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East magazine, Winter 2007 edition
Cover Story


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The New Country Doctors

How ECU's medical grads are caring for small-town families

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This is the second in a three-part series on vital ways that ECU serves the state. Part 1, on teaching, can be read here.




By Steve Row


M
ott Blair wasn’t interested in practicing medicine in a big city after he graduated from East Carolina’s Brody School of Medicine almost 20 years ago. So he hung out his shingle in his hometown of Wallace.

“I’ve always enjoyed small towns. The quality of life is good, and I get to know the people I’m taking care of. Things are more personal. I get to take care of my teachers and know their families. My third-grade teacher’s son is getting ready to go into family medicine,” he says proudly.

Younger brother Seaborn Blair (right), also a Brody graduate, feels the same way, except he set up shop in the coastal village of Oriental. “There are a lot of things I could have done, but a small town is where I felt more comfortable. I wanted to do something in a place where I felt the need. I wanted to do something to make a difference. I’ve gotten way more out of this practice than they [his patients] get out of it.”

“This is a real passion of mine,” Mott Blair adds. “I can get all caught up in family medicine. And I see family medicine and primary care becoming once again in a pre-eminent position.”

Experts agree with the Blairs about the vital importance of primary care medicine in eastern North Carolina, where finding a good doctor has been a thorny problem. Fewer than 800 primary care physicians were practicing in the region east of Interstate 95 the year the Blair brothers graduated from Brody. There wasn’t a single family doctor in Tyrrell County and only one in Camden County; in 12 other eastern counties the number of primary care doctors was in the single digits.

Today there are about 1,600 family doctors practicing in eastern North Carolina; every county has at least one and most have dozens. More than a quarter of those doctors are Brody graduates.

Since the day it opened in 1977, the mission of the Brody School of Medicine has been to train North Carolina residents to become family doctors. The school also does all it can to encourage its graduates to remain in eastern North Carolina because residents here need their help so badly. The eastern part of the state—which covers all or parts of 34 counties east of Interstate 95—suffers from several severe health problems such as heart disease, diabetes and stroke.

“If eastern North Carolina were a state, it might rank worst among the 50 states in premature deaths,” says Dr. Michael J. Lewis, vice chancellor for the Division of Health Sciences. “That’s what we’re trying to overcome.”

As research continues into cures for those life-threatening maladies, including ground-breaking work at Brody, experts say it’s the “boots on the ground”—the ever-increasing number of family doctors providing routine, preventative care—that is East Carolina’s best contribution to improving the health of eastern residents.

The region also depends heavily on the 120 or so nurses who graduate each year from ECU’s School of Nursing, which became the first four-year, degree-granting school in eastern North Carolina when it opened its doors in 1960. And as the complexity of medicine increases, with its dependency on high-tech diagnostic equipment and specialized care, the region also is counting on the more than 200 graduates each year from ECU’s School of Allied Health Sciences, which will mark its 40th anniversary in 2007.

“In my mind the best thing that we have done is to supply primary care doctors and other health care professionals to places that until fairly recently didn’t have anyone,” says Dr. Charles F. Willson, a clinical professor of pediatrics at Brody who is outgoing president of the N.C. Medical Society. “I believe the next generation of doctors will be able to prevent the diseases that are taking such a heavy toll on eastern North Carolina. But for now, it is vital to have people out there who can improve the health and extend the lives of our citizens who have acquired these illnesses over a lifetime.”


On the front lines of medicine

Mott and Seaborn Blair are the fourth generation of physicians in their family, dating back to mid-19th century western North Carolina. Their sister Elizabeth is a Greenville pediatrician who went to medical school at Duke University. A year after Seaborn and Mott graduated from Brody in 1987, their dad, Dr. James Seaborn Blair, was named national family physician of the year.

Their dad treated most everybody in the Duplin County town of Wallace, and both boys often rode along on his frequent house calls. Watching their dad care for the people of Wallace made indelible impressions on the Blair boys. “It was a wonderful experience to see what he did,” recalls Mott Blair, 47. “He made a lot of house calls in the early ’60s, and he had a story for just about every house in town.”

Given their family history, the brothers intrinsically understood the unique mission of East Carolina’s medical school—to train young men and women from North Carolina to go back to their communities and confront the health care problems plaguing the region.

Brody sets rigorous standards because it knows its graduates will be on the front lines of medicine. “We were exposed to so much stuff in our training. From the first day of my residency, I found that I could approach pretty much everything that I would encounter coming through the door,” says Seaborn Blair, 50. “There can be a surprise behind every door,” Mott Blair emphasizes.

Cynda Johnson, dean of the school, says Brody’s mission is simple: “educating primary care physicians, enhancing access to health care services for eastern North Carolina and providing educational opportunities for minorities and disadvantaged students.”

The Brody School has consistently been ranked among the top 10 in the nation for producing primary care physicians, and is among the top five in graduating African-American primary care physicians.

But getting to the point of achieving those successes was not easy. Brody’s very creation came in the face of strong opposition. Although the North Carolina General Assembly authorized a school of medicine for the region as early as the mid-1960s, getting the school started was a 10-year ordeal led by then-Chancellor Leo W. Jenkins.

Political and business leaders in the Piedmont and western North Carolina vehemently opposed a medical school at East Carolina. They thought the money would be better spent expanding the medical school at the University of North Carolina at Chapel Hill. Many of the opponents, including editorial writers at the state’s major newspapers, did little to hide their belief that East Carolina simply wasn’t smart enough or sophisticated enough to host a med school.

Jenkins saw the conflict as an attempt to defend and preserve the status quo, and as a natural dispute between the rural east and the urban Piedmont. In bulldog fashion, he pressed the issue by asking a simple question. “Should the provision of adequate modern medical care be dependent upon geography? Why should residents of the Piedmont be the beneficiaries of a 20th century health care system and Easterners relegated to one more reminiscent of the 19th?”

In 1968, Jenkins persuaded the General Assembly to appropriate nearly $2.5 million to start a two-year medical school. The school began operations in 1972, with students completing their studies at the medical school in Chapel Hill.

In 1974 the state legislature appropriated money to expand the new medical school to a full four-year institution. East Carolina acquired land for its campus in 1976, and the first class of 28 students to enroll in the four-year program came to ECU in 1977.

The School of Medicine building was finished in 1981, with more than 450,000 square feet of space on nine floors, and the first four-year medical school students graduated that year.

Since then Brody has grown tremendously and now enrolls nearly 300 students in nine main disciplines—family medicine, surgery, internal medicine, pediatrics, psychiatry, OB-GYN, emergency medicine, rehabilitation and pathology.

Brody has graduated nearly 1,650 doctors since its founding. Nearly 60 percent of them now practice in North Carolina. That’s “a far greater percent than those graduating from other medical schools in the state,” Dean Johnson says, adding that 27 percent of Brody graduates practice in eastern North Carolina.

Dr. Thomas G. Irons, associate vice chancellor for health sciences, says it often takes a different kind of person to go into this kind of medicine, instead of the highly specialized fields that can appear to be more glamorous.

“Young physicians must see it, feel it, be put in that environment” of family medicine to appreciate it. “You have to expose people to the top quality practices while they are in their residencies, and that’s what we do.”

Irons says it’s also important to let them know they will not be isolated, even if they do practice in a rural area. Through links to the school, family physicians in rural areas are never far away from colleagues or specialists at Brody.

The school’s 14-year-old telemedicine program enables physicians in distant locations to send images of a patient being examined to specialists at Brody and elsewhere. For Seaborn Blair, that’s like having “someone in Greenville help with a partial exam or consult with a patient, even though we’re on the Outer Banks.”

Irons sometimes finds it hard to believe how much has been accomplished since he arrived 25 years ago, the same year as the first four-year class graduated.

“I think we’ve accomplished a great deal—the economic contributions to the region alone are immeasurable. That in itself has had a great impact on health,” he says.

Despite Brody’s successes, however, the region’s health problems “are far from solved. We have a very long way to go, a great deal yet to do,” Irons says. “Health care is expensive, and not all these folks can afford it. This is a poor area.

“While we produce a great number of providers, we have a great distance to cover in learning how to directly intervene in underserved communities. We’ve reached the point of maturity to say that we’re here to stay, but there are still a lot of things we need to do.”


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She knows good nutrition is elementary
Every day, Claudia Bunch (above) sees two of the major health problems that plague eastern North Carolina—obesity and diabetes. What’s worse, she sees these conditions in elementary school children. As a school nurse in rural Perquimans County, she sees children as young as 8 who are overweight, who are showing symptoms of diabetes, whose parents are diabetic.

She’s always nearby when one of the school’s 400 students gets sick at school and always ready with an answer when a teacher has a question about a health issue. You could say she’s a teacher herself because she frequently goes into classrooms to present 10-minute lessons on health matters. She keeps her talks simple and focused on the basics. “I emphasize proper nutrition and exercise,” she says.

That’s why Bunch is thrilled that Perquimans County has received a $750,000 grant from North Carolina’s “Eat Smart—Move More” program because the money will help develop educational resources to combat childhood obesity.

She knows something about the local schools because Perquimans County is where she grew up. “There was no school nurse back then. You went to the sick room until your parents came to get you,” she says.

Bunch was a relative latecomer to nursing. After graduating from high school in Hertford in 1969, she enrolled at ECU, “but I didn’t know what I wanted to be or do.” She left, embarked on other careers, including marriage and family, and then figured out that she wanted to go into nursing. She entered the ECU School of Nursing in 1982 and finished with a bachelor of science degree in 1986 at age 35.

She moved closer to home in 1993 and worked at Albemarle Hospital and Chowan Hospital before being named a nurse in Perquimans Central School in fall 2004, mainly for pre-kindergarten to second grade children. “I wanted to come back home, and I wanted to work with people, especially children,” she says.

Bunch says the ECU nursing program prepared her well for her varied tasks first as a hospital nurse and then as a school nurse. “I received a very intensive, thorough education. We were exposed to the whole range of subjects.”

ECU’s School of Nursing, which now produces more nurses than any school in the state, is the oldest of the three programs that make up the university’s Division of Health Sciences. It faced stiff opposition 50 years ago when the idea first surfaced to create such a program at what was then East Carolina College. In fact, the first proposal for such a school failed in 1957.

When hospital-affiliated nursing schools began closing in the late 1950s, however, some medical professionals and hospital officials began to support the idea of a nursing school in Greenville.

Although state higher education officials remained opposed to the idea of a separate four-year state nursing school at East Carolina, the proposal was finally approved, and the ECU School of Nursing was established in 1960 as the first school in the eastern part of the state to offer bachelor’s degrees in nursing.

The school was founded with two main goals: to supply nurses as generalists for health care agencies in the region and to provide more nurses for the state as a whole.

Dean Phyllis N. Horns says the school is accomplishing those goals. “I am proud that we moved forward with new programs, including master’s and doctoral programs, but I am most proud of our growth and how our growth reflects the needs of the state. We are providing nurses at all levels.”

And the school plans to turn out more nurses in the future. Today’s classes contain approximately 120 students each; by 2010, that number should be about 150 each. The school hopes to attract more students coming out of community college with two-year associate’s degrees, for example.

Since Horns has been dean of the school, the number of undergraduates has doubled, from 260 in 1990 to 528 this year. Including master’s degree candidates and doctoral students (beginning in 2002), the School of Nursing’s growth has shown a threefold increase during Horn’s tenure—from 350 students in 1990 to more than 1,000 now.

Those numbers should grow even more in coming years, Horns says, because “we have more students interested in coming in than we can accommodate. Our applicant pool is quite large.”


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Open your file and say 'ah'
Emmanuel Yennyemb’s initial training was as a systems analyst in banking, but the more he listened to his wife talk about her job, the more he liked her profession. She was a nurse at Pitt County Memorial Hospital in Greenville.

Listening to her, the health care field sounded so exciting. He just wasn’t sure if he wanted to work with doctors and patients.

“I wanted to work more on the data side. Then I learned about the School of Allied Health and the health information management programs. I found out I could combine my skills in computers with the health field.”

Yennyemb (above), 46 and a native of Cameroon, enrolled in the ECU School of Allied Health Sciences in 2003 and completed his degree work—nearly all of it online, via distance education—and graduated in spring 2005 with a double major in health information management and health services management.

A few months later he became director of health information management programs at Bertie Memorial Hospital in Windsor, northeast of Greenville. Coincidentally, he succeeded another ECU Allied Health Sciences graduate, Melissa Chappell, when she became manager of health information systems at Chowan Hospital in Edenton.

Yennyemb’s duties require that he wear several hats. “I am the privacy officer, the compliance officer, the medical staff coordinator. I coordinate all activities in the records department and health management department, including the credentialing of physicians.”

He says he was prepared well for this job by the allied health sciences course work. “The staff was wonderful, and the resources are there,” he says. “The allied health program turned out to be exactly what I wanted.”

Yennyemb’s story is not unlike that of many students in the allied health sciences program, says Stephen W. Thomas, dean of the school.

They often are older than the typical 18- to 22-year-old college student, including those enrolled in distance education undergraduate courses. Some students already are employed in health care positions; some have come from community college with an associate’s degree and now want to complete work on a bachelor’s degree.

Despite its size (nearly 700 students) and longevity, ECU’s allied health education programs still seem to be less well known than the university’s medical and nursing schools, Thomas says.

“You could call this a kind of umbrella school that houses small but viable disciplines,” Thomas says.
Formed in 1967 as the Life Sciences and Community Health Institute, the School of Allied Health Sciences will mark its 40th anniversary next year as the first and only school of its kind in the state, a place where one can earn a degree in one of nine allied health specialties.

The school’s graduates work in physical therapy, occupational therapy, speech pathology, audiology, health information systems, as laboratory clinicians, physician assistants and in systems management.

In all, 15 bachelor’s, master’s and doctoral degrees are offered, and nearly two-thirds of the school’s students are enrolled in graduate programs.

This “umbrella school” has new visibility on ECU’s Health Sciences Campus. In late May, the school moved into about 127,000 square feet of space in a new building north and west of the Brody School of Medicine on the northwest side of Greenville. The School of Nursing relocated to the same structure a few weeks later.

Thomas, who has been at ECU since 1980 and dean since 2003, says the move will improve coordination of instruction among students in all three Division of Health Sciences programs.

“I see more interdisciplinary relationships with the other programs in teaching, research, community service and clinical practice,” he says. “Our ability to serve the region will go up.”