I’ve come down with a severe case of baseball fever this week, earlier than ever before. Could climate change be to blame? Regardless, I thought I’d put that condition to good use with a couple pieces of science news from the sports world.

The Touchy-Feely Strategy

To tide me over through the long, slow crawl of spring training, I’ll be paying extra attention to college basketball as March Madness gets into full swing. As I start to ponder my bracket, I might do some scouting of how the top-ranked teams perform in an unusual statistical category: high-fives. That’s based on an unusual paper, reported recently in the New York Times, that correlated “tactile communication” with better performance in NBA teams analyzed during the 2008-09 season. The vocabulary of such communication includes the following, according to the paper: “fist bumps, high fives, chest bumps, leaping shoulder bumps, head slaps, head grabs, low fives, high tens, full hugs, half hugs, and team huddles.” What, no Christian side hugs?

The authors, from the University of California, Berkeley, wanted to test their hypothesis that touch is an important way by which humans build “trust, cooperation, and group functioning” (The paper has not yet been published, but is available from lead author Michael Kraus’ website). The background section mentions that primates spend as much as a fifth of their time grooming each other, and that several psychology experiments have found that brief touches increase trust and bonding between two people. That benefit, they reasoned, would be especially useful in team sports, where working together presumably increases chances of success (don’t tell Allen Iverson).

Testing this hypothesis involved “scoring” a number of basketball games from early in the 08-09 season for the above list of hands-on celebrations, as well as less overt “expressions of cooperation and trust,” such as talking, gesturing, passing the ball and helping on defense. The researchers then correlated those touch scores to individual players’ and teams’ performances over the rest of the season, and found a positive correlation for both. In other words, the touchier a player was, the better season they had; the touchier a team was as a whole, the more successful they were over the course of a season.

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The pharmacy is a service we mostly take for granted in the United States. No matter how tangled our health care system becomes, it’s relatively easy to have a prescription filled when needed, with most people living within a few minutes’ drive of a drug store. Even more than convenience, we’re fortunate to have the reliability of pharmacists, who apply their training to ensuring that people are receiving the correct drug, the proper dose of drug, and that no dangerous drug-drug interactions are risked.

Such routine pharmacy matters rarely cross our mind, but in a post-disaster setting such as Haiti, they are monumental challenges. The good news is that donations of drugs and other medical supplies started to pour into the country soon after the earthquake that killed and injured hundreds of thousands in the Caribbean nation. The bad news was that most of those supplies arrived in the most disorganized fashion possible - giant cardboard boxes and duffel bags haphazardly filled with pills, syringes, bandages and everything else a medical relief effort requires. Each time a doctor needed a particular type of medicine for a patient, they would have to go digging through these boxes for the right drug, like a child searching for the last Snickers bar in a bag of Halloween candy.

So when Dima Awad, a pharmacist at the University of Chicago Medical Center, arrived at the field hospital in Fond Parisien, Haiti, a cheer literally went up among the medical team stationed in the camp. Awad quickly took charge of the mess of medical supplies and set about organizing them into a functional pharmacy, based in one of the rooms of the Love A Child Orphanage unharmed by the earthquake. With the help of a Haitian carpenter who built wooden shelves and a counter using only hand tools, Awad established the first functional post-earthquake pharmacy in all of Haiti. Members of the University of Chicago Haiti Relief team who have returned from the Fond Parisien camp said that this pharmacy may have been the most important contribution the team made to the field hospital.

John Easton and Cheryl Reed (who is in Haiti this week reporting on the Medical Center’s efforts) interviewed Awad last week about her experiences. Awad talks about the challenge of creating a pharmacy from scratch in adverse conditions, how difficult it was to leave her 4-month-old son behind to volunteer in Haiti, the hardships of living in a camp without a shower, and the lasting impact of the relief effort. “After I went through this experience, I truly really feel that the University of Chicago had made a huge difference in Haiti,” Awad said. “We were able to accomplish a lot in just an incredibly short time frame.”

(Previous interviews with Haiti volunteers can be found here and here.)

There are few areas of medicine filled with more controversy than psychiatry. Compared to heart disease or a viral infection, mental illness is far more difficult to diagnose, with symptoms that are often vague, subjective, or difficult to accurately measure. To try and bring order and reliability to the assessment and treatment of mental illness, the American Psychiatric Association has published The Diagnostic and Statistical Manual of Mental Disorders since 1952. The DSM, as it’s known for short, is a guidebook for psychiatrists, psychologists, mental health researchers and insurance companies, a framework by which to define the amorphous world of mental health for treatment, research and coverage.

Of course, our knowledge and perception of mental health and illness has changed somewhat over the past 60 years. The DSM has changed as well, undergoing several revisions - the current version is the awkwardly named DSM-IV-TR, a sort of intermediate revision that was published in 2000. Virtually since that time, psychiatrists have been working on the fifth total revision of the DSM, an exhaustive process that yielded the “draft” version of the DSM-V published online earlier this month.

Now, the real fun begins. For the next two months, public comments will be accepted on the draft DSM-V, allowing all parties who craft and use the manual to fight it out over several controversial changes before they are officially codified. Because of the competing interests involved in the creation of the DSM, this process can lead to  psychiatric pyrotechnics.

“It’s a little bit like watching a circus,” said Scott Hunter, director of pediatric neuropsychology at the University of Chicago Medical Center. “Ultimately, it’s as much political and cultural as it is scientific. That’s why I’m both encouraged in some ways, and amused in others.”

Hunter has a particular interest in the revisions. As controversial as adult mental illness may be, pediatric mental illness turns the discussion’s temperature up even higher - as Exhibit A, just look at the debate that perpetually rages around autism. Sure enough, the strongest disagreements and the bulk of the media attention surrounding the DSM-V draft have to do with the mental health of children, and autism is sitting shotgun.

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Illustration by Roswell Thomas

In a way, the Human Genome Project had it easy. Sure, mapping the roughly 23,000 genes active in humans was one of the most important scientific achievements of all time, but those genes are only part of the story. In fact, the protein-coding sequences only occupy about 1.5% of the roughly 3 billion base pairs present in human DNA; the actual genes are small islands afloat in a vast sea of largely unknown sequences.

Those mysterious stretches were once referred to dismissively as “junk DNA,” as scientists presumed that all those base pairs between the genes must be largely the cold leftovers of evolution - sequences that may have been important to other species but had lost their utility in humans. But now that we have a pretty reliable map of our 23,000 genes, it’s become apparent that rich treasure lies hidden in the junk DNA. Since all cells of the human body share the same DNA, a set of instructions must be present to direct Cell A to become a neuron and Cell B to become a heart cell and so forth. Increasingly, these “switches” are understood to be key to both construction of a functioning body and the ways that process can break down in genetic diseases. But finding those switches is no easy task.

“These sequences are literally in the middle of nowhere, these tiny things in a sea of anonymous sequences,” said Marcelo Nobrega, assistant professor of human genetics at the University of Chicago. “The question was: How are you going to find those?”

In a recent paper in the journal Genome Research, a team of researchers from the University of Chicago and the National Institutes of Health may have made that search much easier. Just as modern fishermen use computerized fishfinders to help them spot prize catches in the waters below, Nobrega, Ivan Ovcharenko and colleagues have developed a computer tool to scan the DNA depths for the tiny switches important for cell determination. First demonstrating the model’s usefulness by tracking down sequences important for heart development, the authors said the method can be used to sniff out molecular switches that control the fate of every kind of cell, in humans or other organisms.

“The Human Genome Project gave us a book with 3 billion letters, of which 3 million are known words,” said Nobrega, assistant professor of human genetics at the University of Chicago. “But that doesn’t tell the story, and in the time that it’s taking to unravel the other things hidden in genome, we’re learning just how complicated it’s going to be.”

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Two weeks ago, we talked to Richard Cook by satellite phone when he was still in the field hospital in Fond Parisien with the first six-member team from the University of Chicago Medical Center’s Haiti relief effort. Cook, professor of Anesthesia & Critical Care, is remarkably eloquent about his experience in Haiti, whether in that sobering interview (”It is astonishing how many injuries we are seeing,” he reported then) or in front of the Medical Center’s monthly leadership forum, where his 20-minute presentation Wednesday was deeply moving. John Easton interviewed him earlier this week, and though Cook has been fighting a cough since returning from his two weeks of volunteering, he still was full of insight and emotions about the experience. I’ve edited the conversation down to two videos, which you can watch below. The first video contains photographs from the Fond Parisien camp taken by Justin Ide of Harvard University and Christian Theodosis from the Medical Center. In the second video, you’ll see two short video clips filmed by Theodosis of the pharmacy constructed from scratch in the field hospital by the Medical Center’s Dima Awad. 

Meanwhile, the second team is nearing the end of their two-week stint in Fond Parisien and Port-au-Prince. Pictures and updates from that team are being continuously posted at the Haiti Relief blog.

The big science story of the past 24 hours has been a paper from the Journal of American Medical Association about what caused the death of King Tutankhamun, better known as King Tut, the world’s most famous mummy. Many of the news articles have understandably focused on the “smoking gun” that killed Tut - or rather, the lack of anything so exciting as a smoking gun. Through genetic analysis and computed tomography scans, the authors determined that King Tut likely died at age 19 of a rather hum-drum combination: a bone fracture that left the Egyptian monarch vulnerable to a deadly malarial infection. “This is one sick kid,” reacted Emily Teeter, assistant curator at the University of Chicago Oriental Institute in the AP article.

But that conclusion, like most in sciences of ancient civilizations, was not universally accepted. In the midst of thousands of news articles that merely echoed the authors’ diagnosis, Naturenews put together a nice survey of conflicting opinions from Egyptologists and molecular biologists. Many experts believe that a lot of people in ancient Egypt - located along the banks of the rather mosquito-friendly Nile - were probably exposed to malaria, and many likely developed partial immunity to the disease rather than dying from it. Even one of the authors (from the amazingly-named Institute for Mummies and the Iceman), sounded a bit wishy-washy on their diagnosis. ”We will never be able to prove he died from malaria,” co-author Albert Zink told Nature.

That’s okay, because the article is interesting beyond being an uncertain coroner’s report for a famous mummy. King Tut wasn’t the only subject of the article; in all, 11 mummies from museums in Luxor and Cairo were scanned and had tissue extracted for genetic analysis. The authors used that data to construct something of a mummy family tree, organizing five generations of the “18th Dynasty” royal family that ruled Egypt from roughly 1550 to 1295 BC. The results could form the basis for an HBO drama, as evidence strongly suggested that Tut’s parents were brother and sister. Potentially as a result of that incestuous relationship, the teenage King Tut had a number of significant bone abnormalities revealed by the team’s CT scans. Combined with artifacts depicting Tut as more of a sitter than a stander and the discovery of several cane-like implements in his tomb, there’s both cultural and now physical evidence that King Tut was disabled - a Richard III for ancient Egypt, though perhaps without the villainous streak.

One sensational rumor about Tut and his family that the paper does not support is the theory that the young king and his father may have had more severe genetic disorders. Many drawings and sculptures of the time depict Tut and his father, Akhenaten as oddly feminized, leading some Egyptologists to speculate whether the two had a genetic condition such as Marfan syndrome or gynecomastia (which causes men to develop breasts). Both theories were unsupported by the research, both genetically and anatomically - the latter analysis requiring the eyebrow-raising sentence, “The penis of Tutankhamun, which is no longer attached to the body, is well developed.” Instead of having a feminizing condition, the authors conclude, the aesthetic preferences of the day likely inspired artists to give their rulers a fashionable, womanly look.

The University of Chicago has its own mummy “murder” mystery, in the form of Meresamun, a 2,800-year-old Egyptian temple singer who has never been removed from her casing. It’s become a tradition here that every time the Medical Center obtains a new CT scanner, Meresamun is the ceremonial first patient to test out the equipment. And with each subsequent scan, more has been learned about what might have killed Meresamun, with a broken jaw once thought to be the result of trauma during life discovered to be, instead, the result of poor handling after death. Last June, the University turned to a police sketch artist in Maryland to recreate what Meresamun looked like in life, but the cause of her death remains a mystery.

Even as public attention starts to drift away from recovery efforts in Haiti, many non-profit organizations and hospitals continue to send supplies and care to the ravaged Caribbean country. Last week, we talked to some of the 22 volunteers who were part of the second wave of personnel sent by the University of Chicago Medical Center to sites in Port-au-Prince and Fond Parisien, near the border with the Dominican Republic. As those physicians, nurses and house-staff arrived in Haiti, the first team of UChicago volunteers returned home, carrying stories of heartbreaking loss and uplifting hope. We’re working to videotape interviews with all of the returning volunteers, and will post them to the blog as they become available.

Tiffany Cupp is a nurse in the emergency room at Comer Children’s Hospital. She actually was the first Medical Center employee to reach Haiti, having joined an effort through her church and a Christian organization, CURE International, that sent a team of volunteers to staff a community hospital in Port-au-Prince only 9 days after the earthquake. Cupp said she was the only pediatric nurse at one of only two functional hospitals at the time, seeing nearly 500 patients a day. 

While in Haiti, Cupp formed a bond with an 8-year-old girl named Yveline (pictured above) whose house collapsed in the earthquake, killing both of her parents and burying her under rubble for three days before she was rescued by an uncle. “She was so strong,” Cupp said. “We formed this really unique bond that I will cherish forever.” Cupp hopes to return to Haiti for a second visit, possibly with a University of Chicago Medical Center team in March.

“It was just amazing to see how resilient the Haitian people are, and how caring and loving they are,” Cupp said. “It was very overwhelming.”

Rex Haydon is an assistant professor of surgery at the University of Chicago Medical Center, whose specialty is orthopedic surgery and surgical oncology. But Haydon was not needed as a surgeon at the field hospital in Fond Parisien where he spent two weeks with five other Medical Center volunteers and 300 patients. Instead, his expertise was applied to patients who had already received orthopedic surgery for severe crush injuries suffered in the earthquake, surgeries that were sometimes rushed in less than ideal conditions in the days following the disaster. Haydon focused on giving these patients the follow-up care that they had lacked, making sure that they were not suffering from post-surgical complications and putting them on track to a healthy recovery. 

“It was deeply gratifying to be in a position where you could truly not only help people but see them improve over time,” Haydon said. “As an orthopedic surgeon, that’s what we all want to see: patients that have received care but were afraid to put weight [on their injury], afraid to walk, afraid to mobilize, and to see them get up and show everybody else in the camp that they can do it. It’s a chain reaction. It really for me was a major, major change in what we were doing there.”

Imagine a child who gets good grades in school, listens well to his teacher, and is commended for his good behavior in the classroom. Then slowly, his grades start to decline, he grows moodier, and his teacher reports that his attention often drifts in class. The parents are stumped - they can’t think of anything that has changed, except for the appearance of a snoring habit as the child sleeps at night. The parents wonder if their child may be showing signs of ADHD, but could the seemingly innocuous snoring be to blame?

That’s a story often heard in pediatric sleep clinics, said Leila K. Gozal, associate professor of Pediatrics and director of clinical research for the section of pediatric sleep medicine at the University of Chicago Medical Center. Over the past decade, many studies have shown that several behavioral symptoms commonly associated with ADHD - hyperactivity, mood swings, difficulty in school - have been linked in some children to obstructive sleep apnea, the disorder where sleep is frequently interrupted by episodes of blocked breathing.

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information, Gozal said. Previous research conducted by David Gozal, professor and chairman of pediatrics at the Medical Center, found that OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

But many of these measurements of the neurocognitive effects of OSA on child require extensive testing and expert examiners, Leila Gozal said. So she wanted to develop a simpler test, one that could be used in any sleep clinic to directly test the effect of a sleep disorder upon a child’s memory.

“I wanted to come up with something fairly simple that can be easily done in any sleep center with almost no training or background in neuropsychology,” Gozal said. “The theory is if we come up with a simple test of pictorial memory - what you see and memorize - can we actually see any difference between kids who have OSA and kids who don’t have it?”

Using a $3.95 children’s picture book and a simple testing protocol, Gozal and her colleagues found a strong effect of OSA upon learning and memory. Published online earlier this year by the European Respiratory Journal, the study found that children with OSA were slower to learn the task, and retained less of the information the following morning when compared to normal children.

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For most people, when they or their child becomes sick with and illness that over-the-counter medicine can’t treat, the path to a prescription goes through a doctor’s office. But what if you yourself were a doctor? And you were reasonably confident that you knew what was causing a mild illness in you or your child? Would you still go through the formality of a doctor’s appointment, or would you prescribe the necessary treatment yourself - or find a physician friend to write the prescription?

Most medical associations have recommendations on when it is okay for physicians to write a prescription without a formal exam. But little is known about how often those “informal” prescriptions occur, especially in pediatricians for whom dealing with sick children is the focus of their workday, not just an occasional issue at home.

Pediatric resident Jennifer Walter and Lainie Ross, professor of pediatrics and clinical ethics, sought to test those presumptions through a survey of their fellow pediatricians. With questions about prescribing for one’s children or other family members, self-prescribing, and “curbside” prescribing (when a physician asks another physician for a prescription), they looked to characterize how often such informal prescribing occurs, and what the consequences of those actions. What they found, published as two separate articles in The Journal of Clinical Ethics and The Journal of Medical Ethics, was that such practices were overwhelmingly the rule, not an exception.

A whopping 75 percent of pediatricians reported prescribing drugs for their own child at some point - with antibiotics and inhalers the most common prescription. Doctors treating themselves also came in at 75 percent, with 50 percent reporting that they had written a scrip for themselves at least once and another 50 percent reporting they had asked a physician friend to do it for them (50 + 50 = 75 because there was an overlap of self-prescribers and curbside prescribers).

Those high percentages didn’t surprise Walter and Ross. One would expect pediatrician-parents, who may see a dozen ear infections in a routine workday, to feel comfortable in prescribing an antibiotic for their own son or daughter’s illness, they said.

“I don’t think it’s reasonable for people to say you should take your pediatrician hat off when you’re looking at your own kid,” Ross said. “That’s part of who you are, that’s how you look at people.”

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The first patient in the UCMC's 256-slice CT scanner, the mummy Meresamun

Radiation had a bad reputation to overcome. Known for a long time for killing its discoverer and by frightening yellow-and-black warnings, the view of radiation has softened over the years as scientists and physicians corralled its powers for good. Whether used for screening or diagnosis in the form of X-rays and CT scans or therapeutically to kill tumors, radiation has become an essential tool for physicians.

But even with all these beneficial uses, radiation remains dangerous. A recent New York Times article discussed cases where patients received overdoses of radiation during medical procedures, usually due to computer programming errors undetected by the technicians. On the heels of that report, the Food & Drug Administration - which has oversight over medical devices - unveiled a new initiative to reduce unnecessary radiation exposure. Officials hope to improve patient safety by establishing tighter requirements for manufacturers of medical imaging devices, revising the accreditation process for those who use such devices, and conducting more research to find what level of radiation exposure is safe and appropriate for patients.

I asked Michael Vannier, professor of radiology at the University of Chicago Medical Center, to explain what these changes meant for the field and patients. Vannier said that he and his colleagues welcomed the attention being paid to these issues, even as radiologists and manufacturers were already seeking new ways of getting the maximal benefits from a minimum of radiation. At the Medical Center, a state-of-the-art 256-slice CT scanner acquired in 2008 provides higher quality scans than previously possible using 30 percent less radiation, Vannier said - and a computer upgrade scheduled for next week will reduce that radiation by a further 40 percent.

“What will happen, I think, is that the manufacturers will add capabilities to the instruments that make it possible to much more automatically and reliably monitor and minimize the dose,” Vannier said. The rest of our conversation is available below.

Why is the FDA initiative happening now, and why is it necessary?

Vannier: Well, you have several incidents that have attained a lot of notoriety. But what’s also happened is that CT scanning has become extremely popular. Your chances of having a CT scan in your lifetime are extremely high, because it is a very versatile and highly available technique. But it does use X-rays, and the dose you receive from a CT scan is higher than the dose received from X-ray techniques as a general rule. You don’t want to do them unnecessarily.

The second thing is that the CT scanners themselves have improved in their dose efficiency very significantly over the years. If a scan is done with an older scanner, it may very well require a higher dose than the state-of-the-art equipment, which means that getting the same exam in different places can mean different doses received. Even if you know what kind of exam you’re getting, the instrument doing it doesn’t necessarily tell you that the dose is low.

The third thing is the general facts of physics that govern how CT scanners work. If you give a minimal dose you can get an acceptable level of noise in images and the quality can be very high. But if you double the dose, you may see no improvement in image quality, so it’s deceptive in that way, and there’s a potential of overdosing or selecting the wrong dose setting. It takes special care to ensure that the dose is maintaining the standards that are held to that we call ALARA - As Low As Reasonably Applicable, which is the FDA-mandated standard.

In the past, for CT scans in general, it was very difficult to look at scans and tell what dose was used. In the latest scanners, which we use for exams here today, it actually puts a record of the dose in with the images, a printed-out diary or record, if you will. It’s possible to know with a high degree of confidence exactly what dose was received, whereas in past years it wasn’t possible, and people using older equipment may not be included in such a system.

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The latest in our video series where experts from the University of Chicago Medical Center answer frequently asked questions about popular medical topics. To suggest a topic or a question, please contact the editors.

Over the last decade, bariatric weight loss surgery evolved from a curiosity to a routinely-performed procedure, an increasingly popular option for people suffering from severe obesity. According to the American Society for Metabolic & Bariatric Surgery, roughly 220,000 Americans had weight-loss surgery in 2008, almost 20 times the number of patients who had such surgery performed in 1998. As those numbers have grown, the procedure itself has changed and improved - most bariatric surgery is now performed using minimally-invasive, laproscopic techniques, and there are a variety of different surgical options available to each patient.

The University of Chicago Medical Center was among the first hospitals to offer bariatric surgery for weight loss, and are today the only medical center in the area to offer all four surgical options currently approved and available. The strategy behind these options falls into two general groups: reducing the size of the stomach, and rerouting the digestive system to bypass the stomach or large sections of the intestines. In one procedure, called the duodenal switch, both of these strategies are employed, with the stomach reduced to a much smaller “sleeve” while the small intestine is rerouted so that absorption can only occur in the final three feet.

Last fall, the ASMBS accepted one half of the duodenal switch surgery - the stomach reduction portion - as a stand-alone procedure called vertical sleeve gastrectomy. Shortly thereafter, the Medical Center began offering the vertical sleeve gastrectomy procedure as an option to patients seeking weight-loss surgery. I sat down with Dr. Vivek Prachand, who performs all four of the bariatric surgery options, to talk about how the vertical sleeve procedure differs from the other surgeries. We also spoke more generally about what types of patients are appropriate for bariatric weight-loss surgery, common myths surrounding the procedure, and the importance of follow-up care in many dimensions to truly produce a healthier lifestyle in severely obese patients. Enjoy the videos.

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We’ve been keeping a close eye on the University of Chicago Medical Center’s activity in Haiti to help recovery efforts after the earthquake of January 12th. It’s been two weeks since the first batch of physicians and nurses from the Medical Center left, with one emergency medicine physician joining others in Port-au-Prince while six volunteers went to a hospital camp in Fond Parisien, near the border with the Dominican Republic. Yesterday, the first members from a second batch of volunteers traveled to Haiti to take over for the initial crew, most of which will be returning tonight. All told, 22 employees of the Medical Center will be headed to Haiti this week - a dozen to Fond Parisien, 6 to Port-au-Prince, and 4 plastic surgeons traveling to Santo Domingo in the Dominican Republic, where they will see injured Haitians transported by airlift.

John Easton, our director of communications, was present at the preparation meeting for the 22 volunteers on Saturday evening at the Medical Center. In the video below, you can hear from Chrissy Babcock, co-leader of the Haiti effort, and from several of the physicians, nurses, physical therapists and logistics personnel who are joining the recovery effort. Note the giant red duffel bags of supplies - each person traveling to Haiti will check the maximum allowed luggage on their flight to bring the supplies requested by the teams already in the field.

You can also listen to an interview with the other team co-leader, emergency medicine physician Christian Theodosis, that ran today on Chicago Public Radio’s Worldview program. Theodosis was interviewed via satellite phone from the field hospital in Fond Parisien.

  Banda Aceh before the 2004 tsunami

A populace is devastated by natural disaster, without access to medical care for trauma and infectious disease. Physicians and nurses from around the world rush to help, but good intentions are handicapped by logistical challenges - a lack of diagnostic technology, operating room facilities, and clean environments where the severely injured can recover. To alleviate the medical crisis, the U.S. Navy sends one of its two massive floating hospitals, which sits offshore and starts providing advanced medical care for survivors of the disaster with the help of volunteers from non-governmental organizations in a unique military/civilian partnership.

That, in a nutshell, is the current situation in Port-au-Prince, Haiti. But, according to Matthew Wynia, assistant professor of infectious disease at the University of Chicago Medical Center, it could also describe the situation five years ago in Banda Aceh, Indonesia, in the weeks after a deadly tsunami killed as many as 170,000 people in the country. In the rush to provide critically-needed medical resources to the region, strange bedfellows were made between the U.S. Navy and Project HOPE, an international health care organization that provides medical care to developing countries. As part of that effort, roughly 100 physicians and nurses from around the world worked from the USNS Mercy, a Navy hospital ship, to treat the wounded of Banda Aceh - a mission that set the mold for efforts such as the current use of the USNS Comfort to treat survivors of the Haiti earthquake.

Wynia, also director of the Institute for Ethics at the American Medical Association, spoke about that experience Wednesday as part of the MacLean Center for Clinical Medical Ethics weekly lecture series. In light of current events, the talk was particularly interesting - though the Medical Center teams in Haiti are not working from the USNS Comfort, they will be receiving patients discharged from the ship to clear space so that more people can receive operations and care. Usefully, Wynia recapped his experience with candor, addressing the ethical issues that faced medical volunteers working alongside the U.S. military administering care to a nation wary of American intentions.

At the end of 2004, when the tsunami struck Indonesia, public opinion of the heavily Muslim country about the United States was precariously low: only 15 percent positive, Wynia said. What’s more, the country had been in the midst of a civil war before the disaster, and neither side particularly welcomed a naval ship nearly the size of an aircraft carrier floating only 2 miles off shore. As a result, the ship was only allowed to be in Indonesian waters for 90 days following the tsunami, and given the time it takes to sail a gigantic ship from San Diego to Indonesia, it didn’t arrive until a month after the disaster.

By that point, as with the current situation in Haiti, many of the severe trauma victims had already undergone surgery or succumbed to their injuries, Wynia said. As such, despite the fact that the USNS Mercy was equipped to serve as a floating trauma center for severe war injuries, the medical team only saw 300 operating room cases during their 60 days off Banda Aceh. On a ship equipped with 1000 hospital beds (though as Wynia pointed out, half of them were upper bunks unsuited for severely-ill patients), only 170 inpatient admissions were made. Much of the care supplied by the physicians and nurses was either diagnostic (using the state-of-the-art CT scanner on board) or primary care - providing dental care, eyeglasses, and prescriptions for management of chronic disease.

The USNS Mercy alongside the USS Abraham Lincoln

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Very busy today, so please forgive the light posting.

In December, we wrote about a unique collaboration between Argonne National Laboratory and the University of Chicago Medical Center to fight brain tumors with microscopically tiny gold nano-discs. ABC-7-Chicago recently ran a story on that research which you can watch below:

 

And if you have time for two science videos today, enjoy this neurobiological explanation of why the good guys always win gunfights in old Westerns. (from the University of Birmingham)

photos by Christian Theodosis

One week after two medical teams from the University of Chicago traveled to the earthquake-ravaged nation of Haiti, the situation remains critical. In a conference call Monday from the field hospital camp in Fond Parisien, where a six-person Medical Center team, including physicians, nurses and a pharmacist, are stationed, Haiti team co-leader Christian Theodosis gave a sobering reminder that the nation’s recovery is only beginning: “Being injured and homeless and without legs in Haiti is a very bad outcome.”

Though the focus has shifted in some parts of the country from acute surgery to post-operative care and the medical issues that accompany hundreds of thousands of newly homeless people, the need for expert help and supplies remains great. The Fond Parisien camp (pictured above and on Theodosis’ online gallery) is somewhere between a tent hospital and a refugee camp. Built on the grounds of a Haitian orphanage, the rows of tents sheltered 500 people when the University of Chicago team arrived, and now house 230 patients and their families. More patients are arriving every day by helicopter or bus; hospitals in Port au Prince and the USS Comfort - a US Navy ship that has served as a floating hospital since the quake - are sending recovering patients to the camp to clear space in their facilities for more operations. With only one facility equipped for surgical operations on site, medical personnel at the camp have largely tended to the post-operative and displaced, building shelters, vaccinating patients and their families, and providing rehabilitation services.

John Easton and I spoke to Richard Cook, associate professor of anesthesia and critical care at the University of Chicago Medical Center, by phone this morning from the Fond Parisien camp. Though Cook hasn’t been using his primary specialty - “You know, I haven’t given an anesthetic since I arrived,” he said - he has been incredibly busy acting as physician, electrician, construction worker, and anything else the camp needs. He says he’s been shaken by the severity of the injuries, but is comforted by the resilience of the Haitian people.

“I’ve seen more pediatric amputations in my nine days here than I have in the rest of my career combined. The devastation is almost incalculable,” Cook said. “But the Haitian people are stoic, gracious, polite, optimistic, and deeply faithful. They are responding as well as any community possibly could to such a disaster.”

The full interview is after the jump.

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