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Mission: Possible - Children's Hospital Boston

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news<br />

August 2007<br />

Children’s<br />

Investing in<br />

asthma education<br />

Asthma is the leading cause of<br />

Inside<br />

hospitalization at Children’s Hos-<br />

pital <strong>Boston</strong> and its rates in New<br />

England are among the highest in the na-<br />

tion. But some of the best ways to improve<br />

asthma outcomes—education and home<br />

interventions—are often not covered by<br />

insurance. To help resolve this problem, Chil-<br />

dren’s partnered with the Asthma Regional<br />

Council (ARC) to make an economic case for<br />

investing in asthma prevention programs.<br />

With the help of researchers at UMass, Lowell<br />

(UML), they conducted a study called Invest-<br />

ing in Best Practices for Asthma. “We found<br />

cost savings across our 20-year review of the<br />

published literature from more than $7 for<br />

every $1 invested in asthma education to as<br />

high as $36 for every $1 invested,” says UML<br />

researcher Polly Hoppin, PhD. The findings<br />

released on July 6, revealing the following:<br />

• Effective asthma education programs can<br />

lead to fewer emergency room visits and<br />

hospitalizations as well as improvements<br />

in quality of life and lung function, which<br />

can, in turn, result in cost savings.<br />

• Home-based interventions are cost-ef-<br />

fective measures that can result in im-<br />

proved health outcomes for patients.<br />

During a home intervention, a trainer<br />

educates families about environ-<br />

mental factors that trigger asthma<br />

(including cockroach or mouse<br />

problems, pet dander, mold, poor<br />

ventilation and/or uncleanliness).<br />

The trainer also educates fami-<br />

continued on page 6<br />

<strong>Mission</strong>: <strong>Possible</strong><br />

Kim Wilson, MD, MPH, a primary care pediatrician<br />

at the Martha Eliot Health Center (MEHC)<br />

and associate director of the Center for International<br />

Pediatrics at Children’s <strong>Hospital</strong> <strong>Boston</strong>, knew she<br />

had to go the extra mile to properly care for the Dominican<br />

patients who make up more than half of her patient<br />

base. But she faced a major stumbling block. Her<br />

patients made regular trips back to the Dominican<br />

Republic (DR) to visit family, sometimes staying for<br />

months or even years at a time, making continual<br />

care difficult. Adding to the problem was the different<br />

ways doctors and patients approach health<br />

care in the two countries.<br />

When a Dominican mother asked if Wilson<br />

could communicate with her child’s doctor<br />

in Baní in the DR back in 2002, Wilson took<br />

it a step further and started the Dominican<br />

Health Alliance to bridge the communication<br />

gap. “There were many things I didn’t<br />

understand about their health care, beliefs<br />

and traditional remedies that I needed to<br />

learn,” she says. For example, in the DR,<br />

preventive care is an unfamiliar concept,<br />

and most families only seek care for<br />

serious illness. So in collaboration with<br />

Sue Torrey, MD, Emergency Department<br />

physician, and other Children’s staff, Wilson<br />

started to travel to<br />

the DR to gain a better<br />

understanding of their<br />

patients’ native health<br />

care system.<br />

The group soon<br />

learned that there was<br />

more to be done than<br />

simply learning about<br />

their culture and health<br />

care system. “The quality<br />

of health care in the DR was<br />

startling,” Wilson says. She<br />

found that many hospitals<br />

lacked basic supplies, relied<br />

on an intermittent water supply<br />

and didn’t have basic infection<br />

control practices in place. She also<br />

learned some sad statistics: Neo-<br />

natal mortality is more than three times higher in the<br />

DR than it is in the United States, and more than 70<br />

percent of all childhood deaths there occur in the first<br />

month of life. Since hospitals’ nurseries have limited<br />

incubators and oxygen, infants must sometimes share,<br />

or go without treatment.<br />

Wilson and her team concentrated their efforts on<br />

improving newborn and maternal care by educating<br />

the public and local medical staff. In addition to<br />

teaching courses on HIV, neonatal resuscitation and<br />

pediatric infection and emergency care, they provided<br />

equipment and medicine to the DR’s main regional<br />

hospital, the Nuestra Señora de Regla <strong>Hospital</strong> Baní,<br />

the only hospital for the province’s 170,000 people.<br />

By last year, the program had blossomed into a nonprofit<br />

organization called Infante Sano (www.infantesano.org),<br />

Spanish for “healthy infant.” Infante Sano<br />

focuses on improving the quality of neonatal and maternal<br />

care by establishing several community outreach<br />

programs in Baní and its surrounding areas designed<br />

to help mothers realize when their pregnancy or infant<br />

are in danger. The organization provides medical supplies<br />

and works with the hospital to develop a plan<br />

for equipment maintenance. Members also produced<br />

videos for local television to train the community<br />

about health issues, and staff make home visits to<br />

Susan Torrey, MD, fourth from left, works with Dominican<br />

nurses at Nuestra Señora de Regla <strong>Hospital</strong> Baní<br />

with volunteer Luz Maria Davila, RN, BSN, far right.<br />

continued on page 6<br />

Hal turning 17<br />

New Employee of the Month program • Children’s Website in Spanish • Mandy Moore visits


Newborn Medicine A simpler way to check catheter placement<br />

Otolaryngology Neural stem cells may help regrow the cochlea<br />

Hematology/Oncology A faster recovery from marrow transplants<br />

First steps toward a<br />

living cochlear implant<br />

Most cases of deafness are caused by the<br />

dysfunction or death of cells in the cochlea,<br />

the snail-shell-shaped structure in<br />

the inner ear. Douglas Cotanche, PhD, a researcher<br />

in Otolaryngology, now reports that his lab has grown<br />

all the assorted cell types in the cochlea from just one<br />

source: neural stem cells. The study was published<br />

online June 20 by the journal Hearing Research.<br />

Neural stem cells were first isolated from mice<br />

in 1998 by Evan Snyder, MD, PhD, formerly of<br />

Children’s Department of Neurology. Cotanche’s<br />

team implanted the cells deep inside the sound-damaged<br />

cochleas of guinea pigs and mice. Six weeks<br />

later, the cells had migrated throughout the cochlea<br />

and formed satellite cells, spiral ganglion cells and<br />

Schwann cells, which make up the cochlea’s nervous<br />

tissue, as well as the hair cells and supporting cells of<br />

the organ of Corti (the actual hearing organ). “Getting<br />

these cells to integrate into the damaged ear and<br />

make the variety of cochlear cell types is a big step,”<br />

says Cotanche.<br />

The researchers couldn’t show complete rebuilding<br />

of the cochlea, but they believe that with more time<br />

and more stem cells, most of the cochlea could be repopulated.<br />

Cotanche’s next goal is to implant human<br />

neural stem cells in animals and test whether the new<br />

cochlear cells connect with the auditory nerve and<br />

the brain, and whether they respond to sound stimulation—in<br />

other words, whether they restore hearing.<br />

Resident invents a glowing catheter<br />

The placement of central<br />

catheters, which deliver<br />

lifesaving nutrition and<br />

medicine to the most premature<br />

infants, is a “blind” procedure.<br />

The catheter is typically inserted<br />

in the forearm or ankle and advanced<br />

until it reaches a location<br />

near the heart. Only an X-ray can<br />

reveal whether the catheter has<br />

gone astray, veering too close to<br />

the heart, into the neck or even<br />

winding back down the arm.<br />

Adjustments are often required,<br />

leading to delays, more X-rays<br />

and exposure of the infant to<br />

more radiation.<br />

“I thought to myself, there<br />

must be a better way to do this,”<br />

says Farhad Imam, MD, PhD,<br />

a clinical fellow in Newborn<br />

Medicine at Children’s <strong>Hospital</strong><br />

<strong>Boston</strong>, who witnessed several<br />

“misroutings” as a resident in<br />

the Neonatal Intensive Care Unit<br />

(NICU). Imam’s solution was<br />

intuitive: He threaded a central<br />

Farhad Imam, MD, PhD<br />

catheter with an illuminated<br />

fiber-optic wire to make it glow, allowing its progress through the body to be tracked<br />

with the naked eye. After night shifts during his residency and the first year of his NICU<br />

fellowship, Imam spent afternoons testing his design on rabbits. The catheter’s red gleam<br />

was visible through tissue—and even fur.<br />

Initially funded by a Lovejoy Research Award for residents, Imam is now supported<br />

by a Massachusetts Technology Transfer Center grant and he’s con-<br />

tracted with two engineering firms to help build a prototype<br />

Boosting blood stem cells Zebrafish show the way<br />

light-guided catheter over the next year. “The catheter<br />

By systematically screening more than ,500 chemicals in zebrafish, Leonard Zon,<br />

will be most readily usable in newborns,” he<br />

MD, Trista North, PhD, and Wolfram Goessling, MD, PhD, of Children’s Stem<br />

says, “but it should also work in children and<br />

Cell Program, have identified an available drug that ramps up production of blood<br />

possibly in adults.”<br />

stem cells, helping patients recover immune function more quickly after chemotherapy<br />

or bone marrow transplants. The drug, a derivative of prostaglandin E ,<br />

may be tested as early as next year in patients undergoing cord blood transplant for<br />

leukemia. The paper appeared in the June 1 issue of Nature.<br />

Jacqueline Armstrong and Monique<br />

Yoakim-Turk of Children’s Intellectual Property<br />

Office helped Imam file a patent, recognizing<br />

that a light-guided catheter could save money<br />

and time by replacing the current technique. “Residents<br />

have cool ideas,” says Yoakim-Turk. “They’re new and tend to<br />

question what others don’t anymore.”<br />

Go to Children’s News’ Online Extras at<br />

www.childrenshospital.org/chnews to read more research briefs.<br />

Have research news you would like to share?<br />

Email nancy.fliesler@childrens.harvard.edu or call ext. 5-2426.<br />

Cheonil Kim, MD, attended medical<br />

school in Seoul, Korea, where he was<br />

born, but he knew that once he finished<br />

his degree, he wanted to practice medicine<br />

in the United States. But before he could<br />

leave Korea, he had to serve in the medical<br />

branch of its army. “It was just like that show<br />

M*A*S*H,” he remembers, laughing.<br />

After the army, Kim made the move overseas<br />

and in 1980 began his fellowship at Children’s<br />

<strong>Hospital</strong> <strong>Boston</strong>. From the start, he found<br />

it to be a great fit. “I liked it and they liked<br />

me,” he says. “The families make you feel so<br />

good about working here.” One of the biggest<br />

differences he noticed between American<br />

and Korean hospitals was how patient-doctor<br />

relationships worked. “People are more skeptical<br />

of health professionals in Korea,” he says.<br />

“Families here are positive because they trust<br />

in you—and the institution. That motivates me<br />

to give 100 percent.”<br />

Kim trained in General Surgery for two<br />

years before he decided to make a switch to<br />

Gratitudes<br />

Children’s News | August 2007 www.childrenshospital.org<br />

The secret to his success<br />

DESTINATION:<br />

Children’s<br />

The following letter was sent to Jennifer Finn,<br />

general manager at Fitcorp.<br />

The Nussenbaum family<br />

South Korea<br />

il Kim, MD<br />

Anesthesiologist<br />

Anesthesia. “It takes a certain type of person to<br />

be a surgeon and that wasn’t me,” he says. But<br />

that hasn’t kept Kim out of the operating room<br />

(OR). As an OR director focusing on anesthesia<br />

during otolaryngologic (ears, nose and<br />

throat) surgeries, he ensures that the surgeries<br />

run smoothly, while acting as a liaison between<br />

surgeons, nurses, departments and families.<br />

Despite his success, Kim still considers his<br />

language barrier to be a big challenge. “I give<br />

professional talks, but it’s on a basic level of<br />

communication,” he says. “It helps that I’m<br />

in the medical field, especially at Children’s,<br />

since people really try to understand me in<br />

context, despite my mispronunciations.” He<br />

brushes up on his elocution from time to time<br />

with English lessons and gets a fair amount<br />

of practice talking to his three American-born<br />

sons. Kim considers himself a family man and<br />

attributes this to his heritage. “My cultural<br />

identity is pretty strong,” he says. “I’m very<br />

family-oriented and half of the food I eat is<br />

from my culture—I like the spice.” Although<br />

all of his sons are American, he says, “They<br />

have stronger cultural connections to Korea<br />

than I thought they would—their heritage is<br />

always on their minds, and that’s reflected in<br />

the food they eat.”<br />

Being bilingual has been useful to Kim when<br />

treating Korean-speaking patients over the<br />

years, and many departments have sought his<br />

Dear Jennifer,<br />

translation help. “Even if the family speaks<br />

basic English, they may need clear communication<br />

to feel comfortable. I’m proud to help,”<br />

he says.<br />

Kim knows that the decision he made<br />

decades ago to immigrate to the United States<br />

was the right one. “In Korea, the medical<br />

profession is about fame and prestige,” he says.<br />

“Those weren’t my goals and that’s not my<br />

style,” he says. “Here, it’s about respecting the<br />

individual and quality of care. People appreciate<br />

my work and my presence. I consider that<br />

success.”<br />

Five months ago my teenage son was hospitalized at Children’s<br />

<strong>Hospital</strong> <strong>Boston</strong>. What began as a simple case of mono turned into<br />

a serious illness that ultimately necessitated him having a bone<br />

marrow transplant. My wife and I spent four months at Children’s<br />

with our son, and we continue to return with him on an outpatient<br />

basis during the long recovery period.<br />

During my son’s hospitalization, I managed to set aside time every<br />

day to come to Fitcorp so that I could work out, shower, shave and<br />

try to clear my head. As difficult as this ordeal has been for me<br />

and my family, I cannot even begin to imagine what it would have<br />

been like had I not been able to retreat to Fitcorp. It is hard to put<br />

into words just how important it was to have your club available<br />

to me, even for this short time each day.<br />

I just wanted to thank you so much for making this resource<br />

available to me and other families of Children’s patients. It is a<br />

wonderful service that you provide to parents who must endure<br />

the nightmare of having a sick child.<br />

Cheonil Kim, MD<br />

Adam Nussenbaum


1<br />

Time Capsule<br />

5 Cottage Wards<br />

10 Carnegie Building<br />

The Time Capsule contains memorabilia pertaining to the history<br />

of the hospital. It will be opened in 2069 to commemorate the<br />

hospital’s bi-centennial.<br />

2<br />

Operating Room/Farley<br />

Building<br />

When Children’s moved to Long-<br />

wood Avenue in 1914, the hospital<br />

constructed a series of small build-<br />

ings behind the Hunnewell Build-<br />

ing. The Operating Room Building,<br />

usually known simply as “Surgical”<br />

or “The OR,” was one of these.<br />

3<br />

Fegan Building<br />

The Fegan Building was built in<br />

1967 for outpatient visits with<br />

patient comfort in mind: More spa-<br />

cious waiting rooms and play areas<br />

replaced the crowded wooden<br />

benches that served as waiting<br />

areas in the old facilities.<br />

4<br />

Time Capsule<br />

Laboratory Study Building<br />

In 1921, a small laboratory build-<br />

ing was constructed behind the<br />

Hunnewell Building, and in 1926,<br />

a second story was added. James<br />

Lawder Gamble, MD, whose work<br />

developed the scientific basis for<br />

oral and intravenous fluid therapy,<br />

worked here and his library has<br />

been reassembled as the Gamble<br />

Reading Room.<br />

The History Trail A walking tour of Children’s <strong>Hospital</strong> <strong>Boston</strong><br />

Since its founding in 1869, Children’s <strong>Hospital</strong> <strong>Boston</strong> has been at the leading edge of patient care, medical research and teaching. Follow the new historic markers<br />

along the Children’s History Trail to learn more about the people, places and achievements of the past—and learn how they inspire us to do great things today.<br />

Operating room, ca. 1900<br />

Outpatient clinic, 19 0s<br />

Dr. Gamble<br />

Wolbach Building<br />

Several wards were constructed in the<br />

area behind the Hunnewell Building to<br />

house medical and surgical patients.<br />

These “cottage wards” (sometimes<br />

called “chicken coops”) were designed<br />

to maximize air and light and to minimize<br />

the spread of infectious diseases.<br />

6<br />

Wolbach Building<br />

Built in 1914 as a hospital for infants and purchased in 1923 by the Harvard School<br />

of Public Health, the Wolbach Building later became a part of Children’s and cur-<br />

rently houses administrative offices. It features many of its original architectural<br />

details, including marble floors and crown molding.<br />

7<br />

Prouty Garden<br />

The Prouty Memorial Gar-<br />

den and Terrace, designed<br />

by the Olmstead Brothers<br />

landscape design firm, was<br />

donated to Children’s in 1956<br />

by Olive Prouty as a memo-<br />

rial to her two deceased<br />

children. The garden, a reg-<br />

istered site with the National<br />

Association for Olmsted<br />

Parks, was honored with a<br />

gold medal by the Massachu-<br />

setts Horticulture Society.<br />

8<br />

Bader Building<br />

The six-story Bader Building<br />

opened in 1930 primarily to treat<br />

children with neuromuscular<br />

diseases. Named in honor of Mr.<br />

and Mrs. L. F. S. Bader, who were<br />

major donors, this building was<br />

one of the most modern hospital<br />

facilities of its time in the United<br />

States.<br />

Silver from the School of<br />

Nursing on display<br />

9<br />

Exhibit Case<br />

This is the main display case of the Children’s Archives<br />

Program. The hospital’s archives were established in 1993<br />

to acquire, preserve and make available the historical<br />

records that document the ongoing history of Children’s,<br />

its staff, volunteers, patients and families.<br />

The Ida C. Smith Building in the<br />

19 0s, one of the “cottage wards.”<br />

Circus Day took place in the 19 0s where<br />

the Prouty Garden is now located<br />

Bader Solarium, 19 0s<br />

The Carnegie Building, built in 1907,<br />

housed medical and surgical research<br />

laboratories and was where doctors<br />

John Enders, Frederick Robbins and<br />

Thomas Weller did work with polio<br />

and other infectious diseases that led<br />

to their receiving the Nobel Prize for<br />

Medicine in 1954.<br />

11 Ambulances<br />

Children’s has long used ambulances to<br />

transport patients, inlcuding the horse-<br />

drawn “barge,” at right.<br />

12<br />

Enders Building<br />

The John F. Enders Pediatric<br />

Research Laboratories, or Enders<br />

Building, opened in 1970 and<br />

was named for John Enders,<br />

PhD, in recognition of his pioneering<br />

work in the study of viruses, includ-<br />

ing polio, mumps and measles.<br />

13<br />

Longwood Row Housing<br />

In the early years after Children’s<br />

relocated from Huntington to<br />

Longwood Avenue, a series of row<br />

houses were built on both sides of<br />

Longwood that served as housing<br />

for medical residents, nurses and<br />

staff members.<br />

14 Outpatient Visits<br />

In 1938, the Outpatient Department was com-<br />

posed of 25 clinics and handled more than<br />

68,000 visits. Eighty-five doctors took turns<br />

supervising the clinics, which were<br />

available to all patients, regardless of<br />

their parents’ ability to pay. The aver-<br />

age cost to the hospital for each visit<br />

was $1.50 and the average payment<br />

made was 65¢.<br />

Dr. Enders<br />

Carriages outside Hunnewell, 19 0s<br />

15 Hunnewell Building<br />

The oldest continuously occupied build-<br />

ing on campus, Hunnewell is named after<br />

Francis Welles Hunnewell, a major donor to<br />

Children’s and a real estate developer in the<br />

Allston-Brighton neighborhood during the<br />

mid-to-late-19th century.<br />

16 Gardner House<br />

The Gardner House opened<br />

in 1930 and was home to the<br />

School of Nursing through<br />

1978. Nursing students often<br />

gathered in its elegant living<br />

room for high tea. Later, in<br />

the 1980s, families of patients<br />

stayed in the Gardner House’s<br />

family hostel.<br />

Set out on the trail<br />

Take this map, or get a guidebook in the lobby, and walk<br />

around the campus to learn more about each location.<br />

Children’s News | August 2007 www.childrenshospital.org<br />

5<br />

Dr. Weller<br />

Ambulance, 19 0<br />

Longwood Avenue, ca. 19 0<br />

5<br />

4<br />

6<br />

15<br />

7<br />

9<br />

3<br />

16<br />

8<br />

14<br />

2<br />

Hunnewell Building, 19 0s<br />

School of Nursing groundbreaking, 19 9<br />

1<br />

10<br />

13<br />

11<br />

12<br />

© Children’s <strong>Hospital</strong> <strong>Boston</strong> 2007


Dominican Republic continued from page 1<br />

increase awareness. “These interventions are not high-tech or particularly costly,<br />

so it’s very doable,” Wilson says. It’s been going so well, in fact, that she hopes<br />

to expand to more outposts on the Haitian border by January.<br />

When Wilson is back at the MEHC, she draws on her experiences in the DR to<br />

provide more culturally aware care. She knows, for example, that since antibiotics<br />

are available without prescriptions in the DR, her patients are used to taking<br />

them frequently—even to treat minor<br />

viral illnesses. So Wilson makes sure<br />

to explain to patients why this isn’t<br />

always beneficial. After seeing how<br />

entire families, including infants and<br />

young children, travel by moped in the<br />

DR without helmets, she also began<br />

educating her patients about safety<br />

equipment like car seats and bike<br />

helmets. She also learned how to adapt<br />

Kim Wilson, at right, with<br />

Dominican trainees.<br />

medical treatment for patients with<br />

diabetes or asthma, creating a regimen<br />

that they can continue to follow while<br />

they’re visiting family in their home country. This cultural awareness has had a<br />

lasting impact on the many MEHC staff who’ve worked with Wilson.<br />

Infante Sano now has offices in Bani and <strong>Boston</strong>, with 16 Dominican physicians,<br />

nurses, support staff and volunteers. They’ve succeeded in renovating the<br />

special care nursery and the pediatric section of Nuestra Señora de Regla <strong>Hospital</strong><br />

Bani, and opened two clinics in a rural part of the DR late last year. One<br />

specializes in treating malnourished children and the other is a primary care<br />

center. Together, their staff sees more than 300 mothers and children a week.<br />

Still, there’s work to be done. “Our biggest challenge is to have a sustainable<br />

impact,” Wilson says. “It’s very easy to do interventions with a temporary positive<br />

effect, but we want to have a lasting one. We’ve struggled with how to do<br />

that.” That’s why, for now, they’ve transitioned into having a sustained presence<br />

there. But the hard work is gratifying. “What’s really rewarding is that it’s immediately<br />

clear that we’re making a big difference,” Kim says. “I really enjoy seeing<br />

the program grow and the enthusiasm of the people who are so excited to have<br />

the opportunity to improve the care they deliver.”<br />

Exceptional Care<br />

Exceptional Service<br />

Celebrating the first 100 suggestions<br />

On July 9, Children’s <strong>Hospital</strong> <strong>Boston</strong>’s Exceptional Care, Exceptional Service (ECES) program<br />

took a lunch break to honor the first 100 contributors to the ECES suggestions Web site. Since<br />

January, 83 staff members have contributed a total of 110 suggestions on specific ways to improve<br />

the hospital experience and its service. Those who submitted their ideas were invited to a tapas<br />

lunch (replete with a Flamenco guitarist) in the Patient Entertainment Center.<br />

Sandra Fenwick, COO, recognized the ECES team and those who shared their suggestions,<br />

especially the 15 employees whose ideas have already been or are currently being implemented.<br />

Their suggestions include department meet-and-greets for new employees and standardizing<br />

telephone greetings and email signatures.<br />

Christine Powers-Perry, executive assistant in Public Affairs, received a special award for<br />

her six outstanding ECES ideas, three of which have already been put into practice. “No idea<br />

is too small if it’s going to change someone’s experience at the hospital,” says Powers-Perry,<br />

who created ECES training badges and designed and created ECES magnets. “The values of<br />

ECES are all things we should be doing to work together and help support the hospital’s mis-<br />

Asthma continued from page 1<br />

lies by teaching them which cleaning products don’t worsen<br />

asthma, how to seal off areas that collect moisture and offering<br />

allergen-free bed and pillow covers or vacuums.<br />

• Non-physician providers (such as nurses, respiratory therapists,<br />

asthma educators and social workers) can provide<br />

effective asthma education and environmental interventions,<br />

often at a lower cost.<br />

“Studies indicate that current approaches to managing asthma<br />

aren’t working for a lot of people,” says Laurie Stillman, director<br />

of the ARC. “This study shows we can improve asthma outcomes<br />

in a cost-effective manner if high-risk patients are given<br />

education and environmental improvements in the home.”<br />

The study also calls on multiple sectors, including payers,<br />

health provider groups, employers and policymakers to play a<br />

role in implementing these programs.<br />

Many of the study’s recommendations are contained in<br />

legislation, filed this year by the <strong>Boston</strong> Urban Asthma Coalition<br />

(BUAC) and Children’s, that would require insurers in Massachusetts<br />

to cover asthma education and in-home environmental<br />

interventions. At a hearing in May, parents of children with<br />

asthma, community health advocates and hospital leaders and<br />

clinicians—including Shari Nethersole, MD, medical director for<br />

community health, and Susan Sommer, RNC, NP, nurse case<br />

manager for the Community Asthma Initiative—testified in support<br />

of the bill before the Joint Committee on Public Health.<br />

With the study’s results to support them, Children’s will<br />

continue working with its partners to bring about the necessary<br />

changes to asthma care. “Too many families, particularly in<br />

low-income communities, are struggling needlessly with the effects<br />

of asthma,” says Lisa Mannix, coordinator of Child Health<br />

Policy and Education at Children’s. “The evidence accumulated<br />

in this business case shows there are interventions that work.<br />

It’s time for decision-makers to take bold action to implement<br />

them on a broader scale.”<br />

Christine Powers-Perry receives her award<br />

from Bess Andrews, director of Public Affairs.<br />

In their own words<br />

Kitty Scott, RN, retired coordinator of Patient Relations<br />

A nurse looks back on 5 years at Children’s<br />

In 1962, I came to Children’s <strong>Hospital</strong> <strong>Boston</strong><br />

as a young nurse with a plan to work at the<br />

hospital for one year and then return home<br />

to Nova Scotia. I’d written a letter to the Nursing<br />

Department explaining my limited experience<br />

and desire for a job. I received a letter<br />

of acceptance with a start date. There was no<br />

interview and I completed my application after I<br />

arrived. My salary was $82 a week.<br />

I was assigned to Division 35, the cardiology/cardiac<br />

surgical unit. My head nurse did not<br />

meet me until I had completed a few days of<br />

orientation and I worked just a few days with a<br />

senior nurse and then was on my own.<br />

There were no intensive care units (ICUs)<br />

at Children’s when I arrived. We cared for<br />

patients who had open heart surgery in the<br />

“Pump Room.” If patients required a ventilator,<br />

they remained in the Recovery Room (now<br />

the Pediatric Advanced Care Unit) but nursing<br />

staff from Division 35 provided the care. In<br />

some cases, patients were so unstable they<br />

remained on the OR table while we cared for<br />

them. Back then, open heart surgery couldn’t<br />

be done until the child reached 45 pounds<br />

because our heart-lung machine wasn’t adapted<br />

for babies, so many children died waiting for<br />

surgery. Some “blue babies” had palliative procedures<br />

done in the hyperbaric chamber, which<br />

was located in the basement of the Harvard<br />

School of Public Health—now the Wolbach<br />

Building. Imagine the challenge of transporting<br />

a baby across the garden to the hospital following<br />

surgery, sometimes in the dark.<br />

In December of 1964, a very exciting thing<br />

occurred. A Cardiac ICU (CICU) was opened<br />

on Division 25, the first pediatric ICU in the<br />

country. I assisted in transferring the first<br />

patient into the unit. A month later, I became<br />

Assistant Head Nurse for the night shift. In<br />

those days, nurses didn’t apply for promotions,<br />

but were chosen by nursing leadership. It<br />

wasn’t unusual to work up to 10 shifts in a row.<br />

In addition to a modest raise, this new position<br />

gave me every other weekend off—regular<br />

staff nurses worked eight-hour shifts and<br />

worked two out of three weekends. Providing<br />

adequate coverage was the priority, and the<br />

nurses’ personal lives came second. As nurses,<br />

we wore totally white uniforms, white shoes<br />

and stockings, and, of course, the cap that<br />

represented the school of nursing from which<br />

we graduated.<br />

Parents did not stay at<br />

the hospital at night unless<br />

the child was critically ill,<br />

and at 8 p.m., all visitors<br />

left. Parents were not<br />

encouraged to participate<br />

in their child’s care, so the<br />

staff nurses provided all<br />

care, except perhaps an<br />

occasional diaper change<br />

or bottle feeding. Except at<br />

the highest level of nursing<br />

administration, nurses were<br />

not involved in decisionmaking<br />

of the hospital. Staff<br />

nurses did not serve on any<br />

hospital-wide committees<br />

and annual reviews were<br />

done by the supervisors<br />

with no peer input. Promotions<br />

meant getting farther<br />

and farther away from the<br />

bedside.<br />

Fourteen years ago, when I was the Nurse<br />

Recruiter, I was asked to hire for a part-time<br />

position in Patient Relations. A decision had been<br />

made that a nurse should fill this opening. However,<br />

it seemed that no nurses were interested<br />

because no one applied. After a number of weeks,<br />

my director came by to ask me if I would consider<br />

the position. With much trepidation, I decided<br />

to move into this new role while I continued to<br />

do nurse recruitment.<br />

After accepting the fact that an angry call<br />

was not directed at me personally, and that<br />

there are people one simply cannot please, I<br />

learned as much as I could about billing and<br />

insurance practices. I settled in and found<br />

my last job at Children’s as challenging and<br />

satisfying as caring for critically ill patients. I<br />

have enjoyed the more complicated cases and<br />

the challenges of situations involving Risk<br />

Management and the Office of Legal Counsel.<br />

Patient Relations allowed me to use my people<br />

skills, clinical knowledge and familiarity with<br />

the hospital and its players to address the ma-<br />

jority of challenges that came my way. It was a<br />

great job for an old nurse!<br />

Since my early days, I have seen so many<br />

changes—more than can be mentioned! In addition<br />

to the fantastic advances in medical care,<br />

we have gone from one small CICU and several<br />

small “care rooms” to two large, state-of-theart<br />

ICUs. Parents can visit 24 hours a day and<br />

are encouraged to participate in their child’s<br />

care. RN evaluations are done with peer input.<br />

There is a Clinical Ladder that allows nurses to<br />

advance but remain involved in direct patient<br />

care. Most staff work 12-hour shifts and have<br />

two out of three weekends off—not on. Now,<br />

nurses wear brightly colored scrubs and there<br />

is less formality than in the “old days.”<br />

Children’s is an amazing place and I am<br />

very proud to have worked here for so many<br />

years. I have had eight different positions and<br />

enjoyed the challenges and satisfaction of them<br />

all, whether it’s been providing direct care to<br />

the patients as a staff nurse or contributing to<br />

the care in other ways. I’m leaving feeling very<br />

good that I chose to be a nurse.<br />

Do you know how many units (pints) of blood Children’s<br />

collected in 006? Including donations from the Blood<br />

Mobile and donations of whole blood, platelets and double<br />

red blood cells from the Blood Donor Center, the total was<br />

10,858 units!<br />

sion,” she says. To make a suggestion, go to http://web2.tch.harvard.edu/eces/formESS.cfm.<br />

6 Children’s News | August 2007 www.childrenshospital.org<br />

7<br />

Kitty Scott, RN


This month’s<br />

En Español…Children’s <strong>Hospital</strong> <strong>Boston</strong> has just launched<br />

a Spanish version of the hospital Web site for our Spanish<br />

speaking patients and providers. The site features information<br />

such as directions, how to prepare your child for a hospital<br />

stay, health tips, descriptions of our main clinical services and<br />

more. Check it out at www.childrenshospital.org/espanol.<br />

Family Advocacy Day<br />

It all happened at Children’s <strong>Hospital</strong> <strong>Boston</strong>!<br />

Talking politics…Four patients from Children’s headed to Washington,<br />

DC, for Family Advocacy Day, sponsored by the National Association of<br />

Children’s <strong>Hospital</strong>s, in late June. The patients shared their health histories<br />

with senators and congressmen from their home states of Maine, New Hamp-<br />

shire, Massachusetts and Rhode Island to promote the reauthorization of the State<br />

Children’s Health Insurance Programs, the passage of the Children’s Health Care<br />

Quality Act and funding for the Children’s <strong>Hospital</strong>s Graduate Medical Education<br />

Program.<br />

Workouts for community<br />

children…A new high-tech<br />

fitness center for children,<br />

GoKids <strong>Boston</strong>, recently opened at UMass <strong>Boston</strong>,<br />

with Children’s support. The center will investigate the<br />

science and practice of improving fitness in children<br />

and provide exercise programs for children with health<br />

challenges. At the grand opening, Sandra Fenwick,<br />

chief operating officer, gave a speech and local chil-<br />

dren got to test out the excergaming—kid-friendly<br />

exercise equipment that has interactive, built-in games.<br />

Latino youth<br />

recognition…In<br />

an effort to recognize high-achieving Latino middle schoolers, Children’s is<br />

sponsoring a series of Latino youth recognition days at Fenway Park. The<br />

first one was June 15 and the second was July 16; the last one will be held<br />

Sept. 3. At the events, the students are recognized during pre-game, on-<br />

field ceremonies and given certificates of recognition by Red Sox players<br />

David “Big Papi” Ortiz, Wily Mo Peña, Julio Lugo and Alex Cora. El Mundo<br />

newspaper and the Red Sox developed the project to encourage academic excellence and are giving out more<br />

than 500 Sox tickets to inner-city youth.<br />

More Mandy…On July 16, actress/singer Mandy<br />

Moore wowed patients throughout the hospital,<br />

including this young patient-reporter Ashley during<br />

the Midweek Morning Show taping in the 10NW<br />

playroom. Moore stopped by to visit patients before<br />

giving a Mix 98.5 concert at the Prudential Center.<br />

Online Extras at<br />

www.childrenshospital.org/chnews…<br />

Our new anti-violence art and poetry contest • Martha<br />

Eliot Health Center’s Car Seat Checkpoint event • HIV<br />

testing turnout at the Martha Eliot Health Center •<br />

Research briefs • NASCAR’s visit • Transforming Care<br />

at the Bedside project • National Kidney Foundation<br />

donates Sox tickets<br />

Editor: Erin Graham<br />

Designers: Javier Amador-Peña,<br />

Patrick Bibbins<br />

Contributors: Louise Cobb, Nancy<br />

Fliesler, Lisa Mannix, Sheila Spalding<br />

Department of Public Affairs<br />

and Marketing<br />

Children’s <strong>Hospital</strong> <strong>Boston</strong><br />

21 Autumn St., 2nd Floor<br />

<strong>Boston</strong>, MA 02115<br />

(617) 355-6420<br />

VP of Public Affairs and Marketing:<br />

Michelle Davis<br />

Director of Public Affairs:<br />

Bess Andrews<br />

Manager of Public Affairs:<br />

Matthew Cyr<br />

GoKids <strong>Boston</strong> gym<br />

Ashley interviewed Mandy<br />

Moore for the Midweek<br />

Morning Show<br />

More News online at www.childrenshospital.org/chnews<br />

© 2007, Children’s <strong>Hospital</strong> <strong>Boston</strong>. All rights reserved.<br />

Upcoming events<br />

Employee<br />

summer bash<br />

Children’s <strong>Hospital</strong> <strong>Boston</strong>’s annual<br />

summer party, Cowboys Around the<br />

World, will take place August 1, 11 a.m.<br />

to 5 p.m. in the hospital cafe. Stop by<br />

for BBQ, music and entertainment. On<br />

August 2, 10:30 p.m. to 12 a.m., there<br />

will be an event for night shift employees.<br />

Invitations were distributed with<br />

your paycheck on July 27th.<br />

MEHC health fair<br />

You’re invited to attend the annual<br />

Martha Eliot Health Center (MEHC)<br />

health fair August 25, 11 a.m. to 3 p.m.<br />

in the MEHC parking lot. This year’s<br />

health fair will promote physical activity,<br />

sports, healthy eating, education<br />

and youth empowerment. There will be<br />

free preventive and chronic disease<br />

screenings for attendees and staff will<br />

offer assistance in obtaining health<br />

coverage, including Medicaid, Medicare<br />

and Commonwealth Care.<br />

Latino Heritage<br />

Month celebrations<br />

The first of many Children’s events<br />

celebrating Latino Heritage Month will<br />

be the <strong>Boston</strong> Harbor Salsa and Latin<br />

Dance Cruise on Sept. 16, 7 to 10 p.m.<br />

Enjoy the charge of Latin music and<br />

dance, get some exercise, explore the<br />

skyline from the harbor and mingle<br />

with your coworkers at Children’s<br />

private area on the top deck. The<br />

cruise and post-cruise party, including<br />

a salsa lesson, is $20; with a dinner<br />

buffet it’s $30. Sign up for tickets for<br />

you and guests at Human Resources<br />

by Aug. 31.<br />

Exceptional Service<br />

Employee of the<br />

Month<br />

Human Resources (HR) is happy to<br />

announce Employee of the Month, a<br />

new recognition program as a part of<br />

the Exceptional Care, Exceptional Service<br />

(ECES) initiative. Nominating a coworker<br />

or staff member is a wonderful<br />

way to recognize the outstanding<br />

performance, service and teamwork of<br />

a fellow employee/staff who exemplifies<br />

ECES standards. Visit the HR Web<br />

page for more information.<br />

Do you have news?<br />

Email: news@childrens.harvard.edu<br />

or call (617) 355-6420.

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