40 yearsof transplantationat Loma Linda

Contents SCOPE · Spring 2007 · 1

On the front cover:TOP LEFT: Leonard L. Bailey, MD, and his team perform a heart transplant on Baby Fae,using a baboon heart because no system was in place to identify human donors (page 7).

TOP RIGHT: Paul Anderson received the first kidney transplant at Loma Linda in April of1967. Performing the historic surgery was Lou Smith, MD, general surgeon (page 2).

BOTTOM LEFT: Maria Isabel Ancona received her liver transplant at just 16 months of age atLoma Linda University Children’s Hospital on December 26, 2003 (page 2).

BOTTOM RIGHT: Baby Fae looks pink and healthy following her historic surgery. Her newheart remained strong, though she eventually succumbed (page 7).

On the back cover:TOP LEFT: Paul Nobuo Tatsuguchi was Japanese; J. Lawrence Whitaker, American. But bothyoung men were Seventh-day Adventist Christians. Furthermore, they were classmates,graduating from the LLU School of Medicine in 1938. In May 1943, their lives con-verged again on Attu. Both men were now military doctors, on opposing sides of the war(page 16).

TOP RIGHT: A little more than a year ago, the Mobile Telemedicine Vehicle (MTV), part of ajoint effort between the U.S. Army and Loma Linda University Medical Center, knownas the DISCOVERIES project, was unveiled (page 20).

BOTTOM: Members of the pediatric trauma team gather on the helipad (page 12).

In this issue…Transplantation at · · · · · · · · · 2Loma LindaIt’s been 40 years since the first kidneytransplant at Loma Linda

Remembering Baby Fae · · · · 7Leonard L. Bailey, MD, tells the story ofBaby Fae

Everyday heroes · · · · · · · · · 12The pediatric trauma team existsto save young lives

Same family, different sides · 16Circumstances put classmates on oppositesides of a grim 1943 battle

Telehealth: miles away · · · · · 20but face to faceHealth care professionals and educators usetelehealth technologies to serve outlyingcommunities

Newscope· · · · · · · · · · · · · · · · 24News about Loma Linda…

Loma Linda University academic programsSCOPE · Spring 2007

Allied HealthProfessionsClinical laboratory sciences (BS)Coding specialist (CERTIFICATE)Cytotechnology (BS, CERTIFICATE)Diagnostic medical sonography (CERTIFICATE)Dietetic technology (AS, CERTIFICATE)Emergency medical care (BS)Health information administration(BS, CERTIFICATE)

Health information technology(BS; on-campus or online)

Medical radiography (AS)Nutrition (MS)Nutrition care management (MS)Nutrition and dietetics(BS, PROGRESSION BS, CERTIFICATE)

Nuclear medicine technology (CERTIFICATE)Occupational therapy (MOT, PPMOT, OTD*)Occupational therapy assistant (AA)Phlebotomy (CERTIFICATE)Physical therapy (PMPT, PPMPT, DPT, DSC)Physical therapy assistant (AS)Physician assistant (MPA)Radiation sciences (BS)Radiation therapy technology (CERTIFICATE)Rehabilitation sciences (PHD)Respiratory care (BS, PPBS)Special imaging technology–CT/MRI; CVI(CERTIFICATE)

Speech-language pathology (MS,CERTIFICATE)

Speech-language pathology & audiology (BS)Speech-language pathology assistant (AS)

DentistryDental anesthesiology (CERTIFICATE)Dental hygiene (BS)Dentistry (DDS)Dentistry/basic medical sciences (DDS/MS,DDS/PHD)

Endodontics (MS, CERTIFICATE)Implant dentistry (MS, CERTIFICATE)Oral/maxillofacial surgery (MS, CERTIFICATE)Orthodontics & dentofacial orthopaedics(MS, CERTIFICATE)

Pediatric dentistry (MS, CERTIFICATE)Periodontics (MS, CERTIFICATE)Prosthodontics (MS, CERTIFICATE)

Faculty of ReligionBiomedical and clinical ethics(MA, CERTIFICATE)

Clinical ministry (MA, CERTIFICATE)Religion and the sciences (MA)

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OPTION, RNBS OPTION, RNMS OPTION)Master of science in nursing (MS)Adult nurse practitioner (ANP)(POST-MASTER’S CERTIFICATE)

Clinical nurse specialist:Adult & aging family (CNS)(POST-MASTER’S CERTIFICATE)

Growing family (CNS)(POST-MASTER’S CERTIFICATE)

Family nurse practitioner (FNP)(POST-MASTER’S CERTIFICATE)

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Nursing/clinical ethics (MS/MA)Pediatric nurse practitioner (PNP)(POST-MASTER’S CERTIFICATE)

Nursing administrationNursing educator

Doctor of philosophy in nursing (PHD)

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Public HealthBasic & advanced biostatistics (CERTIFICATE)Basic & advanced epidemiology(CERTIFICATE)

Biostatistics (MPH, MSPH)Emergency preparedness and response(CERTIFICATE)

Environmental & occupational health (MPH)Epidemiologic research methods(CERTIFICATE)

Epidemiology (MPH, DRPH)

Global health (MPH*)Health administration (MPH*, MBA, BSPH)Health education (MPH*, DRPH)Health geographics & biomedical datamanagement (BSPH)

Health geoinformatics (CERTIFICATE)Lifestyle intervention (CERTIFICATE)Maternal and child health (MPH)Nutrition (MS, MPH, DRPH)Preventive care (DRPH)Public health practice (MPH*)Reproductive health (CERTIFICATE)Tobacco-control methods (CERTIFICATE*)

Science and TechnologyBiology (MS, PHD)Case management (CERTIFICATE)Child life specialist (MS, CERTIFICATE)Clinical mediation (CERTIFICATE)Counseling (MS)Criminal justice (MS)Drug & alcohol counseling (CERTIFICATE)Earth science (PHD)Environmental & earth system science(MS, CERTIFICATE)

Family counseling (CERTIFICATE)Family life education (CERTIFICATE)Family studies (MA, PHD)Forensic science (CERTIFICATE)Geology (BS, MS)Gerontology (MS)Group counseling (CERTIFICATE)Health professions education(MS, CERTIFICATE)

Marital & family therapy (MS, DMFT, PHD)Natural sciences (MS)Program evaluation & research (CERTIFICATE)Psychology (MA, PSYD)Clinical (PHD)Experimental (PHD)

Public administration (DPA)School counseling (CERTIFICATE)Social policy & social research (PHD)Social work (MSW, PHD)Spanish studies for health care professionals(CERTIFICATE)

LOMA LINDA UNIVERSITYExcellence…in the health sciences

For more information, please contact:Loma Linda UniversityOffice of Enrollment Management11139 Anderson StreetLoma Linda, California 92350(800) 422-4558 · www.llu.edu*Available in non-traditional formats

40 yearsof transplantationat Loma Linda

Executive editor:W. Augustus Cheatham, MSWEditor: Richard W. Weismeyer, MAManaging editor/designer: Larry Kidder, MA

Contributing writers:Dustin R. Jones, MA;Larry Kidder, MA; Hannah Ko; Heather Reifsnyder;Preston C. Smith; Patricia K. Thio; Henry Yeo, MD;and Richard W. Weismeyer, MA

Volume 43, Number 1SCOPE is published by Loma Linda Universityand Loma Linda University Medical Center,educational and medical institutions operatedby the General Conference of Seventh-day Adventists.For subscription information, alumni news notes, oraddress changes, you may write to:

SCOPELoma Linda University Adventist HealthSciences CenterLoma Linda, California 92350

Or send an e-mail message to:scope@llu.edu

Loma Linda University&LLUMedical Center Internet address:www.llu.edu

On the covers…

A history of transplantation at Loma Linda SCOPE · Spring 2007 · 3

agency for transplantation that receivedthe initial federal contract to operate theOrgan Procurement and TransplantationNetwork (OPTN) in 1986, certifiedLLUMC for kidney transplants inAugust 1987. This was the same timethe Medical Center received Medicarecertification for kidney transplants.

An institute is bornBy 1992, more than 400 kidney

transplants had been performed atLLUMC. Heart transplantation hadexperienced seven years of success, andliver transplantation was soon to beadded to the list of solid organ transplan-tations the Medical Center would offerto patients in the Inland Empire. Theneed for centralization and organizationof transplant services into a specialty carewas becoming all too clear.

Medical Center administratorsbegan developing serious plans for a cen-tralized transplant service in 1992, withthe recruitment of a multi-organ trans-plant surgeon from the Mayo Clinic. Theaddition of Erik Wahlstrom, MD, the

first dedicated transplant surgeon atLLUMC, provided the cornerstoneneeded to begin building and growingthe transplant program.

Following this, UNOS designatedLoma Linda University Medical Centeras a liver, pancreas, and kidney transplantcenter in October 1992.

The Transplantation Institute wasborn. The designation followed 463kidney transplants over a period of 26years. Making it all possible was a deci-sion by the Southern California Trans-plantation Society, which controlledorgan distribution in the Los Angelesarea, to allow combined kidney and pan-creas recipients to take precedence overpatients waiting for a kidney alone—inother words, give priority to a patientwho needs both organs from one donor.Candidates for the combined operationare typically diabetics with kidneyfailure.

Also contributing to the inaugura-tion of the Transplantation Institute wasan agreement between all transplant cen-ters in the Los Angeles area for LLUMCto become the first institution in theregion to perform such surgeries.

Reorganization of the Transplanta-tion Institute during 1992 and 1993 com-bined all services necessary for pre- andpost-transplant recipients, such as socialservices, financial counseling, pharmacy,and dietetics. The Institute’s formalorganization also brought together sur-geons, anesthesiologists, nephrologists,gastroenterologists, immunologists, andpathologists, composing a multidiscipli-nary and multicultural managementteam for transplant patients.

In January 1993, the TransplantationInstitute initiated its kidney/pancreastransplant program for diabetic patients.Following transplant, these patients nolonger needed hemodialysis or insulininjections.

The first kidney/pancreas transplantpatient was a 29-year-old man fromRancho Cucamonga, California, who hadsuch a severe case of diabetes that hiskidneys were damaged and useless, and

he was forced to undergo hemodialysis tocleanse his blood. His diabetes was sodevastating to his body that he facedpotential blindness, coma, gangrene,heart attack, stroke, and even death.

Following his kidney/pancreas trans-plant, he spent just 11 days in the hos-pital and left with normal kidneyfunction, no longer a victim of diabetes.His mother came to refer to the day ofhis transplant as his “second birthday.”

There have been a total of 151kidney/pancreas transplantations sincethat first operation. Another milestone inmulti-organ transplants came inNovember 1993, when a rare combinedheart/kidney transplant was performedon an 11-year-old boy at LLUMC.

In September 1993, the MedicalCenter became the only institution inthe Inland Empire and only the thirdhospital in Southern California to offeradult liver transplants. The first livertransplant patient was a 54-year-old manfrom Salem, Oregon, who suffered fromchronic hepatitis B and C.

The surgery, which can sometimeslast 12 hours, proved to be another form-ative milestone of the TransplantationInstitute. The second liver transplantwas done a mere four days later on a 40-year-old man from Tucson, Arizona. Todate, 307 liver transplants have been per-formed at LLUMC.

Since its inception, the Transplanta-tion Institute has developed adult andpediatric programs in kidney, liver, pan-creas, and bone marrow transplantation.

In addition to direct transplantationservices for solid organs, the Instituteoffers medical management of hepatobil-iary disease for non-transplant patients.Teams in the Institute run a hepatologyclinic and cirrhosis management programto help patients avoid transplantation.

“It’s an honor to be part of a teamthat decides what’s best, long-term, forthe patient—and that’s not always trans-plant,” says Margie Imthurn, director ofthe Institute’s clinical services.

The Institute brings together highlyqualified professional and support staff to

A history of transplantation at Loma Linda2 · SCOPE · Spring 2007

Transplantation at Loma LindaIt’s been 40 years since the first kidney transplant at Loma Linda

BY PRESTON CLARKE SMITH

The surgeon who performed thefirst kidney transplant with long-term success made the following

remarks during an address at the U.S.Transplant Games of 2004 (sports eventfor transplant patients): “George Elliottonce wrote ‘Prophecy is the most gratu-itous form of error.’ I make no predictionabout future medical progress. However,I am certain that organ transplantationwill forever remain as one of the greatestgifts to the body and soul of mankind.”

That surgeon, Joseph Murray, MD,performed the historic kidney transplantat Boston’s Peter Bent Brigham Hospitalin 1954.

Ever since the first successfulkidney transplant, organ transplantationhas offered hope and healing to thou-sands of people previously without anytreatment options. Thirteen years afterthat historic surgery, organ transplanta-tion became part of Loma Linda Univer-sity Medical Center’s continuing journey“to make man whole.”

The Medical Center began offeringsolid organ transplantation in April 1967when its first kidney transplant created ahealth care milestone for the institution.That first transplant marked a new erafor Southern California’s Inland Empireas solid organ transplantation became anavailable treatment option for patientswith end stage kidney disease.

During the ensuing 40 years, thetransplantation program has grown tobecome a major center and includesliver, pancreas, heart, and, most recently,bone marrow transplants, with a com-bined total of more than 2,700 transplan-tations performed.

The early yearsLouis Smith, MD, a general surgeon

at Loma Linda University MedicalCenter, spent time in the mid-1960s atPeter Bent Brigham Hospital in Bostonlearning kidney transplantation surgeryfrom Dr. Murray.

Upon his return to Loma Linda, Dr.Smith performed the first kidney trans-plant at Loma Linda in April of 1967 inthe old hospital located on the hill whereNichol Hall now stands. The surgery wasperformed on a 38-year-old-man who hadsuffered from kidney failure, severehypertension, and generalized seizures.

In a few short months, constructionon the present-day Medical Centerwould be completed and the new facilityopened for patient treatment. In theseearly years of transplants, a small teamwithout formal direction or centralizedaccess to resources continued workingwith Dr. Smith and building the legacyof transplantation at Loma Linda Uni-versity Medical Center.

“In those days, patients had a fairlyhigh risk of death from transplantations,”remembers Sieg Teichman, MD, anephrologist who joined the MedicalCenter in 1974, and who worked withDr. Smith and Theodore Mackett, MD,a general surgeon who continued thekidney transplantation program. “But atthe same time, there were no chronicdialysis treatments available, and thereweren’t any other options for patientswith kidney failure.”

For the next 18 years, kidney trans-plantation would be the only solid organtransplantation done at Loma Linda Uni-versity Medical Center. For the first

decade, five to six transplants were doneeach year. Once dialysis became avail-able as a long-term treatment option inthe 1970s, the number of yearly trans-plants grew from 5 to 15 per year, then to30, and continued to expand to the cur-rent pace of more than 100 kidney trans-plants each year.

The kidney transplantation programwould lay the groundwork for all othertransplantation programs to come—hearttransplantation, beginning in 1985; livertransplantation, commencing in 1993;and bone marrow transplantation startingin 1999.

The United Network for OrganSharing (UNOS), the national regulatory

The first successful long-term organtransplant is performed by Dr. JosephMurray and the medical staff atBoston’s Peter Bent Brigham Hos-pital, in 1954. Photo from Surgery of theSoul, Reflections on a Curious Career (2001),by Joseph E. Murray, courtesy of the publishers,Science History Publications USA, division ofWatson Publishing International LLC.

Paul Anderson received the firstkidney transplant at Loma Linda inApril of 1967. Performing the historicsurgery was Lou Smith, MD, generalsurgeon, who had studied withJoseph Murray, MD, at Peter BentBrigham Hospital, in Boston.(University SCOPE, Wednesday, May 24,1967, p. 11)

A history of transplantation at Loma Linda SCOPE · Spring 2007 · 5

In addition to the adult transplantprogram, the institute also has a veryactive pediatric kidney transplant pro-gram, providing kidney transplantation torecipients as small as 13 pounds (6 kilo-grams).

Every potential recipient’s evalua-tion benefits from a comprehensive teamapproach, including the following:

� Transplant surgeons� Adult and pediatric transplantnephrologists

� Transplant nurse coordinators� Financial coordinator� Social worker� Transplant pharmacist� Transplant nutritionistThe liver transplant program pro-

vides comprehensive care to the adultand pediatric patients with liver disease.The primary goal of the program is to

restore those with end stage liver diseaseto an optimal level of health and to allowthem to lead a productive life.

Throughout the past 10 years, theinstitute has implemented strict guide-lines for evaluating and treating patientswith liver and kidney disease. Theseguidelines are part of a more conserva-tive approach to the treatment of liverdisease. Emphasizing education and pre-vention over more traditional therapies,the transplant team has seen positiveresults. Several patients have improvedso much that they have been able to goback to work—some even to the point ofbeing removed from the transplantwaiting list.

Within the past year, the number ofdays most patients stay in the hospitalafter transplantation has been drastically

reduced. As a result, much of the educa-tion with the patient and family must beaccomplished prior to surgery, as well aspost-transplant.

“I believe the statistical data showsthe success we’ve had in creating aseamless inpatient/outpatient service linewith continuity and excellence of care asthe hallmarks of an ethically sound,world-class transplant center,” remarksMs. Imthurn.

Education and preventionAt Loma Linda, candidates for

organ transplantation enjoy a network ofsupport made up of a multidisciplinaryteam of specialists. However, the mostimportant members of the team are thepatients themselves, and they must playan active role in the maintenance andpreservation of their own health.

“We’re big on teaching,” agrees Ms.Imthurn. “Our coordinators spend ahuge amount of time with patientsbefore discharge telling them what toexpect and how to take care of them-selves.” She adds, “One of our biggestchallenges is educating patients and fam-ilies about the importance of compli-ance—taking their immunosuppressantmedications exactly as prescribed.”

The Institute has implemented anaggressive patient education programthat focuses on the many needs of trans-plant patients and their families. Devel-oped over the past several years, theprogram now offers patient educationcourses in various areas of transplant thatmay be of concern to the patients andfamily members.

Prevention is also an important areathat the Transplantation Institute hasaddressed. The Transplantation Institutehas in place a program to make the com-munity aware of the risks of hepatitis C,liver disease due to obesity, andalcohol/liver diseases. While one goal ofthe institute is to work closely with trans-plant patients and their families, anotherequally important goal is to make a differ-ence in the community as a whole.

Through education, the institute

A history of transplantation at Loma Linda4 · SCOPE · Spring 2007

serve patients at all points along the con-tinuum of care, and effectively collabo-rate as interdisciplinary partners.

“People ask me what unit transplantis, and I have to stop and think whichunit we don’t have contact with,” notesJudy Reynolds, MBA, who has served asexecutive director for the Transplanta-tion Institute since November 1997. “Somany services help us, from the clinicallaboratory to infectious disease, to anes-thesiology in the operating room, tofinance to social work—we couldn’t do itwithout any of them.”

Gaining recognitionIn addition to patient care, an

important issue facing all transplant cen-ters is certification from the national gov-erning bodies, such as UNOS andMedicare. Without it, public and privateinsurances will not recognize or reim-burse transplant services.

The Transplantation Institute beganwith UNOS certification for kidney(1987), kidney/pancreas (1992), and livertransplants (1992). The institute has alsoenjoyed Medicare recognition of itskidney program since 1987.

In December of 1994, the 600thkidney was transplanted at the MedicalCenter. At that time, kidney patientsenjoyed a one-year graft survival of 95percent, and, more important to them,the patient survival rate was 97 percent.Several patients at the time had main-tained transplanted kidney function formore than 20 years. The continuedexcellence in patient care and clinicaloutcomes soon led to more certificationsand recognition of the institute as aleader in solid organ transplantation.

By March of 1995, Medicare grantedcertification to the heart transplantationprogram. UNOS certification followed inNovember.

In 1997, the Institute still lackedMedicare certification for the liver trans-plantation program. “When I came on atthe end of 1997, I had several conversa-tions with Dr. Moorhead, our presidentat the time, and he told me ‘This is the

most critical thing we need you to workon,’” remembers Ms. Reynolds. “So forthe next six months, I lived and breathedMedicare standards and criteria.”

Her efforts were not in vain.Medicare certified the TransplantationInstitute’s liver program on April 2, 1998.The certification letter is framed and stillhangs in Ms. Reynolds office.

In 1998, the United States PostalService selected LLUMC to be one ofits national sites for unveiling a 1998organ and tissue donation stamp.

First-day ceremonies were heldAugust 5, 1998, in Columbus, Ohio, inconjunction with the U.S. TransplantGames, August 5 to 8. Official unveilingceremonies were also held at key loca-tions across the United States to promoteorgan donor awareness. Because of itslong history of infant heart transplanta-tion, and in light of the TransplantationInstitute’s growing success, Loma Lindawas chosen as one of a handful of sitesnationwide where the stamp wasunveiled.

The institute todayTo date, LLUMC’s Transplantation

Institute has performed 1,681 kidneytransplants, 179 pancreas transplants, 307liver transplants, 597 heart transplants,and 167 bone marrow transplants. Theinstitute offers a comprehensive programthat provides services in the areas ofliver, heart, kidney, kidney-pancreas, andbone marrow for pediatric and adultpatients. More than 60 health care pro-fessionals form a core group that is com-mitted to providing excellent patientmanagement.

The renal (kidney) transplant pro-gram provides comprehensive evaluationand transplant-related services topatients with chronic renal failure or endstage renal disease (ESRD). Servicesinclude cadaveric, living-related, andliving-unrelated renal transplants, as wellas all aspects of dialysis access surgery.

“Living kidney donation is verygratifying,” says Ms. Imthurn of theliving transplants. “There seems to be aheightened sense of appreciation inthose cases. Every living donor frees upan organ for someone else. I’m pas-sionate about living donation. To me, itrestores your faith in humanity. Itinspires the staff.”

Maria Isabel Ancona, shown here atabout 4 years old, received her livertransplant at just 16 months of age atLoma Linda University Children’sHospital on December 26, 2003.

Lance Cpl. Christopher LeBleuthanked the Medical Center staff forhelping him live long enough toreceive a donor organ liver and for asuccessful transplant surgery on Jan-uary 31, 2005. He was transferredfrom Twentynine Palms on January26, 2005, and placed on the trans-plant list that night after doctors diag-nosed him with acute liver failure.The marine had just completed aseven-month deployment to Iraq inSeptember 2004, where he conductedsupport and stabilization operations.

Juanita Padilla, 17, receives somehelp from her mother in preparing forher high school graduation ceremonyin her hospital room on unit 4800 atLoma Linda University Children’sHospital. She enjoyed a complete in-hospital ceremony, thanks to herteachers and counselors at MorenoValley High School in June 2004.Diagnosed with acute myelogenousleukemia in September 2001, Juanitareceived a bone marrow transplantfrom her brother in April 2004.

Veronica Waring and her daughter,Armani, celebrated the little girl’s firstbirthday at the end of August 2003,made possible by a liver transplantshe received earlier in the year atLoma Linda University MedicalCenter’s Transplantation Institute.

Remembering Baby Fae SCOPE · Spring 2007 · 7

Remembering Baby FaeDr. Bailey tells the story of Baby Fae and Baby Moses, leading up to and including the first-ever suc-

cessful neonatal heart transplant in historyAN INTERVIEW WITH LEONARD L. BAILEY, MD; BY LARRY KIDDER, MA

While I was still in training, Ihad already made up my mindthat someone needed to

investigate transplantation in newborns.At that time, babies born with certainkinds of exotic heart disease weren’teven treated—they were set aside to die.And they uniformly did that.

I had encountered some of thosebabies. We tried various things to see ifwe could prolong their lives. Mostly weprolonged their dying, maybe by a fewdays. But we had no success at all insaving them.

I’d had a fascination with transplan-tation since visiting a laboratory at Stan-ford while I was in medical school. Ithought the natural thing would be toput the two together—babies born withincurable heart disease who are dying,and this transplantation technology thathadn’t found life yet in this age group.

Oddly enough, one of the very firsttransplants—and probably the first

transplant done in this country humanto human—was on a newborn baby. Dr.Adrian Kantrowitz in New York haddone a few infant animal tranplantationsin his laboratory, and had this samenotion that transplantation ought to begood for babies with broken hearts too.

So he made that attempt in 1967.The baby actually didn’t survive. Ibelieve they were able to get the babyout of the operating room and into theintensive care unit for about five or sixhours, and that was as far as it got.

Of course, transplantation of theheart was all the news at that time. Dr.Chris Barnard in South Africa had donethe first human heart transplant usinganother human heart.

Dr. Jim Hardy had put a chim-panzee heart in a human down at theUniversity of Mississippi, in Jackson, inthe mid 1960s. He had a patient withterrible heart disease whom he couldn’twean off the heart/lung machine. He’dalways had an interest in the idea oftransplantation but hadn’t worked it outfully. Nevertheless, he went down to thelab and found an aging chimpanzee, har-vested the heart, and put it in thisfellow. It worked for awhile, but itwouldn’t sustain his circulation beyondthe operating room.

When they performed an autopsyon the chimpanzee’s heart, lo andbehold, the old chimp was suffering fromsevere coronary artery disease. It prob-ably wasn’t really a fair situation.

That wasn’t something done in iso-lation. Dr. Keith Reemtsma had trans-planted chimpanzee kidneys into humanbeings at Tulane in those early days, and

actually had done reasonably well withthat group of patients. One ended upsurviving eight or nine months and wasback on the street living a reasonablelife. That’s at a time, to put it in perspec-tive, when we really didn’t know any-thing about transplantation or about howto suppress the immune system. We hadsome arcane medications to use, butnothing very good yet had come along.

When I returned to Loma Lindafrom training, the surgery department wasvery generous with me. They budgetedsome money for a laboratory. We got thelaboratory going again—it had kind offallen idle for a while. Dr. Lou Smith,who did the first organ transplant at LomaLinda University, had an active laboratoryprogram going for a number of years. Hehad become so busy clinically that hecouldn’t keep it going, and it had fallen

A history of transplantation at Loma Linda6 · SCOPE · Spring 2007

It was my privilege to sit down recently withLeonard L. Bailey, MD, and listen as herecounted his experiences leading up to BabyFae’s historic heart transplant on October 26,1984—just 12 days after her premature birthwith hypoplastic left heart syndrome. Theheroic efforts of Dr. Bailey and his team tosave Baby Fae included the use of a babybaboon heart. Her brief life gripped the worldas few stories have and raised awareness ofthe need for recovery of infant hearts andother organs to give these otherwise healthychildren a chance to live and thrive. Dr.Bailey has a deep appreciation for the labora-tory animals who gave the gift of life so thattransplant research could take place. – LK

Leonard L. Bailey, MD

introduces early or preventive measures,so that individuals can avoid progressingto where they need a transplant.

The prevalence of hepatitis C hasincreased to the point where it hasbecome a leading type of liver disease.Patient information is available regardinghepatitis C, and the TransplantationInstitute has worked to make this avail-able to the community through videosand written literature.

For hepatitis C, it is particularlyimportant to entirely avoid alcoholic bev-erages. Studies show those who drink aremore likely to progress more quickly tocirrhosis (hardening of the liver).

The institute also has a screeningprogram to detect hepatitis C early andto educate the public about it.

Staff members from the institutetravel to alcohol and substance abusetreatment centers in the area to talk tothe clients about liver disease. HepatitisC is the main topic, since it affects thatparticular population more than others.Staff members discuss the disease andwhat individuals should do to protectthemselves.

An important approach of the Trans-plantation Institute is the use of support

groups. Within these groups, transplanta-tion recipients can share their stories, andgive encouragement and support toothers awaiting a transplant, or to thosewho have already received one.Emphasis is on living life to the fullestand not focusing on the fact that one hasa disease.

Social workers show patients that,though they have to deal with the factthat they have a chronic illness, they canstill lead an active and normal life.

Education plays a vital role in theprevention of disease.

The Transplantation Institute holdsthe philosophy that a dollar spent oneducation and prevention about kidney,liver, or heart disease is a dollar wellinvested. The Institute places preven-tion education so highly that the processstarts in childhood whenever possible.

ResearchIn addition to the patient services

provided on a daily basis, the Institute isalso internationally recognized as a leaderin innovative research for the field oftransplantation.

The research team consists of trans-plant surgeons, hepatologists, nurse prac-

titioners, pharmacists, scientists, aresearch coordinator, and supportingmedical staff.

A broad spectrum of research withinthe Transplantation Institute ranges fromclinical trials involving study participantsto molecular research. All clinical studiesare performed either in conjunction withpharmaceutical companies, or initiatedby physicians within the department.These studies are closely monitored byan institutional review board, whichassures safety and compliance in allresearch matters. The knowledge gainedfrom this research leads to the develop-ment of improved drugs and techniquesto benefit transplant recipients.

The Center for TransplantImmunology Research is a division ofthe Transplantation Institute, whereimmunological approaches to transplantare state-of-the-art. At the Center, scien-tists examine transplantation at the cel-lular level, with a focus on solid organs,hepatopoietic cells, pancreatic islet cells,and stem cells. Through the collabora-tive efforts of clinicians and scientists,cutting-edge approaches to transplant arebeing developed.

The future“The last 10 years have been a real

focus on growth,” mentions Ms.Reynolds. “It’s going to take good physi-cian leadership to take us to the nextlevel. And we have a great team of physi-cians to provide that.”

“We are currently seeking a new,unique certification from the Joint Com-mission as a transplant institute,” saysMs. Imthurn. “This [2007] is the firstyear this certification is being offered.We are certified under the MedicalCenter, but this will be a specialized cer-tification that will speak to the standardsof care we meet,” she details.

There are opportunities to partici-pate in clinical trials at the Transplanta-tion Institute.

For information, please contact theTransplantation Institute and LiverCenter at (800) 548-3790. SCOPE

Acting district manager of the San Diego postal district Glenn Crouch (right)unveils the new organ and tissue donation stamp during ceremonies heldAugust 5, 1998, at Loma Linda University Medical Center. Looking on are(from left) Floyd Petersen, MPH, then mayor, city of Loma Linda; Leonard L.Bailey, MD, chair, department of surgery; and J. David Moorhead, MD, thenpresident and chief executive officer, Loma Linda University Medical Center.

Remembering Baby Fae8 · SCOPE · Spring 2007

quite idle. I didn’t see any merit in that.So we found some funding, put the

lab back together, and hired some tech-nical people to help with transplantingand looking after some little newborngoats. We chose goats as recipientsbecause, for one thing, they’re lovelylittle animals, easy to test, and smarterthan most animals—and very hardy, asopposed to lambs, which aren’t nearly astough. So lambs, at some level, becamedonors, and goats were always the recipi-ents. And they were available; we had afarm facility where we raised them.

We would take a baby goat a fewdays old and do a heart transplant—orthotopic heart transplant—and thatlittle baby would be jumping around thecage that evening. The next day, wewould put it in the pens with other goats,and then in a week it would be back outon the farm with its transplanted heart.What we wanted to learn was how farthey would go.

One of the greatest stimuli I hadwhen I was studying pediatric heart sur-gery up in Canada was the awarenessthat the newborn immune system isindeed fairly special—it has very little ofthe aggressiveness of the older child oran adult. It has no experience, whichhelps. And much of the suppressor typebehavior is still intact in the newborn.

So the possibility that a newborn

could receive a graft and actually growup without any immune suppression wascurious enough. We were able to demon-strate close to that. We had a baby goatnamed Livingston who was transplantedas a newborn and grew to 6 months ofage with no immunosuppression at all.

On average however, the trans-planted goats without immunosuppres-sion survived about two and a halfmonths. Then they began a slow rejec-tion process. So their immune systems,we knew from that experience, wereintact—they were just much moreaccommodating as newborns.

Then we wanted to know what wecould do to manipulate the immunesystem some way or other. We set up aseries of experiments with various modi-fications to observe the host immuneresponse. As it turned out, none of themodifications lengthened the mean sur-vival rate.

A fellow by the name of John Borel,in Basil, Switzerland, was working for apharmaceutical house. He had found afungus-like substance out in the hills. Hisjob was to study it and see if there wasanything there that he could make amedicine out of. I think he was originallylooking to see if he could find somethingthat would be effective with allergies.

But he began to study the immuneproperties of this substance and how itmight alter the immune response in ahost. It was pretty promising—some-thing called cyclosporin. It was calledcyclosporin-A at that time. I supposethey thought there would becyclosporin-B, C, and D.

So this substance was being studiedin the laboratories of the Swiss pharma-ceutical house, and by other laboratoryinvestigators around the world. Here inthe West, Stanford had access to it. I con-tacted John Borel—I’d met him earlier ata presentation I was making one timedown in Texas. He had agreed to sendme some of this material.

He began to send this material tome in brown jars. It was a powder. Youhad to mix it with some oily substance inorder to get it suspended. And then youcould begin to quantitate how much youwere giving an animal. We prepared agroup of little goats for allograft trans-plants—goat to goat. Mind you, therewere frequently different subspecies ofgoats, but they were similar enough.

We performed the transplants andtreated them with cyclosporin all along.With that, they lived indefinitely. Thatwas all it took. Cyclosporin-A becamethe mainstay of our immunosuppression.

Remembering Baby Fae SCOPE · Spring 2007 · 9

That took our breath away—the factthat we could transplant a baby at birthand have that baby grow up with nothingmore than receiving injections of this oilysubstance. The baby goats would godown to the farm, grow up, become bigherd animals, and actually grow old. Andif they didn’t get in trouble, they woulddie just of old age.

As goats do sometimes, they get intoa lot of trouble with things they eat. Oneof our older goats, one named Sigmund,was about 3 or 4 years old and he got intoour rubber glove supply—he ate all ofthese rubber gloves and died of an intes-tinal obstruction.

Then we thought, “Well, how arewe ever going to transplant babyhumans? We don’t have a system foridentifying potential donors for babyhumans, so if we’re going to transplantthem, we’re probably going to have tostart with cross-species. So we began totransplant lamb hearts into goats, andeven pig hearts into goats. We had somereally fascinating survival with thesecross-species transplants, usingcyclosporin-A alone.

And then we began to study whatwould be a potential donor for a humanbeing. Chimps were out, and orangutansand gorillas—they’re all endangered. We

wouldn’t think of using an animal likethat. But baboons seem to have a life oftheir own; they’re extraordinarily plen-tiful. There are actually programs to con-trol the populations in South Africa andplaces like that. They are hardy animalsand reproduce easily.

We thought, “Now here’s a subjectwe can study.” We soon discovered thatmore than 80 percent of the DNA in ababoon is identical to that of a humanbeing. The human leukocyte antigen(HLA) typing method is used to identifyyour tissue as being you and not yourneighbor. We found we could actuallytype baboons. And we could put babooncells and human cells together and pre-tend to do transplants in the laboratory,and find out which baboon might be themost compatible with any one humanbeing’s sample.

There were three or four importantimmunologic bench studies that wecould do to select a baboon donor. Thefirst thing we did was acquire somebaboons. We contacted our friends insouthwestern Texas at a huge primatecenter—probably one of the best, if notthe best one, on the planet. We toldthem what we wanted. We preferredjuvenile female baboons. We didn’t wantto have any male baboons growing up

and tearing up the cages.Sure enough, they were able to pro-

vide some juvenile female baboons.They would wean the baboons there andthen ship them out to us. So we hadabout a dozen of these juveniles that wecalled our donor panel. We did someother bench studies—for instance iso-lating a baboon heart and then perfusingthat heart with human blood in an iso-lated heart preparation—and did thesame thing with the goat and pig hearts.With the barnyard animals, none of thehearts functioned at all; the little baboonheart functioned beautifully for 12 hoursin that experiment.

We needed Institutional ReviewBoard approval. It took 14 months fromthe time we started to when we receivedapproval from the board. As I recall, Dr.Dick Sheldon was the chairman of theboard at that time. He was a terrifically—not that he was all for it, but hejust did a really superb, objective job ofassessing and moving his board throughthe process.

We had to bring in externalreviewers. We brought in a number ofpeople to review the protocol and give ustheir opinions. These were prominenttransplant people who were involved inthe process, and we had various opinionsof course—some were somewhat sup-portive, some were not supportive at all.

One of the opinions was “Whynot?” That opinion came from Dr.Sandra Nehlsen-Cannarella. And sheagreed to serve as our chief correspon-ding immunologist as we went forward.She told us she would be available—ifwe ever tried this clinically, she would beon the next plane and come out and helpus. And sure enough, that happened.Ultimately, Dr. Bruce Branson hired herand she moved from where she was inNew York out here, and was here for anumber of years as the chief ofimmunology.

The time came when we were veryclose to being ready to start. The pro-tocol was to do five of these cross-species transplants with newborns with

Dr. Bailey and his team perform a neonatal heart transplant on Baby Fae, usinga baboon heart because no system was in place to identify human donors.

Baby Fae looks pink and healthy following her historic surgery. Her new heartremained strong, though she eventually succumbed.

Remembering Baby Fae SCOPE · Spring 2007 · 11

thought there might be some regionalinterest, but the story became worldnews. That part of it was a little sur-prising. And it was a bit of a distraction—it did affect her care. We felt like wewere operating in a glass bowl.

Initially, Dr. Branson and others tookover talking with the news people. Dr.Nehlsen-Cannarella and I, and our teamwere focused on Baby Fae. We werethere day and night. We didn’t knowexactly what to expect, and didn’t want tomiss anything either, and so we were justthere. And then of course, toward theend, it became heartbreaking—we werelosing her and we didn’t quite understandwhy. Her heart was “gangbusters” still,and yet she was dying. We knew wehadn’t overdone the immunosuppressionor anything like that.

To this day, it’s a bit of a mysterywhat went on. Anyhow, she died, andthat was heartbreaking. We invested a lotof time, energy, and effort. We hadgotten to know her family.

It was also an institutional thing. Idon’t recall the institution ever beingquite as unified on anything as over thislittle baby. We all wanted her to go fur-ther, and it was a major letdown.

And then, of course, there were allsorts of second guessing, “7th inning”

discussions, that went on, some of whichwe tried to listen to with an objective earand learn from. Some were just wild—show business, I guess you’d say.

The media frenzy finally boileddown to a simmer. It was an electionyear, and you hardly knew RonaldReagan was being reelected. Thisprocess was right at the same time. Itnearly knocked him off the front page!

The hate mail and threats poured infor a long time, so much so that theRedlands police wanted us to let themopen our mail and things like that. Theywere excellent. They were a greathometown police department. They justtook over. Wonderful. We felt verysecure. We had two little children,Connor and Brooks, who were quiteimpressed when the police came up tothe house and gave us all lessons abouthow to take care of ourselves.

When we did the first allografttransplant a year later with Baby Moses(his real name was Eddie), wouldn’t youknow there were several busloads ofpeople who came out to picket thehouse. The Redlands police, stars thatthey are, only permitted these peopledemonstrate in front of our neighbors’house—I don’t think our neighbors wereeven home. Up on our property and inour house, there were officials from thepolice department guarding us.

Just like Baby Fae, this first allografttransplant with Baby Moses was veryserendipitous. It just so happened thatEddie was still in our hospital. An obste-trician from the Bay Area called me andsaid, “I know what you did for Baby Fae.Are you still doing transplants, because Ihave a baby here with birth asphyxia,and the parents want the baby’s organsdonated. Nobody else wants baby organsexcept you.” I said, “Well, I think we dowant that heart.”

We talked to Eddie’s mom and dad.They wanted to move forward. They’dlost a baby the year before to heart dis-ease. So we brought that donor babydown to Loma Linda and we performedwhat it turns out was the first successful

clinical newborn heart transplant, done ayear after Baby Fae. That hit the newstoo and went all around. I think initiallythe story received a life because peoplethought the heart was from anotherbaboon donor. But then it took on a lifeof its own because he stayed alive. Andfor the next several months there wasintense interest.

More important than the news—though that was vital—was the develop-ment of a donor base. Procurementagencies said, “Well, if Bailey’s reallygoing to do this, we’d better get our-selves up to speed too.” So procurementagencies all around the country began tomake something out of this human storythat was out there. And people began toconsider donating if their baby had birthtrauma or brain death—they began toconsider organ donation.

Procurement agencies also began towork in that direction. So, ever sinceBaby Fae and Baby Moses, there hasbeen a fairly steady flow of organ donors.There aren’t that many—it’s not terriblypractical—but there has been a steadyflow of somewhere around 100 a yearnationwide.

One comment that I would make isthat Loma Linda as an organizationenabled it, and embraced it, and wepulled it off as an organization better, Ithink, than had I been at any other aca-demic center in the world. With BabyMoses, we crossed the barrier of trans-planting a newborn, something whichhadn’t been accomplished previously.

In 1984, the same year we trans-planted Baby Fae, Sir Magdi Yacoub inLondon had performed an allograft on anewborn, and came close to being suc-cessful, but the baby died. To me, LomaLinda’s claim to fame is the fact that ourbaby, Eddie, is still living. He was off ina corner dying when we found him. Webrought a heart down from the Bay Areaand put it in. Eddie is living up in LasVegas and working at one of the hotelsthere. He’s 21 years old.

So that’s how it all comes around.The rest, as they say, is history. SCOPE

Remembering Baby Fae10 · SCOPE · Spring 2007

hypoplastic left heart syndrome. I wasstopped in the hall one day and one ofour pediatric cardiologists, Dr. GenePetry, asked, “You know, Bailey, how’sthat protocol coming? I happen to havea baby in the nursery now with thisproblem. Are you interested?” I said,“Well, let me do some checking.” I gotback to him and said, “Yes, I think weare.” He said, “Well, I’ve discharged thebaby home to die. The baby and herfamily live up in the high desert. I’llhave someone contact them and see ifthey have any interest.”

So one of four neonatologists, Dr.Doug Deming, called this mother andsaid, “We have this protocol that’s neverbeen tried just like this before. Do youhave any interest?” And they thoughtabout it and phoned back, and said theythought that they might have an interestand that they’d like to talk more about it.We invited them to come down—wespent hours actually in discussion. Part ofthe protocol meant that they had to sign aform saying they were interested. Andthen at some point or other, withinanother 24 hours they had to sign again,saying they were still interested andwould give us the consent to go forward.

After the first meeting, they indi-cated they wanted to go forward with it.The baby was up in the desert andbeginning to die. They brought the babyback down. We did what we needed todo, which, in those days, wasn’t verygood, to try to keep the baby alive. Theassays comparing the baby with thebaboon panel were supposed to havetaken about a week, but on or about thesixth day or so of this effort, the baby wasclearly going to die that day. We neededto move forward so Dr. Nehlsen-Cannarella read the tests a bit early. As itturned out, the tests identified one of thebaboons that was most compatible, andthat little baboon was set up to becomethe donor.

I should mention that, monthsbefore, we had screened these juvenilebaboons for infectious disease—foreverything from A to Z that we knew

and were able to test for in those days—and we knew they were clean. They hadcome to us clean, but we retested themto be sure they were to our satisfaction.

Now we had this donor panel thatwas ready to go. It came down to the day.I knew that Baby Fae was getting closerand closer to dying, and so we knew thatwe were going to do it the next morning.We heard rumors toward the end of ourpreparation that some newspaper up inthe desert had heard about it. I don’tknow how the leak happened, but it did.We were able to placate the news peopleat least until after the transplant wasdone. Fortunately, the pre-operativestory stayed local and didn’t spread.

We had done many of these new-born transplants in the laboratory—trans-planting with a human newborn was justthe next natural thing to do. I don’t recallbeing terribly nervous about it; I didn’thave much angst over it at all. Actually Iwas at a restaurant in Redlands the nightbefore with my wife, Nancy. We dis-cussed the situation together a little bit—what the consequences might be.

We didn’t have any idea of coursewhat might happen, but we thought weshould at least discuss it, and we did.

The next morning, I popped upand was down at the lab by about 6:00 in

the morning. Howard Shattuck, our sur-gical assistant originally brought in fromJohns Hopkins, was my right arm in thelaboratory surgically, helping me withthe transplants. So I had him on theother side of the table with me, as wellas some residents.

We gathered around the operatingtable. I brought the heart up from thelab. I remember taking the heart out andgoing up the back stairs and into theoperating room. We had Baby Fae allready. I arrived with the heart, we madethe incision, and went to work. We’ddone it so many times, although we’dnever really worked with hypoplastic leftheart syndrome. It cast a slightly dif-ferent nuance on the surgery, becausethe whole aortic arch had to be recon-structed as part of the process. We haddreamt of how it might go, but we’dnever actually done it in exactly this wayin a baby.

We were blessed. It just turned outbeautifully. Her response to the surgerywas just perfect.

I expected some reaction to it. Iremember what went on with Dr. ChrisBarnard, for instance. It was like a three-ring circus in Capetown.

I didn’t think that Baby Fae’s trans-plant would set off so many alarms. I

Drs. Bailey and Nehlsen-Cannarella check to see how Baby Fae is doing,.

Now 21 years old, Eddie, who wasknown as Baby Moses, is the longestsurviving newborn recipient of a hearttransplant. He is age 3 in this photo.

Everyday heroes SCOPE · Spring 2007 · 13

hard they work to save the life of thatchild. It gives me a thrill every time I seeit happen.”

A bit later, Sebastian is transferredto the pediatric intensive care unit,where the critical care team takes over.For many LLUCH staff, seeing a criti-cally injured child hits home.

“I always think this could happen tomy own child,” says Shamel Abd-Allah,MD, chief of the pediatric critical caredivision, who is a father of five. “Itmakes me work harder to save this life.”

According to Dr. Abd-Allah, Chil-dren’s Hospital transports more than 700trauma patients a year by ambulance orMercy Air helicopters.

Just a couple of days after Sebas-tian is taken to LLUCH, the little ath-lete plays catch with his nurse, drivesaround his new matchbox cars, andbasks in a sea of new toys that surroundhim on his bed.

“All the nurses have been reallygreat,” shares Carmen Barroso, Sebas-tian’s mom. She laughs, “Sebastian loves

it here. He loves all the attention andsays he doesn’t want to go home.”

Sebastian is discharged a few daysafter his accident with a colorful dinosaursling for his arm, lots of toys and bal-loons, and a full recovery ahead of him.

But while in the hospital, Carmenhears chilling news about a patient in thenext room. Their nurse tells her andJavier how fortunate they are.

In the room next door, a little girlhas had a similar accident. However,being backed over in her driveway by afamily member has left her brain dead.

“I would love it if I did not have tocome in and take care of a child who hasbeen injured,” says Dr. Moores. “Butunfortunately, the world we live in issuch that trauma happens. So we need tobe here to take care of the kids who doget injured.”

According to Dr. Moores, approxi-mately 95 percent of all trauma cases arepreventable.

SAFE KIDS—a nonprofit organiza-tion dedicated solely to preventing unin-

tentional childhood injury—has made avast improvement in trauma deaths.

“This is well evidenced by the factthat over the last 30 years,” explains Dr.Moores, “trauma deaths per year in theUnited States have decreased by about30 percent.”

The Children’s Hospital trauma sup-port services has a local SAFE KIDScoalition.

“Our outreach programs are trulythere to serve our community, tostrengthen it, to make it better andstronger,” says Michelle Parker, LLUCHSAFE KIDS coalition coordinator.

“Injuries that we try to prevent areall unintentional injuries,” says Ms.Parker. “We see children coming in whodon’t need to be hospitalized if therewere just a few things done to create asafer environment.”

According to Ms. Parker, the mostcommon trauma injuries are motorvehicle collisions, near drownings, pedes-trian accidents, and falls.

SAFE KIDS at Children’s Hospital

Everyday heroes12 · SCOPE · Spring 2007

Everyday heroesThe pediatric trauma team exists to saves young lives

BY PATRICIA THIO

As the pediatric critical care teammakes its rounds on a normalTuesday morning, 3-year-old

Sebastian is ready to spend a day withhis family.

Both his mom and dad have time offwork to celebrate the birth of theirsecond child. But first, they have to getready for a routine check-up for theirnewborn at the doctor’s office.

Sebastian’s dad, Javier Barroso, tellshis wife, Carmen, he is going to pull outthe car after putting the baby’s car seatin. Sebastian is told to put on his shoesand stay in the house as Carmen is get-ting the baby ready.

As Mr. Barroso backs out of thegarage in their Ford Expedition…hefeels a bump, and discovers a parent’sworst nightmare. Sebastian is lying facedown under the SUV.

On unit 5700 a call comes in. Aphysician from an area hospital speakswith the pediatric critical care attendingphysician at Loma Linda UniversityChildren’s Hospital—one of 13 Level Ipediatric trauma centers in the country.

Sebastian sustains critical injuriesand is in a nearby emergency room.Right after the physician’s phone call,the Children’s Hospital transport team is

alerted about the event. Within 30 min-utes, the pediatric nurse, respiratory ther-apist, and pediatrician gather the neededmedical equipment and converge at themeeting place—in this case, the ambu-lance outside the emergency entrance.

While the EMT ambulance drivertakes the team to the nearby hospital,they discuss the child’s condition.

“His vital signs seem pretty stable,”says Melissa Siccama, MD, pediatric resi-dent, LLUCH.

“Rib fractures, right clavicle frac-ture…” says Jeff Ambos, RN, pediatricICU nurse, LLUCH.

The team has one goal for the trans-port. “The first thing we do is stabilizethe patient and make sure we coverevery aspect of treatment,” says VictorBannis, RRT–MPS, respiratory transportteam coordinator.

As they make their way to thenearby hospital, the young 3-year-oldlies on a hospital bed with tubes con-nected to his little body, braces strappedaround him, and cuts and bruises on hisface and arms. His parents stand anx-iously next to him, holding his favoritestuffed animal. The transport team nowsurrounds him as Sebastian’s big browneyes look in every direction to see

what’s going on.“Hey Sebastian, look what you’ve

got,” says Dr. Siccama soothingly as shegives Sebastian a cuddly teddy bear. “I’llput him right here next to you.”

The team looks for additionalinjuries that the hospital may havemissed and stabilizes Sebastian for thetrip to Children’s Hospital. They straphim onto a backboard and wheel himout to the ambulance for the trip backto Loma Linda University Children’sHospital.

“I love working with kids,” saysMr. Bannis. “I find a sense of satisfac-tion going out and picking up the verysick patients and bringing them back toa higher level of care and seeing themget well.”

As Sebastian is taken to the emer-gency room at Children’s Hospital, thetrauma service is activated immediately.Physicians, nurses, therapists, X-ray tech-nicians—every specialist that Sebastianneeds is present.

“I am so proud of our team,” statesDon Moores, MD, chief of pediatrictrauma services. “They do so much, andthey do it with such passion. You justhave to see them once as a criticallyinjured child comes in. And you see how

Just a few members of the hundreds involved in pediatric trauma services. The team transports more than 700 patients ayear to Children’s Hospital—one of 13 Level I pediatric trauma centers in the country.

Everyday heroes14 · SCOPE · Spring 2007

educates parents on how to preventchildhood injuries.

Protect your child in a vehicleAccording to SAFE KIDS, four out

of five car seats are used improperly. Itcan take up to 12 years for a child to bebig enough for safety belts—close to 5feet tall and between 80 and 100pounds.

Until children reach that size andweight, they need to use car seats orbooster seats for protection in case of acrash. Children will take three car seatsteps before reaching step four, thesafety belt.

Step 1: Infants should ride in rear-facing safety seats until they are at least12 months old and weigh at least 20pounds. “Facing the rear of the vehicleprotects a baby’s neck and spinal cordfrom violent crash forces,” explains Ms.Parker. “If parents would leave childrenrear facing until they are 18 months to 2years of age if the seat limits allow it, thatwould probably prevent many needlessinjuries.” Another point to remember:never put a rear-facing child in a frontseat with a passenger air bag. If you mustuse the front seat, contact your vehiclemanufacturer about availability of an airbag on/off switch.

Step 2:Toddlers more than a yearold, who weigh 20 to 40 pounds and canno longer ride rear-facing, should ride inforward-facing child safety seats.

Step 3: Children more than 40pounds must use booster seats until thelap and shoulder belts fit correctly(around age 8). A booster seat positionsthe lap belt snugly over hips and upperthighs, and the shoulder belt snuglyacross the chest and shoulder.

Step 4:Once safety belts fit chil-dren correctly, the lap and shoulder beltsshould be used. To fit correctly in asafety belt, kids must be tall enough tosit all the way back against the vehicleseat with knees bent over the edge. Thelap belt should fit snugly over hips andupper thighs, and the shoulder beltsnugly across the chest and shoulder.

Prevent drowningsTwo-year-old Brandon was full of life

and love. He taught his family how toenjoy life and not sweat the small stuff.

“Brandon was a special child,” sayshis mother, Kim Patrick. “He had Downsyndrome,” she adds, “yet, he wasalways smiling and laughing. He didn’tsee it as a problem.”

Brandon would have been 9 yearsold this year, but he drowned in a back-yard pool at the age of 2.

Since that devastating day, Ms.Patrick has dedicated her time to acci-dent prevention.

“To go through the suffering andthe pain that I feel is not something thatI want other parents to experience,” sheexplains, “not for something that’s pre-ventable.”

As the coordinator for InlandEmpire SAFE KIDS coalition at Chil-dren’s Hospital, Ms. Patrick helps planwater safety demonstrations, among

other injury prevention programs.Although swimming pools are the

most common locations for drowning,Ms. Patrick says it has even happened inice chests. When the ice melts, it turnsinto a potential drowning site. Other pre-vention tips include emptying kiddypools and buckets. It only takes one inchof water to drown. Ms. Patrick describesdrowning as a silent scream. A personcannot cry out for help when submergedin water.

“It’s important for parents to knowthat drownings don’t take a long time tohappen,” says Ms. Patrick. “Within about30 seconds to a minute a child has lostconsciousness, and in about four minutesbrain damage is starting to occur.”

Rialto firefighter Matt Payne sharesthe ABCs of water safety:

� Adults: constantly supervise yourchildren.

� Barriers: a self-enclosed gate needsto surround the pool.

Everyday heroes SCOPE · Spring 2007 · 15

� Classes: children should take swim-ming classes, and adults shouldlearn first-aid and CPR.

Keep kids safe near vehiclesThe Barroso family members are

very thankful that 3-year-old Sebastian isO.K. after being accidentally backedover by the family’s SUV.

According to Kids and Cars—anorganization committed to stoppingdeaths and injuries to children in non-traffic, motor-vehicle related events—atleast 50 children are backed over everyweek. Of those, 48 end up in hospitalemergency rooms and two result in death.

As vehicles become larger, visibilitydecreases. In a statistic released by Kidsand Cars, there were 138 back-over fatal-ities between 1997 and 2001, comparedto 474 between 2002 and 2006. Kids andCars recommends the following to keepchildren safe:

� Walk around and behind a vehicleprior to moving it.

� Know where your kids are. Makechildren move away from yourvehicle to a place where they are infull view before moving the car, andknow that another adult is properlysupervising children before movingyour vehicle.

� Teach children that “parked” vehi-cles might move. Let them knowthat even though they can see thevehicle, the driver might not be ableto see them.

� Consider installing cross-view mir-rors, audible collision detectors, rear-view video cameras, and/or sometype of back-up detection device.

� Measure the size of your blind zone(area) behind the vehicles you drive.A 5-foot-1-inch driver in a pickuptruck can have a rear blind spot of 7feet wide by 50 feet long.

Safeguard kids against fallsFalls are the leading cause of unin-

tentional injury among children,according to SAFE KIDS. Childrenoften fall at home—from windows, downstairs, or off of furniture. They also fallwhile playing outside—from bikes andother play equipment. Each year, morethan 100 children ages 14 and under die,and 2.3 million are treated in emergencyrooms for injuries from falls.

The SAFE KIDS “Falls Safety”brochure lists a number of different tipsto protect children against falls.Protect your child at home:� Never leave young children aloneon changing tables, beds, sofas, orother furniture.

� Always strap children into high-chairs, swings, changing tables, andstrollers.

� Use safety gates at the top andbottom of stairs.

� Never let kids play on stairs.� Infants in carriers should always beplaced on the floor—not on tables orother furniture. Use all safety straps.

Protect your child around windowsand balconies:� Remember that children can fallfrom windows open as little as fourinches.

� Move chairs, cribs, beds, and otherfurniture away from windows,window coverings, and balcony rail-ings.

� Never rely on window screens toprevent falls.

Protect your child at play:� Insist children wear their helmetscorrectly every time they ride theirbikes, scooters, skateboards, orinline skates.

� Make sure children wear additionalprotective gear, including kneepads, elbow pads, and wrist guards.

For more safety information, contactthe pediatric trauma service and LomaLinda SAFE KIDS Coalition by calling(909) 558-4704 or visiting the website at<www.llu.edu/lluch/safekids>. SCOPE

The Barroso family shared their persevering story at the 2007 Children’s Hos-pital gala. Sebastian is perfectly fine now. Shamel Abd-Allah, MD, chief, pediatric critical care division, checks Kaley

Yerman’s vitals in the PICU. Kaley was involved in a motor vehicle collision.

Same family, different sides SCOPE · Spring 2007 · 17

Same family, different sidesCircumstance put classmates on opposite sides of a grim 1943 battle. One didn’t

survive—but he left behind a fascinating wartime account.BY HENRY YEO, MD, AND HEATHER REIFSNYDER

I t is famously said that the UnitedStates Civil War pitted brotheragainst brother. But this is a story

about brothers from different parents,different nations, different races.Brothers in the Christian family. They,too, belonged to different sides of a war.

Paul Nobuo Tatsuguchi wasJapanese; J. Lawrence Whitaker, Amer-ican. But both young men were Seventh-day Adventist Christians. Furthermore,they were classmates. Both attendedPacific Union College (PUC), in Angwin,California, and then the College of Med-ical Evangelists (CME)—now known asLoma Linda University. They each grad-uated as medical doctors in 1938.

In May 1943, their lives convergedagain—on Attu, the westernmost islandof the Aleutian chain. Both men werenow military doctors, on opposing sidesof the war.

Of course, neither physician realizedthe coincidence during the nearly 20days of torturous conflict, which endedwith an American victory.

An amazing coincidenceOn the last day of the fighting, Dr.

Tatsuguchi was killed.In the battle’s aftermath, American

soldiers, discovering the body of aJapanese medic, brought the deceased’smedical bags to Dr. Whitaker. Inside wasa medical textbook bearing the name of

a third member of the class of 1938, EdLee, along with Dr. Tatsuguchi’s name.Dr. Whitaker realized Dr. Tatsuguchi’spresence on the island, and his death.

A Japanese diary also surfaced in thewake of the battle. The author’s namewas absent from the document, whichcovered 18 days of conflict on Attu. Butthe diary included details of the author’seducation and military career, whichallowed him to be identified as PaulNobuo Tatsuguchi.

A story that fascinatesThe diary was translated and the

story of Dr. Tatsuguchi was widelyreported in newspapers at the time.

Almost 40 years later, in 1981, LomaLinda University briefly revisited thestory, publishing a transcript of Dr. Tat-suguchi’s diary in Scope. At this point, athird School of Medicine alumnusbecame intimately involved in the tale.

Henry Yeo, MD, graduated frommedical school exactly 30 years after Dr.Tatsuguchi. When he read Dr. Tatsug-uchi’s diary in Scope, he was intrigued.

“I said, this is a fascinating, fasci-nating story. Where’s the rest of it?” Dr.Yeo remembers.

About four years later, he wastalking with Ray West, MD, who wasthen editor of Alumni Journal, the publi-cation of the School of Medicine alumniassociation. The two men talked of thestory, and at Dr. West’s suggestion, Dr.Yeo decided to investigate further. Aftersome eight years of off-and-onresearch—running into lots of deadends—Dr. Yeo published a rich accountof the story of Dr. Tatsuguchi in the

Alumni Journal in 1993, the 50th-yearanniversary of Attu.

“The story just kept pulling meback to the Church connection, becausethat is the core of why this story ispoignant and gripping,” Dr. Yeo says.“The Adventist Church has always beenlike family.”

The amazing circumstances of thestory also drove Dr. Yeo’s fascination.

“This was a great, big war thatengaged practically the whole world,with unimaginable casualties,” he says.“And when the dust settled, here youhave a doctor on the enemy side whohad been killed at the same battlewhere his classmate fought. Not onlywere they two alumni, but two class-mates who had known each other sinceundergraduate study.”

As even more time passes, this storycontinues to fascinate. Just recently, forexample, Dr. Yeo received a phone callfrom a stranger in Seattle, wanting toknow more about the diary.

What follows is taken from Dr. Yeo’swriting and careful research into historyand the lives of his fellow alumni.

Tatsy’s life and deathHis American friends called him

“Tatsy.” Dr. Tatsuguchi’s ties to theUnited States and the Seventh-dayAdventist Church were long and deep.His father had attended Healdsburg Col-lege (the forerunner of PUC) inNorthern California at the turn of the20th century. His older brother attendedPUC and Emmanuel Missionary Col-lege. And then Tatsy also studied atPUC, from 1929 to 1932. Upon the

Inset: Dr. Tatsuguchi’s graduationphoto. Background: A Japanesecemetery on Attu sits below a back-drop of forbidding terrain.

Same family, different sides18 · SCOPE · Spring 2007 Same family, different sides SCOPE · Spring 2007 · 19

tremendous mountain artillery gun firing.Approximately 15 patients come into thefield hospital.

May 13: Continuous flow of wounded tothe field hospital.… Enemy strengthmust be a division. Our desperatedefense is holding up well.

May 14: The enemy has a great numberof Negroes and Indians.… In a raid I wasordered to West Arm, but it was calledoff. Just lay down from fatigue in the bar-racks. Facial expression of soldiers backfromWest Arm is tense. They all wentback to the firing line soon.

May 15:There was an air raid, tookrefuge in former field hospital cave. Theguns of a Lockheed spitted fire and flewpast our cave.

May 16: At night about 1800 undercover of darkness I left the cave. Thestretcher went over muddy roads andsteep hills of no-man’s land. No matterhow far or how much we went, we didn’tget to [the] pass. Was rather irritated inthe fog by the thought of getting lost. Satdown every 20 or 30 steps. Would sleep,dream, wake up again. Same thing overagain. The patient on the stretcher whodoes not move, is frost-bitten.… Thepass is a straight line without width.…Sitting on the butt and lifting the feet, Islide very smoothly and change directionwith the sword.…Walking is nowextremely difficult from left kneerheumatism which reoccurred on thepass.… By the favorable turn since thebattle of East Arm, reserves came back.

May 19:The hard fighting of our 303rdBn. in Massacre Bay is fierce and it is toour advantage. Have captured enemyweapon and used that to fight. Moweddown 10 enemy coming in under the fog.Five of our men and one medical NCO[non-commissioned officer] died.

May 20:Was strafed when amputating apatient’s arm.… Nervousness of Owia,

Commanding Officer, is severe and hassaid his last words to his NCOs and offi-cers—that he will die tomorrow. Gave allhis articles away. Hasty chap, this fellow.The officers at the front are doing a finejob. Everyone who heard this becamedesperate and things became disorderly.

May 22:Officers and men alike in frost.Everybody looked around for food andstole everything they could find.

May 24: Naval gun fire, aerial bombard-ment, trench warfare—the worst is yet tocome.… Am suffering from diarrhea andfeel dizzy.

May 25: No hope for reinforcements.Will die for cause of Imperial Edict.

May 26: Diarrhea continuous, pain issevere, took everything from pills,opium, and morphine, then slept prettywell. Strafing by planes, roof brokethrough. There is less than 1,000 leftfrom more than 2,000 troops.

May 27:The remaining ration is onlyfor two days. Our artillery has been com-pletely destroyed.… Continuous cases ofsuicide.… Heard they gave 400 shots ofmorphine to severely wounded andkilled them. Ate half fried thistle. It isthe first time I have eaten somethingfresh in six months, it is a delicacy.

May 28: The last assault is to be car-ried out. All patients in the hospitalwere made to commit suicide. Only 33years of living and I am to die. I have noregrets. Banzai to the Emperor. I amgrateful I have kept the peace of mysoul which Edict [this word has alsobeen translated Christ, Ehkist, Enkist,and Adict] bestowed upon me. At 1800took care of all the patients withgrenades. Goodbye [Taeko], mybeloved wife, who has loved to the last.Until we meet again, grant you God-speed. [Misako], who just became fouryears old will grow up unhindered. Ifeel sorry for [Mutsuko], born February

of this year and gone without seeingyour father.

After AttuThe Japanese forces made a last

desperate attack in the early morning ofMay 29. What happened next is told inthe words of Dr. Whitaker (who hassince died, in 1999):

“Dr. Tatsuguchi was killed not farfrom our aid station. The soldiers recog-nized that he was a medic and broughtme his medical bags, which contained aGray’s Anatomy book with Ed Lee’s namein it. I subsequently brought it backhome and gave it to Ed as a memento.

“What a surprise this whole thingwas! I should also point out that besidesTatsy and me, there was a third CMEgraduate on Attu: Joseph Mudry [Classof 1939. Dr. Mudry did not know Dr.Tatsuguchi personally]. I still have thebags and a copy of the original translationof Tatsy’s diary, now yellow and fragile.Time has taken its toll on us all.

“I have seen many subsequentwrite-ups about Tatsy, most of theminaccurate.”

Back in Japan, Taeko Tatsuguchiworried and prayed. Anxieties rose withthe announcement of the loss of Attu,but there was no word about where herhusband was. The dreaded news finallyarrived in August.

Now the sole parent to her twodaughters, Mrs. Tatsuguchi determinedto provide the best care and educationalopportunities within her meager circum-stances. Her parents lived in Hawaii,where her father was a pastor to theHawaiian Japanese Seventh-day Adven-tist congregation. She was finally able toreturn there with her children in 1954. In1961, she moved to Angwin, California,for her older daughter, Joy Misako, toattend PUC. Then in the mid-1960s, sherelocated to Southern California, and heryounger daughter, Lori Mutsuko,attended LLU School of Nursing. Now94 years old, Mrs. Tatsuguchi lives inLos Angeles, California, with Lori Mut-suko. She has four grandchildren. SCOPE

unexpected deaths of his parents, hereturned home to Hiroshima to take careof family affairs. But he came back to theUnited States in 1933 to study at theCollege of Medical Evangelists, gradu-ating in 1938.

Dr. Tatsuguchi and his new wife,Taeko Miyake, set sail in the spring of1939 to return to Japan, where heworked in the Seventh-day AdventistTokyo Sanitarium. The couple had adaughter, Misako, in 1940. Then in Jan-uary 1941, Dr. Tatsuguchi was draftedand ordered to report to new quarters onthe grounds of the Imperial Palace. Itwas dreaded news. He could returnhome only on assigned days. Dr. Tatsug-uchi went through officer candidatetraining and army medical school.

On a rainy day in the fall of 1942, Dr.Tatsuguchi said goodbye to Taeko, whowas pregnant again, and his daughter. Hewas not allowed to tell them where hewas going or when he would return. A fewmonths later, in March 1943, the sergeant-major of the Imperial Army was aboard atroop transport en route to Attu. TheJapanese had occupied Attu since June of

the previous year.This small island only measures

some 20 miles by 35 miles and featureshigh winds, dense fog, treeless moun-tains up to 3,000 feet, and bone-chillingcold—even in May, when Attu wouldbecome the final resting place for morethan 2,000 Japanese.

American intelligence had beenaware of the Japanese presence on Attusince the first occupation in June 1942and planned to continue monitoring thesituation until an adequate Americanforce could be gathered to reclaim thispiece of United States territory. The firstAmerican landing was scheduled for May7, 1943, but it was postponed to the 11th.

The American strategy was topinch the Japanese on the islandbetween invading northern andsouthern forces. The original forecastwas that Attu would be deliveredwithin three days. There were 12,000American troops against approximately2,300 Japanese. But it took 18 days todefeat the Japanese, who lost all butabout 30 combatants. As for the Ameri-cans, 549 were killed; 1,148 were

wounded; 1,200 were injured by thecold; 614 were sickened by disease; and318 suffered accidents.

Dr. Tatsuguchi’s diary begins whenAmerican forces landed at Massacre Bay.

As Dr. Yeo points out, the where-abouts of the original diary—if it stillexists—are unknown. He has seen 13different versions of the document.Translation and transcription also presentopportunities for inaccuracies to arise.The following excerpts are as recordedin a translated version owned by retiredFirst Sergeant Charles W. Laird, Com-pany H, 32nd Infantry, 7th Division ofthe U.S. Army.

The diary

May 11: Carrier based plane flew over,fired at it. There is a low fog and thesummit is clear. Evacuated to thesummit. Air raids carried out frequentlyuntil 1000. Heard land noise—it is navalgun firing.

May 12: In the night attack we havecaptured 20 enemy rifles. There is

In this circa 1922 photo, Paul Nobuo Tatsuguchi (far left) is shown as a child with his parents and siblings.

Telehealth: miles away but face to face SCOPE · Spring 2007 · 21

as a result of a gift from Tom and ViZaparra. Shortly thereafter, we began tooffer individual courses. Our first venturewas with Atlantic Union College [inSouth Lancaster, Massachusetts].

Subsequently, we have offereddegree and certificate programs to off-campus sites—for example, the physicaltherapist assistant program at OakwoodCollege, the occupational therapy assis-tant program at Fresno City College,and most recently two additional pro-grams at Fresno—the nuclear medicineand radiation therapy certificate pro-grams administered by the School ofAllied Health Professions department ofradiation technology.

We now have a marriage and familytherapy graduate degree program atCanadian University College [inLacombe, Alberta], a family medicineresidency training program at HanfordCentral Valley Hospital, and a bachelor’sprogram at Humanitec RehabilitationCollege, in Japan.

We have more than 13 years ofexperience in delivering educational con-tent via teleconferencing. Logistically,we have the details worked out for thatform of delivery. So it just seemed nat-ural, since the University had expertisein that area, that we would support theTelehealth Initiative.

Our initial focus is providing accessto health care in rural communities inSouthern California. In reality however,there are communities just 10 to 15 milesaway that, because of limited servicesand no transportation, also have limitedaccess to basic health care. It is a naturalfit for Loma Linda University to offer,through the Telehealth Initiative, accessto specialty care for both rural and urbancommunities.

With our initial grant from CTEC,we identified three hospitals whereaccess to specialty care was not avail-able—although general access was pos-sible. Catalina Island Medical Center,the smallest licensed hospital in theState of California, is one of our partners.

We also have Tehachapi ValleyHealthcare District, as well as RidgecrestRegional Hospital.

It is noteworthy that about two yearsago [to the day of this interview], we hadour initial dialogue with Ridgecrest Hos-pital. Roger Berg, their telehealthdirector, called. We set up a teleconfer-

ence, and as we got into the conversationtalking about the technology and whatthey were seeking from Loma LindaUniversity, the conversation started tomove far beyond continuing medicaleducation or the offering of certificateprograms.

In other words, the educationalthrust for which I thought I was going tobe able to provide some support almostimmediately turned to requests for clin-ical services that the Medical Centercould provide.

I informed the group involved inthe teleconference that I was not in aposition to answer those questions. Ithen called Dr. Behrens and told her wewere getting requests for telemedicineand telehealth services from rural healthproviders. I also told her I thought weneeded to send a consistent message tothose seeking a telehealth relationshipwith LLU. In response, Dr. Behrensformed what has come to be known asthe telehealth coordinating committee, agroup that has oversight for coordinating

Telehealth: miles away but face to face20 · SCOPE · Spring 2007

Telehealth: miles away but face to faceHealth care professionals and educators use telehealth technologiesto establish health services and education in outlying communities

AN INTERVIEW WITH W. WILLIAM HUGHES, PHD; BY LARRY KIDDER, MA

W. William (Billy) Hughes, PhD, has recentlybeen named dean of the Loma Linda Univer-sity School of Pharmacy (see page 24). In hisprevious role as director of educational sup-port services for the University, he washeavily involved with applying many of thelatest technologies to the educational setting. Itwas in this role that he became a key player indeveloping telehealth at Loma Linda. In thefollowing pages, he explains the history andprocess of telehealth in his own words. –LK

Telehealth at Loma Linda Uni-versity is more than clinicaltelemedicine; it involves all

health sciences that can improve accessto health care by providing services torural America.

All health science professionals—allied health, dentistry, medicine, science

and technology, psychology, marriage andfamily therapy, public health, pharmacy,nursing—have something to contributeto telehealth.

We prefer the term “telehealth”over telemedicine just to show theextent to which services are available.

The beginnings of telehealthSome three years ago, consistent

with the mission of the University, Dr.Lyn Behrens [president of Loma LindaUniversity Adventist Health SciencesCenter, or LLUAHSC] saw Loma Lindaas a major player in telehealth.

Dr. Behrens felt that a more con-certed effort to utilize telemedicine andtelehealth technologies would only serveto strengthen our outreach efforts.

I credit Dr. Behrens for providing

the leadership and focusing the institu-tional will to propel LLUAHSC tobecome the telehealth “hub” forSouthern California.

The CTEC grantWith the assistance of a California

Telemedicine and eHealth Center(CTEC) grant, we launched the LomaLinda University Telehealth Initiative(LLUTHI) and started our journey tobecome the Southern California regionaltelehealth hub.

The grant that we were initiallyawarded was coordinated by Dr. JamesKyle, former dean of the School ofPublic Health, and Paul Simms, formerdeputy health director for San DiegoCounty. Mr. Simms currently serves asadministrative director for the LLUTHI.The original award was for $400,000 andover the ensuing two years, that amountwas supplemented by $150,000 to sup-port a telemedicine coordinator.

When Dr. Kyle left the Universityin June 2006, I assumed the role of prin-cipal investigator (PI), since I had beencontributing to the grant since its incep-tion. Much of the technology that is usedfor telehealth involves videoconfer-encing—a technology with which I havefamiliarity.

The University has enjoyed a longand successful track record in the use ofteleconferencing for educational pur-poses.

In 1994, Dr. Behrens and Jerry Daly,the former director of media services[current assistant vice president forglobal outreach, LLUAHSC] purchasedour initial teleconferencing equipment

Dr. Hughes illustrates the simplicity of the equipment needed to create telecon-ferencing capabilities used to provide specialty health care for outlying clinics.

A little more than a year ago, the Mobile Telemedicine Vehicle (MTV), part of ajoint effort between the U.S. Army and Loma Linda University MedicalCenter, known as the DISCOVERIES project, was unveiled. The MTV iscurrently being used in a research project involving a medical clinic in nearbyReche Canyon where study subjects are being remotely assessed by theLLUMC emergency department. Originally designed for assisting with disasterevents, the MTV can also provide help in areas where no Internet or phoneconnections are available, since it maintains connectivity via satellite technology.

W. William Hughes, PhD

Telehealth: miles away but face to face SCOPE · Spring 2007 · 23

home health telemonitoring, particularlywith certain chronic diseases, such as dia-betes, hypertension, and congestiveheart failure, can prevent hospitalizationsthrough scheduled interactions withpatients that are at home or in otherhealth care facilities.

Judith Jensen [director of homehealth and community care coordina-tion services at the VA Loma LindaHealthcare System] is partnering withthe LLUTHI to share expertise andlessons learned, including outcomestudies that demonstrate health bene-fits and cost reductions.

A focus on diabetesIn our CTEC grant, we have

focused on chronic disease manage-ment—particularly diabetes—which wefeel is one of the greatest needs to ben-efit from the LLUTHI. It allows us tocombine store-and-forward retinalimaging technology along with patienteducation, using teleconferencing tech-nology to rural areas where access tohealth care was not previously possible.

When you consider what it takes foran individual on Catalina Island to cometo the mainland to have diabetes educa-tion, to catch the ferry, make the trip, tohave arranged for transportation on themainland, go to the clinic, receivetraining, go back, catch the ferry again—

it consumes an entire day. And that hasan associated economic loss for that indi-vidual, the family, and the community.

It may be what prompts individ-uals not to get help, because theprocess is so laborious in order to makeit happen. To be able to provide thattype of education—diabetes educa-tion—to an individual as close to his orher home as possible, in a familiar set-ting, is both a savings in time and costto the individual.

ReimbursementOf course, one of the concerns is

reimbursement. There are many morecodes that are now reimbursable throughMedicare and Medi-Cal. The CaliforniaState Legislature passed a bill last fall,proposed by Assemblyman DaveCogdill [Republican, Modesto] thatadded store-and-forward techniques tothe list of Medi-Cal approved telemedi-cine procedures.

Traditionally, clinicians have beenrequired to be physically present in theroom with a patient in order to charge fora consultation. Unfortunately, most con-sultations in the past have been deniedreimbursement if performed using tele-conferencing.

While progress has been made,more legislation needs to be enacted andinsurer reimbursement policies rewritten.

To me, the irony is that health care dol-lars are stretched so much farther withtelemedicine—both for the patient andfor the health care provider.

SustainabilityWhen you look at the hundreds of

rural clinics in Southern California, theneed is clearly there. Nearby, our moun-tain hospitals and health care clinics arepartnering with us to provide health careservices to their communities.

We are interested in going into areaswhere we know we can have a sustain-able operation. Sustainability meansmore than providing clinical services. Itmeans there is the potential for educa-tion—whether that be continuing educa-tion, patient education, certificate ordegree programs—those are educationalofferings that all use similar teleconfer-encing technologies.

We also feel that research is a veryimportant component. The outcomesresearch that can be performed has thepotential to validate telehealth as a viablemethod to deliver health care.

The interest and attendance at theAmerican Telemedicine Association isimportant. It illustrates that it’s not justabout the technology—it’s about thepeople and their enthusiasm, thechanges in legislation, the reimburse-ment, and the recognition that if we aregoing to provide truly excellent healthcare to our underserved populations, itwill be through telehealth. SCOPE

Telehealth: miles away but face to face22 · SCOPE · Spring 2007

all the education, research, and clinicalservices associated with telehealth. Thecommittee is chaired by Kevin Lang[executive vice president for finance andadministration, LLUAHSC]. This wasabout the time that we were embarkingon the first CTEC grant, so the timingwas quite appropriate.

A little more than a year ago, theMobile Telemedicine Vehicle (MTV),part of a joint effort between the U.S.Army and Loma Linda University Med-ical Center known as the DISCOV-ERIES project, was unveiled. The MTVis designed to provide emergencytelemedicine services at the scene of dis-asters, such as an earthquake.

The nuts and bolts of telehealthThere are two primary approaches

for the delivery of telehealth: “store-and-forward” technology or interactive tele-conferencing.

Store-and-forward technologyinvolves the storage and sending of stilldigital images to remote specialists fordiagnosis and interpretation.

For ophthalmology, the sending ofretinal images is an important compo-nent, particularly for diabetic screeningas part of an overall strategy for chronicdisease management. CTEC and theUniHealth Foundation each funded anARIS™ retinal camera for Hanford andCatalina Island respectivlely.

For dermatology, surface lesions andother skin abnormalities can be digitallyphotographed, images compressed, andsent as what is commonly called a “jpeg”file. These files are then downloaded atthe appropriate clinical department atLLU Health Care for diagnostic viewingand interpretation.

That’s store-and-forward technology.It works well when you have images thatdo not require a live, interactive video.

The second technology is live tele-conferencing. This modality providesthe capabilitiy for live audio and videoconnections between what we call a“spoke” site— for example, the ruralclinic where individuals seek specialty

health care—and a “hub” site, such asLoma Linda University.

We connect to our rural partners viaa normal Internet protocol (IP), orthrough Independent Subscriber DigitalNetworks (ISDN). The absence of psy-chiatry represents a major unmet need inrural communities—a need that can bemet through telepsychiatry or interactivelive teleconferencing. Pediatric psychi-atry is one of the more popular entrypoints for deliverable services using tele-conferencing. It really doesn’t requireany additional technology—just a cameraand that face-to-face over a distanceinteraction.

With the help of Richard Hergert[vice president and chief informationofficer for Loma Linda University Med-ical Center] and his staff, we have nowconnected the Diabetes TreatmentCenter to the network and are capable ofproviding multilingual diabetic patienteducation classes to our rural partners.

There are, of course, more techni-cally sophisticated forms of telehealththat involve peripheral diagnostic instru-ments that can be connected to the tele-conferencing equipment.

We can support electrocardiograms(ECGs), vital signs monitors, spirometryfor respiratory function, dermscopes forskin lesions, ear/nose/throat (ENT)scopes, otoscopes, ophthalmoscopes—all

with the ability to connect into thesystem and provide video and/or datasignals from that spoke site back to thehub site, where the signal can be viewedby a health care specialist.

Internal benefits and research effortsFor the institution internally, there’s

another opportunity. For example, ourability to connect the urgent care facilityon the LLUMC East Campus with theemergency department at the MedicalCenter allows for rapid access to inten-sivist and emergency consults—youcould eliminate patient transport.

There are other demonstration proj-ects on campus that currently involvetelehealth. For example, the DISCOV-ERIES program connects the emergencydepartment at the Medical Center with ahealth care facility in Reche Canyon.

The goal of this effort is to demon-strate the impact of providing emergencyroom services in a skilled nursing facilityvia telemedicine. This service mayreduce unnecessary transport, a benefitof which would be the reduction inpatient numbers at our already over-crowded emergency rooms.

There are outcome studies thatindicate that telehealth provides a ben-efit that is both a cost savings and pro-motes timely access to health care.

Some of the very low bandwidth

A telehealth training facility will be located on the fourth floor of the new Cen-tennial Complex, currently under construction, with the goal of familiarizing thehealth care professionals of tomorrow with telehealth technologies.

Veidy Almaraz stands next to the telemedicine banner in the LLU FacultyMedical Offices telemedicine facility. Ms. Almaraz is the full-time telemedicinecoordinator.

Teleophthalmological retinal scan-ning capabilities are an importantcomponent in the monitoring of dia-betic patients.

Newscope24 · SCOPE · Spring 2007

The Board of Trustees recentlynamed Beverly J. Buckles, DSW, chairand professor, department of social workand social ecology, SST, the dean of theLLU School of Science and Technology.During the same session, the Board

named David T. Dyjack, DrPH, as deanof the LLU School of Public Health.W. William Hughes, PhD, was named

by the Board to serve as dean of the theLLU School of Pharmacy during a con-ference call on January 31.For the past 14 years, Dr. Buckles has

served at Loma Linda University. In1993, she joined the University as chairfor the department of social work andsocial ecology.According to Ron Carter, PhD, vice

chancellor of academic affairs, LLU, andformer dean of SST, Dr. Buckles is avisionary who toils diligently until thework is done.“She has been one of the finest

department chairs that I have everknown,” says Dr. Carter. “She will takecharge and move SST strategically intoits next developmental stage.”As one of the founders of the LLU

International Behavioral Health TraumaTeam (IBHTT), Dr. Buckles helps healwounds of the heart. The interdiscipli-nary team provides psychologicaldebriefing for the victims of natural orman-made disasters by presenting semi-nars to the local health professionalsliving near the disaster site. IBHTT hasprovided clinical services and training inmore than 15 countries.

Board of Trustees names new deans

Newscope

Newscope SCOPE · Spring 2007 · 25

Dr.Dyjack received his undergraduateeducation in biology from Saint Mary’sCollege ofMaryland in 1982; hismaster ofscience in public health from the Univer-sity of Utah, Provo, in 1992; and his doctorof public health in occupational healthfrom the University of Michigan, AnnArbor, in 1996.In 1994, Dr. Dyjack was named asso-

ciate dean for public health practice inthe School of Public Health. In July 2006,he was appointed interim dean of theSchool of Public Health and officiallyplaced in that position by the Board inOctober of 2006.Dr. Hughes most recently served as

director of educational support services atLomaLinda University. In addition, he isa professor in the LLU School of Scienceand Technology and an associate pro-fessor in the LLU School of Medicine.Before heading up educational sup-

port services, Dr. Hughes served in anumber of positions for the LLU Schoolof Allied Health Professions, including as

program director for off-campus programsand basic science education, professor ofbasic science, and associate dean.The School of Pharmacy recently

graduated its first class of 34 pharmacistswith their PharmD degrees and is in theprocess of seeking full accreditation. Asone of only two Seventh-day Adventistschools of pharmacy in the world, and theonly Adventist school of pharmacy in theU.S., the School of Pharmacy is alreadytaking a lead role in training Adventistpharmacists for leadership in the field.The incoming class has 65 members.“We’re now in the process of maturing

a strong infrastructure for the School,”Dr. Hughes explains, “which will sustainit through the coming years.”Dr. Hughes graduated with a bach-

elor’s degree in biological sciences in1973. In 1974, he completed a master’sdegree in biological sciences from PacificUnion College, in Angwin, California. Hereturned to LLU and completed his PhDin biological sciences in 1978.

Beverly J. Buckles, DSW W. William Hughes, PhD

New LLUCentennial Complexreaches $40 millionmilestone

In mid-December, Loma LindaUniversity achieved a significant mile-stone when gifts and pledges for the newCentennial Complex—currently underconstruction—passed the $40 millionmark, thus meeting a key qualificationfor a $1.5 million challenge grant fromthe Kresge Foundation.

According to Carolyn Cales, MA,Loma Linda University executivedirector for special gifts, the challengegrant was achieved four months early.More than 750 individual donors gavegifts and made pledges to this majorbuilding project—as did several majorfoundations.

As construction continues, so alsowill campaign fundraising efforts to coverbuilding-cost increases beyond originalconstruction estimates.

Raye McAnally Lofgren and CarltonLofgren, DDS, and Patti Shryock Wal-

lace and Carleton Wallace, MD—co-chairs of the campaign for the CentennialComplex—will continue to oversee thiscontinuing fundraising effort.

The Centennial Complex is a hightechnology, student-oriented facility thatwill enable “anytime, anywhere” accessto a vast array of health professions infor-mation. By combining the best in tradi-tional ways of teaching and learning withinformational resources that leading-edge

communication technology makes avail-able, the complex will transform the waythat LLU delivers health professionaleducation to its students on campus,regionally, and globally.

“The planning and design of thecomplex comes at a most appropriatetime for the University and its students,”says Richard H. Hart, MD, DrPH, LomaLinda University chancellor.

“The complex looks toward ananticipated on-campus enrollment growthof 25 percent, from the current 4,000 to5,000 students, by the year 2010. Our stu-dents are quite adept at using up-to-datecommunication technology. Therefore,the complex is designed to integratethese skills into the learning process.

“Furthermore, the University servesas the educational hub for the prepara-tion of competent and compassionatehealth professionals who may work in500 hospitals and health centers aroundthe globe. As such, Loma Linda receivesmultiple requests for educational andhealth care services from many parts ofthe world, especially remote settingswhere basic and continuing education inthe health professions may not be readilyavailable.

“Growth, technological innovation,and global connectivity have been theguiding themes for the design of the

Construction has now begun on the Centennial Complex. This picture, takenMarch 20, shows the beginnings of the south wall.

The LLU School of Pharmacy’s 63-member class of 2010 receives whitelab coats and pins during the annual white coat ceremony, held on Jan-uary 21 in the Loma Linda University Church.

School of Pharmacy white coat ceremony

David T. Dyjack, DrPH

Newscope26 · SCOPE · Spring 2007 Newscope SCOPE · Spring 2007 · 27

Children’s Hospitalhosts KFRG/StaterBros. bicyclegiveaway

Approximately 4,500 families andtheir children attended the fourthannual Loma Linda University Chil-dren’s Hospital bicycle giveaway heldon Sunday, November 12, 2006. Theevent was held at the ArrowheadCredit Union Park in San Bernardino.

Eight hundred fourth-graders andtheir families were invited to attendthe bicycle giveaway hosted by KFRGradio and Stater Bros. Markets. Thefourth-grade recipients of the bicyclesand safety helmets were children whohad never had a bicycle and were rec-ommended by their school teachers.

Inland Empire radio listenersdonated a total of $507,175 for thetreatment of cancer patients at LomaLinda University Children’s Hospital.

For each contribution of at least$200, a Kent bicycle and helmet waspurchased from Toys ‘R’ Us. Theeffort made possible the obtaining ofthe bicycles for fourth grade studentswho live in the Children’s Hospitalservice area of San Bernardino, River-side, Inyo, and Mono counties.

One of the donors, Mike Adamsfrom Anaheim, stood quietly next to abicycle that his donation had helpedmake possible for a child.

Mr. Adams said he had donated tothe KFRG radiothon in honor of hisson, Mike Jr., a 4-year-old child whodrowned in a friend’s swimming poolin 1994. “He would have liked this,”Mr. Adams said. “He liked to ride hisbicycle.” Mr. Adams plans to donate tothe radiothon again next year.

Guests, friends, and local businesssupporters of Loma Linda UniversityChildren’s Hospital raised $523,370 atthe 14th annual Loma Linda Univer-sity Children’s Hospital Foundationgala held at the Riverside ConventionCenter on Sunday, February 25.

Approximately 850 individualsattended the “It’s a Jungle Out There”gala sponsored by the San ManuelBand of Mission Indians.

“Each year we are privileged toselect a Children’s Hospital unit tobenefit from your caring and gen-erosity,” said Larry Sharp, chair of theLLUCH Foundation Board, in hisintroductory remarks. “Tonight, all pro-ceeds will support the pediatric traumaservices, a department that treats chil-dren who are facing the most devas-tating injuries.”

Proceeds from the evening weredesignated for the pediatric traumaservices at Loma Linda UniversityChildren’s Hospital. Last year, nearly5,000 children received care at Chil-dren’s Hospital.

“While the leading causes of

injury are motor vehicle accidents andfalls,” says Donald Moores, MD, chief,division of pediatric surgery at LomaLinda University Children’s Hospital,“children need trauma care for avariety of reasons including neardrowning, child abuse, and snakebites.”

Loma Linda University Children’sHospital is one of only 13 Level Itrauma children’s hospitals in thecountry. Loma Linda’s pediatric traumateam serves the four county area of SanBernardino, Riverside, Mono, and Inyocounties and provides medical care fornearly 5,000 children annually.

Several awards were presentedduring the evening. Receiving theShirley N. Pettis Award was ArleneWillis Lewis, a lifetime resident of SanBernardino County, and chief of staffand spouse to Congressman JerryLewis, who represents California’s 41stCongressional District.

Receiving the 2006 Loma LindaUniversity Children’s Hospital Foun-dation Hometown Heroes Award wereDebi Faris-Cifelli and Bernadette Gal-

Loma Linda University Children’sHospital gala surpasses goal of $500,000

A day with “Dr. Venom” was a $24,000 hit during the live auction. In thephoto above, Sean Bush, MD, and his wife, Ame, hold their snakeSamantha, as Sebastian Barroso, a former patient and star of the Children’sHospital gala video, pets her.

LLUMC unveilsnew constructionproject

On December 13, Loma Linda Uni-versity Medical Center announced plansfor a construction project that will pro-vide a new building to house the Inter-national Heart Institute and establishtwo state-of-the-art centers for imaging,gastrointestinal, and pulmonary services.

The new building will allow forexpansion of services and ease of accessto accommodate the rapidly growingpopulation of the Inland Empire. Thefacility will also allow for the expansionof the Cancer Institute within the cur-rent Schuman Pavilion, and is in align-ment with the overall strategic plan toallow LLUMC to continue providingservice excellence and clinical leadershipin health care for the residents of theInland Empire.

“This is a very important part ofexpanding our services,” says RuthitaFike, MA, CEO of Loma Linda Univer-

sity Medical Center.The proposed pavilion will be built

east of the Schuman Pavilion on thenortheastern corner of the MedicalCenter campus. It will encompass142,000 square feet among four floors,with total project costs estimated to be$96.2 million. Construction is expectedto take between 18 and 24 months once

city approval and appropriate permits arein place. Upgraded parking access will bedeveloped to coincide with the project.

“We really do want to make accessi-bility and convenience hallmarks of thisinstitution,” says Danny Fontoura, MBA,senior vice president of LLUMC. “Weknow parking is going to be a corner-stone of this project.”

(From left) Jesse Mock, vice president for LLUMC facilities; Danny Fontoura,MBA, senior vice president, LLUMC; Lowell Cooper, MPH, chair, Board ofTrustees; Roger Hadley, MD, dean, School of Medicine; and Kevin Lang,MBA, chief financial officer, LLUAHSC, watch as Ruthita Fike, MA (left),CEO, LLUMC, and B. Lyn Behrens, MBBS, president& CEO, LLUAHSC,unveil the new sign marking the ambulatory pavilion site.

LLUAHSC vice president steps downEarly in January, W. Augustus

Cheatham, MSW, vice president forpublic affairs, Loma Linda UniversityAdventist Health Sciences Center, expe-rienced symptoms that caused him toseek medical attention. A small braintumor was identified and removed onJanuary 10.

Mr. Cheatham has expressed appre-ciation to the entire Loma Linda Univer-sity Medical Center and East CampusHospital staff for the wonderful care hereceived while hospitalized. He is cur-rently recuperating at home.

Although he has responded well tothe surgery and rehabilitation treat-ments, and continues to improve, in aletter dated April 2 to B. Lyn Behrens,MBBS, president of LLUAHSC, Mr.Cheatham indicated, pursuant to inputfrom clinicians and discussions with

family, he has come to the conclusionthat he must step down from responsi-bilities effective July 8.

President Behrens has indicatedthat Mr. Cheatham’s letter of resignationhas been accepted with regret andunderstanding of the circumstances thathave necessitated his decision, and withthe deepest of appreciation for his manyaccomplishments over the past 22 years.

“We want to honor Mr. Cheatham,”says Dr. Behrens, “and we will build onhis legacy as we move to select a suc-cessor.”

She further requests that all remainprayerful for the continued improvementof Mr. Cheatham’s health, and for God’sblessing on his family.

A more in-depth report about Mr.Cheatham’s years of service will appearin a future issue of Scope.

W. Augustus and Ida Cheatham

Newscope28 · SCOPE · Spring 2007 Newscope SCOPE · Spring 2007 · 29

LLU professorshows thatpomegranate juicemay reduce risk ofAlzheimer’s disease

When his grandfather passed awayfrom Alzheimer’s disease, RichardHartman, PhD, assistant professor ofpsychology, School of Science and Tech-nology, wanted to make a difference. “Itwas devastating to see the effects,” herecalls.

Dr. Hartman’s experience withAlzheimer’s may help others fight off thedisease. He found that a daily glass ofpomegranate juice could halve the build-up of harmful proteins linked toAlzheimer’s disease. In fact, his study hasshown that pomegranates work just aswell as pharmaceutical medicines.

“This study is the first to show ben-eficial effects (both behavioral and neu-ropathological) of pomegranate juice inan animal model of Alzheimer’s disease,”

says Dr. Hartman, researcher and leadauthor of the study. He also collaboratedwith Washington University researcherson this project.

The study began with transgenicmice predisposed to developAlzheimer’s-like pathology and symp-toms. At a young age, the mice were split

Richard Hartman, PhD, assistant professor of psychology, SST, is currentlystudying the effects of pomegranate juice and A-beta antibodies on braindamage caused by stroke or trauma.

into two groups—half received waterwith added pomegranate-juice concen-trate, and the control group receiveddrinking water with the same amount ofsugar as the juice.

The mice drank an average of 5 mil-liliters of fluid a day, which is roughlyequivalent to a human drinking one totwo glasses of pomegranate juice a day.

The learning and memory abilitiesof the mice were tested in the Morriswater maze, which required the animalsto swim and find a submerged platformin a pool of water.

The results are significant. After sixmonths, the pomegranate juice-treatedmice learned water maze tasks morequickly and swam faster; and the micethat drank the pomegranate juice had 50percent less beta-amyloid plaques in thehippocampus of their brains.

Pomegranates contain very highlevels of polyphenols (an antioxidantphytochemical that tends to prevent orneutralize the damaging effects of freeradicals) as compared to other fruits andvegetables.

The study, titled “Pomegranate juicedecreases amyloid load and improvesbehavior in a mouse model of Alzheimer’sdisease,” is featured in the December2006 journalNeurobiology of Disease.

Motocross freestyle riders Jeff Tilton (left) and Ronnie Renner, two of themost talented freestyle riders in the world, perform for patients and staff atChildren’s Hospital on January 17. The Big Air Kids Fair is now in itsfifth year. After the jump demo, the riders split into two groups and touredthe hospital, distributing loads of shirts, hats, pajamas, toys, and otherproducts generously donated by motorcycle industry leaders.

‘Big Air Kids Fair’ visits LLUCH

What is a networth?SIMS provides bednets to save lives

Every 30 seconds an African childdies of malaria. For many children andfamilies in Africa where malaria is aleading cause of death, a net is worth alife. Sleeping under an insecticide-treated bed net (ITN) is one of the mosteffective and inexpensive ways to pre-vent malaria. An ITN costs approxi-mately $5. However, that is beyondreach for many who need it the most.For the past two years, Students forInternational Mission Service (SIMS)has collected donations for its mosquitobed net project.

In December of 2005, SIMS raisedalmost $30,000 for insecticide-treatedbed nets that were distributed during ahealth fair in Batouri, Cameroon. Inpartnership with local health leaders, theSIMS team trained and educated local

The office of public health practiceand workforce development at LLUSchool of Public Health is partneringwith the County of San Bernardino toreduce the risk of catching food-borneillnesses at restaurants.

The office duplicated 7,500 copiesof an instructional DVD for trainingfood workers produced by the San Ber-nardino County Department of PublicHealth’s division of environmentalhealth services.

“This type of activity helps us fulfillour mission of promoting health,reducing illness, and educating thepeople of our county,” says DavidDyjack, DrPH, dean, School of PublicHealth. “This is an example of apublic/private partnership that benefitsthe citizens of San Bernardino.”

The DVD is part of an effort by SanBernardino County to better enforce

compliance with applicable food-handling law. The new option makesmore accessible the necessary training toobtain a food handler’s card.

In the past, food workers have onlyhad the option to attend a class in personat one of six training facilities in thecounty. The training is also now availableonline, and the county is adding moretesting centers, as well.

Within six months, all food estab-lishments in the county will havereceived the DVD, and the county’senvironmental health inspectors will beverifying 100 percent compliance withcounty code requiring all food handlersto have a current food handler’s cardwithin 14 days of employment in SanBernardino County.

“The protection of public health isdirectly related to the safe food handlingpractices of employees,” says Terri Wil-

A boy in Batouri, Cameroon, happily displays his insecticide-treated bed netthat he received after attending the SIMS health fair in December 2005.

health leaders, and together they put onthe city’s first health fair. Health educa-tion topics included malaria prevention,nutrition, maternal/child health, oralhealth, and HIV/AIDS prevention. Afterattending all of the lectures, participantswere given a free ITN.

In December of 2006, empoweredhealth leaders in Batouri used the edu-

cation and training they received to puton the city’s second health fair.

If you’re interested in providing a $5donation that will help save a life, sendyour tax-deductible gift to SIMS, LomaLinda University, Cottage 80, LomaLinda, California 92350. For more infor-mation, please contact SIMS at (909) 558-8089 or by e-mail at <sims@llu.edu>.

Public health collaborates with county to train food handlersliams, REHS, of the county’s Depart-ment of Public Health.

The School of Public Health is alsohelping the California Department ofHealth Services with a training project.The School is reproducing notebooks ofwritten materials that the CaliforniaDepartment of Health Services will useto train environmental health leaders onnew legislation that takes effect July 1,2007. The leaders will then return totheir respective offices and train thehealth inspectors in California’s 58county and four city health departments.

The Centers for Disease Controland Prevention funds LLU School ofPublic Health as one of five RegionalAcademic Environmental Public HealthCenters in the nation. These university-based centers provide technical resourcesto any environmental health programwithin their respective regions.

Newscope SCOPE · Spring 2007 · 31Newscope30 · SCOPE · Spring 2007

Loma Linda Broadcasting Network(LLBN) launched its signal on globalsatellite Thaicom-5 in November 2006.With this new signal, LLBN nowreaches Africa, Europe, Asia, and Aus-tralia—more than 90 percent of theworld’s population.

In addition, LLBN is reached bysatellite throughout North and SouthAmerica.

“As many of you know, LLBN hasgone from a few hours a week of broad-casting the services of Loma Linda Uni-versity Church on a local cable channelto reaching thousands in the Americasthrough the direct-to-home satelliteAMC-4, cable headends, and other pri-vate low/high power television and radio

Assemblymanaddresses issue ofpremature births inthe Inland Empire

On November 28, elected officialsand community leaders of the InlandEmpire saw firsthand how prematurebirth affects a newborn as they touredthe regional tertiary neonatal intensivecare unit (NICU) and new mother-babyunit at Children’s Hospital. The NICUtour was presented by the March ofDimes Inland Empire division, LLUChildren’s Hospital, and AssemblymanBill Emmerson in an effort to bringattention to the growing crisis of prema-ture birth.

In California, one in ten babies(52,800 babies annually) are born prema-ture. In half those cases the cause isunknown. In 2004 and 2005, more than7,000 babies (or 11 percent of live births)were born premature in San BernardinoCounty alone.

Premature birth is now the numberone cause of newborn death and a majorcause of serious health problems. Thenational total for hospital charges for pre-

LLBN broadcast coverage now spans 90 percent of worldstations,” says Ganim Hanna, LLBNchief executive officer. “Plus, manyother viewers worldwide use ourInternet video streaming services. WithThaicom-5, millions more around theworld can be reached. Negotiations arecurrently under way for distribution inTaiwan, Southeast Asia, the MiddleEast, and parts of Africa.”

Going global is a big leap of faithfor LLBN, which is run entirely onfreewill donations of money and labor,according to Mr. Hanna. “This new ven-ture, including air time and other currentoperational costs, will bring our budgetto approximately $2 million annually.

“As a 100 percent viewer-supported network, we need your

prayers and partnership to reach theworld with the message of hope, health,and healing.”

Through the use of more satellites,LLBN is now a worldwide networkavailable 24 hours per day and reaching194 countries—and the number ofnations reached is expected to grow inthe near future.

LLBN’s range of programming isgrowing. Along with several new spiri-tual programs, LLBN is working withLoma Linda University Medical Centerand Loma Linda University to bringnew programs.

Loma Linda Broadcasting Net-work’s website may be found at<www.llbn.tv>.

A winter storm hit Loma Linda University and Loma Linda UniversityMedical Center with a coat of snow on Friday, January 12. Picturedabove are Loma Linda University Medical Center and Loma Linda Uni-versity Children’s Hospital.

Winter snow storm dusts Loma Linda

mature and low birth weight babies wereestimated at $18.1 billion by the Marchof Dimes in 2003. That figure is almosthalf the total costs for all births in thesame year.

Many of these “preemies” sufferlifelong disabilities, which add evenmore to health and education costs—not

to mention the pain and suffering thesebabies and their families experience.

The March of Dimes and Children’sHospital are taking the lead in the InlandEmpire to address issues around thecapacity to care for an increasing numberof babies being born too soon, and tobetter serve families in this area.

Center for ChristianBioethics presentsnew show on theResearchChannel

Loma Linda University’s Centerfor Christian Bioethics was featured onthe ResearchChannel, a nonprofitmedia and technology organization thatconnects a global audience with theresearch and academic institutionswhose developments, insights, and dis-coveries affect our lives and futures.

The show, “Addressing MedicalErrors: Shifting the Professional Para-digm to Promote Patient Safety,” wasbroadcast on November 20.

“One of the main functions of ourcenter is to educate the academic com-munity on issues in bioethics,” saysMark Carr, PhD, director, Center forChristian Bioethics. “Through ourHealth and Faith Forum we have donean outstanding job of this for many,many years here on our LLU campus.”

According to Dr. Carr, when theidea presented itself that the centercould have these sessions broadcast viathe ResearchChannel to millions ofhomes across the country, the centerthought it was a great opportunity.

“On the ResearchChannel we havetremendous exposure via cable TV andInternet access,” he says.

“We find ourselves in some verygood company in terms of research-oriented universities in America whoalso broadcast on theResearchChannel.”

Johns Hopkins University, the Uni-versity of Washington, and the Libraryof Congress are just a few of the institu-tions whose programs are featured onthe ResearchChannel.

More than 70 institutions partici-pate as members and affiliates, and thatnumber continues to grow.

Through cable and satellite distribu-tion, the ResearchChannel is available tomore than 22 million U.S. households.

A professor in the Loma Linda Uni-versity School of Pharmacy is currentlystudying Antarctica penguins.

Sompon Wanwimolruk, PhD, pro-fessor of pharmaceutical sciences, hasalready completed and published onestudy, and he is in the process of applyingfor further funding of continued study ofthe Adélie penguins, which live in severalcolonies on Ross Island in Antarctica.

Dr. Wanwimolruk is particularlyinterested in studying the levels of asuperfamily of enzymes, known ascytochromes P450, found in the liver.

These enzymes are important formetabolizing—or breaking down—xeno-biotics, such as drugs, environmental pol-lutants, and chemical carcinogens.

A paper, titled “Characterization ofCYP1A enzyme in Adélie penguin liver,”was previously published in the journalComparative Biochemistry and Physiologyand online at Elsevier’s ScienceDirectwebsite. This was actually the thirdpaper published by Dr. Wanwimolruk onhis penguin research.

This earlier study examined 10 pen-guin livers obtained from adult birds who

died of natural causes—most of themprobably killed by skuas, large predatoryseabirds.

Cytochromes P450—otherwiseknown as CYP enzymes—are found inthe liver and help to metabolize varioustoxins produced by the body or taken infrom the external environment.

“CYP enzyme levels found in theliver can be used as a biomarker for thelevels of pollution to which a specieshas been exposed,” says Dr. Wan-wimolruk. “In the past, very little atten-tion has been given to CYP enzymelevels in wild animals.”

Scientists are always looking forways to measure the levels and effects ofvarious pollutants on the earth’s inhabi-tants. The increase in CYP enzymelevels in the penguin livers is one moreindicator of exposure to environmentalcontaminants.

Dr. Wanwimolruk hopes hisresearch will provide new insight into theability of the penguins, other wildlife,and even human beings to cope withdangerous and growing environmentalpollution in the future.

Sompon Wanwimolruk, PhD, professor of pharmaceutical sciences, LLUSchool of Pharmacy, conducts field work on Ross Island in Antarctica in 1998.

School of Pharmacy professor conductsresearch on penguins in Antarctica

Boards of Trustees & administration SCOPE · Spring 2007Newscope32 · SCOPE · Spring 2007

CHAIR: Lowell C. Cooper, MDIV, MPH (1, 2, 3)

MEMBERS:Carol Allen, PHD, RN (1, 2)Donald R. Ammon, MBA (1, 2, 3)Lorne Babiuk, PHD (1, 2, 3)Matthew A. Bediako, MA, MSPH (1, 2, 3)B. Lyn Behrens, MBBS (1, 2, 3)Dennis N. Carlson, DMIN, MDIV (1A, 2A)Robert G. Carmen, OTR, MPA (1, 3)Charles Cheatham (1A, 2A)Jere E. Chrispens, MA (1, 3)Cari M. Dominguez, MA (1, 2, 3)Garland Dulan, PHD (1, 2, 3A)T. Grace Emori, MS, RN (2E)Ruthita J. Fike, MA (1A, 2A, 3)Gwen W. Foster, MPH (1E, 2E)H. Roger Hadley, MD (1A, 2A, 3)Allan R. Handysides, MBCHB (1, 2A, 3)Richard H. Hart, MD, DRPH (1A, 2, 3A)

David B. Hinshaw Jr., MD (1, 3)David B. Hinshaw Sr., MD (1E, 3E)Daniel R. Jackson, MA (1, 2)Gerald Karst (1A, 2A, 3A)Donald G. King, DPH (1, 2)Gerald Kovalski, MA (1A, 2A)Kevin J. Lang, MBA (1A, 2A, 3A)Robert E. Lemon, MBA (1, 2, 3)Ronald A. Lindsey, MBA (3E)Carlton Lofgren, DDS (1, 2)Thomas J. Mostert Jr., MA (1, 2, 3)Luther Park (3E)Jere D. Patzer, DMIN, MBA (1A, 2A)Jan Paulsen, DTH, BD (1, 2, 3)Monica Reed, MD (1, 2, 3)Leroy A. Reese, MD (1E, 2E)Gordon L. Retzer, MDIV (1, 2)Calvin B. Rock, DMIN, PHD (1E, 2E, 3E)Steven G. Rose, CPA (1A, 2A, 3A)Charles C. Sandefur Jr., MDIV (1A, 2A)

Don C. Schneider, MA (1, 2, 3)Claudette J. Shephard, MD (1, 2, 3)Ella Simmons, EDD (1A, 2A, 3A)John Testerman, MD (3)Ralph J. Thompson, MD (3E)Max A. Trevino (1, 2A, 3)Dave Weigley, MBA (1A, 2A)Douglas Welebir, JD (1, 2)Thomas L. Werner, MBA (1, 3)Neal C. Wilson (1E, 2E, 3E)Patrick Y. Wong, MBBS (1, 2)Walter L. Wright (1A, 2A)Tom Zapara (1E, 2E)

LEGEND:1=LLUAHSC2=LLU3=LLUMCE=EmeritusA=Advisor

LOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTERBoards of Trustees

AdministrationLOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTERPRESIDENT & CHIEF EXECUTIVE OFFICER: B. Lyn Behrens, MBBSEXECUTIVE VICE PRESIDENT, finance & administration; CHIEF FINANCIAL OFFICER:Kevin J. Lang, MBA

EXECUTIVE VICE PRESIDENT, hospital affairs: Ruthita J. Fike, MAEXECUTIVE VICE PRESIDENT, medical affairs:H. Roger Hadley, MDEXECUTIVE VICE PRESIDENT, University affairs: Richard H. Hart, MD, DRPHSENIOR VICE PRESIDENT, clinical faculty: Ricardo Peverini, MDSENIOR VICE PRESIDENT, educational affairs: Ronald L. Carter, PHDSENIOR VICE PRESIDENT, faculty practice:David Wren, MHASENIOR VICE PRESIDENT, finance: Steven Mohr, CPASENIOR VICE PRESIDENT, health administration:Daniel Fontoura, MBASENIOR VICE PRESIDENT, human resource management & risk management:Mark L. Hubbard

SENIOR VICE PRESIDENT, managed care: Zareh Sarrafian, MBASENIOR VICE PRESIDENT, strategic planning:Michael H. Jackson, MPHVICE PRESIDENT, allied health professions education: Craig Jackson, JD, MSWVICE PRESIDENT, dentistry: Charles J. Goodacre, DDS, MSDVICE PRESIDENT, diversity: Leslie N. Pollard, DMINVICE PRESIDENT, finance: Verlon Strauss, CPAVICE PRESIDENT, graduate medical education:Daniel W. Giang, MDVICE PRESIDENT, graduate studies education: Anthony Zuccarelli, PHDVICE PRESIDENT, healthcare business development & government relations:Melvin Sauder, MDIV, JD, MBA

VICE PRESIDENT, nursing education:Marilyn Herrmann, PHD, RNVICE PRESIDENT, patient care services: Elizabeth J. Dickinson, RN, MPH, CNORVICE PRESIDENT, pharmacy education:W. William Hughes, PHDVICE PRESIDENT, public affairs:W. Augustus Cheatham, MSWVICE PRESIDENT, public health education:David T. Dyjack, DRPHVICE PRESIDENT, quality: James Pappas, MDVICE PRESIDENT, religion education: Jon Paulien, PHDVICE PRESIDENT, science & technology education: Beverly J. Buckles, DSWVICE PRESIDENT, spiritual life & wholeness: Gerald R. Winslow, PHDVICE PRESIDENT/CIO FOR ACADEMIA:David P. Harris, PHDVICE PRESIDENT/CIO FOR HEALTHCARE MINISTRIES: Richard Hergert, MDIV

LOMA LINDA UNIVERSITYPRESIDENT: B. Lyn Behrens, MBBSCHANCELLOR/CHIEF EXECUTIVE OFFICER: Richard H. Hart, MD, DRPHSENIOR VICE CHANCELLOR, financial affairs; COMPLIANCE OFFICER: Verlon Strauss, CPAVICE PRESIDENT/CHIEF FINANCIAL OFFICER: Kevin J. Lang, MBAVICE CHANCELLOR, academic affairs: Ronald L. Carter, PHDVICE CHANCELLOR, information systems:David P. Harris, PHDVICE CHANCELLOR, public affairs:W. Augustus Cheatham, MSWVICE CHANCELLOR, spiritual life & wholeness: Gerald R. Winslow, PHDSPECIAL ASSISTANT TO THE CHANCELLOR: Leslie N. Pollard, DMIN

DEANS: Beverly J. Buckles, DSW, Science & Technology;W. William Hughes, PHD, Pharmacy; Charles J. Goodacre, DDS, MSD, Dentistry;H. Roger Hadley, MD,Medicine; Craig R. Jackson, JD, MSW, Allied Health Professions;Marilyn M. Herrmann, PHD, RN, Nursing;David T. Dyjack, DRPH, Public Health;Anthony J. Zuccarelli, PHD, Graduate Studies; Jon Paulien, PHD, Religion

LOMA LINDA UNIVERSITY MEDICAL CENTERPRESIDENT: B. Lyn Behrens, MBBSCHIEF EXECUTIVE OFFICER/ADMINISTRATOR: Ruthita J. Fike, MACHIEF FINANCIAL OFFICER: Kevin J. Lang, MBASENIOR VICE PRESIDENT/ADMINISTRATOR, Children’s Hospital; SENIOR VICE PRESIDENT,managed care: Zareh Sarrafian, MBA

SENIOR VICE PRESIDENT/ADMINISTRATOR, East Campus Hospital; SENIOR VICE PRESIDENT,strategic planning:Michael H. Jackson, MPH

SENIOR VICE PRESIDENT/ADMINISTRATOR, University Hospital:Daniel Fontoura, MBASENIOR VICE PRESIDENT, ambulatory services/CNO, patient care services:Elizabeth J. Dickinson, RN, MPH, CNOR

SENIOR VICE PRESIDENT, finance: Steven Mohr, CPAVICE PRESIDENT, business development:Melvin Sauder, MDIV, JD, MBAVICE PRESIDENT, chief information officer: Richard Hergert, MDIVVICE PRESIDENT, facilities & environment: Jesse MockVICE PRESIDENT, human resource management/risk management:Mark L. HubbardVICE PRESIDENT, medical administration:Daniel W. Giang, MDVICE PRESIDENT, mission & ethics: Gerald R. Winslow, PHDVICE PRESIDENT, public affairs & marketing:W. Augustus Cheatham, MSWVICE PRESIDENT, quality and patient safety: James Pappas, MDVICE PRESIDENT, revenue cycle: Cynthia J. Schmidt, MBASPECIAL ASSISTANT TO THE CHIEF EXECUTIVE OFFICER: Leslie N. Pollard, DMIN

LOMA LINDA UNIVERSITY HEALTH SERVICESPRESIDENT: Kevin J. Lang, MBAEXECUTIVE VICE PRESIDENT:Mark L. HubbardCHIEF FINANCIAL OFFICER: Robert Frost, MBA

LOMA LINDA UNIVERSITY HEALTH CAREPRESIDENT:H. Roger Hadley, MDCHIEF EXECUTIVE OFFICER:David Wren, MHACHIEF FINANCIAL OFFICER: Kevin J. Lang, MBA

SCHOOL OF MEDICINE FACULTY PRACTICEPRESIDENT: Ricardo Peverini, MDCHIEF FINANCIAL OFFICER: Kevin J. Lang, MBA

LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTERPRESIDENT/CEO: Ruthita J. Fike, MACHIEF FINANCIAL OFFICER/TREASURER: Steven Mohr, MBAADMINISTRATOR: Jill Pollock, RN, MSEXECUTIVE DIRECTOR OF FINANCE: Edward Field, MBA

LLU students hostCelebration healthfair for community

A student-initiated and student-runcommunity service program called theHealthy Neighborhoods Project (HNP)hosted the first Healthy NeighborhoodsCelebration health fair since 2002.

On Sunday, October 8, the HNPsponsored a community-focused healthfair at SACHS–Norton on East 3rdStreet in San Bernardino.

The community was invited to takepart in screenings and awareness exhibi-tions on breast and skin cancer, dia-betes, immunizations, obesity, dentalhealth, and child safety, among others.

The health professional students atLLU have a long-standing involvementin the Norton Neighborhoods, a largelyuninsured and medically underservedpopulation in San Bernardino.

The health fair initially began in2001 as part of a “Caring for Communi-ties” grant by Pfizer/AMA that two med-ical students received to begin theCommunity Kids Connectiontutoring/mentoring program. The healthfair and a race were supposed to be thefundraiser to keep the

tutoring/mentoring program going. Thehealth fair and race continued for twoyears, then in 2003, the event was can-celled due to the fires that ravaged theInland Empire.

This year, under the direction ofLeslie Hsu, a fourth-year medical stu-dent and the health fair director, andwith sponsorship from LLUMC–EastCampus’s PossAbilities program and theInland Empire Health Plan, the healthfair was resurrected with many student

booths and community booths for edu-cational purposes for the SanBernardino community.

Besides the health fair, the men-toring and academic tutoring programsthat are part of the Healthy Neighbor-hoods Project give LLU students theopportunity to form ongoing friendshipswith local children and parents.

The mentoring programs are stu-dent-initiated and student-run and arebased in the School of Medicine.

Beginning in July 2007, the LLUSchool of Allied Health Professionsdepartment of occupational therapy willlaunch its online doctoral program.

The online degree programreceived accreditation in December2006 from the Western Association forSchools and Colleges.

“The flexibility of our online pro-gram is designed to fit the busy lives ofworking occupational therapists,”according to Heather Javaherian, OTD,OTR/L, assistant professor and directorof the occupational therapy doctoral pro-gram, “helping to meet the ever-changingtechnological demands of society.”

The coursework includes anemphasis on spirituality, diversity, criticalreasoning, advocacy, participation, edu-cation, and independent research, saysDr. Javaherian.

Graduates from the program will beprepared to enter academia; conductresearch; develop, implement, and assessinnovative programs; influence publicpolicy, and experience personal as well asprofessional growth in the spirit of LomaLinda University.

“Our online community will fosterlearning and professional growth,” Dr.Javaherian continues, “through creativelearning experiences, critical reflections,

community, and in-depth discussions.”The program’s capstone is a 16-unit

professional rotation designed by theindividual students and approved by thedoctoral committee.

“Our faculty envisions the rotation,”Dr. Javaherian explains, “as a way ofallowing students to express their cre-ativity, explore new areas of practice, andengage in innovative research and com-munity program development.”

For more information, visit<www.llu.edu/llu/sahp/ot/doctorate.html>, contact Dr. Javaherian at<hjavaherian@llu.edu>, or call (909)558-4628.

Occupational therapy program announces online doctoral program

Maryann Bautista with her son Jose, from San Bernardino, gets her blood pres-sure taken by Lisa Turner, a physician’s assistant at LLUMC.

LOMA LINDA UNIVERSITY ADVENTISTHEALTH SCIENCES CENTERLoma Linda, California 92354Volume 43, Number 1

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