University of New England

[Editor's Note: The COMmunicator is now published in two pages for better scrolling and ease of download. You can check out page two here, or look for the link at the end of this page.]

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A Path Less Beaten: Curt Senita, MS II

In a trackless wilderness, the traffic might kill you.

Alaskan grizzly bears can tip the scales at 1500 lbs. and leave paw prints bigger than dinner plates. When provoked, grizzlies stand on their hind legs and whoof loudly like a dog barking in the distance. “You know exactly what it is,” says second year student Curt Senita, “whether you’ve heard it before or not.” He watched a bear burn him with its beady black eyes before it dropped to all fours and bumbled off in a huff. “It was only 25 yards away,” Curt recalls, “We shouldn’t have made camp by the grizzly trail.”

Curt Senita grew up somewhere between town and country, and that means he’s always been on a path less beaten.

The Candy Bar Tree

Curt was born on the outskirts of Erie, Pennsylvania. Five minutes in one direction brought him to concrete city; five minutes the other put him out to golden pasture. His grandparents owned a dairy farm, so Curt’s childhood was a boy’s dream of romping in the hay with three brothers, a clutch of cousins, and the various animals associated with his dad’s veterinary practice.

Large-animal calls were his favorite, when Curt would accompany his dad on farm calls to inspect sheep, pigs, cattle, and horses. He was James Harriot among the dells of northwest Pennsylvania, and the experience shaped his life. He has always been at home in the field.

“I was five years old when I accompanied my dad on my first hunting experience,” Curt remembers. They packed a little lunch, bundled against the mid-December chill, and went out early - “but not too early”- to find game. Curt was too young to hold a weapon, so while his dad scanned the bleak forest, Curt did his part and slowly fell asleep against a tree. When he awoke, his dad decided it was time for a candy bar from the “candy bar tree.” Curt watched wide-eyed as his dad pulled a chocolate bar from the crook of a nearby hardwood. The “candy bar tree” was very rare and only produced a harvest during hunting time, his dad said. Curt never thought to doubt it. To him, in the big woods with his dad, it was gospel. Such are the delightful yarns spun between a young boy and his father.

Quiet Mr. Everything

Curt’s figure-skating lessons were not so delightful. “I think they were my Mom’s attempt to make a daughter out of one of her boys,” Curt chuckles. For two years he did his best to jump and glide before giving it up as a bad job and devoting himself to guns and athletics. Honestly, there were few things Curt did not try, and few of those to which he did not display some affinity. With a farm-boy’s body and an academician’s mind, the only trouble was deciding which area to pursue. He ended up tramping through the wilderness with his nose in a book. He made his own path.
 
Curt tried wrestling in middle school, but dropped the sport after he attended a high school awards ceremony where only two wrestlers received academic honors. He didn’t want to put himself in a culture where academics were not treated seriously; plus, the practices conflicted with hunting season. Instead, Curt became a varsity volleyball player at McDowell High. Incidentally, he also enjoyed swimming, ran track, played baseball, rode Western style, and became an Eagle Scout. He was a quiet Mr. Everything.

“I was always pretty self-motivated,” Curt says, “I always wanted to do well.” His parents encouraged him academically, and Curt’s dad placed special emphasis on the importance of math and science. His only encounter with the academic Gestapo came in 3rd grade when he decided that he could slack off in spelling and brought home a “C.” “My parents made clear that that was not acceptable,” says Curt, “I could do better.” 

Corps Commander

While at McDowell, Curt signed up for Junior ROTC at his parents’ behest. “My older brother had gone through the program,” says Curt, “and it had done him a lot of good. My Mom was particularly pleased that they had formal training in etiquette and social interaction, besides all the training in physics, weapons, weather, and wilderness survival.” Mrs. Senita had decided that if she couldn’t have a daughter, she could at least refine her sons. And Curt loved it.

“I learned to become comfortable introducing myself to all sorts of people,” he says, “and I learned how to set a table for all sorts of occasions.” Curt maintains confident eye contact while speaking, and smiles readily with just a hint of bashfulness that shows he hasn’t lost his humility. JROTC, however, was far more than just folding doilies and wielding butter knives. As commander of the arms drill team, Curt worked his crew with vintage World War II M-1 rifles.

As a senior, Curt was commissioned Cadet Commander of the Corps, with oversight of 140 cadets. Again, Curt rose to the occasion and enjoyed every moment. “I learned to speak confidently in public settings,” he says, “and I helped to organize a volleyball tournament, besides being the physical fitness officer for the Corps. It was a great experience.” With his close-cropped hair and upright posture, there is still a bit of military in Curt Senita.

Nittany Lions and Salmon Passes

Curt started an application to the military academy at West Point, then reconsidered. Instead, he went to a little school down the road called Penn State, where his father, older brother, uncle, cousin, grandpa, and nearly every other relative had gone before him. Curt became a biology major without a clear sense of where he was heading. “I thought it would give me plenty of options, and I could just decide when the time came,” he says, “I knew I wanted to do something health-related, I just didn’t know what.”

It was between semesters at Penn State that Curt went to Sitka, Alaska for three months with the Student Conservation Association. In a land where death was often just a six-inch step off the side of a gorge, Curt had the time of his life. “We were there to build salmon passes so that salmon could swim farther upstream,” Curt says, “and the only way to get to that particular location was 2 hours by boat or 45-minutes by float plane.” The remoteness appealed to him, and he lived it as high adventure.

“We had to sling in everything by helicopter,” Curt recalls, “and then backpack most of the explosives and cement down the side of the gorge. We rigged a zip-line to unload re-bar and cement-mixers, and spent a week at a time blasting channels in the rock and mixing concrete.” Fish passes are like a series of steps built into the bottom of a gorge where a waterfall used to thunder. The idea is to give migrating salmon a graduated ascent so that they can travel farther upstream to spawn.

So Many Ways to Die

In the wild beauty of Alaska, there were so many ways to die. To compound the risk of accidental death by slipping, crushing, or blasting, there was always the chance that one could be mauled to death by a bear. “I worked with twelve other guys and 23 different bears,” Curt jokes, “We identified the bears by their distinctive markings.” Days off could be spent hiking, fishing, or hunting; all at your own risk, of course. Curt grew a Grizzly Adams beard and hiked to his heart’s content.

He soon found that his unruly whiskers were not the only brown mass of fearsome furriness in the neighborhood. Curt and a friend went hiking through uncharted territory one day, rifles at the ready. “It was all bush-whacking,” he says, “there were no trails except grizzly trails, so that’s what we used.” After pitching their tent, the two adventurers settled down for a relaxing night, forgetting momentarily that they were not the highest level of the local food chain.

Suddenly, a large bear wandered past, took offense at the strange squatters, and whoofed loudly to show its displeasure. Curt opened the tent flap to see an enormous grizzly standing on its hind legs, staring at him. After an ocular dressing-down, the bear dropped to all fours and ambled off. Curt and his friend moved their tent a little farther from the grizzly trail. They survived the night, learning once again that a path less beaten is often best.  

“They All Seemed Unhappy”

After a few rough semesters at Penn State, things started to click and Curt’s grades improved. “I just try to work hard at whatever I’m doing,” Curt says, “and then look at my options to see where I should go next.”

Despite his dad’s veterinary practice, “next” seemed more and more like medical school for humans. Curt shadowed an ER doc who was into cranial osteopathy and was also a UNECOM alum. “Dr. Tim Barrett, ’97, got me excited about medicine and about osteopathy,” Curt recalls, “and so I applied to UNECOM. The interviewers were great, and I loved the location.”

He also noticed a qualitative difference in the students he met in Biddeford. “Most of the students seemed pretty laid back, down-to-earth, and friendly,” he says, “whereas at other schools they all seemed unhappy. Why would you want to go someplace where everyone is depressed all the time?” He decided that medical school didn’t have to feel like a mortuary and came to UNECOM in the fall of 2005.

He has no regrets. “It was really a lifestyle choice, as much as anything,” Curt says, “I decided that I have a certain approach to life and I wanted to be around like-minded people.” The slower-paced, friendly ambiance of southern Maine agreed with Curt’s natural disposition, and the gorgeous scenery and rugged mountains didn’t hurt, either. For an outdoorsman who wants to become a doctor, UNECOM is the proverbial fish pass to higher elevation.

Otter Dog

Even in Maine, Curt is no typical medical student. One of his greatest passions is training Chesapeake Bay Retrievers, a love his mother instilled. “She was the president of the Presque Isle (PA) Retriever Club,” he says, “She got me started with training dogs when I was a teenager.” Chesapeake Bay Retrievers are moderate-sized, chocolate-brown dogs with silky soft fur and quiet, bright dispositions.

Many years ago, market hunters saw the sleek animals slicing through frigid waters to retrieve waterfowl and called them “otter dog.” Curt gave his own retriever the name “DaweDo,” short for the Seneca Indian phrase “DaweDo Jiyah,” or “otter dog.” Curt and DaweDo participated in many hunt tests hosted by the American Kennel Club (AKC) or the North American Retriever Association (NARA). Hunt tests are simulated hunting scenarios that showcase a dog’s obedience and an owner’s ability to train. Curt reached Master level status, an elite ranking that put DaweDo through multiple-bird, one-look tests in the wetlands of late autumn.   

According to Curt, Chesapeake Bay Retrievers have a throw-back personality that makes them a little less domesticated than golden retrievers. “They can be a little stubborn,” says Curt, “it takes a little longer for them to learn something, but then they don’t forget it. When you’ve trained them daily for years, and they do well, it’s like seeing your kid succeed.” He spent many patient hours teaching DaweDo to trust his hand signals, whistles, and various subtle directional devices in search of fallen birds. When a stiff wind is blowing, the water is creased, and the ducks are migrating, there is no other place he’d rather be. 

Sometimes He Hunts Alone

At UNECOM, Curt has been able to combine his medical and outdoor interests in a way he never thought possible. “I had an epiphany last year,” he says, “ when I realized that life was not ever going to slow down. I would never have tons of free time as a physician. So I made the decision to keep doing the little things I love while still a medical student.” Exercise, sports, and outdoor activities are areas he has chosen to resurrect.

He has also encountered unexpected areas of growth. Living with three fellow students has been like having “three sisters,” and the girls have encouraged Curt to socialize and do more than just study. A lifetime spent around men and guns has not necessarily prepared him for the vagaries of convivial friendships or the intricacies of living with women. Hardly a day goes by that Curt doesn’t stumble unwittingly into some feminine faux pas and hear the anguished, “Cu-u-r-r-t-t!” that means he has earned several sheepish minutes in an admittedly mild doghouse. He doesn’t mind. “They’re great,” Curt says simply.

One day, Curt hopes to be an ER doc in some small town. “Someplace with a slight city feel,” he says, “but where I can still enjoy rural activities.” He likes the excitement that emergency medicine offers, and he wouldn’t mind having some semblance of regular hours. While he will be a physician by profession, he will always be an outdoorsman by affection. And while you’ll often find him hunting with friends, he also hunts alone.

He’s never happier than on a path less beaten.

(Take a look at www.sitka.com - even the wilderness has a website!)

-Steve Smith, RSAS

UNE/COM News and Events

Midas touch. Gilsland Farm, Falmouth, Maine. Photo by Steve Smith, RSAS

UNECOM White Coat Ceremony

UNECOM’s tenth annual White Coat Ceremony will be held at 7pm on Thursday, October 5, at the Holiday Inn by the Bay in Portland. A reception will follow in the Casco Bay Exhibition Hall.

Event highlights will include presentation of the white coats by members of the second-year class; remarks by William G. Anderson, D.O., Associate Dean of the Kirksville College of Osteopathic Medicine; brief remarks by second-year medical student Lisa Wuerdeman, president of the Student Osteopathic Medicine Association (SOMA); and a reading of the Osteopathic Oath by Charlotte Paolini, D.O. (UNECOM ‘89), president of the UNECOM Alumni Board.

During the Civil Rights Era, Dr. Anderson was a leader in the Albany Movement in Georgia. Dr. Anderson is currently a clinical professor of osteopathic surgical specialties at Michigan State University College of Osteopathic Medicine. He is also the Associate Dean of the Kirksville College of Osteopathic Medicine. He was the first African-American president of the American Osteopathic Association, and has been a member of the board of directors of the American Osteopathic Association for the last 18 years.

The White Coat Ceremony was an idea conceived by the Arnold P. Gold Foundation to create a psychological contract for professionalism and empathy in medicine. The first White Coat Ceremony took place in 1993 at Columbia College of Physicians and Surgeons. Since then, more than 100 other medical schools in the U.S. and abroad have initiated a similar ceremony.

Directions to Holiday Inn by the Bay
From I-95, take Exit 6a to I-295. Take I-295 to Exit 7, (Franklin Street). Stay on Franklin Street for five (5) lights. Take a right onto Middle Street, travel approximately 1 mile (Middle Street turns into Spring Street.) Holiday Inn is on the left.

Parking Information
Parking – Parking is available in the Anthem BC/BS lot located immediately next to the Holiday Inn. It WILL NOT BE ACCESSIBLE UNTIL AFTER 5:30 pm., so please plan accordingly. Limited parking spaces are available; carpool if possible. If the lot becomes full, you will be able to park at the Civic Center garage, across from the Holiday Inn, on Spring Street. According to the Parking garage company, the garage will be open until midnight and the cost is $1.00 per hour. Check signs at garage to make sure hours are accurate. Make sure your vehicle is out of the parking garage by closing time, as the garage will not open again until morning.

Hotels/Motels
A number of hotels/motels have offered discounted rates for White Coat and Alumni Weekend attendees. Click here for more information.

Henry Wheat awarded UNE med school's 2006 Annual Service Award

Henry (Hank) Wheat was awarded the 2006 College of Osteopathic Medicine (COM) Annual Service Award at the University of New England's Fall Assembly on August 30, 2006.

A 1980 graduate of St. Francis College, Wheat has been a UNE employee since 1998 and a member of the COM Department of Anatomy since 2000. He serves as both the diener – that is, laboratory assistant - and as the COM chemical hygiene officer. He also coordinates the Body Donor Memorial Service, works with the Emergency Medicine Club and the Student Osteopathic Surgical Association and assists at Commencement, the White Coat Ceremony and the annual COM student orientation program. He lives in Saco.

"Hank is one of those unsung heroes who goes about doing a great deal of the behind the scenes work that contributes so greatly to the UNE family," said presenter Boyd R. Buser, D.O., interim dean of the College of Osteopathic Medicine. "He is always willing to step forward and offer whatever assistance he can to offices that need him."

The COM Annual Service Award is presented each year at the University of New England Fall Assembly. The criteria for selection are service to the College of Osteopathic Medicine over and above that required by one's position and a clear contribution to the mission of the College. 

(University Relations press release issued Aug. 30, 2006)

Invitation to 2006 COM Fall Weekend: Primary Care Update

All UNECOM students are invited to attend the 2006 UNECOM Fall CME Weekend's Primary Care Update on Friday, Oct. 6th and Saturday, Oct. 7th, free of charge. This 14+ hour symposium at the Holiday Inn by the Bay in Portland features lectures on a variety of topics, as well as the UNECOM Founders' Reception and Dinner on Friday evening, and the Dean's Lunch on Saturday. The Founders' Dinner speaker will be Lawrence Bouchard, D.O., former AOA President and staunch UNECOM supporter. The featured speaker at the Dean's Lunch will be former UNECOM Dean Steve Shannon, D.O., who is now President and CEO of the American Association of Colleges of Osteopathic Medicine. 

You can attend all or part of the weekend activities, but we ask that you call or email the CME Office to register so that we know how many people to expect. We can be reached by phone at 207-602-2589, fax at 207-602-5957, or email at mbissonnette@une.edu.

-Leslie Ingraham, Director, Continuing Medical Education, UNECOM

News story cites importance of UNECOM as source of Maine family physicians

The Bangor Daily News reported on Maine physicians from 15 Maine communities who attended a rally staged in Washington, D.C. for national health care reform and the increasing need for family physicians around the nation and in Maine.

The story reports that both Jim Dowling, recruiter for the Maine Primary Care Association, and Jane Ham, director of the Maine Recruitment Center for the Maine Hospital Association noted that the University of New England College of Osteopathic Medicine attracts many medical students who then choose to practice in Maine.

According to a report conducted by the American Academy of Family Physicians, by the year 2020, the country will need to increase its supply of family care doctors by 39 percent over the current number. The story reports that in Maine, 438 family doctors are now practicing. The study projects that, given the state’s anticipated growth in population, the incidence of chronic disease, and Mainers’ advancing average age, by 2020 Maine will need 589 family practice doctors - an increase of 34 percent.
Bangor Daily News, Sept. 28, 2006

-University Relations

A Peek into the UNECOM class of 2010: The Numbers

During the 2005-2006 application cycle, UNECOM received nearly 2,900 AACOMAS applications - 2894 to be exact. That is about 1,000 more than had been received for the class that entered in July 2004 and an approximately 20 percent increase from the year before. After an initial review, nearly 2,500 UNECOM-specific supplemental applications were offered.

Files are not reviewed in-depth for possible interview until the supplemental is complete and all required letters of recommendation have been received. More than 475 interviews were offered last year, a significant narrowing in the funnel from the number of supplementals received and files completed; close to 400 interviews were conducted between mid-September 2005 and the first of April 2006.

One hundred and twenty-three first-year students now sit in lecture hall 106 in the Alfond Center for Health Sciences. (With 125 seats in the lecture hall, UNECOM is very near capacity.) The average age of a first-year student is 27 years old, as is typical at UNECOM. Interestingly, the classes of 2008 and 2009 are some of the youngest two classes in the College's history with an average age of 25 years. There are 65 men in the class and 58 women. This is the only class of the current four that has more men than women.

The average GPA for this class is 3.34. Their science GPA is the highest of the current four classes. The same can be said for their MCAT scores - the highest of the current classes with an average of 25.

Typically, about 60 percent of the class is from the six New England states, but there are 94 members of this class from New England - 76 percent. Maine and Massachusetts always hold the top two places for state of residence, toggling back and forth year to year. For the class of 2010 there are 38 students from Massachusetts and 25 from Maine. Connecticut is well represented this year with 16 students, as is New Hampshire with eight; there are five from Rhode Island and two from Vermont.

Thirteen other states are represented in this class, with New York and Pennsylvania being counted the most. Generally, there are a dozen to 20 states outside of New England represented. California, Florida, New Jersey and Michigan are almost always represented, but no students from California this year. There are students from both North and South Carolina in the south as well as South Dakota in the north. They are from as far away as Oregon, Idaho and Colorado.

According to AACOM as of September 1, 2006, 1771 primary applicants have designated they would like their completed AACOMAS application forwarded to UNECOM. As of this time last year, 1280 had made that designation. This is a year-to-date increase of nearly 40 percent. Nearly 1,100 of those applications have already been received, and more than 900 supplemental applications have been offered.

Interviews will take place three days a week, nearly every week, from early October until early December. Interviews will resume the same three-day schedule in early January and continue until some time (to be determined) in April 2006. It is expected that four- to five hundred candidates will be invited to interview between now and next April.

- James Gaffney, Coordinator of Recruitment and Alumni Services, RSAS

Where UNECOM Will Be This Year: Grad Fairs and Other Events

As currently scheduled, representatives from UNECOM will be at most of the graduate and professional school fairs in New England scheduled for the month of October. The schedule includes:

October 11 - Brandeis University Graduate and Professional School Fair (afternoon)
Tufts University Career and Graduate Fair (evening)

October 16 - AACOM's Osteopathic Medicine presentation and fair at University of Nevada - Las Vegas (early evening)

October 24 - Colby College Graduate and Professional School Fair (late afternoon)

October 25 -
Bates College Graduate and Professional School Fair (mid-day)
UMass/Five Colleges Graduate and Professional Schools Information Day at UMass-Amherst (afternoon)
Bowdoin College Graduate and Professional School Fair (late afternoon)
Springfield, Massachusetts, event being planned for evening, details TBA

October 26 -
University of New Hampshire Graduate and Professional School Fair (mid-day)
University of Southern Maine Graduate and Professional School Information Day (afternoon)

November 3 - University of Vermont health professions panel discussions (afternoon)

A reception with the chair of the admissions committee and alumni was held September 14th  in Burlington, Vermont. A similar event involving third-year students and a College representative was held in late August in conjunction with the Rhode Island Society of Osteopathic Physicians and Surgeons (RISOPS) CME conference. A similar event will be held in conjunction with the Maine Osteopathic Association's Mid-winter Conference in early February.

Individual campus visits are still being planned for late fall and throughout the late winter and spring. Watch the UNECOM Admissions webpage for new places and dates.

-James Gaffney, RSAS

Student Films Welcome

Dear filmmakers and filmgoers,

We need you as we never have before.

There are big changes for “Cookies Shorts,” UNE’s short-film festival. We have merged with the Biddeford film festival, “Milldance,” to become “Cookies in the Mill.” This is a chance to work with our neighbors down the road, and as everyone knows, Biddeford is the new, hot, fresh, cool, happening art scene.

“Milldance” was the brainchild of Cool Coffee’s Jessica Peck and Biddeford guy-about-town Brendan Wallach. Both festivals believe in and support filmmakers - send it and we’ll show it!

We will be showing in Biddeford this November. Our next festival is November 18th, 2006 and will be located in a historic building in downtown Biddeford. Deadline for films is October 18th.

We look forward to seeing and showing your films!

-Kari Wagner, Media Services
602-2771 or UCMediaServices@une.edu

New Stamp Vending Locations

Mail Services would like to inform the UNE Community that we are offering two new locations on the Biddeford Campus to purchase stamps.

We have installed a stamp vending machine in the Lobby of the Ketchum Library, which dispenses single stamps for First Class Mail (.40) or Postcard stamps (.25). There is also a mailbox for regular out-going mail (no inter campus mail please!)

You can also now buy books of stamps at the Student Accounts Department, located in Decary Hall. Books are available in 10 or 20-count.

Students can still purchase single stamps in the vending machines located in East Hall and Avila Mailroom.

Remember, we also offer the sale of stamps in both mailrooms, as well as full-service package shipping services with UPS/DHL/FedX and USPS. We are located in the rear of the Facilities Management building (UC) and the lower level of Proctor Hall (WCC)

-Matthew Haas
Assistant Vice President of Campus Services

On Guard

UNE Security Officers have recently observed an increase in conditions or situations that might leave members of our community more vulnerable to criminal activity.

Regrettably, it is not uncommon to walk around campus parking lots and find car doors unlocked with valuables left in plain view. We regularly see laptops, Ipods, cameras, calculators, pocketbooks and cash sitting on car seats or left on dashboards. We had two students vehicles entered this past week. We also find these same items left unattended in classrooms and common areas. While making rounds at night we find students’ room doors propped open and faculty and staff offices left unlocked. You can help us with these few simple precautions:

-Don't leave valuables in plain view in your car; lock them in your trunk, or at the very least, keep them out of sight
-Don't leave your pocketbooks, laptops etc. unattended especially in common areas
-Don't carry excess credit cards or large amounts of cash 
-Don't leave UNE keys hanging in your office or dorm room door lock
-Our officers extend a special request to faculty and staff: If you are the last one in your classroom or office, please take a moment to make sure your windows are closed and your door is locked.

Thank you for all of your efforts and help in making UNE a safe place to learn and work.

– Don Clark, Director of Safety and Security

Current Students

MSIIs Adrienne Kovalsky and Josh Mularella (2nd from right and right) pose with friends near Annapurna, Nepal. Photo Courtesy Adrienne Kovalsky

“Khandbari” by Adrienne Kovalsky, MS II

[Editor's Note: Adrienne Kovalsky and Josh Mularella visited Nepal this past summer to assist in a rural clinic. The following is Adrienne's account of their trip. All photos courtesy Adrienne Kovalsky.]

The jeep we’re riding in just lurched frightfully close to the edge of the cratered muddy tract down the mountain, knocking us against the window as it teetered on its left axis and providing a clear view of the steep rows of scalloped rice paddies below. As the four people on my seat compress me against the window, I estimate seven or eight flips before we’d be stopped by a row of trees. There are eight more passengers crammed into the excavated cargo area and three up front, but I’m more worried about those riding on the roof who might disrupt the jeep’s center of gravity as we sway.

Eventually, we reach the forest and I relax a little – only a couple of flips should we topple over the edge, probably survivable. The elderly woman behind me, the only other female on this leg of the journey, coughs again and I try to turn my head away – we’ve encountered TB more than once in this region. The next thing I know, she has coughed a mass of phlegm onto my window. I pass back some tissue and she cleans it off. A few minutes later, she thanks me by jabbing her black umbrella at the feet that were hanging into my now open window from the passengers on the roof. 

We are descending from Khandbari, a remote village in eastern Nepal. It is the last major settlement before the mud track ends, and it is a place where distance to villages above, first in the lush Arun Valley and then high into the Makalu region of the Himalayas, is measured by number of days walk instead of kilometers. After arriving in Tumlingtar, we cross a red clay airstrip to board our 16-seater turboprop for the flight back to Kathmandu. As we sign out with the military, I note in the logbook that Josh and I are two of only 10 Westerners who have visited in the last year. Travel to the area is difficult under any circumstances, but treks have virtually ceased since the Maoists gained a stronger foothold in the last decade. 

The flight from Tumlingtar to Kathmandu is choppy due to the impending monsoon weather - at one point, we are nearly thrown from our seats, and as the clouds clear momentarily, I see that we are at a strange 60 degree angle to the ground.  I try to distract myself by feeling sorry for the girl up front vomiting every few minutes, but still I can’t help but dwell upon what we are leaving behind.

~

Khandbari is the way you might envision a watering hole of the classic Wild West, except it is tucked into the steep hills that support the Himalayas. The streets are cobblestoned and dusty red clay, and turn into raging rivers when it rains. Buildings are generally two to three stories, with porches and balconies overhanging and steep wooden ladders between floors. Roosters wander randomly among the countless dogs collapsed onto their sides in the scorching heat. 

The town square is filled with the village’s children who, televisionless, spend their free time outdoors playing soccer with a deflated basketball and practicing martial arts on each other. Ironically, in a town where even electricity is so sporadic that the clinic must run a generator periodically through the day, an expensive projection screen towers on one end of the square – it was mysteriously set up to allow the villagers to watch World Cup soccer every night.

Were you to follow the path that parallels the square, you would start entering the outlying towns in these lowlands, where architecture becomes more classically tropical, and mud-walled thatched roofs homes are perched on wooden stilts overlooking brilliant green rice paddies carved from the steep hillsides. Instead, ascending toward the newer end of town, you reach the Helping Hands clinic tucked between the open storefronts of a tailor and a ‘convenience store.’

The first two stories are dedicated to the clinic, which has an ‘OR’ with no windows and only curtains separating it from the waiting room; a rather public exam room where patients crowd around the single doctor, allowing absolutely no privacy or confidentiality; an x-ray room that uses a clothes line to dry films; and a dark lab where the ‘paramedic’ draws patients’ blood samples among smears scattered on the counter and used needles and syringes that didn’t quite make it to the bucket where they are collected to be washed.  Almost everything is reused, including the washed latex gloves that are frequently seen drying open-air on a wooden railing well-worn from waiting patients.

A steep ladder (that the locals can scramble up like a flight of stairs but requires both hands for us to balance) ascends to the living quarters on the third floor – 3 bedrooms and a kitchen shared by the doctor, the cook and maid, and ourselves. The toilet is the standard squatting latrine down in the courtyard, a hairy journey in the middle of the night that helps explain why bedpans ever existed for non-medical purposes. Running water is essentially diverted from a high mountain stream, untreated, and stored for each household in massive 500-liter holding tanks. These are the same tanks sometimes seen carried in enormous loads on the backs of porters up the mountains (along with produce, clothing, televisions, kerosene, farm animals, tires, and occasionally humans). 

Kitchen appliances are generally non-existent – food is bought daily or weekly at the market, and stored out in the open along with the un-refrigerated left-over curried vegetables and rice. I once made the mistake of looking for a snack and saw that three roaches had taken up residence on the bread that was served to us daily at breakfast…perhaps they were relatives of the dozen or so that socialized in the outhouse nightly. 

The clinic ran from about 9am until 4pm daily, but often the 25-year-old Nepali doctor worked later. The exam room was frequently chaotic, crammed with as many patients and relatives as could fit. Often, a patient who had been sent for testing would walk in and proceed directly to the doctor who, mid-sentence into taking a history, would turn away and with the other hand hold the returning patient’s film to the window and provide a diagnosis. 

In that indiscreet setting, Josh and I would alternate taking the history onto tissue-thin forms as the doctor translated for us, and then would practice palpating livers and spleens – gloveless, and without drapes, just a curtain away from the other stranger in the exam room. We were taught instead to turn the patients’ heads to their far side during the exam – infectious disease prevention. 

Most frequent were GI infections, women with UTIs or post-delivery complications, and it seemed there were a handful of standardized diagnoses: viral hepatitis, colitis, UTI, or typhoid. On a couple occasions we helped diagnose TB and malaria, witnessed the stitching of a days-old episiotomy, and an early-term abortion. During rounds at the hospital in the center of town pneumonia was common, often diagnosed by respiratory rate – 60 in a child and 45 in an adult. There we also saw the common GI infections, a couple of organophosphate pesticide ingestions (attempted suicides), a lightning strike, and the handful of sad cases where the hospital was not equipped with sufficient lab technology and medication to render a diagnosis or help relieve the patients’ suffering. And we watched a tiny young woman give birth on a hard wooden bed in a dark and stuffy room, with no coaching or medical support beyond the plainclothes doctor standing complacently by for the episiotomy – a drastic change from the deliveries standard to the U.S., replete with a sterility given by fluorescent lights, immaculate white walls, scrubs, and shiny instruments and equipment standing by.

Yet for most of the patients, the poorly equipped hospital and clinic in Khandbari were a last resort. Many traveled for days, often on stretchers carried by family or neighbors, after waiting as long as possible before seeking treatment. The Maoist insurgency had shut down many of the outlying ‘health posts,’ which rarely had doctors anyway. While more frequently the volunteers are physicians or students doing rotations, our presence there was more than as shadows, as is often the experience of first year medical students. Our contribution was perhaps more than anything a demonstration of moral support – recognizing the situation was often times dire, and making efforts to ameliorate it. Even the outdated medical references and equipment we could afford to leave behind was well-appreciated, and visiting medical students or physicians often do more by sending additional supplies upon their return to the U.S., or sometimes returning with medical missions to perform specialized procedures. 

We recognized that we did not have the resources to contribute much financially or in equipment, nor did we have the experience yet to provide much impact in treatment. Instead, we focused on investigating public health ramifications of water quality, parasitic infection, and water purification practices with the intent of returning to the village and implementing an education intervention that might decrease the high incidence of parasitic infection and consequent high infant mortality, childhood morbidity, and decreased lifespan.

The community embraced this as well, and welcomed us with open arms. We were included in family and social gatherings, invited into homes and into lives. On a daily basis, we were greeted by the villagers as we walked through town. And unlike Kathmandu or touristy areas where children greet you so they can ask for goodies, here the children were so modest – when we’d clasp our hands before us and bow with the greeting “Namaste,” they would either freeze like deer, hide behind their mother’s legs and peer out shyly, or break into the most radiant smile and bow back, often unable to utter “Namaste” in response through their ear-to-ear smiles. Despite the language barriers and cultural differences, Khandbari became more than a stop, it became our home, and we left behind strong friendships that fostered during our brief stay.

~

The flight bounces onto the runway in Kathmandu, and as we wait for our bags, I already feel empty. At the hotel, we take long showers, wash every stitch of dusty discolored clothing we have left, and begin a mission to find a meal that does not include rice, curried cabbage, potatoes, eggs, or chicken necks. The Thamel tourist quarter has begun to see the advent of some (I daresay “cosmopolitan”) restaurants and cafes, and we enter one replete with dark hardwood tables, a stone pavilion, exposed wooden beams, a granite bar, and white-apronned waiters. Josh’s coffee arrives before the meal and he freezes momentarily, then closes his eyes, brings his hands to his face, and releases a long and controlled sigh. As he takes a sip, I think I see a tear roll from the corner of his eye. 

Our transitory days in Kathmandu quickly blend together, as we wander somewhat soullessly through the foreign streets, being hawked at by every vendor, being harassed incessantly by the men who walk by and whisper, “Hashish? Hashish?” into our ears. The stores in our neighborhood are nearly all full of cheap tie-dyes, hemp and glass paraphernalia, oversized rainbow-colored wool socks and sweaters, and beaded jewelry. We have become blind to the bags of fly-infested trash and piles of horse manure, the miscellaneous axed cow legs lying in the street, and the crumbling disheveled brick architecture. So we hide often in the restaurants, becoming gluttons for the food that was unavailable during the last month in the remote hinterland beyond Kathmandu. We can treat ourselves here – a three-course meal with drinks at one of the higher-end restaurants costs no more than $10.

On occasion, we join the rivers of mopeds, motorbikes, rickshaws and busses that manage to flow through intersections without streetlights and meld with oncoming traffic and pedestrians; inertia never changing, just deflecting around obstacles. We release ourselves from the river in outlying communities, or in the historic temple quarter, seeking some fulfillment, but it’s hard to recreate the warmth and, perhaps selfishly, worth we felt in Khandbari. 

And so we always find ourselves floating back downstream to our hotel, watching fuzzy Bollywood videos and waiting for our next excuse to find a meal. The experience in Khandbari imparted a much stronger sense of the impact we, as practicing physicians, will make, and has more clearly defined my own ambitions in international public health. But for the remaining days in Kathmandu, we are again but shadows passing through.

-Adrienne Kovalsky, MS II

The following is a photo montage of the Nepal trip. All photos courtesy Adrienne Kovalsky.

Annapurna at dawn. Photo by Adrienne Kovalsky

Choomroong. Photo by Adrienne Kovalsky

Poon Hill Prayer Flags. Photo by Adrienne Kovalsky

Josh Mularella, right, puts something not-coffee to his lips. Photo by Adrienne Kovalsky

Mmmm...

Josh's Room. Photo by Josh Mularella

Arun Valley. Photo by Adrienne Kovalsky

Long day of hiking. Photo by Josh Mularella

Operating Room. Photo by Adrienne Kovalsky

Annapurna Sanctuary. Photo by Adrienne Kovalsky

Misty morning at 10,000 feet. Photo by Adrienne Kovalsky

Tamang woman. Photo by Adrienne Kovalsky

Toilet: Nepal-style. Photo by Josh Mularella

Rice paddies. Photo courtesy Adrienne Kovalsky

Adrienne with schoolchildren. Photo courtesy Adrienne Kovalsky

I came, I saw, I comsa-ed

This is a reminder that current students should use the comsa@une.edu address for all communication with the RSAS office. The rsas@une.edu address, while extant, is designed primarily for prospective students, and its use should be discontinued upon matriculation. Thanks. Hail Caesar. 

Tidal river near Biddeford Pool. Photo by Steve Smith, RSAS

A Different Approach to Pain: John Lowery, MS III

A Marine struck down in the dirt of Fallujah and a grandmother tucked away in some quiet corner of Vermont may soon thank John Lowery for his different approach to pain.

Lowery, a third year student at UNECOM, helps Edward Bilsky, Ph.D., conduct research with synthetic glycopeptides that may soon replace morphine as an analgesic. If successful, the new approach to pain management could drastically reduce dangerous side-effects and increase the effectiveness of both acute and inflammatory pain management.

Lowery is the first candidate in UNECOM’s dual-degree D.O./Ph.D program, which affords him a full clinical experience while also providing time to participate in cutting-edge research.

Contested Monarchy

For the last century, morphine has ruled as monarch over the house of pain. Widely prescribed to alleviate severe suffering, the drug has enjoyed a largely un-contested throne. John Lowery hopes to change all that.

Currently, critically wounded troops on the battlefield in Iraq are administered morphine to dull their pain. Unfortunately, morphine also suppresses respiration and can kill a casualty if over-administered. In the chaos of battle, young medics must often make the heart-wrenching decision between administering another dose of potentially lethal morphine, or under-medicating casualties who are in agony. The glycopeptides Lowery studies do not significantly suppress respiration and therefore have a wider margin of safety.

Patients suffering from arthritis may also benefit from the Bilsky Lab research. Presently, chronic pain patients may be hooked to a morphine drip or pump system that releases controlled doses of medication. The system works well at first blush, but patients often build up a tolerance to morphine that requires increased dosage for equal effect. Common side-effects may include constipation so severe that patients must be taken off morphine.

Tests conducted by the Bilsky Lab indicate that mixed-acting mu/delta compounds are not subject to the same level of tolerance as traditional opioids, nor do they have as harsh side effects.

In a proposal to the American Society for Pain and Experimental Therapeutics (ASPET) Fellowship Lowery wrote, “Synthetic peptides based on the structures of endogenous opiate peptides (enkephalins and endorphins) are more potent and selective than morphine and cogeners for subtypes of the opioid receptors. These pharmacological attributes can directly improve drug efficacy, selectivity and potency along with blood serum stability.” In short, glycopeptides may be the analgesic dynasty of the future.

Dual Degree Makes it Possible       

Lowery’s research is made possible by a special dispensation. He is the first participant in the arduous D.O./Ph.D. program at UNECOM. The course, inaugurated last summer, involves a partnership between UNECOM and the University of Maine at Orono. The dual-degree curriculum is the brainchild of research professor Ed Bilsky, Ph.D., and it affords selected COM students the opportunity to participate in cutting-edge research while also fulfilling the clinical training of an osteopathic degree. Former COM Dean Steve Shannon, D.O., also helped jump-start the program. “They were both instrumental in making this happen,” says Lowery.

For Lowery, it is the best of both worlds. “When Ed presented the idea to me,” he says, “it seemed like the perfect combination of areas. I had just finished my first two years of clinical training, and I knew I wanted something more. I have a strong research background, but I also love the osteopathic principles of patient-care. To be able to do both is fantastic.”

The six-year curriculum is not for the weak of mind. Lowery finished his first two years of didactic training at UNECOM in the spring of 2005, then transitioned to working in Bilsky’s lab over the summer. He plans to continue researching until the summer of 2007, when he will resume the COM program and begin his clinical rotations. At the moment, he works from 8-5 in the lab, then returns home to study for his combined comprehensive exams, which will take place over three days in October. It is a grueling schedule, but one for which Lowery is uniquely prepared.

Better than Perfect

John Lowery does not look the part of a genius. He is soft-spoken and somewhat reserved at first meeting. He does not wear spectacles, nor does a calculator double as his wristwatch. How did such a normal looking fellow climb to such rare academic heights?  

“My Dad always challenged me to do my best,” says Lowery, “just like he pushes himself.” Owner of CID Performance Tooling in Saco, the elder Lowery is a tireless worker who serves as an inspiration for his son. The younger Lowery attended Cheverus High, a private Catholic school in Portland known for its stellar academics, community service, and athletic programs. While there, Lowery was president of the Key Club, played sports, and quietly achieved a better-than-perfect 4.036 GPA. “I’m quite competitive,” he says with dry understatement.

After Cheverus, Lowery attended a large college in Boston for a year, but hated the feeling that he was just a number at the mammoth institution. “They posted exam scores by Social Security Number,” he recalls with a grimace, “you can’t get much more impersonal than that.” So he returned to Maine and was admitted to UNE, the only place he really wanted to go. “The medical school was definitely an attraction,” he says, “and the campus was small, beautiful, and much more personal.” The faculty-to-student ratio was ideal for Lowery, who believes that education is a cooperative venture.

“I felt that my instructors had a vested interest in my performance,” he says, “and they really challenged me to learn. I’m motivated by learning and by one-on-one interaction.” After his sophomore year, Lowery began to do opioid pharmacology research with Dr. Bilsky. The research fascinated him, and it became a passion. When he was a senior, Lowery applied to UNECOM to pursue his other passion: osteopathy.

He never considered anything other than becoming an osteopath. “I recognized and appreciated that by treating each patient as a unique person consisting of an integrated mind, body and soul, osteopathic physicians are better able to improve their patients’ quality of life,” he wrote in a personal statement. “You have all the abilities of an M.D.,” he says, “but with the additional tools of OMM. Why would anyone want to be an M.D.?”

A Passion Cocktail

After his training at UNECOM, Lowery would like to enter a neurology or orthopedic residency in hopes of securing a clinical position at a major university or teaching hospital. Seeing patients as a clinician is his greatest ambition; research is secondary to that, but by no means a minor chord. The two realms form a sort of passion cocktail for the bright medical student. “I can see myself collaborating with researchers as a clinician,” he says, “I really want to blend both of my passions to benefit patients the most.”

Lowery credits the D.O./Ph.D. program with increasing his medical repertoire and his ability to conduct future research: “The dual degree program here at UNECOM has given me a greater knowledge base and better grant-writing power,” he says, “and only a handful of other schools in the nation have anything like this.” He feels that such a program can only be a good thing for patient care in the future.

“I believe that by integrating both biomedical research and clinical medicine I will be better suited to diagnose, treat and improve my patients’ quality of life by advancing medicine through an evidence-based approach” says Lowery.

Marines and grandmothers may say he already has.

-Steve Smith, RSAS

On the rocks. Atlantic Coast near Biddeford Pool. Photo by Steve Smith, RSAS

The Legacy of the OHM (Part 3 of 3) by Dan Sheps, MS II

Neal Cross, Ph.D., the department chair of Anatomy at the University of New England College of Osteopathic Medicine, remembers Osteopathic Hospital of Maine as the place where all five of his children were delivered. After he finished graduate school in Oregon, Dr. Cross planned to return to Maine to work at the proposed allopathic medical school in Bangor. Dr. Cross was informed of the planned medical school affiliated with the University of Maine by his undergraduate advisor.

When plans failed, Dr. Cross thought that he would not be able to return to his home state of Maine. He then found the vacancy at the new Osteopathic Medical School at St. Francis College and had to look up what Osteopathic Medicine was about. He is now a devoted supporter of the school and of the profession, and he prides himself on being involved since the beginning. Working with students, Dr. Cross helped publish research on the common compensatory pattern by precise measurement of lower back vertebrae from various museum collections.
 
Dr. Cross has worked on inroads for students to receive training at Maine Medical Center and is on the faculty of a postgraduate program in Sports Medicine at Maine Medical Center. This program is the only one of its kind in the country with a mandatory anatomy curriculum. Participants in this program have passed their family practice boards and are either D.O.s or M.D.s. Remembering the Osteopathic Hospital of Maine, Dr. Cross states that “It was really what a small town hospital should be.”

In his editorial on Osteopathic Medical Education in 2006, Dr. Steve Shannon (former Dean of UNECOM) cites primary issues of eminent importance, including growing enrollment at osteopathic medical schools, aging of the baby boomer population, and declining federal and state funding. All of these factors influence the need for clinical training sites for osteopathic students and the availability of teaching hospitals to support these students. Even more rare are teaching hospitals that use osteopathic principles as their guiding philosophy in treating the patient, and hospitals that are staffed predominately by osteopathic physicians.

Dr. Shannon was one of the seven students from the UNECOM class of 1986 who trained at the Osteopathic Hospital of Maine, representing 8 out of 57 students who elected to stay in Maine for their internship training. Dr. Steve Shannon is now president of the American Association of the Colleges of Osteopathic Medicine, and he represents the strong heritage of national and regional achievement achieved by doctors trained at OHM.

The Osteopathic Hospital of Maine changed its name to Brighton Medical Center in October of 1990, reflecting a tide of marketing away from the osteopathic name for community hospitals. A local newspaper reported that the name change reflected more allopathic physicians now practicing at the hospital and resulted from the public’s misconception about the hospital’s mission. Waterville Osteopathic hospital also changed its name to Inland Hospital in Waterville, Maine.
 
Changes in hospitalization and managed care around the United States influenced the Osteopathic Hospital of Maine and other small, community hospitals. The demand for expensive technology in medicine was on the rise, while at the same time the average inpatient stay was shortening, and in fact, many procedures were being performed on an outpatient basis. Small hospitals like OHM had traditionally used the inpatient days to pay for expensive new medical equipment.

Further evaluations by area planners indicated that the Portland area in Cumberland County, Maine, had an excess of some 600 hospital beds. Consolidation of services was needed if hospitals were to survive while still providing high quality care. Brighton Medical Center became part of Maine Medical Center in 1998, and the staffs were merged at this time, eliminating the independence of a unique cornerstone in osteopathic history in the Maine area, but leaving behind a long legacy of great teaching, stewardship of the community, and certainly excellent patient care.
 
Acknowledgment

I would like to acknowledge the New England Osteopathic Heritage Center and Gay Marks for her enthusiasm in helping me with this project and directing me to sources within her collection.

Gay Marks
Archivist
New England Osteopathic Heritage Center
207-283-0170 ext. 2131
neohc@une.edu

-Dan Sheps, MS II

Page Two of October COMmunicator

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