Meet the new dean of public health

Harvard professor Paul Cleary, a medical sociologist, has studied how patients relate to health systems.

At first glance, Paul D. Cleary, Ph.D., might seem an unorthodox choice to be dean of public health. The one-time rock and blues pianist started out as a medical sociologist, but a look at his research projects and publications shows that he’s spent his career exploring behaviors that affect health and how people interact with the systems that provide health care. His work has sought better ways to find out how patients view their care; he has also studied what determines variations in the quality of care. He’s traveled the world to study HIV/AIDS, smoking, alcohol abuse and mental illness.

“The things I have focused on are health behavior, analytic methods, research that people refer to as social epidemiology, statistical modeling, health policy and behavioral science,” Cleary, a member of the Institute of Medicine of the National Academy of Sciences, said in an interview in March, about two weeks after Yale President Richard C. Levin and School of Medicine Dean Robert J. Alpern, M.D., announced his appointment as dean of public health and chair of the Department of Epidemiology and Public Health.

Cleary, who enjoys bicycling, skiing and flying his private plane, began his work at Yale in July. He succeeds Michael H. Merson, M.D., the Anna M.R. Lauder Professor of Public Health, who stepped down as dean in 2005 after 10 years on the job. Brian P. Leaderer, M.P.H. ’71, Ph.D. ’75, served as interim dean for 18 months.

“My philosophy of organization,” Cleary said, “is that I should make it easier for the faculty to do their job better.”

Cleary also believes in programmatic research. “Let’s say you have two people, three people, four people who want to focus on cancer research. They may reinforce each other. You may be able to get more support for certain programs. You may be more likely to have an impact. Young assistant professors who want to work in that area will have mentors,” Cleary said. “I feel very strongly about developing research programmatically, fostering multidisciplinary collaborations and developing excellence in focused areas.”

Those areas of inquiry, he stressed, would be determined by the faculty. And his programmatic view would not preclude individual scholarship by faculty members, he said. “You rely on their vision and innovation to do things,” he said.

Cleary’s academic path, also a bit unorthodox, began with his graduation from the University of Wisconsin in 1970 with an undergraduate degree in physics, a field that still fascinates him. Advanced studies in physics seemed too abstract at a time when the real world of social ferment inspired by the Vietnam War and civil rights movement was beckoning. After taking time off from school to play in blues and rock bands, he chose to study medical sociology, also at Wisconsin.

In 1982 he joined the faculty at Harvard, where, at the time of his appointment at Yale, he was professor of health care policy in the departments of health care policy and social medicine at Harvard Medical School.

“I know that many of you, as I do, look forward to working with him in the years ahead,” Levin told a gathering of public health faculty in the Winslow Auditorium. “You will find that he can be a sympathetic listener, someone who can pay attention to people and at the same time be capable of independent thinking and leadership.”

Alpern, Ensign Professor of Medicine, said he shares Cleary’s vision of programmatic research and multidisciplinary collaborations.

Cleary and his wife, Cynthia Barnett, J.D. ’82, a corporate and environmental lawyer in Boston, have two children, Janet, 19, and Barnett, 14.

—John Curtis

Cancer Center moves forward after vote by New Haven Board of Aldermen

In a unanimous vote in May, New Haven’s Board of Aldermen cleared the way for the construction of a new cancer facility at Yale-New Haven Hospital (YNHH) for patient care and clinical research. With groundbreaking for the 14-story, $450 million structure scheduled for this fall, the facility will open its doors to patients at the end of 2009.

The vote followed a marathon negotiating session in March in which the city, the hospital, a labor union and community groups resolved numerous issues surrounding the Yale Cancer Center (YCC). Under the agreement the city agreed to approve needed zoning changes; the hospital increased its offer of benefits to the community; and the hospital and the Service Employees International Union agreed to a nine-month organizing period for hospital workers, to be followed by a secret-ballot election. Mayor John DeStefano Jr. called the deal a “win-win-win” for all parties.

For the hospital and medical school, the deal means the chance to continue improvements in cancer treatment and research.

“The facility will allow us to meet our mission of providing exceptional care to the most acutely ill patients we serve,” said Marna P. Borgstrom, M.P.H. ’79, CEO and president of YNHH. Richard L. Edelson, M.D. ’70, professor of dermatology and director of YCC, agreed. “This is a huge step forward for the Yale Cancer Center’s capacity to provide truly state-of-the-art care,” he said.

The hundreds of physicians, nurses, clinical researchers and laboratory technicians involved in cancer treatment at Yale are now dispersed throughout the hospital and medical school. The new building on Park Street will bring them together under one roof, with immediate benefits for patients, said José Costa, M.D., professor of pathology and deputy director of the YCC. “Our current facilities are the result of a cancer center that has been in existence for 30 years, and with the passage of time they have grown and have been remodeled to adapt to progress in clinical medicine, but in a less-than-ideal fashion,” Costa said. “The new building benefits from a clean, forward-looking design.”

One of the biggest advantages of the unified facility will be easier access to state-of-the-art care for patients and families facing a challenging illness, Borgstrom said.

“Cancer care is multidisciplinary, involving important input from several specialties,” Edelson said. “Bringing collaborative physicians together for face-to-face discussions—to put their heads together to discuss a challenging case when it is fresh in their minds, rather than simply reading one another’s notes in the chart—is simply the best way to do it.”

Although it is still three years from its scheduled completion date, Edelson said the project has already had an impact. Thanks in part to the plans for a new building, Edward Chu, M.D., the cancer center’s chief of medical oncology and director of clinical research, was able to recruit 11 top clinical investigators to Yale in just two years. “We have to have the best doctors that we can possibly have, and we can do a much better job attracting them if we have the very best facilities,” Edelson said.

With that new expertise and a new building on the way, Yale will be able to direct more clinical trials of treatments discovered at the School of Medicine, Edelson said. For Costa, the building’s advancement of both care and research will mark a new era in the YCC’s 30-year history. “We want to be practicing the medicine of tomorrow,” said Costa. “Let’s not remodel the house; let’s build a new house that is ideally suited not just for today, but for where we think we will be in 10 years.”

—Peter Farley

Ugandan doctors visit Yale in first steps of collaboration on medical education

In 2002 Majid Sadigh, M.D., associate clinical professor of medicine, made the first of three trips to the Makerere University Medical School in Uganda. “I am stunned,” he said on his return, “by the level of scientific elegance in that institution.” On his second visit two years later, Sadigh taught Ugandan medical students and residents. On his third trip, in the fall of 2005, he was joined by Asghar Rastegar, M.D., associate chair of medicine. Their goal this time went beyond simply teaching. “Makerere was a gold mine for some sort of collaboration,” Sadigh said, noting the enthusiasm for a partnership on both sides.

In March three ranking members of Makerere’s medical faculty spent a week at Yale to pursue that collaboration. “The major areas of interest are medical education and the importance of clinical care,” said Samuel Luboga, M.D., deputy dean of the medical school at Makerere. “Under that umbrella there will be specific programs.”

The largest university in Uganda, Makerere is the alma mater of several presidents of African nations. The medical school was recently selected by the Academic Alliance for AIDS Care and Prevention in Africa, an international public-private partnership, as the site of the Infectious Diseases Institute, a regional center of excellence for HIV/AIDS care, training, research and prevention in East Africa. To be sure, HIV/AIDS is the country’s leading health problem, but not the only one. Infectious diseases, malaria and maternal morbidity and mortality also rank high. Then there is the shortage of doctors.

In the best of circumstances, Luboga said, there is one physician per 18,000 people. In the countryside, though, only one doctor may be available for 35,000 to 50,000 people. “If I had my way,” Luboga said, “it would be one per thousand.”

While at Yale, Luboga, Harriet Mayanga, M.D., chair of medicine, and Samuel Kaggwa, M.D., chair of surgery, visited colleagues in surgery, infectious diseases and medical education.

As envisioned, the collaboration would see a year-round presence by Yale attendings, who would rotate through the 1,600-bed Mulaga Hospital in Uganda. Students and residents would also do rotations there. Ugandan faculty, residents and attendings would come to Yale for training.

The program fits into Yale’s vision of its mission as a global university and would offer Yale physicians, residents and students experience with diseases not usually seen in the United States. Funding is being sought in Uganda and the United States. Ideally, the program would be sustainable for the long term.

David L. Coleman, M.D., HS ’80, professor and interim chair of medicine, said the department is also seeking a partnership with a facility in an underserved community in Connecticut. “We have taken the responsibility to improve public health and health care in communities, particularly communities that are underserved or have resource constraints.” He hopes to have the Ugandan exchange in place by the end of the 2006-07 academic year. “We want to help improve the health of the citizens of Uganda by assisting the leadership of Makerere University to improve medical education. We hope to make an enduring contribution while also learning from our colleagues in Uganda.”

—John Curtis

Students reach out to the uninsured at free medical clinic in Fair Haven

The first patient to arrive at the HAVEN Free Clinic when it opened its doors last November was in serious danger. The man had the highest level of thyroid-stimulating hormone that both the attending physician and medical director had ever seen. Although his condition could have been easily treated, he hadn’t sought help before because he has no health insurance. Since his visit to HAVEN, however, he has had access to medications that keep his hyperthyroidism under control.

HAVEN, a new medical clinic in the Fair Haven neighborhood of New Haven, was founded with just such patients in mind, said Mallika Mendu, co-director of the clinic with Margaret Samuels-Kalow, a fellow member of the medical school’s Class of 2008. Organized by students in public health, medicine and nursing and in the Physician Associate Program (PA), HAVEN (an acronym for Health Care, Advocacy, Volunteerism, Education and Neighborhood) provides an array of medical services to uninsured patients free of charge every Saturday morning. Each patient is seen by a team of students and a volunteer attending physician, as well as at least one of the clinic’s medical directors. A physician or nurse practitioner from the Fair Haven Community Health Center, which houses HAVEN, acts as attending supervisor. In addition, faculty from the medical and nursing schools and the PA program serve as attendings.

HAVEN differs from the Fair Haven Clinic in several ways. The Fair Haven Clinic is not free—patients are seen on a sliding scale—and it is open only on weekdays. And HAVEN incorporates Yale faculty, who serve as attendings and provide pro bono specialty referrals. In this way HAVEN hopes to reach a population for which few medical services are available.

Most patients come in with multiple unmanaged chronic diseases such as diabetes and hypertension, said education coordinator and medical student Corinna Levine. The students run an education program that provides general information about diseases and their management, which supplements the instructions the patient receives from the attending physician.

Patients also receive a social work consultation about agencies that provide assistance with such nonmedical issues as housing. Cynthia Correll, the clinic’s social work coordinator and a second-year medical student, said that most patients are unaware that they may be eligible for public health insurance programs. Applications are complicated and often not available in Spanish, the language spoken by most of the clinic’s patients. To overcome the language barrier, the clinic staff includes student interpreters.

HAVEN receives funding from all the Yale health professions programs and is seeking grants from community sources. Yale-New Haven Hospital is donating laboratory services and clinic organizers have built up a stock of medicines to give to patients.

For the students, the clinic is a way to help others. “There’s a real need in our own community,” said first-year student Rachel Solomon.

—Colleen Shaddox

et cetera

Yale joins in AIDS initiative

Public health faculty at Yale will work with the William J. Clinton Foundation HIV/AIDS Initiative and the Ethiopian Ministry of Health to launch the Ethiopian Hospital Management Initiative to improve management of the public hospital system in Ethiopia.

Under this initiative, mentors from the United States and other countries will work with directors of 10 to 12 public hospitals and health bureaus in Ethiopia to identify systemic changes that can improve provision of health care to the country’s 76 million people.

“We want the Yale-Clinton Foundation mentors to think outside the box, tell us what they see and what they recommend, and then we will consider it,” said Adhanom Ghebeysus M.D., the Ethiopian minister of health, who proposed the collaboration.

Elizabeth H. Bradley, M.B.A., Ph.D., associate professor of public health, directs the project at Yale. The Yale team has completed a needs assessment in Ethiopia and has recruited the 22 fellows to serve in this effort, which began on July 1.

—J.C.

CDC funds preparedness center

To ensure a swift, coordinated response to disasters, disease outbreaks and acts of terrorism, the Department of Epidemiology and Public Health received a $4.5 million, five-year grant in February from the Centers for Disease Control and Prevention to establish the Yale Center for Public Health Preparedness.

Staff at the center, one of 52 nationwide, will assess the training needs of Connecticut’s public health work force, develop curricula and ensure that training is provided. The center will also expand the public health preparedness curriculum available at Yale.

Brian P. Leaderer, M.P.H. ’71, Ph.D. ’75, the Susan Dwight Bliss Professor of Public Health, is the principal investigator on the grant.

Linda C. Degutis, M.S.N. ’82, Dr.Ph. ’94, associate professor of surgery (emergency medicine) and of epidemiology and public health, is the director of the center.

—J.C.


			Originally published in Yale Medicine, Autumn 2006. Copyright © 2006 Yale University School of Medicine. All rights reserved.