those specialists.

"Through consults you begin to learn what they are looking for, what questions they ask and check that out first, thereby equipping me with advancement in my knowledge and skills

"But ultimately for the patient, telemedicine allows them to remain in an environment they are comfortable with, yet feel like they've been given a good shot at a second opinion with the specialists."

Luecke was describing one of the challenges rural towns face in securing physicians, said Provost. "But does every town need one? (physician) Not necessarily."

Telemedicine is part of the answer to providing health care to rural Texas, said Dr. David Smith, president of TTUHSC and advocate of the medical technology.

The residents in Hart, a rural farming community about 75 miles northwest of Lubbock, faced such a situation. With the closest physician's office 12 miles away in Dimmitt, residents often postponed seeing a doctor until it became an emergency. But in 1998, TTUHSC enhanced a project it already had in place through telemedicine, establishing the Hart School-Based Health Clinic, perhaps the only one of its kind, headed by school nurse Retta Knox, R.N. For five years, Tech had sponsored a physician visit to Hart to provide medical care to the town's residents. Through telemedicine, Knox now conducts those visits connected to TTUHSC medical professionals.

More recently, TTUHSC helped Hendrick Health System in Abilene link up four rural hospitals to this 21st century medicine. As a result, Hendrick CEO Michael Waters dubbed Texas Tech a national pioneer in the field.

As one of the oldest programs providing medical services through telemedicine, Texas Tech consistently has garnered the attention of industry experts. Its services are ranked among the top 10 in the nation, and in 1998, Telehealth Magazine named Texas Tech to the Telemedicine Hall of Fame.

In the early '90s, Texas Tech saw telemedicine as a way to reduce costs and improve healthcare in fulfilling its contract with the State of Texas to provide health care for some 34,000 prison inmates in the western half of the state.

"What we soon began to realize is that such advancements could be beneficial among the private sector as well," McBeath said. Today, TTUHSC telemedicine network includes 13 prison sites, four rural sites and the medical center's four campuses, as well as a link to the independent network in Abilene that supports five sites. And its future looks promising, he said.

"There is unlimited potential for its use," McBeath said. "One in the forefront is in geriatric care. with telemedicine, elderly patients can access to specialized medical treatment through their hometown physician. In the case of non-ambulatory patients, such as those in nursing homes, specialty care is available without moving the patient from the home."

Tech also is developing plans to implement its Telemedicine Training Institute in order to train practicing medical professionals in the use of telemedicine, said Jon Phillips, administrator for TTUHSC's telemedicine/telehealth.

While the technology exits, getting it into the communities that need it still remains a challenge, McBeath said. "Cost is one of the main inhibitors of implementing it." The technology itself, one TeleDoc unit (the technology in which doctors transmit and receive images), costs between $20,000 and $60,000, depending on the machine's technical capabilities, plus on-plus transmission fees. In the past, TTUHSC has provided financial supported through research grants to help fund the technology. But, Provost said, communities are going to have to help in order for the program to work. "We don't want to replace the medical care they have, we want to enhance it."

Additionally, Medicaid, Medicare and insurance reimbursements originally restricted some physicians and patients from utilizing the technology, McBeath said, "but key legislation in the past few years is turning the tables in our favor."

The future for telemedicine and Texas Tech's involvement points to an evolution of technological advancements and operations. There is no doubt, industry experts say, that smaller desktop versions of the "TeleDoc" already exist, prohibited from mass production only by cost.

"In time I think we'll see a return to the home visit, in which the physician makes the house call via the personal computer," Smith said.

Luecke agrees. "There will come a time when it will be as routine as making a phone call. I see that as an asset. Ultimately it is our goal to serve people without discriminating against those who are economically and geographically unable to access care. This is just one more way to reach that group."

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LOST IN AMERICA
by John Walls

I have always enjoyed the view in rural West Texas, far away from the congestion of a city. You can nearly see forever as you scan the countryside, consisting of perfectly contoured rows in farmers' fields and telephone lines paralleling country roads that disappear once they reach the edge of the horizon. There is no deception. The future is clear and certain.

Seeing those lands and the endless blue skies remind me of my childhood, when I worked for my father on his farms. Early mornings and late evenings, my boots would scuff the dry earth as I carried irrigation pipe to prepare another drink for parched maize. Days hoeing cotton in the blistering summer heat, hot sand filtering into my sneakers, made me feel like I was one with the land.

The land was my father's mode of living; in return for its service, he honored the land and provided tender care for the fragile soil. Each year, he went through a cycle of life on the farm, planting seed, watering it, nurturing it, and tending to it until it was time for harvest. On those Sundays away from the farm, I occasionally would hear a preacher draw a parallel between the farm and the cycles of life, saying that to everything there is a season, and a time for every purpose under heaven.

For the past seven years, I have heard many people talk about Alzheimer's and how it has severed families, cutting connections from their loved ones, from the certainty of life's cycles and nature's planned seasons.

In a car headed toward Floydada to hear the story of another family that has suffered from this disease, I stare out the window and watch the fields go by, one row giving way to another and another until the scenery nearly ripples past. My eyes refocus on the horizon, and it seems like I'm staring eternity in the face.


Dorothy Campbell's face shines as she welcomes visitors to her home. She waves her guests in and offers refreshment and a place to sit.

Dorothy's house includes many mementos and photos of family through many happy years together, and she's happy to tell when it all started. Although it's been nearly 54 years ago, Dorothy says with a smile, she vividly recalls the night she met David Campbell.

A dance in the Spur Inn ballroom brought young adults from across the area. Dorothy, a clerk with AAA in Matador, was with a gentleman suitor; David, recently back from a four-year stint in the U.S. Air Corps, had appeared with a buddy.

"Sometime during the dance, my friend got separated from me and I started dancing with David. And he said, "Could I take you home?" And I said, "No you can't, I came with somebody else."

But after the dance, Dorothy couldn't find her date and her eyes turned back to David. "I said, "Do you still want to take me home? " and he said, "Sure," So that was the beginning."

Two months after that first dance in the ballroom, Dorothy and David were married. In the following years, they celebrated three healthy sons, fulfilling careers and plenty of happy travels across the country after retiring from their jobs.

About a decade ago, however, things began to change for the Campbells and their family.

"We all just noticed that David wasn't doing the things that he had usually done," Dorothy said. "He was getting provoked at things that didn't usually upset him. I guess that was the first inkling we had that there was any Alzheimer's or anything like that."

For quite a while, the signs were not so apparent. But as problems such as memory loss increased, the diagnosis of Alzheimer's disease was eventually made.

As the Alzheimer's disease became more pronounced it was difficult for the family to handle because David had always been very independent. Gale Campbell, Dorothy and David's second oldest son who now operates the farms, said the first firm belief that something was wrong came when David would get lost on his way home from the farm. "My dad always enjoyed his vehicles. He enjoyed going to the farm," Gale said. "(But as Alzheimer's progressed) we spent several days at certain times of the day trying to find him.

Greg Campbell, Dorothy and David's youngest son, recalls his mother saying that David would become confused after a trip and wonder whether he was in Bracketville, the winter home for the Campbells, or Floydada.

One day, it was clear that the family had to take away David's keys, Gale said. "My dad was a very independent individual. It had to be done and it was the toughest thing we've ever done. It took away some of his independence. It was the last independent thing he could do without someone helping him."

Eventually, one night proved to be pivotal in deciding what to do with David, Dorothy said. "David was doing strange things and seeing strange sights that none of the rest of us saw," she said. "On his birthday in 1996 or 1997, he had a real good day. � but shortly after midnight, I heard him fall, and I couldn't get him up. � After that, things just fell to pieces. He never was comfortable."

He spent 10 days in the hospital and shortly thereafter, he moved into a nursing home. "That was the worst day of my life � worse than the day he was buried," Dorothy says as she clasps her hands. "It was terrible. I just knew that day that he never would be at home again, that things would never be the way they were again. And they weren't. But my family has been so supportive �. I know that everything was done for David that could be done. And I know that we all loved him more than he'll ever know."

Dorothy recounts days of David being restless and fitful, of sometimes wandering off from the nursing home and walking across town to be discovered by old friends. Alzheimer's brought a new stress to Dorothy's life as she coped with David's changing moods, his emotional distance and a loss of companionship.

"I prayed a lot. I had friends. My family was really my mainstay. The two boys that live here � I depended on them. My church family was great. My pastor was wonderful," she says. "I have wonderful neighbors, anytime they would see me out in the yard, looking around like I was hunting for someone, they would say, "Have you lost David again?" And I would say yes. And we'd go searching for him."

The greatest comfort was to have the nursing home only a few blocks away.

"We were certainly happy to have him nearby," Dorothy says. "Almost every time I went by the nursing home, I'd go in and visit with him � he did not seem to recognize me as his wife."

Alzheimer's brought a new reality to the family, Greg said. "When daddy passed away, we were very sad about the moment. But he'd been gone for three years. We'd been missing him a long time before that."

For the sons, it also brought another concern. David's mother exhibited Alzheimer's like signs when she passed away in the 1970s. "(His death) made us more aware of our ultimate destiny," Greg said. "The possibilities that we may end up just like dad. But the love that we'll always have for one another �. that was what got us through all that. No matter what was going on in his head, we still loved him, and we missed him. There were times he just didn't know where home was. You just would have to be patient with him and remember how much they cared for you all your life. That makes it easy. All the things they did for us, we can never repay."


Margaret "Kiki" Wilcox takes visitors on a tour through the Floydada Rehabilitation and Care Center. It's the facility where David spent the last few years of his life.

In the halls, medical staff exchange friendly words, mull over medical charts and go about their routine looking after patients. In the day room, some patients gather to watch television.

Although the care center is more than an hour away from Lubbock, Wilcox notes that the 16-bed facility draws patients from surrounding rural towns such as Matador, Silverton and Quitaque.

The resilience and strength of farming communities such as these are reflected in how small towns bond together to care for their loved ones and help those families stricken with Alzheimer's, she says. "So when someone like David gets stricken with Alzheimer's the family support and the community support is so overwhelming.

"These people are either related to each other or they've grown up with each other �. ," she says. "Everybody in a small community knows the situation and they all help out as much as they can."

Because the disease can linger for so long, a caring safety net is necessary, says Paul Walker, director of social services at the care center.

"Alzheimer's is a gradual, slow killer. Most times, the family has been dealing with Alzheimer's for seven to 10 years," Walker says.

"In reality, the disease takes just as savage a toll on the caregivers," Walker says, noting that the caregivers themselves sometimes need hospitalization. "In other words, they continue to help until they are exhausted themselves."

"It is just so tragic. I've always said that there are some things worse than death. And I think that going through Alzheimer's, particularly toward the end, is so difficult for families," she says.


Our party pulls out of Floydada and begins the ride back to Lubbock. The wind has grown in force since earlier this morning, and the sky has changed its color as topsoil has been swept up by the wind.

Before we left, Dorothy handed me a letter her oldest son Gary had written to David in the last year of his life. It was very difficult at that time to communicate with David, and Gary had written the letter to try and voice his feelings, Dorothy said.

The letter reads:

"� You may be wondering, as I am, why I'm writing this letter today. I know you can't read it and I won't hear it even if it's read to you. Well, I guess I'm writing it for me. There are lots of things I want to say to you -- even though I know it's too late -- and even if you can't hear me, I want to write them down.

"Like what it was like to have you for a Dad. �."

The letter recounts memories of days gone by, of learning how to play baseball, and learning to drive a tractor, just like dad.

"You always encouraged and supported me -- and Gale and Greg -- in everything. �"

"Certainly the best lesson you ever taught me was to love my family. You did that purely by example but it was easy to see and understand. �"

"You taught me a lot and advised me well through the years. Hopefully you don't need this letter to tell you how I feel about you, but thanks for listening anyway. You know, Father's Day is about three weeks away. Thanks for being my Dad, and thanks for teaching me how to be a father. I love you very much �. Gary."

As we drive on, I think of my wife, my family, my parents and how their birthdays are just a few weeks away. What so many of us feel about our families can be found in that letter.

Maybe that's why Alzheimer's strikes such a nervous chord. The stories are personal, and the disease leaves emotional wreckage, separating loved ones from each other prematurely, cutting short the seasons of life and leaving us with uncertain horizons.

I gaze through my window and admire the strength of the West Texas spring. Windy, alive and vibrant. A passing tree obeys the command of nature and bows slightly as another strong breeze blows through.

Gary's letter and the words of the Campbells are a reminder that Alzheimer's may be cruel, but it cannot rob a family of its collective soul, the love they feel for each other and the memories that endure from years of caring for one another. Much like the tree, we bend, but we do not break. We endure.

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BUILDING A BRIDGE: Side-bar Article to Lost In America
by John Walls

Alzheimer's disease ultimately destroys communication between families, robbing the victim of memory and the ability to maintain relationships.

To help bridge that gap, Texas Tech University Health Sciences Center has established an Alzheimer's Outreach Program to benefit the afflicted and their families.

Kena Dubberly, interim director, says the program provides patient screenings to determine who might have the disease, patient care, case management and family support.

"Our goal is to make living with this disease easier for West Texans," Dubberly said.

Initiated in 1993, the program has received national awards and recognition from the National Coalition of Rural Aging and the Robert Wood Johnson Foundation.. In 1999 alone, the program provided its services to more than 25,000 people.

Dubberly, a native of Tulia, said one way the program has reached out to the small towns across Tech's 135,000-square-mile service area has been to educate and work with the region's many ministers, pastors and religious leaders.

"Religion plays such an important role in these communities," Dubberly said. "The church is a major influence in the town's social structure, and the ministers are the gatekeepers in these communities. By educating them and developing relationships with them, they can identify the early signs of Alzheimer's in their parishioners and long-time friends. With a call to us, we can help that person and that family get help sooner."

Dorothy Campbell of Floydada saw the way that Alzheimer's was affecting her husband David. His slow deterioration was painful for her and her family, but the Texas Tech program provided a support group and solace during difficult times.

"At one time, we had about eight or 10 women (in the support group) whose husbands had been in the nursing home for Alzheimer's," Dorothy said. The group would meet with Dubberly or other program representatives to discuss the problems they faced. "They were so supportive. We'll never forget the support they gave us," Dorothy said. "Kena has always told me that if I have a problem to call her."

Margaret "Kiki" Wilcox, administrator at the Floydada Rehabilitation and Care Center, said Texas Tech helped to train the center's staff and provided assistance in making the care center more compatible for people with Alzheimer's.

"Anytime I need them, I call them and they are out here," Wilcox said. "Out here in the rural setting, you kind of feel isolated some times. But I know that I have that resource, and it gives me a lot of confidence."

Alzheimer's is "an emotional roller coaster," Dubberly said. "It's difficult for everyone involved. It's tragic for the patient, but the family suffers so because of the progressive nature of the disease. We don't have a cure for Alzheimer's yet, so our mission is to reach out and provide all the support and assistance we can to help these families in need. Giving those families the tools to manage and deal with this disease, one day at a time, is the way we can help and be effective."

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ANSWERING THE CALL: Rural West Texans Respond to Communities' Emergency Needs

Emergency Medical Service, particularly in rural West Texas, has come a long way since the 1970s, when it wasn't uncommon for a funeral home hearse to transport sick or injured patients to the nearest hospital.

Mary Helen Jamerson, city administrator of Ralls, remembers those days well. "In 1972, our local funeral home, which covered Lorenzo and Ralls, wrecked the hearse they were using as an ambulance and couldn't replace it," she said. "At about the same time, the funeral home in Crosbyton sold, so all three cities in Crosby County (Crosbyton, Lorenzo and Ralls) found themselves suddenly without ambulance service."

Mayors and administrators from the three cities finally worked out an agreement in which the county would purchase the ambulances, with each city responsible for supplying and operating the units. That's when a reluctant Mary Helen became involved in EMS, from organizing classes at the mayor's request, to eventually becoming certified as an intermediate EMT. "I first took the class under a tremendous amount of objection, because I was sure there was no way I would be able to look at people who were bleeding," she said.

Mary Helen and her husband, James, a rancher, have been EMS volunteers for nearly 30 years. "I started dragging him with me on emergency runs, and he was hooked," she said.

James, who became involved with EMS in 1975, admitted he had never been one for needles or blood, either. "The first IV I ever did in paramedic school, I did on myself because my partner was out in the hall about to throw up.

"And the first five runs I ever went on, the patients were either dead at the scene or DOAs," he continued. "I didn't know if I wanted to keep doing it. But it's addicting. There's nothing like knowing you did it right, that you saved someone's life."

Rusty Powers, EMS director in Olton, became involved in 1980 after being recruited by his brother because there was a shortage of volunteers. Olton's EMS program was formed in February of 1979 and had, until that time, been provided by the local funeral home, as well.

"I always thought it seemed like a conflict of interest for the funeral home to be taking people to the hospital," he joked.

Powers, in addition to directing the Olton program part time, is a full-time paramedic with the Plainview Fire Department. He says he never intended to go into the medical field before he became involved with EMS. "I had no interest in medical service before I got involved, and I ended up making a career out of it."

Olton has about 52 volunteers associated with EMS, Powers said, a substantial number for a city with a population of about 2,300. About 15 of the volunteers are certified. The others volunteer as drivers or dispatchers.

"One thing about taking emergency calls in a small town, you know about 95 percent of the patients you're working on," Powers said. "I've picked up practically every member of my family - my dad, my son, my sister, my nieces, my wife's grandparents. It does make it harder on me, but I think it makes them feel more comfortable, knowing they are in good hands."

Communities pulling together

Ralls and Olton are like most towns across the South Plains, in which members of the community go through courses to become certified as a basic or intermediate Emergency Medical Technician or a paramedic, which is the most advanced level of EMS certification. And in rural areas, these services often are provided on a strictly volunteer basis.

"The volunteers in rural communities are mostly farmers or agricultural workers," said Charla Mitchell, regional coordinator of South Plains Emergency Medical Services Inc. (SPEMS), a network of rural and suburban EMS providers. "Sometimes there is one paid position, usually the EMS director, but most of the service is completely volunteer. They will leave their job when paged; they will jump off the tractor to tend to an emergency call."

The Emergency Medical Services Programs in Texas Tech Health Sciences Center's School of Allied Health, in conjunction with South Plains College, provides basic EMT, intermediate EMT and paramedic training programs. Some courses are offered at the Tech Health Sciences Center. Others are offered all over the South Plains, usually in the evenings. Powers and the Jamersons have all taught courses - usually on a volunteer basis - throughout the area in towns like Jayton, Bovina and Silverton, as well as their hometowns. SPEMS named Mary Helen Instructor of the Year in 1995.

This fall, TTUHSC will begin an EMS bachelor's program - the first of its kind in Texas. In fact, fewer than 10 such programs exist nationwide, said Paul Brooke, dean of the TTUHSC School of Allied Health.

"This EMS program will specifically focus on preparing non-traditional students to assume leadership roles," he said. "It was specifically designed to enhance educational opportunities for rural West Texans."

TTUHSC also serves as the statewide education coordinator for EMS training, said Mike Nunnelee, academic instructor for EMS at the Health Sciences Center. Tech provides the state training coordinator, who offices at the Texas Department of Health in Austin and serves as advisor to TDH. Tech is responsible for writing and producing the statewide EMS certification exam.

Rural EMS in the 21st century

James and Mary Helen Jamerson and Rusty Powers all agree that the practice of EMS has changed dramatically since they began volunteering.

"The level of skills that EMTs have now is great," Powers said. "We're really blessed in this area. The TTUHSC emergency service doctors have a lot of confidence in area paramedics, because we practice under their licenses." Charles R. F. Baker Jr., M.D., professor of surgery at TTUHSC and former director of EMS training programs, wrote the first protocols allowing paramedics to practice under a doctor's license.

Fred Hagedorn, M.D., associate medical director for EMS training programs at TTUHSC and medical director of Lubbock County EMS, said rural medics face special burdens, such as longer transport time and distance to the patient. "And these patients are not strangers," he said. "They are friends, neighbors and sometimes members of their own family. I really think it's amazing what they do."

Hagedorn, who also serves as medical director of SPEMS, noted that in the past 20 years or so, there has been tremendous growth in what paramedics are allowed to do. "We absolutely think paramedics provide a vital link with the outlying communities," he said. "There are counties on the South Plains with no hospital and sometimes no physician. The ranking paramedic is the health provider in those communities."

Technological advances like radio access to a physician in the emergency room, as well as increased skills levels, have made a tremendous impact on EMS programs.

"When we would get a call, we didn't have radios, so we would get on the phone and start calling the list of volunteers until we got somebody that could go," Mary Helen Jamerson said. "Until SPEMS formed, there was no radio communication." Francis Jackson, M.D., currently a professor of surgery at TTUHSC, was instrumental in creating SPEMS in 1977 and acquiring grant money for radio equipment.

Ralls, with a population of about 2,200, has 16 EMS volunteers now. Three-man crews rotate taking emergency calls. Mary Helen says it is particularly hard to track down EMS volunteers during the day because so many work outside the city.

"I envision us contracting with a paid service in the future, because it is becoming more and more difficult to operate with volunteers," she said.

As EMS has evolved and more services have hired personnel, public expectation has risen, Mary Helen continued. "We did a lot of good patient care all those years just using very basic principles. Sometimes I think all the bells and whistles we have now, they're nice and are certainly more fun, but young paramedics sometimes tend to forget to take care of the basic things because it's easy to just let the machines take care of everything."

James and Mary Helen have both performed CPR on patients for the duration of the trip from Ralls to Lubbock, which is about 32 miles. "You can't even get out of the unit after that, you're so exhausted," James said. "You can physically do CPR the whole way, because you're running on adrenaline, but once you get there, you're just completely spent."

But the gratitude of the community is a potent motivation for EMS volunteers. James recalled a young woman approaching him in the local Dairy Queen, asking to hug his neck. He didn't remember her at first, but later realized he had treated her about four years earlier for insulin shock. "Her doctor told her if I had not correctly diagnosed and treated her on the scene, she would have had severe brain damage," said James, who was SPEMS Volunteer of the Year in 1997. "Things like that make you feel good and make you want to keep helping people."

Mary Helen agrees that being able to help others makes it all worthwhile. "When I got my certification and was able to help people, it was wonderful," she said. "It's the best feeling I've ever had in my life.

"It's hard to believe we've spent 25 to 30 years doing something we never thought we really wanted to do."

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A DAY IN THE LIFE OF A LUBBOCK EMS TEAM
By Julie Toland

The station house is almost like home. Two recliners and a couch surround a television, there is a full service kitchen with a bar, a computer, bookshelves - and a bedroom for catching naps during the 24-hour shift.

Lynn Wallace and Britton Wood, paramedics for Lubbock EMS, arrive by 7 a.m. for their shift that will end at 7 a.m. the next morning. This is their schedule every three days.

Today they have agreed to let me spend several hours observing first hand what it's like to respond to medical emergencies in Lubbock County.

The morning passes quietly with no calls and very little radio activity. Wood flips through television channels, while Wallace attempts to contact the district attorney's office by phone. EMS personnel are frequently called to testify when they have responded to calls that result in legal action - shootings, stabbings, domestic violence.

The five Lubbock Emergency Medical Services stations respond to 911 calls within the city. Lubbock EMS serves Lubbock County and is the training ground for Texas Tech Health Sciences Center EMS students. Wallace serves as a field trainer for students and EMS personnel new to Lubbock.

EMS personnel fall into three categories: EMT basic, intermediate and paramedic, which requires an additional three semesters of course work. "Paramedics can administer drugs, put in chest tubes and perform more advanced procedures," Wood said.

Later in the morning, Debbie Smith, continuing education training officer, arrives to give a refresher course in proper medication dosages. "We have to take a state test every four years to recertify," Wood says. Wood, Wallace and trainee Glen Anderson, who has recently moved to Lubbock from Austin, sit in the adjoining classroom and answer every question with ease.

The first call comes at 11:15 a.m. The patient is at Freedom Clinic and is having trouble breathing.

Upon arrival, we are met by a doctor at the clinic, who had been treating the woman's grandson. The elderly patient has congestive heart failure and the doctor felt she should be transported to the hospital for further tests.

Once she is loaded and we are on our way, at a reasonable speed without flashing lights and siren, the paramedics go to work starting an IV and easing the patient's fears as best as they can, as the Hispanic woman speaks no English. They are very kind with their tone, and they try to make her understand where they are going and what they are doing.

Once at the University Medical Center emergency room, the patient is unloaded, taken to a room and a full report is given to the attending physician. There is a camaraderie between the EMS workers and the emergency room staff, a mutual respect for each other and the similar jobs they perform.

Outside by the ambulance, Wallace talks about some of his more harried days. "One time we had 21 calls in a 24-hour shift," he says. "That's probably the most I've ever worked. The average is usually 10 to 12 in a day."

On the way back to the station riding in back with Wood, I ask him if he's ever had to work an accident that involved someone he knew.

"Probably the only one is Hunter," he says after a time, referring to his 8-year-old son. "I got called to a car wreck north of town. Hunter was hurt pretty badly with a head injury, a lot of swelling. He didn't know who I was when I got there.

"We took him to the ICU," he continued. "It didn't really affect me until I sat down in the ER waiting room and someone else had taken control."

Hunter later was able to recognize his dad and has fully recovered.

Back at the station house, we resume the waiting game. The second call, an assault, comes at 1:30 p.m. Upon arrival at the home, we are greeted by two Lubbock police officers, who direct us to a 19-year-old woman who has fallen and twisted her knee after being shoved by her husband.

On the way to the hospital, Wallace gently counsels the young woman. "Has he ever done anything like this before?" he asks.

She tearfully replies that this is the first time it has escalated beyond verbal fighting.

"You know," he continues, "most men who hit will hit again."

She nods.

"I don't mean to tell you what to do," Wallace says. "But you need to think about your options. You need to know that you have options."

The young woman is silent the rest of the way to the hospital.

Again standing outside the ER, waiting for the final reports to be given, Wallace talks about his experiences and describes the worst scenes he's encountered.

"I've worked several multiple fatalities - those are always bad," he says. "Severe burns are really bad because you know what their future will be like, if they make it.

"It is always hard to see children in arrest," he continues, "especially if they are close to your own kids' ages."

Wallace says a majority of calls are medical - chest pains, congestive heart failure, emphysema complications. He notes that with the growing aged population in this region, most calls will be medical. He estimates that about 20 percent are trauma related - accidents, falls, gunshots.

"In this job, you have to be compassionate, but sometimes you have to be almost cold to distance yourself, to get through it," he says. "There's a lot of stress involved with what we do.

"There's a lot of bad stuff with this job," he continues. "But you feel good when you're able to help people. That's why I do it."

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Rounds: News, Views & Trends

LASER SURGERY NOW AVAILABLE AT TTUHSC SOUTHWEST CENTER

The Laser Surgery and Vision Institute at Texas Tech Medical Center Southwest opened its doors on Dec. 10, its mission to focus on research and resident education, as well as offer the highest quality of patient care.

Doctors at the center use an Excimer laser to treat nearsightedness, farsightedness and astigmatism, said David McCartney, M.D., chairman of the Texas Tech Department of Ophthalmology and director of the center. "This is a very different surgical procedure than most of what we do because it is all about patient satisfaction," he said.

Two full-time Texas Tech Medical Center surgeons, McCartney and Clint Gregg, M.D., as well as two community physicians, are trained to use the center's Excimer laser. But any clinical faculty member who goes through the proper training can be credentialed to use the equipment.

The center was established as a collaborative effort between the departments of ophthalmology and managed health care at Texas Tech Medical Center. "This was developed as a business venture, though we don't expect the center to make huge amounts of money," said John Murgai of the Department of Managed Health Care and administrator of Texas Tech Medical Center Southwest. "Our main objective was to provide a service for our residents, physicians and the community."

The Excimer laser reshapes the cornea using energy from the pulses of emitted ultraviolet light. The laser is used in two different procedures - photo refractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK). PRK involves removing surface cells of the cornea by laser, chemical or mechanical means, then reshaping the cornea. The LASIK procedure uses a microkeratome (specially designed vibrating knife) to precisely split the cornea, which is folded back as the laser reshapes the cornea.

The laser treatment is very quick - generally less than 60 seconds per eye. The entire procedure, including anesthetizing the eye with drops, takes about 15 minutes. Patients cannot see the laser and experience little or no pain. Sometimes a protective contact lens or eye patch is used to protect the treated eye, and patients generally are able to see clearly a couple of days following the surgery.

More and more Americans are undergoing the treatment; it already has been performed on more than 1 million eyes in the United States alone. And in the next year, McCartney expects the procedure to be more common than cataract surgery.

DIET EMPHASIZES WHOLE FOODS

Many Americans are consumed with losing weight, yet nearly 25 percent are obese and that number continues to grow, says Kathy Chauncey, Ph.D., R.D., of Texas Tech Medical Center's Department of Family and Community Medicine.

In fact, the percentage of obese Americans has risen by about 10 percent since 1980. Chauncey attributes the jump to increased soft drink consumption, salty snacks, cookies, fast foods and convenience or microwaveable foods.

But Chauncey has found success in reducing patients' weight, triglycerides and overall health risks with the "Whole Foods Weight Loss Diet," which focuses on getting back to whole, unprocessed foods.

"This is not the diet for everyone, but it is the diet for most everyone," Chauncey said. "Patients find it very doable and tend to leave my office a bit more optimistic, rather than feeling like they are going on a diet that's going to ruin their life, or that they are going to have to starve to death."

Chauncey has extensively researched the types of foods Americans are eating, and has concluded that the sharp increase in obesity is largely a result of too much emphasis on low-fat or fat-free foods, along with an increased intake of refined sugar and flour products. "We've put too much emphasis on low-fat and non-fat, when actually unsaturated fats in moderation are good for us."

The Whole Foods Weight Loss Diet categorizes foods as green-light or "go" foods, yellow-light or "caution" foods and red-light or "stop" foods. "Go" foods, or foods than can be eaten as much as needed to satisfy hunger, include fruits and vegetables, lean meats and low-fat cheeses, eggs, condiments and low-calorie beverages.

Foods that should be eaten with caution (5 servings a day) include carbohydrates, especially refined flour and sugar products. However, all carbohydrate choices, including bread, pasta, breakfast cereal, oatmeal, potatoes and beans, are limited to 5 servings per day. An occasional alcoholic beverage can be substituted for a carbohydrate, as well. Two cups of low-fat milk a day are included in this category, along with 6 servings of mono-unsaturated fats.

Prohibited or "stop" foods include additional carbohydrates, sweets, cereals, thick sauces or soups, puddings, ice cream, sugar, or additional alcoholic drinks, sweetened fruit drinks or sugar-sweetened carbonated beverages. Animal fat, which raises LDL or "bad" cholesterol, should be avoided, as well.

She also recommends 30 minutes of moderate exercise, such as walking or swimming, five days a week. And anyone starting a weight-loss and exercise program should check with their doctor before beginning.

Chauncey has been using the Whole Foods Weight Loss Diet with patients for more than a year now, and she and her patients are very pleased with the results. "This is by far the most successful program I have ever used," she said. "And patients respond to it very well. Not only are they losing weight and body fat, but they are becoming healthier overall."

GREEN NAMED NEW SON DEAN

Alexia Green, R.N., Ph.D., has been appointed new dean of the Texas Tech Health Sciences Center School of Nursing.

Green currently is chair and professor in the Department of Nursing at Lamar University in Beaumont.

"During her tenure at Lamar, she has provided leadership and a personal touch for students while enhancing educational programs, research and grant activities and community support services," said TTUHSC President David Smith, M.D. "She will be a valuable asset to the nursing school and the health sciences center."

Green said her first goal upon arriving by July 1 will be establishing a relationship with students, faculty, and the community. "I especially look forward to getting to know the students. As a previous advisor to the Texas Nurses Student Association, I have always admired the Tech nursing students for their enthusiasm and leadership qualities. It will be an honor to work directly with them."

Another short-term goal will be to work with the faculty and students to strengthen the undergraduate curriculum.

"Long term, I hope to assist the faculty and students to establish a broad based research program which will attract state, federal, and local funding opportunities. My experience in grant writing has shown me that research and grant activities strengthen all components of the nursing program and create opportunities to link to the community."

In addition to attracting grand funding, Green worked with faculty at Lamar to redesign the undergraduate curriculum and to create a new curriculum for a master's of science in Nursing Administration degree.

Green, who has been involved in telemedicine programs in the past, said knowing that TTUHSC has a strong telehealth program helped convince her she was a "good fit" for Tech. "I hope to leverage my past experiences with Texas Tech and to strengthen my knowledge in distance learning and telehealth," she said "Both areas are exciting and challenging."

Green says she looks forward to relocating to West Texas, though it is somewhat different than East Texas. "Obviously there are fewer trees, but I found the West Texas people very receptive and friendly, 'willing to take an East Texan and work toward making them into a strong West Texan'!"

GOVERNOR APPOINTS SANCIBRIAN TO BOARD

Sherry Sancibrian, M.S., speech-language pathologist and program director for the Department of Communication Disorders at Texas Tech Health Sciences Center, has been appointed by Gov. George Bush to the State Board of Examiners for Speech-Language Pathology and Audiology.

"This is a prestigious honor for Sherry and the Department of Communication Disorders," said Paul Brooke, dean of the TTUHSC School of Allied Health. "Her knowledge and professionalism will serve the state board well."

Sancibrian will serve on the seven-member board until August of 2005. The board, based out of the Texas Department of Health, meets at various locations around the state to approve licenses, establish rules for continuing education, receive consumer complaints, and basically maintain licenses for about 6,000 professionals in Texas.

The board evaluates qualifications of and provides examinations for individuals applying for licenses as speech-language pathologists or audiologists.

DAUM ASKED TO SERVE ON ADVISORY BOARD

ODESSA-Wayne J. Daum, M.D., regional dean for the School of Medicine at Texas Tech University Health Sciences Center Permian Basin, has been asked to serve on the School of Medicine Advisory Board of Saint Louis University in Saint Louis, Mo.

A 1971 graduate of Saint Louis University, Daum has held teaching positions at the University of Texas Medical Branch in Galveston and the University of Texas Medical School in Houston.

The newly formed Advisory Board of Saint Louis University will work Daum to provide valuable, external perspectives; offer advice, expertise, and useful criticism for the School of Medicine programs; and identify trends in healthcare. As ambassadors for the university, board members will promote valuable relationships with alumni and friends and identify opportunities for the placement of graduates.

"One of the benefits of my serving on this Advisory Board is that it will allow me to network with other academicians outside of this region which could possible lead to shared projects in the future," Daum said.

LITERACY PROGRAM PROMOTES READING AT AN EARLY AGE

ODESSA-The School of Nursing in the Permian Basin received approval from the national organization of Reach Out and Read to be a site for the national literacy program which seeks to encourages parents to read to their children at an early age.

Texas Tech Reach Out and Read Permian Basin allows nurse practitioners to give a book to every patient receiving a well-child checkup between the ages of 6 months and 5 years. The program teaches parents how to effectively read to their children by offering reading tips.

"The ability to read is a lifelong gift that impacts every aspect of a person's life. Giving children an early start in reading will give them a head start on a love for learning," said Sharon Cannon, R.N., Ed.D., regional dean, School of Nursing Permian Basin.

Volunteer readers in the clinic waiting room read to children as they wait for their appointments, demonstrating to parents the joys and techniques of looking at books with children. While the pediatric patient receives a new book from the health care provider, siblings receive a used book from the volunteer.

Through Texas Tech Reach Out and Read Permian Basin, every child can begin kindergarten with a home library of at least 10 children's books.

CONSTRUCTION TOP PRIORITY TTUHSC FOR PERMIAN BASIN

ODESSA-The School of Allied Health at Texas Tech University Health Sciences Center in the Permian Basin is putting "construction" on its priority list. Two major construction projects are under way on both the Midland College and Odessa campuses.

Started in March, a new building is being constructed on the Midland College campus to house the school's new Physician Assistant Program. The building reflects the "developing collaborative effort between Texas Tech University and Midland College," said Robin Satterwhite, regional dean of TTUHSC's School of Allied Health. The building under construction is planned to have one side designed to accommodate Midland College's needs, and the other half designated for TTUHSC. Completion for the project is planned for June 2001.

"The Tech side will have classrooms, teaching labs, administrative offices and student areas," Satterwhite said. "We have emphasized the student areas because the students in the Physician Assistant Program spend a tremendous amount of their time at school. We want a student-friendly environment."

Physician assistants are trained in a variety of medical settings to serve in both rural and urban areas, which will ease problems caused by a physician shortage.

"We are very excited about what is going on with the PA program," Satterwhite said. "We have just recruited a new class of 12 students for the baccalaureate program. I feel very comfortable with how the PA program has progressed."

The other construction project currently occurring at the TTUHSC Permian Basin is a remodeling project that will allow for the entire School of Allied Health to be housed under one roof.

Currently, some classes are held in the TTUHSC academic building while administrative offices and other classes are housed several blocks away in the Professional Tower.

The project will involve remodeling about 14,000 square feet of vacated space into classrooms, student areas, administrative offices, computer facilities and labs. "This will complete the strategic plan to accommodate all the various schools at one location," Satterwhite said.

The total project is expected to be finished Sept. 1, 2000.

PERMIAN BASIN ADVISORY COUNCIL ALLOCATES $12,000 TO SCHOLARSHIPS

ODESSA-The Advisory Board of Texas Tech University Health Sciences Center Permian Basin allocated $12,000 in local scholarship funds to the School of Nursing and the School of Allied Health.

The TTUHSC School of Allied Health received $10,000 from the Advisory Council, and the Permian Basin School of Nursing received $2,000.

"The impact of this type of giving is pivotal in the development of the School of Allied Health and its programs," said Robin Satterwhite, regional dean, School of Allied Health. "This will more firmly establish a community and regional commitment to the students who are attending our programs within the Permian Basin. Additionally, it provides a significant base of money to develop the enrollment within new and existing programs."

These scholarship monies will help students in the various programs to purchase books as well as pay for tuition. This money will help in the development of both schools and the programs that each offers. Students will be chosen for the scholarships based on merit and need.

"Support of medical education in the Permian Basin is three fold," said Margaret Purvis, chairman, TTUHSC Advisory Council. "First, area residents and other students are given the opportunity to fulfill their dreams of becoming nurses, physical therapists, occupational therapists or physician assistants. Secondly, adult students with families can remain at home to receive the training they desire. Finally, it allows for the retention of highly skilled healthcare professionals in the Permian Basin."

SOUTHWEST FACILITY HAS GRAND OPENING

Officials celebrated the grand opening today of the new Texas Tech Medical Center Southwest facility, Quaker Avenue and South Loop 289 (the old South Park Hospital facility).

This major medical site will include family medicine, obstetrics and gynecology, pediatric, internal medicine and occupational medicine clinics.

In addition, Texas Tech Medical Center Southwest will include a day surgery center, a laser surgery and vision institute, a treatment center for chronic pain, and a dialysis center.

"We're particularly happy to have a "Fast Track Clinic" to help families in need after hours and on weekends," said Joel Kupersmith, M.D., dean of the Texas Tech School of Medicine. "The emphasis in the clinic will be to provide quick and timely attention to patients who need medical care, but who don't need the complex attention provided in an emergency room." The clinic will be open from 5 p.m. to 10 p.m. on Monday through Friday and from 9 a.m. to 3 p.m. on weekends and on holidays.

Texas Tech Medical Center bought the old South Park Hospital from Tenet Corporation in 1998. With all the new clinics and institutes in operation on the complex, about 160 people will be employed at the complex. Of that total, more than 80 new jobs have been created for the Lubbock economy.

"We're happy that this complex provides us the chance to extend our expertise to a new location in southwest Lubbock and to partner with some great companies," Kupersmith said. "We also will continue to look at opportunities with other health care partners to add more health care services to Texas Tech Medical Center Southwest."

CAMPBELL JOINS TTUHSC DEVELOPMENT TEAM

LUBBOCK-With over 20 years experience in development, Linda Campbell assumed the role of associate vice chancellor for development at Texas Tech University Health Sciences Center June 1.

"We are looking forward to the knowledge and leadership she has to offer to the development of TTUHSC," said David R. Smith, M.D., president of Texas Tech University Health Sciences Center.

Campbell says her overall goal for development at TTUHSC is to maximize fundraising opportunities.

"I think this is an exciting time to be at TTUHSC, especially with the development program and the ongoing advances in health care and academic medicine. I came here to continue to build and expand the HSC development program," she said, referring to the newly created position.

Campbell was formally employed with the Medical College of Wisconsin in Milwaukee as the assistant vice president for development. Prior to that she worked at MD Anderson and Rice University in Houston.

Originally from Middletown, Penn., she holds a bachelor's degree in history from Wilson College, Chambersberg, Penn. and a master's degree in European history from Boston College.

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The Last Word: Health Care & the Bottom Line
By David R. Smith, M.D. - President, Texas Tech Medical Center

The mystery of medicine has grown with the increasing use of space-age technology and genetically engineered pharmaceuticals that help us in our battles against crippling diseases and killers such as cancer.

Perhaps the greatest mystery, however, is how we are losing the art of medicine.

For all the glory and the glamour, many of our patients would trade technical proficiency for personal kindness, an extra moment by the bedside or a kind word on the phone.

At its best, medicine combines scientific knowledge with the compassion to reach out and touch the lives of patients. With too much attention focused on the cost of health care, the caring side of health care has suffered.

Studies have shown us that patients are dissatisfied with medicine -- they want a greater say in choosing their practitioner, and they want that practitioner to be human, not a mystery.

The perception among some people is that medicine has changed for the worse. And as any public relations person worth their salt will tell you, perception is reality. So we better get about the business of embracing the roots of this profession.

We must change the culture of medicine and embrace the needs and values of our patients so we can reestablish personal bonds, and we will need help from the payers of care to allow patients the opportunity to maintain those bonds and not disrupt them every 12 months.

Medicine treats people at their most vulnerable moment. In some situations, our patients find themselves in embarrassing, sometimes degrading situations, wrapped up in ill-fitting gowns and offering up blood and urine for various tests.

Health care is scary enough when patients are on stretchers and forced to look wide-eyed at blinding overhead lights. We must remember that antiseptic applies to the cleanliness of the facilities, not the personalities.

Medicine must "individualize" the patient. Unfortunately, more attention is paid to the business bottom line in health care. There is only one bottom line -- the patient. That patient is a feeling, thinking person who has come to us for help.

Changing the system will mean rewarding those who excel in the humanities of medicine.

As a part of our new "Patient First" program at Texas Tech Medical Center, we are making patient feedback a part of our incentive program for all of our clinic faculty and staff. Good patient reviews can lead to incentives for both physicians and the staff

Also as a part of that program, we are reemphasizing patient satisfaction in our approach to education. We are dedicating classes to ensure that our students are more than technically trained; they also must be able to establish communication and understanding with their patients.

Ask anyone you know about their preferences for any kind of product, ranging from restaurants to automobiles to shoes. Most of the people you talk to will mention service and mention it as a primary consideration in making their decisions.

Medicine is no different. If we want to continue delivering the best health care in the world, we must take a hard look at ourselves and put the focus back on treating people not just with the utmost care, but with the utmost consideration as well.

If we don't, we'll continue to suffer from this impersonal ailment. And two aspirin in the morning isn't going to fix the problem.

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