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August 17, 2011 Volume 1, Issue 7


Helping Victims of Violence Move Forward

In this job, first impressions mean everything.

Violence Intervention Advocacy Program staff
The VIAP team

“When we approach a client at his bedside, we approach with caution and respect and show him that we are not a threat. We are there to help him,” says Leroy Muhammad, a Violence Intervention Advocate with Boston Medical Center’s Violence Intervention Advocacy Program (VIAP). “It’s our opportunity to break the ice.”

That approach is what has led to the success of BMC’s VIAP, an eight-person team that helps victims of violence (i.e., shot or stabbed) recover from physical and emotional trauma. No day is the same for this close-knit group that served 482 victims of violence last year and has served more than 200 victims this year.

The backbone of the program are violence intervention advocates, three men who contact violently injured patients when they arrive at the Emergency Department, and meet with them to determine the services they need. Such services can range from a conversation about safety and peaceful alternatives upon discharge, to short-term in-hospital or outreach services, to long-term case management relationships.

Once advocates have connected with the victim, gaining his or her trust, they are able to help him/her and the family deal with the trauma they have experienced. But the advocates’ job doesn’t end when the physical wounds heal. They, along with other members of the team, continue to help patients move forward by empowering them with skill, services and opportunities to make positive changes in their lives. This may mean attending GED classes with them, helping them find housing, and assisting them with job searches.

“Progress can mean different things in this job,” says Jumaane Kendrick, a Violence Intervention Advocate with the program for two years. “Sometimes it’s just seeing a patient get out of bed. Other times it’s preventing additional violence from happening. And then there is seeing a client receive his GED, an accomplishment that we recently celebrated. What’s rewarding is seeing the outcomes of our work. And there are many successes.”

VIAP By the Numbers

  • 475 patients managed during FY 09-10
  • Average age of VIAP patient: 27
  • Average number of patients needing VIAP services: 10 per week
  • VIAP patient genders: 89% male, 11% female
  • Type of violent injury: 57% stab wound, 42% gunshot wound, 1% other
  • 67% of shootings and stabbings in Boston directed to BMC

Those successes have led to VIAP’s growth. The program, which celebrates its five-year anniversary in September, recently hired two new staff members: Keith Gilliam, LMHC, and Andrea Malagon-Meagher, LCSW, clinicians who provide in-hospital mental health services to victims and their families. The team is rounded out by Donald Leonard, VIAP Advocate, Program Manager Elizabeth Dugan, LICSW, Kim Odum, Family Support Coordinator, who provide comprehensive support services to family members of the victims of violence, and Emergency Department Physician Thea James, MD, who oversees the program.

“We are a VIAP family,” says James. “We support one another and come together to celebrate our joys and our clients’ joys. We couldn’t do the work we do without the respect we have for each other.”

VIAP Advocate Leonard agrees.

“Our staff is authentic, sincere and real. I know what we have is special and that it doesn’t exist everywhere. We are all doing a job bigger than us and we’re doing our best to do it right.”

VIAP programs similar to BMC's operate at the emergency departments of Massachusetts General Hospital and Baystate Medical Center in Springfield. Funding is provided by the Massachusetts Department of Public Health Bureau of Substance Abuse Services, the Boston Public Health Commission Division of Violence Prevention through a Robert Wood Johnson grant, the Boston Foundation and contributions from the three hospital emergency departments. During a recent visit to BMC, Senator John Kerry called the VIAP a national best practice model.

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Letter to a Young Patient

Kimball Prentiss, MD, Pediatric Emergency Medicine, wrote this letter in 2010 in the emotional aftermath of caring for a young gunshot victim. Below are her words.

Dear UNKNOWN, BB:

I knew we would meet exactly three minutes before we did. I got a call on a special phone late last night telling me that you were an estimated age of 3 and that you had been shot in your chest and were not breathing. That was all I knew, but that was enough to get my attention. The truth is I had been preparing to meet you for many years, getting myself ready in every way so that I would be able to take the very best possible care of you in the seconds that mattered most if we should ever meet under these circumstances, even though I wished we never would.

In those three minutes before you arrived, we started methodically – albeit furiously – to prepare for you. I invited many smart, talented people I work with to meet you, too. I knew that I couldn’t take care of you alone, so I sent an announcement to the best people in my special hospital telling them to come running so that we would be ready and waiting for you when you rolled in. We wanted to order the medications and blood that we thought you might need ahead of time, so we had to give you a name in our computer. Nobody could tell us your name yet, so we named you Baby Boy Unknown, which was shortened in computer language to UNKNOWN, BB.

And then, we met.

I doubt that you remember me or the details of the trauma room, but if you do, then I’m relieved that you know how hard we tried to save you and how motivated and determined we were to try even harder when we felt your pulse return for the first time. If you don’t, do not worry. Sometimes when our bodies are that sick, they don’t know what is going on around them. Maybe, though, you would recognize my voice? It was the one coming from the foot of your bed, making sure we were all working together to do everything and anything we could for you. Or maybe you would recognize it as the one that was beside you as we rolled you down the hall toward the elevator and operating room? The one that asked people in the hallway if anyone from your family was there to give you a kiss? Anyone? To which replied a voice I did not know but cannot forget: “No, there is no one here. No one.”

Letter 

You see, during all that training I told you about earlier, and even more so in the years since, I learned how to talk to parents during times like this - times when their kids are so sick that we don’t even know if they will ever wake up. As much as I have hated those conversations, I realize now that the scenario I experienced with you is even harder. I couldn’t explain to anyone what we had done to you, where we were headed, where they could sit or stand, or alternate sitting, standing and pacing the floor while they waited for you. There was no one to kiss you goodbye or scream in deafening pain or drip heavy tears down your face for you - your sweet, young, innocent, flawless face. There was no one that could call out for you and tell me your name.

This scenario – one from which you did not die from the force of cars colliding with each other on a slippery street early one morning or colliding with a tree on a snowy night – is unforgivable. You did not die by accident. You did not die from a rare genetic disease for which a cure has not yet been found or from a heartbreaking form of childhood cancer for which rounds and rounds of chemotherapy were no match. You did not die after a long battle with a chronic disease or even after a short fight with an acute illness. You died because you were murdered. You were shot along with your mother, the one who should have - and would have if she could have - been there to tell me your name.

Now I hear from the news that your murder was not random and that you died in the largest mass murder our city has seen in many years. A hate crime or drugs, they say. I wonder: who could hate a 3-year-old boy? Who could think that you had anything to do with drugs?

I am told that there was nothing we could have done to save you. But who could have? And, more importantly, who should have? That question I ask now not as one of your doctors, but as your heartbroken neighbor and disgusted fellow citizen of humanity.

I find some solace knowing that you did not die alone in our operating room. Every single part of you, except your very strong young heart, died before we even met. You died in the arms of your mother.

Now I have met your aunt and I know that you have family that is alive, who loved you tremendously, and who are grieving deeply over your devastating death. She confirmed that you did indeed have the most spirited and sweetest of hearts and that you loved playing like a big boy with your older cousins. She told me that even as much as you loved playing, you would intermittently run into the kitchen just to be next to your mom for a few seconds. I guess we all sometimes act bigger than we feel and we all deserve someone in the next room who makes us feel safe. I’m so relieved to learn that your mom was that person for you. Your aunt told me that you had very recently celebrated your second, not your third, birthday, and that your mom had wanted to do something special for you but that she didn’t have much money, so she decided to take you to the beach!

I also learned that you had just - two days before you died - started to say your own name.

And so now, I finally also know your name. You were indeed a precious baby boy, but you were not unknown. You were not unloved. And you will not be forgotten.

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Possible Biomarker and Therapeutic Target for Melanoma Found

Researchers have identified a potential new biomarker and therapeutic target for melanoma, a skin cancer that affected more than 68,000 people in 2010. The novel cell screening method used in the study also clarifies the process behind tumor metastasis and may allow the identification of biomarkers for other aggressive cancers.

Rhoda Alani, MD

Rhoda Alani, MD

According to the American Cancer Society, melanoma is the most serious type of skin cancer and one in 55 people will be diagnosed with it during their lifetime. Previous research has found that metastasis causes more than 90 percent of solid tumor deaths throughout the world and is particularly aggressive in melanoma.

Working with biologists and biomedical engineers, researchers identified molecules that were essential to the process that allows tumors to metastasize. Neuropilin-2 played a large role and by silencing it cancer growth is inhibited.

“We found that Neuropilin is an important mediator of melanoma cell and blood vessel cell interactions,” says Rhoda Alani, MD, Chair of Dermatology at BMC. “We can now investigate this molecule as a potential biomarker and melanoma treatment target. We can also use the unique methodology developed in these studies to evaluate cellular crosstalk between other tumor cell types and vessel cells. Such studies are likely to provide important insights into the metastatic process for other cancers.”

According to the researchers the cell-to-cell communication process necessary for metastasis of tumors has garnered much attention recently but detailed knowledge of its underlying molecular mechanisms is lacking. These findings clarify this process in melanoma tumors and support the use of the team’s methods to discover novel factors controlling cell communication for a variety of malignances.

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What Do You Do, George Barth, MMHC, RN, CCRN?

Name: George Barth, MMHC, RN, CCRN
Title: Director of Nursing, Perioperative Services
Department: Nursing
Years at BMC: 11

George Barth
George Barth, MMHC, RN, CCRN

What brought you to BMC?
I started here in 1999 as a staff nurse in the Medical Intensive Care Unit. From there, I was promoted to a nurse manager and then director of Nursing for Critical Care. In January, I assumed the role of director of Nursing for Perioperative Services.

What do you do here?
I oversee the operating rooms and PACUs in the Menino Pavilion, Newton Pavilion and Moakley Ambulatory Surgery. There are three nurse managers and three assistant managers who report to me and they oversee more than 250 staff members. The operating rooms are busy places, as you can imagine, and I like the challenge of working with multi-disciplinary teams that comprise surgeons, anesthesiologists, nurses, surgical technicians and others.

What traits make you successful at your job?
Because the operation rooms (ORs) are so busy, the environment tends to be stressful. My role is to support the managers the best I can. My goal is to keep them motivated and engaged and work with them to develop the skills they need to be successful. I have a great deal of respect for the OR management team.

What projects are you currently working on?
We have a year-long quality and safety project happening in the ORs right now. Each month we address a new initiative, such as improving surgical hand hygiene. Each initiative starts with a policy revision to reflect best practice, education of staff on the change, and then implementation. Through a collaboration of Nursing, Anesthesia and Surgery staff, we have developed a timeline to get these initiatives done. We are also conducting daily audits on the changes and reporting back to the OR committees with our progress. Our end goal is to enhance the patient experience in the OR while making safety a priority.

We hear you are a tri-athlete. Tell us about that.
Well, I decided to do triathlons because I have a family history of heart disease and I find them to be great stress relief. I started back in 2004 and did my first Ironman Triathlon in 2007. Since then, I’ve completed the Ironman four times and just completed Ironman Lake Placid on July 22, which consisted of a 2.4-mile swim, 112-mile bike ride and a 26.2-mile run. Next year I will be competing in Ironman Coeur d’Alene in Idaho. My long-term goal is to qualify for the Ironman World Championship, which is held in Kona, Hawaii, every October.

Whew! Do you have time for anything else?
Not really! I swim before work and do biking, running and strength training in the afternoon. All told, I do eight to 17 hours of training per week and I love it. My plan is to continue to do them as long as I can stay healthy!

Do you know a staff member who should be profiled? Send your suggestions to communications@bmc.org.

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In Their Words

Patients share their BMC experience

I am writing with words of praise for the staff and physical plant at BMC. My husband was a recent patient in the emergency room, and without question, he was treated extremely well in all phases of his stay. In the ER, we were there for nine hours and the staff under Ricky Kue, MD, MPH, was unfailingly kind, patient and eternally informative through the long day. Our nurse, Hope, was perfect in every way.

Letter writing 

When he was admitted to the Newton Pavilion, the staff there was caring and patient, seeing to his needs at all times.

I spoke with my husband’s primary care doctor, Michael Miller, MD, about my appreciation of his stay there and he said you and your staff are trying to bring “exceptional care, without exception.” In our case, you certainly succeeded!

Even Thomas Einhorn, MD, took time from his busy day to visit my husband (whom he had an appointment with the next day) to consult with him and calm him down as far as his orthopedic issues were concerned. Extraordinary!

The Infectious Disease team was outstanding as well, treating my husband with the utmost care, patience and concern. Their diligent work found, at last, the cause of his illness.

Keep up the good work and should any further medical problems arise, I am confident that he will get the best care at BMC.

Scituate, Mass.

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News of Note

Wael Youseff, DMD 
Wael Youseff, DMD

Wael Youseff joins BMC

Wael Youseff, DMD, has joined the faculty of the Department of Oral and Maxillofacial Surgery as Director of Outpatient Services. Youseff also is an Assistant Professor of Oral and Maxillofacial Surgery at the BU Goldman School of Dental Medicine.

Youseff is a dental graduate of Damascus University, Syria. He obtained his DMD from the Advanced Standing program at Case Western Reserve University School of Dental Medicine, Cleveland. Following completion of the BU/BMC oral and maxillofacial surgery residency program in 2009, he completed a one-year surgical fellowship in St. Louis, with emphasis on facial cosmetic surgery. Youseff practices at BMC’s Yawkey Ambulatory Care Center (maxillofacial surgery clinic), BU School of Dental Medicine (oral surgery clinic) and the BU Dental Health Center at 930 Commonwealth Avenue (facial cosmetic surgery clinic). To refer a patient, visit the oral and maxillofacial surgery departmental website or call 414-4838 or 638-4350.

BMC physicians featured in MMS program on Parkinson’s Disease
The August edition of "Physician Focus" with the Massachusetts Medical Society took an in-depth look at Parkinson's disease, a progressive, chronic movement disorder that affects nearly one million people in the United States. The show featured two BMC physicians who specialize in the treatment of Parkinson’s: Anna Hohler, MD, Staff Neurologist, and President-Elect of the Massachusetts Neurologic Association; and Neurologist Samuel Frank, MD.

"Physician Focus" is a noncommercial production of the Massachusetts Medical Society and Hopkinton Community Television. The half-hour program brings viewers health and medical information on timely topics from physicians and other healthcare experts. View the program at www.physicianfocus.org.

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Awards and Accolades

Daniel Alford, MD, MPH
Daniel Alford, MD, MPH

Daniel Alford, MD, MPH, Primary Care, and Medical Director for the Massachusetts’ Screening, Brief Intervention, and Referral to Treatment Program (MASBIRT), was honored by the White House for his work to reduce drug use and its consequences and for empowering and inspiring members of the community. Alford helps identify individuals both at risk for, and with, problems related to substance use, provides medical advice to help patients understand the consequences of substance use, and refers patients with substance use disorders to specialty addiction treatment during routine medical visits. MASBIRT has screened more than 130,000 patients for unhealthy substance use in the greater Boston area, and has assisted more than 22,500 patients who required and received a brief intervention for substance abuse between 2007 and 2010.

BMC is one of six organizations around the country recently recognized as a leader in the field of addiction health care. BMC received an iAward for its Office-Based Opioid Treatment (OBOT) program. The program is funded through the Department of Public Health’s Bureau of Substance Abuse Services, and serves more than 450 patients through the outpatient General Medicine practice. It also provides training and technical support to 14 community health centers in the state. The iAwards highlight innovations in process improvement and management practices that position an organization to meet the challenges of future service delivery.

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