East Carolina University. Tomorrow starts here.®
Meet Our Pirates

You have been working here since 1981. What led you to ECU?



I went to Davidson College then attended medical school at UNC-Chapel Hill. I did my first year of residency in California. I loved the city and thought I would live there forever. But, I wasn’t satisfied with the quality of training. I was following around very important people and doing their bidding, but I didn’t feel like I was learning anything. So, I came back to UNC-Chapel Hill with my family and finished residency there. Due to a three-year military obligation, my family and I went to Germany and I served there for three years. After that, I decided I wanted to practice medicine and teach as well. I went into a private practice in Raleigh and had a quarter-time teaching appointment in Chapel Hill. We rotated the teaching appointment within the practice, and it was all done there in Raleigh with the students coming to us. I thought this would make me happy, but I grew increasingly unhappy. I was making a lot of money, but my work wasn’t rewarding in the way I thought it should be. I came home one night and told my wife I couldn’t continue to go on this way. I figured I could work another 10 years in the job so we could save money, then I could do something worthwhile. Well, my wife told me we weren’t waiting, and I was going to do something worthwhile now. In 1981, I was posted in New Bern, where my family and I lived for two years while I set up a primary training program there. I was then moved to ECU and became the section head of general pediatrics.



Tell me what you enjoy about being a pediatrician and teaching at ECU.



I absolutely love and respect all of my patients and their families. I also love the staff—everyone from the nurses to the custodians. I feel like they are my family. They are all wonderful people, and there is such a good spirit here.



Teaching is in my blood, and I truly love it. I enjoy all different kinds of teaching from one-on-one, to teaching in the classroom, to small groups, to bedside instruction. I especially love to have the resident come out and tell me about the patient, and then we go in to see them. Hopefully, I can model for the residents the right way to interact and how to respect people in such a way that they will trust you.



Tell me more about working with medical students.



I love to teach them about the science of medicine, but I also really love teaching them about the art. I want them to learn how to listen mindfully to the patient and to figure out what’s going on by understanding better where the patient is. To do this, they must think about the context in which the patient is operating, the context in which the illness is occurring, where this person lives, and what their environment might be like. I also like to teach them how to hone in on subtle cues—the tear that pops into the eye, the face that looks down suddenly. I want my students to learn not to move on but to stop a minute and say, “What’s going on? Are you ok? Tell me.” The patient usually wants to talk, and it doesn’t take long! It’s not as if you have to sit there all day, but you do need to stop and listen. This is a family. It’s forming an intimate relationship with the patient to feel a little bit of what they feel, to see into their hearts, and to reach out to the good that’s in them and to help them deal with the problems they have.



How did you become interested in pediatrics?


 

I was born into it. Both of my parents were doctors, wonderful human beings, and great role models for me. My mother was also a pediatrician. She took my brothers and me everywhere. We hung out in her office in the afternoons after school, and we went on house calls. When I was 12, I was allowed to go on the hospital wards with her and help. I would hold a baby for a spinal tap or just do whatever had to be done. She taught me in the process a lot about social justice and set my heart right in terms of advocacy of social justice in health care. I went to medical school pretending that I didn’t know what kind of medicine I wanted to do. But, I eventually realized that pediatrics was what I wanted to go into.



You have received many awards, including the Award of Excellence in Public Service and the Clinical Science Faculty Award. How does it feel to be recognized for your various accomplishments?



I really don’t want to be rewarded for anything other than what I have given. When I am rewarded for what I have given, for my service, I feel really good about that. But, I am careful to make sure that doesn’t go to my head. Truly, nothing for which I have ever been recognized is really mine. It belongs to the colleagues, patients, families, community members, and all of those with whom I have had the privilege to serve. It’s just not mine. It’s so important to retain the posture of service. I use a mental picture of myself on my knees in front of a patient examining them rather than standing. It’s where you are supposed to be, and that helps a lot. As long as one remains in that posture, one can be far more effective.



You were an integral part of the creation of the James D. Bernstein Community Health Center. Tell me more about that.



The flood of 1999 gave me a huge epiphany. Before then, I had gotten involved with a national group called Community Campus Partnerships for Health. This was an organization formed around the philosophy that institutions should serve the communities in which they reside and genuinely partner with them on an equal level. I was on the board of this group and was feeling very important traveling and talking about service-learning. But I kept thinking that we were not practicing this philosophy very well at home. The flood opened my eyes, and I realized the extent of the economic, educational, social, and health challenges in this region. I got involved in the flood relief effort and ran the program of care for the shelters across the county. In the shelters, I talked to hundreds of people, and I began to see and deal in whatever way I could with their medical conditions. The worst problems were in the adults who weren’t on Medicaid but were low income and didn’t have any health insurance. I looked at these people, the number of medicines they were on, and the conditions in which they were living, and it was just terrible. I thought, “OK. This is what I have to do.” I resigned from that board and a number of other national obligations, and I decided we would try to do something here at home. We formed a community coalition called Pitt County Care Inc. This coalition was born out of Pitt Partners for Health, which is a group of people who come together to address the issue of health care of low-income people. By this point, we had formed a close relationship with the North Carolina Office of Rural Health and particularly with the director, Jim Bernstein. I began to travel to Raleigh frequently to meet with him to discuss various problems in the east and to look at what we might do differently to create a better system of health for the region—specifically the rural part. This partnership led to the large federal grant we received from the Health Resources and Service Administration, and we then developed the Health Assist Project. Under this project, we built small community resource centers around the county and tried a whole different model where we would provide some basic level of healthcare, but that we would also do something to help the community develop itself. So the Health Assist Project partnered with Pitt Community College to offer basic skills education in the resource centers. We offered medication assistance and a fairly sophisticated version of Patient Navigation—care management that helped patients access the services they needed when uninsured. A few years later, due to the political landscape, the federal funds diminished. We knew that we needed to come up with a more sustainable program because we didn’t have the money to support the services in those small centers without a new source of funding. This is when I began to dream about building a community health center.



When did your dream become a reality?



We partnered with Greene County Health Care. By working together, the Bernstein Center could receive operating funding through the federally qualified health center program, and Greene County Health Care could expand their services into Pitt County. We had to raise the construction funding and as partners, we set about to accomplish improving health care in our region. We formed Access East, an independent, charitable, non-profit organization, which built and owns the Bernstein Center. Harvey E.R. Lewis of Lewis Construction offered three and a half acres of land for the center and provided site preparation work.



Tell me more about how the name of the center was chosen.



It’s called the James D. Bernstein Community Center because Jim was a very dear friend, an extraordinary rural health leader, and the founder of the Office of Rural Health in North Carolina. He and I had talked many times about building a community health center that was different from others and would offer educational services. He got sick and died from bladder cancer during the construction process. It was terrible. But it was obvious to me that we should name the center for him.




Why is a community health center like the Bernstein Center important to Greenville?



There is a whole population of people who are working but could never possibly afford health insurance. They simply cannot get adequate health care. They can get emergency services when they need them, but they can’t walk into a doctor’s office and get care without receiving a big bill. There is a program here at ECU that reduces the amount of that bill to about $50, but that is still more than most of them can pay. It’s hard to say exactly how many people are in this group, but it’s a large amount. The numbers show that Pitt County has an uninsured rate of well over 20 percent. It was also important to me that we address the health issues of our immigrant population, which has become a controversial issue. But community centers are charged with caring for farm-worker populations as well. A community health center is a place where the local entities that reach out to this population in various ways like free clinics and so forth can have a medical home they can go to and help these patients. The Health Assist program provides financial assistance to patients in everything from medication to care management, to shared co-pays when they can’t afford to pay co-pays and those sorts of things. And we strove to recruit volunteer private doctors and specialists who would see patients in their specialty practices for a deeply discounted rate. This combination formed a network, and we needed the community health center to be the hub for that network.



Any last words of wisdom?



I started out, I think, as a pretty arrogant guy, even with all my social justice ideas and my strong opinions of human rights. I thought I was really smart and hot stuff. I learned that one of the most liberating things on earth is to realize that you are really not hot stuff at all. When you do that, you turn outside yourself, and once you can get out of a self-centered universe, you can become part of something bigger. You can really effect change. This is hard to do, but is so rewarding. Pride, ego, and cynicism are all dangerous. Giving that all up really changed my whole trajectory.

Dr_Irons(Text)