Helping Those Most Vulnerable
“Our children’s future and the world’s future are one,” asserted Dr. C. Henry Kempe, founder of the Kempe Center and a decades-long champion for abused and neglected children. The Kempe Center, located on the Anschutz Medical Center campus, has been a world leader for over forty years in child abuse treatment and prevention programs. CHA/PA graduate Cindy Tanner has aligned herself with this amazing organization for over twenty years.
As a graduate of the first CHA/PA class in 1972 consisting of nine women, Cindy was part of paving the way for so many PAs to come. She was even unsure when she began the program if she would ever be able to practice medicine. There were no laws in place that allowed PAs to practice medicine in CO at that time. Cindy was able to get a job after graduation, with her first job being in a pediatric primary care setting. She experienced a fair amount of opposition from both nurses and physicians. Yet, over time, everyone’s roles became defined and the nurses, PAs, and physicians began working as a team.
Looking back, Cindy is amazed at the evolution of the PA profession and the various roles that PAs can now fulfill; PAs are able to function in such a broad spectrum of specialties and subspecialties. She cannot imagine having chosen a career better suited for her. She notes, “I have realized that I will never stop learning as long as I am a practicing PA, an aspect of the profession that I love.”
Cindy’s long-term position has been as a member of the Child Protection Team at the Kempe Center, which consists of physicians, a pediatric nurse practitioner, a social worker, and a psychologist. The Child Protection Team is a consult group that evaluates cases where there are concerns of abuse and neglect. Children may be patients at The Children’s Hospital Colorado or they may be referred to the Kempe Center by community physicians, law enforcement, or social services. Cindy manages her own cases and reports abuse to appropriate agencies as needed. As a contact person for social services and law enforcement, she provides updated medical information for children staying at The Children’s Hospital. Additionally, she testifies as an expert witness in both civil and criminal court and shares her vast experience with medical students, residents, and PAs who rotate with her team.
As one can only imagine, there is a significant emotional toll that takes place in working with abused children. She becomes frustrated when the system does not work as it should and children are not protected. Yet, she finds tremendous satisfaction as well. Her aspiration is to be someone who is there for those who cannot help themselves. “Children are vulnerable members of our society, who often cannot speak up for themselves. Knowing that I may have made a difference in a child’s life is incredibly rewarding,” asserts Cindy.
April is Child Abuse Prevention Month. The Kempe Center is hosting numerous activities to raise awareness, educate, and garner more community support for abused and neglected children. You can get involved and learn more at The Kempe Center website.
A Student's Motivation for PA School
Sarah Davis did not take the direct route to becoming a Physician Assistant, despite having an early interest in medicine. One experience that had a profound impact on her was the illness of her niece, Amberlyn. Amberlyn was hospitalized most of her short life due to biliary atresia, which is a life threatening condition in which the bile ducts inside or outside the liver do not have normal openings. As a junior in high school, Sarah visited little 11-month old Amberlyn at Children’s Hospital in Seattle as often as she could. Sadly, Amberlyn ultimately passed away due to complications from a liver transplant. Witnessing the care that the health professionals provided to her niece and family further impassioned Sarah toward the medical field.
Yet, family expectations redirected Sarah to choose a different path out of high school. She obtained an undergraduate degree in Technical Sales and a master’s degree in business with an emphasis in marketing. After working several years as a sales representative, sales director, and a marketing manager for a publishing firm on the east coast, Sarah found herself unsatisfied. She found outlets for her medical aspirations and desire to help the underserved where she could. While pursuing her MBA, she chose to participate in a volunteer project that focused on expanding a non-profit healthcare micro franchise in Ghana. Additionally, she spent time at the 4th Street Homeless Clinic in Salt Lake volunteering.
Eventually, Sarah felt it was time for a change; life was too short to not do what you love. She opted to pursue a PA degree, rather than a MD as she had originally planned. She felt the PA field enabled her to help others, practice the art of medicine, and engage in a lifetime of learning and challenge-without some of the downfalls of other fields. The University of Colorado’s program interested her in particular, as it is a three year program that includes a year of rotations that provide extensive clinical experience and exposure. She joined the Class of 2015 in the summer of 2012.
CHA/PA offers four track options, one of which is the CU-Unite track, which focuses on serving the uninsured and those with limited access to health care in urban areas. PA, MD, and Nurse Practitioner students work in teams on various topics that provide an understanding of healthcare disparities and inequities, the multifaceted role of the healthcare provider in urban communities, and the health issues of specific populations of patients in urban areas.
Sarah chose to participate in the CU Unite track primarily based on her experiences volunteering at organizations like the 4th Street Homeless Clinic and the Big Brothers/Big Sisters program. Sarah encountered one gentleman during her time at the 4th Street Clinic who lacked consistent work, thus access to healthcare. He had been arrested many times for drugs and had suffered the life consequences of his decisions. Sarah found herself judging this man until she learned more about his life. He shared with her that he was introduced to drugs at thirteen by a parent. Sarah found herself humbled by his story and the stories of many others that she encountered.
Sarah is thriving in her first year at CHA/PA. She has found herself challenged and pushed intellectually, and she loves it. Yet, her favorite aspect of her time at CU has been the relationships that have developed with fellow students. “The thing I’ve enjoyed the most is the friends I’ve met! There are so many incredibly talented, intelligent, and great people in this program. I’m amazed every day by their stories, experiences, and accomplishments.”
CHA/PA Graduate Serves as Program Director for a UK PA Program
Karen Roberts graduated from CHA/PA in 2004 and spent her subsequent years practicing in family medicine in Thornton. Karen has had a passion for the United Kingdom since she was a teenager. She loves the history and tradition of the country, as well as the diversity and tolerance of the people. She decided to take the leap in 2007 and moved to the UK. Karen practices as a surgical PA and also accepted the role of Program Director for the Physician Assistant Program at St. Georges University in London in September.
The PA profession is quite different in England. The main challenge is that PA’s are not licensed, thus they do not prescribe medicine or request imaging. The UKAPA (UK Association of PAs) is working hard toward expanding PAs scope of practice, and Karen is optimistic that these issues will be resolved in the future. In other ways, medical providers have much more freedom in the UK. All residents have access to medical care; there is no charge for receiving services. Karen loves that insurance is not a limitation. She can focus on patient need, rather than preferred insurance medications.
As a practicing PA, Karen enjoys establishing relationships with her patients and helping them to lead healthy lives and cope with ongoing health issues. As Program Director at St. Georges University of London, she loves being on the forefront of educating PAs that are competent, enthusiastic and caring. Karen also is passionate about advocating for the importance of PAs within the National Health Service medical system. She hopes to see specialty care and training programs expand in the UK over the next decade. The number of PAs in the UK has increased from 30 when she arrived in 2007 to currently over 170. One of the main reasons Karen moved to the UK is to grow the profession and we’re excited to have a CHA/PA grad as part of the PA movement in the UK.
The Value of Precepting
Precepting is an integral component of PA education at CU. Clinical rotations begin for CHA/PA students in the fall of their first year and culminate into a full third year of one month rotations. Preceptors are essential to the growth of students as they transition from being a student to becoming a practicing PA. The third year is especially important as students become more autonomous and confident in their skills and knowledge-base.
Jacqueline Sivahop, CHA/PA’s third year Clinical Coordinator, precepted students while working in a rheumatology clinic. She found that the students’ enthusiasm for learning was infectious. “The students came to clinic excited for the experiences we could offer them and the providers and staff were excited to teach them all aspects of medicine from physical diagnosis, injections, infusions, DEXA scans, prior authorizations, prescription refills, and much more.”
Wayne DuBois has been a CHA/PA preceptor for over fifteen years. He is a Physician Assistant who worked in cardiology for twelve years, and currently works with Kaiser Permanente in Family Practice and Trauma. He was initially drawn to the profession due to his desire to practice medicine as part of a team. Wayne finds that the PA profession continues to challenge him to unravel the mysteries of life while taking care of patients and easing their worries.
As an experienced preceptor, Wayne hopes that students “try to put themselves in the patient’s place to understand what is going on with them, so that patients can ‘know how much they care’ as well as ‘care how much they know’.” When not backpacking, cycling, or fly fishing, he also finds time to support the PA profession through legislative efforts.
Beyond the Classroom
We are six third-year CHA/PA students who chose to spend an elective month working at Hillside Health Care International (Hillside). Hillside is located in southern Belize, situated five miles inland from the oceanside town of Punta Gorda in a village named Eldridgeville. Each month Hillside accepts eight PA or MD students, together with three Pharmacy students, who run the clinic under the supervision of long-term medical providers.
Preparing for this trip was a long journey in itself. We met several times with our preceptor, Dr. Dick Anstett, in order to learn about the culture of Belize, discuss common medical issues, and ponder the broader social issues related to global health care. In addition, we were in contact with Hillside’s director months before departure and were able to actively solicit donations for medicines and equipment from the clinic’s wish list. Dr. Anstett was right when he told us preparation for these types of trips begins a full year in advance, and we accordingly started planning early.
Through the generosity of community members and organizations here in the United States, we were able to carry down an impressive amount of medical supplies to Belize. Among our collected donations were a doppler fetal heart rate monitor, over 300 pairs of eyeglasses, a variety of cardiovascular medicines, and an abundant supply of toothbrushes, toothpaste and fluoride varnish kits. Additionally, the CHA/PA Silver Society donated a large portion of their proceeds from their annual silent auction to Hillside, and we felt proud and fortunate to be able to offer a monetary donation to Hillside in the name of our program and all CHA/PA students. Needless to say, we and our donations were met with humble gratitude.
We all feel fortunate to have participated in this rotation and thank everyone who contributed to our learning and our efforts at Hillside clinic, including Dr. Dick Anstett, the Hillside staff and our student colleagues, as well as the CHA/PA program for making this rotation possible.
We would also like to thank the many donors who filled our luggage to the brim with the medications, eyeglasses, toothbrushes, fluoride varnish, and other supplies which allowed us to provide much-appreciated assistance to Hillside clinic. Our backs literally ached with the weight of your generosity. We would like to give special thanks to the following:
•CHA/PA Silver Society
•Dr. Schieber from Lintecum & Nickell, PC in Kansas for her donation of a fetal Doppler
•Dr. Elizabeth Shick, DDS, MPH and the TCH Dental Clinic
•Drs. John and Olinga Hargreaves, DDS
•Dr. Andrew White, DMD
•Bob Slonecker and Lion’s Club of Denver
•Dr. Anthony Knowlton, DDS
•Dr. Peter Sonntag, DDS
Annette Schieber, Jill Lindeman, Dayna Hochevar, Valana Frohardt, Laura Smith, & Laura Kaningher
Making a Difference One Person at a Time
"To the world you may be one person, but to the one person you may be the world.” This quote provided comfort to Kevin Bogart, a 2010 graduate, as he traveled to Kenya during his third year as a CHA/PA student. He spent a clinical rotation working in a private rural hospital and a government hospital. Ninety percent of patients he worked with were infected with AIDS and suffered the complications of the disease, such as Pneumocystis Pneumonia, Cryptococcal Meningitis, Kaposi’s Sarcoma, Tuberculosis, and Malaria. The small medical facilities could not manage the ballooning number of patients, thus very sick patients would lay head to toe sharing twin beds.
At times he struggled to handle the severity of the medical situation he was faced with. A gentleman passed away in a crowded medical ward and the only sign of his passing was the wailing of his family. Medical personnel did not rush over; rather they kept working with the surviving patients. Death is so common, and there were other patients to save. Kevin was shocked as severely ill patients were discharged from the hospital. A western-trained Kenyan doctor noted Kevin’s reaction and provided perspective, “The patient is stable and we need beds for other sick patients.”
Kevin was only one of three European “Mzungu’s” whom he met over the three months he spent in Kenya. He walked by an orphanage every day on his way to the hospital, and just the sight of a “Mzungu” would interrupt classes as kids would scream out to him. Kevin met so many remarkable children and adults during his stay. One person of note was American Dr. John Ott who has lived and worked in Kenya for years. He became a father to numerous orphans, an ever growing problem in Kenya with over 11.6 million children orphaned by AIDS. Kevin was also touched by the community’s reaction to the orphan crisis – most families had taken in nieces, nephews, and neighbors.
Facing such overwhelming difficulties, Kevin noted, “you either close off to the world around you or you become involved and take care of the community around you." He anticipated before arriving in Kenya that he would face poverty and disease on a level he’d never seen before, which was true. Yet, he also was pleasantly surprised by the resilience and happiness of the Kenyan people in the face of such adversities. The people were not focused on what they didn’t have, but rather on what they did. They found great pleasure in simple things such as singing while doing laundry or dancing when no one was watching.
Kevin has been able to use all he learned in Kenya as a PA at a primary care clinic at the Denver Health campus. His practice primarily serves urban underserved and uninsured patients. With a large immigrant patient population, he has conducted medical interviews in over fifteen different languages. Many patients have not had medical care for decades, and some immigrants have never seen a medical provider in their lives. Kevin finds working with this population extremely rewarding. He continues to find inspiration in that he cannot change the world alone, but he can impact the lives of individuals.
A Graduate's Life in Alaska
“You must be crazy! I do not belong in Alaska.” This was Kimberly Cray’s initial response to a suggestion by a friend that she consider working in Alaska after graduation. Kimberly knew she wanted to leave her comfort zone and have an adventure after she graduated in May 2011. After researching Alaska, specifically Unalaska, Kimberly realized that she had found the right destination. Unalaska, which includes Unalaska Island and Amaknak Island, is 800 miles west of Anchorage and can only be accessed by boat or plane. It is 110 square miles, with only a small portion of that land being developed and inhabited, and offers only 6 miles of paved roads. As the largest fisheries port in the U.S. by volume of seafood caught, the local population includes 4000 residents that increases to 7000 during the busiest fishing seasons.
Four months into her arrival in Alaska, Kimberly is having the experience of a lifetime. In a typical day, she may treat a simple cold, a large fish hook impaled in someone’s hand, a heart attack, and hypothermia. Oftentimes, patients must be medevacked off the island. “Being able to practice pediatrics, family practice, urgent and emergency care all in one place (usually all in one day!) is truly a unique situation, especially for a recent graduate,” she notes. Occasionally, Kimberly's position requires venturing into animal medicine. With no full time veterinarian on the island, residents are forced to bring in their pets, mostly dogs, when crisis arises. The clinic does the best they can to treat them and consults with a veterinarian in Anchorage as needed.
Kimberly is pleasantly surprised at the number of great friends she has made so far in her community. Unalaska attracts people from all around the world – Japan, Russia, Philippines, and the Lower 48. With patients from all around the world, Kimberly is challenged to overcome many language and cultural barriers. She feels it is very important to relate to patients on a personal level so that she can better treat them. Life is Alaska is not without its challenges. Kimberly has had to adjust to living in one of the rainiest places in the U.S. The weather, number of daylight hours, and isolation can lead to “island fever.”
All in all, Kimberly is growing and changing in a remote spot in Alaska. She observes, “working with my patients and collagues has reinforced in my mind why I wanted to become a PA in the first place, and that is to help people.” Want to hear more about Kimberly's experience in Alaska? Follow Kimberly’s blog at: www.adventureunalaska.blogspot.com/
A Third Year Student's Perspective
Eleanor Perry is a 5th generation Coloradoan who grew up in a small town on a Herford ranch in Carbondale. She spent much of her formative years outdoors enjoying kayaking, skiing, sledding, and backpacking. As a Cell & Molecular Biology major at Fort Lewis College in Durango, Eleanor initially planned on attending medical school. She learned of the physician assistant profession her junior year and changed gears. She considers choosing the PA profession the best decision she has ever made.
Eleanor is in the midst of her third year at CHA/PA, rotating to a new rotation each month in various settings from hospitals to rural family practices. CHA/PA is unique in that it offers a full third year of clinical experience, rather than a two year program. She has found that working in such diverse settings has given her a broad perspective on how providers treat the variety of patients that walk in their doors. “Every month has provided me with a different set of skills and new knowledge. All of this will only make me a better physician assistant,” she notes. While rotations can be challenging in the fast pace and knowledge they require, rotations do afford students the opportunity to explore various fields of medicine. For Eleanor, this exposure has helped her find her passion. She has spent two rotations in hospitalist settings, a field that she wasn’t even aware of until her 3rd year at CHA/PA. Hospitalists provide medical care to acutely ill hospitalized patients. Eleanor loves the team aspect of hospitalists as well as working with complicated patients to whom she can provide complete patient care.
Eleanor is approaching her May graduation feeling a combination of excitement and apprehension. Leaving three years of structured life is intimidating, but she is excited to pursue her passions and hopefully find a hospitalist position after graduation.
A Graduate Gives Back to CHA/PA Through Precepting
Brian Englund became interested in the PA profession while working in Radiology at The Children’s Hospital. His passion was always working with children, and he decided at that time that he wanted to do more and be more. Brian reenrolled in college, and ultimately was admitted to the Class of ’97 at CHA/PA. Brian has been a Pediatric PA at Greenwood Pediatrics for over 14 years, where he currently precepts 24-28 students each year. He had some great preceptors as a student, which drove him toward precepting after graduation. He is passionate about being the best teacher he can, and to help the students see the need for preceptors in the PA profession.
Brian strongly believes that a great preceptor is defined by three important tools. The first is to educate the students, which requires staying current on new medical topics and teaching methods. Secondly, preceptors must observe. Students need to be viewed in action so that they can be provided with insight into their performance of exams and patient interaction. Lastly, feedback is essential to the students’ growth. They need to know what makes them intriguing PA’s, so they can try to reproduce those moments of brilliance.
Preceptors are a crucial component of the PA program at CHA/PA. Precepting is a way of giving back and sowing into the next generation of PA’s. Providers (PA/MD/DO/NP) can earn Continuing Medical Education hours and the opportunity to become Clinical Faculty at the University of Colorado. Contact David Eckhardt, one of our Clinical Coordinators, if you would like more information on precepting with CHA/PA: David.Eckhardt@ucdenver or 303-724-1347.
Combining Law and Medicine to Benefit Multiple Sclerosis Patients
Thomas Stewart hopes his patients and clients perceive him as a “trusted resource who will work diligently to see that they receive top-quality care.” As a CHA/PA program graduate (Class of '99), Thomas has had the opportunity to weave together his previous career as a lawyer with his interest in medicine. He has utilized his medical training to benefit individuals with Multiple Sclerosis. Thomas practices at Metro Community Provider’s Network, where he created a care model for people with MS who are uninsured or underinsured.
Thomas’ passion for those dealing with MS includes tackling the federal disability application process. MS sufferers deal not only with the symptoms of MS itself, but also the common ramifications of the disease such as loss of income, loss of access to care, and at times, homelessness. Nationally, only 35% of disability claims result in the award of benefits. Thomas works closely with clinicians and specialists to provide the necessary medical base to his clients to increase those odds to 90%.
Additionally, he finds time to collaborate with community-based neurologists and researchers to conduct clinical trials. One of which involves an agent intended to promote remyelination, and possibly axonal growth. These developments would profoundly affect those with MS and other neurological diseases. We are grateful that Thomas Stewart chose the PA profession and graduated from our program, and we are confident that MS patients feel the same.
A Student's Passion for the Hispanic Community
Veronica Carrillo is part of the Class of 2014. As one of four children, she grew up in Lamar, CO by parents who were born in Mexico and immigrated to the U.S. in their early teens. Veronica is the first person in her family to receive a four-year degree, so her family is extremely proud of her for pursuing her Master’s through CHA/PA. Veronica’s interest in the medical profession began when her sister was born while Veronica was a teenager. Being part of the doctor’s visits with her Mother throughout the pregnancy peeked her interest in the type of work and care health professionals offer. Veronica is very close to her younger sister, and this relationship drives her to become the type of PA that will have a positive impact on the lives of expectant mothers and their children.
While pursuing her undergraduate degree in Biology at CU Colorado Springs, Veronica initially planned on going to medical school. In her junior year, she was exposed to the Physician Assistant profession and realized that it was a better fit. Her adjustment to the CHA/PA program has been a challenge after a year break from school. Yet, she truly enjoys the program due of the atmosphere the faculty and staff create. Everyone is encouraging and helpful, wanting all students to succeed.
Veronica is excited for what the future holds. She is making lifelong friends and colleagues during her time at CHA/PA, and she looks forward to having the opportunity to be a role model for others upon graduation. She specifically would like to focus attention on the Hispanic community, encouraging a healthy lifestyle and higher education.
Costa Rica's Impact on a CHA/PA Student
Hola Como esta? Thankfully my vocabulary is no longer comprised of just these phrases after spending 4 weeks overseas. This summer a few of us second year CHA/PA’s joined with MD and NP students for a Spanish immersion experience in Costa Rica. Along with improving our Spanish we learned how to become more culturally competent as future healthcare providers. Mornings were spent in Spanish class and the afternoons were spent in various locations teaching and performing well child checks. In groups we gave lectures within the community on child development, substance abuse and sex education.
My best memories are with my host family. They were extremely hospitable and gracious to speak slow and teach me about their culture and lifestyle. We often had salsa dancing parties in the living room! Even though I wasn’t able to express myself verbally all the time, I realized that sometimes the best communication involves action accompanied with a smile of understanding. I hope that this carries over to my practice as a future PA!
Sarah Wong, Class of 2013